Strategies for elective red blood cell transfusion.
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Blood Component Transfusion↗
Biomedical subjects
R J Faust
Publications and source records attributed to R J Faust.
The effect of desflurane and isoflurane on cerebrospinal fluid pressure in humans with supratentorial mass lesions.
Desflurane, a new volatile anesthetic, produces cerebral vasodilation. The purpose of this study was to compare the effects of 1 MAC desflurane with those of isoflurane on cerebrospinal fluid pressure (CSFP) in patients with supratentorial mass lesions and a mass effect on computerized tomography (CT scan). Twenty adult patients undergoing craniotomy for removal of supratentorial mass lesions were studied. Ten patients received desflurane and 10 patients received isoflurane. Prior to induction of anesthesia, a radial artery catheter was inserted and a 19-G needle was inserted into the lumbar subarachnoid space to measure CSFP. Baseline arterial blood gases and CSFP were measured with the patient awake and unmedicated. Anesthesia was induced with thiopental (6-9 mg/kg) and muscle relaxation achieved with vecuronium (0.2 mg/kg). The lungs of all patients were hyperventilated to achieve an arterial CO2 tension of 24-28 mmHg. Anesthesia was maintained with 1 MAC volatile anesthetic, either 7.0% desflurane or 1.2% isoflurane in an air:O2 mixture to maintain an inspired O2 fraction (FIO2) of 0.50. Patients were not administered any other anesthetic until the dura was incised. Mean arterial pressure was kept within 20% of the patient's mean ward values with the use of esmolol or phenylephrine. CSFP, mean arterial pressure, end-tidal CO2 concentration (PETCO2), hemoglobin O2 saturation, and cerebral perfusion pressure were recorded with the patient awake, immediately postinduction with thiopental, postintubation, after institution of the volatile anesthetic, and every 5 min until the dura was incised. There was no difference in the mean (+/- SD) awake CSFP between the desflurane (11 +/- 4 mmHg) and the isoflurane (10 +/- 2 mmHg) groups.(ABSTRACT TRUNCATED AT 250 WORDS)
Administration, Inhalation↗
Transfusion risks.
Hepatitis remains the most serious transfusion risk, in terms of incidence and severity. Transfusion-associated AIDS, hemolytic reactions, TRALI, and anaphylaxis are severe problems that occur relatively rarely, while febrile reactions and mild allergic reactions are common but not serious. The key to avoiding all these complications is autotransfusion (see the article "Autologous Transfusion" in this issue). Although intraoperative scavenging became available in many centers in the United States in the 1980s, it is hoped that pre-deposit autotransfusion will also become widely utilized in the next decade.
Acquired Immunodeficiency Syndrome↗
Status of the match in anesthesiology: 1988.
The majority of anesthesia program directors agreed 2 years ago to use the National Resident Matching Program (NRMP) as the mechanism for appointing senior medical students to second postgraduate year positions in anesthesiology. Eighty-seven applicants for the Mayo Clinic program were surveyed to measure the level of cooperation with the NRMP by programs and applicants. Low percentages of applicants reported pressures to sign contracts (22.4%) or make verbal commitments before February (32.8%). The frequency of these incidents was extremely low when considered in light of the number of applicant interviews reported by the applicants who responded. Nonparticipation in the match is a more important problem than infractions of NRMP rules.
Anesthesiology↗
Post-thoracotomy intercostal block: comparison of its effects on pulmonary function with those of intramuscular meperidine.
Study of 34 patients who had undergone thoracotomy revealed that the group given intercostal nerve block analgesia had a significantly smaller decline in vital capacity after operation than did the group given narcotic analgesia only. The postoperative increase in arterial CO2 tension of the nerve block group also was significantly smaller than that of the narcotic group. The study suggests that intercostal nerve block for post-thoracotomy analgesia offers some advantage in preserving effort-dependent pulmonary function when compared with postoperative narcotic analgesia.
Anesthesia, Intravenous↗