Anesthesia and analgesia
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Anesthesia and analgesia · May 1975
Comparative StudySquamous metaplasia of tracheal epithelium associated with high-volume, low pressure airway cuffs.
The tracheas of 12 patients, intubated from 2 hours to 20 days with tracheal airways equipped with the newer style, high-volume, low-pressure (HVLP) cuffs, were examined at autopsy. The type and severity of iatrogenic damage to the epithelium and submucosa was determined and compared to that seen in a previous study of 54 patients, who had been intubated with the older-style low-volume, high-pressure (LVHP) cuffed airways. ⋯ However, the pseudostratified ciliated epithelium, which normally lines the trachea, was often replaced by stratified squamous epithelium. If such a zone of nonciliated epithelium remains in the trachea of a long-term survivor, its detrimental effect on the removal of particulate matter from the tracheobronchial tree may have to be considered.
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Missionary anesthesiologists are needed for developing areas around the world. Missionary work has both rewarding and frustrating aspects. The rewards include adventures in living and medicine and the chance to aid less fortunate people. The frustrations include separation from family, uncomfortable living conditions, language barriers, and inability to change medical practices that seem improper.
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Anesthesia and analgesia · Mar 1975
The lower limits of flammability of halothane, enflurane, and isoflurane.
Halothane, enflurane, and isoflurane, generally regarded as nonflammable, can be ignited under laboratory conditions. Attainment of similar conditions during clinical anesthesia is most unlikely. Nevertheless, early in the course of anesthesia while the concentration of the agent is still high, electrosurgery is best avoided if nitrous oxide is part of the anesthetic mixture and the operative field is exposed directly to the inflowing gases (as during certain laryngeal procedures).
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The cluster of abnormalities characteristic of myotonia dystrophica makes anesthesia a hazardous procedure. A thorough history and physical examination are essential, anesthetic agents must be selected with care, and ventilation requires meticulous attention.
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Anesthesia and analgesia · Mar 1975
Comparative StudyBupivacaine compared with etidocaine for vaginal delivery.
A comparison of 0.5 percent etidocaine with 0.25 and 0.5 percent bupivacaine, using continuous (intermittent) caudal block in 60 vaginal deliveries, showed the latter two solutions to be the agents of choice. All solutions contained a final concentration of 1:2000,000 epihephrine. In 40 parturients given either 0.25 or 0.5 percent bupivacaine, all had pain relief after the initial dose, while 5 of 20 given etidocaine required a refill dose within 30 to 50 minutes for complete pain relief. ⋯ The degree of motor blockade with 0.5 percent etidocaine was greater than with 0.5 percent bupivacaine, and with 0.5 percent concentrations of either etidocaine or bupivacaine was greater than with 0.25 percent bupivacaine. The duration of motor blockade of 0.5 percent etidocaine and bupivacaine was comparable. The duration of motor blockade of the 0.25 percent concentration of bupivacaine was shorter than with the 0.5 percent concentration of both etidocaine and bupivacaine; and with both bupivacaine concentrations the duration of sensory anesthesia in the extremities was longer than motor blockade; with etidocaine, the opposite occurred.