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Anesthesia for the asthmatic patient
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OF CIJBRENTLITERATUIEE
Aneatheaia for the A&lunatic 28: 886, 1961.
Patient.
A. M. Shnider and E. M. Parker. Anesthesiology
The anesthetic management of asthmatic patients was studied at Presbyterian Hospital in New York. These were consecutive patients, unselected except for a history of asthma. During an eighteen-month period anesthesia was administered to 687 patients with bronchial asthma. Six hundred thirty-eight patients were symptom-free and fortynine were wheezing prior to induction of anesthesia. Asthma developed during anesthesia in 6.5 per cent of the patients who had clear chests preoperatively (2.6 per cent during induction and 3.9 per cent during the maintenance of anesthesia). Regional anesthesia was associated with the same incidence of wheezing as general anesthesia without an endotracheal airway. The most common single factor which precipitated an attack of wheezing during general anesthesia was the presence of an endotracheal tube. This finding does not contraindicate endotracheal intubation during operation on asthmatic patients but points out the need for better management of endotracheal airways in these patients. Ralothane is a valuable drug for anesthetizing asthmatic patients and for treating attacks of asthma should they occur during anesthesia. When possible, conduction anesthesia is the method of choice for asthmatic patients. The choice of agents remains controversial when general anesthesia must be used. Competent preoperative medical preparation and postoperative care of the asthmatic patient are important in holding pulmonary complications to a minimum. Rhabdomyoaarcoma of the Head and Neck. Arch. Surg. 84: 582, May, 1962.
W. R. Ditto
and J. G. Batsakis.
A. M. A.
The uncommon malignant soft-tissue neoplasm, rhabdomyosarcoma, has been reported as arising from a wide variety of anatomic sites. The majority of documented rhabdomyosarcomas have had their origin in peripheral skeletal muscle and soft tissues. One hundred seventy cases of rhabdomyosarcoma arising from structures in the head and neck have been reviewed with reference to their biologic behavior. Nine cases are from personal experience; the remainder were collected from the literature. In the cases reported the tumors occurred in the tongue, palate, floor of mouth, gingiva, mandibular region, and other sites. Rhabdomyosarcoma is considered a disease of childhood. Surgical excision well around the tumor, and often including lymph-node dissection, is the most effective mode of treatment. The latter is important, in that the rhabdomyosarcoma, although primarily disseminating by hematogenous routes, does frequently spread to lymph nodes. The prognosis in head and neck rhabdomyosarcoma is disheartening; these cases have an 8.2 per cent five-year survival, as compared to 33.8 per cent for peripheral rhabbdomyosarcomas. Early wide surgical excision has offered the best therapeutic results to date. 1151
OF THE LITERATURE
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.
.
.
.
ABSTRACTS
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
OF CIJBRENTLITERATUIEE
Aneatheaia for the A&lunatic 28: 886, 1961.
Patient.
A. M. Shnider and E. M. Parker. Anesthesiology
The anesthetic management of asthmatic patients was studied at Presbyterian Hospital in New York. These were consecutive patients, unselected except for a history of asthma. During an eighteen-month period anesthesia was administered to 687 patients with bronchial asthma. Six hundred thirty-eight patients were symptom-free and fortynine were wheezing prior to induction of anesthesia. Asthma developed during anesthesia in 6.5 per cent of the patients who had clear chests preoperatively (2.6 per cent during induction and 3.9 per cent during the maintenance of anesthesia). Regional anesthesia was associated with the same incidence of wheezing as general anesthesia without an endotracheal airway. The most common single factor which precipitated an attack of wheezing during general anesthesia was the presence of an endotracheal tube. This finding does not contraindicate endotracheal intubation during operation on asthmatic patients but points out the need for better management of endotracheal airways in these patients. Ralothane is a valuable drug for anesthetizing asthmatic patients and for treating attacks of asthma should they occur during anesthesia. When possible, conduction anesthesia is the method of choice for asthmatic patients. The choice of agents remains controversial when general anesthesia must be used. Competent preoperative medical preparation and postoperative care of the asthmatic patient are important in holding pulmonary complications to a minimum. Rhabdomyoaarcoma of the Head and Neck. Arch. Surg. 84: 582, May, 1962.
W. R. Ditto
and J. G. Batsakis.
A. M. A.
The uncommon malignant soft-tissue neoplasm, rhabdomyosarcoma, has been reported as arising from a wide variety of anatomic sites. The majority of documented rhabdomyosarcomas have had their origin in peripheral skeletal muscle and soft tissues. One hundred seventy cases of rhabdomyosarcoma arising from structures in the head and neck have been reviewed with reference to their biologic behavior. Nine cases are from personal experience; the remainder were collected from the literature. In the cases reported the tumors occurred in the tongue, palate, floor of mouth, gingiva, mandibular region, and other sites. Rhabdomyosarcoma is considered a disease of childhood. Surgical excision well around the tumor, and often including lymph-node dissection, is the most effective mode of treatment. The latter is important, in that the rhabdomyosarcoma, although primarily disseminating by hematogenous routes, does frequently spread to lymph nodes. The prognosis in head and neck rhabdomyosarcoma is disheartening; these cases have an 8.2 per cent five-year survival, as compared to 33.8 per cent for peripheral rhabbdomyosarcomas. Early wide surgical excision has offered the best therapeutic results to date. 1151