Journal of clinical anesthesia
-
Case Reports
Emergency cesarean section in a patient with Fontan circulation using an indwelling epidural catheter.
Management of parturients with a history of Fontan procedure requires careful monitoring of cardiovascular parameters and anticipation of potential complications. We describe potential pitfalls in a parturient with atriopulmonary Fontan circulation, who received epidural analgesia for labor and who later required emergency cesarean section. Low-dose local anesthetic in combination with meperidine provided excellent perioperative epidural analgesia and cardiovascular stability. Epidural analgesia during labor offered optimal pain relief and facilitated conversion to surgical anesthesia for an emergency cesarean section.
-
This case report describes the use of a bronchial blocker (BB) with a wheel-controlled tip (Cohen flexitip endobronchial blocker) to provide initially middle and lower right lobe isolation and then right lung isolation (RLI) during right lower lobectomy in a patient with compromised pulmonary function preoperatively. As predicted, RLI and one-lung ventilation were associated with worsening oxygenation. ⋯ The BB design made lobar isolation easier and enabled repositioning of the BB during surgery. The techniques used for BB insertion as well as lobar and lung separation are described.
-
Randomized Controlled Trial Comparative Study
The effect of injection of two vs 10 mL saline on the subsequent spread and quality of epidural analgesia in parturients.
To determine whether two vs 10 mL of saline injected into the epidural space affects the subsequent spread and quality of epidural analgesia in parturients. ⋯ 10 mL saline was associated with a higher total number of dermatomes blocked for both cold and pinprick sensation than the two mL saline. However, the pain relief was adequate in both groups, and two mL saline was as effective as the 10 mL in the ease of catheter insertion and prevention of intravascular cannulation.
-
Randomized Controlled Trial
Improved postoperative analgesia with coadministration of preoperative epidural ketamine and midazolam.
To assess postoperative pain regulation and pharmacokinetic effects of preoperative administration of ketamine and midazolam. ⋯ Preoperative epidural coadministration of a low dose of ketamine with midazolam is more effective in relieving postoperative pain than using ketamine alone. In addition, epidural midazolam prolongs the elimination of ketamine.
-
Randomized Controlled Trial Comparative Study
Extubation time, hemodynamic stability, and postoperative pain control in patients undergoing coronary artery bypass surgery: an evaluation of fentanyl, remifentanil, and nonsteroidal antiinflammatory drugs with propofol for perioperative and postoperative management.
To compare three anesthetic strategies with respect to the time of extubation after coronary artery bypass graft (CABG) surgery and to assess patient satisfaction with the procedure. ⋯ Intravenous propofol with bolus doses of IV fentanyl intraoperatively in combination with postoperative nonsteroidal antiinflammatory drugs had the best recovery profile in patients undergoing primary CABG than did the other two regimens studied.