Postanesthetic complications after inpatient general anesthesia for odontectomy: report of cases.
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Adult↗
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Regional anesthesia in pediatric surgery: complications and postoperative comfort level in 174 children.
Postoperative pain control (PPC) in children is a difficult management problem. Systemic narcotics often result in respiratory depression, while nonnarcotic analgesics are associated with inconsistent PPC. This report reviews a 29-month (January 1989 through July 1991) experience with 174 children (aged < 18 years) who received regional PPC through indwelling catheters. There were 105 males and 69 females. Patient age ranged from 1 day to 17 years 10 months (mean age, 97 months). All catheters were placed using introduction needles ranging from 24 to 16 gauge. Agents were delivered as either continuous infusion (151 patients, 87%) or bolus injections (23 patients, 13%). Analgesics were age- and weight-determined dosages of bupivacaine with or without narcotic supplementation. All patients had surgical procedures except two who had catheters placed for pain control after trauma and one who had a catheter for intractable abdominal pain of unknown etiology. Twenty-five (15%) children had thoracic incisions, 76 (43%) abdominal, 16 (9%) flank, and 54 (31%) extremity. Catheter placement included 40 thoracic epidurals (23%), 100 lumbar (57%), 27 caudal (16%), and 7 pleural (4%). Catheters were utilized for a duration of 0.5 to 8 days (mean, 2.1 +/- 1.2 days). One hundred forty-four children required no additional pain medications (83%). Thirty (17%) patients required supplemental medications. Acetaminophen was used in 6 (3%), acetaminophen with codeine in 4(2%), morphine in 18 (10%), and Percocet in 1(1%). Minor complications occurred 21 times in 16 children (9%).(ABSTRACT TRUNCATED AT 250 WORDS)
Adolescent↗
[Anesthesia in the pleuropulmonary complications surgery of tuberculosis: a 79 cases study].
Reported is a retrospective study carried out from Aristide Le Dantec Hospital in patients who underwent pleuropulmonary surgery after tuberculosis complication, from June 1995 to June 1999. The aim of this study was to evaluate the anaesthesiology procedures and outcomes of tuberculosis pleuropulmonary complications surgery. Seventy nine patients were studied. Their mean age was 34.63 years, and the sex ratio was 3.14. They all underwent general anaesthesia procedures with barbituric, morphinics et myorelaxants drugs. The peroperative complications noted were distributed as follow: 50 cases of haemorrhage needing transfusion, 18 cases of hypotension associated to the anaesthesia. In the intensive care period, we have noticed 30 atelectasia cases associated to a spastic bronchopathy, 3 cases of pulmonary oedema and 1 case of pulmonary infarctus. In the postoperative period, 8 cases of hemodynamic instability occurred, including 5 cases of cardiovascular collapsus treated by filling, and 2 septic shocks cases. An infectious bronchopneumopathy was noticed on 11 patients with two cases of septicaemia. The mortality rate was 6.3% (5 cases of death). The pleuropulmonary surgery in tuberculosis complication is very haemorrhagic, and therefore require an adequate preoperative preparation.
Adolescent↗
[Comparative study in pediatric inhalation anesthesia. Clinical characteristics and anesthetic complications with halothane and isoflurane].
OBJECTIVES: Comparative study of clinical characteristics and complications during induction, maintenance, and recovery in pediatric inhalational anesthesia between two commonly used fluoride agents (halothane and isoflurane). MATERIAL AND METHODS: We studied 66 children aged 1 month to 13 years undergoing general anesthesia for short lasting surgery who were divided into two groups of 33 patients each one: Isoflurane group and halothane group. Induction and maintenance anesthesia was performed with the corresponding inhalant agent. Parameters measured were duration of unconsciousness, time elapsed for intubation and recovery, heart rate, arterial blood pressure, and incidence of complications. RESULTS: Children anesthetized with isoflurane showed a shorter period of unconsciousness (1.55 +/- 0.11 min) than those anesthetized with halothane (1.91 +/- 0.12 min); whereas that the time required for intubation was significantly more prolonged (8.94 +/- 0.51 and 6.57 +/- 0.32 min, respectively). The incidence of complications was higher in the isoflurane group, mainly expressed as laryngeal spasm during the induction period. Both groups of patients showed a similar hemodynamic behaviour, although diastolic arterial pressure during maintenance anesthesia was significantly lower with isoflurane. Anesthesia recovery was faster and more predictable with isoflurane than with halothane. CONCLUSIONS: Anesthetic agent isoflurane is less appropriate than halothane for induction in pediatric anesthesia due to a high incidence of complications, specially laryngeal spasm.
Administration, Inhalation↗
The impact of minor perioperative anesthesia-related incidents, events, and complications on postanesthesia care unit utilization.
