Anesthesia and analgesia
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Anesthesia and analgesia · Jul 2004
Twenty months' routine use of a new percutaneous tracheostomy set using controlled rotating dilation.
After a favorable trial period, we introduced the new percutaneous tracheostomy set, PercuTwist, in February of 2002 for our routine procedures. Over the next 20 mo, 90 procedures were performed with minimal complications. To prospectively evaluate this experience, we collected information on reasons for unit admission, operators' previous experience, the duration of prior tracheal intubation, the time needed for the procedure, the grading of the difficulty, the amount of bleeding, and the complications of the procedure. ⋯ In only one procedure during the entire study was any difficulty observed during the insertion process. This occurred because the initial skin incision was too small. However, no major bleeding or complications were encountered.
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Life-threatening anaphylaxis or febrile nonhemolytic transfusion reactions after transfusion of platelet concentrates (PCs) is a serious clinical problem caused by the sensitizing of recipients to plasma components, such as immunoglobulin A, or by cytokines. There is a possible indication for washing of PCs in these thrombocytopenic patients. However, only platelets that show activation after physiological stimulation are useful. ⋯ Because of increased spontaneous activation after washing we could demonstrate cytometrically a loss of induced activation of washed platelets. Furthermore, washing resulted in an impaired ADP-induced aggregability of platelets. These results have led us to reduce the frequency of washing of PCs in our institution, where the only current indication for washing of PCs is in patients with a history of severe nonhemolytic transfusion reactions.
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Anesthesia and analgesia · Jul 2004
Case ReportsVasopressin during spinal anesthesia in a patient with primary pulmonary hypertension treated with intravenous epoprostenol.
Primary pulmonary hypertension (PPH) is a progressive disease with frequent morbidity and mortality, including the risk of cardiac decompensation and death, during general anesthesia. Administration of IV epoprostenol (Flolan) improves symptoms and survival of patients with PPH and thus is an increasingly used long-term treatment for this condition. ⋯ We present a case report of a patient with severe PPH receiving a continuous epoprostenol infusion undergoing skin grafting for a leg ulcer under spinal anesthesia. An IV infusion of vasopressin was given to prevent systemic hypotension resulting from sympathetic blockade while avoiding increases in pulmonary vascular resistance that may have resulted from catecholamine usage.
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Anesthesia and analgesia · Jul 2004
Clinical TrialNocturnal arterial oxygen desaturation and episodic airway obstruction after ambulatory surgery.
Some patients experience disordered breathing during sleep and arterial oxygen desaturation after major inpatient surgery. We performed this study to determine whether similar events occur after ambulatory surgery. Forty-five ambulatory surgery patients received an unrestricted anesthetic. ⋯ Nine patients had a respiratory disturbance index >10 and/or >1% of recording time with oxygen saturation <90% on at least one study night. These nine patients had a significantly older median age and a significantly larger median body mass index. Their median respiratory disturbance index and median percentage of time with oxygen saturation <90% were significantly higher on the first postoperative night than on the preoperative night.
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Anesthesia and analgesia · Jul 2004
Case ReportsClinical management of cardiogenic shock associated with prolonged propofol infusion.
This case report details the development of cardiogenic shock after craniotomy in a patient sedated with a propofol infusion. The patient survived with the assistance of extracorporeal membrane oxygenation. A literature review summarizes the syndrome of cardiogenic shock associated with prolonged propofol infusion. This is the first report of survival in this syndrome resuiting from mechanical circulatory support.