Anesthesia and analgesia
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Anesthesia and analgesia · Mar 1993
Letter Case ReportsOrogastric intubation: near-strangulation of endotracheal tube.
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Anesthesia and analgesia · Mar 1993
Randomized Controlled Trial Comparative Study Clinical TrialThe effect of two levels of hypotension on intraoperative blood loss during total hip arthroplasty performed under lumbar epidural anesthesia.
The degree of induced hypotension necessary to achieve a significant reduction in intraoperative blood loss has never been defined. Forty patients undergoing primary total hip arthroplasty during epidural anesthesia by a single surgeon were randomly assigned to have mean arterial pressure maintained at 50 +/- 5 mm Hg or 60 +/- 5 mm Hg throughout surgery. ⋯ No difference in transfusion requirements, postoperative hematocrit, or duration of surgery was noted. A difference in mean arterial blood pressure of 10 mm Hg from 50 to 60 mm Hg during surgery for total hip arthroplasty under epidural anesthesia has a measurable effect on intraoperative blood loss.
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Frequently fluid may be aspirated from epidural catheters during epidural anesthesia/analgesia. This fluid may be either cerebrospinal fluid or local anesthetic. Several methods for differentiation of the two fluids have been recommended. ⋯ When the glucose-positive aspirates were subjected to immunoelectrophoresis, 6 of 7 aspirates revealed a prealbumin band. In conclusion, the glucose test for cerebrospinal fluid may be misleading. The source of this glucose may be normal cerebrospinal fluid drainage into the epidural space.
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Anesthesia and analgesia · Mar 1993
Comparative StudyComplications and fiberoptic assessment of size 1 laryngeal mask airway.
In pediatric practice, complications due to the laryngeal mask airway (LMA) have been studied with size 2 LMA, but not with size 1 LMA. We, therefore, compared prospectively the complications induced by LMA size 1 and 2 in 141 children aged 21 days to 11 yr. Intraoperative and lowest SpO2 values after removal of LMA were recorded. ⋯ The number of attempts, complications, intraoperative SpO2, and lowest SpO2 values were similar when using size 1 and size 2 LMA. Fiberoptic examination of size 1 LMA showed a high incidence of impinging of the epiglottis in the LMA bars without airway obstruction. In conclusion, there was no difference in the complication rate between the two pediatric sizes of LMA when used in pediatric patients.
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Anesthesia and analgesia · Mar 1993
Effect of phenylephrine bolus administration on left ventricular function during high thoracic and lumbar epidural anesthesia combined with general anesthesia.
The effect of phenylephrine (PHE) boluses on left ventricular (LV) function was examined in patients without cardiovascular disease who developed arterial hypotension during high thoracic epidural anesthesia (TEA) combined with general anesthesia (GA) (group 1) or lumbar epidural anesthesia (LEA) combined with GA (group 2). LV function was assessed by transesophageal echocardiography (TEE) before and after central venous injection of 1 microgram/kg PHE. Fractional diameter shortening (FDS), end-systolic wall stress (ESWS), and rate-corrected velocity of circumferential fiber shortening (mVcfc) were determined. ⋯ FDS was reduced from 38% to 25% (mean, P < 0.01) in group 1 and remained unchanged in group 2. ESWS increased from 70 to 143 x 10(3) dyne.cm-2 (P < 0.01) and from 57 to 86 x 10(3) dyne.cm-2 (P < 0.05), in groups 1 and 2, respectively. mVcfc was significantly reduced from 1.11 to 0.80 circ/s (P < 0.05) in group 1 and was not altered in group 2. The authors conclude that PHE given as an intravenous bolus to patients under high TEA plus general anesthesia causes a transient impairment of LV function.