Journal of clinical anesthesia
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Any drug or blood product administered in the perioperative period has the potential to produce a life-threatening allergic (immune reaction) called anaphylaxis. Anaphylactic reactions represent adverse reactions mediated by immunospecific antibodies (IgE and IgG) that interact with mast cells, basophils, or the complement system to liberate vasoactive mediators and recruit other inflammatory cells. ⋯ Rapid and timely cardiopulmonary intervention with airway maintenance, epinephrine, and volume expansion is essential to avoid an adverse outcome. Severe reactions may be protracted, especially during anesthesia, requiring even larger doses of catecholamines and intensive care observation.
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Review Case Reports
The difficult airway in obstetric anesthesia: techniques for airway management and the role of regional anesthesia.
A case is presented illustrating the use of a continuous spinal anesthetic in a parturient with a difficult airway who required urgent cesarean delivery. Options for endotracheal intubation of a parturient with a difficult airway are reviewed. ⋯ Available data suggest that regional anesthesia, specifically continuous spinal anesthesia, may be a safe and effective option for management of a parturient with a difficult airway. Further investigation of this technique is merited.
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Biography Historical Article
A 19th century medical gift: the Herbert Leslie Burrell Ether Prize of 1896.
The Herbert Leslie Burrell Ether Prize of 1896 was established to recognize the skill and compassion of surgical house officers who administered ether in the most humane manner. The gift was made in tribute to a prominent surgeon at Boston City Hospital and serves to acknowledge the significance of ether anesthesia as one of the pivotal factors in the development of modern surgery.
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Data on all obstetric patients delivering at the Brigham and Women's Hospital during the years 1982 through 1987 were collected. The anesthetic techniques used, the type and amount of anesthetic agents administered, and the postpartum relapse rate of multiple sclerosis patients were compared. ⋯ However, all of the women who experienced postpartum relapses had received concentrations of bupivacaine greater than 0.25%. This finding may suggest that a higher concentration of drug over a longer period of time may adversely influence the relapse rate.
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Airway obstruction during the induction of general anesthesia remains a persistent problem in modern anesthesia practice, particularly in obstetric patients. Generally, a careful preoperative airway evaluation uncovers most abnormalities that might make intubation difficult. ⋯ Although every anesthesia provider is trained to manage such acute airway problems, the provision of a patent airway is not always possible, particularly when repeated attempts at endoscopic or blind intubation have failed, leaving a bloody field that prevents optimal visualization, or when time does not allow to wake up the patient. In this article a difficult airway problem is reported in which translaryngeal guided intubation was lifesaving.