Journal of clinical anesthesia
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Case Reports
Potential toxicity from prolonged anesthesia: a case report of a thirty-hour anesthetic.
Selection of anesthetics for prolonged administration must include consideration of potential toxicity resulting from extended exposure. This report deals with a patient undergoing a 30-hour anesthetic that included nitrous oxide (N2O) and isoflurane (9.7 MAC-hours). ⋯ In addition to outlining basic care guidelines for patients undergoing a prolonged anesthetic, this report discusses potential toxicity from prolonged exposure to both N2O and isoflurane. It concludes that isoflurane can be tolerated in doses up to 10 MAC-hours without fluoride toxicity but cautions against the use of N2O for periods longer than 24 hours.
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Neuroleptic malignant syndrome is an uncommon, idiosyncratic, and sometimes life-threatening disorder associated with the use of neuroleptic drugs. The pathogenesis of neuroleptic malignant syndrome is uncertain, but it may be similar to that of malignant hyperthermia (MH). ⋯ We anesthetized a 17-year-old man with this syndrome multiple times for electroconvulsive therapy (ECT) using a variety of anesthetic techniques. In this patient, dantrolene pretreatment and the use of nondepolarizing muscle relaxants did not relieve symptoms of the syndrome, including fever and creatine phosphokinase (CPK) increases.
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The assessment of deep neuromuscular blockade produced by nondepolarizing neuromuscular blocking agents is not possible with the conventional use of the Datex NMT-221 "relaxograph" (Datex NMT-221 monitor, Datex Instrumentarium, Helsinki, Finland), an otherwise useful electromyographic (EMG) monitoring device. A method whereby the relaxograph can be adapted to quantitatively measure posttetanic responses is described here. In anesthetized adult patients, neuromuscular blockade was monitored simultaneously on both hands with two relaxographs. ⋯ However, no significant difference was observed in the recovery rate when the tetanic stimuli were spaced at 15-minute intervals. Pharmacologic reversal by atropine and neostigmine was found to be identical in all patient groups. The author concludes that the Datex relaxograph is suitable for the quantitative assessment of profound surgical neuromuscular blockade with the described modification.
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Letter Case Reports
Asystole following neostigmine administration during carotid sinus stimulation.
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Randomized Controlled Trial Comparative Study Clinical Trial
Effects of alfentanil and lidocaine on the hemodynamic responses to laryngoscopy and tracheal intubation.
This study was undertaken to determine whether lidocaine and/or alfentanil can effectively abolish or attenuate the increase in mean arterial pressure (MAP), heart rate (HR), and rate pressure product (RPP) associated with rapid sequence induction of anesthesia. Sixty patients were randomly divided into four groups. Group 1 received saline 10 ml, group 2 received lidocaine 2 mg/kg, group 3 received alfentanil 15 micrograms/kg, and group 4 received alfentanil 30 micrograms/kg. ⋯ Blood pressure (BP) and HR were recorded at the following times: before induction; after induction but before laryngoscopy and intubation; and 1, 3, and 5 minutes after intubation. Alfentanil 15 and 30 micrograms/kg given in rapid sequence fashion with thiopental and succinylcholine effectively blunted the hemodynamic responses to laryngoscopy and tracheal intubation. Lidocaine 2 mg/kg and saline were found to be ineffective in blunting these same responses.