Anesthesia and analgesia
-
Anesthesia and analgesia · Mar 2006
Case ReportsSuccessful intraoperative use of recombinant tissue plasminogen activator during liver transplantation complicated by massive intracardiac/pulmonary thrombosis.
During orthotopic liver transplantation a patient received epsilon-aminocaproic acid and clotting factors. Shortly after hepatic artery clamping the patient developed a massive intracardiac/intravascular thrombosis that resulted in cardiac arrest. ⋯ The patient was ultimately discharged to home. We report the successful intraoperative resuscitation of a patient with acute intracardiac/intravascular thrombosis during an orthotopic liver transplantation using thrombolytic therapy.
-
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.
-
Anesthesia and analgesia · Mar 2006
Comparative StudyDeterminants of volatile general anesthetic potency: a preliminary three-dimensional pharmacophore for halogenated anesthetics.
We investigated the molecular basis for the immobilizing activity of halogenated volatile anesthetics using comparative molecular field analysis. In vivo potency data (expressed as minimum alveolar concentrations) for 69 structurally diverse anesthetics were obtained from the literature. The drugs were randomly divided into a training set (n = 52) used to derive the activity model and a test set (n = 17) used to independently assess the model's predictive power. ⋯ The final model explained 94.2% of the variance in the observed activities of the training set compounds. The model showed good predictive capability for both the training set (cross-validated r2 = 0.705) and randomly excluded test set anesthetics (r2 = 0.837). Three-dimensional pharmacophoric maps were derived to identify the spatial distribution of key areas where steric and electrostatic interactions are important in determining immobilizing activity of the halogenated drugs and were compared with our previously published maps obtained for nonhalogenated volatile anesthetics.
-
Anesthesia and analgesia · Mar 2006
Case ReportsNegative arterial to end-tidal carbon dioxide gradient: an additional sign of malignant hyperthermia during desflurane anesthesia.
Widespread use of desflurane anesthesia has changed the clinical presentation of malignant hyperthermia (MH). Delayed onset of MH symptoms has been reported previously. ⋯ The same conditions exist in cases of MH crisis. We describe an unusual case of MH in which a negative value of (a-ET) Pco2 gradient has been used as diagnostic and monitoring tool.
-
Anesthesia and analgesia · Mar 2006
Case ReportsVentilatory support using bilevel positive airway pressure during neuraxial blockade in a patient with severe respiratory compromise.
In pregnant patients with myasthenia gravis and respiratory compromise, neuraxial anesthesia for lower abdominal surgery can risk further respiratory depression. We report the use of epidural anesthesia for dilation and curettage and tubal ligation in a 26-yr-old woman with a 12-wk intrauterine pregnancy with severe myasthenia gravis and respiratory insufficiency in whom ventilatory support during anesthesia was provided successfully using bilevel positive airway pressure ventilation. This report demonstrates how the use of bilevel positive airway pressure for ventilatory support may improve the safety of regional anesthesia in patients with severe respiratory compromise.