Anesthesia progress
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Anesthesia progress · Jan 2015
Case ReportsInadvertent Endobronchial Intubation in a Patient With a Short Neck Length.
Inadvertent placement of the endotracheal tube into the right bronchus during intubation for general anesthesia is a fairly common occurrence. Many precautions should be taken by the anesthesia provider in order to minimize the incidence of endobronchial intubation, including bilateral auscultation of the lungs, use of the 21/23 rule, and palpation of the inflated endotracheal cuff at the sternal notch. These provisions, however, are not foolproof; anesthesia providers should realize that endobronchial intubation may occur from time to time because of variations in patient anatomy, changes in patient positioning, and cephalad pressures exerted during surgery. ⋯ Bilateral breath sounds were confirmed with auscultation, although they were distant because of his chronic obstructive pulmonary disease. After radiographic examination in the postanesthesia care unit, a right main-stem intubation was revealed to have taken place, resulting in complete atelectasis of the left lung. After repositioning of the endotracheal tube, radiography confirmed that the patient had an anatomically short tracheal length.
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Anesthesia progress · Jan 2015
Randomized Controlled Trial Comparative StudyEfficacy of Benzocaine 20% Topical Anesthetic Compared to Placebo Prior to Administration of Local Anesthesia in the Oral Cavity: A Randomized Controlled Trial.
The aim of the present study was to compare the effects of a topical anesthetic to a placebo on pain perception during administration of local anesthesia in 2 regions of the oral cavity. A split-mouth, double-blind, randomized clinical trial design was used. Thirty-eight subjects, ages 18-50 years, American Society of Anesthesiologists I and II, received 4 anesthetic injections each in regions corresponding to the posterior superior alveolar nerve (PSA) and greater palatine nerve (GPN), totaling 152 sites analyzed. ⋯ A higher value on the VAS for the anesthesia of the GPN, relative to the PSA, was observed for both groups. Regarding gender, male patients had higher values on the VAS compared with female patients, but these differences were not meaningful. The topical anesthetic and the placebo had similar effects on pain perception for injection of local anesthesia for the PSA and GPN.
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Anesthesia progress · Jan 2014
Randomized Controlled Trial Comparative StudyA new protocol to evaluate the effect of topical anesthesia.
This double-blind, placebo-controlled, randomized cross-over clinical experimental study tested the reliability, validity, and sensitivity to change of punctuate pain thresholds and self-reported pain on needle penetration. Female subjects without orofacial pain were tested in 2 sessions at 1- to 2-week intervals. The test site was the mucobuccal fold adjacent to the first upper right premolar. ⋯ The study found good to excellent test-retest reliability for all measures. None of the sensory measures detected changes in sensitivity following lidocaine 2% or placebo gel. Electronic von Frey assessments of MPT/MPS on oral mucosa have good validity.
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Anesthesia progress · Jan 2014
Randomized Controlled Trial Comparative StudyDexmedetomidine sedation with and without midazolam for third molar surgery.
Twenty-four patients were randomly divided into 2 groups. Intraoperatively, one group received a continuous intravenous infusion of dexmedetomidine alone, whereas the other received a continuous dexmedetomidine infusion plus a small dose of midazolam. Early measurements of patient anxiety and psychomotor performance were lower in patients who had received midazolam. ⋯ This effect, however, did not translate into increased patient satisfaction in the group receiving midazolam. Our findings suggest a prolonged discharge time for patients who had been given midazolam that may be clinically significant. Overall, dexmedetomidine showed an unpredictable sedative response and may be less practical than more common alternatives for oral surgery procedures.
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Anesthesia progress · Jan 2014
Randomized Controlled Trial Comparative StudyIV ATP potentiates midazolam sedation as assessed by bispectral index.
In this study, by measuring bispectral index (BIS), we tested the hypothesis that intravenous adenosine 5'-triphosphate (ATP) infusion would deepen the level of midazolam-induced sedation. Ten healthy volunteers underwent 2 experiments with at least 2 weeks' interval: immediately after intravenous bolus administration of midazolam (0.04 mg/kg), they received continuous infusion of either ATP infusion (100 μg/kg/min) or placebo (saline) for 40 minutes in a double-blind, randomized, crossover manner. ⋯ Coadministration of ATP with midazolam further reduced BIS value to 51 ± 13, associated with complete loss of consciousness without adverse effect on the cardiorespiratory systems. We conclude that the addition of ATP infusion to midazolam significantly enhances midazolam sedation without disturbing cardiorespiratory functions.