Anesthesia for percutaneous renal procedures.

Anesthesia for radiologic procedures is usually provided in locations remote from the operating theater. The anesthesiologist is removed from the environment in which experienced support is available for the care of anesthetized patients. Therefore, reliable anesthetic techniques that cause the least perturbation in the patient's physiology are often preferred. This is a report of the application of a paravertebral and lumbar sympathetic block to provide anesthesia for the renal pelvis and ureter so that percutaneous radiologic procedures that involve the manipulation and dilation of those areas can be performed with minimal patient discomfort.

Success of reentry into anesthesiology training programs by residents with a history of substance abuse.

To determine incidence and outcome of reentry into anesthesiology training programs by residents with histories of substance abuse, a survey was sent to the 159 US anesthesiology training programs. One hundred thirteen (71%) responded, with 82 (73%) submitting at least one case report of substance abuse. A total of 180 case reports were submitted, including 26 in which the resident died as a result of substance abuse. The prevalence of substance abuse among trainees was 2%. Sixty-one (74%) of the responding training programs submitted a total of 113 case reports of resident reentry into anesthesiology training. The success rate of reentry in the parenteral opioid abuser group was 34% (27/79). The success rate of reentry for the nonopioid abuser group was 70% (16/23). There were 14 cases of suicide or lethal overdose among trainees who were allowed to reenter anesthesiology training. Death as the initial relapse symptom occurred in 16% (13/79) of the parenteral opioid abusers who were allowed to reenter anesthesiology training. This study suggests that drug rehabilitation followed by redirection into another specialty may be the most prudent course for the anesthesiology trainee who abuses parenteral opioids.

A comparison of pulse oximeters during helicopter flight.

Pulse oximetry would be an invaluable parameter to monitor during patient transport. While original models of oximeters were not battery powered nor very portable, this has changed. Seven currently available commercial pulse oximeter models were evaluated in the noisy vibration-prone environment of a helicopter. Three (3) units were judged to be unacceptable on the basis of weight, duration of battery life, or lack of ease of use. In two (2) units, the sampling algorithms appeared to interface with their performance. Of the seven (7) units tested, two (2) units were found to be reliable, portable, and easy to use. The use of portable pulse oximetry monitors should rapidly become routine during the transport of critically ill patients.

Clinical evaluation of commonly used blood administration sets.

Five commonly available blood transfusion sets, the Fenwall Blood Recipient set, the Abbott HEMAR Y-type Blood Set, the Bentley Infusion Blood Set (PFF-100), the Medex Hi-Flo TraumaR Quad Set (MX 884) and the Pall Ultipor Transfusion Set with Filter are compared. Flow rates and lifespan are evaluated by measuring the time required for 150 mL aliquots of homogeneous units of human red blood cells to pass through the devices under 300 mmHg constant pressure. Microfiltration of blood is briefly reviewed.

Rapid tracheal intubation with vecuronium: the timing principle.

A method of administration of vecuronium for intubation that allows excellent intubating conditions in 60 seconds after the induction of anesthesia is described. Patients were divided into three groups based on the dose of vecuronium given. These patients were given either 0.10 mg/kg, 0.15 mg/kg, or 0.20 mg/kg of vecuronium intravenously. Intubating doses of vecuronium were given prior to the induction of anesthesia with sodium thiopental. Administration of the sodium thiopental was timed to the onset of clinical weakness in each patient.

Sphenopalatine ganglion blocks for the treatment of nicotine addiction.

The purpose of this study was to investigate the effects of sphenopalatine ganglion block upon the physical symptoms of nicotine withdrawal in a double-blind placebo-controlled study. Seventeen patients completed a course of treatment which involved daily intranasal application of local anesthetic (bupivacaine or cocaine) or saline over the sphenopalatine ganglion. The reported numbers of daily symptoms of physical discomfort were recorded during the preprocedure period. Analysis of variance results indicated that patients in all three groups experienced a significant decline in the number of symptoms of physical discomfort over the six-day withdrawal period. Further findings provided evidence of significantly fewer symptoms of discomfort for patients in the anesthetic treatment groups than in the placebo control group, though no statistically significant difference emerged between the two anesthetic treatment groups. Accelerated alleviation of discomfort during nicotine withdrawal may increase the success of smoking cessation.

Radionuclide-anesthetic flow study: a new technique for the study of regional anesthesia.

A new technique to study the dynamics of in vivo distribution of regional anesthetics is described. Five hundred microcuries of technetium-99m diethylenetriaminepentaacetic acid (DTPA) added to the anesthetic in a syringe prior to injection allows both dynamic and static imaging to assess the initial distribution of the injected anesthetic. Superimposed bone scans or transmission scans help delineate anatomy. The radionuclide-anesthetic flow study is a simple, safe technique to investigate both the spread of regional anesthetics and the factors that affect it.