Journal of clinical anesthesia
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To assess the effects of desaturation on stroke index (SI), cardiac index (CI), and heart rate (HR) using the ICON continuous noninvasive cardiac output monitor in children undergoing general anesthesia. ⋯ Events associated with desaturation in children under general anesthesia were significantly associated with decreased SI with a greater effect with lower saturation nadirs. It is unclear if other concurrent events could have also contributed to adverse hemodynamic responses during desaturation. In most children, a compensatory increase in HR generally offsets concurrent decreases in CI. It would appear that bradycardia is a late manifestation of hypoxemia.
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Obstructive sleep apnea (OSA) has been historically underdiagnosed and may be associated with grave perioperative complications. The ASA and American Academy of Sleep Medicine recommend OSA screening prior to surgery; however, only a minority of patients are screened. The objective of this study was to determine the proficiency of anesthesiologists, otolaryngologists, and internists at predicting the presence of OSA by visual photographic analysis without the use of a computer program to assist, and determine if prediction accuracy varies by provider type. ⋯ The ability to predict OSA based on visual inspection of frontal and lateral photographs is marginally superior to chance and did not differ by provider type. Knowledge of comorbidities did not improve prediction accuracy.
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We report the case of a 17-month-old child who underwent laparotomy under general anesthesia and caudal block. Electrocardiogram ST-T changes were observed after local anesthetic injection. ⋯ Thereby, we conduct a brief review of the subject in pediatrics. As a major conclusion, we strongly recommend the "fast-track" lipid rescue as soon as this severe complication is detected.
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We investigated the prevalence of lifestyle risk factors in patients admitted to our preoperative assessment outpatient clinic, and compared patient self-reports and anesthetist reports of health risk factors to evaluate the patient self-image of preoperative health status. ⋯ The prevalence of lifestyle risk factors in perioperative patients is high, and differences in reporting between patients and anesthetists may suggest that patients are unaware of or ignore their unhealthy state. Further studies are warranted to investigate the association between the lifestyle risk factors and outcome in the anesthesiology setting.
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Intubating laryngeal mask airways can be used to provide continuous ventilation throughout intubation. This is a case of a morbidly obese (body mass index = 58) 65-year-old woman with T10 and T11 compression fractures. Optimal positioning for airway management was hindered by her unstable spine, minimal neck range of motion, and extreme pain with any movement. An intubating laryngeal mask airway was placed in the awake, topically anesthetized patient, and the laryngeal mask airway and endotracheal tube combination was left in place throughout surgery.