Journal of clinical anesthesia
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To ascertain patients' recall of the risks of labor epidural analgesia from a discussion of informed consent during active labor. ⋯ Recall of risks by parturients is similar to the recall of risks by other patients, and it does not appear to be affected by parity or the reported level of pain.
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Clinical Trial
Effects of split torso positioning and laparoscopic surgery for donor nephrectomy on respiratory mechanics.
To test whether split torso positioning, abdominal insufflation, and other procedures performed during laparoscopic nephrectomy would affect mechanical impedances to inflation [i.e., elastance (E) and resistance (R) of the total respiratory system (Ers, and Rrs), lungs (EL and RL), and chest wall (Ecw and Rcw)] differently from previously studied laparoscopic procedures. ⋯ Laparoscopic nephrectomy affects lung and chest wall mechanical properties differently from other laparoscopic procedures. This finding could be due to the split torso positioning, and the effects of abdominal swelling on the chest wall caused by administration of more perioperative fluids with laparoscopic nephrectomy.
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To determine the utility of cerebral oximetry for monitoring the adequacy of cerebral blood flow (CBF) during carotid cross-clamp. ⋯ Cerebral SaO2 decreased significantly on carotid cross-clamp in patients undergoing awake CEA. Hemodynamically stable patients demonstrated no evidence of regional brain failure when SaO2 decreased to 63% (mean decrease of 7.2%). Two hemodynamically unstable patients had evidence of global brain failure when SaO2 was less than 48% (mean decrease of 36%). Our findings suggest that cerebral oximetry reflects CBF, and it may be an effective, noninvasive method of monitoring regional cerebral oxygenation changes during CEA. Significant reductions in regional SaO2 may be tolerated without evidence of brain failure. Further studies are needed to define an SaO2 threshold that reflects regional brain failure.
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Muscle relaxant pharmacophysiology can be altered in various clinical situations. We report increased requirement of vecuronium in a patient diagnosed with testicular feminization. Increased level of endogenous testosterone and steroidal-core structure of vecuronium may explain the increased tolerance to vecuronium in this patient.
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Randomized Controlled Trial Multicenter Study Clinical Trial
Oral dolasetron mesylate for prevention of postoperative nausea and vomiting: a multicenter, double-blind, placebo-controlled study. The Oral Dolasetron PONV Prevention Study Group.
To examine the safety and effectiveness of a range of single oral doses of dolasetron mesylate for the prevention of postoperative nausea and vomiting. ⋯ Single oral doses of dolasetron, administered 1 to 2 hours before induction of anesthesia, are safe and effective for preventing postoperative nausea and vomiting in this patient sample. Maximal antiemetic response was seen with the 50 mg oral dolasetron dose.