Anesthesia and analgesia
-
Anesthesia and analgesia · May 2001
Case ReportsCaudal epidural blood patch for treating intractable vomiting in a child after placement of a permanent intrathecal catheter.
Postdural puncture cerebral spinal fluid (CSF) leak most often manifests as a postdural puncture headache (PDPH). The reported frequency in young children varies (1-4). ⋯ We present a case of postoperative nausea and vomiting resulting from a presumed lumbar CSF leak in a nonverbal child after surgical placement of a permanent intrathecal catheter. Treatment with an epidural blood patch (EBP) via the caudal approach resulted in complete relief of symptoms.
-
Anesthesia and analgesia · May 2001
The use of an anesthesia information management system for prediction of antiemetic rescue treatment at the postanesthesia care unit.
We used an anesthesia information management system (AIMS) to devise a score for predicting antiemetic rescue treatment as an indicator for postoperative nausea and vomiting (PONV) in the postanesthesia care unit (PACU). Furthermore, we wanted to investigate whether data collected with an AIMS are suitable for comparable clinical investigations. Over a 3-yr period (January 1, 1997, to December 31, 1999), data sets of 27,626 patients who were admitted postoperatively to the PACU were recorded online by using the automated anesthesia record keeping system NarkoData(R) (IMESO GmbH, Hüttenberg, Germany). Ten patient-related, 5 operative, 15 anesthesia-related, and 4 postoperative variables were studied by using forward stepwise logistic regression. Not only can the probability of having PONV in the PACU be estimated from the 3 previously described patient-related (female gender, odds ratio [OR] = 2.45; smoker, OR = 0.53; and age, OR = 0.995) and one operative variables (duration of surgery, OR = 1.005), but 3 anesthesia-related variables (intraoperative use of opioids, OR = 4.18; use of N(2)O, OR = 2.24; and IV anesthesia with propofol, OR = 0.40) are predictive. In implementing an equation for risk calculation into the AIMS, the individual risk of PONV can be calculated automatically. ⋯ The aim of this study was to investigate predictors for postoperative nausea and vomiting by using online anesthesia records. With the help of computerized data evaluation, 7 of 34 variables could be detected as risk factors. By implementing an automatic score into the record keeping system, an individual risk calculation could be made possible.
-
Anesthesia and analgesia · May 2001
The effects of prone positioning on intraabdominal pressure and cardiovascular and renal function in patients with acute lung injury.
To detect any harmful effects of prone positioning on intraabdominal pressure (IAP) and cardiovascular and renal function, we studied 16 mechanically ventilated patients with acute lung injury randomly in prone and supine positions, without minimizing the restriction of the abdomen. Effective renal blood flow index and glomerular filtration rate index were determined by the paraaminohippurate and inulin clearance techniques. Prone positioning resulted in an increase in IAP from 12 +/- 4 to 14 +/- 5 mm Hg (P < 0.05), PaO(2)/fraction of inspired oxygen from 220 +/- 91 to 267 +/- 82 mm Hg (P < 0.05), cardiac index from 4.1 +/- 1.1 to 4.4 +/- 0.7 L/min (P < 0.05), mean arterial pressure from 77 +/- 10 to 82 +/- 11 mm Hg (P < 0.01), and oxygen delivery index from 600 +/- 156 to 648 +/- 95 mL. min(-)(1). m(-)(2) (P < 0.05). Renal fraction of cardiac output decreased from 19.1% +/- 12.5% to 15.5% +/- 8.8% (P < 0.05), and renal vascular resistance index increased from 11762 +/- 6554 dynes. s. cm(-)(5). m(2) to 15078 +/- 10594 dynes. s. cm(-)(5). m(2) (P < 0.05), whereas effective renal blood flow index, glomerular filtration rate index, filtration fraction, urine volume, fractional sodium excretion, and osmolar and free water clearances remained constant during prone positioning. Prone positioning, when used in patients with acute lung injury, although it is associated with a small increase in IAP, contributes to improved arterial oxygenation and systemic blood flow without affecting renal perfusion and function. Apparently, special support to allow free chest and abdominal movement seems unnecessary when mechanically ventilated, hemodynamically stable patients without abdominal hypertension are proned to improve gas exchange. ⋯ Prone positioning is increasingly used to improve gas exchange in patients with acute lung injury. However, during prone positioning an increase in intraabdominal pressure in these critically ill patients may promote dysfunction of other organs. Therefore, we performed a randomized study in mechanically ventilated patients with acute lung injury to investigate the cardiovascular and renal effects of prone positioning.