Nurse anesthesia
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Case Reports
The effect of intraoperative retrobulbar block on anesthetic management of enucleation under general anesthesia.
This case chronicles the effect of a retrobulbar block on a coincident general anesthetic for enucleation in an elderly man. This ASA II patient had a medical history of insulin-dependent diabetes with few apparent cardiovascular complications and mild chronic obstructive pulmonary disease. Induction of anesthesia was accomplished with small doses of midazolam, droperidol, and alfentanil followed by thiamylal. ⋯ Within 10 minutes the patient suffered a profound decrease in blood pressure and pulse requiring repeated doses of glycopyrrolate, phenylephrine, and ephedrine to maintain effective perfusion. These effects do not appear to have resulted from direct elicitation of the oculocardiac reflex, but rather from the loss of surgical stimuli from the block that essentially resulted in inadequate sympathetic tone. The author concludes that anesthetists in similar circumstances should anticipate the possibility of hypotension and lessened anesthetic requirements following retrobulbar block when coincident general anesthesia is planned.
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Over the last 15 years a rapid growth has occurred in the number of pediatric patients that are encountered in the operating room. A developing sophistication on the part of both children and parents, coupled with a rapidly expanding recognition of the need to minimize the amount of physical and psychological trauma that a child has to experience, has led to a growing use of premedication agents for children. A review of the premedication agents currently in use, their various routes of administration, as well as their associated benefits and risks, is presented.
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The purpose of this study was to determine if the use of intraoperative steroids was effective in decreasing the incidence of postanesthetic nausea and vomiting and whether or not those complications were gender related. This retrospective study involved a chart review of 208 patients undergoing lumbar laminectomy at a large metropolitan hospital during a 10-month period in 1989-1990. Sixty-one patients met inclusion criteria and were accepted into the study. ⋯ Results demonstrated that those patients who received intraoperative steroids were less likely to experience problems of nausea and vomiting than those who did not receive the drug. Requirements for postoperative pain medication were also reduced in the steroid group. Female patients in both groups were shown to have a greater incidence of nausea and vomiting than male patients.
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Maintaining normal thermal balance in the anesthetized patient remains a primary physiological consideration for the anesthetist. Because hypothermia occurs frequently during surgery and anesthesia, it is imperative that the anesthetist fully appreciate the variety of factors associated with unintentional hypothermia. This knowledged, coupled with an understanding of physiological ramifications and meaningful therapeutic interventions will enable the anesthetist to provide optimal care for patients, particularly those at risk for developing hypothermia intraoperatively. This survey article will trace current research as it applies to the principles underlying proper management of the hypothermic patient.