Anesthesia and analgesia
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Anesthesia and analgesia · Sep 2003
Comparative Study Clinical TrialA comparative evaluation of transcutaneous and end-tidal measurements of CO2 in thoracic anesthesia.
We performed this study to assess the accuracy of transcutaneous CO(2) (PTCCO(2)) monitoring compared with end-tidal CO(2) (PETCO(2)) in thoracic anesthesia. Twenty-six patients undergoing pneumonectomy with thoracotomy for which a long period of one-lung ventilation (OLV) was required were studied. The lungs were mechanically ventilated in the lateral decubitus position. ⋯ All patients completed the study protocol. Bland-Altman analysis revealed a bias of -0.4 mm Hg with a precision of +/-2.5 mm Hg during OLV and 1.4 mm Hg with +/-4.3 mm Hg during TLV when PTCCO(2) and PaCO(2) were compared and revealed a bias of -5.8 mm Hg with a precision of +/-4.1 mm Hg during OLV and -7.1 mm Hg with +/-4.6 mm Hg during TLV when PETCO(2) and PaCO(2) were compared. We conclude that PTCCO(2) monitoring is accurate for evaluating CO(2) levels during thoracic anesthesia.
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Anesthesia and analgesia · Sep 2003
Case ReportsSuccessful resuscitation after ropivacaine-induced ventricular fibrillation.
Human data about resuscitation after cardiac arrest from ropivacaine are limited. We present a case of successful cardiopulmonary resuscitation after accidental ropivacaine-induced ventricular fibrillation. A 76-yr-old female patient presented for foot osteotomy. ⋯ The patient was admitted to the hospital and discharged the next morning without complications. This case demonstrates that techniques used to detect intravascular injection may reduce but not eliminate catastrophic events. Consequently, regional anesthesia using large amounts of local anesthetic should be done in locations with resuscitation equipment and by individuals trained to recognize these complications and begin early treatment.
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Anesthesia and analgesia · Sep 2003
Comparative StudyPulmonary uptake of ropivacaine and levobupivacaine in rabbits.
Local anesthetic toxicity produced by an inadvertent IV injection is attenuated by the pulmonary uptake of local anesthetics. We compared the pulmonary uptake of ropivacaine and levobupivacaine after a bolus injection in rabbits. Sixteen anesthetized rabbits were randomly assigned to either a ropivacaine group or a levobupivacaine group. ⋯ The first-pass uptake of levobupivacaine (31.4% +/- 8.3%; mean +/- SD) was larger than that of ropivacaine (22.9% +/- 5.6%), and the maximum arterial concentration of ropivacaine (21.2 +/- 2.8 micro g/mL) was larger than that of levobupivacaine (18.6 +/- 1.9 micro g/mL). We conclude that the pulmonary uptake of levobupivacaine is larger than that of ropivacaine after a bolus injection. Therefore, the advantages of ropivacaine over levobupivacaine in terms of less cardiovascular toxicity may be offset by the smaller pulmonary uptake after an inadvertent IV injection.
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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
Midazolam-induced muscle dysfunction and its recovery in fatigued diaphragm in dogs.
Midazolam, widely used for sedation and anesthesia, decreases contractility in nonfatigued diaphragm; however, its effects on contractility in fatigued diaphragm that are implicated as a cause of respiratory failure have not been established. We therefore studied the effects of midazolam on diaphragm muscle function and recovery in fatigued diaphragm. Dogs were divided into three groups of eight each. ⋯ At 60 min after the cessation of midazolam administration, in Group II, Pdi and Edi recovered from midazolam-induced values (P < 0.05) and returned to fatigued values. In Group III, Pdi and Edi did not change from midazolam-induced values. We conclude that midazolam causes, in a dose-related manner, diaphragm muscle dysfunction in fatigued canine diaphragm and that at a sedative dose, but not at an anesthetic dose, midazolam does not delay its recovery.