Journal of clinical anesthesia
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Sixteen cases in which celiac plexus block with depot steroid was used to treat chronic pancreatitis pain were reviewed. Only 4 of 16 patients reported pain relief with the procedure. ⋯ Prior pancreatic surgery was present in 9 of the 12 patients without relief and in 1 of 4 patients with relief. It is postulated that refractory chronic pancreatitis pain may be an extreme form of what has been termed "abnormal illness behavior." Furthermore, these results underscore the poor results experienced using neural blockade for the relief of chronic pain when narcotic dependence is present.
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Warming of intravenous fluids may help to prevent shivering and hypothermia in the surgical patient. Increasing the fluid temperatures to as high as 60 degrees C has been suggested. An in vitro study was performed in which temperature changes following the rapid infusion of heated lactated Ringer's solution within a vein were measured. ⋯ This effect of possible regional tissue heating may well occur in vivo. It is known that the rate of human blood cell hemolysis and membrane enzymatic function is affected by temperature. Further efforts need to be directed toward appreciating the effects of warmed intravenous fluids upon intact physiologic preparations and red blood cells.
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Anesthesiologists must be competent in the technique of fiberoptic laryngoscopy and intubation in airway management. The goal of this study was to test the hypothesis that an acceptable level of technical expertise in fiberoptic laryngoscopy and intubation may be acquired within 10 intubations while maintaining patient safety. The learning objectives were an intubation time of 2 minutes or less and greater than 90% success on the first intubation attempt. ⋯ After the tenth intubation, the mean time was 1.53 minutes and the percent success on the first attempt at intubation was greater than 95%. There were no clinically important changes in O2 saturation, mean arterial pressure (MAP), or heart rate (HR) as a consequence of fiberoptic intubation. The results suggest that an acceptable level of technical expertise in fiberoptic intubation can be obtained (as defined by the learning objectives) by the tenth intubation, and patient safety is maintained.(ABSTRACT TRUNCATED AT 250 WORDS)
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During cataract surgery, both the surgeon and the anesthesiologist need access to the patient's face. At our institution we achieved a working compromise by using an oxygen insufflating hoop, which allowed the surgeon access to the eye and a sterile field. The patient's airway was kept free by the hoop, and the patient breathed a high inspired oxygen fraction. ⋯ Reducing the oxygen flow below 10 L/min led to increased retention of CO2 under the drapes. Paper drapes are permeable to CO2, but plastic drapes are impermeable. We did not measure the arterial partial pressure of CO2, and so we do not know whether CO2 accumulation was accompanied by respiratory acidosis.