Acta anaesthesiologica Taiwanica : official journal of the Taiwan Society of Anesthesiologists
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Acta Anaesthesiol Taiwan · Sep 2007
Changes of regional cerebral oxygen saturation during spinal anesthesia.
During spinal anesthesia, hemodynamic status is routinely monitored, but this may not give an accurate assessment of cerebral oxygenation. Cerebral oximetry, facilitated by using a near-infrared spectroscope, is a way of estimating regional cerebral oxygen saturation (SrO2). We designed this prospective clinical study to determine whether the changes in mean arterial pressure (MAP) and heart rate (HR) could predict changes in SrO2 during spinal anesthesia. ⋯ Based on the time-lag pattern between two predictors (MAP and HR) and SrO2 during spinal anesthesia, we ventured to conclude that a change in MAP or HR caused a significant decrease in SrO2. Since no patient developed any neurologic complication perioperatively, further study must be performed to elucidate the clinical importance of our findings.
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Flexible fiberoptic endoscope is the most valuable tool for anesthesiologists to manage difficult airways. Correctly positioning of the patient during fiberoptic intubation aids the clinician to rapidly secure the airway, because it not only saves time, but also minimizes the risk of repeated attempts of intubation with possible serious consequences in the wake. ⋯ We can often obtain a superior view from fiberoptic intubation. Fiberoptic intubation in the sitting position can be applied to all patients, as long as there is no contraindication of having a patient be sat.
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Acta Anaesthesiol Taiwan · Sep 2007
Randomized Controlled TrialClosed-circuit isoflurane-based anesthesia provides better fast-tracking anesthesia than fentanyl/propofol-based anesthesia for off-pump coronary artery bypass graft surgery.
In recent years, low-dose fentanyl combined with short-acting hypnotic drug has been thought to be better than traditional high-dose fentanyl in cardiac anesthesia. On the other hand, the practice of closed-circuit inhaled anesthesia offers many advantages, including hemodynamic stability, maintenance of adequate anesthesia depth and early recovery. This study sought to evaluate the effect of closed-circuit isoflurane-based anesthesia (CIA) and fentanyl/propofol-based anesthesia (FPA) on off-pump coronary artery bypass graft (OPCABG) surgery. ⋯ These results suggest that CIA, as compared with FPA, provides a significant reduction in the time to extubation after OPCABG surgery with less use of inotropic agents.
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Acta Anaesthesiol Taiwan · Sep 2007
Case ReportsTransesophageal echocardiography for diagnosis of acute hemothorax during the insertion of hemodialysis catheter.
We report a 45-year-old obese uremic female, who developed sudden and profound shock followed by cardiac arrest during the percutaneous insertion of a permanently cuffed and tunneled hemodialysis catheter under local anesthesia. Upon our rush to the scene for succor, inspection revealed that she was pale, comatose, and tachypneic, while her peripheral radial pulse was not felt on palpation. In addition to immediate airway management, setting up vital signs monitoring, aggressive fluid resuscitation, we promptly put transesophageal echocardiograph into use. ⋯ Right thoracostomic drainage tube was placed, from which massive blood was drained out, and her vital signs were restored rapidly. She was returned to ordinary ward after a 5 days' intensive care. We suggested that transesophageal echocardiography is valuable and potent in facilitating rapid, accurate differential diagnosis and in guiding proper management in such critical condition.