Anesthesia progress
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Anesthesia progress · Jan 1999
ReviewKetamine: review of its pharmacology and its use in pediatric anesthesia.
The management of the uncooperative pediatric patient undergoing minor surgical procedures has always been a great challenge. Several sedative techniques are available that will effectively alleviate anxiety, but short of general anesthesia, no sedative regimen is available that will enable treatment of the uncooperative child. Ketamine produces a unique anesthetic state, dissociative anesthesia, which safely and effectively enables treatment of these children. The pharmacology, proposed mechanisms of action, and clinical use of ketamine (alone and in combination with other agents) are reviewed and evaluated.
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Anesthesia progress · Jan 1997
Review Case ReportsOxygen desaturation in a child receiving a combination of ketamine and midazolam for dental extractions.
A combination of 0.35 mg/kg midazolam and 5 mg/kg ketamine, administered orally for pediatric sedation, resulted in a severe decreases in blood oxygen saturation postoperatively. The patient, a 2-yr-old child, did not respond to command or mild physical stimulation in the recovery room 60 min after receiving the drugs. ⋯ No adverse effects were observed thereafter, and the postoperative recovery was uneventful. Combining different classes of drugs may result in less variability in patients response, but there is a greater potential for drug-induced side effects and drug interactions.
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Anesthesia progress · Jan 1994
Review Case ReportsAsystole and bradycardia during maxillofacial surgery.
A Chinese female undergoing maxillary osteotomy developed asystole when the maxillary tuberosity was cut. Surgery was stopped. ⋯ Atropine was administered intravenously, resulting in an increase in heart rate. No further episodes of asystole or bradycardia were encountered.
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Addition of a vasoconstrictor to a local anesthetic may have several beneficial effects: a decrease in the peak plasma concentration of the local anesthetic agent, increase in the duration and the quality of anesthesia, reduction of the minimum concentration of anesthetic needed for nerve block, and decrease of blood loss during surgical procedures. The addition of a vasoconstrictor to a local anesthetic may also have detrimental effects. A review of the literature indicates that vasoconstrictor concentrations in local anesthetics marketed for dental use in the United States are not always optimal to achieve the purposes for which they are added. In most cases, a reduced concentration of vasoconstrictor could achieve the same goal as the marketed higher concentration, with less side-effect liability.