Journal of clinical anesthesia
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To ascertain the benefits of the preoperative discussion of the risks of anesthesia with parents of ASA status I or II pediatric day surgery patients. ⋯ Our study suggests the benefits of the explanation of the risks of anesthesia appear to be rooted in satisfying parental responsibility and understanding, and not in providing information for decision making or anxiety relief. Anesthesiologists should not feed compelled to always detail all the risks, but should seek to satisfy individual parental needs.
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Sudden cardiac arrest, a rare and often fatal complication of total joint replacement, usually occurs during the insertion of polymethyl methacrylate cement and a prosthesis. We describe a cardiac arrest during insertion of a customized long-stem prosthesis (without the use of a tourniquet) for revision of an earlier total knee replacement. We attribute this complication to the "fat embolism syndrome" (FES)--hypoxemia from an acute pulmonary embolism composed of fat and marrow elements extruded into the venous circulation--coupled with systemic hypotension from absorption of the cement monomer. ⋯ Intraoperative increases in pulmonary artery and pulmonary artery occlusion pressures and pulmonary vascular resistance during unexplained hypoxemia should alert the clinician to the possibility of FES. Proper diagnosis relies on recognizing the three most common clinical manifestations: hypoxemia, neurologic derangements, and fever. Other manifestations of FES are petechiae, thrombocytopenia, anemia, lipuria, changes on ECG, tachycardia, and dyspnea.
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T-cell lymphoma is the fastest growing non-Hodgkin's lymphoma occurring in children. Its clinical presentation is frequently abrupt, and total tumor mass can double every few days. ⋯ What information do we need, and how recent should it be? This case shows that recent diagnostic imaging studies not showing the presence of a mediastinal lymphoma can be misleading. It provides a strong warning to all anesthesiogists involved in ambulatory anesthesia.
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Randomized Controlled Trial Comparative Study Clinical Trial
Study of the optimal duration of preoxygenation in children.
To determine the optimal length of preoxygenation in children. ⋯ 2 minutes of preoxygenation in children can provide the maximum benefit of denitrogenation and achieve 2 minutes of safe apea. 95% and 99% confidence intervals were 69 to 100 and 59 to 100, respectively. Succinylcholine had only a slight effect on the safe apneic period.
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In the last decade, anesthesiologists have become increasingly involved in administering regional eye blocks, while providing care for patients undergoing ophthalmic surgery. This article describes the two major approaches to regional eye block, namely retrobulbar and peribulbar, with special consideration given to relevant orbital anatomy and technical guidelines. Potential complications, ocular and systemic, with their risk factors, are reviewed. Anesthesiologists wishing to acquire skill in administering safe regional blockade are encouraged to familiarize themselves with regional anatomy and specific guidelines suggested herein.