Anesthesia and analgesia
-
Anesthesia and analgesia · Mar 2006
Case ReportsUnanticipated difficult endotracheal intubations in patients with cervical spine instrumentation.
We present two cases of unanticipated difficult airway in patients requiring reoperation after cervical spine instrumentation. In both cases, the upper airway examination was normal, and fiberoptic-guided intubation proceeded with the patient sedated and breathing spontaneously. ⋯ Later review of radiographs showed the previously unrecognized protrusion of cervical hardware into the meso- and hypopharynx. We recommend that anesthesiologists review recent radiographic studies for potential airway compromise before approaching the airway of patients presenting for revision of cervical instrumentation.
-
Anesthesia and analgesia · Mar 2006
Comparative StudyAnesthetic complications of awake craniotomies for epilepsy surgery.
Awake craniotomies are often performed for resection of epileptogenic foci close to vital areas of the brain. For awake craniotomies at our institution, propofol is infused during local anesthetic injection and craniotomy, spontaneous ventilation is preserved, and no endotracheal tube or laryngeal mask airway is used. Propofol is discontinued for language, motor, and/or sensory mapping and for electrocorticography. ⋯ We compared the incidence of intraoperative respiratory and hemodynamic complications and incidence of seizures, nausea, brain swelling, patient movement, bleeding, aspiration, air embolism, and death. Airway compromise was uncommon in AAA cases and although incidences of hypertension, hypotension, and tachycardia were statistically increased in AAA versus general anesthesia craniotomy, these were treated appropriately. In only one patient the use of our AAA technique may have contributed to a poor clinical outcome.
-
Anesthesia and analgesia · Mar 2006
Anesthetic, patient, and surgical risk factors for neurologic complications after prolonged total tourniquet time during total knee arthroplasty.
Nerve injury after prolonged tourniquet inflation results from the combined effects of ischemia and mechanical trauma. Tourniquet release, allowing a reperfusion interval of 10-30 min followed by re-inflation, has been recommended to extend the duration of total tourniquet time. However, this practice has not been confirmed clinically. ⋯ Postoperative neurologic dysfunction was associated with younger age (P < 0.001; odds ratio = 0.7 per 10-yr increase), longer tourniquet time (P < 0.001; odds ratio = 2.8 per 30-min increase), and preoperative flexion contracture >20 degrees (P = 0.002; odds ratio = 3.9). In a subset of 116 patients with tourniquet times > or =180 min, longer duration of deflation was associated with a decreased frequency of neurologic complications (P = 0.048). We conclude that the likelihood of neurologic dysfunction increases with total tourniquet time and that a reperfusion interval only modestly decreases the risk of nerve injury.
-
Anesthesia and analgesia · Mar 2006
Case ReportsNegative arterial to end-tidal carbon dioxide gradient: an additional sign of malignant hyperthermia during desflurane anesthesia.
Widespread use of desflurane anesthesia has changed the clinical presentation of malignant hyperthermia (MH). Delayed onset of MH symptoms has been reported previously. ⋯ The same conditions exist in cases of MH crisis. We describe an unusual case of MH in which a negative value of (a-ET) Pco2 gradient has been used as diagnostic and monitoring tool.
-
Anesthesia and analgesia · Mar 2006
Case ReportsSuccessful intraoperative use of recombinant tissue plasminogen activator during liver transplantation complicated by massive intracardiac/pulmonary thrombosis.
During orthotopic liver transplantation a patient received epsilon-aminocaproic acid and clotting factors. Shortly after hepatic artery clamping the patient developed a massive intracardiac/intravascular thrombosis that resulted in cardiac arrest. ⋯ The patient was ultimately discharged to home. We report the successful intraoperative resuscitation of a patient with acute intracardiac/intravascular thrombosis during an orthotopic liver transplantation using thrombolytic therapy.