Journal of clinical anesthesia
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We describe the case of a parturient who developed dysphagia shortly after the intrathecal injection of a local anesthetic-opioid combination for cesarean section. Dysphagia was the only symptom of cephalad spread of the spinal anesthetic, and it was not associated with a "high" motor or sensory block. Although it resolved spontaneously, the dysphagia was extremely distressing to the patient. We conclude that dysphagia, even in the absence of an overtly "high spinal," should be added to the possible side effects of intrathecal local anesthetic-opioid administration in parturients.
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Randomized Controlled Trial Comparative Study Clinical Trial
Abdominal wall lift versus carbon dioxide insufflation for laparoscopic resection of ovarian tumors.
To evaluate and compare changes in pulmonary mechanics and stress hormone responses between abdominal wall lift (gasless) and carbon dioxide (CO2) insufflation laparoscopic surgery during controlled general anesthesia. ⋯ Abdominal wall lift laparoscopic surgery is physiologically superior to CO2 pneumoperitoneum laparoscopic surgery as seen during the conditions of this study. Abdominal wall lift laparoscopic surgery provides normal acid-base balance and a lesser degree of hormonal stress responses, it maintains urine output, and it avoids derangement of pulmonary mechanics.
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Review Case Reports
Anesthetic care for the child with congenital central alveolar hypoventilation syndrome (Ondine's curse).
Idiopathic congenital central alveolar hypoventilation syndrome, otherwise known as Ondine's curse, is a rare neuropathologic syndrome characterized by an inadequate respiratory drive with hypoventilation and periods of prolonged apnea resulting in hypercarbia and hypoxemia. Although no definite pathologic abnormality has been identified to account for the disorder, it is thought to represent a primary defect related to altered function of central chemoreceptors resulting in defective control of minute ventilation. Associated problems related to neural crest cell migration, including neuroblastoma formation and Hirschsprung's disease, suggest that the primary defect is defective neural crest cell migration and function. ⋯ Cardiovascular issues include the possible presence of cor pulmonale and autonomic nervous system dysfunction. Central nervous system issues include the frequent occurrence of seizures and mental retardation. The preoperative work-up, premedication, and the intraoperative/postoperative care and monitoring of these patients is reviewed.
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Randomized Controlled Trial Clinical Trial
Remifentanil as an adjuvant during desflurane anesthesia facilitates early recovery after ambulatory surgery.
To investigate the effect of using a remifentanil infusion during desflurane anesthesia on the early recovery profile and side effects. ⋯ The adjunctive use of a remifentanil infusion (0.07 +/- 0.03 microgram.kg-1.min-1) during desflurane-N2O anesthesia facilitated early recovery without increasing PONV, pain, or the need for rescue medication after laparoscopic surgery.
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To determine the influences of age and gender on the dose response and the time course of effect of atracurium. ⋯ Age and gender have significant effects on the dose response and time course of effect of atracurium. Older patients and women are more sensitive to atracurium-induced neuromuscular block than are young patients and men.