International anesthesiology clinics
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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.
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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.
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Lidocaine, tetracaine, and bupivacaine are the local anesthetic agents most commonly employed for spinal anesthesia in the U. S. Lidocaine provides a short duration of anesthesia and is primarily useful for surgical and obstetrical procedures lasting less than one hour. ⋯ Lidocaine and bupivacaine do not appear to benefit as much from the addition of vasoconstrictors. In general, the local anesthetic agents that are currently available for spinal anesthesia provide significant versatility. By carefully considering the planned surgical procedure, the surgeon's requirements, and the patient's characteristics (e.g., age, height, gravidity), and by understanding the factors that influence spinal anesthesia, the anesthesiologist can select a local anesthetic agent that will assure adequate and satisfying spinal anesthesia.