Journal of clinical anesthesia
-
A 69-year-old white female presented for corneal transplant, but her numerous medical problems placed her at unacceptably high risk for prolonged general anesthesia. Routine monitored anesthesia care measures would not have provided her or the surgeon the comfort and repose necessary for a successful outcome. We describe anesthetic management for ophthalmic surgery, using epidural anesthesia in conjunction with retrobulbar block, in an elderly patient at high risk for general anesthesia whose intractable back and leg pain would have otherwise precluded her cooperation in maintaining a motionless operative field.
-
Perioperative smoking causes acute changes in cardiopulmonary function that can have unfavorable implications for patients undergoing anesthesia. These cardiopulmonary effects are carbon monoxide and nicotine mediated changes in oxygen (O2) delivery and myocardial O2 balance. ⋯ Bringing about a decrease in postoperative pulmonary complications requires a much longer period of preoperative abstinence. Because the perioperative period is in many ways an ideal time to abandon the smoking habit permanently, anesthesiologists, in cooperation with other health professionals, can perhaps play a more active role in facilitating this process.
-
To establish the frequency of large visible bubbles or collections of bubbles in the jugular vein during radical neck dissection in the supine position. ⋯ We theorize that some unexplained, undesirable intraoperative events (hypotension, arrhythmia, and hypoxemia) during radical neck dissection could be a result of venous air embolus or paradoxical air embolus. The anesthesia community should be aware of the high frequency of these visible bubbles in the jugular veins during radical neck surgery, even in the supine position. At minimum, this phenomenon is a frequent event of intellectual interest. At worst, these bubbles may be harbingers of significant central air embolism.
-
Editorial Historical Article
A historic occasion: an anesthesia journal turns 70.
-
Comparative Study
Comparison of train-of-four and posttetanic response as guides for endotracheal intubation in children.
To evaluate and compare the predictive values of the absence of train-of-four (TOF) or posttetanic response as guides for endotracheal intubation in children. ⋯ Good intubating conditions can generally be counted on when the TOF has disappeared; additional waiting for the disappearance of posttetanic response is unnecessary. The observation that the disappearance of the tetanus-twitch sequence is a good indicator of deep neuromuscular blockade during recovery from atracurium in children cannot be extrapolated to the induction period.