Anesthesia and analgesia
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Anesthesia and analgesia · Mar 2006
Case ReportsUnanticipated difficult endotracheal intubations in patients with cervical spine instrumentation.
We present two cases of unanticipated difficult airway in patients requiring reoperation after cervical spine instrumentation. In both cases, the upper airway examination was normal, and fiberoptic-guided intubation proceeded with the patient sedated and breathing spontaneously. ⋯ Later review of radiographs showed the previously unrecognized protrusion of cervical hardware into the meso- and hypopharynx. We recommend that anesthesiologists review recent radiographic studies for potential airway compromise before approaching the airway of patients presenting for revision of cervical instrumentation.
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Anesthesia and analgesia · Mar 2006
Anesthetic, patient, and surgical risk factors for neurologic complications after prolonged total tourniquet time during total knee arthroplasty.
Nerve injury after prolonged tourniquet inflation results from the combined effects of ischemia and mechanical trauma. Tourniquet release, allowing a reperfusion interval of 10-30 min followed by re-inflation, has been recommended to extend the duration of total tourniquet time. However, this practice has not been confirmed clinically. ⋯ Postoperative neurologic dysfunction was associated with younger age (P < 0.001; odds ratio = 0.7 per 10-yr increase), longer tourniquet time (P < 0.001; odds ratio = 2.8 per 30-min increase), and preoperative flexion contracture >20 degrees (P = 0.002; odds ratio = 3.9). In a subset of 116 patients with tourniquet times > or =180 min, longer duration of deflation was associated with a decreased frequency of neurologic complications (P = 0.048). We conclude that the likelihood of neurologic dysfunction increases with total tourniquet time and that a reperfusion interval only modestly decreases the risk of nerve injury.
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Anesthesia and analgesia · Mar 2006
Comparative StudyPharmacokinetics and pharmacodynamics of a 0.1 mg/kg dose of cisatracurium besylate in children during N2O/O2/propofol anesthesia.
We studied the pharmacokinetics and pharmacodynamics of cisatracurium in 9 children (mean weight, 17.1 kg) aged 1-6 yr (mean, 3.75 yr) during propofol-nitrous oxide anesthesia. Neuromuscular monitoring was performed. Venous samples were taken before injection of a 0.1 mg/kg dose of cisatracurium and then at 2, 5, 10, 30, 60, 90, and 120 min. ⋯ Steady-state volume of distribution (0.207 +/- 0.031 L/kg) and total body clearance (6.8 +/- 0.7 mL/min/kg) were significantly larger than those published for adults. Pharmacodynamic results were comparable to those obtained in pediatric studies during halothane or opioid anesthesia with the exception of a longer recovery to 25% baseline. Although the plasma-effect compartment equilibration rate constant was twofold faster (0.115 +/- 0.025 min(-1)) than that published for cisatracurium in adults, the effect compartment concentration corresponding to 50% block was similar (129 +/- 27 ng/mL).