Ramon Martin

Anesthesia for in vitro fertilization: the addition of fentanyl to 1.5% lidocaine.

UNLABELLED Ultrasonically guided transvaginal oocyte retrieval is relatively short procedure that is performed on an out-patient basis. The optimal anesthetic technique should allow good surgical anesthesia with minimal side effects, a short recovery time, and, if possible, a high rate of successful pregnancy. Spinal anesthesia is often used in this institution, as well as many others, for this procedure. The addition of fentanyl may be effective for both intraoperative and postoperative pain relief. We assessed the effect of adding fentanyl to 1.5% lidocaine in women undergoing ultrasonically guided oocyte retrieval. Seventy-eight women were randomized to receive 45 mg of hyperbaric 1.5% lidocaine with or without 10 microg of fentanyl. Visual analog scale (VAS) pain scores were lower in the operating room (OR) (P < 0.05) and postanesthesia care unit (PACU) (P < 0.0005) for the group that received fentanyl. In addition, the amount of narcotic required in the PACU was less in the fentanyl group (P < 0.005). There was no difference in VAS scores the evening of or 24 h after the procedure. The amount of analgesics and narcotics required after discharge was the same for both groups. Timed variables, such as time to urination, ambulation, and discharge, were the same for both groups of women. The addition of fentanyl to lidocaine for transvaginal oocyte retrieval results in a more comfortable patient in the OR and PACU. IMPLICATIONS This study demonstrates that when fentanyl is added to a local anesthetic, lidocaine, with spinal anesthesia for egg retrieval procedures, patients are more comfortable during the procedure compared with those who receive lidocaine alone. In addition, the narcotic requirements of patients are less in the postanesthesia care unit.

Interventional radiology and anesthesia.

Interventional radiology (IR) encompasses a broad and expanding array of image-guided, minimally invasive therapies that are essential to the practice of modern medicine. The growth and diversity of these non-OR procedures presents unique challenges and opportunities to anesthesiologists and interventional radiologists alike. Collaborative action has led to better patient care and quality management. This discussion considers some angiographic and cross-sectional IR procedures in more detail and comments on some of the anesthesia choices and considerations. In addition, specific concerns regarding anesthesia in the area of IR are reviewed.

An appraisal of William Thomas Green Morton's life as a narcissistic personality.

The troubled life and death of William Thomas Green Morton has been described in several texts. His first public demonstration of ether anesthesia was the highpoint of a life that was less than successful in many of his endeavors. Close examination of this life reveals a pattern of behavior that progresses from narcissistic traits to narcissistic personality pathology. This retrospective psychiatric analysis of Mortons life was undertaken to theorize as to why Morton, after having successfully demonstrated ether anesthesia, did not continue to develop anesthesia as a clinical specialty. Biographies about Morton were used to explore details of his life. The Diagnostic and Statistical Manual of Mental Disorders classification of narcissistic personality disorder was used to analyze his life. We conclude that Morton progressed from displaying narcissistic personality trait to disorder over his lifetime.

An Appraisal of the Life of Charles Thomas Jackson as Attention Deficit Hyperactivity Disorder

Charles Thomas Jackson claimed to have original ideas that led to the creation of guncotton, the electromagnetic telegraph, and the use of ether as an anesthetic. There was, though, a gap between when the idea was enunciated and when it became reality, with other individuals accomplishing the latter. An examination of Charles Jacksons life reveals a pattern of behavior that is compatible with attention deficit hyperactivity disorder with an associated diagnosis of oppositional defiant disorder. These diagnoses are explored in the context of Jacksons life to explain why he did not carry his initial thoughts to fruition.

Anesthetic impact of body mass index in patients undergoing assisted reproductive technologies

STUDY OBJECTIVE To determine the prevalence and anesthetic impact of obesity in patients undergoing assisted reproductive technologies. DESIGN Retrospective analysis of a complete calendar year of oocyte retrieval procedures. SETTING Center for reproductive medicine of a tertiary care university teaching hospital. PATIENTS 1,289 ASA physical status I, II, and III women undergoing oocyte retrieval procedures. MEASUREMENTS Patient demographics, body mass index (BMI), comorbid conditions, frequency and characterization of intraoperative and postoperative events, route of oocyte retrieval, and anesthetic technique were assessed. MAIN RESULTS Of the 1,289 women, 33% were overweight or obese. The prevalence of gastroesophageal reflux disease, depression/anxiety, hypothyroidism, diabetes, and hypertension was associated with increasing BMI (P < 0.02). Transvaginal oocyte retrieval and the use of total intravenous anesthesia were less common with increasing BMI (P < 0.01; P < 0.003). Oxygen desaturation occurred more frequently intraoperatively and postoperatively in patients with high BMI (P < 0.0001), as did the reports of postoperative discomfort and the need for additional analgesia (P < 0.001). No patients managed with spinal anesthesia experienced intraoperative desaturation or required conversion to general anesthesia with endotracheal intubation. CONCLUSIONS Patients with high BMI have a greater prevalence of comorbid conditions, require alterations in anesthetic and oocyte retrieval management, and more often experience intraoperative and postoperative events.

S5. The History and Evolution of Anesthetic Care in Rwanda

Although the development of anesthesia as a specialty and its practice in Rwanda have occurred postindependence, there are several contributing factors that have had an impact on the current state of the delivery of anesthetic care. European colonization of Africa, in general, and Belgiums control, in particular, are primary factors that have had a significant impact on education. The ripple effect has had a long-lasting impact on health care as well as other facets of present-day Rwandan society. Tertiary education did not start until the latter half of the 20th century and has left this country with the belated development of an educated population in sufficient numbers to handle health care problems and provide sufficient care to its population. This article will examine the history of Rwanda and delineate factors that have led to the current state of anesthetic practice.

Anesthetic Concerns in the MR Environment

Magnetic resonance (MR) is used increasingly for therapeutic procedures as well as diagnostic scans. There is also a parallel increase in the use of anesthesia for these procedures and the scans. Static, gradient, and radiofrequency fields pose several challenges when providing anesthetic support in the MR environment. Training in and knowledge of these effects are necessary to provide safe anesthetic care. This is of utmost importance when an emergent clinical situation develops, where the patient needs to be taken care of, and where the potential harmful effects of MR must be avoided.