Acta anaesthesiologica Taiwanica : official journal of the Taiwan Society of Anesthesiologists
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Acta Anaesthesiol Taiwan · Jun 2009
Case ReportsEarly application of extracorporeal membrane oxygenation in a patient with amniotic fluid embolism.
Amniotic fluid embolism occurs rarely but is a leading cause of maternal mortality. Regardless of emergent supportive medical treatment, it is associated with a very high mortality rate. ⋯ Hemodynamic decompensation may be transient and recoverable within a few hours. Early application of extracorporeal membrane oxygenation should be considered in patients who are unresponsive to medical therapy before severe organ damage supervenes.
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Acta Anaesthesiol Taiwan · Jun 2009
Hydroxyethyl starch interferes with human blood ex vivo coagulation, platelet function and sedimentation.
Hydroxyethyl starch (HES) solutions are widely used for intravascular volume expansion. In Taiwan, the medium molecular weight of HES 200/0.5 and HES 130/0.4 solutions are most commonly used. It has been demonstrated that HES may affect coagulation and platelet function significantly. However, the differential effects of each medium molecular weight HES on platelets remain poorly reported. Therefore, we studied the influence of the two HES solutions on platelet function in vitro by mixing whole blood with different proportions of HES 130 kD, HES 200 kD, and saline to determine the differences. ⋯ Our data demonstrated that HES200 and HES130 possess noticeably inhibitory effects on platelet function, especially when the HES replaced proportion was more than 20%. HES200 has a greater effect on blood cells and plasma separation than does HES130.
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Acta Anaesthesiol Taiwan · Jun 2009
Case ReportsAlteration of capnogram as the first sign of pneumothorax in an infant who underwent bronchoscopy with jet ventilation.
A 3-month-old male infant underwent rigid bronchoscopy with manual jet ventilation due to persistent right upper lobe collapse under capnographic surveillance. The CO2 waveform abruptly vanished soon after application of jet ventilation, while breath sounds decreased gradually until the left side breath sounds were barely audible. ⋯ In this case, the sudden onset of CO2 waveform change was the first warning sign of pneumothorax, which is the most common complication of jet ventilation. Therefore, we strongly recommend that continuous capnographic surveillance be applied during bronchoscopy with jet ventilation.
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Acta Anaesthesiol Taiwan · Jun 2009
Case ReportsTracheal ring fracture as a consequence of external laryngeal manipulation during endotracheal intubation.
We report a case of tracheal ring fracture after external laryngeal manipulation for assisting intubation because of difficult laryngoscopy during induction of anesthesia. The patient was a 64-year-old female suffering from a large multinodular goiter scheduled to undergo general anesthesia with endotracheal intubation for thyroidectomy. Laryngoscopy was performed, which did not visualize the glottis. ⋯ The patient was discharged 3 days after operation. At the 3-month follow-up, she displayed good airway function and phonation. After review of her clinical history, we speculated that the tracheal ring fracture was caused by forced external compression of the tracheal cartilage during endotracheal intubation.
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Acta Anaesthesiol Taiwan · Jun 2009
Determining an optimal tracheal tube cuff pressure by the feel of the pilot balloon: a training course for trainees providing airway care.
High cuff pressure of tracheal tube (TT) may cause tracheal damage. Maintaining an optimal cuff pressure is important in tracheal intubation. This study aimed to examine whether inexperienced anesthetists or airway care providers, after training and practice, demonstrate more expertise in the determination of optimal cuff pressure by feeling the pilot balloon with their fingers. ⋯ The anesthesia trainers in this study are capable of teaching TT cuff inflation correctly. After practical training, the airway care providers, irrespective of seniority or age, can roughly determine an optimal TT cuff pressure non-instrumentally.