Journal of clinical anesthesia
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Surgical removal of a cerebral hemisphere may be undertaken in patients with intractable seizure disorders. Anesthetic management of such patients has not been reviewed in detail before. This study retrospectively analyzed hospital records of ten patients undergoing cerebral hemispherectomy at the Johns Hopkins Hospital between July 1983 and February 1988. ⋯ Monitoring of intra-arterial pressure and central venous pressure (CVP) is necessary for patient management during the intraoperative and postoperative periods. Intravenous (IV) access should allow rapid intravascular volume administration as it becomes necessary. Patients should remain intubated and observed closely during the immediate postoperative period due to difficulties with hemodynamic stability, seizures, and hemorrhage.
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An 86-year-old man receiving antiarrhythmic treatment with an intravenous (IV) lidocaine infusion experienced a prolonged emergence from general anesthesia. A venous blood sample was sent for determination of the lidocaine concentration, the infusion was stopped, and the patient awakened 15 minutes later. ⋯ The overdose was the result of a miscalculated infusion rate, plus an underestimation of effects of age, cardiac disease, and general anesthesia on the rate of lidocaine biotransformation. Infusion of any drug during and after general anesthesia requires scrupulous attention to dosage determination and to the clinical condition of the patient receiving the infusion.
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Randomized Controlled Trial Comparative Study Clinical Trial
Effects of alfentanil and lidocaine on the hemodynamic responses to laryngoscopy and tracheal intubation.
This study was undertaken to determine whether lidocaine and/or alfentanil can effectively abolish or attenuate the increase in mean arterial pressure (MAP), heart rate (HR), and rate pressure product (RPP) associated with rapid sequence induction of anesthesia. Sixty patients were randomly divided into four groups. Group 1 received saline 10 ml, group 2 received lidocaine 2 mg/kg, group 3 received alfentanil 15 micrograms/kg, and group 4 received alfentanil 30 micrograms/kg. ⋯ Blood pressure (BP) and HR were recorded at the following times: before induction; after induction but before laryngoscopy and intubation; and 1, 3, and 5 minutes after intubation. Alfentanil 15 and 30 micrograms/kg given in rapid sequence fashion with thiopental and succinylcholine effectively blunted the hemodynamic responses to laryngoscopy and tracheal intubation. Lidocaine 2 mg/kg and saline were found to be ineffective in blunting these same responses.
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Case Reports
Management of the difficult pediatric airway in an austere environment using the lightwand.
Increasingly, medical teams are providing sophisticated surgical treatment to pediatric patients in developing nations. Such care is often administered under relatively austere conditions using easily transported equipment. Because some of these patients may present with congenital or acquired airway abnormalities that make direct laryngoscopy difficult or impossible, alternative methods of endotracheal intubation should be available. ⋯ Use of the lightwand has a proven record of success and obviates the need for the heavier, more delicate, and more expensive flexible fiber-optic laryngoscope or pediatric bronchoscope. Two cases are reported in which pediatric patients with difficult airway anatomy due to severe burn scar contractures were successfully and easily intubated using the lightwand. This technique is useful for management of the difficult pediatric airway in the austere environment of the typical medical relief mission.
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Pulmonary edema developing after the relief of upper airway obstruction has been reported in association with a diversity of etiologic factors, including hanging, strangulation, tumors, foreign bodies, goiter, and laryngospasm. Since 1977, 18 cases of adults with postobstructive pulmonary edema associated with anesthesia have been reported. ⋯ Risk factors for the development of upper airway obstruction have been identified in the majority of these cases. A heightened awareness among anesthesiologists of this poorly recognized and hence often perplexing syndrome may help reduce the occurrence and facilitate the treatment of this potential complication of perioperative airway management.