Journal of clinical anesthesia
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Randomized Controlled Trial
Dexmedetomidine infusion is associated with enhanced renal function after thoracic surgery.
To test the hypothesis that dexmedetomidine, a selective alpha-2 agonist, enhances urine flow rate and perioperative renal function, a post hoc analysis was conducted on a recently completed study of dexmedetomidine used as an adjunct to epidural analgesia after thoracotomy. ⋯ Dexmedetomidine infusion administered as a supplement to epidural analgesia induced diuresis in postthoracotomy patients with normal preoperative renal function and undergoing fluid restriction. Although this finding may represent simple reversal of a tubular antidiuresis, the lower DeltaS(Cr)% and preservation of cCl(Cr) suggest a beneficial effect on glomerular filtration compared with controls.
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To determine whether there has been any recent change in the mortality experience of American anesthesiologists. ⋯ We observed a significant increase in the average age at death and a decreased risk of death among anesthesiologists who died in the years 1992 to 2001. Parallel changes were observed in the control population of obstetricians.
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Case Reports
Anesthesia for cesarean section in a patient with placenta previa and methylenetetrahydrofolate reductase deficiency.
We describe the anesthetic management of a patient with placenta previa presenting for a cesarean section, who had methylenetetrahydrofolate reductase (MTHFR) deficiency. Methylenetetrahydrofolate reductase deficiency increases homocysteine levels in the body and, therefore, predisposes to thrombosis. After a cerebrovascular accident at 8 weeks of gestational age, the patient received anticoagulants throughout the course of her pregnancy. ⋯ Thus, we chose a subarachnoid block because the patient remained hemodynamically stable, and anticoagulation had been stopped 8 hours before surgery. To our knowledge, there is no reported case of a parturient with MTHFR deficiency complicated with a cerebrovascular accident and associated with placenta previa presenting for a cesarean section. Anesthetic considerations are discussed in patients presenting with placenta previa associated with MTHFR deficiency.
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Comment Letter
Assessment and management of airway obstruction with tumors.