International journal of clinical and experimental medicine
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Managing ventilation and oxygenation during laparoscopic procedures in severely obese patients undergoing weight loss surgery presents many challenges. Pressure-controlled ventilation, volume-guaranteed (PCV-VG) is a dual-control mode of ventilation and an alternative to pressure (PC) or volume (VC) controlled ventilation. PCV-VG features a user-selected tidal volume target, that is auto-regulated and pressure controlled. We hypothesized that PCV-VG ventilation would provide improved oxygenation and ventilation during laparoscopic bariatric surgery with a lower peak inflating pressure (PIP) than either PC or VC ventilation. ⋯ In adolescents and young adults undergoing laparoscopic bariatric surgery, PCV-VG and PC were superior to VC ventilation in their ability to provide ventilation with the lowest PIP.
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Ketamine is currently the N-methyl-D-aspartate receptor channel blocker in clinical use. Morphine in pain management is usually limited by adverse effect such as nausea and vomiting. Adjuvant treatment with ketamine may be value in giving better analgesia with fewer adverse effects. The purpose of this meta-analysis was to evaluate the differences when patients received morphine with adjuvant ketamine (MK) compared with higher dose of morphine (MO) for acute pain. ⋯ The use of ketamine plus 1/4~2/3 the dose of morphine is better than higher dose of morphine alone in reducing pain scores, and rescuing analgesic requirement. It also improved PONV and wakefulness.
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A 64-yr-old man was admitted because of repeated pneumonia. Both fiberoptic bronchoscopy and esophagoscopy revealed a large tracheoesophageal fistula (15 mm) in the right posterior trachea 1 cm beyond the carina. ⋯ We took advantage of laryngeal mask airway to insert the fiberoptic bronchoscope to guide the stent placement. Our method of sealing a large tracheoesophageal fistula with LMA under total intravenous anesthesia was successful.
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There is no generally accepted treatment strategy for cervical esophageal carcinoma. The purpose of this study was to evaluate the operative outcomes of reconstruction after resection of cervical esophageal and hypopharynx-esophagus junction carcinoma with larynx preservation. ⋯ Surgical resection of cervical esophageal carcinoma and laryngeal preservation is possible. Complete esophagectomy should be performed when the resection extends below the thoracic inlet. The reconstruction methods we performed were safe and effective for the immediate restoration of alimentary continuity after resection of cervical esophageal and pharyngo-cervical esophageal carcinoma; and the patients with PMF/CWSG reconstruction had a better survival than those with GP or CI reconstruction. Combined with radiotherapy, the resectability rate and survival rate of cervical esophageal carcinoma can be improved.
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Many scholars are seeking for an anesthesia induction regimen to meet the requirements of both intubation and instant recovery of spontaneous breathing in case of "cannot intubate, cannot ventilate" to prevent severe consequences. This study aims to investigate whether the combination use of remifentanil 1 μg/kg and small dose of succinylcholine (0.6 mg/kg) is superior to single use of remifentanil 1.5 μg/kg in improving intubation conditions and shortening apnea time under anesthesia induction with propofol. ⋯ Compared with single use of remifentanil 1.5 μg/kg, the combination use of remifentanil 1 μg/kg and succinylcholine 0.6 mg/kg may offer better intubation conditions and may not prolong apnea time under anesthesia induction with propofol 2 mg/kg.