Journal of clinical anesthesia
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Comparative Study
Cost impact of unexpected disposition after orthopedic ambulatory surgery associated with category of anesthesia provider.
To provide estimates of the costs and health outcomes implications of the excess risk of unexpected disposition for nurse anesthetist (NA) procedures. ⋯ Provision of anesthesia for ambulatory knee and shoulder procedures by physician anesthesiologists results in better health outcomes, at a reasonable additional cost, compared with procedures with NA-administered anesthesia, at least when using updated cost-effectiveness willingness-to-pay benchmarks.
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The manipulation of an airway is always a critical moment in the anesthetic management of patients with pheochromocytoma due to the high incidence of undesirable hemodynamic events in relation with the stimulus represented by the laryngoscopy. A known difficult airway in which it is necessary to carry out an orotracheal intubation while preserving spontaneous ventilation subjects the patient to a stressful situation. The objective is to obtain an acceptable level of comfort and sedation avoiding respiratory depression (Anesthesiol Clin 2015;33:233-40). In this case, we describe the management of a known difficult airway in a patient with a pheochromocytoma and a personal history of arterial hypertension and chronic obstructive pulmonary disease who underwent orotracheal intubation with spontaneous ventilation with Airtraq and with dexmedetomidine as the only sedative agent.
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Evaluation of bacterial growth in atropine and glycopyrrolate. ⋯ Drawing up atropine or glycopyrrolate at the beginning of the operating list and use within 24 hours if needed are a safe practice and do not pose infection hazard. We can also reduce hospital costs if we do not throw away these unused syringes following each case.
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Case Reports
Lack of electrical interference between spinal cord stimulators and other implanted electrical pulse devices.
Spinal cord stimulators (SCSs) have been used for decades to treat chronic pain. SCSs are often used to treat patients with chronic back pain caused by failed back surgery syndrome, patients with complex regional pain syndrome, or individuals who are not candidates for surgery. SCSs are a relative contraindication in patients with another electrical pulse device. ⋯ The second case was a nonsurgical candidate with a pacemaker who received an SCS to help with lower back pain due to an occupational injury. The third case was a patient with complex regional pain syndrome and a bladder stimulator with a previous SCS who received a revision to help manage the pain. In all these patients, pain scores significantly improved after the trial.
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A 69-year-old woman undergoing treatment for hypertension and epilepsy was scheduled to undergo cataract surgery. All preoperative examination results were within normal limits. Despite being tense, she walked to the operating room. ⋯ The respiratory depression and bradycardia were thought to be due to an inadvertent bolus of remifentanil. We surmised that the patient had received a slight amount of retained medication when the anesthesia resident established the intravenous line, which caused severe respiratory depression. It is important to note that adverse effects such as severe respiratory depression and bradycardia can be caused by even small doses of remifentanil.