Journal of clinical anesthesia
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Randomized Controlled Trial Comparative Study Clinical Trial
Postoperative analgesia and plasma levels after transdermal fentanyl for orthopedic surgery: double-blind comparison with placebo.
To determine whether transdermal fentanyl can provide a significant component of postoperative analgesia. ⋯ Efficacy of transdermal fentanyl for postoperative pain relief is shown, but intense respiratory depression is sometimes seen.
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Recent case reports suggest there may be an increased risk of abnormally high blockade ("high spinal") from subarachnoid anesthesia if it is performed immediately after epidural anesthesia. We describe two cases of high spinal anesthesia following failed epidural block in obstetric patients scheduled for cesarean delivery. Using a retrospective chart review, we estimate the incidence of high spinal anesthesia to be 11% in patients after prior failed epidural blockade versus fewer than 1% in patients undergoing spinal anesthesia alone.
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To describe the clinical experience with high-frequency jet ventilation (HFJV) of the lungs during endolaryngeal surgery and its effect on acid-base balance and capillary PO2 (PcO2), PCO2, central hemodynamics, and tracheobronchial mucous membrane. ⋯ HFJV leads to optimal conditions for endolaryngeal surgery, reverses constant outflow of the respiratory gas mixture, prevents aspiration of tissue products and blood, and removes smoke from the operative site when using laser surgery.
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Continuous infusion of intravenous (i.v.) drugs is increasing in popularity, as technological advances in equipment (such as "smart" pumps) and pharmacologic improvements of drugs (such as ultra-short acting drugs) are introduced into clinical anesthesia practice. Such new technology, however, also introduces potential new complications. We report one such complication associated with the improper manufacturing of a proprietary i.v. tubing and cassette system.
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In carbon monoxide (CO) poisoning, the mortality and morbidity risk does not always correlate with the level of carboxyhemoglobin (COHb). Recent studies confirm that the mitochondrial cytochrome portion of the respiratory chain is susceptible to CO toxicity at concentrations traditionally considered nontoxic. ⋯ Hyperbaric oxygen (HBO) therapy in pregnant patients has not been shown to have adverse effects on the fetus. We present a case of CO intoxication in late pregnancy treated with HBO therapy without adverse consequences.