Journal of clinical anesthesia
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Inhaled nitric oxide is a selective pulmonary vasodilator that has been used successfully to treat hemodynamic embarrassment and right-to-left interatrial shunting in acute right heart failure. Previous reports have been in the setting of disorders causing elevated right heart afterload, such as pulmonary embolism, acute respiratory distress syndrome, and chronic obstructive pulmonary disease. ⋯ We report a patient with right ventricular infarction for whom cardiogenic shock and refractory hypoxemia due to right-to-left interatrial shunting were effectively treated with inhaled nitric oxide. The potential for broader application of inhaled nitric oxide as a therapy for right ventricular infarction is discussed.
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Case Reports
An initially unnoticed piece of nasal jewelry in a parturient: implications for intraoperative airway management.
The literature documenting the anesthetic implications of body piercing consists only of a few case reports that focus exclusively on interference with airway management by oral jewelry. To date, no case reports documenting anesthetic problems resulting from the presence of nasal jewelry have been reported. ⋯ This situation necessitated fiberoptic examination of the nasopharyngeal and oropharyngeal cavities and radiologic imaging studies to rule out aerodigestive tract aspiration of retained and missing piece(s) of the jewelry. Based on this experience, we now advise all laboring parturients with nasal or oral jewelry in situ to remove the hardware on admission to Labor and Delivery for safety precautions.
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Spinal cord injuries continue to be a devastating medical problem. By impairing voluntary and involuntary nervous system function, virtually every body system function is affected. However, pulmonary function alteration and respiratory complications continue to be the major causes of morbidity and mortality in patients with spinal cord injuries. The current understanding of respiratory problems faced by patients with loss of innervation from cervical spinal cord injuries are reviewed.
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Randomized Controlled Trial Clinical Trial
Unilateral spinal block for outpatient knee arthroscopy: a dose-finding study.
To evaluate the onset time, success rate, and recovery profile of unilateral spinal anesthesia produced with 4 mg, 6 mg, and 8 mg of 0.5% hyperbaric bupivacaine. ⋯ Hyperbaric bupivacaine 4 mg injected slowly through pencil-point directional needles in patients who are maintained in the lateral decubitus position for 15 minutes provided a surgical block that was mostly restricted to the operative side and adequate to perform knee arthroscopy, with a faster recovery profile than when a 6 mg or 8 mg dose was used.