Anesthesia and analgesia
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Anesthesia and analgesia · Apr 2004
Case ReportsParadoxical embolus after multiple trauma resulting in a cerebrovascular accident.
We present the case of a 57-yr-old patient who suffered an unexplained cerebrovascular event 3 days after being struck by a motor vehicle. Workup demonstrated a previously unknown patient foramen ovale. The etiologies of paradoxical embolism in trauma are discussed. ⋯ Paradoxical embolism after multiple traumas is described. Delay in diagnosis may occur given the need for near continuous sedation in the patient with injuries undergoing multiple surgeries and diagnostic tests.
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Anesthesia and analgesia · Apr 2004
Comparative StudyDo anesthesiologists die at a younger age than other physicians? Age-adjusted death rates.
I designed this study to determine whether anesthesiologists are susceptible to premature death. Three specialty groups were studied: anesthesiologists, internists, and all other physicians. Records were examined of all American physicians who died in the years 1989, 1990, 1995, 2000, and 2001, and those who were alive at the end of 1989, 1995, 2000, and 2001. Anesthesiologists had a statistically significant younger mean age at death (crude mortality) (68.98 +/- 15.55 yr) (n = 723) than did internists (74.41 +/- 14.24 yr) (n = 2285) and all other physicians (75.21 +/- 13.3 yr) (n = 18,328) (P < 0.001). However, by factoring in the ages of the living members of the study populations, there was no statistical difference in age-specific mortality. ⋯ It has been suggested that one of the potential occupational hazards of the practice of anesthesiology is premature death. This study disproves the notion that anesthesiologists die at a younger age than other physicians.
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Anesthesia and analgesia · Apr 2004
The variable effects of dopamine among human isolated arteries commonly used for coronary bypass grafts.
The direct actions of dopamine on human arterial coronary bypass grafts are not well known. We investigated its effects on isolated rings cut from radial arteries (RA), gastroepiploic arteries (GEA), and internal mammary arteries (IMA) harvested from patients undergoing coronary artery bypass surgery. Dopamine produced dose-dependent contractile responses in RA, an effect independent of the presence of a functional endothelium. The contractions were enhanced by the dopamine A(1) (DA(1))-receptor antagonist SCH23390, whereas they were blocked by an alpha(1)-adrenergic antagonist, prazosin. Results qualitatively similar to these were obtained in both GEA and IMA, although the contractile responses were far smaller. In RA, DA enhanced the norepinephrine (NE)-induced contraction, and this action of dopamine was enhanced by SCH23390. In GEA, small concentrations (<10(-7) mol/L) of DA attenuated the NE-induced contraction but larger concentrations did not. In IMA, DA induced a vasorelaxation on the NE-contraction only at higher concentrations (10(-6)-10(-5) mol/L). In both GEA and IMA, the dopamine-induced vasorelaxations on the NE contraction were completely inhibited by SCH23390. These results suggest that the affinities of DA for DA(1)- and alpha(1)-adrenergic receptors may explain its variable contractile and vasorelaxant effects among these arteries. ⋯ Differing affinities of dopamine for dopamine A(1)- and alpha(1)-adrenergic receptors may lead to it having variable contractile and vasorelaxant effects among the arteries supplying grafts for coronary bypass surgery.
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Anesthesia and analgesia · Apr 2004
Case ReportsProlonged cardiovascular collapse due to unrecognized latex anaphylaxis.
We present a case of a prolonged anaphylactic reaction that occurred in temporal relationship to the administration of cefazolin. Subsequent allergy testing was positive for latex and negative for cefazolin-both unexpected results. Our case illustrates that medications administered before the onset of anaphylaxis should not be assumed to be the causative allergen and that a latex allergy should be considered in the differential diagnosis. Because the etiology of an anaphylactic reaction cannot be immediately determined, patients experiencing intraoperative cardiovascular collapse should be treated in a latex-free environment. ⋯ We describe a patient who experienced latex-induced intraoperative anaphylaxis. The event coincided with antibiotic administration, which prompted us to erroneously assume that the causative allergen was medication related. Allergy to latex must always be considered as a potential culprit of perioperative cardiovascular collapse.