Acta anaesthesiologica Taiwanica : official journal of the Taiwan Society of Anesthesiologists
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Acta Anaesthesiol Taiwan · Mar 2007
Randomized Controlled TrialEarlier cessation of desflurane supply in closed-circuit anesthesia reduces emergence time in patients undergoing breast surgery.
Minimizing the time of anesthesia emergence can facilitate faster patient turnover in the operating rooms of a busy surgery center. According to Lin's new concept of inhalation uptake, after turning off the vaporizer under close-circuit anesthesia (CCA) with a very low fresh gas flow rate, the concentration of desflurane decreases at a slow rate. The aim of this study was to determine if earlier cessation of desflurane supply would shorten the emergence time and at the same time register the changes of desflurane concentration in the circuit after turning off the vaporizer. ⋯ Ceasing desflurane supply earlier in CCA (250 mL/min) significantly shortens emergence time without significant hemodynamic changes.
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Acta Anaesthesiol Taiwan · Mar 2007
Case ReportsGabapentin relieves post-dural puncture headache--a report of two cases.
Post-dural puncture headache (PDPH) is a vexing problem of the patients following spinal anesthesia or a complication relative to inadvertent dural puncture in epidural anesthesia. The prevention and management of PDPH contain a laddered forestallment and therapy with varying results. ⋯ After treatment with gabapentin 400 mg three times daily, the headache was relieved remarkably in 24 hr. Discussions of the pathophysiology of PDPH, pharmacological actions of gabapentin, and possible mechanisms of action of gabapentin on PDPH are brought forward in the text.
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Acta Anaesthesiol Taiwan · Mar 2007
Case ReportsPersistent systemic air embolism and delayed pulmonary hemorrhage after weaning from cardiopulmonary bypass--a case report.
Systemic air embolism (SAE) occurring during cardiac surgery is usually associated with high morbidity and mortality. We present a fatal case of persistent SAE identified by transesophageal echocardiography (TEE) after weaning from cardiopulmonary bypass (CPB). Perplexities in identification of a bronchovascular fistula and hesitation in aggressive management to arrest the resultant continuous air entry into systemic circulation caused death as an aftermath. Related instances in literature have been reviewed and appropriate managements are herein discussed.
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Acta Anaesthesiol Taiwan · Mar 2007
Case ReportsSuccessful management of severe upper airway obstruction during emergence of anesthesia in consequence of fracture of deflated laryngeal mask airway due to biting--a case report.
Biting the laryngeal mask airway during general anesthesia in the absence of a bite block as a forestallment is a common but usually uncomplicated event. We report a young healthy adult female patient who underwent removal of fixation implant in the right elbow under general anesthesia, during the emergence of which she bit and severed the airway tube of the laryngeal mask airway (LMA) after cuff deflation and developed upper airway obstruction in consequence of air blockade by the displaced deflated LMA cuff remaining inside the mouth. Removal of residual part of the LMA in the mouth was successful with propofol re-anesthetization without molestation of 02 saturation. We discuss the management of this critical airway condition resulting from fracture of deflated LMA in the closed mouth.
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Acta Anaesthesiol Taiwan · Mar 2007
Ultrasonographic examination to search out the optimal upper arm position for coracoid approach to infraclavicular brachial plexus block--a volunteer study.
Infraclavicular brachial plexus block has been widely used for surgical procedures below the mid humerus owing to its excellent anesthetic quality and ease of practice. However, what is the optimal upper arm position for carrying out the procedure still lacks consensus of opinion. The primary goal of this study was to determine the optimal upper arm position for coracoid infraclavicular block by ultrasonographic examination. ⋯ We recommend the most optimal position for carrying out coracoid infraclavicular brachial plexus block is to abduct the upper arm 90 degrees with external rotation of the shoulder. Though ultrasonographic guidance is suggested for infraclaricular brachial plexus block, an optimal position for puncture site determined by anatomical landmark is also acceptable.