Acta anaesthesiologica Taiwanica : official journal of the Taiwan Society of Anesthesiologists
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Acta Anaesthesiol Taiwan · Jun 2005
Case ReportsPneumothorax after central venous cannulation via the infraclavicular axillary vein--a case report.
It has ever been reported that central venous cannulation via the infraclavicular axillary vein (IAV) could cause pneumothorax. However, recently at our hospital, a 66-year-old female patient undergoing craniectomy for brain tumor sustained pneumothorax after cannulation of the IAV for intraoperate monitoring. ⋯ The departmental panel on morbidity reviewed the anatomy of the infraclavicular area to explore the possible causes of the incident. As to prevention of pneumothorax, we also bring forward some important points for discussion that have not been discoursed in previous reports.
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Acta Anaesthesiol Taiwan · Jun 2005
Case ReportsPost-dural puncture arm and upper back pain--a report of two cases.
The typical postdural puncture headache manifests as postural frontal, frontotemporal, or occipital headache, which is worsened by ambulation, and improved by decubitus. Accompanying symptoms are nausea, vomiting, and neck stiffness. Various rare presentations after dural puncture, such as upper back pain, arm pain, thoracic pain, bowel and bladder dysfunction have been sparsely reported. We report two cases who sustained arm and upper back pain after spinal anesthesia, and epidural blood patch gave them a complete relief of the symptoms.
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Acta Anaesthesiol Taiwan · Jun 2005
Case ReportsReal-time detection of migratory thrombi by transesophageal echocardiography in a patient undergoing thrombectomy.
We report a 44-year-old male patient who sustained a right atrial (RA) thrombosis with evolvement into right pulmonary artery embolism in consequence of placement of a temporary pacing lead and was successfully treated with surgical thrombectomy under the guidance of perioperative transesophageal echocardiography (TEE). Because of intermittent complete atrioventricular block he therefore underwent implantation of a transvenous temporary pacing. On the ensuing day a large mass was incidentally found echographically in the RA suggestive of a large thrombus. ⋯ Over the on-going surgical course no further abnormal echogenic objects were visible in the cardiac chambers. It is perceivable that transvenous pacing might cause thrombois or dislodgement and dehiscence of thrombi already in existence in the cardiac chamber. Careful and continuous intraoperative surveillance with echocardiography over a patient who is undergoing cardiac embolectomy is quite important in detecting thrombus escape and residual thrombi during surgery.
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Acta Anaesthesiol Taiwan · Jun 2005
Randomized Controlled Trial Clinical TrialStarting dose of gabapentin for patients with post-herpetic neuralgia--a dose-response study.
Gabapentin has been shown to provide pain relief for post-herpetic neuralgia at dosage of 1200 to 2400 mg/day. However, the initial dosing strategy has not been thoroughly investigated. The purpose of this study was to establish the initial dosing strategy in the treatment of the gabapentin-naive patients with post-herpetic neuralgia. ⋯ This study shows that elderly gabapentin-naive subjects no matter whether receiving 200, 400 or 600 mg/day of gabapentin benefited a moderate pain relief with minimal side effects at the first three days of treatment. Since starting with a minimal dose of 200 mg/day did not offer a better reduction of side effects, we suggest that 600 mg/day gabapentin could be a safe and effective starting dose for patients with post-herpetic neuralgia.
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Acta Anaesthesiol Taiwan · Jun 2005
Randomized Controlled Trial Clinical TrialEvaluation of the effects of caudal or cephalic epidural catheterization on the characteristics of lumbar epidural anesthesia.
The delayed and incomplete sensory block of the sacral roots in epidural anesthesia often results from too huge the size of the first sacral nerve root. To overcome the problem, the enhancement of anesthetic effect on the sacral segment by injecting the local anesthetic toward the caudal direction has been reported. Thus, in this study, we compared the anesthetic effects of epidural anesthesia by catheterization toward caudal direction with that toward cephalic direction on the areas innervated by the sacral nerve roots. ⋯ Epidural injection of local anesthetic via catheter oriented caudad or cephalad did not change the characteristics of epidural anesthesia including onset time, duration, anesthetic level, and analgesic effect on the surgical areas innervated by the sacral roots.