Articles: general-anesthesia.
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Review Case Reports
Anesthetic management of a patient with limb-girdle muscular dystrophy 2B:CARE-compliant case report and literature review.
Limb-girdle muscular dystrophies (LGMDs) belong to few neuromuscular disorders mainly involving pelvic and shoulder girdle muscles. Also, cardiac or pulmonary complications, increased rhabdomyolysis risk when exposed to volatile anesthetics and succinylcholine may increase anesthesia related risks. However, current reports about the anesthesia management of these patients are limited. ⋯ Carefully conducted general anesthesia with TIVA technique is a good choice for LGMD patients. Neuraxial anesthesia may be used if general anesthesia needs to be avoided. To warrant safe anesthesia for surgery, any decision must be well thought out during perioperative period.
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Patients undergoing emergency surgery may present with the acute respiratory distress syndrome (ARDS) or develop this syndrome postoperatively. The incidence of ARDS in the postoperative period is relatively low, but the impact of ARDS on patient outcomes and healthcare costs is relevant Aakre et.al (Mayo Clin Proc 89:181-9, 2014). The development of ARDS as a postoperative pulmonary complication (PPC) is associated with prolonged hospitalisation, longer duration of mechanical ventilation, increased intensive care unit length of stay and high morbidity and mortality Ball et.al (Curr Opin Crit Care 22:379-85, 2016). ⋯ In addition, the use of low tidal volume, minimising plateau pressure and titrating a low-moderate PEEP level based on the patient's need can improve outcome and reduce intraoperative adverse events. Moreover, perioperative management of ARDS patients includes specific anaesthesia and ventilator settings, hemodynamic monitoring, moderately restrictive fluid administration and pain control. The aim of this review is to provide an overview and evidence- and opinion-based recommendations concerning the management of patients at risk of and with ARDS who undergo emergency surgical procedures.
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Review Case Reports
Anesthetic management of tracheal laceration from traumatic dislocation of the first rib: a case report and literature of the review.
Tracheobronchial lacerations from trauma can be life-threatening and present significant challenges for safe anesthetic management. Early recognition of tracheal injuries and prompt airway control can be lifesaving. ⋯ Early diagnosis and multidisciplinary collaborations are keys to the successful management of this patient. Flexible bronchoscopy is particularly useful in airway management for urgent trachea tracheal laceration repair.
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This article reviews the key considerations when managing a patient with a difficult airway. The difficult airway may be anticipated from preassessment allowing time for investigations and preparation. ⋯ Current guidelines are included that demonstrate how the techniques are incorporated into an overall strategy with a plan A-D when failure occurs. It is critical to progress through such an algorithm in a timely manner to prevent the onset of hypoxia.
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There is still insufficient evidence to link particular anaesthetic or analgesic interventions with tumour recurrence following cancer surgery.
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