Articles: adult.
-
Rev Bras Anestesiol · Aug 2004
[Evaluation of residual neuromuscular block and late recurarization in the post-anesthetic care unit.].
Residual postoperative paralysis impairs airway patency increasing the risk for postoperative complications. Anti-cholinesterase agents improve neuromuscular transmission by acetylcholine build up in the endplate. However, when there is no longer neostigmine effect, 'recurarization' is theoretically possible since the antagonist agent does not displace neuromuscular blocker from its action site. This study aimed at determining the degree of residual neuromuscular block in the Post Anesthetic Care Unit (PACU) and at observing whether patients receiving neostigmine presented the late 'recurarization' phenomenon. ⋯ The incidence of residual block was significantly higher in the pancuronium group. There has been no case of recurarization with neostigmine suggesting that this phenomenon has no clinical significance when patients have no signs of organ failure or co-morbidity impairing neuromuscular transmission.
-
This review focuses on the technological principles, safety considerations, monitors and equipment, patient issues, and a general overview of the anesthetic management of both conventional and intraoperative magnetic resonance imaging based on the most recent literature. ⋯ The magnetic resonance imaging suite is a challenging environment for the anesthesiologist, and carries inherent risks. Several factors account for this, including the remote location, the unique features of the magnetic resonance imaging scanner, and patient-related factors. Understanding the implications of the magnetic resonance imaging environment will facilitate ensuring the safety of the patient and personnel.
-
Tracheobronchial foreign body (FB) aspiration is a common problem in children and adults. The medical history is the single most predictive factor in the clinical suspicion of FB aspiration. The "penetration syndrome" defined by the sudden onset of choking and coughing with or without vomiting should prompt concerns for FB aspiration. ⋯ Airway control can be achieved with an endotracheal tube or a laryngeal mask airway. A delay in diagnosis increases morbidity including cough, wheeze, edema, and granulation tissue formation. Bronchoscopic evaluation and removal should be performed as soon as the diagnosis is suspected.
-
It may be appropriate for nurse practitioners (NPs) to provide care for a subset of emergency department (ED) patients with non-urgent problems. Our objective was to determine the attitude of ED patients with minor problems to being treated by an NP. ⋯ A majority of ED patients with minor problems accepted being treated by an NP, often without additional physician assessment. Several factors, including impact on ED staffing and patient flow, logistics, cost and quality of care should be evaluated before implementing such strategies.
-
Anesthetic management guided by bispectral index monitoring has been demonstrated to facilitate earlier recovery in adults. Recent preliminary data also suggest that titration of drugs to achieve a specific bispectral index value may reduce the incidence of intraoperative awareness in high-risk adults. It is unclear, however, if this technology will benefit children as it is based on an algorithm developed from adults. This article reviews the literature on the use of the bispectral index monitor in children. ⋯ Bispectral index monitoring may be used to guide anesthetic administration in older children, but its use as a tool for guiding sedation in the younger pediatric patient needs further investigation. It may be necessary to develop a different bispectral index algorithm for children in the younger age groups.