Anesthesiology
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Adverse reactions to drugs require that their mechanisms be elucidated, particularly when anaphylaxis is suspected. Early diagnosis can be achieved by plasma histamine measurements. Unfortunately, the short plasma half-life of histamine and the difficulties in handling the sample usually preclude this measurement, although a sensitive radioimmunologic kit is routinely available. ⋯ At least 15 min was necessary to reach the peak level when the responsible drug was administered intravenously. The best time for measuring tryptase was 1-2 h after the reaction (not greater than 6 h), whereas for histamine it was 10 min to 1 h. We conclude that measurement of plasma tryptase along with measurement of plasma histamine may aid in diagnosis of anaphylaxis.
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Adverse outcomes associated with respiratory events are the single largest class of injury in the American Society of Anesthesiologists Closed Claims Project (762 of the 2,046 cases, 37%). Inadequate ventilation, esophageal intubation, and difficult tracheal intubation are the most common mechanisms of respiratory-related adverse outcomes. An analysis of closed claims data regarding these mechanisms has been reported previously. ⋯ Aspiration (56 claims, 3% of the database) usually occurred during general anesthesia, either during induction prior to tracheal intubation or during maintenance of anesthesia delivered via mask. Bronchospasm (40 claims, 2% of the database) tended to occur during induction of general anesthesia in patients with a history of asthma or chronic obstructive pulmonary disease and/or smoking. The incidence of severe injury (brain damage and death) among these cases in the five categories was 47% overall, ranging from 12% in airway trauma claims to nearly 90% in claims for airway obstruction and bronchospasm.(ABSTRACT TRUNCATED AT 250 WORDS)
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Randomized Controlled Trial Comparative Study Clinical Trial
A randomized double-blind comparison of epidural versus intravenous fentanyl infusion for analgesia after thoracotomy.
This study compared epidural and intravenous fentanyl infusions for pain relief for the first 20 h after thoracotomy, in order to examine whether an thoracic epidural fentanyl infusion offers clinical advantage over an intravenous infusion. Forty patients were assigned randomly to receive either fentanyl epidurally and saline intravenously or fentanyl intravenously and saline epidurally in a double-blind fashion. ⋯ Respiratory function was better preserved and the incidence of nausea and sedation was less in the epidural group than in the intravenous group. In conclusion there appears to be a clinical advantage to the epidural infusion over the intravenous infusion of fentanyl for analgesia after thoracotomy.