Journal of anesthesia
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Neuromuscular disease covers a wide range of conditions, with anesthesia management being required either for problems relevant to the disorder or for comorbid conditions. The diseases often have specific problems that can usually be predicted from their pathophysiology. The anesthesiologist must ensure a thorough preoperative assessment, appropriate choice of anesthetic technique and neuromuscular blocking drugs, and careful monitoring of both hemodynamic parameters and the degree of neuromuscular blockade. With these considerations, the patient with neuromuscular disease, although challenging, can be given anesthetic care in a safe fashion.
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Journal of anesthesia · Jan 2003
Randomized Controlled Trial Clinical TrialHemodynamic and catecholamine responses during tracheal intubation using a lightwand device (Trachlight) in elderly patients with hypertension.
Tracheal intubation using a lightwand device (Trachlight) should minimize hemodynamic change by avoiding direct-vision laryngoscopy. We evaluated hemodynamic and catecholamine responses during tracheal intubation using a Trachlight in elderly patients with hypertension. ⋯ A lightwand has no advantage over a laryngoscope in terms of hemodynamic and plasma catecholamine responses to tracheal intubation in elderly patients with hypertension, despite a shorter intubation time.
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The low-dose technique of combined spinal/epidural analgesia is to be welcomed in obstetrics. Its merits include rapid onset of analgesia, with the flexibility of an epidural technique, and high maternal satisfaction. It is a safe and effective technique. ⋯ At our institution, we do not delay spinal anesthesia for urgent cesarean section in order to administer a predetermined volume of fluid; in such cases, we simultaneously administer a fluid preload and spinal anesthesia. Recent studies regarding the use of cell savers for blood conservation in obstetrics are based on small numbers of patients. These studies show great promise, particularly with the modern emphasis on avoiding blood transfusion, which can be massive in this usually young patient population.
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Journal of anesthesia · Jan 2003
Randomized Controlled Trial Comparative Study Clinical TrialTemperature and humidity of the Dräger Cato anesthetic machine circuit.
The Dräger Cato anesthetic machine (Dräger, Lübeck, Germany) effectively humidifies and warms anesthetic gases, because it has a built-in hotplate to heat the breathing system, and expired gas passes through the CO2 absorbent three times during one breath. In the present study, we measured the temperature and absolute humidity (AH) of the anesthetic circuit in the Dräger Cato machine with and without heat moisture exchangers (HME), and compared them with those in another anesthetic machine, the Aestiva/5 (Datex-Ohmeda, Helsinki, Finland). ⋯ The present study indicates that the Dräger Cato machine was more effective in warming and humidifying respiratory gas than the Aestiva/5, and that Aestiva/5 without HME does not reach the optimal temperature and humidity ranges, even if minimal flow anesthesia (0.51 x min(-1)) is performed.