Acta anaesthesiologica Taiwanica : official journal of the Taiwan Society of Anesthesiologists
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Acta Anaesthesiol Taiwan · Mar 2007
Ultrasonographic examination to search out the optimal upper arm position for coracoid approach to infraclavicular brachial plexus block--a volunteer study.
Infraclavicular brachial plexus block has been widely used for surgical procedures below the mid humerus owing to its excellent anesthetic quality and ease of practice. However, what is the optimal upper arm position for carrying out the procedure still lacks consensus of opinion. The primary goal of this study was to determine the optimal upper arm position for coracoid infraclavicular block by ultrasonographic examination. ⋯ We recommend the most optimal position for carrying out coracoid infraclavicular brachial plexus block is to abduct the upper arm 90 degrees with external rotation of the shoulder. Though ultrasonographic guidance is suggested for infraclaricular brachial plexus block, an optimal position for puncture site determined by anatomical landmark is also acceptable.
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Acta Anaesthesiol Taiwan · Dec 2006
Randomized Controlled TrialUrinary catheterization may not be necessary in minor surgery under spinal anesthesia with long-acting local anesthetics.
This prospective study was designed to compare the incidence of urinary retention after spinal anesthesia between 0.5% hyperbaric bupivacaine and 0.5% hyperbaric tetracaine in patients who underwent minor orthopedic and general surgeries. ⋯ Our results show that, in younger surgical patients who did not receive large amount of fluid intraoperatively, the incidence of urinary retention was low, although prolonged sensory blockade by both long-acting local anesthetics was evident. Thus, urinary catheterization should not be a routine must for every patient undergoing minor surgery with long-acting spinal local anesthetics. From the viewpoint of financial expense, avoidance of complication and annoyance of urinary catheterization, careful observation of urinary bladder fullness in the form of lower abdominal distension, discomfort, bradycardia, or vomiting after surgery is superior to routine retention urinary catheterization just for ease with work in younger patients under-going minor surgery under long-acting spinal local anesthetics.
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Acta Anaesthesiol Taiwan · Dec 2006
Case ReportsIntravenous propofol precipitates the hypotension induced by inadvertent epidural thiopental injection.
Administration of improper drugs into epidural space is occasionally present in anesthetic practice. In most instances it would not contribute to significant neurological complications. ⋯ Rapid vascular uptake of thiopental in the epidural space and synergistic action of propofol jointly contributed to the development of the hypotension. Attempts to forestall neurological sequela after the inadvertence seem unnecessary unless apparent symptoms or signs of neurological injury have come upon.
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Acta Anaesthesiol Taiwan · Dec 2006
Serial changes of pulse wave velocity and correlations with hemodynamic parameters during general anesthesia.
Increased pulse wave velocity (PWV) is a marker of increased arterial stiffness and is correlated with cardiovascular mortality and mortality of all causes in the elderly and in patients with essential hypertension and type 2 diabetes. There is also a positive correlation between PWV and arterial blood pressure. The changes of PWV in response to general anesthesia and surgical stimulation remain unclear. The aim of this study was to continuously monitor the PWV, blood pressure and heart rate, and to assess their correlations during general anesthesia in women receiving gynecologic surgery. ⋯ We could evaluate the serial changes of PWV in response to general anesthesia and surgical stimulation using a simple and noninvasive dual-channel photoplethysmography system. The value of PWV, an index of arterial stiffness, has significant correlation with arterial blood pressure.
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Acta Anaesthesiol Taiwan · Dec 2006
Randomized Controlled TrialEffect of oral ketamine on the postoperative pain and analgesic requirement following orthopedic surgery.
Ketamine is a potent analgesic agent in addition to its anesthetic properties. Oral ketamine has been used to treat postoperative stump pain following lower limb amputation. In this study, oral ketamine was used to reduce the severity of postoperative pain following orthopedic surgery. ⋯ Oral ketamine may be used to reduce postoperative pain following orthopedic procedures in the traumatic patients. Since only one patient developed psychological side effect (which we can not attribute to ketamine with certainty) it can be concluded that oral ketamine is not so fearsome with respect to emergence reaction.