AANA journal
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Review Case Reports
Isoproterenol-induced elevated bispectral indexes while undergoing radiofrequency ablation: a case report.
The use of bispectral index (BIS) for monitoring neuronal function under general anesthesia has been expanding in practice. However, the meanings of the values are not always clear and have been shown to be altered by such drugs as ketamine, ephedrine, and physostigmine. ⋯ The patient reported no intraoperative recall despite BIS values in the high 70s. This case reinforces that BIS values require interpretation and can only be relevant to the circumstances of the individual case.
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Preoperative cardiac assessment has become an integral part of contemporary anesthesia practice. Simple clinical markers can identify high-risk patients, but the question of how to reduce cardiac complications among high-risk patients has been controversial. Good quality randomized controlled trials have showed that neither preoperative coronary revascularization nor the placement of pulmonary artery catheters reduces perioperative cardiac complications. ⋯ The data supporting these conclusions are reviewed in an evidence-based manner. At present, it is prudent to treat moderate- to high-risk patients undergoing elective surgery with beta-blockers if possible. Because not all patients are candidates for beta-blocker therapy, data regarding the perioperative use of alternative medications to reduce perioperative cardiac complications have been explored and are reviewed.
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Randomized Controlled Trial Comparative Study
Comparison of two approaches to brachial plexus anesthesia for proximal upper extremity surgery: interscalene and intersternocleidomastoid.
We conducted a prospective, randomized study to compare differences between groups of patients given a brachial plexus block using an interscalene (IS) or an intersternocleidomastoid (ISCM) approach. Specific variables analyzed included overall success rates, time to achieve sensory and motor anesthesia, time to place block, and incidence of side effects. For the study, 81 patients were randomized to receive a brachial plexus blockade using the IS or ISCM approach followed by general anesthesia for their surgical procedure. ⋯ No differences in demographics, block success rate, pain scale scores, and analgesia duration were noted between groups. The ISCM group required less time to complete the block (7.08 +/- 2.9 min) compared with the IS group (9.62 +/- 5.31 min) (P = .039), achieved a significantly higher rate of complete motor and sensory block at 30 minutes (P = .032), and had fewer side effects (P = .049). Based on our results, we found that using the ISCM approach to the brachial plexus resulted in a faster onset of anesthesia and a higher ratio of complete block at 30 minutes compared with the IS approach.
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Review Case Reports
Unintended subdural injection: a complication of epidural anesthesia--a case report.
Epidural anesthesia is practiced in virtually every clinical setting. Its safety and versatility have supported increasing use for more and varied therapies. In a healthy patient in whom near-complete left hemiparesis developed following a routine continuous epidural anesthetic for labor, subdural deposit of the local anesthetic was suspected. The following case and discussion may help illustrate the mechanism behind this complication and how it can be detected, treated, and, possibly, avoided.
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The popularity of regional anesthesia blocks for both intraoperative anesthesia and postoperative pain management supports the inclusion of the administration of regional anesthesia into discussions about operating room (OR) efficiency. This article reviews the literature on OR efficiency with a focus on day-of-surgery decision making. ⋯ Regional anesthetic block placement can affect surgical schedules, and thus OR efficiency. When patient safety is unaffected, rearranging OR schedules on the day of surgery to place regional blocks, meet surgeon requests, or move up incision times should generally not be done if doing so results in otherwise unnecessary increases in overutilized OR time.