Journal of clinical anesthesia
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Randomized Controlled Trial Comparative Study Clinical Trial
Laryngeal mask airway: a more successful method of insertion.
To compare the ease of insertion of the laryngeal mask airway (LMA) by two methods. ⋯ Inserting the LMA with the cuff partially inflated is likely to be more successful than with the cuff fully deflated. When it is not possible to insert the LMA with the cuff fully deflated, partial inflation before insertion may result in correct placement.
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Randomized Controlled Trial Clinical Trial
Hypoxemia during outpatient gastrointestinal endoscopy: the effects of sedation and supplemental oxygen.
To compare the effects on oxygen saturation as measured by pulse oximetry (SpO2) and ECG changes of endoscopy alone, sedation followed by endoscopy, and sedation followed by endoscopy with supplemental oxygen (O2) during upper gastrointestinal (GI) endoscopy. ⋯ The use of hypnotic doses of benzodiazepines is the primary factor responsible for the reduced oxygenation seen during endoscopy. Neither the presence of the endoscope alone nor the use of midazolam with supplemental O2 caused a decreased oxygenation. This study also suggests that the routine use of benzodiazepines is unnecessary when the endoscopy is of short duration, and the endoscopist employs good topicalization of the oropharynx. In patients who require sedation for endoscopy, O2 administration prevents hypoxemia.
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Randomized Controlled Trial Clinical Trial
The efficacy of routine central venous monitoring in major head and neck surgery: a retrospective review.
To further define the efficacy of routine central venous catheter placement for major head and neck surgery from the standpoint of fluid and blood administration, and various other parameters of perioperative management. ⋯ The study raises doubt about the efficacy of routine central venous catheter placement as a necessary guide for fluid and blood administration for these procedures, or as a necessary adjunct for several other parameters of perioperative management. It suggests the need for a randomized, prospective evaluation.
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Clinical Trial
Postoperative myocardial ischemia: etiology of cardiac morbidity or manifestation of underlying disease?
To determine the relationship between postoperative ST segment changes and clinically apparent cardiac morbidity in noncardiac surgery patients. ⋯ These observations suggest that clinically apparent cardiac events are associated with prolonged ST segment changes detected on ambulatory ECG recorders. The cardiac ischemia leading to prolonged postoperative ST segment changes may itself result in cardiac morbidity, or it may be a reflection of underlying pathophysiology.
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We report a case in which sufentanil was given to a patient who was already taking both a monoamine oxidase (MAO) inhibitor and a tricyclic antidepressant. Anecdotal reports have recommended discontinuing MAO inhibitors 2 to 3 weeks prior to elective surgery. ⋯ She was given an uneventful elective anesthetic with measures to minimize the risk of an adverse drug reaction involving the antidepressants she was taking. Our experience suggests that the use of an opioid other than meperidine may allow the anesthetist to proceed cautiously to provide an anesthetic for an elective surgery patient who is also currently receiving MAO inhibitor therapy.