Articles: patients.
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Review Case Reports
Use of intraoperative fluoroscopy for the safe placement of C2 laminar screws: technical note.
Rigid fixation of the atlantoaxial joint can be quite challenging due to complex anatomic variants. Numerous techniques have evolved over time, improving the surgeon's adaptability. The recent advent of C2 laminar screws adds to the surgeon's armamentarium, but is not without its own set of limitations. Risk of ventral laminar breach with possible spinal cord injury, CSF leak, or poor bony fixation have led some to recommend prefabricated models or expensive intraoperative spinal navigation to aid screw placement. The purpose of this report is to detail how the use of intraoperative fluoroscopy can be used to aid in the safe placement of C2 laminar screws. ⋯ Use of intraoperative fluoroscopy is an easy and safe method for the placement of C2 laminar screws. Given its use of readily available equipment, this method can be implemented without significant pre-planning, or as an impromptu salvage maneuver.
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J Clin Neurophysiol · Dec 2015
ReviewShould Postanoxic Status Epilepticus be Treated Aggressively?-No!
Electrographic status epilepticus and myoclonus represent frequent findings in patients surviving cardiac arrest; both features have been related to poor clinical outcome. Recent data have outlined that status epilepticus appearing during therapeutic hypothermia and sedation is practically and invariably related to a fatal issue, as opposed to some patients presenting status epilepticus and/or myoclonus after return to normothermic conditions. Although it seems reasonable to give a chance of awakening to the latter patients by administering consequent antiepileptic treatment, especially if other favorable prognostic markers are observed, an aggressive treatment of status epilepticus arising during hypothermia seems futile in view of the existing evidence.
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Journal of anesthesia · Dec 2015
Randomized Controlled TrialFlurbiprofen axetil increases arterial oxygen partial pressure by decreasing intrapulmonary shunt in patients undergoing one-lung ventilation.
In the present study, we investigated whether flurbiprofen axetil (FA) alleviates hypoxemia during one-lung ventilation (OLV) by reducing the pulmonary shunt/total perfusion (Q s/Q t) ratio, and examined the relationship between the Q s/Q t ratio and the thromboxane B2 (TXB2)/6-keto-prostaglandin F1α (6-K-PGF1α) ratio. ⋯ Treatment with FA reduced the Q s/Q t ratio and further increased the PaO2 level during OLV, possibly due to upregulation of the vasoactive agent TXB2/6-K-PGF1α ratio.
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Semin Respir Crit Care Med · Dec 2015
ReviewCritical Care Beds and Resource Utilization: Current Trends and Controversies.
Recent studies have shown a dramatic increase in the number of intensive care unit (ICU) beds in recent decades. As technologies have become more complex, ICUs continue to grow in size and in specialization. The driving forces behind ICU bed expansion include not only the incorporation of advanced technologies but also other factors such as the increased utilization of ICU beds for patients who previously were not offered ICU care--those who may be terminally ill and those who are not critically ill. ⋯ ICUs are also now commonly used in the care of dying patients. In coming decades it is likely that changes will need to take place to forestall exorbitant costs and labor shortages. In addition to bringing in new forms of medical staff such as hospitalists and physician assistants, recent opinion papers have suggested that a de-escalation of ICU growth and a new tiered system of ICU care will be necessary in the United States.
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Given substantial advances in venovenous extracorporeal membrane oxygenation (ECMO) technology, long-term support is increasingly feasible. Although the benefits of short-term ECMO as a bridge to recovery in acute respiratory distress syndrome (ARDS) are well described, the utility and outcomes of long-term support remain unclear. ⋯ Previously, long-term ECMO support was thought to be associated with unfavorable outcomes. This study, however, may provide support for the efficacy of ECMO support even for 3 weeks or more as a bridge to recovery or transplantation.