UNLABELLED: The German Society of Anesthesiology and Intensive Care Medicine evaluates the standardized and routine reporting of perioperative anesthesia-related incidents, events, and complications (IEC). As part of the long-term project's definitions, IECs are graded according to severity and to their clinical consequence on further postanesthesia monitoring and treatment demands. The adult study population of our department comprised 37,079 patients recovering from anesthesia in a tertiary university hospital from July 1992 through June 1997. Cardiac, obstetric, craniotomy, thoracotomy, laparotomy, and emergency operations were excluded. Multivariate regression statistics were used to calibrate the impact of minor graded IECs on necessary postanesthesia care unit (PACU) utilization. Minor and severe IECs appeared in 22.1% and 0.2% of the patients. A minor IEC occurrence was a statistically significant (P < 0.001) predictor of PACU utilization in a multivariate regression model. The mean difference of PACU length of stay for patients with minor IECs was prolonged by a range of 6%-26% when adjusted for coexisting severity features such as age, gender, ASA physical status, and type and duration of anesthesia and surgery. We conclude that the IEC methodology integrates epidemiologic information about perioperative anesthesia outcome. Minor but frequently occurring IECs have an impact on PACU utilization and are thus important to measure and follow. IMPLICATIONS: It is desirable to know how anesthesia-related incidents, events, and complications influence postanesthesia care. Analyses of standardized and routine perioperative outcome data, as proposed by the German anesthesia quality project, can show that even minor events consume relevant resources and are thus important to measure and follow.
Adolescent↗
Corneal abrasions during general anesthesia.
The eyes of 200 healthy adult patients undergoing general anesthesia were stained with fluorescein strips for detection of corneal abrasion in the immediate postoperative period. Twenty-six of 59 patients in whom the eyes remained partly open showed positive staining--an incidence of 44 percent. The remaining 141 patients in whom the eyes were naturally closed or protected with adhesive tape or vaseline gauze did not develop exposure keratitis. It is suggested that covering of eyes is necessary in all cases undergoing general anesthesia so as to avoid this frequent complication of anesthesia.
Adult↗
Anesthesia-related morbidity and mortality after surgery for muscle biopsy in children with mitochondrial defects.
BACKGROUND: Children with mitochondrial defects (MD) may have an increased risk for cardiorespiratory and neurological complications from anesthesia. The aim of this study was to determine the incidence of perioperative complications and adverse events in children with MD. METHODS: We performed a retrospective review of the anesthesia, surgical and medical records of 155 children up to 10 years who underwent a diagnostic surgical muscle biopsy for suspected mitochondrial and muscle disorders between 1999 and 2003. The data of the 122 patients where a definite MD diagnosis was found were analyzed. Anesthesia was conducted according to the discretion of the attending staff. In children with MD the activity of the different complexes of the oxidative phosphorylation system was measured. RESULTS: From the preoperative assessment, signs of encephalopathy were most frequent (n = 93), followed by muscle weakness (n = 32), lactic acidosis (n = 15), cardiomyopathy and/or conduction defects (n = 10) and chronic respiratory problems (n = 7). The mean age of the children with MD was 32.4 months (SD = 26.9). The mean duration of anesthesia was 36.0 min (SD = 12.6) and the mean length of stay in the recovery room was 33.0 min (SD = 24.0). There were no major changes in heart rate or blood pressure which required pharmacological intervention during anesthesia or postanesthesia care unit (PACU) stay. A short episode of SpO2 <80% with airway obstruction occurred once in the PACU. Biochemical analysis in the children with a MD showed an isolated deficiency of one of the five protein complexes of oxidative phosphorylation in 42 children, a combination of complex deficiencies in 41 and no definite localization in 39 children. CONCLUSION: With standard preoperative assessment, monitoring and anesthesia management, there were no major peroperative and postoperative anesthesia-related complications in children undergoing surgical muscle biopsy with a MD diagnosis.
Anesthesia↗
[SURGICAL COMPLICATIONS IN THE OBESE].
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Anesthesia↗
[A CASE OF DIFFUSE SUBCUTANEOUS EMPHYSEMA AS A COMPLICATION OF POSTANESTHETIC RECOVERY].
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Anesthesia↗
Anaesthetic complications in surgical out-patients.
This study reports retrospectively the post-anaesthetic complications in surgical out-patients. We have studied the incidence and severity of these complications during the first five post-operative days in 500 female patients who underwent tubal ligation by laparoscopy. The report shows that post-anaesthetic complications in surgical out-patients are frequent but of mild severity. Although they produced some discomfort for the patients most of them were of the opinion that the advantages of having the operation as out-patients made up for the discomfort.
Ambulatory Care↗
Cervical epidural anesthesia for head and neck surgery.
Patients with head and neck cancer frequently suffer from chronic obstructive pulmonary disease and arteriosclerotic cardiovascular disease, making them poor risks for anesthesia. Arrhythmogenic inhalation anesthetics along with assisted ventilation used in general anesthesia further complicate the intraoperative, as well as the postoperative, course. Cervical epidural anesthesia has been employed in a number of cases of breast and upper thoracic surgery at Walter Reed Army Medical Center with remarkable success. It has also been used in chronic pain control. We described the use of cervical epidural anesthesia for a neck dissection. The technique of placing 0.5% Marcaine at the level of C7-T1 is described. Indications, limitations, complications, and the potential uses of cervical epidural anesthesia in head and neck cancer patients are discussed.
