Anesthesiology clinics of North America
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The goals of tracheal intubation are to place the tube in the trachea and to position the tube at an appropriate depth inside the trachea. Various clinical signs and technical aids are described to verify tracheal intubation and to diagnose esophageal intubation. Many of these methods fail under certain circumstances. ⋯ Based on available information, two algorithms are proposed: one for emergency intubation (Fig. 9) and the other for verification of tracheal tube position in elective intubation (Fig. 10). These algorithms are designed [figure: see text] to assist the clinician and should not be substituted for clinical judgment. Under no circumstances should clinical signs be ignored in the presence of conflicting information from monitors and technical aids.
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Anesthesiol Clin North America · Dec 2001
ReviewNeuromuscular blockade. Inadvertent extubation of the partially paralyzed patient.
Residual neuromuscular block is common after the use of neuromuscular blocking drugs during anesthesia. Although careful reversal [table: see text] techniques usually result in adequate return of neuromuscular recovery, sometimes it is not possible to achieve full recovery of neuromuscular block. ⋯ In those situations, in which some TOF fade is still obvious, the anesthesiologist should consider retaining the endotracheal tube in position; it is not a sign of failure to return a patient whose trachea is still intubated to the postanesthesia care unit. The inadvertent extubation of patients who are partially paralyzed results in increased postoperative morbidity.
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Anesthesiol Clin North America · Dec 2001
ReviewSpinal cord monitoring: somatosensory- and motor-evoked potentials.
Monitoring myogenic motor EPs after transcranial electrical stimulation is effective in detecting spinal cord ischemia. During thoracoabdominal aortic aneurysm surgery, this technique is sufficiently rapid to allow timely interventions aimed at correcting ischemic conditions and preserving spinal cord blood flow. ⋯ The response time is too slow to be of practical use. SSEPs also do not provide information regarding anterior horn motor function and supply, whereas the motor neurons in the anterior horn are most likely to sustain ischemic injury.
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Anesthesiol Clin North America · Sep 2001
ReviewAnesthesia considerations for lung volume reduction surgery.
Patient selection is of crucial importance for outcome after lung volume reduction surgery. The anesthesiologist should be involved actively in patient selection, because he or she is in charge of the treatment during the critical perioperative period. Patient history and status and results from chest radiographs, high-resolution CT scans, and catheterization of the right heart should be taken carefully into account in the patient selection process. ⋯ The anesthesiologist's understanding of the principles involved is important for the successful conduct of lung volume reduction surgery. It is unclear if lung volume reduction surgery is superior to conventional therapy in the long run because the decline in lung function is progressive after the procedure. A multicenter trial comparing patients undergoing lung volume reduction surgery with patients with emphysema who are treated conventionally hopefully will clarify this important question in the future.
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Because of recent advances in anesthesia and surgery, almost any patient with a resectable lung malignancy is now an operative candidate, given a full understanding of the risks and provided he or she is investigated appropriately. This progress necessitates a change in the paradigm that one uses for preoperative assessment. Understanding and stratifying the perioperative risks allows the anesthesiologist to develop a systematic focused approach to these patients at the time of the initial contact and immediately before induction, which then can be used to guide anesthetic management (Fig. 7).