Journal of clinical anesthesia
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Any drug or blood product administered in the perioperative period has the potential to produce a life-threatening allergic (immune reaction) called anaphylaxis. Anaphylactic reactions represent adverse reactions mediated by immunospecific antibodies (IgE and IgG) that interact with mast cells, basophils, or the complement system to liberate vasoactive mediators and recruit other inflammatory cells. ⋯ Rapid and timely cardiopulmonary intervention with airway maintenance, epinephrine, and volume expansion is essential to avoid an adverse outcome. Severe reactions may be protracted, especially during anesthesia, requiring even larger doses of catecholamines and intensive care observation.
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Review Case Reports
The difficult airway in obstetric anesthesia: techniques for airway management and the role of regional anesthesia.
A case is presented illustrating the use of a continuous spinal anesthetic in a parturient with a difficult airway who required urgent cesarean delivery. Options for endotracheal intubation of a parturient with a difficult airway are reviewed. ⋯ Available data suggest that regional anesthesia, specifically continuous spinal anesthesia, may be a safe and effective option for management of a parturient with a difficult airway. Further investigation of this technique is merited.
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Clonidine and other clinically available alpha-2 adrenergic agonists reduce inhalational and narcotic anesthetic requirements while providing hemodynamic stability during stressful periods of surgery. Like the opiates, the alpha-2 adrenergic agonists are potent analgesics when given systemically, epidurally, or intrathecally. Their effects are reversed by alpha2 adrenergic antagonists. ⋯ They have anxiolytic properties and therefore can be potentially useful in the preanesthetic period. This drug class has the potential to provide many of the component effects required for perioperative care. For these reasons, the alpha2 adrenergic class of drugs should be important in the future of anesthesia.