Journal of clinical anesthesia
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A 32-week parturient required partial thyroidectomy for suspicious carcinoma. The surgeon requested laryngeal nerve monitoring to decrease the chances of laryngeal nerve injury during surgery. ⋯ A fiberoptic bronchoscope inserted through the laryngeal mask airway provided an unhindered view of vocal cords for laryngeal nerve identification and testing during surgery. This combined technique also offered the advantages of a secured airway, as well as positive pressure ventilation in the parturient during thyroid surgery.
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The objective of this study was to evaluate the effectiveness of a modified Macintosh blade for reducing the chances of directly contacting the teeth and providing a satisfactory laryngoscopic view during laryngoscopies by novice laryngoscopists. ⋯ The modified Macintosh blade used in this study proved to be a useful device for training novice laryngoscopists with respect to procedure effectiveness and patient safety.
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Randomized Controlled Trial Clinical Trial
Epidural analgesia improves early rehabilitation after total knee replacement.
To compare epidural anesthesia and analgesia with spinal anesthesia with intravenous morphine analgesia for its effect on range of motion (ROM) and early rehabilitation after total knee replacement. ⋯ By using epidural analgesia in the first 7 days postoperatively, we achieved improved early rehabilitation due to excellent pain relief effect and an antithrombotic effect with an efficacy comparable to low molecular-weight heparin.
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Randomized Controlled Trial Clinical Trial
Morphine sparing with droperidol in patient-controlled analgesia.
To determine if droperidol has a morphine-sparing effect when coadministered with morphine via patient-controlled analgesia (PCA) for postoperative pain management. ⋯ Coadministration of 50 mug droperidol and 1 mg morphine on demand via PCA provides a morphine-sparing effect and reduces the frequency of postoperative nausea and vomiting.
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Case Reports
Exacerbation of preexisting neurological deficits by neuraxial anesthesia: report of 7 cases.
We undertook this case series to determine if preexisting neurological disease is exacerbated by either spinal or epidural anesthesia. In the website of the Arachnoiditis Foundation, we posted an offer to advise anesthesiologists in cases of neurological problems after either of these techniques was used. Contacts were made first by way of the Internet, confirmed by telephone, and maintained by fax, e-mail, or by special mail. ⋯ Two patients had continuous lumbar epidural anesthesia, 3 had spinals; in 2 more, attempted epidural blocks led to accidental dural puncture and were converted to subarachnoid anesthetics. All patients accepted neuraxial anesthesia without informing the anesthesiologists that they had mild neurological symptoms before surgery. Because anesthesiologists did not specifically inquire about subclinical neurological symptoms or prior neurological disease, anesthesiologists are advised to carefully inquire about prior neurological disease whether neuraxial anesthesia techniques are considered.