Anesthesia and analgesia
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Anesthesia and analgesia · Oct 2000
Smaller-than-expected sevoflurane concentrations using the Sevotec 5 vaporizer at low fill states and high fresh gas flows.
Smaller-than-expected concentrations of sevoflurane were delivered by Sevotec 5 vaporizers (Datex-Ohmeda, Madison, WI) at low-fill states, 8% dialed concentrations, and high fresh gas flows. Clinically, this would lead to prolonged induction times. The risk of complications from prolonged inhaled induction could be increased when using a vaporizer with these characteristics.
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On two occasions, sevoflurane distributed for clinical practice has been found to be contaminated with compounds thought to include hydrogen fluoride (HF) and silicon tetrafluoride (SiF(4)). Both compounds can produce pulmonary injury. However, injury would require fractional distillation of the compounds during the course of sevoflurane vaporization. ⋯ Nuclear magnetic resonance studies indicated that HF interaction with glass changed all HF to three other compounds, one being SiF(4) and the others being unknown. HF and SiF4 distill from sevoflurane more rapidly than sevoflurane is vaporized. Measurement of acidity after sevoflurane administration may not reveal a previous presence of such contaminants.
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Anesthesia and analgesia · Oct 2000
Case ReportsA modified intubating laryngeal mask for endotracheal tube exchange.
It is often necessary to change a patient's breathing tube (endotracheal tube). This can be a risky procedure. This report describes a technique for changing an endotracheal tube by using a modified "intubating laryngeal mask" (a commonly used airway and breathing device) and a fiberoptic bronchoscope.
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Anesthesia and analgesia · Oct 2000
Case ReportsArm pain as an unusual presentation of postdural puncture intracranial hypotension.
We report a case of a patient experiencing severe arm pain after dural puncture. This complication has not been reported previously. The patient was successfully treated with an epidural patch.
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Anesthesia and analgesia · Oct 2000
The efficacy and safety of EMLA cream for awake fiberoptic endotracheal intubation.
EMLA Cream (EC; Astra, Westborough, MA) has been widely used as a local anesthetic. Limited safety information is available with respect to the application of EC to the oral mucous membranes. The purpose of this pilot study was to evaluate the efficacy and safety of EC when applied to oral mucosa for fiberoptic intubation. ⋯ The measured peak plasma concentration of lidocaine or prilocaine did not reach toxic levels in any patient. Methemoglobin levels did not exceed normal values (1.5%) in any patient, and there was no relationship between methemoglobin levels and patient weight, amount of EC used, measured peak plasma concentration, or times to measured peak concentrations of prilocaine or lidocaine. We conclude that EC provided satisfactory topical anesthesia allowing for successful oral fiberoptic intubation in all patients and should be considered a safe alternative for anesthetizing the airway of patients requiring awake oral fiberoptic intubation.