Journal of clinical anesthesia
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To investigate the effect of different plasma levels of fentanyl on the concentration of propofol and the Bispectral Index (BIS) required for patients to regain consciousness and orientation following surgery. ⋯ The plasma levels of fentanyl affect the concentrations of propofol required for patients to regain consciousness. The BIS values for wakefulness are unaltered at the different combinations of propofol and fentanyl concentrations. Thus, the BIS appears to be a useful and consistent indicator for level of consciousness during emergence from propofol/fentanyl intravenous anesthesia.
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We present a case of prolonged recovery from mivacurium. Neuromuscular monitoring using acceleromyography was extremely helpful following attempted reversal of residual block in determining when tracheal extubation could be safely performed. If a method of objective estimation of the TOF ratio had not been available, tracheal extubation would have taken place at a time when the train-of-four fade ratio was below 0.40.
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Case Reports
Transpleural subclavian central venous catheter placement in a child with scoliosis discovered during a thoracotomy.
Placement of central venous catheters in dysmorphic children can be difficult because of distortion of normal anatomical landmarks. We present such a case of a 16 year-old child who had a central venous catheter inserted in the left subclavian vein. Although a conventional roentgenogram was consistent with correct placement, the catheter was found to traverse the pleural space before entering the subclavian vein.