Anesthesia and analgesia
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Anesthesia and analgesia · Jul 2010
Global warming potential of inhaled anesthetics: application to clinical use.
Inhaled anesthetics are recognized greenhouse gases. Calculating their relative impact during common clinical usage will allow comparison to each other and to carbon dioxide emissions in general. ⋯ Under comparable and common clinical conditions, desflurane has a greater potential impact on global warming than either isoflurane or sevoflurane. N2O alone produces a sizable greenhouse gas contribution relative to sevoflurane or isoflurane. Additionally, 60% N2O combined with potent inhaled anesthetics to deliver 1 MAC of anesthetic substantially increases the environmental impact of sevoflurane and isoflurane, and decreases that of desflurane. N2O is destructive to the ozone layer as well as possessing GWP; it continues to have impact over a longer timeframe, and may not be an environmentally sound tradeoff for desflurane. From our calculations, avoiding N2O and unnecessarily high fresh gas flow rates can reduce the environmental impact of inhaled anesthetics.
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Anesthesia and analgesia · Jul 2010
A survey of current management of neuromuscular block in the United States and Europe.
Most anaesthetists and anesthesiologists incorrectly estimate the incidence of post-operative residual paralysis to be less than 1%.
pearl -
Anesthesia and analgesia · Jul 2010
ReviewTransesophageal echocardiographic evaluation during aortic valve repair surgery.
For patients with aortic valve (AV) disease, the classic treatment has been AV replacement and this remains true for aortic stenosis. In contrast, repair of isolated aortic insufficiency (AI), with or without aortic root pathology, is emerging as a feasible and attractive option to replacement. ⋯ Intraoperative transesophageal echocardiographic evaluation permits analysis of the mechanisms of aortic regurgitation as well as differentiation between repairable and unrepairable AV pathology. Immediate postrepair transesophageal echocardiography provides important information about the quality and durability of repair and identifies variables associated with recurrent AI.