The dose-related effects of bolus esmolol on heart rate and blood pressure following laryngoscopy and intubation.

Many researchers have studied esmolol and its effects on heart rate and blood pressure. All studied relatively large doses of esmolol. Therefore, the purpose of the present study was to determine whether small doses of esmolol would blunt the transient increases in blood pressure and heart rate caused by laryngoscopy. This double-blind, prospective, randomized study included 61 subjects. The subjects were randomized to 1 of 3 groups: group 1 received esmolol, 0.2 mg/kg; group 2 received esmolol, 0.4 mg/kg; and group 3 received saline placebo. Groups 1 and 2 had smaller increases in heart rate than group 3. We also found that the 0.4 mg/kg dose significantly blunted the increase in mean arterial pressure seen in group 3. This study shows that small doses of esmolol may block the increases in heart rate and blood pressure resulting from laryngoscopy and intubation.

Illicit drugs and anesthesia.

Substance abuse is the nation's number one health problem. With illicit drug use so prevalent, the anesthesia care team undoubtedly sees more people under the influence of illicit drugs. Cocaine, heroin, and marijuana are the drugs that are commonly used. Cocaine acts as an intense stimulant, heroin has profound sedative effects, and marijuana may cause various respiratory problems. Many times when drug users present for anesthesia, they will not admit to using illicit drugs, leaving the anesthetist to treat complications intraoperatively. This article discusses the history, street practices, pharmacodynamics, and anesthetic management of people using cocaine, heroin, and marijuana. This knowledge of how to treat patients abusing drugs will undoubtedly improve anesthetic outcomes. There are many illicit drugs used by people that anesthetists do not see frequently in the care of their patients, but the anesthetist should be aware of the common street drugs in use.

Latex allergy: who, what, when, where, why, and how.

Patients with an allergy to latex are being encountered more often by healthcare providers than ever before in the past. Latex allergy is also common among healthcare providers. This article will describe who, what, when, where, why and how to deal with these patients and colleagues. Latex allergy can be as minor as a rash on the hands or as life threatening as an anaphylactoid reaction. Healthcare in a latex-free environment is necessary when providing care for these patients. Therefore, it is necessary to remove all latex products from the area where care will be provided. It may also be beneficial to pretreat the patient with steroids and other medications. The best prevention for an allergic reaction to latex is to take a thorough history for every patient before providing care.

Thoracoscopy: anesthetic considerations.

Thoracoscopy is surgical procedure which was performed in the early 1900s primarily for the treatment of tuberculosis until antibiotics became the treatment of choice. Over the last two decades, thoracoscopy has experienced a rebirth as the indications for this endoscopic procedure have become numerous. Although less invasive than the thoracotomy, thoracoscopy is not without potential complications. The anesthesia provider must be alert for problems related to one-lung ventilation, lateral positioning, and pleural cavity insufflation. The anesthetic technique must be planned with the physiological changes which occur during thoracoscopy in mind.

Blood component therapy and changing transfusion triggers.

Transfusion trigger points and appropriate blood component therapy must be continuously evaluated by the anesthesia team during a surgical procedure. This article examines the composition of homologous blood, the storage of blood products, and transfusion reactions. Additionally, the incidence of transfusion transmitted infections is explored. Finally, a review of the current recommendations for transfusions in the clinical setting is provided.