Journal of clinical anesthesia
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Clinical Trial Controlled Clinical Trial
Nitrous oxide, nausea, and vomiting after outpatient gynecologic surgery.
Postanesthetic nausea and vomiting can delay discharge of outpatients and can cause occasional admissions to hospital. Nitrous oxide (N2O) has been thought to increase this frequency, but previous studies have been indecisive. One hundred eighty-five unpremedicated outpatients undergoing laparoscopic tubal ligation were studied to determine the effect of N2O on postanesthetic nausea and vomiting. ⋯ Further study is justified. Fentanyl, given postoperatively for pain, did not increase the prevalence of nausea and vomiting. It was concluded that N2O is associated with an increased prevalence of nausea and vomiting.
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Neuroleptic malignant syndrome is an uncommon, idiosyncratic, and sometimes life-threatening disorder associated with the use of neuroleptic drugs. The pathogenesis of neuroleptic malignant syndrome is uncertain, but it may be similar to that of malignant hyperthermia (MH). ⋯ We anesthetized a 17-year-old man with this syndrome multiple times for electroconvulsive therapy (ECT) using a variety of anesthetic techniques. In this patient, dantrolene pretreatment and the use of nondepolarizing muscle relaxants did not relieve symptoms of the syndrome, including fever and creatine phosphokinase (CPK) increases.
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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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Surgical removal of a cerebral hemisphere may be undertaken in patients with intractable seizure disorders. Anesthetic management of such patients has not been reviewed in detail before. This study retrospectively analyzed hospital records of ten patients undergoing cerebral hemispherectomy at the Johns Hopkins Hospital between July 1983 and February 1988. ⋯ Monitoring of intra-arterial pressure and central venous pressure (CVP) is necessary for patient management during the intraoperative and postoperative periods. Intravenous (IV) access should allow rapid intravascular volume administration as it becomes necessary. Patients should remain intubated and observed closely during the immediate postoperative period due to difficulties with hemodynamic stability, seizures, and hemorrhage.