Journal of clinical anesthesia
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Comparative Study
Regional versus general anesthesia in high-risk surgical patients: the need for a clinical trial.
Regional anesthesia is often preferred over general anesthesia for patients with cardiovascular disease because of presumed decreased risk of perioperative myocardial ischemia. However, few studies have addressed this issue directly. To determine whether the type of anesthesia is independently associated with myocardial ischemia, records of 134 patients undergoing peripheral vascular grafting under general or regional anesthesia were examined. ⋯ The association between anesthetic approach and perioperative myocardial ischemia or infarction remained after adjustment for preoperative factors associated with ischemia or with type of anesthesia. General anesthesia does not appear to be associated with increased risk of myocardial ischemia, and stringent recommendations to avoid it in this population may be unfounded. A clinical trial is needed to define more clearly the risks and benefits of different types of anesthesia in high-risk patients.
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Sixteen cases in which celiac plexus block with depot steroid was used to treat chronic pancreatitis pain were reviewed. Only 4 of 16 patients reported pain relief with the procedure. ⋯ Prior pancreatic surgery was present in 9 of the 12 patients without relief and in 1 of 4 patients with relief. It is postulated that refractory chronic pancreatitis pain may be an extreme form of what has been termed "abnormal illness behavior." Furthermore, these results underscore the poor results experienced using neural blockade for the relief of chronic pain when narcotic dependence is present.
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This North Carolina case study addresses the migration of anesthesiologists into subspecialty, clinical areas of anesthesiology over a 4-year period (1984 to 1987). Three hundred fourteen members of the North Carolina Society of Anesthesiologists (NCSA) were surveyed using a one-page questionnaire. The response rate was 93.6%. ⋯ Respondents expected additional practice options over the next 3 years with anesthesia for ambulatory diagnostic and therapeutic modalities projected to emerge at the fastest rate. In conclusion, anesthesiologists in North Carolina seem to be filling unmet needs in obstetric and cardiac anesthesia, critical care, ambulatory surgery, and pain therapy units. These observations may represent a vignette of the national scene.
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Anesthesiologists must be competent in the technique of fiberoptic laryngoscopy and intubation in airway management. The goal of this study was to test the hypothesis that an acceptable level of technical expertise in fiberoptic laryngoscopy and intubation may be acquired within 10 intubations while maintaining patient safety. The learning objectives were an intubation time of 2 minutes or less and greater than 90% success on the first intubation attempt. ⋯ After the tenth intubation, the mean time was 1.53 minutes and the percent success on the first attempt at intubation was greater than 95%. There were no clinically important changes in O2 saturation, mean arterial pressure (MAP), or heart rate (HR) as a consequence of fiberoptic intubation. The results suggest that an acceptable level of technical expertise in fiberoptic intubation can be obtained (as defined by the learning objectives) by the tenth intubation, and patient safety is maintained.(ABSTRACT TRUNCATED AT 250 WORDS)
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Approximately 3% of patients undergoing hip arthroplasty develop postoperative sciatic neuropathy. The factors associated with changes in somatosensory evoked potentials (SSEP) and sciatic neuropathy were examined in patients undergoing hip arthroplasty, to evaluate whether the use of intraoperative SSEP could help reduce the incidence of postoperative sciatic neuropathy. Eighty-eight patients were assigned to either monitored or unmonitored groups. ⋯ Both of these patients had flattened SSEP for two or more surgical events (p less than 0.01) and flattened SSEP were present at the end of the surgical procedure. There were no false-negative SSEP changes. Simultaneous amplitude and latency changes appear to be predictive of sciatic nerve function following hip arthroplasty.