Anesthesia and analgesia
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Anesthesia and analgesia · Nov 2005
The optimal depth of central venous catheter for infants less than 5 kg.
To avoid fatal complications of central venous catheterization such as cardiac tamponade, the tip of the central venous catheter (CVC) should be placed outside of the cardiac chamber. To suggest a guideline for a proper depth of CVC in infants, we measured the distance from the skin puncture site to the junction between superior vena cava and right atrium (SVC-RA junction) by using transesophageal echocardiography (TEE). Fifty infants less than 5 kg undergoing surgery for congenital heart disease were enrolled in this prospective study. ⋯ After the tip of the CVC was placed at the SVC-RA junction using TEE guidance, the length of the CVC inserted beneath the skin was measured. The measured distance had a high correlation with the patient's height, weight, and age (r = 0.88, 0.76, and 0.64, respectively). In infants smaller than 5 kg, the following guideline can avoid intraatrial placement of the CVC: a depth between 40 and 45 mm for infants 2.0-3.0 kg in weight, 45-50 mm for those 3.0-3.9 kg, and 50-55 mm for those more than 4.0 kg.
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Anesthesia and analgesia · Nov 2005
Comparative StudyThe feasibility of laryngoscope-guided tracheal intubation in microgravity during parabolic flight: a comparison of two techniques.
We determined the feasibility of laryngoscope-guided tracheal intubation (LG-TI) in microgravity obtained during parabolic flight and tested the hypothesis that LG-TI is similarly successful in the free-floating condition, with the patient's head gripped between the anesthesiologist's knees, as in the restrained condition, with the torso strapped to the surface. Three personnel with no experience in airway management or microgravity participated in the study. LG-TI of a sophisticated full-size manikin was attempted on seven occasions in each condition by each investigator after ground-based training. ⋯ There were no differences in performance among investigators. We conclude that LG-TI is feasible in microgravity obtained during parabolic flight, but the success rate is infrequent because of severe time restrictions. There were no differences in success rate between the free-floating condition, with the head gripped between the knees, and the restrained condition, with the torso strapped to the surface.
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Anesthesia and analgesia · Nov 2005
Comparative StudyAn in vitro comparison of the electrical conducting properties of multiport versus single-port epidural catheters for the epidural stimulation test.
Effective conduction of electricity through a catheter is essential for the success of the epidural stimulation test. In this in vitro study we examined the electrical conductivity of single and multiport epidural catheters (with and without embedded metal elements) after being primed with normal saline. Seven different types of 19-gauge catheters (n = 5), either single-port or multiport catheters, with or without embedded metal elements, were studied. ⋯ The volume of saline in the syringe had no impact on the measured electrical resistances. This study suggests that multiport metal reinforced epidural catheters have low electrical resistances and, thus, are a reasonable alternative to single-port catheters for transmitting sufficient current for performing the epidural stimulation test. On the other hand, epidural catheters without metal elements (single-port or multiport) are not suitable for performing the stimulation test.
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Anesthesia and analgesia · Nov 2005
The prevalence and significance of low preoperative hemoglobin in ASA 1 or 2 outpatient surgery candidates.
Asymptomatic anemia in healthy patients undergoing low risk surgery is rare. In this retrospective study, we examined the records of 9584 ASA class I-II patients scheduled for elective low risk surgery who had a preoperative hemoglobin (hgb) test for the presence of anemia. Hgb <9 g/dL was detected in 75 patients (0.8%). ⋯ Transfusion of red cells occurred in four other patients, all of whom had hgb >9 g/dL. In all cases, management decisions were based on clinical factors rather than the preoperative hemoglobin test. In healthy patients undergoing low risk elective surgery, routine preoperative hgb testing is not indicated.
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Anesthesia and analgesia · Nov 2005
Denaturing high performance liquid chromatography screening of ryanodine receptor type 1 gene in patients with malignant hyperthermia in Taiwan and identification of a novel mutation (Y522C).
We performed the present study to identify the mutation in patients in Taiwan with malignant hyperthermia (MH). We also test the hypothesis that a denaturing high-performance liquid chromatography (DHPLC) protocol can be used for mutation detection in these patients. We identified five Taiwanese patients with typical clinical presentations of MH after general anesthesia. ⋯ None of the MH-related mutations were found in the control group. In conclusion, we identified RYR1 mutations in 5 Taiwanese patients with MH using a DHPLC-based approach. A DHPLC-based genetic test may be developed as a noninvasive and convenient test for MH.