Journal of clinical anesthesia
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A 13-year-old girl with Goltz's (Goltz-Gorlin) syndrome (focal dermal hypoplasia) and cloacal exstrophy underwent day surgery cystoscopy. During the administration of inhalation anesthesia by mask, persistent partial upper airway obstruction was noted. ⋯ The patient later returned for a complete endoscopic examination, followed by cup forcep and laser excision of these verrucous and pedunculated lesions, and remained intubated in the intensive care unit (ICU) for 48 hours following this procedure. Airway management and pathology specific to this rare disorder are discussed.
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Randomized Controlled Trial Clinical Trial
Midazolam potentiates thiopental sodium anesthetic induction in patients.
To test the hypothesis that midazolam potentiates thiopental sodium-induced unconsciousness. ⋯ A subhypnotic dose of midazolam potentiates thiopental sodium-induced unconsciousness. This effect suggests the possibility that midazolam enhances barbiturate binding.
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A 30-year-old parturient requested epidural analgesia during labor. Immediately after the epidural space was presumably identified using the loss-of-resistance-to-air technique, she reported severe back pain, followed by neck pain, which progressed to severe unrelenting headache. An emergency computerized tomographic (CT) scan performed during labor showed air in the intracranial subarachnoid space.
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To determine whether the anesthetic cardiac arrest rate decreased following the introduction of enhanced respiratory monitoring and increased safety awareness during the past decade. ⋯ The results support the hypothesis that improved respiratory monitoring was effective in decreasing anesthetic morbidity.
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Patients with Sturge-Weber disease and Klippel Trenaunay syndrome may have several neurologic abnormalities. The effects of hemangiomas in the brain cortex and the spinal cord are responsible for most of the anesthetic challenges associated with this disease, particularly the risks of intracerebral bleeding, disseminated intravascular coagulation (DIC), and airway management. The successful management of this case illustrates that adequate preparation to handle the possible complications may result in safe anesthetic management in patients with these problems.