Anesthesia and analgesia
-
Anesthesia and analgesia · Nov 2013
Prevention of Airway Fires: Do Not Overlook the Expired Oxygen Concentration.
It is generally accepted that when an ignition source is used the inspired oxygen concentration (FIO2) should be <30% in the breathing circuit to help prevent airway fires. The time and conditions required to reduce a high O2% in the breathing circuit to <30% has not yet been systematically studied. ⋯ Both inspired and expired circuit oxygen concentration may take minutes to decrease to <30% depending on circuit length, FGF rate, and starting circuit oxygen concentration. During the reduction in FIO2, the expiratory oxygen concentration may be >30% for a considerable time after the FIO2 is in a "safe" range. An increased expired oxygen concentration should also be considered an airway fire risk, and patient care protocols may need to be modified based on future studies.
-
Anesthesia and analgesia · Nov 2013
Adenosine-Induced Flow Arrest to Facilitate Intracranial Aneurysm Clip Ligation Does Not Worsen Neurologic Outcome.
When temporary arterial occlusion of the parent artery is difficult for anatomical reasons, or when inadvertent aneurysmal rupture occurs during surgical dissection, adenosine administration can be used to produce flow arrest and brief, profound systemic hypotension that can facilitate intracranial aneurysm clip ligation. There is a concern, however, that the flow arrest and profound hypotension produced by adenosine, although brief, may cause cerebral ischemia and therefore worsen neurologic outcome compared with other techniques to facilitate aneurysm clip ligation. Therefore, we performed a retrospective, case-control study to determine whether adenosine-induced flow arrest had negative effects on the neurologic outcome of our patients. ⋯ When used to facilitate intracranial aneurysm clip ligation, adenosine-induced flow arrest was associated with no more than a 15.7% increase or a 12.7% decrease in the incidence of a poor neurologic outcome at either 48 hours or at the time of hospital discharge. In addition, adenosine use was not associated with cardiac morbidity in the perioperative period (i.e., persistent arrhythmia or biomarkers of cardiac ischemia).
-
Anesthesia and analgesia · Nov 2013
Is Dilutional Coagulopathy Induced by Different Colloids Reversible by Replacement of Fibrinogen and Factor XIII Concentrates?
In this in vitro trial, we assessed the effect on blood coagulation of 60% dilution with different colloids and investigated reversibility by replacement of factor XIII (F XIII), fibrinogen, and the combination of fibrinogen and F XIII. ⋯ Coagulation and platelet function are impaired by all 3 colloids. However, in vitro gelatin-induced coagulopathy was significantly more reversible than HES-induced coagulopathy.
-
Anesthesia and analgesia · Nov 2013
Historical ArticleResearches Regarding the Morton Ether Inhaler at Massachusetts General Hospital, Boston.
The Morton ether inhaler in the possession of Massachusetts General Hospital, Boston, MA, was traced back to 1906 when the earliest known photograph of it was published. The authors believe that the inhaler was given by William T. G. ⋯ Mason Warren, MD. The inhaler is not believed to be the one that Morton used on October 16, 1846, at Massachusetts General Hospital. It is the only known example of a Morton ether inhaler with valves (excluding replicas or reproduction inhalers) and is probably of similar design to the inhaler that Morton used on October 16, 1846.
-
Anesthesia and analgesia · Nov 2013
Historical ArticleCorrespondence by Charles T. Jackson Containing the Earliest Known Illustrations of a Morton Ether Inhaler.
A letter, dated December 1, 1846, from Charles T. Jackson, MD, to Josiah D. Whitney contains a previously unreported description of a Morton ether inhaler and the only known contemporaneous hand-drawn illustrations of this type of ether inhaler. This letter and 2 other known letters on ether anesthesia were probably carried from Boston, MA, to Liverpool, United Kingdom, on the same paddle steamer (Acadia) that carried the well-known letter from Jacob Bigelow, MD, to Francis Boott, MD.