Anesthesia and analgesia
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Respiratory and pharyngeal muscle function are impaired during minimal neuromuscular blockade. Tracheal extubation in the presence of residual paresis may contribute to adverse respiratory events. In this investigation, we assessed the incidence and severity of residual neuromuscular block at the time of tracheal extubation. ⋯ Immediately before tracheal extubation, the mean TOF ratio was 0.67 +/- 0.2; among the 120 patients, 70 (58%) had a TOF ratio <0.7 and 105 (88%) had a TOF ratio <0.9. Significantly fewer patients had TOF ratios <0.7 (9 subjects, 8%) and <0.9 (38 subjects, 32%) in the postanesthesia care unit compared with the operating room (P < 0.001). Our results suggest that complete recovery from neuromuscular blockade is rarely present at the time of tracheal extubation.
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Anesthesia and analgesia · Jun 2005
Clinical TrialAn external monitoring site at the neck cannot be used to measure neuromuscular blockade of the larynx.
Using phonomyography, a new monitoring technique of neuromuscular blockade (NMB), we compared NMB after mivacurium 0.1 mg/kg at the lateral cricoarytenoid muscle (LCA) with a possible external monitoring site of the larynx. In 12 patients, data were obtained at both sites using phonomyography. Anesthesia was induced with remifentanil 0.25-0.5 microg . kg(-1) . min(-1) followed by propofol 2-3 mg/kg. ⋯ We used phonomyography with a microphone placed at the neck to evaluate the possibility to externally monitor NMB at the larynx. When compared with LCA, we found a more pronounced peak effect and longer offset of NMB. The acoustic signals recorded at this external site are unlikely to stem from laryngeal muscle contraction but are rather a result of contraction of the strap muscles of the neck.
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We report a case of possible air embolism during a three-port pars plana vitrectomy and air-fluid exchange of the vitreous cavity of the eye. After the start of intraocular air flushing, sudden tachycardia, a decrease in oxygen saturation and end-tidal carbon dioxide tension, and a distinct "mill-wheel" murmur were observed. ⋯ Once intraocular air flushing was ceased, clinical variables returned to normal within minutes. In conclusion, during air-fluid exchange of the vitreous cavity, air embolism should be considered as a possible rare complication.
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Anesthesia and analgesia · Jun 2005
Case ReportsA complication associated with the Murphy eye of an endotracheal tube.
In this case report, we describe a complication associated with the manufacture of an endotracheal tube that had direct clinical consequences. In retrospect, the standard external inspection of an endotracheal tube may not be sufficient enough to insure the quality and safety of each endotracheal tube used.
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Anesthesia and analgesia · Jun 2005
Case ReportsRecurrent persistent hiccups after epidural steroid injection and analgesia with bupivacaine.
This case report presents a patient who developed persistent hiccups after epidural administration of dilute bupivacaine on several different occasions. Substitution of saline for the dilute bupivacaine during epidural steroid injection did not result in hiccups; however, subsequent postoperative epidural analgesia with bupivacaine caused a recurrence of the hiccups.