Anesthesia and analgesia
-
Anesthesia and analgesia · Jul 2013
The effects of the Trendelenburg position and intrathoracic pressure on the subclavian cross-sectional area and distance from the subclavian vein to pleura in anesthetized patients.
The effects of maneuvers to increase intrathoracic pressure and of Trendelenburg position on the cross-sectional area (CSA) of the subclavian vein (SCV) and the relationship between the SCV and adjacent structures have not been investigated. ⋯ The combined application of inspiratory hold and Trendelenburg position provided a greater and more relevant degree of CSA increase without compromising DSCV-pleura, which may facilitate SCV catheterization. Further investigations are needed to determine whether these results affect the success rate of catheterization and the risk of procedural injury.
-
Anesthesia and analgesia · Jul 2013
Case ReportsCase report: inadvertent intrathecal placement of a pulmonary artery catheter introducer.
We present a case of unintended intrathecal cannulation by a pulmonary artery catheter introducer in a patient scheduled for coronary surgery. This complication was likely due to multiple attempts of placing the guidewire. Switching to the straight tip of the guidewire may have created a false route, facilitating entrance in the subarachnoid space. ⋯ A lumbar epidural blood patch alleviated all complaints. One month later the patient underwent surgery successfully. We hypothesize that ultrasound imaging may have prevented this complication.
-
Anesthesia and analgesia · Jul 2013
Special article: evaluation of a novel noninvasive respiration monitor providing continuous measurement of minute ventilation in ambulatory subjects in a variety of clinical scenarios.
Currently there is no technology that noninvasively measures the adequacy of ventilation in nonintubated patients. A novel, noninvasive Respiratory Volume Monitor (RVM) has been developed to continuously measure and display minute ventilation (MV), tidal volume (TV), and respiratory rate (RR) in a variety of clinical settings. We demonstrate the RVM's accuracy and precision as compared with a standard spirometer under a variety of clinically relevant breathing patterns in nonintubated subjects. ⋯ This study demonstrates RVM's clinically relevant accuracy and precision in measuring MV, TV, and RR over a 24-hour period and during various breathing patterns.
-
Anesthesia and analgesia · Jul 2013
Case ReportsCase report: profound hypotension after anesthetic induction with propofol in patients treated with rifampin.
Rifampin is commonly used for the treatment of tuberculosis and staphylococcal infections, as well as for prevention of infection in cardiac valve and bone surgeries. We report a case of profound hypotension after anesthesia induction with propofol in a patient who was treated with two 600 mg doses of rifampin for prophylaxis of infection before surgery. In a retrospective case-control study of 75 patients, we confirmed this potentially serious drug-drug interaction. After rifampin, there was a significant and prolonged arterial blood pressure reduction when patients received propofol, but not thiopental.
-
Anesthesia and analgesia · Jul 2013
Case ReportsSpecial article: retained guidewires after intraoperative placement of central venous catheters.
Guidewire retention is a rare complication of central venous catheter placement, and has been related to operator fatigue, inexperience, and inattention, and inadequate supervision of trainees. The true incidence of guidewire loss after intraoperative placement of central venous catheters is unknown. ⋯ Worsening of patients' clinical condition during catheter placement and complex procedures necessitating more than one guidewire insertion are recurring scenarios in cases involving guidewire loss. Over 6 years at our institution, intraoperative wire loss occurred at a rate of 1:3291 procedures (95% confidence interval of 1/10,000 to 8/10,000).