Anesthesia and analgesia
-
Anesthesia and analgesia · Nov 2004
Case ReportsSuspected central anticholinergic syndrome in a 6-week-old infant.
A 6-wk-old male infant became unresponsive after an uneventful general anesthetic for hernia repair. His symptoms were consistent with central anticholinergic syndrome. ⋯ Because of the recurrence of sedation, a second physostigmine infusion was administered, which again led to transient arousal. Finally, the patient awoke spontaneously after 24 h and recovered uneventfully.
-
Anesthesia and analgesia · Nov 2004
Clinical TrialIncreased systemic catecholamines in complex regional pain syndrome and relationship to psychological factors: a pilot study.
We have demonstrated that subjects with complex regional pain syndrome (CRPS) have asymmetric venous pool plasma concentrations of norepinephrine (NE) when affected and unaffected limbs are compared, with most demonstrating decreased NE levels in the affected limb. This pilot study explored whether systemic venous plasma catecholamine levels in CRPS subjects with sympathetically maintained pain (SMP) differ from those found in healthy volunteers. We also explored whether catecholamine levels were correlated with scores on psychometric measures of depression, anxiety, and personality. ⋯ This preliminary work suggests that increased NE and E levels in CRPS/SMP patients may result from the pain of CRPS, consequent affective distress, or both. Alternatively, our findings could reflect premorbid adrenergic hyperactivity caused by affective, endocrine, or other pathology, which might predispose these individuals to develop the syndrome. Definitive studies are needed to examine these hypotheses in detail.
-
Anesthesia and analgesia · Nov 2004
Randomized Controlled Trial Comparative Study Clinical TrialDeveloping a strategy to improve ventilation in an unprotected airway with a modified mouth-to-bag resuscitator in apneic patients.
The strategies to ensure safety during ventilation of an unprotected airway are limiting airway pressure and/or inspiratory flow. In this prospective, randomized study we assessed the effect of face mask ventilation with small tidal volumes in the modified mouth-to-bag resuscitator (maximal volume, 500 mL) versus a pediatric self-inflatable bag versus automatic pressure-controlled ventilation in 40 adult apneic patients during induction of anesthesia. The mouth-to-bag resuscitator requires the rescuer to blow up a balloon inside the self-inflating bag that subsequently displaces air which then flows into the patient's airway. ⋯ The tidal volumes were similar between groups. No stomach inflation occurred in either group. We conclude that using a modified mouth-to-bag resuscitator or automatic pressure-controlled ventilation with similar small tidal volumes during face mask ventilation resulted in an approximately 25% reduction in peak airway pressure when compared with a standard pediatric self-inflating bag.
-
Anesthesia and analgesia · Nov 2004
Randomized Controlled Trial Comparative Study Clinical TrialDifferent F-wave recovery after neuromuscular blockade with pancuronium and mivacurium.
We performed this study to assess the recovery period after neuromuscular blockade by electromyographic F-wave analysis, a method that supplies more information about more proximal parts of the motor system than conventionally used methods, e.g., mechanomyography (MMG). In 20 neurosurgical ASA physical status I or II patients anesthesia was induced and maintained with IV fentanyl and midazolam. Patients were randomly assigned to receive either 0.25 mg/kg mivacurium (MV group, n = 10) or 0.1 mg/kg pancuronium (PC group, n = 10) intraoperatively. ⋯ F waves were recorded at the abductor pollicis muscle of the contralateral hand at train-of-four (TOF) ratios of 0.1, 0.25, 0.5, 0.7, 0.75, 0.8, 0.85, 0.9, and 0.95. Recovery of F-wave amplitudes after neuromuscular blockade with pancuronium was significantly slower compared with mivacurium (P = 0.004) during the clinically important recovery period defined by MMG TOF ratios from 0.7 to 0.95. This electrophysiologic finding suggests a differential recovery of the motor system after administration of pancuronium and mivacurium not detected by MMG.
-
Anesthesia and analgesia · Nov 2004
Brand and size matter when choosing a syringe to relieve pressure in a tracheal tube cuff.
We studied the use of an inline syringe as a pressure relief valve for tracheal tube cuffs during exposure to nitrous oxide to see if the technique works. Bench testing was done to determine the stick and slip characteristics of syringes of different brands and sizes. Cuffs were inflated with 20 mL of air, producing a cuff pressure of 100-120 mm Hg. ⋯ We conclude that a syringe attached to the pilot balloon connector can be used to control tracheal tube cuff pressure during nitrous oxide anesthesia. However, not all syringes are suitable for this purpose: large syringes are better than small syringes, and the Terumo brand is more suitable than BD or Monoject. The system does not work automatically, and intermittent compression of the syringe plunger to overcome static friction is required to avoid overdistension.