Acta anaesthesiologica Taiwanica : official journal of the Taiwan Society of Anesthesiologists
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Acta Anaesthesiol Taiwan · Dec 2007
Case ReportsAnother source of airway-leakage: inadvertent endobronchial misplacement of nasogastric tube in a patient intubated with double-lumen endotracheal tube under anesthesia.
Nasogastric (NG) tube placement for gastrointestinal decompression is a common procedure for most major surgeries in the operating rooms. However, it could cause life-threatening complications in some difficult cases if it is not correctly placed in the stomach and recognition of misplacement is not prompt. ⋯ Traditional methods such as aspiration of gastric contents or auscultation of gastric insufflation air for confirmation are unreliable to exclude misplacement of NG tube. We suggest that using capnography to detect misplacement of NG tube in the trachea or facilitating NG tube insertion by videolayrngoscope (GlideScope) could be considered in the operating rooms to avoid complications.
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Acta Anaesthesiol Taiwan · Sep 2007
Case ReportsUnilateral fixed dilated pupil during plastic surgery--a case report.
A 34-year-old man was referred to our hospital for management of multiple trauma in consequence of a car accident. Initial examination showed mild intracranial hemorrhage proven by computed tomographic scan (CT) of the brain and multiple fractures of face and thigh. Surgical repair of the multiple fractures was undertaken with stable vital signs and neurological condition. ⋯ In fear of exacerbation of the existing intracranial hemorrhage with progressive bleeding, the operation was hastily brought to an end. An urgent CT of the brain was immediately carried out but it revealed no obvious progression compared with the preoperative examination. The patient awaked in the postanesthesia care unit (PACU) uneventfully with the left pupil returning to normal condition.
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Acta Anaesthesiol Taiwan · Sep 2007
Delayed onset of sevoflurane-induced juvenile malignant hyperthermia after second exposure.
Malignant hyperthermia (MH) is a rare condition consisting of increased temperature and rigidity with mild to fulminant manifestation during anesthesia. Sevoflurane was thought to be a less potent triggering agent of MH; however, in literature review, the onset of MH after exposure to sevoflurane may be associated with calcium release from the sarcoplasmic reticulum. We present here a case of rarely-seen delayed MH induced by an inhalation agent of low-inducing probability, sevoflurane, after the second exposure to which within a short period of time. ⋯ Gradually elevated heart rate during the second exposure to sevoflurane was the atypical sign in the episode of MH in this case. One plausible explanation for the development of delayed onset of MH is the latent effect of the volatile anesthetic on the skeletal muscles. Therefore, it is worth noting for the anesthesiologists to recognize the possibility of an atypical MH and be alert for the possible occurrence of MH during routine anesthetic practice.
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Acta Anaesthesiol Taiwan · Sep 2007
Simulation analysis of the performance of target-controlled infusion of propofol in Chinese patients.
The performance of target-controlled infusion (TCI) devices is important for the safety of patients. This study examined the performance of two propofol pharmacokinetic parameter sets in Chinese patients by computer simulation. ⋯ The performance of TCI infusion of propofol in Chinese patients is generally acceptable with Marsh's or Schnider's model apart from using Schnider's model in Chinese elderly patients. Further study to investigate the difference of propofol pharmacokinetics between Chinese and non-Chinese elderly patients is necessary.
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Acta Anaesthesiol Taiwan · Sep 2007
Improved satisfaction of preoperative patients after group video-teaching during interview at preanesthetic evaluation clinic: the experience of a medical center in Taiwan.
Anesthesiologist-directed anesthetic preoperative evaluation clinic (APEC) is used to prepare patients to receive anesthesia for surgery. Studies have shown that APEC can reduce preoperative tests, consultations, surgery delays and cancellations. APEC with video-teaching has been purposed as a medium to provide comprehensive information about the process of anesthesia but it has not been practiced in small groups of patients. It is rational to assume that video-teaching in a small group patients can provide better information to patients to understand the process of anesthesia and in turn improve their satisfaction in anesthesia practice. This study was designed to evaluate the difference of satisfaction between patients who joined in small group video-teaching at APEC and patients who paid a traditional preoperative visit in the waiting area, using questionnaire for evaluation. ⋯ The results indicated that APEC with group video-teaching could not only make patients more satisfied with process of anesthesia in elective surgery but also reduce the expenditure of hospitalization and anesthetic manpower.