Journal of clinical anesthesia
-
Comparative Study Clinical Trial
Stress hormone changes in general anesthesia of long duration: isoflurane-nitrous oxide vs sevoflurane-nitrous oxide anesthesia.
There are few comparative studies of stress hormone changes during general anesthesia with long duration between isoflurane-nitrous oxide and sevoflurane-nitrous oxide anesthesia. We investigated perioperative changes of stress hormone in these two anesthetic methods with duration of more than 10 hours. ⋯ In inhalation anesthesia with the duration of more than 10 hours, isoflurane-nitrous oxide and sevoflurane-nitrous oxide had the same effects on stress hormone changes except for epinephrine, norepinephrine, and ADH. Epinephrine, norepinephrine, and ADH concentrations were higher in isoflurane-nitrous oxide anesthesia.
-
Mechanical stabilization of target coronary arteries in the beating heart has facilitated the practice of "off-pump" coronary artery bypass grafting. Exposing the target coronary artery for stabilization involves maneuvers that frequently cause hemodynamic alterations including decreased cardiac output and increased pulmonary artery and/or central venous pressures (CVP). The presence of a patent foramen ovale (PFO) in the setting of increased CVP may produce a right-to-left shunt through the PFO. ⋯ During manipulation and elevation of the heart to expose the target vessel, the CVP increased from 15 to 30 mm Hg and the shunt through the PFO reversed direction, going from right to left atrium with a flow of 161 mL/min. Mixed venous oxygen saturation and the calculated shunt fraction decreased from 84% to 78% and 14% to 10%, respectively. All parameters returned to normal after the heart was lowered back inside the chest.
-
Randomized Controlled Trial Comparative Study
Fentanyl-induced hemodynamic changes after esophagectomy or cardiac surgery.
The goal of this study was to characterize the hemodynamic response to propofol vs propofol with fentanyl when used for sedation after esophagectomy or cardiac surgery. ⋯ Propofol has a differential effect on hemodynamics and sedation when comparing patients after cardiac surgery and esophagectomy.
-
Randomized Controlled Trial
Anesthesia with 1.5 minimum alveolar concentration sevoflurane is not altered by physostigmine as measured by bispectral and clinical indices.
To evaluate the effect of physostigmine on 1.5% sevoflurane anesthesia and recovery. ⋯ Physostigmine did not influence BIS values or early recovery when administered to patients anesthetized with 1.5 MAC sevoflurane anesthesia.
-
Anesthesiologists are often involved in the early management and resuscitation of patients who have sustained cervical spine injuries (CSIs). The most crucial step in managing a patient with suspected CSI is the prevention of further insult to the cervical spine (C-spine). In this review, important factors related to initial management, diagnosis, airway and anesthetic management of patients with CSI are presented. ⋯ A high level of suspicion and anticipation are the major components of decision making and management in a patient with CSI. Endotracheal intubation using the Bullard laryngoscope may have some advantages over other techniques as it causes less head and C-spine extension than the conventional laryngoscope, and this results in a better view. However, the current opinion is that oral intubation using a Macintosh blade after intravenous induction of anesthesia and muscle relaxation along with inline stabilization is the safest and quickest way to achieve intubation in a patient with suspected CSI. In summation caution, close care and maintenance of spinal immobilization are more important factors in limiting the risk of secondary neurological injury than any particular technique.