Anesthesiology
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In a recent editorial, Kapur described perioperative nausea and vomiting as "the big 'little problem' following ambulatory surgery."257 Although the actual morbidity associated with nausea is relatively low in health outpatients, it should not be considered an unavoidable part of the perioperative experience. The availability of an emesis basin for every patient in the postanesthesia recovery unit is a reflection of the limited success with the available therapeutic techniques.257 There had been little change in the incidence of postoperative emesis since the introduction of halothane into clinical practice in 1956. However, newer anesthetic drugs (e.g. propofol) appear to have contributed to a recent decline in the incidence of emesis. ⋯ Research into the mechanisms of this common postoperative complication may help in improving the management of emetic sequelae in the future. As suggested in a recent editorial, improvement in antiemetic therapy could have a major impact for surgical patients, particularly after ambulatory surgery. Patients as well as those involved in their postoperative care look forward to a time when the routine offering of an emesis basin after surgery becomes a historical practice.
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Difficult tracheal intubation, often unexpected, has been identified as the commonest contributory factor to anesthetic-related maternal death. The ability to predict such cases preoperatively would be of great value. Preoperative airway assessment and potential risk factors for difficult tracheal intubation were recorded in 1,500 patients undergoing emergency and elective cesarean section under general anesthesia. ⋯ Multivariate analysis removed obesity and missing and single maxillary incisors as risk factors. Obesity was eliminated because of its strong association with short neck. The probability of experiencing a difficult intubation for various combinations of risk factors was determined.(ABSTRACT TRUNCATED AT 250 WORDS)
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Comparative Study
Which vasopressor should be used to treat hypotension during magnesium sulfate infusion and epidural anesthesia?
Ephedrine restores and/or protects uterine blood flow and fetal well-being in laboratory animals. In contrast, alpha 1-adrenergic agonists worsen uterine blood flow and fetal condition. We previously demonstrated that magnesium sulfate (MgSO4) attenuates the detrimental effects of phenylephrine on uterine vascular resistance in gravid ewes. ⋯ Phenylephrine significantly increased uterine vascular resistance when compared with NS-control, but ephedrine did not. As a result, fetal pH and PO2 were significantly greater during ephedrine infusion than during infusion of NS-control. Fetal pH was stable during ephedrine infusion, but it continued to decrease during phenylephrine infusion.(ABSTRACT TRUNCATED AT 250 WORDS)
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When systemic cooling and rewarming are performed during cardiopulmonary bypass (CPB), the pulmonary artery temperature typically decreases after CPB. This decrease may be rapid enough to cause substantial underestimation of cardiac output (CO) measured by thermodilution, due to changing baseline temperature during the thermodilution measurement. In 16 patients undergoing CPB for coronary artery grafts, digital recording of pulmonary artery temperature was done during room-temperature thermodilution CO (TDCO) injections. ⋯ At 30 min the temperature change was -0.012 degrees C/min (not significant), and CO error was -0.13 +/- 0.14 l/min. Duration of CPB was 104 +/- 30 min, with rewarming for 44 +/- 13 min; the average minimum bladder temperature was 25.1 +/- 2.3 degrees C during cooling and 36.7 +/- 0.7 degrees C at the end of CPB. Under these conditions TDCO measurements within the first 10 min after CPB often underestimate the true CO.