Nurse anesthesia
-
Clinical Trial Controlled Clinical Trial
Does the duration of N2O administration affect postoperative nausea and vomiting?
Nausea and vomiting are the most frequent postoperative complications in the ambulatory surgical setting. In the present study, data were obtained from 184 adult ambulatory cosmetic surgery patients to determine if the use of nitrous oxide (N2O) was associated with an increased incidence of postoperative nausea and/or vomiting (PNV). Anesthesia was induced with thiopental and maintained with an opioid (fentanyl or sufentanil) and isoflurane with or without N2O. ⋯ The major finding was that the incidence of PNV was directly related to the duration of anesthesia in the patients who received N2O, but not in those who were N2O-free. Anesthesia times and the percentages of patients who exhibited PNV in the N2O-free and N2O-treated groups, respectively, were: (1) less than 1 hour, 0% and 6.3%; (2) between 1.0 and 1.9 hours, 35.3% and 36.8%; (3) between 2.0 and 2.9 hours, 24.2% and 66.7% (p = .06); (4) between 3.0 and 5.3 hours, 35% and 100% (P less than .05). Thus, avoidance of N2O in ambulatory cosmetic surgery cases lasting 3, and quite probably 2 or more hours in which general anesthesia is maintained with a synthetic opioid and isoflurane appears to reduce the likelihood that these short-stay patients will experience PNV.
-
The anesthetic technique chosen for a malignant hyperthermia (MH) susceptible patient should include drugs that do not trigger MH, while providing stress-free conditions. This case report describes a MH susceptible patient who was successfully induced and maintained with propofol for third molar extractions while under general anesthesia. Based on this case report, and the other relative few in the literature, it appears unlikely that propofol will trigger an episode of MH. Propofol provides the anesthetist with an alternative for inducing MH susceptible patients, but continued experience is necessary to document its safety and efficacy in these patients.
-
Case Reports
The effect of intraoperative retrobulbar block on anesthetic management of enucleation under general anesthesia.
This case chronicles the effect of a retrobulbar block on a coincident general anesthetic for enucleation in an elderly man. This ASA II patient had a medical history of insulin-dependent diabetes with few apparent cardiovascular complications and mild chronic obstructive pulmonary disease. Induction of anesthesia was accomplished with small doses of midazolam, droperidol, and alfentanil followed by thiamylal. ⋯ Within 10 minutes the patient suffered a profound decrease in blood pressure and pulse requiring repeated doses of glycopyrrolate, phenylephrine, and ephedrine to maintain effective perfusion. These effects do not appear to have resulted from direct elicitation of the oculocardiac reflex, but rather from the loss of surgical stimuli from the block that essentially resulted in inadequate sympathetic tone. The author concludes that anesthetists in similar circumstances should anticipate the possibility of hypotension and lessened anesthetic requirements following retrobulbar block when coincident general anesthesia is planned.