Journal of clinical anesthesia
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Randomized Controlled Trial Clinical Trial
Electroconvulsive therapy-induced cardiac arrhythmias during anesthesia with methohexital, thiamylal, or thiopental sodium.
To determine the frequency of electroconvulsive therapy (ECT)-induced arrhythmias under methohexital, thiamylal, or thiopental sodium anesthesia with and without atropine premedication. ⋯ These data suggest that anesthesia for ECT therapy should be induced with methohexital to minimize the possibility of potentially life-threatening cardiac arrhythmias. Atropine premedication may further decrease the frequency of premature atrial contractions and bradycardia, while increasing the frequency of tachycardia.
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The laryngeal mask airway (LMA) is a new concept in airway management. A miniature inflatable mask is positioned in the hypopharynx, forming a low-pressure seal around the laryngeal inlet. The mask is attached via a tube to the breathing circuit. ⋯ It is now widely used in the United Kingdom; however, it is not yet available for sale in the U. S. It has already had a major effect on practice in Britain and has the potential to do the same in the United States.
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Case Reports
Total intravenous anesthesia with propofol for transsternal thymectomy in myasthenia gravis.
Patients with myasthenia gravis (MG) represent a significant management problem for the anesthesiologist. Anesthetic concerns center on the MG patient's unpredictable response to muscle relaxants and increased susceptibility to postoperative respiratory failure, resulting in prolonged dependence on mechanical ventilation. We describe the first reported use of total intravenous anesthesia with propofol to provide satisfactory surgical conditions in two patients with MG undergoing trans-sternal thymectomy. Propofol is a suitable drug for intubation and continuous infusion anesthesia, allowing fine control of anesthetic depth, good operating conditions, and a recovery profile suitable for MG patients undergoing surgery.
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Case Reports
Rapid orotracheal intubation in the clenched-jaw patient: a modification of the lightwand technique.
Emergency airway management of the patient with a clenched jaw can present a special challenge to the anesthesiologist. We describe four cases in which the patients had a clenched jaw and nasotracheal intubation was either contraindicated or several attempts had failed. All patients were successfully orotracheally intubated by a modification of the lightwand technique.
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To assess the policy and practice of anesthesiology departments in regard to their management of the presurgical do-not-resuscitate (DNR) patient. ⋯ The need for a written policy for the DNR patient undergoing surgery is exemplified by the low percentage of institutions that have existing policies.