Anesthesia and analgesia
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Anesthesia and analgesia · Jan 2011
Comparative StudyThe wolf is crying in the operating room: patient monitor and anesthesia workstation alarming patterns during cardiac surgery.
Vital sign monitors and ventilator/anesthesia workstations are equipped with multiple alarms to improve patient safety. A high number of false alarms can lead to a "crying wolf" phenomenon with consecutively ignored critical situations. Systematic data on alarm patterns and density in the perioperative phase are missing. Our objective of this study was to characterize the patterns of alarming of a commercially available patient monitor and a ventilator/anesthesia workstation during elective cardiac surgery. ⋯ Approximately 80% of the total 8975 alarms had no therapeutic consequences. Implementation of procedure-specific settings and optimization in artifact and technical alarm detection could improve patient surveillance and safety.
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Anesthesia and analgesia · Jan 2011
Case ReportsCase report: bilateral angle closure glaucoma after general anesthesia.
Acute angle closure glaucoma is a rare complication of general anesthesia. However, in case of delayed diagnosis, it may lead to blindness. We present a case of bilateral acute angle closure glaucoma after cervical spine surgery under general anesthesia in a hypermetropic patient. In this case, the most likely trigger was the use of ephedrine, but nefopam administration and the prone surgical position are discussed as additional potential factors.
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Anesthesia and analgesia · Jan 2011
Comparative StudyTechnical communication: respiratory variation in pulse pressure and plethysmographic waveforms: intraoperative applicability in a North American academic center.
Dynamic variables are the best predictors of fluid responsiveness in patients under general anesthesia and mechanical ventilation; namely, respiratory variations in pulse pressure and in the plethysmographic waveform. However, these variables have potential limitations. ⋯ We extracted clinical data from all anesthesia procedures performed at our institution in 2009 and identified the number of cases that presented predetermined conditions of application. Among the 12,308 procedures, 39% met the criteria for the noninvasive monitoring of variations in the plethysmographic waveform of which 23% had arterial lines and met the criteria for the invasive monitoring of variations in pulse pressure.
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Anesthesia and analgesia · Jan 2011
Case ReportsCase report: computed tomography scan-guided Gasserian ganglion injection of dexamethasone and lidocaine for the treatment of recalcitrant pain associated with herpes simplex type 1 infection of the ophthalmic division of the trigeminal nerve.
We describe the case of a 17-year-old boy with dermatologic herpes simplex virus-1 outbreaks with incapacitating facial pain requiring multiple hospitalizations. He failed to respond to aggressive treatments including antiviral drugs, opioid analgesics, stellate ganglion, and supraorbital and supratrochlear nerve blocks. ⋯ The patient remained pain free during 6-month follow-up visits. This is the first reported use of Gasserian ganglion block for treatment of herpes simplex virus-1 infection of the trigeminal nerve.
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Anesthesia and analgesia · Jan 2011
Comparative StudyCurrent-distance relationships for peripheral nerve stimulation localization.
Successful peripheral nerve blocks require accurate placement of the injection needle tip before local anesthetic application. In this investigation, we experimentally reconstructed polarity-dependent (anode and cathode) stimulation maps using ex vivo and in vivo animal models. ⋯ Cathodic stimulation may produce conduction block at close tip-to-nerve distances. In contrast, anodic stimulation elicited output characteristics that were predictable and more suitable for nerve localization. We believe anodic stimulation is a viable option at near-nerve distances, despite the increased current requirements. This hypothesis is a paradigm shift in stimulation nerve localization, which conventionally has been cathode based. The hypothesis should be clinically validated.