Anesthesiology
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Letter Case Reports
The effect of autotransfusion on catecholamine levels during pheochromocytoma.
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Letter Comparative Study
Caudal and ilioinguinal/iliohypogastric nerve blocks in children.
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Randomized Controlled Trial Clinical Trial
Addition of nitrous oxide to fentanyl anesthesia does not induce myocardial ischemia in patients with ischemic heart disease.
Although nitrous oxide is commonly administered to patients with ischemic heart disease, recent reports suggest that it may induce myocardial ischemia in these patients. The authors compared the effects of nitrous oxide on segmental left ventricular (LV) function and the ST segment of the electrocardiogram with the effects of an equal concentration of nitrogen (crossover design) before the start of surgery in 18 patients who required coronary-artery bypass grafting. The patients studied did not have valvular or LV dysfunction. ⋯ Surgery did not begin until the study was concluded. No patient experienced an ST segment change greater than 1 mm during the study, and none developed a new segmental wall motion abnormality during inhalation of either nitrous oxide or nitrogen. The authors conclude that nitrous oxide does not induce myocardial ischemia when used as an adjunct to fentanyl anesthesia in patients who have severe coronary-artery disease accompanied by well-preserved valvular and LV function.
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No standard outcome measures exist to evaluate the effect of interventions intended to improve the quality of anesthesia care. The authors established a clinically practical definition of outcome, and used it to assess the effect of feedback of information about complications and the effect of pulse oximetry on the rate and severity of important anesthesia-related problems encountered in the operating room (OR) and recovery room (RR). On admission to the RR, the patient's anesthetist documented Recovery-Room-Impact Events (RRIE), defined as an "unanticipated, undesirable, possibly anesthesia-related effect that required intervention, was pertinent to recovery-room care, and did or could cause at least moderate morbidity." Following a control period with no feedback of data, intense feedback of grouped (anonymous) RRIE rates was provided. ⋯ Although significantly fewer patients experienced RRIEs (15.6% vs. 12.4%, P less than 0.0001), hypotensive RRIEs (5.2% vs. 3.8%, P = 0.0003), and hypovolemic RRIEs (0.88% vs. 0.42%, P = 0.0017) following the introduction of pulse oximetry in the OR, confounding factors prevent establishment of a cause-and-effect relationship. Quality assurance may require more direct intervention and individual feedback to be effective. Still, the RRIE measure requires minimal effort at low cost and encourages improved transmission of information at the time of admission to recovery-room care.
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A new laryngoscope blade has been designed for emergency visualization of the pharynx and larynx when the pharyngeal space is restricted. The blade incorporates a 7-cm tube in the distal portion and an intraluminal light source protected from obstruction. It attaches to standard battery-powered light handles, making it practical for emergency use. The new blade has been tested on dogs and used successfully in 12 patients with edematous pharynges and in one patient with a bleeding pharyngeal tumor, where standard non-tubular blades failed to produce a view of the larynx.