Joanne M. Conroy

The Effects of Desmopressin and 6% Hydroxyethyl Starch on Factor VIII: C

In moderate doses of 20 mL/kg (1.2 g/kg), hydroxyethyl starch (HES) 6% decreases factor VIII:C activity. Desmopressin (DDAVP) increases circulating levels of factor VIII:C by stimulating the release of factor VIII:C from peripheral storage sites. The objective of this study was to monitor the changes in factor VIII:C associated with sequential HES and DDAVP administration. Thirty patients undergoing surgical procedures with a predicted blood loss of less than 750 mL were enrolled. After induction of anesthesia, HES was administered, 20 mL/kg, to a maximum of 1500 mL, at a rate to meet intraoperative fluid requirements. Patients then randomly received either a 10-mL solution containing 0.3 micro gram/kg of DDAVP (Group 1) or 10 mL of normal saline (Group 2). After HES administration, factor VIII:C levels decreased significantly, to 69% of baseline, in both groups. After study drug administration, factor VIII:C in Group 1 increased significantly to 135% of baseline at 30 min and 115% of baseline at 60 min while in Group 2 average factor VIII:C levels remained below baseline at 30 and 60 min. DDAVP produced an increase in factor VIII:C activity despite HES administration and should be considered a treatment option for the mild coagulopathy infrequently associated with HES administration. (Anesth Analg 1996;83:804-7)

ELECTROCAUTERY-INDUCED AIRWAY FIRE DURING TRACHEOSTOMY

Although most of the recent attention regarding airway fires has focused on the intraoperative use of the laser, it is important to remember that electrocautery may also serve as a source of ignition during surgery involving the airway and/or oropharyngeal cavity. This subject is mentioned in only a handful of isolated reports in the recent literature (1-3). The following is, we believe, the first case report of an electrocautery-induced fire occurring during an elective tracheostomy.

A comparison of wound instillation and caudal block for analgesia following pediatric inguinal herniorrhaphy

Regional analgesia, in a variety of forms, has been shown to afford effective postoperative pain relief after pediatric inguinal hernia repair. This study compares the efficacy of wound instillation with 0.25% bupivacaine (n = 20), caudal block with 0.25% bupivacaine (n = 35), and a control group (n = 15). Outcome parameters examined include total operating room time, time to extubation, postoperative objective pain scales, and requirement for supplemental analgesics. Patients who received caudal blocks had significantly decreased emergence times (P < .002), exhibited fewer pain-related behaviors postoperatively (P < .0025), and required less narcotic to maintain normal hemodynamics (P < .05). Operating room time was not statistically different between the three groups. The use of perioperative analgesic blocks resulted in quicker awakening, a more comfortable postoperative course, and potentially earlier discharge from same-day surgery.

Comparison of blood pressure measurement by Doppler and by pulse oximetry techniques

The continuous assessment of arterial oxygen saturation by pulse oximetry was introduced into clinical anesthesia in 1983 (1). Such monitoring has now become standard in our institution for all patients during anesthesia. Routine blood pressure determinations performed in the same extremity with the oximeter probe consistently interrupt the function of the oximeter. Because of this, oximeter probes were usually placed at sites not affected by blood pressure cuff inflation. However, small infants and patients with major burn injuries have little surface area available for multiple sensor placement. In such patients the oxirneter probe and the Doppler flow meter for measurement of blood pressure often had to be placed on the same extremity. We noticed that the oximeter pulse display seemed to have some correlation with the svstolic blood pressure determined by Doppler meth-

The anesthetic management of the pediatric strabismus patient

Postoperative nausea and vomiting continues to be a common perioperative complication for pediatric strabismus patients. Postoperative pain management and the choice of general anesthetic can increase the incidence of perioperative nausea. Current techniques for induction of general anesthesia and selection of agents, prevention and treatment of postoperative pain, and options for antiemetic therapy will be reviewed.

Avoiding an Impairment of Factor VIII: C by Using Hydroxyethyl Starch with a Low In Vivo Molecular Weight

pethidine. Eur J Clin l’harmacol 1988;34:625-31 4. Paech MJ, Moore JS, Evans SF. Meperidine for patient-controlled analgesia after cesarean section: intravenous versus epidural administration. Anesthesiology 1994;80:1268-76. 5. Rosaeg OP, Lindsay MI’. Epidural opioid analgesia after caesarean section: a comparison of patient-controlled analgesia with meperidine and single bolus injection of morphine. Can J Anaesth 1994;41:1063-8. 6. Etches RC, Gammer T, Cornish R. Patient-controlled epidural analgesia after thoracotomy: a comparison of meperidine with and without bupivacaine. An&h Analg 1996;83:81-6.