Journal of clinical anesthesia
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Review Case Reports
Postextubation laryngeal spasm in an unanesthetized patient with Parkinson's disease.
We present a patient with Parkinson's disease who experienced laryngeal spasm after tracheal extubation without having been anesthetized. This patient's trachea was intubated because of respiratory arrest. We postulate that her postextubation laryngospasm was related to Parkinson's disease.
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Approximately 40% of physician office time and 33% of hospital time are devoted to patients 65 years of age or older. Over half of the older population requires some surgical intervention. Because of decreased physiologic reserve and increased number of underlying medical disorders, the older patient is at increased risk for intraoperative and postsurgical complications. ⋯ Risk factors should be assessed initially by a focused history and physical examination and by simple tests. Additional diagnostic testing should be reserved for the patient who is not clearly at low or high risk. For optimal preoperative evaluation of the elderly patient, the physician should identify systemic disease, determine if the patient is receiving appropriate therapy, delineate the operative risks, and make recommendations that can potentially reduce the operative risks and postoperative complications.
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To compare actual infectious disease precautions with current recommendations and to determine the influence of age, clinical experience, human immunodeficiency virus (HIV) knowledge, previous personal HIV exposure, and education on practices. ⋯ Adequate infectious disease precautions were not taken by anesthesia personnel. An HIV educational program resulted in only a small increase in precautionary measures.
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Case Reports
Acute hemodynamic effects of indigo carmine in the presence of compromised cardiac function.
This report describes the acute hemodynamic effects of indigo carmine in a surgical patient with compromised cardiac function. A 68-year-old woman with stable but severe cardiac dysfunction and renal artery stenosis was scheduled for an elective aortorenal bypass procedure. ⋯ At that time, the patient experienced an acute increase in afterload, which resulted in acute left ventricular failure documented by a decrease in cardiac output (CO) and an increase in pulmonary artery pressure (PAP). Until further studies defining the mechanism for its hypertensive side effect are performed, indigo carmine should be used with caution in patients with severe cardiac dysfunction.
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Letter Case Reports
A thoracic leiomyosarcoma producing tracheal obstruction.