Study to assess the impact of analytics software on operating room controlled substance management and drug diversion.

Purpose: This study investigated the impact of an advanced analytics software solution in the operating room (OR) on tracking and evaluating controlled substance discrepancies. The authors hypothesized that the software would increase identification of these discrepancies and improve the efficiency of the preexisting manual process.

Methods: In this evaluation comparing data from before to after implementation of the software, data were collected using the preexisting manual process for 50 days before implementation, followed by a 25-day period for acclimation to the new software, and ending with a 49-day postimplementation review period.

Dexmedetomidine Used to Maintain Spontaneous Ventilation in a Patient With Anterior Mediastinal Mass and Superior Vena Cava Syndrome.

Anterior mediastinal masses (AMMs), which can be benign or malignant, are a common cause of superior vena cava (SVC) syndrome. Because of their location, AMMs can cause significant airway compromise during the perioperative period, so anesthetic management of a patient with SVC syndrome can present significant challenges. A patient presented with SVC syndrome secondary to a large AMM.

Postoperative Recurarization in a Pediatric Patient After Sugammadex Reversal of Rocuronium-Induced Neuromuscular Blockade: A Case Report.

We present a case of a pediatric patient who developed recurarization after a cardiac catheterization procedure. Intraoperative neuromuscular blockade was achieved with 2 doses of rocuronium, and the blockade was reversed with a bolus dose of sugammadex at the end of the procedure. While recovering in the pediatric cardiac intensive care unit, the patient developed respiratory failure and a decline in the train-of-four response.

Prolonged Activated Clotting Time Immediately Prior to Open Cardiac Surgery.

Background: Prekallikrein deficiency is an extremely rare disorder in which functional prekallikrein in the plasma is reduced or absent.

Case Report: We present the case of a 15-year-old male with prolonged activated clotting time incidentally noted preoperatively prior to repair of an atrial septal defect. The patient was subsequently found to have prekallikrein (Fletcher factor) deficiency.

Dexmedetomidine for anterior mediastinal mass computed tomography-guided biopsy: a case series.

Background: Sedation of children undergoing biopsies of anterior mediastinal masses can be challenging because of the absolute necessity of ensuring minimal smooth muscle relaxation and preventing airway collapse. Furthermore, positive pressure ventilation may be difficult or impossible and may also pose the additional risks of hemodynamic compromise in the pediatric patient.

Case Reports: We present a case series of 3 children who were successfully sedated for computed tomography (CT)-guided mediastinal biopsies with dexmedetomidine.

A new risk of facemask ventilation: entrained esophageal air.

Facemask ventilation has been associated with the development of postoperative nausea and vomiting, increasing the risk of tracheal aspiration; development of gastric distension that further impairs alveolar ventilation; perforation of gastric and duodenal ulcers; development of pneumothorax; extrabronchial air dissection; and development of cardiac dysrhythmias, including bradycardia from indirect vagal nerve stimulation. An unusual complication that occurred during prolonged facemask ventilation is presented: development of a pseudo-obstruction of the intrathoracic airway due to the presence of entrained esophageal air.

Dexmedetomidine: clinical application as an adjunct for intravenous regional anesthesia.

The selective α-2 adrenoceptor agonist, dexmedetomidine, has been shown to be a useful, safe adjunct in perioperative medicine. Intravenous regional anesthesia is one of the simplest forms of regional anesthesia and has a high degree of success. However, intravenous regional anesthesia is limited by the development of tourniquet pain and its inability to provide postoperative analgesia.

Dexmedetomidine: a review of clinical applications.

Purpose Of Review: The present review serves as an overview update in the diverse uses of the sedative dexmedetomidine.

Recent Findings: Dexmedetomidine is a selective alpha2 adrenoreceptor agonist that has been described as a useful, safe adjunct in many clinical applications. This paper reviews current clinical uses, mechanism of action, and side effects of dexmedetomidine.