Anesthesia and analgesia
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Anesthesia and analgesia · May 1997
Neurologic complications of 603 consecutive continuous spinal anesthetics using macrocatheter and microcatheter techniques. Perioperative Outcomes Group.
Recent case reports of cauda equina syndrome after continuous spinal anesthesia have led to a reevaluation of the indications and applications of this regional anesthetic technique. However, few large studies have formally investigated the frequency of neurologic complications using macro- and microcatheter (smaller than 24 gauge) techniques. This retrospective review examines 603 continuous spinal anesthetics, including 127 administered through a 28-gauge microcatheter, performed between June 1987 and May 1992. ⋯ An epidural blood patch was performed in 41 (6.8%) patients. The frequency of neurologic complications, excluding PDPH, is similar to those in published reviews. However, PDPH in microcatheter patients is more frequent than previously reported.
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Anesthesia and analgesia · May 1997
Malignant hyperthermia testing in patients with persistently increased serum creatine kinase levels.
We describe 49 neurologically asymptomatic patients with persistently increased serum creatine kinase (CK) levels (idiopathic hyperCKemia or IHCK) who were referred to our institution for diagnostic muscle biopsy, including malignant hyperthermia (MH) susceptibility testing between 1979 and 1993. Muscle biopsy samples of the vastus lateralis were obtained for histologic analysis and MH contracture testing with halothane and caffeine. From 1979 to November 1987, patients were tested for MH in accordance with a standardized institutional protocol. ⋯ Twenty-four of the 49 IHCK patients (49%) had positive contracture tests. No significant correlation was found between the magnitude of CK increase and the incidence of MHS or histologic abnormalities. Unexplained persistently increased CK levels in an otherwise healthy patient should alert the anesthesiologist to the possibility of MHS and/or myopathy.
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Anesthesia and analgesia · May 1997
Duration of intrathecal labor analgesia: early versus advanced labor.
Early first-stage labor pain is primarily visceral in origin. Increasing pain intensity and transition to somatic nociceptive input characterizes late first- and second-stage labor pain. The effect of this change in nociceptive input on the duration of intrathecal labor analgesia has not been well studied. ⋯ Duration of analgesia was defined as the lesser of time until the pain score exceeded 5 or until a request for supplemental epidural analgesia was made. The duration of spinal analgesia was significantly less when intrathecal injection was made in advanced labor (120 +/- 26 min) compared with early labor (163 +/- 57 min, P < 0.01). We conclude that cervical dilation and stage of labor significantly impact the effective duration of intrathecal sufentanil/ bupivacaine labor analgesia.
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Anesthesia and analgesia · May 1997
Respiratory mechanics, gastric insufflation pressure, and air leakage of the laryngeal mask airway.
A potential risk of the laryngeal mask airway (LMA) is incomplete mask seal, which causes air leakage or insufflation of air into the stomach. The objective of the present study was to assess respiratory mechanics, quantify air leakage, and measure gastric air insufflation in patients ventilated via the LMA. Thirty patients were studied after induction of anesthesia but prior to any surgical manipulations. ⋯ The end point of 40 cm H2O airway pressure was reached in only three patients. We conclude that the LMA is not better in preventing airway pressure transmission to the esophagus than a conventional face mask. However, a high FL is associated with reduced gastric air insufflation.