AANA journal
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The authors discuss their experience with chloroprocaine for epidural anesthesia in five pediatric patients. While bupivacaine remains the most commonly used local anesthetic in children, recent reports of toxicity document the risks of this agent. The major advantage of chloroprocaine is its rapid metabolism, which thereby minimizes the risks of toxicity, especially in patients with preexisting problems such as young age or underlying hepatic dysfunction, which may limit the metabolism of local anesthetics of the amide class. ⋯ Adequate intraoperative conditions were achieved in all five patients. No complications related to chloroprocaine epidural anesthesia were noted. This initial experience suggests that chloroprocaine offers an acceptable alternative to bupivacaine for epidural anesthesia in the pediatric population.
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Randomized Controlled Trial Comparative Study Clinical Trial
Oral midazolam versus meperidine, atropine, and diazepam: a comparison of premedicants in pediatric outpatients.
An effective premedicant minimizes the emotional trauma children experience when facing surgery and may facilitate a smoother induction with fewer airway complications. In a randomized, double-blind study, the preoperative sedative effects and the postoperative recovery profiles of two oral pediatric premedicants were compared. Children (n = 102) were randomly assigned to receive 0.5 mg/kg midazolam or .2 mL/kg of a combination of meperidine 6.0 mg/mL, atropine 0.08 mg/mL, and diazepam 0.6 mg/mL 15-45 minutes before separation from parents. ⋯ Midazolam subjects initially arrived in the PACU sleepier than pediatric anesthesia medicine subjects, but all other recovery scores were similar. There were no differences in analgesic requirements, side effects, or time to discharge between groups. We conclude that both premedicants are effective in most children, but that midazolam may offer more effective sedation in younger, distressed children.
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Review Case Reports
Tympanic membrane rupture following general anesthesia with nitrous oxide: a case report.
Although rare, tympanic membrane rupture during general anesthesia with nitrous oxide has been reported previously in the literature. Nitrous oxide administration and the effects on closed body cavities will be reviewed. Key factors in patient assessment which can determine safe use of nitrous oxide in the clinical setting will also be discussed.
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There are circumstances when induction of general anesthesia followed by direct laryngoscopy and intubation is contraindicated. This case report describes and presents a protocol for a method of endotracheal intubation that combines the benefits of light wand and fiberoptic techniques. The patient was a 73-year-old male with a history of two cervical fusions. ⋯ The bronchoscope allowed direct visualization of the pharyngeal, laryngeal, and tracheal anatomy. Since our initial experience, the hybrid technique has been modified by replacing the light wand with a conventional stylet. Subsequent uses of the technique have been successful and free of complications.
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Randomized Controlled Trial Comparative Study Clinical Trial
Postoperative nausea and vomiting: a comparison of propofol infusion versus isoflurane inhalational technique for laparoscopic patients.
Gynecologic laparoscopic procedures frequently precipitate postoperative nausea and/or vomiting. The use of specific anesthetic agents and premedicants may decrease the incidence. This study determined the occurrence of postoperative nausea/retching/vomiting (N/R/V) when propofol was used for anesthesia maintenance compared with isoflurane when both groups of patients received metoclopramide and ranitidine preoperatively and were induced with propofol. ⋯ No significant difference in the incidence of N/R/V was demonstrated between the propofol and isoflurane groups (P < 0.05). Sixty percent of the patients who received meperidine in the recovery room experienced nausea and/or vomiting. The use of propofol versus isoflurane for maintenance of anesthesia had no effect on the incidence of postoperative N/R/V when patients were premedicated with metoclopramide and ranitidine.