Anesthesia and analgesia
-
Anesthesia and analgesia · Oct 1996
Pseudoankylosis of the mandible after supratentorial craniotomy.
After temporal craniotomy, pseudoankylosis of the mandible can cause difficult airway management during subsequent anesthesia. However, postcraniotomy changes in maximal mouth opening and the incidence of limited mouth opening have not been characterized. Ninety-two adult patients who underwent elective craniotomy were divided into three groups: Group A (n = 28) included patients who underwent parietal, occipital, or frontal craniotomy without incision of the temporalis muscles; Group B (n = 25) included patients who underwent temporal craniotomy; and Group C (n = 39) included patients who underwent frontotemporal craniotomy. ⋯ In Group C, the incidence of limited mouth opening was 33.3% and 20.5% 2 wk and 1 mo after operation, respectively; however, limited mouth opening resolved within 3 mo in most patients. Supratentorial craniotomies separated by short intervals can increase the risk of limiting the mandibular opening, which may result in a difficult intubation. Careful preoperative assessment of the airway is mandatory if patients have previously undergone temporal or frontotemporal craniotomy.
-
Anesthesia and analgesia · Oct 1996
Practice patterns of anesthesiologists regarding situations in obstetric anesthesia where clinical management is controversial.
A survey consisting of 47 questions, 40 regarding clinical practice and 7 regarding demographics, was mailed to 153 directors of obstetric anesthesia in academic practice and to 153 anesthesiologists in private practice. Questions relating to the following areas of practice were asked: 1) preoperative laboratory testing; 2) preeclampsia and possible coagulopathies; 3) epidural catheter placement in women with "spinal problems"; and 4) use of epidural opioids and intravenous supplementation. ⋯ These eight questions related to preoperative laboratory testing in the healthy parturient, preoperative laboratory testing in the preeclamptic patient, and the use of intravenous supplementation during a cesarean section with regional anesthesia. Although there were some differences in the responses between anesthesiologists in academic and private practice, overall the responses were similar.
-
Anesthesia and analgesia · Oct 1996
Comparative StudySmall-volume resuscitation using hypertonic saline improves organ perfusion in burned rats.
Resuscitation using small volumes (3-5 mL/kg) of 7.5% hypertonic saline (HTS) is effective for hemorrhagic shock. Whether HTS is beneficial for the initial resuscitation of burn injury is not clear. We compared the hemodynamic effects of HTS versus lactated Ringer's solution (LR) and examined organ tissue perfusion during burn resuscitation (R). ⋯ Resuscitation using HTS was associated with rapid improvement in organ tissue perfusion in anesthetized rats subjected to burn injury. In comparison to LR, greater increases in blood flows to the heart, kidney, liver, and testis were observed with HTS. The results suggest that significant improvement in blood flow distribution can be achieved using HTS at less than one fifth the volume of LR for the initial treatment of burn shock.
-
Anesthesia and analgesia · Oct 1996
Comment Letter Comparative StudySingle breath induction technique: comparison of sevoflurane and isoflurane.