Juniper Publishers Journal of Anesthesia and Intensive Care Medicine

Juniper Publishers - Journal of Anesthesia Abstract A 66 year old man developed sudden apnea and unresponsiveness after a large cerebellopontine angle tumor debulking. Based on the findings of a focused neurologic exam, the patient was emergently mask ventilated with subsequent return of spontaneous ventilation minutes later and recovery without further complications. Remifentanil bolus from residual infusion in an IV line was suspected due to rapid return to baseline and acute neurologic findings. We review remifentanil and highlight a challenging diagnostic dilemma in an acutely apneic patient after major neurosurgery. Keywords: Remifentanil; Neuroanesthesia; Post-op respiratory failure; Neurologic Emergencies Key Messages a. A focused neurologic exam can affect emergent management. b. A high index of suspicion and staff education are necessary for those involved in the care of patients receiving remifentanil. Int...

Juniper Publishers - Journal of Anesthesia Abstract Study objective: The anesthetic management of a patient with MMD presents a challenge to the anesthesiologist as it may affect the prevalence of further complications of the disease. We hypothesize that anesthetic management significantly affects the long term neurological outcome in patients with MMD and an ideal anesthetic will reduce the length of stay. Study design: Retrospective cohort study Patients: We performed a retrospective review of 32 patients with MMD who underwent craniotomy and surgical revascularization. The data was divided into two equal case cohorts based on two equal time periods. Measurements: Data was collected on usage of anesthetic agents such as fentanyl, propofol, remifentanil, isoflurane, sevoflurane and desflurane. Patient length of stay and adverse events that were associated with each case were also noted. Results: Remifentanil use increased significantly over the two period...