Journal of clinical anesthesia
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Norepinephrine (NE) is mostly used to treat severe hypotension. However, NE has potentially adverse vasoconstrictive effects on regional vascular beds of kidney, liver, and gut, with a potential for ensuing organ dysfunction. NE therefore is considered as a last reserve in otherwise refractory hypotension. ⋯ Therefore, the doses of NE needed to maintain or restore blood pressure may be extremely high. Surprisingly, no adverse vasoconstriction with subsequent hypoperfusion occurs during sepsis, despite the high doses of NE administered. Instead, NE rather causes an increase in blood flow and oxygen delivery.
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We report a case of epidural catheter shearing, an uncommon complication of removal of a wire-reinforced epidural catheter. The catheter was removed without incident, and with the tip intact, after we allowed the patient to relax for 3 hours, placing the patient in the lateral decubitus position, and placing continuous tension on the catheter itself so as to let it "work its way out".
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Difficult airway management is a critical aspect of anesthesiology training and practice. A survey was conducted of American anesthesia residency programs to determine the prevalence of a specific airway rotation and its curriculum. ⋯ Of the programs with an airway rotation, the flexible fiberoptic bronchoscope and the laryngeal mask airway represent the most frequently used devices, excluding the standard laryngoscopes. There is minimum emphasis on more invasive techniques. Traditional methods of instruction continue to be utilized more frequently than nontraditional methods.
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Randomized Controlled Trial Clinical Trial
Wound infiltration with ropivacaine and fentanyl: effects on postoperative pain and PONV after breast surgery.
To determine whether postoperative wound infiltration with local anesthetics combined with fentanyl improves analgesia following breast surgery; and to investigate awakening and postoperative nausea/vomiting. ⋯ Postsurgical ropivacaine wound infiltration, with or without adding fentanyl, demonstrates no differences in postoperative pain relief and nausea/vomiting compared to a balanced general anesthetic including i.v. fentanyl.
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To investigate the effect of different plasma levels of fentanyl on the concentration of propofol and the Bispectral Index (BIS) required for patients to regain consciousness and orientation following surgery. ⋯ The plasma levels of fentanyl affect the concentrations of propofol required for patients to regain consciousness. The BIS values for wakefulness are unaltered at the different combinations of propofol and fentanyl concentrations. Thus, the BIS appears to be a useful and consistent indicator for level of consciousness during emergence from propofol/fentanyl intravenous anesthesia.