Anesthesia and analgesia
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Anesthesia and analgesia · Oct 2003
Comparative StudyRelative performance of the level 1 and ranger pressure infusion devices.
Pressure infusion devices are often used to administer fluids in the operating room, but they may rarely be associated with serious venous air embolism. We studied the performance of the Level 1 and the Ranger Pressure Infusor in the laboratory. The Ranger delivered less air and delivered fluid faster than the Level 1 but did not warm fluid or blood as well. Although the Ranger device may be safer in terms of the risk of air embolism, its inferior warming performance shows that the optimal pressure infusion device has yet to be manufactured. ⋯ Pressure infusion devices are widely used to treat patients with large-volume blood loss. The use of these devices may subject patients to the risk of venous air embolism. Our study found the new Ranger device to be superior to the widely used Level 1 in air elimination.
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Anesthesia and analgesia · Oct 2003
Case ReportsAnesthetic management for a five-day separation of craniopagus twins.
Craniopagus twinning is a rare form of the already uncommon entity of conjoint twins. With advances in medical technology and expertise, future attempts at surgical separation of these increasingly complex cases are likely to occur. Despite this, medical literature on the anesthetic management of these cases is sparse. The following case report details the anesthetic management and planning leading to and including the 5-dy separation of 11-mo-old craniopagus twins. The report emphasizes the importance of teamwork, communication, and advanced planning required in cases such as this. ⋯ The following case report documents the anesthetic planning and management leading to and including a 5-day separation of twins joined at the head. This case report also details the difficulties encountered during the unique combination of a rarely performed procedure and a long operating time.
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Anesthesia and analgesia · Oct 2003
Clinical TrialSevoflurane in exhaled air of operating room personnel.
Evidence on potential health hazards arising from exposure to volatile anesthetics remains controversial. Exposure may, in principle, be supervised by monitoring of ambient air or, alternatively, in vivo. We used the Proton Transfer Reaction-Mass Spectrometry to screen the breath of 40 operating room staff members before operating room duty, 0, 1, 2, and 3 h after duty, and before commencing duty on the consecutive day, and control persons. Staff members exhibited significantly increased sevoflurane levels in exhaled air after duty, with a mean of 0.80 parts per billion as compared with baseline values of 0.26 parts per billion (P < 0.05). Analysis of variance with adjustment for within correlation (repeated measurements) showed a statistically significant time-effect (P < 0.001). We conclude that (a) Proton Transfer Reaction-Mass Spectrometry biomonitoring of exhaled sevoflurane can serve as a simple and rapid method to determine volatile anesthetic excretion after occupational exposure, and (b) significant concentrations of sevoflurane may be continuously present in persons exposed to sevoflurane on a daily basis. ⋯ The present study depicts the profile of volatile anesthetics, isoflurane and sevoflurane, in exhaled air of ambulatory patients. Biomonitoring of expired anesthetic concentrations is a noninvasive and rapid method to determine volatile anesthetic excretion.
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Anesthesia and analgesia · Oct 2003
Clinical TrialAnesthetic management for implantation of the Jarvik 2000 left ventricular assist system.
The Jarvik 2000 Heart(TM) is a left ventricular assist device that produces continuous nonpulsatile axial flow by means of a single, rotating, vaned impeller. Anesthetic and perioperative considerations of the Jarvik 2000 Heart(TM) differ from those of conventional assist devices. The Jarvik 2000 is implanted within the left ventricle through a left thoracotomy, which is aided by left lung isolation. A brief period of cardiopulmonary bypass and induced ventricular fibrillation facilitate implantation. Transesophageal echocardiography is essential to assure proper intraventricular positioning of the device and aortic outflow, confirmed by observation of aortic valve opening in the presence of adequate left ventricular volume. Because continuous flow devices function best in the presence of lower systemic and pulmonary vascular resistance, milrinone was preferentially used as an inotropic drug. In the first group of 10 patients to receive the Jarvik 2000, the pump provided a cardiac output of up to 8 L/min, depending on preload, afterload, and pump speed. There were no early perioperative deaths. The average support duration was 81.2 days; the range was 13-214 days. Seven of the 10 patients survived to transplantation. Survivors underwent complete physical rehabilitation during pump support. ⋯ The Jarvik 2000 is a left ventricular assist device that produces continuous nonpulsatile axial flow by means of a rotating, vaned impeller. Because the anesthetic considerations differ from those of conventional left ventricular assist devices, we report the perioperative management of the first 10 patients who participated in a bridge-to-transplantation feasibility study of the Jarvik 2000.
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The authors present a rare case of a cervical cord dysfunction after uncomplicated coronary artery bypass grafting. The preoperative neurological examination did not reveal any abnormalities; however, the postoperative magnetic resonance image showed significant spinal canal stenosis at the same levels as high signal lesions. Although the pathophysiological basis of the case was impossible to determine retrospectively, it seems probable that placing the neck in an extended position during surgery might have aggravated a preexisting spinal canal stenosis to produce cervical injury. ⋯ The authors present a rare case of tetraplegia after coronary artery bypass grafting. It is suggested that neck extension during surgery might have aggravated an occult preexisting cervical spinal canal stenosis to produce cervical injury.