Journal of clinical monitoring and computing
-
J Clin Monit Comput · Jan 2000
ReviewEffects of high thoracic epidural anesthesia and local anesthetics on bronchial hyperreactivity.
Bronchial hyperreactivity can cause life threatening bronchospasm after airway irritation. Therefore, endotracheal intubation is avoided in asthmatics when feasible. High thoracic epidural anesthesia can be used to avoid endotracheal intubation and offers less postoperative pulmonary complications when compared to systemic postoperative analgesia. ⋯ The attenuation of bronchial hyperreactivity can be shown as a dose dependent effect of lidocaine and bupivacaine. The intravenous effect of lidocaine is comparable to the effect of a moderate dose of salbutamol and leads to an additive effect when both drugs are used in combination. Overall, high thoracic epidural anesthesia can be used safely in patients with bronchial hyperreactivity and intravenous administration of lidocaine (1.5-2.0 mg x kg(-1)) can be used as a prophylactic treatment prior to airway instrumentation.
-
J Clin Monit Comput · Jan 1998
ReviewPulse oximetry monitoring and late postoperative hypoxemia on the general care floor.
Hypoxemia has long been recognized as a risk to patients in the operating room and postanesthesia care unit, and hemoglobin oxygen saturation (HbO2) monitoring with pulse oximetry has become a standard of care in these areas. There is growing evidence, however, suggesting that later postoperative hypoxemia also may play a role in organ dysfunction leading to morbidity and mortality. ⋯ In this environment, telemetric pulse oximetry monitoring may represent a cost-effective approach to maximizing quality of care while enhancing risk management. This review discusses late postoperative hypoxemia and identifies areas for further investigation.