Anesthesia and analgesia
-
Anesthesia and analgesia · Oct 2010
Review Case ReportsSymptomatic axillary hematoma after ultrasound-guided infraclavicular block in a patient with undiagnosed upper extremity mycotic aneurysms.
We present a case of axillary hematoma complicating an ultrasound-guided infraclavicular block in a patient with undiagnosed mycotic aneurysms of the peripheral arteries. Mycotic aneurysm is a rare medical condition with well-identified risk factors. When performing regional anesthesia in patients with these risk factors, clinicians should have a high degree of suspicion about the possible existence of vascular anomalies. A preprocedure Doppler study of the block area and real-time guidance of the needle using ultrasound may be useful.
-
Anesthesia and analgesia · Oct 2010
ReviewThe anesthetic considerations of tracheobronchial foreign bodies in children: a literature review of 12,979 cases.
Asphyxiation by an inhaled foreign body is a leading cause of accidental death among children younger than 4 years. We analyzed the recent epidemiology of foreign body aspiration and reviewed the current trends in diagnosis and management. In this article, we discuss anesthetic management of bronchoscopy to remove objects. ⋯ An induction that maintains spontaneous ventilation is commonly practiced to minimize the risk of converting a partial proximal obstruction to a complete obstruction. Controlled ventilation combined with IV drugs and paralysis allows for suitable rigid bronchoscopy conditions and a consistent level of anesthesia. Close communication between the anesthesiologist, bronchoscopist, and assistants is essential.
-
Anesthesia and analgesia · Oct 2010
Randomized Controlled Trial Comparative StudyThe influence of time of day of administration on duration of opioid labor analgesia.
Medications administered into the epidural or intrathecal space for labor analgesia may demonstrate variable effects dependent on time of day, and this may affect clinical research trials investigating the pharmacology of specific drugs. In this retrospective study, we evaluated the effect of time of day of administration of intrathecal fentanyl and systemic hydromorphone labor analgesia from data collected as part of a randomized clinical trial examining the influence of analgesia method on labor outcome. ⋯ Time of day of administration did not seem to influence combined spinal-epidural or systemic labor analgesia duration under these study conditions.
-
Anesthesia and analgesia · Oct 2010
Randomized Controlled Trial Comparative StudyA comparison of liver function after hepatectomy with inflow occlusion between sevoflurane and propofol anesthesia.
In this study, we compared liver function tests after hepatectomy with inflow occlusion as a function of propofol versus sevoflurane anesthesia. ⋯ Sevoflurane and propofol anesthetics resulted in similar patterns of liver function tests after hepatectomy with inflow occlusion. These data suggest that the 2 anesthetics are equivalent in this clinical context.
-
Anesthesia and analgesia · Oct 2010
Randomized Controlled Trial Comparative StudyAdaptive support ventilation with protocolized de-escalation and escalation does not accelerate tracheal extubation of patients after nonfast-track cardiothoracic surgery.
It is uncertain whether adaptive support ventilation (ASV) accelerates weaning of nonfast-track cardiothoracic surgery patients. A lower operator set %-minute ventilation with ASV may allow for an earlier definite switch from controlled to assisted ventilation, potentially hastening tracheal extubation. We hypothesized that ASV using protocolized de-escalation and escalation of operator set %-minute ventilation (ASV-DE) reduces time until tracheal extubation compared with ASV using a fixed operator set %-minute ventilation (standard ASV) in uncomplicated patients after nonfast-track coronary artery bypass graft. ⋯ Compared with standard ASV, weaning of patients after nonfast-track coronary artery bypass graft using ASV with protocolized de-escalation and escalation does not shorten time to tracheal extubation.