Journal of clinical anesthesia
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The influence of increasing doses of propofol (from 6 to 12 mg/kg/h by continuous infusion) on hypoxic pulmonary vasoconstriction was studied in 10 patients prior to thoracic surgery. All patients were intubated with a left-sided double-lumen endobronchial tube. Initial anesthesia and muscle relaxation were accomplished by administering fentanyl, droperidol, and pancuronium. ⋯ There was no change in any respiratory or circulatory variables except systemic vascular resistance, which decreased significantly immediately after the propofol infusion commenced but returned to control values 15 min later for the rest of the observation period. After reestablishing two-lung ventilation, all variables did not differ from control values. In all patients, the hypoxic pulmonary vasoconstriction reflex was present after institution of one-lung ventilation and was not abolished after administration of propofol in doses from 6 to 12 mg/kg/h.
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Polyvinyl chloride tracheal tubes from 50 consecutive CO2 laser operations of the larynx and trachea were collected after tracheal extubation. In all cases, the helium protocol for laser operations was used, which includes the following: helium in the anesthetic gas mixture at 60% or more during laser resection (FIO2 less than or equal to 0.4); tracheal intubation with plain, unmarked polyvinyl chloride tubes; laser power density less than or equal to 1,992 W/cm2; and laser bursts of less than or equal to 10-second duration. No tracheal tube fires or airway burns occurred. ⋯ Most of the cuffed tubes that came in contact with the laser sustained damage at the cuff (77%). It was concluded that the risk of tracheal tube contact with a laser beam is at least 1 in 2, that cuffed tubes are more likely to be hit with a laser beam than noncuffed tubes, and that cuffed tubes that are hit usually sustain damage to the cuff. Because no fires occurred in this series despite frequent laser contact with the tube, these data indicate that the helium protocol helps to prevent polyvinyl chloride tube fires.
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Comparative Study
Regional versus general anesthesia in high-risk surgical patients: the need for a clinical trial.
Regional anesthesia is often preferred over general anesthesia for patients with cardiovascular disease because of presumed decreased risk of perioperative myocardial ischemia. However, few studies have addressed this issue directly. To determine whether the type of anesthesia is independently associated with myocardial ischemia, records of 134 patients undergoing peripheral vascular grafting under general or regional anesthesia were examined. ⋯ The association between anesthetic approach and perioperative myocardial ischemia or infarction remained after adjustment for preoperative factors associated with ischemia or with type of anesthesia. General anesthesia does not appear to be associated with increased risk of myocardial ischemia, and stringent recommendations to avoid it in this population may be unfounded. A clinical trial is needed to define more clearly the risks and benefits of different types of anesthesia in high-risk patients.
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This North Carolina case study addresses the migration of anesthesiologists into subspecialty, clinical areas of anesthesiology over a 4-year period (1984 to 1987). Three hundred fourteen members of the North Carolina Society of Anesthesiologists (NCSA) were surveyed using a one-page questionnaire. The response rate was 93.6%. ⋯ Respondents expected additional practice options over the next 3 years with anesthesia for ambulatory diagnostic and therapeutic modalities projected to emerge at the fastest rate. In conclusion, anesthesiologists in North Carolina seem to be filling unmet needs in obstetric and cardiac anesthesia, critical care, ambulatory surgery, and pain therapy units. These observations may represent a vignette of the national scene.
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Sixteen cases in which celiac plexus block with depot steroid was used to treat chronic pancreatitis pain were reviewed. Only 4 of 16 patients reported pain relief with the procedure. ⋯ Prior pancreatic surgery was present in 9 of the 12 patients without relief and in 1 of 4 patients with relief. It is postulated that refractory chronic pancreatitis pain may be an extreme form of what has been termed "abnormal illness behavior." Furthermore, these results underscore the poor results experienced using neural blockade for the relief of chronic pain when narcotic dependence is present.