AANA journal
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Pulmonary edema is a generalized descriptive term for the accumulation of fluid within the interstitium and/or the alveolar spaces of the lungs. This accumulation of fluid has a cause that may be termed cardiogenic or noncardiogenic. ⋯ Some occurrences of NCPE can be traced directly to the administration of anesthesia. For example, NCPE can result from upper airway obstruction or the administration of naloxone.
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Case Reports
Epinephrine-induced potentially lethal arrhythmia during arthroscopic shoulder surgery: a case report.
Arthroscopic shoulder surgery performed on a healthy female could have resulted in a fatal outcome when the epinephrine present in the arthroscopic irrigating solution contributed to the onset of ventricular tachycardia requiring defibrillation during surgery. During this procedure, the shoulder was infiltrated with 30 mL of a 1:100,000 solution of epinephrine into the subacromial space and glenhumeral joint. Subsequently, instrumentation of the glenhumeral joint by the orthopedic surgeon with a standard arthroscopy trocar resulted in a 0.5-cm size lesion to the posterior humeral cortex. ⋯ A diagnosis of epinephrine-induced ventricular tachycardia was made. The arthroscopic irrigating solution was immediately discontinued and lidocaine, 100 mg intravenously, was administered; however, the patient's cardiac rhythm degenerated into a sustained ventricular tachycardia that was unresponsive to pharmacologic intervention. A full code was called; the surgeon, anesthesia team, and operating room personnel succesfully provided advanced cardiac life support and cardioverted the patient back into a sinus rhythm with no untoward effects.
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Radiofrequency (RF) interstitial tissue ablation is a new, minimally invasive procedure for patients with liver cancer who are not candidates for conventional therapy. The percutaneous RF ablation therapy involves placing a needle electrode under ultrasound guidance into a selected portion of the tumor and heating the tissue between 90 degrees C and 100 degrees C. ⋯ The patient's ability to cooperate with regard to breathing is critical for accurate needle placement. Intravenous sedation must be meticulously titrated to maintain a delicate balance of patient cooperation and optimal comfort.
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A recently developed procedure known as MIDCAB (minimally invasive direct vision coronary artery bypass) offers a select group of patients with coronary artery disease an alternative to coronary artery bypass grafting with cardiopulmonary bypass. Compared with customary coronary artery bypass graft surgery, the MIDCAB procedure has a smaller modified incision, requires less operative time, eliminates the risk of cardiopulmonary bypass, and is, as the name implies, far less invasive. Single or multiple vessels are revascularized while the heart remains warm and beating. ⋯ Extubation and recovery times are far shorter for MIDCAB procedures, leading to earlier discharge and substantial cost savings. The surgical techniques for cardiac bypass surgery have evolved dramatically during the past few years. It is the unique combination of anesthetic monitoring, quick response to hemodynamic changes, and manipulation of physiologic parameters that makes providing anesthesia for minimally invasive cardiac bypass surgery exceptionally challenging.
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Randomized Controlled Trial Clinical Trial
Effects of intrathecal fentanyl on duration of bupivacaine spinal blockade for outpatient knee arthroscopy.
The purpose of this study was to determine if intrathecal fentanyl speeds the onset and prolongs the duration of sensory and motor block, prolongs the duration of postoperative analgesia, or increases the incidence of adverse effects in patients undergoing spinal anesthesia for outpatient knee arthroscopy. Fifty patients were randomized to receive 12 mg of hyperbaric bupivacaine 0.75% with 25 micrograms (0.5 mL) of fentanyl (group 1) or 12 mg of hyperbaric bupivacaine 0.75% with 0.5 mL of preservative-free normal saline (group 2). One-tailed t tests were used to determine differences in onset and duration of sensorimotor block and postoperative analgesia. ⋯ Group 1 demonstrated significantly more pruritus, but there were otherwise no differences. We conclude that fentanyl does not enhance the onset and duration of sensory or motor block produced by 12 mg of intrathecal bupivacaine. Fentanyl, however, prolongs postoperative analgesia and increases the risk of pruritus.