Journal of anesthesia
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Journal of anesthesia · Jan 2009
Effect of posture on mouth opening and modified Mallampati classification for airway assessment.
Several bedside airway assessment methods have been proposed for preoperatively identifying patients who are difficult to intubate. To date, the Mallampati grading remains a time-tested technique for difficult airway assessment. Both Mallampati and the further modification by Samsoon and Young assessed patients in the seated position. ⋯ Eighty adult patients of American Society of Anesthesiologists (ASA) physical status I and II, aged 18-65 years, admitted to our neurosurgical ward were enrolled and assessed for airway. Our study revealed that change in posture produced a significant change in the mouth openings and Mallampati grades of the patients. This change was always toward a higher grade when the patient was turned supine from the sitting position.
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Journal of anesthesia · Jan 2009
Case ReportsA plantar flexion response to nerve stimulation indicates needle misplacement in the epidural/spinal space during psoas compartment block.
We report two cases of plantar flexion due to epidural misplacement of the needle during psoas compartment block, providing a response feedback for needle position during this procedure. In one case, the response occurred contralaterally, and in the other bilaterally. ⋯ At this point, 3 ml of radiopaque medium was injected, and it diffused throughout the epidural space. Subsequently, single-shot epidural anesthesia was achieved by injection through this needle.
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Journal of anesthesia · Jan 2009
Gradient of bronchial end-tidal CO2 during two-lung ventilation in lateral decubitus position is predictive of oxygenation disorder during subsequent one-lung ventilation.
Hypoxemia is one of the major problems during one-lung ventilation (OLV). During two-lung ventilation (TLV) using a double-lumen bronchial tube, bronchial endtidal carbon dioxide partial pressure (ETbr(CO2)) can be determined on both sides, independently. The ETbr(CO2) is mainly dependent on the pulmonary perfusion to each lung. If the degree of oxygenation disorder during OLV were to be predictable before starting OLV, this could provide time to prepare for any subsequent hypoxemia. The aim of this study was to investigate whether the difference of ETbr(CO2) (D-ETbr(CO2)) between the dependent and the nondependent lungs during TLV in the lateral decubitus position (LP) could be a predictive factor for the severity of oxygenation disorder under subsequent OLV. ⋯ The D-ETbr(CO2) predetermined during TLV in LP could be a predictive factor for the severity of oxygenation disorder after starting OLV in LP.
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Journal of anesthesia · Jan 2009
Case ReportsSuccessful extracorporeal membranous oxygenation for a patient with life-threatening transfusion-related acute lung injury.
A case of transfusion-related acute lung injury (TRALI) that was successfully treated with extracorporeal membranous oxygenation (ECMO) is reported. A 58-year-old male patient underwent hepatectomy, and pulmonary edema occurred after the administration of fresh-frozen plasma and packed red cells. In the postoperative period, the impaired oxygenation progressively worsened, resulting in life-threatening hypoxemia, despite vigorous treatments. ⋯ As a treatment for ARDS, ECMO does not cure the underlying disease of the lungs, however, with ECMO, TRALI, usually improves within 96 h with respiratory support. ECMO for TRALI-induced lethal hypoxemia is useful for providing time to allow the injured lung to recover. It is suggested that ECMO might be a useful option for the treatment of TRALI-induced, potentially lethal hypoxemia.
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Journal of anesthesia · Jan 2009
A simple, lightweight CPAP-delivery device, composed of a three-way stopcock, for the nondependent lung.
We aimed to introduce a simple, lightweight continuous positive airway pressure (CPAP)-delivery device for the nondependent lung during one-lung ventilation, to investigate how the type of three-way stopcocks, and the compliance and resistance of a test lung affect the relationship between the oxygen flow rate and CPAP level produced, and to examine how the device works in a clinical setting. ⋯ The lightweight CPAP delivery-device can provide variable CPAP levels by adjusting the oxygen-flow rate without real-time monitoring of the pressure.