Acta anaesthesiologica Taiwanica : official journal of the Taiwan Society of Anesthesiologists
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Acta Anaesthesiol Taiwan · Jun 2011
Randomized Controlled TrialThe effect of combined ephedrine and lidocaine pretreatment on pain and hemodynamic changes due to propofol injection.
Injection pain and hypotension are two main adverse effects of propofol that discourage uniform acceptation. The aim of this study was to compare the effect of ephedrine-lidocaine combination with lidocaine and ephedrine alone on injection pain and hemodynamic changes caused by propofol injection. ⋯ Pretreatment with combination of small-dose ephedrine and lidocaine could reduce the incidence and intensity of propofol-induced pain and also result in more stable hemodynamic profile, but however, the combination of two drugs failed to work better in further reduction of pain.
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Functional hemodynamic parameters, such as stroke volume variation (SVV) and pulse pressure variation (PPV), are useful hemodynamic monitoring tools for the assessment of fluid responsiveness. These parameters are based on heart-lung interaction during positive mechanical pressure ventilation: Cyclic changes of intrathoracic pressure result in a reduced venous return and a decreased cardiac stroke volume after inspiration followed by a restoration of preload and stroke volume after expiration. Hemodynamic monitoring systems based on pulse wave analysis allow an automatic assessment of SVV and--at least for some of the devices--of PPV. ⋯ Arrhythmia and right heart failure, but also spontaneous breathing of a patient, or small tidal volumes may preclude reliable assessment. Based on these aspects, an ideal area of application of these parameters may be the use during perioperative hemodynamic optimization to improve patient outcome. However, only few studies on goal-directed therapy guided by these parameters have been published so far.
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Acta Anaesthesiol Taiwan · Jun 2011
Case ReportsBacterial infection in deep paraspinal muscles in a parturient following epidural analgesia.
We report a case of paraspinal muscle infection shortly after epidural analgesia for labor pain in a nulliparous parturient who was subjected to emergent Cesarean section because of fetal distress. Epidural morphine was administered for 3 days for postoperative pain control. She began to have constant lower back pain on postpartum Day 4. ⋯ Epidural analgesia is effective to control labor pain and, in general, it is safe. However, the sequelae of complicated infection may be underestimated. We herein report a case complicated by iatrogenic infection, discuss the causes, and give suggestions for prevention.
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Acta Anaesthesiol Taiwan · Jun 2011
Case ReportsSuccessful reversal of bupivacaine and lidocaine-induced severe junctional bradycardia by lipid emulsion following infraclavicular brachial plexus block in a uremic patient.
Cardiac toxicity of bupivacaine has long been documented and it could be potentiated in certain circumstances, such as preexisting cardiac conduction abnormality or uremic status. The concept that lipid emulsion acts as a rescue of bupivacaine's toxicity has prevailed pending universal recognition. Herein, we report the successful use of lipid to resuscitate a female uremic patient who sustained junctional bradycardia while she was receiving ultrasound-guided infraclavicular brachial plexus block with the dose of local anesthetics far below the currently recommended maximum one. The possible mechanisms for the occurrence of cardiotoxicity in this case are discussed and the role of lipid emulsion as a treatment is reviewed.
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Acta Anaesthesiol Taiwan · Jun 2011
Randomized Controlled TrialDo nondiabetic patients undergoing coronary artery bypass grafting surgery require intraoperative management of hyperglycemia?
To study the effect of blood glucose (BG) control with insulin in preventing hyperglycemia during and after coronary artery bypass grafting (CABG) surgery in nondiabetic patients. ⋯ Hyperglycemia (BG≥126 mg/dL) is common in nondiabetic patients undergoing CABG surgery. A modified insulin therapy to maintain BG level between 110 mg/dL and 126 mg/dL may be acceptable for avoiding hypoglycemia and keeping intraoperative BG levels in acceptable range in nondiabetics.