Acta anaesthesiologica Taiwanica : official journal of the Taiwan Society of Anesthesiologists
-
Acta Anaesthesiol Taiwan · Dec 2007
Case ReportsAnesthesia for cesarean section in a parturient with acute pulmonary edema--a case report.
Pulmonary edema is a rare complication in preeclampsia patients without pre-existing cardiac disease, tocolytic therapy, infection, or multiple gestations. We present a preeclamptic patient complicated by overwhelming pulmonary edema just prior to cesarean section and the massive edematous fluid production made it an exceptional challenge to the anesthesiologist on airway management. Emergent classic laryngeal mask airway (cLMA) placement was an effective alternative means for ventilation to provide temperate oxygenation in this case.
-
Acta Anaesthesiol Taiwan · Dec 2007
Case ReportsAnesthesia for emergency cesarean section in a parturient with undiagnosed acute fatty liver of pregnancy--a case report.
Few clinical diagnoses of acute fatty liver of pregnancy (AFLP) are established immediately upon admission, while anesthetic interventions are frequently required on an emergent basis. We report a patient with the admitting diagnosis of severe preeclampsia with fetal distress necessitating an emergency cesarean section. An epidural block was instituted before laboratory data were available. ⋯ The peripartum anesthetic care of the pregnant woman is presented. AFLP was confirmed by liver needle biopsy 26 days later. Taking our case as an examplification, clinicians must have a high suspicion that AFLP may exist in concurrence with preeclampsia when a parturient presents manifestations of nausea, jaundice, elevated bilirubin, elevated liver enzyme activities, prolonged PT and PTT, or thrombocytopenia.
-
Acta Anaesthesiol Taiwan · Dec 2007
Risk factors affecting adverse outcomes of cardiac surgery in patients aged 70 years and older.
The elderly segment of the population in Taiwan is increasing rapidly. According to the latest information from the Directorate-General of Budget, Accounting and Statistics, Executive Yuan, Taiwan, 1,553,367 civilians of the total population of 22,879,510 (6.8%) are seventy years old and older in 2007. The proportion of high-risk patients has increased dramatically owing to a greater number of elderly patients and increased number of average patients with heart diseases presenting for cardiac surgery. We analyzed the preoperative risk factors for in-hospital mortality, morbidity and the likelihood of prolonged intensive care unit (ICU) stay in elderly patients after cardiac surgery. ⋯ The perioperative risk of cardiac surgery increases in older patient groups, and some risk factors have different influences on mortality, morbidity and ICU stay. Risk assessment in older cardiosurgical patients with convenient risk factors helps the clinicians to apply rational and cost-effective treatment strategies into practice.
-
Acta Anaesthesiol Taiwan · Dec 2007
Effect of cervical epidural blockade with 2% lidocaine plus epinephrine on respiratory function.
Cervical epidural anesthesia has been used widely for surgery of upper limbs. Although cervical epidural anesthesia with local anesthetic of 2% lidocaine (plain) has demonstrated the safety in respiratory function in spite of unavoidable phrenic and intercostal palsies to certain extent, the replacement of local anesthetics with 2% lidocaine plus epinephrine has not been investigated yet. I conducted this study to look into the effect of 2% lidocaine plus epinephrine on respiratory function. ⋯ Cervical epidural anesthesia with 2% lidocaine plus epinephrine could reduce lung volumes and capacities, resulting from partially paralytic intercostal muscles and diaphragm innervated respectively by thoracic intercostal nerve and phrenic nerve. Without inadvertant total spinal or intravenous anesthesia or pre-existing pulmonary dysfunction, the patients with normal lungs could tolerate these changes well with the procedure.
-
Acta Anaesthesiol Taiwan · Dec 2007
Sternocleoidomastoid muscle length predicts depth of central venous catheter insertion.
Correct central venous catheter (CVC) insertion avoids serious complications, especially fatal intracardiac impalement. There are only few methods which discussed the depth of CVC insertion previously. Predicting the depth of CVC by body surface landmark is an easy and quick way, which is applied most wildly. Chest X-ray is a standard procedure to examine the depth of CVC. However, chest X-ray is not routinely availale, especially in emergency situations. Recent publications demonstrated that the determination of accurate placement by chest X-ray can be substituted by ECG guidance. We would like to find the correlation between surface anatomic landmarks and the depth of CVC insertion, and a method that could be applied easily and quickly to predict the depth of CVC insertion through ECG guidance. ⋯ Both the length of SCM muscle and body height have statistically meaning for predicting the depth of CVC insertion (P < 0.001 vs. P = 0.012). In point of accuracy, SCM muscle length might be more significant in view of yielding a smaller P-value. And, the depth of CVC is equal to half of the length of SCM muscle plus 6.5 cm in adults aged 18 to 78 yrs.