Journal of clinical anesthesia
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Airway management in patients with unstable cervical spines remains a challenge for anesthesia providers. Because neurologic evaluations may be required following tracheal intubation and positioning for the surgical procedure, an awake intubation technique is desirable in this patient population. ⋯ After topical local analgesia, the ILMA was inserted easily, and a tracheal tube was passed through the glottic opening without complications. Thus, the ILMA may be an acceptable alternative to the fiberoptic bronchoscope for awake tracheal intubation.
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Randomized Controlled Trial Clinical Trial
Preoperative pulse wave velocity fails to predict hemodynamic responses to anesthesia and to surgical stimulation.
To determine whether pulse wave velocity (PWV), which is a useful indicator of cardiovascular disease, can predict the hemodynamic responses to anesthesia and surgical stimulation in surgical patients. ⋯ Preoperative PWV fails to predict hemodynamic responses to anesthesia and to surgical stimulation.
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Randomized Controlled Trial Clinical Trial
Optimal length and angle of a new lightwand device (Trachlight).
To investigate the effects of angle and length of the Trachlight lightwand and the effect of obesity on transillumination of the neck and difficulty of intubation. ⋯ To increase the success rate of tracheal intubation using the lightwand, the lightwand should be bent in 40 degrees to 60 degrees, with the extrusion of 1 to 2 cm from the tracheal tube. For obese patients with body weight > or = 120% of the standard, the lightwand was not useful.
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To determine whether anesthesiologists agree with each other when assessing actual malpractice clinical scenarios, whether their assessments comport with the actual malpractice verdicts, and whether they can accurately guess jury verdicts. ⋯ For this sample of homogeneous anesthesiologists who demonstrated high clinical agreement, it appears that the malpractice system may not be able to function on its own terms in adjudicating malpractice claims. Although there was agreement among respondent anesthesiologists, these assessments were in direct opposition to actual verdicts, a significant percentage of cases resulted in disagreements as to the appropriate standard of care, and anesthesiologists could not successfully predict jury verdicts. The malpractice system appears to be operating far from its theoretical ideal if these results could be applied more generally. Thus, in practice, the legal system, which is to provide an optimal level of injury deterrence, may be a poor method to limit patient injury, improve patient safety, and provide compensation to negligently injured patients in the health delivery system.
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Randomized Controlled Trial Clinical Trial
Comparative effects of oral clonidine and intravenous esmolol in attenuating the hemodynamic response to epinephrine injection.
To evaluate oral clonidine and intravenous esmolol in blunting hemodynamic changes associated with intranasal injection of an epinephrine-containing local anesthetic solution during general anesthesia. ⋯ In this healthy, young, nonsmoking outpatient population, premedication with oral clonidine, 0.2 to 0.4 mg, was effective in blunting the acute hemodynamic changes associated with injection of an epinephrine-containing local anesthetic solution during endoscopic sinus or septoplasty surgery.