Hallucinations after hypospadias repair.

The authors report a case of a 4-year-old child who developed hallucinations after hypospadias repair. He was brought to the emergency department the morning after outpatient surgery where the diagnosis of central anticholinergic syndrome was made. We review oxybutynin overdose and the importance of providing clear instruction to parents and caregivers about the administration of medications.

A comparison of airway responses during desflurane and sevoflurane administration via a laryngeal mask airway for maintenance of anesthesia.

Although sevoflurane is less pungent than desflurane at larger concentrations, neither anesthetic seems to irritate the airway when administered at the smaller concentrations often used during maintenance of anesthesia. Both anesthetics may be delivered effectively via a laryngeal mask airway, with minimal evidence of airway irritation.

Using the laryngeal mask airway to manage the difficult airway.

Before 1990, the choice of an airway device essentially was limited to the facemask or the endotracheal tube. Since then, a number of novel supraglottic airway devices have been developed. The laryngeal mask airway (LMA) was introduced to the United States in 1991 after 3 years of use in the United Kingdom and other countries.

Clinical and economic factors important to anaesthetic choice for day-case surgery.

Clinical and economic factors that are important to consider when selecting anaesthesia for day-case surgery can differ from those for inpatient anaesthesia. Patients undergoing day-case surgery tend to be healthier and have shorter durations of surgery. They expect less anxiety before surgery, amnesia for the surgical experience, a rapid return to normal (normal mentation with minimal pain and nausea) after surgery, and lower expenses.

A multicenter comparison of maintenance and recovery with sevoflurane or isoflurane for adult ambulatory anesthesia. The Sevoflurane Multicenter Ambulatory Group.

Sevoflurane was compared with isoflurane in 246 adult ASA class I-III patients undergoing ambulatory surgery. After administration of midazolam 1-2 mg and fentanyl 1 microgram/kg, anesthesia was induced with propofol 2 mg/kg and maintained with either sevoflurane or isoflurane in 60% nitrous oxide to maintain arterial blood pressure at +/- 20% of baseline. Fresh gas flows were 10 L/min during induction and 5 L/min during maintenance.

Axillary lymphadenectomy for breast cancer without axillary drainage.

Objective: To evaluate axillary lymph node dissection done without closed drainage in conjunction with breast conservation cancer surgery.

Design: Prospective clinical study.

Setting: Two university hospitals.

Parental upset associated with participation in induction of anaesthesia in children.

To evaluate the magnitude of parental upset associated with (1) the features of induction most upsetting to parents; (2) the characteristics of parents most likely to become upset; and (3) the accuracy of the anaesthetist's perception of the magnitude of parental upset. The parents (101 mothers and 43 fathers) of 103 children scheduled for elective outpatient surgery requiring general anaesthesia with induction by mask were asked on admission to participate in this study. Parents and children were educated about anaesthesia and surgery according to unit protocols.

Pharmacologic patient management in pediatric dentistry: an update.

This paper reviews the issue of sedation in pediatric dentistry in the light of recent controversies and rapidly increasing legal, professional and governmental regulations. Consideration is given to "Guidelines for safe administration of pharmacologic agents in dental practice". The various avenues of drug administration are reviewed with specific comment on recent approaches.

Anesthesia for pediatric outpatient surgery.

Children are ideal patients for outpatient surgery. Thorough preoperative medical evaluation and selection of appropriate surgical and anesthetic procedures allow most pediatric surgery to be performed safely on an outpatient basis. Psychological preparation, the presence of parents whenever possible, and the appropriate use of premedication minimize the emotional trauma inherent in having anesthesia and surgery.

Cardiovascular actions of nitrous oxide or halothane in hypovolemic swine.

During normovolemia, nitrous oxide causes mild sympathetic stimulation and direct myocardial depression; these effects offset each other, resulting in only minimal cardiovascular changes. To test the hypothesis that during hypovolemia this balance would change and depression predominate, 10 swine were made hypovolemic (30% blood loss) and then were given 70% N2O (0.25 MAC in swine) or an equipotent concentration of halothane, an agent that does not cause sympathetic stimulation.

Haemorrhage decreases the anaesthetic requirement for ketamine and thiopentone in the pig.

The anaesthetic requirements of ketamine and thiopentone were studied in eight pig littermates during normovolaemia and after haemorrhage (30% blood loss). Four animals received ketamine and four thiopentone, and the minimal anaesthetic doses of both drugs were determined. Moderate hypovolaemia decreased the anaesthetic requirements significantly and similarly: thiopentone 33 +/- 5%; ketamine 40 +/- 5% (mean +/- SEM).

Pre-hospital tracheal intubation versus esophageal gastric tube airway use: a prospective study.

A prospective study compared the respiratory effectiveness of the endotracheal tube (ET) with that of the esophageal gastric tube airway (EGTA) for victims of nontraumatic cardiac arrest in the pre-hospital setting. Arterial blood gases were obtained within 3 minutes of hospital arrival, and survival (defined as discharge from the hospital) was determined. During EGTA ventilation, mean pH was 7.

Recall of surgery for major trauma.

Major traumatic injury frequently causes hemodynamic instability that necessitates reducing the usual dose of anesthetic given for surgery. Nevertheless, a lower dose may be sufficient to provide anesthesia because of conditions present in trauma victims that are known to reduce anesthetic requirement (hypotension, hypothermia, and acute alcohol intoxication). To determine the incidence and patient perception of recall of surgery, 51 patients were interviewed after surgery for major trauma.

Minimum alveolar concentrations (MAC) of halothane and nitrous oxide in swine.

To compare anesthetic effects using a swine model, we needed to know the minimum alveolar concentrations (MAC) of halothane and nitrous oxide that produce anesthesia in the pig. This information does not exist in literature. Furthermore, MAC varies considerably among species: by more than 60% for halothane, and by more than 200% for nitrous oxide.

Cardiovascular and metabolic sequelae of inducing anesthesia with ketamine or thiopental in hypovolemic swine.

If further sympathetic stimulation is neither possible nor desirable during moderate hypovolemia, anesthetic agents capable of sympathetic stimulation would not be advantageous for induction of anesthesia during hypovolemia. To test this hypothesis, 21 swine were studied during normovolemia and after 30% of their estimated blood volume was removed. Swine were divided randomly into three equal groups to receive no anesthetic or the minimal anesthetic dose of ketamine (6.