Research Article 

Analyzing Volatile Anesthetic Consumption by Auditing Fresh Gas Flow: An Observational Study at an Academic Hospital

Luis Tollinche, KaySee Tan, Austin Han , Leslie Ojea and Cindy Yeoh
Abstract

In a climate of cost containment, it is critical to analyze and optimize all perioperative variable costs. Fresh gas flow is one important variable that determines utilization of inhalational agents and can be tightly controlled by the anesthesia provider. Manufacturers of inhalational agents have recommendations for minimum gas flow for their respective agents. Any gas flow above these recommendations is considered misuse and leads to unnecessary expense. The purpose of this study was to characterize and quantify the excess use of inhalational agents by analyzing fresh gas flow rates for long duration cases.

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Case Report 

Acute Pain Management in a Child: A Case Report of 46-Days of Popliteal Sciatic Nerve Catheter

Hertz Laurent, Sola Chrystelle, De La Arena Pablo and Dadure Christophe
Abstract

The use of perineural catheter for more than 72 hours is rare in perioperative practice, but was especially reported for chronic pain, oncologic related pain or palliative care. The main concern remains the risk of neurological or infectious complication. No guideline clearly specifies the maximum duration of perineural catheter maintenance and the safety of long-term catheters is discussed.

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Case Report 

Perioperative Cardiac Stent Thrombosis Versus Bleeding: A Clinical Dilemma in Trauma Patients

Nwokolo Omonele O and Wegner Robert C
Abstract

Heart disease is prevalent in current patient population at an increasing level. Some of these patients have had interventions such as stent placements to improve quality of life and are started on antiplatelet therapy for a definite period of time or indefinitely based on their risk factors, comorbidities or type of stents placed. When these patients present to the hospital with major trauma, the surgical and anesthetic management threads a delicate line between protection of the stents and preventing life-threatening bleeding.

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Case Report 

Phenytoin in Topical Formulations Augments Pain Reduction of Other Analgesics in the Treatment of Neuropathic Pain

David J Kopsky and Jan M Keppel Hesselink
Abstract

Topical analgesic formulations are gaining interest for the treatment of peripheral neuropathic pain since the beginning of 2000. Advantages of topical analgesics over oral medication are the absence of systemic side effects and drug-drug interactions, higher concentrations of active compound at the pain area, fast onset on action, improvement of compliance, and no risk of abuse. In many peripheral neuropathic pain states the pain area is small and thus topical analgesics are suitable. Most patients experience pain reducing effect within 30 minutes after application of compounded topical analgesics, such as creams containing amitriptyline, ketamine, baclofen, or clonidine. This helps to quickly identify responders on selected analgesic creams.

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Case Report 

Timely Detection of Epidural Catheter Migration: Diagnosis and Management: A Case Report

YC Tay and MJ Abrahams
Abstract

Epidural catheters that are commonly placed for anaesthesia or analgesia have a serious complication of migration. Besides intravascular local anaesthetic infusion which could lead to systemic toxicity, a subdural migration is often diagnosed late and presents with life-threatening outcomes noted either at post-mortem or requiring intensive care management.

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Case Report 

Pourfour Du Petit Syndrome Presenting as Subdural Block. A Rare Complication of Obstetric Epidural Analgesia: A Case Report

Edward M Becerra, Jose L Aguilar, Raquel Pelaez, Jakeline R Jurado and Jordi Ballabriga
Abstract

To report a rare case of Pourfour du Petit Syndrome (PDPS), presenting clinically as subdural block (SDB), as a complication of Obstetric Epidural Analgesia (OEA). PDPS is described as reverse HornerĀ“s syndrome. It is characterized by mydriasis, exophthalmos, eye-lid retraction and hyperhidrosis.

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Original Article 

A New Age for Sepsis/Septic Shock Diagnosis and Management?

Enrico Giustiniano
Abstract

On April 2014 the New England Journal of Medicine published the results of the trial ProCESS (Protocolized Care for Early Septic Shock): a multi centers study conducted on 1341 patients of 31 academic hospitals of United States. The trial compared three different way to approach and care the septic shock during the first 6 hs.

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Original Article 

Which Guidance Method during Tracheotomy Procedure in Patients with Short Neck in the ICU? A Prospective Randomized Study

Esra Ozayar, Handan Gulec, Zehra Baykal Tutal, Munire Babayigit, Mehmet Sirin, Aysun Kurtay and Eyup Horasanli
Abstract

Percutaneous tracheotomy is a common procedure in the intensive care units (ICU). Although majority of the complications related to this procedure are considered minor, serious complications secondary to tracheotomies are still being reported. Definition of short neck is not clear in the medical literature, but well known to anesthesiologists since they are flagged for possible difficult airway. Thyromental and sternomental distance, range of neck extension and neck circumference are some of the predictors of difficult airway.

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Research Article 

Pre-Clinical Pharmacokinetics of Sufentanil-2-Hydroxypropyl-Β-Cyclodextrin Inclusion Complex

Silvana Aparecida Calafatti, Marcelo de Macedo, Juliana Zampoli Boava Papini, Edvaldo Coelho, Cintia Maria Saia Cereda, Jose Pedrazzoli Junior, Eneida de Paula, Daniele Ribeiro de Araujo and Giovana Radomille Tofoli
Abstract

Opioids are used for the postoperative period, cancer pain and for moderate to severe chronic noncancer pain. Sufentanil (SUF) is a highly lipophilic opioid that presents rapid and highly effective pain relief, but it presents short duration of action. Due to this short duration of action, SUF is currently used as an intravenous anesthetic agent and analgesic adjuvant for surgery and labor.

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