Journal of clinical anesthesia
-
Randomized Controlled Trial Comparative Study Clinical Trial
Mivacurium as an alternative to succinylcholine during outpatient laparoscopy.
To compare (1) the adequacy of conditions for tracheal intubation; (2) the onset, depth, clinically effective duration, and recovery profile; and (3) adverse effects associated with mivacurium as an alternative to succinylcholine during general (endotracheal) anesthesia for outpatient laparoscopy. ⋯ Mivacurium 0.15 mg/kg given intravenously provided good to excellent conditions for tracheal intubation in 2 to 3 minutes. This dose provided a clinically effective duration of action of 20 to 25 minutes, and the residual blockade was readily reversible with neostigmine. Mivacurium did not, however, offer any apparent advantage over succinylcholine in this outpatient population.
-
Review Case Reports
Management of a severed endotracheal tube during LeFort osteotomy.
An unusual but serious case in which the endotracheal tube was severed during LeFort osteotomy is presented. The aspects of the surgery that can create this problem are reviewed. Past literature is reviewed, and various procedures for the management of this problem, including the plan followed in this case, are discussed.
-
Case Reports
Mechanical ventilation of a patient with decreased lung compliance and tracheal dilatation.
Tracheal injury resulting from tracheal intubation is common. Injuries vary in type and severity, from mucosal sloughing to tracheal stenosis and fistula formation. ⋯ To reduce the tracheal dilatation but maintain adequate ventilation and continuous positive airway pressure, we substituted a longer double-cuff tracheotomy appliance and used an automatic intermittent cuff inflator. The problems related to the design of modern tracheal tube cuffs are discussed.
-
Comparative Study
A comparison of propofol, midazolam, and methohexital for sedation during retrobulbar and peribulbar block.
To compare the efficacy of propofol, methohexital, and midazalom in providing adequate sedation during administration of retrobulbar block and satisfactory postoperative amnesia. ⋯ Grimacing or verbal response during the retrobulbar or peribulbar block did not predict or correlate with patient recall. Propofol was equal to both midazolam and methohexital in providing adequate sedation and postoperative amnesia but possesses the added advantages of reduced postoperative vomiting, lower intraocular pressure, and earlier return-to-home readiness.
-
Endoesophageal prostheses are sometimes used in palliative therapy of esophageal carcinoma. Placement or subsequent manipulation of these devices may require general anesthesia, and these anesthetics are fraught with potential complications, both from the patient's illness and from the prosthesis itself. The two patients in our report presented anesthetic challenges, including acute upper airway obstruction occurring outside the operating theater and management of malignant tracheoesophageal fistula.