Anesthesia progress
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This article presents a different method of venous cannulation. It has been used successfully to teach dental residents working on pediatric and developmentally disabled patients. The technique includes using a syringe of 1% lidocaine hydrochloride attached to a 25-ga needle to produce a skin wheal by "jet injection." This is accomplished by placing the bevel of the needle downward and forcing the syringe in a downward and backward direction, with pressure being continuously exerted on the plunger. ⋯ The catheter is bent, with its bevel up, approximately three-fourths of the way from the tip to form a gradually sloping bend of approximately 40 degrees to 45 degrees. The catheter is then inserted into the skin wheal and advanced into the vein. The advantages of this technique are that it (1) can eliminate the pain associated with a subcutaneous infiltration of a local anesthetic solution, (2) provides a method of venous cannulation that is easier to master by the novice, and (3) gives a visual check on successful catheterization of the vein.
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Anesthesia progress · Jan 1993
Case ReportsTotal intravenous anesthesia with propofol for thymectomy in a patient with myasthenia gravis.
Experience with the use of propofol for induction and maintenance of anesthesia in patients with myasthenia gravis is limited. This case report documents the safe use of propofol in a patient with myasthenia gravis. Because of its unique pharmacodynamic and pharmacokinetic profile, propofol may be an ideal agent for safe use in the young patient with myasthenia gravis.
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Anesthesia progress · Jan 1992
Randomized Controlled Trial Comparative Study Clinical TrialComparison of nalbuphine and fentanyl as intravenous analgesics for medically compromised patients undergoing oral surgery.
This study compared the efficacy and side effects of equianalgesic doses of nalbuphine and fentanyl as intravenous (IV) analgesics for medically compromised patients undergoing oral surgery with local anesthesia. A total of 24 inpatients scheduled for oral surgery and with an ASA physical status of 3 or 4 were randomly assigned to two treatment groups and received IV analgesia with an injection of either 0.2 mg/kg nalbuphine or 2 micrograms/kg fentanyl. Three minutes later, local anesthesia was administered. ⋯ Analgesia and sedation appeared sufficient and comparable according to the surgeon, anesthesiologists, and patients in the two groups, and there were no significant differences in blood pressure or heart rate. Respiratory rate and SpO2 were lower in patients treated with fentanyl (P < 0.05), and eight patients of this group experienced episodes of oxygen desaturation (SpO2 < 90%) compared with only two patients who received nalbuphine (P < 0.05). Nalbuphine produced less respiratory depression and should be considered a suitable alternative to fentanyl for use in medically compromised patients undergoing oral surgery.