Nurse anesthesia
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Case Reports Comparative Study
Isoflurane and mivacurium chloride neuromuscular blockade in patients with myasthenia gravis.
The relaxograph findings are presented in two patients. In the first, isoflurane alone is administered, and mivacurium with isoflurane is administered to the second patient with myasthenia gravis. A significantly lower dose of mivacurium is required. ⋯ In the patient that only received isoflurane, T1 was 60% to 70% of the baseline, indicating the neuromuscular blocking effects of isoflurane. These cases illustrate that inhalation anesthetics are adequate for muscle relaxant effects, and if neuromuscular blockers are necessary, then a lower dose of nondepolarizer should be administered, and the patient carefully monitored. Mivacurium appears to be an ideal agent for neuromuscular blockade in myasthenia gravis as long as careful neuromuscular blockade is performed.
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Echocardiography is recognized as a excellent diagnostic tool for non-invasive cardiac assessment. Recently, transesophageal echocardiography has been utilized as an "on line, real time" intraoperative monitoring device in cases where patients are at significant risk for intraoperative cardiac ischemia, large shifts in hemodynamic parameters, and/or air embolism. This advancement in cardiac and hemodynamic intraoperative monitoring is significant as it enables early recognition of cardiac ischemia through assessment of cardiac contractility and regional wall motion abnormalities; accurate volume status assessment with direct monitoring of cardiac chamber volumes, valvular function, and intracardiac shunting; and real time assessment of the presence, size, and location of intracardiac air. Transesophageal echocardiography is a safe and accurate tool enabling early recognition of those physiological intraoperative changes where early intervention is critical for improved patient outcome.