Journal of clinical anesthesia
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The fundamental skill required of the anesthesiologist and rescuer is to treat upper airway obstruction and maintain adequate ventilation. Adult one-hand face mask ventilation is a complex technique, often applied with suboptimal results. ⋯ An ergonomic face mask has an asymmetrical dome that accommodates the hand grip required for chin lift and may be better for one-hand ventilation. The historical and theoretical considerations patent to the design and technique of the ergonomic face mask are reviewed.
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Endometriosis occurs in 5% to 10% of women of childbearing age and involves the proliferation of endometrial tissue outside the uterine cavity. Thoracic endometriosis is the most frequent extrapelvic manifestation of endometriosis, numbering some 100 reported cases. ⋯ Because the tissue is hormonally responsive, all of these manifestations are related to the menstrual cycle (catamenial) and are likeliest to occur during menses. We report the successful anesthetic management of a patient with thoracic endometriosis and recurring catamenial pneumothorax who presented for elective pelvic surgery.
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To present our preliminary experience using a thoracic paravertebral block (TPVB) as the sole anesthetic in percutaneous hepatic radiofrequency ablation (RFA). ⋯ The use of thoracic paravertebral block as the sole anesthetic for RFA of liver produced satisfactory unilateral anesthesia and minor adverse events.
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Ipsilateral shoulder pain after thoracic surgery is a distressing problem and is associated with impairment of respiratory and shoulder function. The most suggested etiology for this shoulder pain is referred phrenic nerve pain. However, we have made clinical observations that suggest shoulder ligament strain as another cause of the shoulder pain.
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The intraoperative monitoring of neuromuscular blockade usually involves measurement of the muscular responses to motor nerve stimulation. Although researchers have the time and technology to obtain predrug control measurements of the twitch responses, these are seldom available to the clinician. ⋯ Concentrations in the effect compartment associated with these two extremes of the TOF count are combined with concentration-time profiles of vecuronium with various dose regimens. This study models the effect compartment concentrations associated with vecuronium-induced paralysis, combining them explicitly with the range of concentrations associated with the TOF count to demonstrate the kinetic mechanisms underlying the time-course of paralysis.