Journal of clinical anesthesia
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Comparative Study
Orthotopic liver transplant patients require less postoperative morphine than do patients undergoing hepatic resection.
To compare postoperative morphine use, analgesic efficacy, and side effect profiles in patients following orthotopic liver transplantation (OLTx) and liver resection (LR). ⋯ Orthotopic liver transplant patients experienced less pain and used less morphine postoperatively than did liver resection patients.
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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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To evaluate the effect of carbon dioxide (CO(2)) pneumoperitoneum and retropneumoperitoneum insufflation on CO(2) excretion. ⋯ This study may focus attention on the need for continuous ventilatory adjustments during transperitoneal endoscopic surgery.
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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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Case Reports
Unilateral Horner's syndrome and brachial plexus anesthesia during lumbar epidural blockade.
Horner's syndrome is a rare side effect of epidural analgesia. In association with ipsilateral brachial plexus block, it has only been reported once before, in French. Unilateral blockade has also been reported, although its etiology is unclear and may be multifactorial. The patient described here experienced an asymmetrical epidural blockade with a unilateral Horner's syndrome and ipsilateral brachial plexus block.