Journal of clinical anesthesia
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Substance abuse has crossed social, economic, and geographic borders and--throughout the world--remains one of the major problems facing society today. The prevalence of substance abuse in young adults (including women) has increased markedly over the past 20 years. ⋯ The diverse clinical manifestations of drug abuse combined with physiologic changes of pregnancy, and pathophysiology of coexisting pregnancy-related disease may lead to life-threatening complications and significantly impact the practice of obstetrical anesthesia. Regardless of the drug(s) ingested and clinical manifestations, it is always difficult to predict the exact anesthetic implications in chemically dependent patients.
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A 6-year-old girl with laryngeal papillomatosis underwent ablation of the tumors with Nd-YAG laser under microlaryngosurgery. During the surgery, she was managed with subglottic high-frequency jet ventilation using a stainless steel cannula made from a nerve block needle. ⋯ There was no hypoxia or barotrauma to the lungs during the surgery. The postoperative course was uneventful.
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Beta-adrenergic agents have been widely used in obstetrics to attenuate premature labor (termed tocolytic therapy), delay delivery, allow fetal maturation, and thereby reduce neonatal morbidity and mortality. Hypokalemia is a common side effect during beta-adrenergic tocolytic therapy for the treatment of preterm labor. Although rebound hyperkalemia after cessation of tocolytic therapy with ritodrine has been reported, there have been no reports of hyperkalemia occurring after the cessation of beta-adrenergic tocolytic therapy with terbutaline for preterm labor; we report such a case.
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Comparative Study Clinical Trial
A comparison of three techniques for acute postoperative pain control following major abdominal surgery.
To compare the analgesic efficacy of a nonsteroidal antiinflammatory drug (NSAID) alone (basic pain treatment) with that of NSAID in conjunction with either intravenous (IV) patient-controlled analgesia (IV-PCA) or intermittent epidural morphine (epidural morphine), among patients recovering from major intraabdominal surgery; and to assess the fixed and variable costs of providing the respective acute pain treatment modalities. ⋯ Considering the respective pain profiles, complication rates, and institutional costs associated with the three analgesic regimens analyzed, the basic pain Treatment alone constitutes a useful alternative to the other two analgesic regimens assessed.
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Clinical Trial
Perioperative use of the Thrombelastograph in patients with inherited bleeding disorders.
There are few reports of the use of Thrombelastgraph (TEG) in patients with isolated or inherited bleeding disorders. Three surgical patients are presented with von Willebrand's disease, factor XII deficiency, and hemophilia A with dysfibrinogenemia in which the abnormalities detected by the TEG were similar to the expected coagulation abnormalities based on preoperative laboratory studies. This initial report suggests that this potential application of the TEG be further investigated.