Journal of clinical anesthesia
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We report a case of awake, fiberoptic tracheal intubation of a difficult airway (Ludwig's angina) using remifentanil as part of the sedation-analgesia regimen. Remifentanil's rapid onset-rapid offset pharmacokinetic profile enabled precise control of the level of opioid effect. In combination with other drugs, remifentanil may offer some clinical advantages compared to the other fentanyl congeners in providing the opioid component of conscious sedation-analgesia for awake tracheal intubation in patients with difficult airways.
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To assess the patient's understanding and knowledge of the anesthesiologist's role and responsibilities in the operating room and in other areas of hospital activity, and to delineate the effect of previous anesthetic experience on this knowledge. ⋯ If able to be extrapolated to all of Israel, our results show a high appreciation for the physician status of the anesthesia professional and role in safe recovery. Passive learning from a prior anesthetic experience did not appear to improve such appreciation.
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Myocardial ischemia in pregnancy poses a significant challenge for the anesthesiologist. It is a relatively rare disorder (approximately 180 cases published in the indexed literature since 1922) but it carries high mortality. ⋯ The etiology of cardiac ischemia also is multifactorial and occurs during a very dynamic period. A case of acute coronary syndrome in a parturient during urgent cesarean delivery for placental abruption is presented, followed by a brief review of the topic.
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Several potential complications may occur during identification of the epidural space. We present a case of subarachnoid pneumocephalus as a rare complication of epidural catheter placement.