ABSTRACT
Magnesium sulfate is used frequently in the operation room and risks of wrong injection should be considered. A woman with history of pseudocholinesterase enzyme deficiency in the previous surgery was referred for cesarean operation. Magnesium sulfate of 700 mg [3.5 ml of 20% solution] was accidentally administered in the subarachnoid space. First, the patient had warm sensation and cutaneous anesthesia, but due to deep tissue pain, general anesthesia was induced by thiopental and atracurium. After the surgery, muscle relaxation and lethargy remained. At 8-10 h later, muscle strength improved and train of four [TOF] reached over 0.85, and then the endotracheal tube was removed. The patient was evaluated during the hospital stay and on the anesthesia clinic. No neurological symptoms, headache or backache were reported. Due to availability of magnesium sulfate, we should be careful for inadvertent intravenous, spinal and epidural injection; therefore before injection must be double checked
ABSTRACT
Delayed awakening from anesthesia remains one of the biggest challenges that involve anesthesiologists. Most commonly, delayed awakening is due to drugs effects persistence. Metabolic [like hypo- hyperglycemia], electrolyte, acid-base disorders and hypothermia may cause delayed emergence from anesthesia. Structural disorders of cerebral nervous system [like increase in intracranial pressure, brain ischemia] and psychological disorders can be regarded as other uncommon causes of this condition. Hypokalemia is induced by low potassium intake, excessive excretion from gastrointestinal [GI] and kidneys [like using diuretics] or a shift from extracellular space into intracellular space. In these two reported cases, although proper measures had been taken to reverse the effects of anesthetic drugs, the patients did not regain their consciousness as fast as expected. The only significant finding in postoperative tests, along with respiratory alkalosis, was low serum potassium level [K=2.5 and K=2.9 in the first and the second patients, respectively]. Correction of serum potassium [to K=3.3 and K=3.2 in the first and the second, respectively] improved patients level of consciousness, and they were discharged from intensive care unit [ICU] with good general condition. During surgery; pain, stress, sympathetic increase, catecholamine release and the consequent beta-stimulation, certain drugs, and respiratory alkalosis due to hyperventilation may cause acute shift of potassium into the cells, which will be intensified in the patients with preoperative hypokalemia. Hypokalemia induces consciousness impairment and increases muscle relaxation, both of which affect patient awakening. Serum potassium evaluation is recommended in cases of delayed emergence from anesthesia.
Subject(s)
Humans , Male , Female , Acid-Base Imbalance , Water-Electrolyte Imbalance , Hypokalemia , AlkalosisABSTRACT
Because of airway stimulations during bronchoscopy and lack of direct access to the airway, preferred method of anesthesia for rigid bronchoscopy is already controversial. In this study we compared inhalation anesthesia with total intravenous anesthesia [TIVA] for rigid bronchoscopy. 30 patients aged 2-6 years were chosen divided into two same groups. Anesthesia in group I maintained with halothane and in group II maintained with remifentanil and propofol. Oxygenation, heart rate, respiratory rate, coughing, bucking, laryngospasm, bronchospasm were evaluated during and after surgery. Also operation success and surgeon's satisfaction were recorded as well. Demographic findings were the same in both groups. Oxygenation and heart rate were more stable in group II [P=0.047 and P=0.026 respectively] but there was no significant difference in respiratory rate between two groups [P=1]. Success rate was also similar in both groups but surgeon's satisfaction was significantly higher in TIVA [P=0.003]. There was not any significant different between complications in two groups. We suggest TIVA for rigid bronchoscopy because of better oxygenation, more homodynamic stability, surgeon's satisfaction, lack of air pollution and less interference with surgeon's visual field
ABSTRACT
Objective: Postoperative apnea is a major concern in infants undergoing surgery. In this study, we evaluated incidence and related factors for postoperative apnea in infants less than 60 weeks postconceptual age after herniorrhaphy
Methods: One-hundred fifty infants with post conceptional age [PCA] less than 60 weeks who underwent elective herniorrhaphy were studied over eight months in 2012. General anesthesia was induced by sevoflurane and maintained by remifentanil, atracurium, and N2O 60%. Postoperatively, they were monitored for two hours in the recovery room and ten hours in the ward using pulse oximetry and nasal capnography
Findings: Totally, 31 [20.7%] cases of postoperative apnea were reported. By comparing the patients, factors associated with postoperative apnea included postconceptional age, birth weight, and history of apnea, oxygen therapy, metabolic diseases, icterus, or cardiac disease. Twenty-seven [18%] apnea cases occurred in recovery room in infants with gestational age [GA] of 35.64+/-2.73 weeks, while only four [2.6%] patients of GA 36.02+/-2.0 weeks developed delayed apnea]
Conclusion: In our study, the incidence of postoperative apnea following inguinal herniorrhaphy under general anesthesia in infants younger than 60 weeks PCA was 20.7%, which is considerable. We recommend longer surveillance and monitoring in recovery room for these infants with high-risk of postoperative apnea. This should be followed by evaluation of risk factors to determine the indication for elective intensive care unit transfer for longer-term monitoring of higher-risk patients