Journal of clinical anesthesia
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With improvements in the surgical technique for orthotopic liver transplantation, patients with significant underlying systemic disease are considered candidates for transplantation, thus increasing the complexity of the medical management of these patients and necessitating additional monitoring in order to minimize the anesthetic risk. We describe the anesthetic management of orthotopic liver transplantation for a patient with severe hypertrophic cardiomyopathy and mitral insufficiency. In this case, transesophageal echocardiography proved useful in the management of the postreperfusion period of the surgical procedure.
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To determine the incidence and severity of vomiting in pediatric patients who have had inhalation anesthesia for magnetic resonance imaging (MRI). ⋯ Protracted post-procedure vomiting is an infrequent complication of inhalation anesthesia for MRI. Inhalation anesthesia may be a less important cause of postoperative vomiting than factors such as the type of operative procedure, use of opioids, or presence of postoperative pain.
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Comparative Study
A re-evaluation of the ability of thiopental to identify cerebrospinal fluid in epidural catheter aspirate.
Sodium thiopental has been used to determine whether fluid aspirated from an epidural catheter is previously injected local anesthetic or cerebrospinal fluid (CSF). The purpose of this study was to test the efficacy of this test in distinguishing opioids from CSF. ⋯ Use of thiopental to differentiate opioids from cerebrospinal fluid is unreliable. In addition, in some simulated situations, opioids may mask the presence of local anesthetic.
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The anesthetic challenge of managing a difficult airway is demanding under the best of conditions. An emergency operation compounds the difficulty. Seldom do we have the opportunity to truly plan for a possible emergency. This report presents a solution to the problem of knowing of a difficult airway but having no control over the timing or possible emergent state of the operation.
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Comparative Study
Cardiac output measurement: lack of agreement between thermodilution and thoracic electric bioimpedance in two clinical settings.
To determine the agreement between thermodilution (TD) and thoracic electric bioimpedance (TEB) techniques in cardiac output (CO) measurements in hyperdynamic kidney recipients and normodynamic patients subjected to radical cystectomy. The main objective was to determine the reliability of TEB in CO measurement. ⋯ These findings demonstrate lack of agreement between TEB and TD in CO measurements in a hyperdynamic and a normodynamic clinical setting. It is concluded that the TEB device is unreliable in CO measurement and cannot replace or be interchanged with TD.