Articles: postoperative.
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Case Reports
[Awake ECMO therapy in airway stenosis : Bronchoscopic treatment using laser resection.]
This article presents the case of a 62-year-old patient with cancer in the left upper pulmonary lobe who underwent lobe resection with postoperative respiratory insufficiency. The right upper lobe had already been resected 5 years earlier because of an adenocarcinoma. Prior to the present surgery a computed tomography scan detected a narrow stenosis at the former resection site; however, both pulmonary lobes beyond this stenosis appeared to be sufficiently ventilated. ⋯ Each of these surgeries was conducted with the patient under general anesthesia with oral intubation and jet ventilation in combination with the ECMO. The patient was extubated after each treatment session and weaned from ECMO after the final resection within 2 days. This case demonstrates the use of ECMO in combination with surgical procedures in a spontaneously breathing patient as a causal therapy and option for selected patients to prevent complications from long-term ventilation.
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Anesthesia and analgesia · May 2014
Comparative StudyA Prospective Comparison of a Noninvasive Cardiac Output Monitor Versus Esophageal Doppler Monitor for Goal-Directed Fluid Therapy in Colorectal Surgery Patients.
The NICOM non-invasive cardiac output monitor is non-inferior to oesophageal doppler monitoring for guiding fluid therapy in colorectal surgery.
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Anesthesia and analgesia · May 2014
Randomized Controlled TrialThe Risk of Hypertension after Preoperative Discontinuation of Angiotensin-Converting Enzyme Inhibitors or Angiotensin Receptor Antagonists in Ambulatory and Same-Day Admission Patients.
The continued use of angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin II subtype I receptor antagonists (ARBs) medications in the preoperative period has been reported to be associated with intraoperative hypotension that can be unresponsive to pressor drugs. As a result, several investigators suggested discontinuation of these medications before scheduled surgery but did not report on unintended consequences that might result from discontinuation. We conducted a prospective, single-blind, randomized trial to observe the effect of the medications on preoperative arterial blood pressure recordings in patients presenting for ambulatory and same-day surgery. ⋯ Discontinuing ACEIs and ARBs in patients on the day of surgery did not result in a substantively increased incidence of pre- or postoperative HTN compared with patients who continued these medications on the day of surgery. The results provide an evidentiary basis for the safety of discontinuing ACEIs and ARBs on the day of surgery without increasing adverse hemodynamic outcomes.