Anesthesiology
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Modern anesthesiology differs widely from what it was 40-50 years ago, not only because of what anesthesiology now involves in the operating room, but also because anesthesiology has expanded its horizons and activities above and beyond the provision of surgical anesthesia. These changes and the identity of modern anesthesiology are, however, but poorly understood, if understood at all, by the majority of laity and physicians alike. ⋯ The problem of public identity of our specialty includes the historically correct, but, contemporaneously, all too often misleading name of our specialty. It is suggested that it is appropriate, at this time, to at least consider the potential advantages of changing the name of our specialty to, say, metesthesiology and metesthesiologist, to indicate that while, today, our specialty continues to involve operative anesthesia, it extends above and beyond to include a wide variety of professional activities outside the operating room richly rewarding to patient and practitioner alike.
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The LMA is a useful airway device for most adult and pediatric patients. It is easy and atraumatic to insert, with minimal somatic and autonomic responses from the patient. ⋯ In addition, the LMA facilitates blind and fiberoptic techniques of intubation, but its role in the emergency scenario has yet to be established. The preliminary experience gained with this device in Europe and Australasia suggests that it may also transform contemporary anesthetic practice in the United States.
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Clinical Trial
Pupillary assessment of sensory block level during combined epidural/general anesthesia.
Currently, no reliable method exists to determine the level of sensory block during combined epidural/general anesthesia. However, the pupil dilates markedly in response to noxious electrical stimulation during general anesthesia. Presumably, sensory block produced by epidural anesthesia decreases or obliterates this autonomic response. Accordingly, we tested the hypothesis that pupillary dilation in response to noxious stimulation would predict the level of sensory block achieved during combined epidural/general anesthesia. ⋯ We conclude that dilation of the pupil in response to electrical stimulation is an accurate test of the sensory block level during combined epidural/general anesthesia.
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Case Reports
False-negative results with muscle caffeine halothane contracture testing for malignant hyperthermia.
During the period 1985-1991, 350 muscle contracture studies have been performed in the authors' laboratory, and during this period, they became aware of an occasional false-negative result. The findings pertaining to the four cases so classified are presented in detail. ⋯ This study documents the rarity of false-negative results and substantiates the reliability of caffeine halothane testing as a biologic test in diagnosing the presence of a potentially serious problem.
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The pupillary light reflex often is evaluated in the perianesthetic period to assess drug effects and brainstem function. Mild hypothermia alone or combined with isoflurane does not impair pupillary responses. Although perioperative hyperthermia is less common than hypothermia, abnormal increases in core temperature remain an important thermal disturbance. Accordingly, the pupillary effects of hyperthermia alone and hyperthermia combined with isoflurane and enflurane were evaluated. Additionally, the effects of nitrous oxide on pupillary responses were determined. ⋯ Anesthetic-induced inhibition of the pupillary response to light is reversed partially by core hyperthermia. In contrast to enflurane and isoflurane, 60% N2O has little effect on the pupil.