Journal of clinical anesthesia
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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.
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Airway obstruction during the induction of general anesthesia remains a persistent problem in modern anesthesia practice, particularly in obstetric patients. Generally, a careful preoperative airway evaluation uncovers most abnormalities that might make intubation difficult. ⋯ Although every anesthesia provider is trained to manage such acute airway problems, the provision of a patent airway is not always possible, particularly when repeated attempts at endoscopic or blind intubation have failed, leaving a bloody field that prevents optimal visualization, or when time does not allow to wake up the patient. In this article a difficult airway problem is reported in which translaryngeal guided intubation was lifesaving.
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Venous air embolism has been reported to occur during total hip arthroplasty. The incidence of venous air embolism, however, has not been previously studied in a large series using Doppler ultrasound and mass spectrometry. Seventy patients undergoing total hip arthroplasty were monitored for venous air embolism with precordial Doppler ultrasound, central venous catheter, end-tidal N2 and CO2 (mass spectrometry), and arterial blood gases (ABG). ⋯ Venous air embolism in total hip arthroplasty is a common event and may be responsible for hemodynamic changes previously ascribed to the use of methylmethacrylate cement. Routine monitoring with Doppler ultrasound appears warranted. The routine use of central venous catheterization may also be warranted.
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Data on all obstetric patients delivering at the Brigham and Women's Hospital during the years 1982 through 1987 were collected. The anesthetic techniques used, the type and amount of anesthetic agents administered, and the postpartum relapse rate of multiple sclerosis patients were compared. ⋯ However, all of the women who experienced postpartum relapses had received concentrations of bupivacaine greater than 0.25%. This finding may suggest that a higher concentration of drug over a longer period of time may adversely influence the relapse rate.