Journal of clinical anesthesia
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Comparative Study
Can we reduce anesthesia exposure? Neonatal brain MRI: Swaddling vs. sedation, a national survey.
Neonatal magnetic resonance imaging (MRI) is a diagnostic modality that requires minimal motion to acquire quality images. Sedation or even general anesthesia may be necessary to achieve acceptable scans. There is a growing body of literature, especially in animal studies, that links neurotoxicity with anesthetic exposure to the developing brain. There is no study outlining strategies used by neonatal intensive care units (NICU) to achieve quality MRI images with limited exposure to medications identified as possibly harmful to the developing brain. ⋯ The majority of NICUs in the US that responded to the survey utilized feed and swaddle as their primary technique for obtaining MRIs of the brain and reported a high success rate. Given the growing concern over the possible neurotoxic effects of anesthetic drugs on the developing brain, more centers should consider this technique as a first line method to obtain brain MRIs, with sedation and GA reserved for failed feed and swaddle attempts and special circumstances.
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We report a case of paradoxical presentation of a postural postdural puncture headache secondary to dural puncture with a 25-gauge Whitacre needle for combined spinal-epidural anesthesia. This 27-year-old female patient presented to the emergency department with elevated blood pressure and a global headache 9 days after administration of epidural anesthesia for a spontaneous vaginal delivery after an uncomplicated pregnancy. The patient reported that the headache was more intense when lying down and immediately improved when she sat or stood up from a recumbent position. The patient was discharged from emergency department after an improvement following treatment with labetalol, ondansetron, ketorolac, and fluid resuscitation.
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Comparative Study
Pharmacokinetics and pharmacodynamics of cisatracurium in patients undergoing surgery with two hemodilution methods.
To investigate the pharmacokinetics and pharmacodynamics of cisatracurium in patients undergoing surgery under acute normovolemic hemodilution (ANH) and acute hypervolemic hemodilution (AHH). ⋯ When using cisatracurium under AHH, the dosage should be increased appropriately, while it need not be adjusted under ANH.
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Clinical Trial
The impact of anesthesia on hemodynamic and volume changes in operative hysteroscopy: a bioimpedance randomized study.
Operative hysteroscopy is accompanied by the use of distention medium. Its absorption can lead to volume overload and hemodynamic disturbances that can lead to serious complications. We investigated the impact of the type of anesthesia on decreasing these complications with the use of noninvasive thoracic bioimpedance. ⋯ Spinal anesthesia is associated with less glycine absorption, less thoracic fluid load, better control of hemodynamics, and better patient satisfaction in operative hysteroscopy.