Anesthesia and analgesia
-
Anesthesia and analgesia · Nov 2011
Case ReportsCase report: Severe vasospasm mimics hypotension after high-dose intrauterine vasopressin.
Intramyometrial vasopressin injection reduces bleeding during myomectomy. Subsequent loss of peripheral pulses and nonmeasurable arterial blood pressure have been attributed to cardiovascular collapse or hypotension. ⋯ We describe a patient who developed loss of peripheral pulses and nonmeasurable blood pressure by noninvasive means after myometrial administration of 60 U vasopressin, with documented severe peripheral arterial vasospasm and elevated proximal blood pressure. We discuss the pathophysiology and emphasize the danger of misinterpreting pulselessness as global hypotension instead of vasospasm in this setting.
-
Anesthesia and analgesia · Nov 2011
What rules of thumb do clinicians use to decide whether to antagonize nondepolarizing neuromuscular blocking drugs?
In anesthesia practice, inadequate antagonism of neuromuscular blocking drugs (NMBD) may lead to frequent prevalence of residual neuromuscular block that is associated with morbidity and death. In this study we analyzed the clinical decision on antagonizing NMBD to generate hypotheses about barriers to the introduction of experts' recommendations into clinical practice. ⋯ In our institution, the clinical decision to antagonize NMBD is mainly based on the pharmacological forecast and a qualitative judgment of the adequacy of the breathing pattern. Clinicians judge themselves as better skilled at avoiding residual block than they do their colleagues, making them overconfident in their capacity to estimate the duration of action of intermediate-acting NMBD. Awareness of these systematic errors related to clinical intuition may facilitate the adoption of experts' recommendations into clinical practice.
-
Anesthesia and analgesia · Nov 2011
Randomized Controlled Trial Comparative StudyA randomized comparison between the Pentax AWS video laryngoscope and the Macintosh laryngoscope in morbidly obese patients.
The Pentax AWS is a novel video laryngoscope designed to facilitate tracheal intubation by providing indirect visualization of the laryngeal inlet. We sought to compare the intubation success rate and time to intubation for the Pentax AWS and the classic Macintosh laryngoscope. Specifically, we tested the hypothesis that intubation with the Pentax AWS would be easier and faster than with a standard Macintosh #4 blade in obese patients. ⋯ The time required for tracheal intubation using the Pentax AWS was longer than for the Macintosh laryngoscope and #4 blade. The AWS should not routinely be substituted for a conventional Macintosh #4 blade in morbidly obese patients.