Acta anaesthesiologica Sinica
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Acta Anaesthesiol. Sin. · Jun 2000
Case ReportsConvulsions during superior laryngeal nerve block--a case report.
Complications following local anesthesia for fiberoscope-assisted intubation are rare. We report a case with surgical condition indicating awake endotracheal intubation for general anesthesia, suffering from convulsions after receiving left superior laryngeal nerve block to facilitate the procedure. The possible cause may be accidental injection of the local anesthetic into the vertebral artery. ⋯ The central nervous system toxicity of local anesthetic depends not only on the dosage used, but also on the rate of injection, as well as the site at which it is injected. Starting from a small dose together with careful monitoring of patient's response is advised when nerve block in the neck is performed. Here, we also emphasize the importance of availability of resuscitation equipment for maintaining adequate ventilation and circulation in case of emergency.
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Acta Anaesthesiol. Sin. · Jun 2000
Case ReportsAwareness due to disconnection from the fresh gas supply: why could ventilation be achieved in spite of disconnection from the fresh gas supply?
An anaesthesia ventilator of to-and-fro type incorporated into the anesthesia machine was used for mechanical ventilation in a patient undergoing plastic surgery under sevoflurane anaesthesia. During operation, elevation of blood pressure and tachycardia, which suggested inadequate anesthesia could not be managed by adjustment of sevoflurane to higher concentrations. However, the patient's lungs could be well ventilated without problems. ⋯ As a result, anaesthetic gas is replaced by a driving gas. A ventilator of to-and-fro type is still used in clinical anesthesia due to its simple design. The phenomenon reflects the pitfall in the design of a to-and-fro type anaesthesia ventilator.
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Acta Anaesthesiol. Sin. · Jun 2000
Randomized Controlled Trial Comparative Study Clinical TrialComparison of inhalation induction with 2%, 4%, 6%, and 8% sevoflurane in nitrous oxide for pediatric patients.
Sevoflurane is almost the idealest volatile anesthetic agent regarding inhalation induction of general anesthesia. Previous studies have established a role of sevoflurane in high concentration primed in the circuit for inhalation induction in pediatric patients. However, which concentration of sevoflurane is suitable has not yet been reported. This study was designed to compare the efficiency of different concentration of sevoflurane i.e. 2%, 4%, 6%, and 8% and with N2O in 50% oxygen for induction of anesthesia in pediatric patients and at the same time to evaluate the tolerance of patients. ⋯ Sevoflurane 6% for inhalation induction apparently caused low incidence of adverse effects and hastened induction. We suggest that 6% sevoflurene is a concentration more practical for inhalation induction in pediatric patients.
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Acta Anaesthesiol. Sin. · Jun 2000
Case ReportsSpinal anesthesia in MELAS syndrome: a case with mitochondrial myopathy, encephalopathy, lactic acidosis and stroke-like episodes.
MELAS syndrome (mitochondrial myopathy, encephalopathy, lactic acidosis, and stroke-like episodes) is one of the classic mitochondrial encephalomyopathies with variable clinical presentation and multisystem involvement. Enhanced sensitivity to neuromuscular blockade or anesthetic agents and susceptibility to malignant hyperthermia in these patients have ever been reported, all of which complicate the management of general anesthesia. ⋯ Although there is little information about the application of regional anesthesia in MELAS patients, we demonstrate that it may be a satisfactory choice. However, it is suggested that regional anesthesia is performed only when neurological abnormalities of spinal cord or peripheral nerves are definitely ruled out.
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Acta Anaesthesiol. Sin. · Jun 2000
Case ReportsFatal anaphylactoid shock associated with protamine for heparin reversal during anesthesia.
A 19-year-old female was scheduled for elective surgery of repair of ventricular septal defect (VSD). She had no known previous food or drug allergy history. She was not previously exposed to protamine and did not have any of the risk factors pointing to protamine hypersensitivity reaction. ⋯ One was caused by intravenous (i.v.) administration of antibiotics, and the other happened following i.v. drip of protamine sulfate for reversal of systemic heparinization. She had none of the risk factors suggestive of hypersensitivity to drugs and was therefore considered not at risk for such severe adverse reactions which happened. This article was to discuss the anaphylactoid shock induced by antibiotics and protamine during anesthesia, and the prevention and management of such a reaction.