Journal of clinical anesthesia
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Aneurysmal rupture represents the most common cause of subarachnoid hemorrhage. Approximately two-thirds of persons who experience a subarachnoid hemorrhage will die or become disabled. ⋯ The anesthetic management of these patients is reviewed, emphasizing principles relating to the facilitation of surgery--by optimizing operative conditions and minimizing the risks of intraoperative aneurysmal rupture or the aggravation of neurologic deficits--and to the provision of a smooth, stable recovery. Despite the disappointing overall prognosis following subarachnoid hemorrhage, adherence to these principles can optimize the outcome for those patients who reach the operating room.
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Randomized Controlled Trial Comparative Study Clinical Trial
Comparative effects of desflurane and isoflurane on vecuronium-induced neuromuscular blockade.
To evaluate the neuromuscular effects of a nondepolarizing muscle relaxant (vecuronium) during anesthesia with equipotent concentrations of either desflurane or isoflurane. ⋯ Vecuronium has similar neuromuscular effects when administered in the presence of desflurane 3% and isoflurane 0.6%.
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Clinical Trial Controlled Clinical Trial
Variability of onset times within and among relaxant regimens.
To evaluate the consistency of times to 95% twitch height depression (T95%) in groups of patients receiving identical induction and relaxant regimens. ⋯ The wide variability in onset times among subjects receiving the same regimen indicates that monitoring of neuromuscular response, preferably to a relatively slow rate of neurostimulation, is essential if one elects to use moderate to high doses of atracurium and/or vecuronium for rapid-sequence induction in a patient in whom movement or coughing is unacceptable. Since onset times were not symmetrical about the mean, the magnitude and frequency of unacceptable onset times would not be fully appreciated unless the individual data points were displayed. Such information may be critical when reporting the suitability of a neuromuscular blocking drug for rapid intubation.
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To determine how well Laser-Guard protects polyvinyl chloride (PVC) endotracheal tubes from the carbon dioxide (CO2) laser. ⋯ Laser-Guard protects the shafts of combustible PVC endotracheal tubes from direct, high-power, continuous CO2 laser radiation.
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A 69-year-old white female presented for corneal transplant, but her numerous medical problems placed her at unacceptably high risk for prolonged general anesthesia. Routine monitored anesthesia care measures would not have provided her or the surgeon the comfort and repose necessary for a successful outcome. We describe anesthetic management for ophthalmic surgery, using epidural anesthesia in conjunction with retrobulbar block, in an elderly patient at high risk for general anesthesia whose intractable back and leg pain would have otherwise precluded her cooperation in maintaining a motionless operative field.