AANA journal
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Clinical Trial
Utility of thromboelastography during neuraxial blockade in the parturient with thrombocytopenia.
No consensus exists on when it is safe to administer neuraxial blockade in a patient with a low platelet count. It has been suggested that thromboelastography (TEG) may be useful in assessing platelet function in parturients with thrombocytopenia. ⋯ All parturients whose platelet count was less than 100,000 mm(-3) were required to have TEG before a neuraxial technique was administered. This case series suggests that neuraxial techniques in parturients can be performed with a platelet count greater than 56,000 mm3 and a normal TEG result.
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Randomized Controlled Trial
Evaluation of postprocedure cognitive function using 3 distinct standard sedation regimens for endoscopic procedures.
The primary purpose of this investigation was to evaluate postprocedure cognitive function associated with 3 distinct standard sedation regimens used for endoscopic procedures. A secondary aim was to identify complications requiring provider interventions. Subjects scheduled for colonoscopies were approached for enrollment the day of their procedure. ⋯ The propofol-alone group had a mean TICS score of 35.09 at 24 hours compared with 35.98 at 48 hours (P = .924). The results of this investigation indicate that the sedation regimen of propofol alone has the least impact on postprocedure cognitive function. Additionally, the number of jaw lift interventions was significantly higher in both groups who received fentanyl.
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Randomized Controlled Trial Comparative Study
Ventilation with increased apparatus dead space vs positive end-expiratory pressure: effects on gas exchange and circulation during anesthesia in a randomized clinical study.
Atelectasis formation can be reduced by positive end-expiratory pressure (PEEP), but resulting increases in intrathoracic pressure could affect circulation. We have earlier demonstrated that increased tidal volumes with larger apparatus dead space improves oxygenation and sevoflurane uptake. In the present study, we hypothesize that isocapnic ventilation with increased tidal volumes increases oxygen and sevoflurane uptake similar to ventilation with PEEP, but with less impact on cardiac output. ⋯ Oxygen tension and arterial sevoflurane concentration were significantly higher in the DS group (P < .05). Cardiac output decreased significantly less in the DS group compared with the PEEP group (5% and 33%, respectively; P < .05). Consequently, isocapnic ventilation with increased tidal volumes using apparatus dead space increased oxygen and sevoflurane tensions in arterial blood and preserved cardiac output better than did PEEP.
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Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (HIPEC) is a complex procedure used for the treatment of various types of cancer. Specifically, HIPEC has shown success where treatment failure sites (metastases) thrive. A classic example of one such area is the peritoneal surface, which remains a prominent failure site for patients with gynecologic and gastrointestinal cancer. ⋯ Anesthetic complications are common during this procedure with disturbances in hemodynamics, coagulation, and respiratory gas exchange. A knowledge of what to anticipate anesthetically will guide the practitioner to achieve successful management during and after the case. In this case report, a 71-year-old woman was treated for stage Ill peritoneal and ovarian cancer by cytoreductive surgery with HIPEC.
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Hip fractures occur commonly in elderly patients. Many of these patients have multiple comorbidities requiring the use of anticoagulants. ⋯ This case report discusses the advantages and pitfalls of the selection of local anesthetic and monitored anesthesia care using a propofol-ketamine-lidocaine admixture for an elderly patient with a femoral neck fracture who was receiving dabigatran etexilate (Pradaxa). This case illustrates the potential for sedation during monitored anesthesia care to progress to general anesthesia and its associated risks as well as special considerations for anesthesia in geriatric patients.