AANA journal
-
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.
-
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.
-
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.
-
Eisenmenger syndrome is an insidious disease entity. This disease is characterized by an unrepaired congenital heart defect and left-to-right cardiac shunting. After many years of increased blood flow through the pulmonary system as a result of the shunting, damage to the pulmonary vessels occurs, culminating in severe pulmonary hypertension. ⋯ Because of the great strides in medical care, more patients with Eisenmenger syndrome require anesthesia. Maintaining the patient's systemic vascular resistance at the preoperative level is of paramount importance. Choosing the best anesthesia technique is difficult, at best.
-
Perioperative beta blockade has been proven to significantly reduce the incidence of myocardial ischemia and myocardial infarction and of long-term overall mortality related to cardiac events after various surgeries in patients at intermediate or high risk for such events. The major physiologic effects of beta blockers result in a positive balance of myocardial oxygen supply and demand. Although the optimal time frame for initiation of treatment is not clear from the available data, it has been shown that beta blocker therapy is effective when started at least 1 week before the scheduled surgery and continued throughout the postoperative period. The current recommendations for perioperative beta blockade for patients at intermediate and high risk for a perioperative cardiac event are to use a beta1 blocking agent, begin therapy several weeks before a planned operation, titrate the dose to achieve a heart rate of 60 to 70 beats per minute, and taper the dose of the beta blocker after the postoperative period.