Journal of clinical anesthesia
-
We treated a patient with a 30-year history of ethanol and benzodiazepine abuse who, on emerging from general anesthesia, was combative and confused. Our working diagnosis was acute ethanol withdrawal, and the patient received intravenous (i.v.) propofol, and midazolam. Initially small doses (10 to 20 mg) of propofol, combined with a midazolam infusion (50 mg/hr), produced sedation. ⋯ Immediate sedation was produced by thiopental bolus (500 mg) and i.v. infusion (200 mg/hr). The implication of the patient's initial appropriate response to propofol, followed by the lack of effect when much higher doses were employed, is discussed. While tachyphylaxis has been reported after long-term propofol use, we believe this to be the first case of acute tachyphylaxis.
-
To evaluate left ventricular (LV) dimensions and function during myocardial ischemic episodes in anesthetized patients undergoing coronary artery bypass surgery. ⋯ In anesthetized patients undergoing coronary artery bypass surgery, myocardial ischemia observed during atrial pacing results in increases in LV dimensions and decreases in FAC compared with values in patients without ischemia. These results support further investigations of the clinical usefulness of monitoring LV EDA and LV ESA with TEE as a method of myocardial ischemia detection.
-
Randomized Controlled Trial Clinical Trial
Effects of intrathecal opioid on extubation time, analgesia, and intensive care unit stay following coronary artery bypass grafting.
To determine if intrathecal opioid decreases time to extubation after coronary artery bypass surgery without compromising postoperative analgesia. ⋯ Intrathecal opioid can facilitate early extubation and discharge from the ICU without compromising analgesia or increasing myocardial ischemia.
-
Randomized Controlled Trial Clinical Trial
Lidocaine in the endotracheal tube cuff reduces postoperative sore throat.
To test the hypothesis that continuous application of local anesthesia at the contact area between the endotracheal tube cuff and trachea would reduce both the incidence and severity of postoperative sore throat by blocking the tracheal pain receptors with local anesthetic delivered via endotracheal tube (ETT) cuff. ⋯ Using lidocaine to inflate the ETT cuff decreases the severity of postoperative sore throat at one hour, and both the incidence and severity at 24 hours.
-
Randomized Controlled Trial Clinical Trial
Nausea and vomiting following thyroid and parathyroid surgery.
To determine the incidence of postoperative nausea and vomiting (PONV) following thyroid and parathyroid surgery. To determine whether PONV is reduced when propofol is used for maintenance of anesthesia as compared to isoflurane and to evaluate the costs and resource consumption associated with these two anesthetic regimens. ⋯ Patients undergoing thyroid or parathyroid surgery are at high risk for the development of PONV. Propofol for maintenance of anesthesia, although more expensive than isoflurane, reduces the rate of PONV in women.