Journal of anesthesia
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Journal of anesthesia · Jan 2008
Case ReportsDelayed respiratory depression associated with 0.15 mg intrathecal morphine for cesarean section: a review of 1915 cases.
A low dose of morphine, given intrathecally is an effective postoperative analgesic technique and is widely used in cesarean section. Delayed respiratory depression is the most feared side effect of this technique. However, this side effect has not been thoroughly reported in the obstetric population. The aim of this study was to describe respiratory depression associated with intrathecal morphine in postcesarean women, and to estimate its incidence. ⋯ Of 1915 patients, 5 women (0.26%) developed bradypnea associated with 0.15 mg intrathecal morphine. The incidence of severe bradypnea requiring naloxone was 1/1915 (0.052%).
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Journal of anesthesia · Jan 2008
ReviewManagement of the difficult and failed airway in obstetric anesthesia.
Difficulty with airway management in obstetric patients occurs infrequently and failure to secure an airway is rare. A failed airway may result in severe physical and emotional morbidity and possibly death to the mother and baby. Additionally, the family, along with the medical and nursing staff, may face emotional and financial trauma. ⋯ Finally, the need for specific equipment in the obstetric difficult and failed airway is discussed. Worldwide maternal mortality reflects the health of a nation. However, one could also claim that, particularly in Western countries, maternal mortality may reflect the health of the specialty of anesthesia.
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Journal of anesthesia · Jan 2008
Randomized Controlled Trial Comparative StudyInfluence of low-molecular-weight hydroxyethyl starch on microvascular permeability in patients undergoing abdominal surgery: comparison with crystalloid.
Adequate volume therapy is essential for stable hemodynamics and sufficient urinary output perioperatively. Hydroxyethyl starch (HES) has been reported to attenuate the microvascular hyperpermeability which occasionally occurs in surgical patients. This study was carried out to evaluate the effect of low-molecular-weight HES on the urinary microalbumin/creatinine ratio (MACR), a marker of microvascular permeability, in surgical patients. ⋯ Although low-molecular-weight HES does not improve microvascular hyperpermeability, the expansion of the intravascular volume by HES results in higher urinary output in the postoperative period than that seen with crystalloid solution. The lower concentration of sICAM-1 after surgery may be due to hemodilution.
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Journal of anesthesia · Jan 2008
A neutrophil elastase inhibitor, sivelestat, improved respiratory and cardiac function in pediatric cardiovascular surgery with cardiopulmonary bypass.
Several reports indicate that a neutrophil elastase inhibitor, sivelestat, may have prophylactic efficacy against a systemic inflammatory response after cardiovascular surgery with cardiopulmonary bypass (CPB). We evaluated the clinical pulmonary and cardiac effects of sivelestat. ⋯ We have shown that pediatric patients who underwent cardiovascular surgery with CPB who received sivelestat had a higher P/F ratio, a lower RI, and better FAC of the LV in the postoperative course.