Acta anaesthesiologica Taiwanica : official journal of the Taiwan Society of Anesthesiologists
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Acta Anaesthesiol Taiwan · Dec 2004
Case ReportsPneumothorax associated with tube exchanger-aided intubation following LMA-Fastrach placement in a patient during anesthesia induction.
The use of intubating laryngeal mask airway (LMA-Fastrach) is indicated to facilitate endotracheal intubation in a patient with cervical spine disorder or suspected difficult airway. A 65-year-old female patient was referred to our hospital for cervical spine surgery under general anesthesia. ⋯ As massive pneumothorax associated with subcutaneous emphysema was disclosed by chest roentgenography, a chest drainage was performed immediately. This article discourses the possible mechanism, diagnosis and treatment of pneumothorax during the course of general anesthesia and the prevention of lower airway injury by AEC is also touched.
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Acta Anaesthesiol Taiwan · Dec 2004
The valid time of soda lime could be safely prolonged according to the inspired pressure of carbon dioxide.
Carbon dioxide (CO2) absorbent, a disposable chemical mixture enclosed in a canister of anesthetic breathing systems functions to remove the carbon dioxide expired from the patients during general anesthesia. The timing of replacing the exhausted CO2 absorbent is usually decided by discoloration of the indicator dye or the valid time of use. However, these methods are subjective. We designed a study to validate our idea of replacing the exhausted CO2 absorbent according to the inspired pressure of carbon dioxide (PiCO2) and comparison of the pressure difference between the arterial carbon dioxide tension (PaCO2) and end-tidal CO2 in the exhausted and fresh CO2 absorbent circuits. ⋯ Even though the PiCO2 concentration reached 6 mmHg in the rebreathing circuit with exhausted soda lime, the gradient between the PaCO2 and end-tidal CO2 was of no statistical difference compared with that of the fresh soda lime circuit. Thus the pressure difference was not affected by the exhausted CO2 absorbent in spite of a reach of PiCO2 to 6 mmHg. Under CO2 monitoring, the valid time of soda lime could be safely prolonged until the PiCO2 was elevated to 6 mmHg rather than 8 h strictly pursuant to traditional method of discoloration of indicator dye.
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Acta Anaesthesiol Taiwan · Dec 2004
Randomized Controlled Trial Clinical TrialThe efficacy and safety of transnasal butorphanol for postoperative pain control following lower laparoscopic surgery.
The aim of the study was to evaluate the efficacy and safety of transnasal butorphanol for postoperative analgesia in adult female patients undergoing lower laparoscopic surgery. ⋯ In contrast with placebo transnasal butorphanol was effective in the treatment of postoperative pain in female patients undergoing lower laparoscopic surgery. It had minimum side effects.
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Acta Anaesthesiol Taiwan · Dec 2004
ReviewTreatment of cerebral vasospasm after subarachnoid hemorrhage--a review.
Delayed cerebral ischemia as a result of cerebral vasospasm is the most common cause of death and disability after aneurysmal subarachnoid hemorrhage (SAH). It leads to death or permanent neurologic deficits in over 17-40% of SAH patients. The initial and main symptom of cerebral vasospasm is diffuse headache and may be accompanied with a slight increase in discomfort from neck stiffness and fever. ⋯ Newly recognized mediators of cerebral vasospasm after SAH include endothelium-derived mediators, vascular smooth-muscle-derived mediators, proinflammatory mediators involved in blood-brain barrier disruption, cytokines and adhesion molecules, stress-induced gene activation, and platelet-derived growth factors. Moreover, observations in the laboratory have, in many circumstances, matched those of reported small series. Larger, prospective, randomized trials are needed to verify several hypotheses of molecular pathophysiology and clinical treatment regimens.
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Acta Anaesthesiol Taiwan · Dec 2004
Randomized Controlled Trial Clinical TrialImproving the success rate of laryngeal mask airway insertion during etomidate induction by using fentanyl or succinylcholine.
Smooth and successful insertion of a laryngeal mask airway (LMA) during etomidate induction requires a proper mouth opening and efforts to minimize airway reflexes such as gagging, coughing, or laryngospasm. We hypothesized that the concurrent use of fentanyl or succinylcholine with etomidate, the induction agent, could reduce the occurrence of airway reflexes and increase the success rate of LMA. ⋯ As an induction agent to facilitate insertion of LMA, etomidate alone was far from perfect. The concurrent use of 2 microg/kg of fentanyl with etomidate might significantly reduce the occurrence of airway reflexes in response to LMA insertion and increase the success rate of insertion. However, concurrent use of 1 mg/kg succinylcholine with etomidate might provide better results in terms of shortened time for the LMA insertion, jaw relaxation, and the success rate of LMA insertion than that of fentanyl.