Journal of clinical anesthesia
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Modern anesthetic techniques involve combinations of intravenous (i.v.) and inhaled anesthetic drugs that may produce synergistic (supraadditive), additive, or antagonistic interactions. Synergistic interaction is most likely to occur when two or more drugs produce similar effects by different mechanisms. ⋯ The usefulness of a drug interaction depends on whether it produces greater efficacy or reduced toxicity. Surprisingly, these outcomes have only been specifically measured for a handful of common drug combinations.
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Randomized Controlled Trial Clinical Trial
Active warming, not passive heat retention, maintains normothermia during combined epidural-general anesthesia for hip and knee arthroplasty.
to compare passive heat retention by low-flow anesthesia, alone and with additional thermal insulation by reflective blankets, with forced-air warming preventing intraoperative hypothermia during combined epidural-general anesthesia. ⋯ During combined epidural-general anesthesia for elective hip and knee arthroplasty, passive heat retention by means of low-flow anesthesia alone and in combination with reflective blankets is ineffective in maintaining intraoperative normothermia and definitely inferior to active forced-air warning.
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Catheters used to facilitate extubations of the known difficult airway are usually placed through an existing endotracheal tube (ETT), prior to its removal. We present a case in which a #11 Cook airway exchange catheter was placed adjacent to the ETT and left intratracheal for an extended period following removal of the ETT.
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Case Reports
Management of Jehovah's Witness patients for scoliosis surgery: the use of platelet and plasmapheresis.
Four patients whose religious beliefs prohibited accepting blood during surgery for scoliosis were anesthetized and managed successfully using plateletpheresis and plasmapheresis. Blood losses were replaced with crystalloid and hetastarch solutions. In addition, a moderate hypotensive technique was used to minimize surgical blood loss. ⋯ Three of these patients had an uncomplicated postoperative course, however, the fourth patient had some postoperative bleeding with initial hemodynamic instability. We believe that patients who refuse to receive blood transfusion during surgery because of religious beliefs or health issues can be managed safely using other alternatives and techniques such as plateletpheresis and plasmapheresis, which conserve and minimize blood loss. Each case should be assessed on an individual basis.
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To identify variables influencing the likelihood of unanticipated admission following scheduled ambulatory surgery. ⋯ Surgery duration of 60 minutes or longer was the most important predictor of unanticipated admission following scheduled ambulatory surgery.