Journal of clinical anesthesia
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Heparin-induced thrombocytopenia (HIT) is a common complication of heparin therapy. There are three types of HIT. In the majority of patients, thrombocytopenia is modest and resolves without sequelae (HIT I). ⋯ It is advisable that heparin not be administered in any form to patients with documented or suspected HIT II or HITT. This situation, of course, poses a problem for those patients requiring cardiopulmonary bypass (CPB) surgery. In this report, we summarize our experience with Lepirudin (Hoechst, Frankfurt Ammain, Germany), which is a recombinant hirudin (r-hirudin), as an alternative to heparin for systemic anticoagulation, as well as the use of the ecarine clotting time (ECT) for monitoring anticoagulation status during CPB.
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Randomized Controlled Trial Clinical Trial
Late antinociception and lower untoward effects of concomitant intrathecal morphine and intravenous buprenorphine in humans.
To evaluate the perioperative antinociceptive effect of intrathecal morphine (a pure mu agonist), intravenous (IV) buprenorphine (a partial mu agonist) or their combination. ⋯ The concomitant administration of intrathecal morphine and IV buprenorphine alleviates pain sensation and minimizes sedation more effectively than when given after the administration of either drug separately. In addition, IV buprenorphine affords a reduction in side effects.
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Clinical Trial Controlled Clinical Trial
Coagulation status using thromboelastography in patients receiving warfarin prophylaxis and epidural analgesia.
To determine the coagulation status of patients receiving postoperative warfarin and epidural analgesia using thromboelastography (TEG(R)). Prospective, observational, clinical study. Orthopedic postoperative division at a university hospital.52 ASA physical status II and III patients undergoing knee arthroplasty and receiving prophylactic warfarin and epidural analgesia. ⋯ There was no change in the coagulation index. However, INR was abnormal and significantly increased (INR = 1.48+/-0.3; p < 0.0001), compared with preoperative values, on the day when the epidural catheter was removed. When the epidural catheters are removed, overall coagulation status, as measured by TEG(R), and despite an elevated INR (mean INR <1.5), remained within normal limits in patients receiving low-dose warfarin prophylaxis.
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Case Reports
Severe respiratory failure after infraclavicular block with 0.75% ropivacaine: a case report.
Upper extremity surgery is usually performed with an axillary block. There is a risk of pneumothorax and phrenic nerve block when interscalene or supraclavicular block are used in day case surgery, or in patients with chronic obstructive pulmonary disease. ⋯ No clinically relevant respiratory effects have been reported with infraclavicular block. Nonetheless, we report a case of a chronic obstructive pulmonary disease patient who developed severe respiratory failure requiring tracheal intubation after an infraclavicular block.
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We present here a case of a common problem for the anesthesiologist, i.e., difficulty in placing a Laryngeal Mask Airway (LMA). One solution is the use of the Yodfat technique to facilitate placement of the LMA.