Anesthesia and analgesia
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Anesthesia and analgesia · Mar 1994
Hypertonic saline dextran prime reduces increased intracranial pressure during cardiopulmonary bypass in pigs.
Children and adults who develop neurologic deficits after cardiac surgery may experience cerebral ischemia during cardiopulmonary bypass. Increased intracranial pressure (ICP) may contribute to cerebral ischemia during bypass. Hypertonic saline dextran (HSD), a hyperosmotic, hyperoncotic resuscitation solution, decreases ICP in trauma resuscitation. ⋯ Brain water in the cerebrum did not differ between groups but was reduced in the cerebellum to 75.9% +/- 1.4%. We conclude that HSD prevented any significant increase in ICP during normothermic bypass, and substantially improved fluid balance during bypass. In cardiac surgery patients in whom maintaining decreased ICP and reducing isotonic fluid administration is important, HSD may be a useful addition to the bypass prime solution.
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Anesthesia and analgesia · Mar 1994
Low plasma lidocaine concentration does not affect oxygen uptake at awakening from isoflurane anesthesia.
To clarify the effects of lidocaine in plasma after epidural administration on oxygen uptake (VO2) at awakening from isoflurane anesthesia, we measured VO2 in 45 patients undergoing abdominal hysterectomy under four conditions: control group, intravenous normal saline; epidural group, 3 mg/kg of 1.5% lidocaine epidurally as a bolus; and groups CIV-A and CIV-B, continuous intravenous infusion of 2% lidocaine, 0.5 and 1 mg/kg, respectively, for 5 min followed by 30 micrograms.kg-1 x min-1. VO2 at both periods of steady state during anesthesia before lidocaine administration and awakening from anesthesia were measured using a mass spectrometer system during spontaneous breathing. ⋯ These results indicate that epidural lidocaine prevents the increase in VO2 associated with arousal from isoflurane anesthesia. This effect is not due to the absorbed plasma lidocaine but due to the epidural neural block.
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Anesthesia and analgesia · Mar 1994
Oxygen leakage around the laryngeal mask airway during laser treatment of port-wine stains in children.
The flash-lamp pumped pulsed dye laser is the current treatment of choice for cutaneous port-wine stains. In our practice, most children with these lesions are treated under general anesthesia. At energy levels used clinically, it is possible to ignite hair in the presence of supplemental oxygen; we are aware of four cases in which either the eyebrows or eyelashes were ignited during the administration of general anesthesia via a face mask. ⋯ During controlled ventilation with the LMA, oxygen leaked around the mask in 19% of cases. Use of the LMA markedly decreases the incidence of potential oxygen leakage into the laser field, and is recommended for use, with preservation of spontaneous ventilation, during these cases. We suggest measuring oxygen concentrations at the mouth for laser treatment of facial port-wine stains to confirm that the larynx has been isolated.(ABSTRACT TRUNCATED AT 250 WORDS)
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Anesthesia and analgesia · Mar 1994
Psychologic testing as an aid to selection of residents in anesthesiology.
There are no precise psychologic criteria for the selection of residents in anesthesiology. We attempted to provide an objective guide by comparing clinical performance with psychologic tests which we administered to 95 beginning residents in six training programs. ⋯ Prediction of high performance can also be based on Alpha personalities, who typically are independent, reliable, and self-disciplined. The California Psychological Inventory (CPI) is valuable in selecting people with these characteristics.