International anesthesiology clinics
-
Int Anesthesiol Clin · Jan 1990
ReviewContinuous infusions of local anesthetics and narcotics for epidural analgesia in the management of labor.
It appears that complete analgesia for labor using epidural and subarachnoid opiates alone, with a minimum of side effects, remains an unfulfilled goal. However, the combination of extremely small doses of local anesthetics and opiate drugs seems to provide excellent analgesia with a minimum of side effects. ⋯ These drugs include catecholamines, clonidine, GABA agonists, substance P antagonists, prostaglandin synthetase inhibitors, and many other drugs capable of altering neural transmission in such a way that analgesia results. Obviously, labor analgesia is one area in which these combinations will be explored extensively, and the next few years should be very exciting ones.
-
We now have the technology through reflectance spectrophotometry to evaluate and display continuously mixed venous oxygen saturation SvO2 through use of a modified pulmonary artery catheter. Adding this method of assessing the balance of oxygen supply and demand to our standard armamentarium of hemodynamic monitoring may improve our ability to diagnose and treat cardiovascular aberrations at an earlier stage than was previously possible. Through analysis of the Fick equation, it can be seen that SvO2 depends upon the cardiac output, the arterial oxygen saturation, the hemoglobin level, and the rate of oxygen consumption. ⋯ As seen in the variety of patient care examples cited above, the usefulness of SvO2 monitoring continues to grow. It appears that there are no intrinsic risks associated with SvO2 monitoring beyond those of customary PA monitoring. This new technology provides us with online information not previously available, at an associated cost that needs to be further examined.
-
Nitrous oxide has been widely employed by dentists as an anesthetic agent throughout its history of clinical use. While hypoxic general anesthetic techniques using nitrous oxide are rarely if ever employed today in the United States, and appear to be on the decline abroad, nitrous oxide is extensively and successfully used in dentistry as a conscious sedative to reduce anxiety and provide some supplemental analgesia. Less frequently it is used as a co-agent with intravenous anesthetics or sedatives during oral surgery or restorative dentistry. Considering the number of patients given this agent on a yearly basis, its relative lack of reported side effects when used appropriately is remarkable.
-
While adverse outcomes linked to anesthesia are uncommon in healthy patients, they do occasionally happen. There is rarely a single cause. Anesthesia and surgery bring the patient into a complex world in which innumerable small failings can converge to produce an eventual catastrophe. ⋯ Sometimes these errors are due to faulty vigilance or incompetence, but usually they are made by appropriately trained, competent practitioners. Anesthesiologists can err in many ways, and recognizing these ways makes it easier to analyze the events leading to an anesthetic accident. More importantly, it better equips us to eliminate or minimize them in the future--and this is the real challenge.