Anesthesia and analgesia
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Anesthesia and analgesia · Nov 2006
Comparative StudyPerioperative complications of adenotonsillectomy in children with obstructive sleep apnea syndrome.
We evaluated the rate of complications experienced by children who undergo adenotonsillectomy for obstructive sleep apnea syndrome (OSAS), the safety of a standard anesthetic protocol for these children, and preoperative predictors of complications. Sixty-one children with OSAS, confirmed by polysomnography, and 21 children with recurrent tonsillitis were anesthetized using a standard protocol before adenotonsillectomy (ages 2-16 yr, ASA 1-3). The number of complications and medical interventions in the perioperative period were recorded and correlated with the presence and severity of OSAS. ⋯ Medical intervention was necessary in more children with OSAS during recovery and emergence than in the non-OSAS group (17/61 vs 1/21, P < 0.05). Both groups of children had similar opioid requirements and time to discharge from the recovery room. These findings suggest that children with OSAS are at risk for respiratory complications after adenotonsillectomy, but that these complications do not prolong the time to discharge.
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Anesthesia and analgesia · Nov 2006
Comparative StudyEducating anesthesiology residents to perform percutaneous cricothyrotomy, retrograde intubation, and fiberoptic bronchoscopy using preserved cadavers.
Experience with invasive airway procedures may be difficult to obtain during residency training, and anesthesiologists may therefore be hesitant to use these life-saving techniques. We designed a prospective study to determine whether using embalmed cadavers to teach percutaneous cricothyrotomy (PC), retrograde intubation (RI), and fiberoptic intubation to anesthesiology residents would improve their perceived procedural confidence and ability. After demonstration of these techniques by experienced attending physicians, residents were allowed to practice, with instructor guidance, on the cadavers. ⋯ Likewise, the number of residents who reported they would use RI increased from 6% to 67% (P
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Anesthesia and analgesia · Nov 2006
Comparative StudyThe effects of dexmedetomidine/remifentanil and midazolam/remifentanil on auditory-evoked potentials and electroencephalogram at light-to-moderate sedation levels in healthy subjects.
Avoidance of excessively deep sedation levels is problematic in intensive care patients. Electrophysiologic monitoring may offer an approach to solving this problem. Since electroencephalogram (EEG) responses to different sedation regimens vary, we assessed electrophysiologic responses to two sedative drug regimens in 10 healthy volunteers. ⋯ We conclude that ERPs in volunteers sedated with dex/remi, in contrast to mida/remi, indicate a cortical response to acoustic stimuli, even when sedation reaches deeper levels. Consequently, ERP can monitor sedation with midazolam but not with dexmedetomidine. The reverse is true for BIS.
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Anesthesia and analgesia · Nov 2006
Comparative StudyClinical measures of heparin's effect and thrombin inhibitor levels in pediatric patients with congenital heart disease.
In this investigation, we examined the relationship among three thrombin inhibitors, antithrombin III (ATIII), heparin cofactor II (HCII), and alpha-2-macroglobulin (alpha2M), and several clinical tests of heparin's effect in pediatric patients with congenital heart disease undergoing cardiopulmonary bypass. One hundred eighteen children were stratified into six age groups: <1 mo, 1-3 mo, 3-6 mo, 6-12 mo, 12-24 mo, and >10 yr. Baseline ATIII, HCII, and alpha2M values were measured. ⋯ In contrast to what has been demonstrated in adults, ATIII showed no positive correlation with the clinical tests of heparin's effect nor did the other thrombin inhibitors. Additionally, patients <1 mo old had unexpectedly low levels of alpha2M accompanying their expected low levels of ATIII and HCII. Our findings raise concerns about the ability of heparin to adequately anticoagulate these neonates during cardiopulmonary bypass and, consequently, challenge the accuracy of ACT prolongation to truly reflect the extent of their anticoagulation.
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Anesthesia and analgesia · Nov 2006
Comparative StudyLaryngeal mask airway and bougie intubation failures: the Combitube as a secondary rescue device for in-hospital emergency airway management.
When conventional intubation methods fail, an accessory rescue airway device must be immediately available and rapidly deployed to assist the clinician in managing the airway. I reviewed an emergency intubation database to determine what airway devices were used as a backup to rescue the primary rescue device failures. The bougie and the laryngeal mask airway each have an intrinsic failure rate. The Combitube(R), commonly used in the emergency prehospital setting, appeared to be a useful secondary rescue device in the hospital setting when the bougie and laryngeal mask airway failed.