Journal of clinical anesthesia
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Submental intubation, a less invasive alternative to tracheostomy, was first described for acute airway management of maxillofacial trauma patients, where nasoendotracheal intubation was contraindicated and oral intubation was not possible due to the desire to establish dental relationships perioperatively. While submental intubation is used most commonly in trauma patients, the range of indications for its use has broadened to include many orthognathic and skull base surgical procedures. Submental intubation is a safe, effective technique for many maxillofacial procedures, requiring the cooperation of both anesthesiologists and maxillofacial surgeons.
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Angelman syndrome arises by one of 4 genetic mechanisms. Patients often have craniofacial abnormalities, vagal hypertonia, skeletal muscle atrophy or underdevelopment, a history of seizure disorders, and pharmacodynamic unpredictability. Its pathogenesis, clinical manifestations, diagnosis and treatment options, and perioperative anesthetic considerations are presented.
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We sought to determine the rate of cardiorespiratory complications following neuraxial opioid administration in the setting of obstructive sleep apnea (OSA). This systematic review of the leading biomedical databases originated from a university-affiliated, tertiary-care teaching hospital. A systematic search of Medline, Embase, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and the International Pharmaceutical Abstracts Database (1970 - September 2011) was undertaken. ⋯ Six major cardiorespiratory complications were reported among 5 (4.1%) patients and included three deaths, one cardiorespiratory arrest, and two episodes of severe respiratory depression. Five of these complications occurred during continuous fentanyl-containing epidural infusions and without concurrent positive airway pressure treatment. The rate of cardiorespiratory complications following the administration of neuraxial opioids to surgical patients with OSA is difficult to determine.
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Glycemic control has received intense scrutiny in the last decade as an important aspect of patient care. Earlier studies suggested that tight glycemic control (target level of 80 - 110 mg/dL) improved outcomes in intensive care unit (ICU) patients. Subsequent trials did not confirm the same benefit. ⋯ Tight glycemic control was associated with a high incidence of hypoglycemia, which may offset some of its potential benefits. Tight glycemic control in the perioperative and intensive care settings should not be totally abandoned either as a clinical practice or as a subject of future research. Beneficial effects of tight glycemic control may be demonstrated when the appropriate glycemic targets are matched to the appropriate population.
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Understanding the management of the parturient with single ventricle physiology starts with knowledge of the lesion, the patient's current stage of surgical palliation, her current functional status, and the impact of pregnancy and labor on her cardiac physiology. A multidisciplinary team approach, described in this article, is crucial to a positive outcome.