Journal of clinical anesthesia
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Randomized Controlled Trial Multicenter Study Comparative Study Clinical Trial
A comparison of the remifentanil and fentanyl adverse effect profile in a multicenter phase IV study.
To compare the frequency of adverse effects of remifentanil and fentanyl in a large and diverse patient population. ⋯ In the doses used, both remifentanil and fentanyl have a similar frequency of adverse effects except for the higher frequency of hypotension associated with the use of remifentanil.
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To assess the impact of a new postanesthesia care unit (PACU) on intensive care unit (ICU) utilization, hospital length of stay, and complications following major noncardiac surgery. ⋯ Increased availability of PACU beds resulted in reduced utilization of ICU resources without compromising patient care after major noncardiac surgery.
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Case Reports
Horner's syndrome and trigeminal nerve palsy after lumbar epidural analgesia for labor and delivery.
This report highlights transient Horner's syndrome and trigeminal nerve palsy following labor epidural analgesia. A 29-year-old primigravida had a lumbar epidural catheter placed for analgesia in labor. ⋯ There were no other neurologic changes. Horner's syndrome and cranial nerve palsies can occur as a consequence of epidural analgesia for labor.
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A 76-year-old woman underwent double-lumen endotracheal tube intubation for right upper lobectomy. During one-lung ventilation, she developed tension pneumothorax on her dependent lung and suffered cardiac arrest. The presenting signs of tension pneumothorax--hypoxemia, hypotension, and increased airway pressure--are relatively common during this procedure, leading to a delay in diagnosis and effective treatment. When all three signs occur together during one-lung ventilation, cardiovascular collapse can result and serious consideration must be given to the diagnosis of tension pneumothorax in the dependent lung.
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Comparative Study
The association of intraoperative neuraxial anesthesia on anticipated admission to the intensive care unit.
To determine whether use of intraoperative neuraxial anesthesia would decrease the frequency of ICU admission postoperatively in orthopedic patients. ⋯ Intraoperative neuraxial anesthesia in higher-risk patients undergoing elective hip or knee replacement surgery is associated with a decrease in anticipated ICU admission postoperatively. A causal relationship cannot be determined with this type of study and further research is needed to better understand this association.