Anesthesia and analgesia
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Anesthesia and analgesia · Sep 2003
Case ReportsContinuous paravertebral catheter and outpatient infusion for breast surgery.
Paravertebral somatic nerve block (PVB) provides improved analgesia and decreased side effects compared with general anesthesia for breast surgery. The analgesia is limited with single injection PVB to the duration of the local anesthetic. ⋯ We describe the successful use of continuous paravertebral anesthesia in two patients undergoing major breast surgery. A novel needle system for paravertebral catheter insertion is also presented.
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Anesthesia and analgesia · Sep 2003
The effect of lidocaine on the globule size distribution of propofol emulsions.
In this study, we sought to determine the globule size distribution of a propofol/lidocaine mixture as a function of lidocaine concentration and time elapsed after mixing in a standard formulation of propofol emulsion (Diprivan) and in a new formulation containing L-lysine to improve stability. The globule size was measured with a laser diffraction technique. The median diameter of the globule size in 20 mL of Diprivan immediately after the addition of 0, 10, 20, 30, 40, and 50 mg of lidocaine was similar to that of chylomicrons, ranging from 0.28 +/- 0.01 micro m to 0.30 +/- 0.02 micro m, over the whole range of lidocaine concentration. ⋯ The maximum globule diameter in the propofol emulsion to which L-lysine was added as a stabilizer did not exceed 3.0 micro m even when the largest amount of lidocaine was added. This study demonstrated that when 30 mg of lidocaine was added to 20 mL of Diprivan and the solution was left for a period of time, the globule size increased. Its increase was minimized by the addition of L-lysine to the propofol emulsion.
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Anesthesia and analgesia · Sep 2003
Case ReportsA case of difficult airway due to lingual tonsillar hypertrophy in a patient with Down's syndrome.
In this report, we describe airway management of symptomatic lingual tonsillar hypertrophy in a pediatric patient with Down's syndrome. Besides obstructive sleep apnea, the history included a small atrial septal defect with mild aortic regurgitation and Moyamoya disease. Anesthesia was induced with IV administration of 1 mg/kg of propofol, followed by inhalation of sevoflurane in 100% oxygen. ⋯ Fiberoptic bronchoscopy through the nasal cavity in combination with jet ventilation successfully identified the glottis and allowed nasotracheal intubation to be accomplished. After lingual tonsillectomy, the patient was extubated on the seventh postoperative day, after supraglottic edema had resolved. Fiberoptic nasotracheal intubation under inhaled anesthesia may therefore be preferable in pediatric or uncooperative patients with symptomatic lingual tonsillar hypertrophy.
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Anesthesia and analgesia · Sep 2003
Case ReportsUse of the ProSeal Laryngeal Mask Airway to initiate ventilation during intensive care and subsequent percutaneous tracheostomy.
The ProSeal Laryngeal Mask Airway is a supraglottic airway that aims to provide improved airway seal and separation of the gastrointestinal and respiratory tracts. We report two cases in which the ProSeal Laryngeal Mask Airway was used to initiate controlled ventilation in the intensive care unit and subsequently provide airway maintenance during percutaneous dilational tracheostomy. The first case involved a patient with a known difficult airway who had previously been impossible to intubate conventionally. In both cases, airway management and subsequent tracheostomy were performed without complication.
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Anesthesia and analgesia · Sep 2003
Doxapram produces a dose-dependent reduction in the shivering threshold in rabbits.
Dopamine is a thermoregulatory neurotransmitter that provokes hypothermia when injected in or near the hypothalamus. Doxapram stimulates release of dopamine from carotid bodies, but is known to have central effects that are probably, at least in part, similarly mediated. We thus tested the hypothesis that doxapram produces a substantial, dose-dependent reduction in the shivering threshold in rabbits. ⋯ The control rabbits shivered at 36.3 degrees +/- 0.3 degrees C, those given 0.25 mg x kg(-1) x h(-1) doxapram shivered at 34.8 degrees +/- 0.5 degrees C, and those given 0.50 mg x kg(-1) x h(-1) shivered at 33.7 degrees +/- 0.6 degrees C. All the shivering thresholds significantly (P < 0.001) differed from one another. The magnitude of this inhibition, if similar in humans, would be clinically important.