Journal of clinical anesthesia
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Review Case Reports
Apparent focal motor seizure with a jacksonian march induced by fentanyl: a case report and review of the literature.
This report describes an unusual presentation of focal motor activity resembling Jacksonian march, which developed during fentanyl induction of general anesthesia. Simultaneous spectral-edge activity recording of electroencephalography (EEG) failed to show evidence of an epileptic focus. A negative history of previous seizures, as well as failure to show postoperative postictal symptoms or seizure activity by 16-lead EEG, suggested a myoclonic rather than epileptic nature of the observed muscle activity. Pertinent literature and current theories regarding opioid-induced seizures are discussed.
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Comparative Study
A comparison of propofol, midazolam, and methohexital for sedation during retrobulbar and peribulbar block.
To compare the efficacy of propofol, methohexital, and midazalom in providing adequate sedation during administration of retrobulbar block and satisfactory postoperative amnesia. ⋯ Grimacing or verbal response during the retrobulbar or peribulbar block did not predict or correlate with patient recall. Propofol was equal to both midazolam and methohexital in providing adequate sedation and postoperative amnesia but possesses the added advantages of reduced postoperative vomiting, lower intraocular pressure, and earlier return-to-home readiness.
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Case Reports
Mechanical ventilation of a patient with decreased lung compliance and tracheal dilatation.
Tracheal injury resulting from tracheal intubation is common. Injuries vary in type and severity, from mucosal sloughing to tracheal stenosis and fistula formation. ⋯ To reduce the tracheal dilatation but maintain adequate ventilation and continuous positive airway pressure, we substituted a longer double-cuff tracheotomy appliance and used an automatic intermittent cuff inflator. The problems related to the design of modern tracheal tube cuffs are discussed.
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Endoesophageal prostheses are sometimes used in palliative therapy of esophageal carcinoma. Placement or subsequent manipulation of these devices may require general anesthesia, and these anesthetics are fraught with potential complications, both from the patient's illness and from the prosthesis itself. The two patients in our report presented anesthetic challenges, including acute upper airway obstruction occurring outside the operating theater and management of malignant tracheoesophageal fistula.
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To determine the sites and rates of the leakage of disposable breathing circuits. ⋯ Most disposable breathing circuits can be used safely for closed-circuit anesthesia, as the leakage volume is too small to be of clinical importance. The variation in the leakage rates stresses the importance of quality control of the connector seals.