Acta anaesthesiologica Taiwanica : official journal of the Taiwan Society of Anesthesiologists
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Acta Anaesthesiol Taiwan · Jun 2008
Randomized Controlled TrialSingle vital-capacity and successive tidal-volume breathing of sevoflurane in induction of anesthesia for tracheal intubation in gynecologic patients.
The optimal end-tidal concentrations of sevoflurane in induction of anesthesia for tracheal intubation have been widely studied and discussed. Single vital-capacity breathing of a high concentration of inspiratory sevoflurane rapidly elevates the end-tidal concentration to cause loss of consciousness, although it does not bear relation to proportional body or brain uptake. This study was designed to investigate the time effect of fast wash-in of alveolar sevoflurane in induction of anesthesia for tracheal intubation with single vital-capacity and ensuing tidal-volume breathing in gynecologic patients. ⋯ This study demonstrated that vital-capacity induction with a high concentration of sevoflurane is a safe and feasible technique for our female patients. The end-tidal 1.5 minimum alveolar concentration sevoflurane following 4.5 minutes of tidal-volume ventilation did not suppress intubation-induced hemodynamic responses. Pretreatment with fentanyl helped to shorten the induction time and provide better hemodynamic control for tracheal intubation.
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Acta Anaesthesiol Taiwan · Jun 2008
Hemodynamic changes during spinal surgery in the prone position.
Hypertension and fluctuations in blood pressure (BP) during lumbar spinal surgery in the prone position under anesthesia are not unusual. The purpose of this study was to investigate the causes of the decrease in BP during lumbar spinal surgery in the prone position using a noninvasive monitor of cardiac output. ⋯ Decreases in SV and CI are the main causes of a decrease in BP in the prone position during lumbar spinal surgery.
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Acta Anaesthesiol Taiwan · Jun 2008
Case ReportsTemporomandibular joint dislocation after laryngeal mask airway insertion.
Temporomandibular joint (TMJ) dislocation after general anesthesia is not rare. Most victims usually have a past history of TMJ dysfunction or subluxation. It is possible that incomplete TMJ integrity, inadequate articular eminence shape and anesthetic agents that precipitate masticatory muscle hypotonicity are the main factors leading to dislocation. ⋯ TMJ dislocation has been reported after the placement of a laryngeal mask airway for general anesthesia. After reviewing two such cases between August 2004 and July 2007, we found that some iatrogenic factors might intensify the risk of TMJ dislocation. The clinical implications of these findings are discussed herein.
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Acta Anaesthesiol Taiwan · Jun 2008
Review Case ReportsParaplegia following spinal anesthesia in a patient with an undiagnosed metastatic spinal tumor.
Although extremely rare, paraplegia can be a complication following spinal anesthesia if the patient has a previously unrecognized spinal tumor. We describe a 75-year-old male patient who underwent retrograde ureteroscopic examination under spinal anesthesia. He developed complete paraplegia 24 hours later. ⋯ The aim of this case report is to highlight the importance of neurological examination of patients undergoing neuraxial block both in the pre-anesthetic interview and postoperative examination in the recovery period. Careful observation of the postoperative course is essential to exclude any possible neurological complications. If motor and sensory functions do not satisfactorily recover, an MRI examination should be undertaken without delay to determine whether the underlying pathology is treatable or reversible.
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Acta Anaesthesiol Taiwan · Jun 2008
Comparative StudyComparison of the upper lip bite test with measurement of thyromental distance for prediction of difficult intubations.
The upper lip bite test (ULBT) introduced in 2003 is a simple method for predicting difficult intubations. According to this test, the higher a patient can bite the upper lip with the lower incisors, the lower the risk of difficult intubation. Given the necessity for evaluation and re-evaluation of a newer predictive method, this study was conducted to compare the ULBT with another method for difficult airway prediction, the measurement of thyromental distance (TMD). ⋯ The findings suggest that the sensitivity of the ULBT and TMD for predicting difficult intubations may not be significantly different, but the specificity of the ULBT is significantly higher. The positive predictive value of the ULBT was significantly higher than that of TMD, signifying that a positive ULBT is more predictive of a difficult airway than is a positive TMD.