Journal of clinical anesthesia
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Surgical removal of a cerebral hemisphere may be undertaken in patients with intractable seizure disorders. Anesthetic management of such patients has not been reviewed in detail before. This study retrospectively analyzed hospital records of ten patients undergoing cerebral hemispherectomy at the Johns Hopkins Hospital between July 1983 and February 1988. ⋯ Monitoring of intra-arterial pressure and central venous pressure (CVP) is necessary for patient management during the intraoperative and postoperative periods. Intravenous (IV) access should allow rapid intravascular volume administration as it becomes necessary. Patients should remain intubated and observed closely during the immediate postoperative period due to difficulties with hemodynamic stability, seizures, and hemorrhage.
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During whole body radiation therapy of children, treatment may be done in places not equipped with acceptable scavenging systems for anesthetic gases and where clinical observation of the patient may be impossible. In order to solve this problem, the authors have used a total intravenous (IV) anesthetic technique using midazolam, pancuronium, and fentanyl. With midazolam as the only hypnotic agent, the problem with scavenging is solved, and a computer simulation of the plasma concentration of midazolam is presented. ⋯ This anesthetic technique and the stethoscope have been used in seven children. The total IV anesthesia proved to be a useful method for children during whole body radiation. The modified stethoscope functioned very well and was a useful complement to the monitoring equipment.
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Pulmonary edema developing after the relief of upper airway obstruction has been reported in association with a diversity of etiologic factors, including hanging, strangulation, tumors, foreign bodies, goiter, and laryngospasm. Since 1977, 18 cases of adults with postobstructive pulmonary edema associated with anesthesia have been reported. ⋯ Risk factors for the development of upper airway obstruction have been identified in the majority of these cases. A heightened awareness among anesthesiologists of this poorly recognized and hence often perplexing syndrome may help reduce the occurrence and facilitate the treatment of this potential complication of perioperative airway management.
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An 86-year-old man receiving antiarrhythmic treatment with an intravenous (IV) lidocaine infusion experienced a prolonged emergence from general anesthesia. A venous blood sample was sent for determination of the lidocaine concentration, the infusion was stopped, and the patient awakened 15 minutes later. ⋯ The overdose was the result of a miscalculated infusion rate, plus an underestimation of effects of age, cardiac disease, and general anesthesia on the rate of lidocaine biotransformation. Infusion of any drug during and after general anesthesia requires scrupulous attention to dosage determination and to the clinical condition of the patient receiving the infusion.
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Carboxyhemoglobin and methemoglobin levels in 312 units of banked blood and their relationship to the duration of storage were determined. The carboxyhemoglobin level decreased as the storage time increased, and its mean was 1.4% +/- 2.0% (SD) with a range from 0% to 9.6%. Methemoglobin increased during storage, showing a mean level of 1.6% +/- 0.4% and a range from 0.5% to 4.2%. ⋯ The mean initial level of carboxyhemoglobin was 4.4% +/- 1.6%, and the mean half-life of carboxyhemoglobin was approximately 47 days. Methemoglobin increased from an initial 1.3% +/- 0.2% to 2.4% +/- 0.6% at the end of storage. The use of banked blood containing high levels of these abnormal hemoglobins could be a potential risk in critically ill patients.