Biomedical subjects
Publications and source records attributed to R W Klotz.
The search for an optimal analgesic and route of administration continues. The development of the epidural route of administration of local anesthetic solutions and opioids approaches this ideal. In this article, the author details why epidural blockade is a multifaceted anesthetic technique useful in obstetrics, surgery, and pain therapy.
A total intravenous anesthetic using propofol and alfentanil was evaluated to determine if it would provide a shorter recovery-room stay than a more traditional balanced anesthetic using isoflurane and alfentanil. Forty-three ASA I or II patients between 17 and 50 years of age undergoing major abdominal or orthopedic procedures were studied. The propofol group received alfentanil 50 mg/kg followed by propofol 1 mg/kg for anesthesia induction. Continuous propofol infusion was initiated at induction using 170 mg/kg/min for 10 minutes, followed by 130 mg/kg/min for 10 minutes, then maintained at 100 mg/kg/min until 10 minutes before the end of surgery. Ventilation was supported with an air-oxygen mixture. The group receiving balanced anesthesia received alfentanil 1 mg/kg, and anesthesia was induced with sodium thiopental 4 mg/kg. A 1% isoflurane inhalation with air-oxygen was initiated immediately upon induction. Both groups received a continuous infusion of alfentanil titrated to maintain heart rate within 10% of preinduction levels. Recovery from anesthesia was measured using a subjective pain assessment, a verbal fluency test, and a short-term memory test. No differences were detected in the rate of recovery at 30 minutes or 60 minutes postextubation. Hemodynamic stability during induction and intubation was slightly better in the propofol group than in the isoflurane group. One episode each of intraoperative awareness and delayed eye opening occurred in the propofol group. Total intravenous anesthesia using propofol and alfentanil is just as effective as a balanced inhalation anesthetic and provides equally rapid recovery. However, practitioners are cautioned to include an amnestic adjuvant when using propofol as the sole anesthetic agent.
The anesthetic technique chosen for a malignant hyperthermia (MH) susceptible patient should include drugs that do not trigger MH, while providing stress-free conditions. This case report describes a MH susceptible patient who was successfully induced and maintained with propofol for third molar extractions while under general anesthesia. Based on this case report, and the other relative few in the literature, it appears unlikely that propofol will trigger an episode of MH. Propofol provides the anesthetist with an alternative for inducing MH susceptible patients, but continued experience is necessary to document its safety and efficacy in these patients.
Herpetic whitlow is a herpes infection of the digits of the hand, first described in 1909, caused by either herpes simplex virus type 1 or type 2. It was not until 1959 that herpetic whitlow was reported to occur in health care professionals. Nurse anesthetists are among the many health care professionals considered to be at high risk for acquiring herpetic whitlow, making it an occupational, but preventable, disease. After an initial infection, the virus invades the nerve tissue supplying the affected area, thus creating a reservoir for the virus to remain latent until reactivated. The recurrence of herpetic whitlow suggests that the infection persists for life. Pain, tingling and burning of the distal phalanx are the initial symptoms. Swelling and vesicles on an erythematous base follow. The infection is self-limiting, usually resolving in about three weeks. Primary infections are very inflammatory and persistent. Diagnosis can be made clinically and confirmed by many laboratory tests. Early recognition is most important, and treatment is symptomatic. The drug acyclovir has proven to be an effective chemotherapeutic agent for suppressive therapy.