Journal of clinical anesthesia
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To determine if recommendations regarding perioperative beta-blocker therapy were followed by an increase in the number of eligible presurgical patients receiving beta-blockers and the number achieving the recommended heart rate (HR <60 beats per minute [bpm]). ⋯ At our institution, preoperative beta-blocker use was not significantly changed by publication of the recommendations.
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Case Reports
Complex regional pain syndrome (CRPS) with resistance to local anesthetic block: a case report.
We present a case of complex regional pain syndrome (CRPS) Type 1 in a 12-year-old girl. The patient did not respond to the usual therapeutic modalities used to treat CRPS, including physical therapy, lumbar sympathetic block, epidural local anesthetic block, intravenous lidocaine infusion, or other oral medications. Of note is the fact that, during epidural block, the patient demonstrated a resistance to local anesthetic neural blockade in the area of the body involved with the pain problem. The mechanism of this resistance could be related to the changes in the dorsal horn cells of the spinal cord, secondary to activation of N-methyl-D-aspartate receptors, which may play a role in the pathophysiology of this pain syndrome.
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An improvised mechanism for delivering supplemental oxygen to a spontaneously breathing, tracheally intubated patient set the stage for a case of barotrauma, bilateral tension pneumothorax, and cardiovascular collapse. Diagnosis and treatment was delayed by failed needle decompression of the pneumothoraces. Recommendations are made regarding the prevention and treatment of this complication to improve patient safety.
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To quantify the prevalence of perioperative beta-blocker use and its impact on preoperative and preinduction heart rate (HR), in light of the recent publication of specific recommendations regarding perioperative beta-blocker use and desired HR. ⋯ Only half of the patients who qualify to receive preoperative beta-blockers by current recommendations actually receive them before noncardiac surgery, and the majority of these patients have preadmission and preinduction HR less than 60 bpm. Targeting beta-blocker therapy treatment to an HR less than 60 bpm may not be readily achievable in many patients.