Journal of anesthesia
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Journal of anesthesia · Jan 2008
ReviewManagement of the difficult and failed airway in obstetric anesthesia.
Difficulty with airway management in obstetric patients occurs infrequently and failure to secure an airway is rare. A failed airway may result in severe physical and emotional morbidity and possibly death to the mother and baby. Additionally, the family, along with the medical and nursing staff, may face emotional and financial trauma. ⋯ Finally, the need for specific equipment in the obstetric difficult and failed airway is discussed. Worldwide maternal mortality reflects the health of a nation. However, one could also claim that, particularly in Western countries, maternal mortality may reflect the health of the specialty of anesthesia.
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Journal of anesthesia · Jan 2008
Randomized Controlled Trial Comparative StudyInfluence of low-molecular-weight hydroxyethyl starch on microvascular permeability in patients undergoing abdominal surgery: comparison with crystalloid.
Adequate volume therapy is essential for stable hemodynamics and sufficient urinary output perioperatively. Hydroxyethyl starch (HES) has been reported to attenuate the microvascular hyperpermeability which occasionally occurs in surgical patients. This study was carried out to evaluate the effect of low-molecular-weight HES on the urinary microalbumin/creatinine ratio (MACR), a marker of microvascular permeability, in surgical patients. ⋯ Although low-molecular-weight HES does not improve microvascular hyperpermeability, the expansion of the intravascular volume by HES results in higher urinary output in the postoperative period than that seen with crystalloid solution. The lower concentration of sICAM-1 after surgery may be due to hemodilution.
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Journal of anesthesia · Jan 2008
Randomized Controlled Trial Comparative StudyBoth clonidine and metoprolol modify anesthetic depth indicators and reduce intraoperative propofol requirement.
Beta-blockers have been used in the past to decrease the depth of anesthesia, but the results are conflicting. However, beta-blockers are known to suppress electroencephalographic activities. This study was carried out to assess the effect of metoprolol on anesthetic depth indicators. We also compared the effect of metoprolol in reducing propofol requirements. ⋯ Our study showed that, like clonidine, metoprolol attenuated the hemodynamic response to intraoperative stimuli and also had a sparing effect on the propofol dose requirement.
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Journal of anesthesia · Jan 2008
Medication errors in anesthesia: an 8-year retrospective analysis at an urban university hospital.
The Japanese Society of Anesthesiologists (JSA) has investigated critical events in several fields of anesthesiology. However, the types, frequency, and characteristics of medication errors related to anesthesia have not been investigated. By analyzing incident reports retrospectively, we investigated medication errors that occurred during anesthetic practice over the past 8 years at our institution. ⋯ We found that overdose, substitution, and omission were the main causes of anesthesia-related medication errors in our department.
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Journal of anesthesia · Jan 2008
Factors predicting successful noninvasive ventilation in acute lung injury.
Noninvasive ventilation (NIV) has been successfully used to treat various forms of acute respiratory failure. It remains unclear whether NIV has potential as an effective therapeutic method in patients with acute lung injury (ALI). The aims of this study were to determine factors predicting the need for endotracheal intubation in ALI patients treated with NIV, and to promote the selection of patients suitable for NIV. ⋯ We determined an APACHE II score of more than 17 and a respiratory rate of more than 25 breaths x min(-1) after 1 h of NIV as factors predicting the need for endotracheal intubation in ALI patients treated with NIV.