Journal of clinical anesthesia
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Randomized Controlled Trial Comparative Study Clinical Trial
A comparison of vecuronium by continuous infusion with either isoflurane or fentanyl-nitrous oxide anesthesia.
The average infusion rate and efficacy of vecuronium bromide continuous infusions for surgical relaxation in human subjects was evaluated. Nineteen adult patients requiring more than 120 min of neuromuscular blockade for surgery were randomized to receive either fentanyl-nitrous oxide (Group 1) or isoflurane-fentanyl-nitrous oxide (Group 2). Neuromuscular function was monitored using train-of-four evoked electromyography (EMG). ⋯ An infusion of vecuronium at an initial rate of 60.0 micrograms/kg/h was then started and adjusted to maintain the first twitch at 10% of control. The average infusion rate (total infusion dose divided by the duration of the infusion) was 57.2 +/- 14 micrograms/kg/h in Group 1 (n = 10) and 42.4 +/- 12 micrograms/kg/h (n = 9) in Group 2, approximately 25% less (p = 0.02). There was a significant decrease in the infusion rate with time in Group 1 (p = 0.02), but this decrease was not observed in Group 2.
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Approximately 3% of patients undergoing hip arthroplasty develop postoperative sciatic neuropathy. The factors associated with changes in somatosensory evoked potentials (SSEP) and sciatic neuropathy were examined in patients undergoing hip arthroplasty, to evaluate whether the use of intraoperative SSEP could help reduce the incidence of postoperative sciatic neuropathy. Eighty-eight patients were assigned to either monitored or unmonitored groups. ⋯ Both of these patients had flattened SSEP for two or more surgical events (p less than 0.01) and flattened SSEP were present at the end of the surgical procedure. There were no false-negative SSEP changes. Simultaneous amplitude and latency changes appear to be predictive of sciatic nerve function following hip arthroplasty.
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Any drug or blood product administered in the perioperative period has the potential to produce a life-threatening allergic (immune reaction) called anaphylaxis. Anaphylactic reactions represent adverse reactions mediated by immunospecific antibodies (IgE and IgG) that interact with mast cells, basophils, or the complement system to liberate vasoactive mediators and recruit other inflammatory cells. ⋯ Rapid and timely cardiopulmonary intervention with airway maintenance, epinephrine, and volume expansion is essential to avoid an adverse outcome. Severe reactions may be protracted, especially during anesthesia, requiring even larger doses of catecholamines and intensive care observation.
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Clonidine and other clinically available alpha-2 adrenergic agonists reduce inhalational and narcotic anesthetic requirements while providing hemodynamic stability during stressful periods of surgery. Like the opiates, the alpha-2 adrenergic agonists are potent analgesics when given systemically, epidurally, or intrathecally. Their effects are reversed by alpha2 adrenergic antagonists. ⋯ They have anxiolytic properties and therefore can be potentially useful in the preanesthetic period. This drug class has the potential to provide many of the component effects required for perioperative care. For these reasons, the alpha2 adrenergic class of drugs should be important in the future of anesthesia.
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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.