Journal of clinical anesthesia
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Case Reports
Potential toxicity from prolonged anesthesia: a case report of a thirty-hour anesthetic.
Selection of anesthetics for prolonged administration must include consideration of potential toxicity resulting from extended exposure. This report deals with a patient undergoing a 30-hour anesthetic that included nitrous oxide (N2O) and isoflurane (9.7 MAC-hours). ⋯ In addition to outlining basic care guidelines for patients undergoing a prolonged anesthetic, this report discusses potential toxicity from prolonged exposure to both N2O and isoflurane. It concludes that isoflurane can be tolerated in doses up to 10 MAC-hours without fluoride toxicity but cautions against the use of N2O for periods longer than 24 hours.
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Expanded outpatient surgery for pediatric patients makes it difficult to provide an unhurried and thorough preoperative visit. A useful component could be a videotape to be seen by parents at the time of their initial hospital visit. For this study, a videotape was made that included an actual induction of anesthesia procedure, information about pediatric anesthesia, and a discussion of the risks of injury or death during anesthesia. ⋯ Most parents (65%) appeared to accept discussion of the risk of perioperative death, although some had strongly negative reactions. The results suggest that a supportive preoperative tape can acquaint parents with the basis for anesthesiologists' concerns and facilitate the preoperative visit. Seeing an actual anesthetic may help to reassure parents about the anesthetic care their children will receive.(ABSTRACT TRUNCATED AT 250 WORDS)
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The assessment of deep neuromuscular blockade produced by nondepolarizing neuromuscular blocking agents is not possible with the conventional use of the Datex NMT-221 "relaxograph" (Datex NMT-221 monitor, Datex Instrumentarium, Helsinki, Finland), an otherwise useful electromyographic (EMG) monitoring device. A method whereby the relaxograph can be adapted to quantitatively measure posttetanic responses is described here. In anesthetized adult patients, neuromuscular blockade was monitored simultaneously on both hands with two relaxographs. ⋯ However, no significant difference was observed in the recovery rate when the tetanic stimuli were spaced at 15-minute intervals. Pharmacologic reversal by atropine and neostigmine was found to be identical in all patient groups. The author concludes that the Datex relaxograph is suitable for the quantitative assessment of profound surgical neuromuscular blockade with the described modification.
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Letter Case Reports
Asystole following neostigmine administration during carotid sinus stimulation.
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Pulmonary edema developing after the relief of upper airway obstruction has been reported in association with a diversity of etiologic factors, including hanging, strangulation, tumors, foreign bodies, goiter, and laryngospasm. Since 1977, 18 cases of adults with postobstructive pulmonary edema associated with anesthesia have been reported. ⋯ Risk factors for the development of upper airway obstruction have been identified in the majority of these cases. A heightened awareness among anesthesiologists of this poorly recognized and hence often perplexing syndrome may help reduce the occurrence and facilitate the treatment of this potential complication of perioperative airway management.