Journal of clinical anesthesia
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To compare the cross-sectional area (in cm(2)) of the left internal jugular vein (LIJV) and right internal jugular vein (RIJV) in anesthetized children, and measure the response to the Trendelenburg tilt position (TBRG) and a positive inspiratory pressure hold. ⋯ The cross-sectional area of the RIJV is often greater than the LIJV; the TBRG was not effective to increase the cross-sectional area of the internal jugular veins, and only a PIP hold increased significantly the cross-sectional area of the RIJV. In this study, the LIJV appeared of smaller size and less compliant compared with the RIJV.
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The perioperative use of neuraxial techniques in the presence of anticoagulation is a controversial issue. There are significant pharmacokinetic differences between anticoagulants that will affect the timing of neuraxial needle insertion or catheter removal. The pharmacologic profiles of commonly used anticoagulants in the perioperative period are reviewed. Studies examining the use of neuraxial techniques in the presence of various anticoagulants are reviewed and evaluated in the context of the American Society of Regional Anesthesia consensus statements.
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One-lung ventilation is a commonly used technique to facilitate surgical visualization during thoracic surgical procedures. New devices for one-lung ventilation have been introduced into clinical practice over the recent years. One such device is the Arndt Endobronchial Blocker which is a bronchial blocker with a central lumen through which a wire with a looped end has been passed. ⋯ The port for the bronchial blocker can be tightened down so as to hold the blocker in place during the procedure. However, patient issues such as size or airway alterations such as the presence of a tracheostomy may make necessary certain alterations in airway management. I describe four cases and provide suggestions for minor alterations in airway management that may be used to provide successful options for one-lung anesthesia.
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Randomized Controlled Trial Comparative Study Clinical Trial
Nicardipine versus nitroprusside for breakthrough hypertension following carotid endarterectomy.
To evaluate the effectiveness of nicardipine and nitroprusside for breakthrough hypertension following carotid endarterectomy. ⋯ Nicardipine administration produced more rapid BP control, most likely related to the administration of a loading dose. In addition to more rapid control, nicardipine-treated patients had less variability in BP and required significantly fewer additional interventions. Although no patient suffered a major event during this study, this study was not powered sufficiently to assess safety.