Anesthesia, essays and researches
-
Review
Improving neurological outcome after cardiac arrest: Therapeutic hypothermia the best treatment.
Cardiac arrest, irrespective of its etiology, has a high mortality. This event is often associated with brain anoxia which frequently causes severe neurological damage and persistent vegetative state. Only one out of every six patients survives to discharge following in-hospital cardiac arrest, whereas only 2-9% of patients who experience out of hospital cardiac arrest survive to go home. ⋯ It has been shown to reduce mortality and has improved neurological outcomes after cardiac arrest. Nevertheless, hypothermia is underused in critical care units. This manuscript aims to review the mechanism of hypothermia in cardiac arrest survivors and to propose a simple protocol, feasible to be implemented in any critical care unit.
-
The purpose of this study was to evaluate the efficacy of transtracheal lidocaine injection to reduce the anesthetic requirements in patients who underwent brachial plexus surgery under general anesthesia. ⋯ The present study showed that the group of patients who received transtracheal block with lidocaine had a reduction in the requirement of the induction agent, propofol, and were more stable hemodynamically in the intraoperative period compared to those patients who did not receive transtracheal lidocaine. We conclude that transtracheal injection of lidocaine performed just prior to induction of general anesthesia is an effective alternative to intraoperative propofol infusion when long-acting muscle relaxants are to be avoided.
-
The administration of opioids intrathecally as a sole anesthetic has proven to be effective in providing adequate surgical anesthesia without much hemodynamic instability. ⋯ Because of adequate surgical anesthesia, intraoperative hemodynamic stability and prolonged post-operative analgesia, we recommend the use of intrathecal pentazocine as a sole anesthetic agent for lower limb surgeries.
-
This study was undertaken in 100 patients scheduled for lower limb orthopaedic surgeries. ⋯ In conclusion, this study has demonstrated that addition of 20 μg fentanyl to intrathecal 30 μg clonidine and 12 mg bupivacaine enhanced the duration of post-operative analgesia with moderately increased sedation and was not associated with hemodynamic instability or other complications.
-
A 17-year-old girl was posted for spinal surgery for traumatic spinal injury. The patient was a well-controlled epileptic with history of seizure since 8 years of her age. She was induced with thiopentone sodium and muscle relaxant atracurium was administered. ⋯ Next 24 hours, she was kept on mechanical ventilation. Within 24 hours, Glasgow Coma Scale (GCS) improved and patient was conscious and extubated. We suggest that the neuromuscular blocking drug contributed to an anaphylactic reaction which might be the cause of cardiac arrest and highlight the importance of prolonged resuscitation and successful outcome in this scenario.