Anesthesiology
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Comparative Study
Lower-extremity motor neuropathy associated with surgery performed on patients in a lithotomy position.
Motor neuropathy of a lower extremity is well-recognized as a potential complication of procedures performed on patients in a lithotomy position. Most of this awareness is based on anecdotal reports, however, and the incidence and risk factors for this complication have not been reported. ⋯ These data suggest that prolonged duration in lithotomy and patient risk factors, including very thin body habitus and smoking in the preoperative period, are associated with the development of a lower-extremity neuropathy after procedures performed on patients in a lithotomy position. A reduction of time in the lithotomy position may be particularly worthwhile for patients with these risk factors.
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Comparative Study
Vecuronium neuromuscular blockade reflects liver function during hepatic autotransplantation in pigs.
Rapid assessment of hepatic function early after reperfusion of the liver graft is of great importance, because it may allow for prompt detection of incipient hepatic graft failure. The current study was undertaken to determine whether the continuous recording of neuromuscular transmission could be used as an on-line assessment of hepatic function during liver transplantation when a muscle relaxant with high hepatic uptake is used. ⋯ These results indicate that, compared with the control studies, there is a similar decrease in the recovery rate of vecuronium-induced neuromuscular blockade and in the metabolic rate of 14C-labeled aminopyrine during the progressive recovery of hepatic function immediately after unclamping of the liver vessels. Metabolism of 14C-labeled aminopyrine increased progressively during the reperfusion phase. Therefore, recording of neuromuscular transmission during liver transplantation could serve as a continuous and easy to perform assessment of liver graft function provided that a muscle relaxant with a high hepatic uptake is used for neuromuscular blockade.
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Back pain after childbirth is a frequent complaint. The purpose of this study was to determine the incidence of back pain 1-2 months post partum and to identify the factors, including epidural anesthesia for labor and delivery, that may predispose to it. ⋯ The overall incidence of back pain 1-2 months post partum in this population was 44%. Predisposing factors were a history of back pain, younger age, and greater weight. Predisposing factors for new-onset post partum back pain were greater weight and shorter stature. Epidural anesthesia for labor and delivery did not appear to be associated with back pain 1-2 months post partum.
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Comment Letter Case Reports
Sympathetically maintained pain after surgery may be prevented by regional anesthesia.
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Large (0.5-1.0 MAC), rapid increases of desflurane to concentrations greater than 5% can transiently increase heart rate, mean arterial blood pressure (MAP), sympathetic nerve activity, and plasma epinephrine concentration. We tested the hypothesis that small (1% = 0.14 MAC), rapid increases of desflurane concentration to greater than 5% do not increase heart rate, blood pressure, and plasma catecholamine concentrations. ⋯ Small (1%) increases in desflurane concentration to and greater than 6% can transiently increase heart rate, mean arterial pressure, and plasma epinephrine concentration. These data and those from a previous study indicate that these increases occur with a lesser frequency and magnitude than those associated with a single, rapid step from 4% to 12% end-tidal desflurane.