Journal of anesthesia
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Journal of anesthesia · Jan 2006
Combined effects of propofol and mild hypothermia on cerebral metabolism and blood flow in rhesus monkey: a positron emission tomography study.
Propofol reduces the cerebral metabolic rate for oxygen (CMRO2), regional CMRO2 (rCMRO2), cerebral blood flow (CBF), and regional CBF (rCBF), but maintains the coupling of cerebral metabolism and blood flow. Under mild to moderate hypothermia, the coupling is maintained, while rCBF is reduced, but no direct measurement of rCMRO2 has yet been reported. This study aimed to evaluate the effects of propofol under normothermic and mild hypothermic temperatures upon rCMRO2, rCBF, and their regional coupling, through direct measurement by positron emission tomography. ⋯ During propofol anesthesia, it is possible to reduce cerebral metabolism throughout the entire brain as well as in any brain region by increasing the propofol dose or inducing hypothermia. The concurrent use of these two interventions has an additive effect on metabolism, and can be considered as safe, as their combination does not impair the coupling of cerebral metabolism and blood flow.
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Journal of anesthesia · Jan 2006
Case ReportsIdentification of the lumbar intervertebral level using ultrasound imaging in a post-laminectomy patient.
A spinal block was performed in a post-laminectomy patient, using both ultrasound imaging and X-ray imaging. Ultrasound imaging clearly identified the L3/4 intervertebral level, the spinal canal, the corpus vertebrae, and the dura mater. ⋯ A 25-G needle for the spinal block was accurately advanced into the spinal canal with the use of X-ray imaging (43 mm from the skin to the subarachnoid space). We report here that ultrasound imaging was useful for performing a spinal block in a post-laminectomy patient in whom there was anatomical change around the spine.
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As the result of a locking phenomenon that may occur in a guidewire inside a metal puncture needle when using the Seldinger technique to insert a central venous catheter, the guidewire can break and cause an embolism. To counter this possibility we devised a guidewire with a structure that made it difficult for locking to occur and compared it to conventional guidewires. Conventional guidewires are wound lengthways with a spring. ⋯ We then compared the frequency of locking and the frequency of bending of the guidewire tips that have been withdrawn. In group A, locking occurred in 72% of the cases where the guidewire was unable to be inserted, but this figure was 0% in group B. The improved guidewire has the advantage of reducing the risk of locking and of guidewire breakage.
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Journal of anesthesia · Jan 2006
Case ReportsTwo cases of spinal epidural abscess with granulation tissue associated with epidural catheterization.
Two cases of spinal epidural abscess are reported whose abscesses became granulated after epidural catheterization. Although emergency surgical intervention was performed almost within 24 h after the diagnosis of epidural abscess in case 1, the patient revealed a poor outcome. After laminoplasty, case 2 received lumbar epidural catheterization, and he had a complete recovery. ⋯ Those findings suggest the midpoint of the abscess is the puncture site and that MSSA is found in or around the catheter. Infection at epidural catheterization seems to be caused by catheter insertion or skin contamination after catheterization. As those catheterizations were completed in the outpatient theater, we conclude that epidural catheterization should be performed in the operating room or with a restricted aseptic technique.
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Journal of anesthesia · Jan 2006
Clinical effects of a neutrophil elastase inhibitor, sivelestat, in patients with acute respiratory distress syndrome.
We assessed the effects of a neutrophil elastase inhibitor, sivelestat, on respiratory and organ functions as well as on the mortality of patients with acute respiratory distress syndrome (ARDS) associated with systemic inflammatory response syndrome (SIRS). ⋯ Our results suggested that sivelestat has a beneficial effect only on the pulmonary function of ARDS patients with SIRS.