AANA journal
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Review Case Reports
Fire in the operating room during open heart surgery: a case report.
A patient had a fire in his chest cavity during dissection of the left internal mammary artery before coronary artery bypass graft. The electrosurgical unit indirectly ignited gauze, resulting in a fire. It was determined that oxygen was being entrained into the surgical field through open pulmonary blebs. This case identifies the need for continued fire training and prevention strategies, persistent vigilance, and quick intervention to prevent injury whenever electrosurgical units are used in an oxygen-enriched environment.
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Surgical excision of cancerous tumors and the human stress response can lead to metastasis of tumor cells. Furthermore, the medications used during the perioperative period (eg, opioids and anesthetic agents) have been shown to inhibit or suppress natural killer (NK) cell activity, one of the body's main defenses against spread of cancer. ⋯ However, there may be anesthetic techniques that attenuate surgical suppression of NK cell activity. This article reviews the effects of various anesthetics and analgesics on NK cell activity and suggests techniques to attenuate the suppressive effects of these compounds.
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The use of propofol presents chemical and clinical concerns, including pain on injection, allergy risks, possible bacteria growth, and hyperlipidemia. These concerns have encouraged the search for alternative propofol formulations. Elimination of the soybean oil and lecithin carrier agents is difficult because the highly lipophilic diisopropyl phenol molecule does not dissolve in water. ⋯ Fospropofol is an aqueous solution of a propofol prodrug intended for injection. The discovery and development of this drug may address the concerns with the current propofol emulsion formulations while offering altered pharmacokinetics and pharmacodynamics for sedation. The structure, pharmacokinetics, pharmacodynamics, clinical studies, clinical applications, and implications are discussed.