Anesthesiology and pain medicine
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The brachial plexus block is a commonly performed procedure in the anesthetic practice today. It is performed for analgesia as well as anesthesia for upper limb procedures. It has been used for amputation and replantation surgeries of the upper limb. ⋯ The brachial plexus block can be performed at different levels in the same patient to achieve desired results, while employing sound anatomical knowledge and adhering to the maximum safe dose limit of the local anesthetic.
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Chronic pain tends to be difficult to manage because of its complex natural history and poor response to therapy. Recently, it has been reported that telecare management by nurses improved outcomes of patients with chronic pain. ⋯ Telephone consultation partially based on a cognitive-behavioral approach significantly reduced the intensity of pain and improved the QOL in patients with chronic pain in Japan.
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Patients with mandible deformity may die, as a result of airway management failures. The awake nasal fiberoptic intubation is known as the optimum intubation method, in the mentioned patients, although, in several cases, fiberoptic intubation fails. ⋯ In this case, after failure of awake fiberoptic intubation, awake direct laryngoscopy and blind nasal intubation, finally awake nasal intubation in sitting position, using fiberoptic led to success.
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Ultrasound-Guided Out-of-Plane vs. In-Plane Interscalene Catheters: A Randomized, Prospective Study.
Continuous interscalene blocks provide excellent analgesia after shoulder surgery. Although the safety of the ultrasound-guided in-plane approach has been touted, technical and patient factors can limit this approach. We developed a caudad-to-cephalad out-of-plane approach and hypothesized that it would decrease pain ratings due to better catheter alignment with the brachial plexus compared to the in-plane technique in a randomized, controlled study. ⋯ Our out-of-plane technique did not provide superior analgesia to the in-plane technique. It did not increase the number of complications. Our technique is an acceptable alternative in situations where the in-plane technique is difficult to perform.
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Patients with undifferentiated systolic murmurs present commonly during the perioperative period. Traditional bedside assessment and auscultation has not changed significantly in almost 200 years and relies on interpreting indirect acoustic events as a means of evaluating underlying cardiac pathology. This is notoriously inaccurate, even in expert cardiology hands, since many different valvular and cardiac diseases present with a similar auditory signal. ⋯ With a thorough preoperative assessment incorporating focused echocardiography, anaesthetists are in the unique position to enhance their role as perioperative physicians and influence short and long term outcomes of their patients.