Anesthesiology
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In patients undergoing neurosurgical procedures at high risk for venous air embolism (VAE), the presence of a right-to-left shunt adds an additional risk for paradoxical air embolism (PAE). Although this is a rare complication, it can have devastating results. The most common form of right-to-left shunt is a patient foramen ovale (PFO), which can be detected by contrast echocardiography. ⋯ Of these, four were detected by TEE. This is less than the expected incidence based on the known incidence of PFO in the general population. The usefulness of preoperative ECHO as a screening test for PFO in patients undergoing neurosurgical procedures is limited, but when a PFO is found, valuable information is acquired to help manage these patients.
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A total of 2,511 patients who received spinal anesthesia for cesarean delivery were observed for the development of postdural puncture headache (PDPH); 804 patients received a mixture of tetracaine and procaine, 942 received bupivacaine-glucose, and 765 received lidocaine-glucose. They were observed for the development of PDPH for a minimum of 72 h. ⋯ The differences between all groups was statistically significant. No differences were found in the percentage of patients who ultimately required epidural blood patch for relief of symptoms after 36 h.
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Randomized Controlled Trial Comparative Study Clinical Trial
Clonidine-induced analgesia in postoperative patients: epidural versus intramuscular administration.
To compare the analgesic efficacy and plasma concentration of intramuscular (IM) versus epidural (EP) clonidine, 20 patients recovering from orthopedic or perineal surgery were randomly divided into two groups of ten. Clonidine (2 micrograms/kg) was administered epidurally in group 1 and intramuscularly in group 2. Analgesia was assessed using a visual analog scale (VAS) over a period of 6 h following clonidine administration. ⋯ Hypotension, bradycardia, and drowsiness occurred with both methods of administration. None of these effects required treatment. Thus, in postoperative patients clonidine produces similar analgesia and side effects after parenteral or EP administration.