Journal of clinical anesthesia
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Case Reports
Laser endotracheal tube failure: kinking of the Rüsch Lasertubus resulting in near-total airway occlusion.
We report a case in which kinking of the Lasertubus resulted in near-total occlusion of the endotracheal tube, which in turn precluded adequate ventilation. Although the reporting of kinked endotracheal tubes is not uncommon in the anesthesia literature, our case is unique with respect to the physical mechanism responsible for tube deformation.
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To study labor outcomes in parturients receiving oxytocin for augmentation or induction of labor, in the presence of labor epidural analgesia. ⋯ Patients who have their labor induced request analgesia sooner and are at a higher risk of cesarean section than are patients who go into labor spontaneously. Any study that purports to assess the effects of epidural analgesia in labor should distinguish between induced and augmented/spontaneous labor.
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Serious maternal bradycardia and asystole in laboring parturients after combined spinal-epidural labor analgesia are rare. We report such a case in a morbidly obese laboring parturient after receiving combined spinal-epidural labor analgesia. The differential diagnosis, risk factors, potential contributing factors, and the successful management of the complications with our positive patient outcome are discussed. Even with the low dose of neuraxial drugs commonly administered in combined spinal-epidural labor analgesia, this case underscores the importance of vigilance, frequent monitoring, proper positioning, and rapid resuscitation with escalating doses of ephedrine, atropine, and epinephrine, all of which are essential in the presence of bradycardia or asystole in these patients.
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Comparative Study
Establishing a nurse-based, anesthesiologist-supervised inpatient acute pain service: experience of 4,617 patients.
To describe our nurse-based Acute Pain Services (APS) and present the results of 4617 patients treated by our service. ⋯ A nurse-based APS provides effective and safe postoperative pain management.
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Management of the difficult airway is an essential skill that should be taught during an anesthesiology residency. However, only a minority of anesthesiology residency programs have formal rotations in advanced airway management. ⋯ We believe that this rotation has been beneficial in improving the residents' exposure to advanced airway techniques, and has dramatically improved their capabilities in this important aspect of anesthetic of anesthetic training. Additionally, the structure of the rotation ensures uniformity in the residents' acquisition of advanced airway skills.