Journal of clinical anesthesia
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Review Comparative Study
Comprehensive review: is it better to use the Trendelenburg position or passive leg raising for the initial treatment of hypovolemia?
Hypovolemia is a common clinical problem. The Trendelenburg position and passive leg raising (PLR) are routinely used in the initial treatment while awaiting fluid resuscitation. In this meta-analysis, we evaluated the hemodynamic effects of PLR and Trendelenburg positioning to determine which position had the most optimal effect on cardiac output (CO). ⋯ The effect persisted after this period by 6%, or 0.17 L/min. Both Trendelenburg and PLR significantly increased CO, but only PLR seemed to sustain this effect after one minute. Although the Trendelenberg position is a common maneuver for nurses and doctors, PLR may be the better intervention in the initial treatment of hypovolemia.
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Review Case Reports
Intraoperative hypercyanosis in a patient with pulmonary artery band: case report and review of the literature.
A case of intraoperative cyanosis in a patient with a common atrioventricular canal palliated with a pulmonary artery (PA) band is presented. The patient's physiology was consistent with cyanosis due to inadequate pulmonary blood flow, and responded quickly to typical interventions used for a hypercyanotic episode in a patient with unrepaired Tetralogy of Fallot. Differences and similarities in the physiology of PA banding compared with Tetralogy of Fallot are presented, including a rationale for treatment options for hemodynamic decompensation occurring in the setting of anesthesia and surgery.
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Since the first robotic prostatectomy in 2000, the number of prostatectomies performed using robot-assisted laparoscopy has been increasing. As of 2009, 90,000 robotic radical prostatectomies were performed worldwide, and 80% of all radical prostatectomies performed in the United States were performed robotically. Robotic prostatectomy is becoming more common globally because of the many advantages offered to patients, primarily due to the minimally invasive nature of the procedure. Several new perioperative concerns and challenges for anesthesiologists and are described.
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To evaluate the outcome of airway management in patients with complex maxillofacial fracture by submental intubation, time required for intubation, accidental extubation, and postoperative complications. ⋯ Submental endotracheal intubation is a simple technique with very low morbidity, and may be used as an alternative to tracheostomy in selected cases of maxillofacial trauma.
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Conditions leading to iron overload range from rare hereditary disorders to more common medical conditions associated with chronic blood transfusions. Iron overload has deleterious effects on various vital organs (eg, liver, heart, and endocrine glands). Serum ferritin (in conjunction with transferrin saturation) is the most widely used test to evaluate iron burden and to screen for iron overload. The management plan should be adjusted to account for iron overload and potential consequences of liver, heart, and other organ involvement.