Nitric oxide (NO) inhalation has been used after mitral valve surgery in attempts to control pulmonary hypertension. The cost of NO therapy in some countries has made its use prohibitive and has led to attempts to use aerosolized nitroglycerin.
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Several techniques have been described for percutaneous internal jugular vein catheterization. Some of them are associated with complications, such as tracheal tube cuff puncture. We describe two cases of this rare but potential devastating complication, after which our patients recovered uneventfully
Continue readingThe value of transesophageal echocardiography (TEE) in cardiac surgery is well proven[1]. TEE is evolving as a perioperative monitoring and diagnostic tool in noncardiac surgery as well, especially for the treatment of high-risk cardio-vascular patients. Its significance lies in that it is the only direct method for imaging and eva-luating heart function.
Continue readingMedical equipment can interfere with an electrocardiogram (ECG) and mimic a dysrhythmia [1-7]. Unnecessary interventions may occur when artifact is misdiagnosed as ventricular tachycardia (VT) [8,9]. We encountered such an ECG artifact when an orthopaedic shaver was engaged during knee arthroscopy.
Continue readingΌπως όλοι γνωρίζουμε, υπάρχουν σοβαροί περιορισμοί στη δημιουργία ανθρώπινων μοντέλων σχετικά με την επιτέλεση πειραμά-των, που αφορούν τους μηχανισμούς και τις οδούς αίσθησης του πόνου. Τα ερεθίσματα, που μπορούν να εφαρμοστούν σε εθελοντές, είναι απαραίτητα μικρής έως μέσης έντασης και συνήθως εξαρτώνται από τις χειρουργικές συν-θήκες και την υποκείμενη νόσο.
Continue readingAlthough the experience of nociceptive pain ultimately depends on interpretation by the cerebral cortex, it occurs primarily as a result of a noxious stimulus (one which when prolonged produces damage resulting in the humoral and cellular responses of inflammation) activating myelinated A-δ and unmyelinated C noci-ceptors.
Continue readingNSAIDs are widely used compounds in the management of several acute and chronic pain syndromes. NSAIDs induce their action by blocking the cyclooxygenase enzymes, cox-1 and cox-2, during the conversion of arachidonic acid to prostaglandins. Conventional NSAIDs inhibit both cox isoforms and are therefore at risk of serious complications as gastrointestinal irritation, postoperative bleeding, renal failure, water and sodium retention and hepatic failure.
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The pericardial diseases result in cardiovascular perturbations ranging from asymptomatic electrocardiographic findings (in pericarditis of end-stage renal disease) to circulatory shock (in acute hemorrhagic pericardial tamponade). Despite of clinical features that resemble right-, or left-side failure, the clinical management of pericardial pathology may differ significantly from those of ventricular systolic or diastolic dysfunction. Therefore, prompt diagnosis and appropriate medical or surgical therapy is imperative.
Continue readingSince the advent of clinical anesthesia, there has been a continuous need for evaluating the depth of anesthesia. Depth of anesthesia was always important in avoiding either overdose (toxicity) or “underdose” (administering less than absolutely necessary). The problem of overdosing has been partly solved by assignment of dedicated and specially trained doctors to provide anesthesia services, by accumulating more than a 100 years of experience in administering anesthesia, by using safer drugs (volatile and intravenous) with extremely smaller toxicity than the older ones and by recognizing and establishing the stages of anesthesia (such as Guedel stages) and the hemodynamic parameters as indirect but useful indices of the depth of anesthesia. The current trend of minimizing expenses of anesthesia calls for tight titration of drug administration.
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