Journal of clinical anesthesia
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In adults, peripheral nerve block provides an effective alternative to general anesthesia. In pediatric anesthesia practice, several factors may limit the use of such techniques. ⋯ Cervical plexus block was used to provide surgical anesthesia for superficial/deep lymph node biopsy and excision of a thyroid nodule. The technique for cervical plexus block and its possible application in the practice of pediatric anesthesia are reviewed.
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Review Case Reports
Anesthetic care for the child with congenital central alveolar hypoventilation syndrome (Ondine's curse).
Idiopathic congenital central alveolar hypoventilation syndrome, otherwise known as Ondine's curse, is a rare neuropathologic syndrome characterized by an inadequate respiratory drive with hypoventilation and periods of prolonged apnea resulting in hypercarbia and hypoxemia. Although no definite pathologic abnormality has been identified to account for the disorder, it is thought to represent a primary defect related to altered function of central chemoreceptors resulting in defective control of minute ventilation. Associated problems related to neural crest cell migration, including neuroblastoma formation and Hirschsprung's disease, suggest that the primary defect is defective neural crest cell migration and function. ⋯ Cardiovascular issues include the possible presence of cor pulmonale and autonomic nervous system dysfunction. Central nervous system issues include the frequent occurrence of seizures and mental retardation. The preoperative work-up, premedication, and the intraoperative/postoperative care and monitoring of these patients is reviewed.
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Review Case Reports
Aortic stenosis with end-stage liver disease: prioritizing surgical and anesthetic therapies.
A 48-year-old man with end-stage liver disease and aortic stenosis (AS), was being evaluated for liver transplantation. This report focuses on the question of which medical problem to correct first, the end-stage liver disease or the AS. Risk factors for surgical correction of AS and liver transplantation are reviewed and discussed, and the surgical and anesthetic management strategies for this patient are outlined.
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The pharmacokinetic and pharmacodynamic interactions between opioids and propofol increasingly have been described and used in clinical practice. It is now known that propofol inhibits both alfentanil and sufentanil metabolism, thereby increasing the plasma concentrations of these opioids, while alfentanil also elevates propofol concentrations. ⋯ From the interaction data, the optimal propofol concentrations have been extracted that assure adequate anesthesia and the most rapid recovery possible. In the presence of fentanyl, sufentanil, and alfentanil, the optimal propofol concentration is approximately 3.5 microgram/ml, whereas in the presence of remifentanil, lower propofol concentrations of 2.5 to 3 microgram/ml are required.
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For more than 40 years, succinylcholine has been the traditional choice of muscle relaxant to facilitate tracheal intubation, particularly for anesthesia in the emergency patient with a full stomach. This presentation reviews factors that determine the onset of neuromuscular blockade, particularly with regard to tracheal intubation. Measurement of neuromuscular block, both clinical and via nerve stimulators, is described and compared, and correlations with intubating conditions are attempted. ⋯ None of the currently available drugs, or those undergoing clinical investigation, possesses the rapid onset and prompt recovery of succinylcholine. Despite the formidable side effect profile of succinylcholine, it has not been replaced by a nondepolarizing agent for use in emergency conditions. However, the alternatives, particularly rocuronium and mivacurium, are drugs with a greater safety profile that, in many circumstances, can substitute for succinylcholine.