Articles: general-anesthesia.
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Arch Phys Med Rehabil · Jul 1978
Case ReportsParaplegia: succinylcholine-induced hyperkalemia and cardiac arrest.
The rapid development of hyperkalemia leading to cardiac arrest can occur in patients with spinal cord injuries and other conditions when succinylcholine is used during the induction of anesthesia. Three patients with thoracolumbar spinal cord injuries resulting in lower motor neuron lesions or lesions above the lower extremity motor units developed hyperkalemia followed by cardiac arrest after succinylcholine administration. The mechanism by which succinylcholine leads to hyperkalemia from denervated muscle is described and precautions to be taken are mentioned. Physicians caring for patients with denervated muscle due to spinal cord injuries should be aware of this danger and nondepolarizing muscle relaxants should be used instead of succinylcholine.
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We recommend the use of one dose of physostigmine salicylate, a few minutes before the termination of a general anesthetic, to prevent confusion, struggling, disorientation, or delirium during the recovery from anesthesia. We believe that it is well to prevent such behavior, particularly in patients who have just undergone reconstructive surgery where the unmanageable behavior could jeopardize surgical results. Our results indicate that such behavior is largely preventable.
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In this article, we have presented an overview of obstetric analgesia and anesthesia. If one central theme could be developed, it shoud be that analgesia either for labor and delivery or cesarean section must be chosen and performed with absolute exactness and safety. There is no margin for error. ⋯ Such service must provide contiguous around-the-clock coverage for tertiary hospital centers. On the one hand, most anesthesiologists are not well suited to many of the special demands of the obstetric suite, and, on the other hand, many obstetricians lack the full understanding and capabilities that the anesthesiologists possess. One solution for this dilemma might be to encourage obstetric colleagues to seek anesthesia training in order to organize obstetric anesthesia coverage.