Anesthesia, Epidural↗
Choosing general versus regional anesthesia for the elderly.
Although clinical perceptions and theoretic considerations suggest regional anesthesia should be safer than general anesthesia in elderly patients, current studies indicate no difference in outcomes. Regional anesthesia may still prove superior to general anesthesia if the right patient population or right endpoints are identified for comparison. A study of consequence of outcome, comparing the two approaches has created an expansion of the definition of anesthesia-related complications.
Aged↗
Strümpell's disease in a patient presenting for Cesarean section.
PURPOSE: The anesthetic management of a parturient with Strumpell's disease (hereditary or familial spastic paraparesis) who presented for Cesarean section is described. This neurological disorder is briefly reviewed and anesthetic implications of the condition are discussed. CLINICAL FEATURES: A 30-yr-old woman in premature labour presented for Cesarean section. She had bilateral lower limb spastic paresis which had resulted in her being confined to a wheelchair from the age of 13 yr. A diagnosis of Strumpell's disease had been made in childhood. She was currently receiving thromboprophylaxis, having suffered a deep venous thrombosis four weeks after a previous Cesarean section. The patient was in mild respiratory distress. Despite a history of uneventful general anesthesia and the aforementioned complicating factors, epidural anesthesia was considered the most appropriate technique in these circumstances. An epidural catheter was sited at the L3-L4 interspace. Adequate anesthesia for the procedure was obtained after administration of 20 ml lidocaine 2% with 100 microg epinephrine and 100 microg fentanyl in saline. Postoperatively and at six month follow-up there were no neurological complications related to the use of epidural anesthesia. CONCLUSION: Strumpell's disease is an inherited progressive spastic paresis predominantly affecting the lower extremities. Epidural anesthesia appears to be an appropriate technique when administering anesthesia for Cesarean section under similar circumstances.
Adult↗
The effect of brief halothane anesthesia during daily gavage on complications and body weight in rats.
We examined retrospectively the effects of brief halothane anesthesia during daily gavage administration of vehicle on gavage-related complications and body weight in ovariectomized female Wistar rats. The number of gavage-related deaths or animals requiring euthanasia due to gavage problems was dramatically reduced, but the occurrence of incomplete vehicle retention during gavage was increased appreciably in halothane-anesthetized animals. Halothane-anesthetized rats maintained daily body weight for a longer period than did awake animals. Our observations suggest that the use of brief inhalational anesthesia reduces gavage-associated death and euthanasia due to esophageal trauma and minimizes stress-related weight loss.
Anesthesia↗
Silent compartment syndrome complicating total knee arthroplasty: continuous epidural anesthesia masked the pain.
Posterior dislocation is an uncommon complication of total knee arthroplasty (TKA) using a posterior stabilized total knee prosthesis, and it usually results from flexion instability. Acute posterior dislocation of a posterior stabilized prosthesis complicated by compartment syndrome of the leg has not previously been reported in the literature. We report a 62-year-old woman with posterior dislocation of her posterior stabilized TKA when her knee was in extension. It was further complicated by compartment syndrome with severe muscle necrosis. The diagnosis of compartment syndrome was delayed, partly because of continuous epidural anesthesia that completely abolished the pain and partly because of the low index of suspicion, as compartment syndrome is not well recognized as a possible complication of TKA. This case report strongly emphasizes that continuous epidural anesthesia is contraindicated in the case of complicated TKA because important clinical cues to neurovascular complications could be masked.
Anesthesia, Epidural↗
Anesthesia-related maternal mortality in Michigan, 1972 to 1984.
We reviewed maternal deaths in the state of Michigan occurring from 1972 through 1984. There were 15 maternal deaths in which anesthesia was considered the primary cause and 4 deaths in which anesthesia was a contributory factor. Complications of regional anesthesia were the main cause of death during the early part of the period, whereas the inability to accomplish endotracheal intubation emerged as the principal cause of death in recent years. Eleven of the 15 patients had undergone cesarean section. Obesity was a risk factor in 12 patients, in an equal number of patients the risk factor was the emergent nature of the operation, and hypertensive disease was a risk factor in eight. Thirteen of the 15 deaths occurred in black patients.
Adolescent↗
Some laryngotracheal complications associated with endotracheal anesthesia.
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Anesthesia↗
[Accidental catheterization of the subdural space: a complication of continuous spinal anesthesia and continuous peridural anesthesia].
Two cases of subdural catheter placement following continuous spinal and continuous epidural anaesthesia are presented. In the first, despite an easy reflux of clear cerebrospinal fluid through the catheter, the injection of 4 ml bupivacaine 0.5 per cent with epinephrine 1:200,000 followed by 3 ml tetracaine 0.5 per cent showed a failure of spinal anesthesia. In the second, the administration through the catheter of 20 ml lidocaine 2.0 per cent CO2 plus epinephrine 1:200,000 and of ten ml bupivacaine 0.5 per cent lead to an insufficient, patchy and asymmetrical analgesia. The clinical signs observed in these two cases are compared with previous publications. The importance of an x-ray contrast study to confirm the diagnosis of subdural catheter insertion is stressed.
Adolescent↗