Journal of clinical anesthesia
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We report a case in which sufentanil was given to a patient who was already taking both a monoamine oxidase (MAO) inhibitor and a tricyclic antidepressant. Anecdotal reports have recommended discontinuing MAO inhibitors 2 to 3 weeks prior to elective surgery. ⋯ She was given an uneventful elective anesthetic with measures to minimize the risk of an adverse drug reaction involving the antidepressants she was taking. Our experience suggests that the use of an opioid other than meperidine may allow the anesthetist to proceed cautiously to provide an anesthetic for an elective surgery patient who is also currently receiving MAO inhibitor therapy.
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Clinical Trial
Postoperative myocardial ischemia: etiology of cardiac morbidity or manifestation of underlying disease?
To determine the relationship between postoperative ST segment changes and clinically apparent cardiac morbidity in noncardiac surgery patients. ⋯ These observations suggest that clinically apparent cardiac events are associated with prolonged ST segment changes detected on ambulatory ECG recorders. The cardiac ischemia leading to prolonged postoperative ST segment changes may itself result in cardiac morbidity, or it may be a reflection of underlying pathophysiology.
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Randomized Controlled Trial Comparative Study Clinical Trial
Hemodynamic effects during induction, laryngoscopy, and intubation with eltanolone (5 beta-pregnanolone) or propofol. A study in ASA I and II patients.
To evaluate the cardiovascular changes following induction of anesthesia, laryngoscopy, and intubation in patients receiving a bolus dose of either eltanolone or propofol. ⋯ Patients receiving either eltanolone or propofol showed similar cardiovascular changes to induction of anesthesia, although there were greater increases in arterial pressure and HR in those patients receiving eltanolone.
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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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The dorso-radial aspect of the wrist and hand is a common location for intravenous (IV) cannulation prior to anesthesia. The sensory branch of the radial nerve lies superficially in this area, and it can be injured during routine insertion of IV catheters. In this case, the nerve was lacerated during insertion and a painful neuroma developed after elective surgery and anesthesia. Knowledge of this complication may help with its recognition and treatment.