Journal of anesthesia
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Journal of anesthesia · Jan 2009
Acid-base variables in patients with acute kidney injury requiring peritoneal dialysis in the pediatric cardiac care unit.
We aimed to clarify the acid-base abnormalities of patients with acute kidney injury (AKI) requiring peritoneal dialysis (PD) in pediatric cardiac care units. ⋯ Patients with AKI requiring PD in a pediatric cardiac care unit had significant metabolic acidosis compared to controls matched by the type of surgery and body weight. Hyponatremia and hypoalbuminemia were characteristics of these patients. The calculated SIDa was smaller in the PD than in the control group. Only the serum albumin had a significant prognostic value.
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Journal of anesthesia · Jan 2009
Case ReportsLife-threatening spontaneous hemothorax in a patient with thrombotic thrombocytopenic purpura.
Spontaneous hemothorax in the left pleural space occurred suddenly in a patient with thrombotic thrombocytopenic purpura (TTP). In spite of massive blood transfusion, the hemorrhage could not be stopped. The patient suffered shock due to tension hemothorax and hypovolemia, resulting in cardiac arrest. ⋯ The main cause of the bleeding was rupture of the left intercostal vein. TTP is a severe microvascular occlusive thrombotic microangiopathy that can induce congestion, vasculitis, and ischemia. This mechanism is thought to have been involved in the rupture of the intercostal vein in the present patient.
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Journal of anesthesia · Jan 2009
Case ReportsUltrasound-aided unilateral epidural block for single lower-extremity pain.
We report an ultrasound-aided unilateral epidural block, employed in two patients, to provide better analgesia and motor function for lower-extremity pain. The patient in case 1 was a 72-year-old woman who suffered pain arising from Herpes zoster rash on the left leg (the second lumbar nerve area). A left-dominant continuous unilateral epidural block was performed to reduce her pain. ⋯ His left knee pain was clearly reduced, with partial paralysis, but motor function in his right leg was completely normal during the continuous epidural block with 4 ml h(-1) of 0.2% ropivacaine. Ultrasound imaging around the epidural space facilitated effective unilateral epidural block for single lower-extremity pain in both patients. This technique could decrease possible side effects and improve patient satisfaction during continuous nerve block by maintaining motor function and sensation in the nondependent side.
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Journal of anesthesia · Jan 2009
Case ReportsReal-time three-dimensional ultrasound for continuous interscalene brachial plexus blockade.
Two-dimensional ultrasound guidance is used commonly for regional anesthetic techniques. This report describes the novel use of three-dimensional, ultrasound-guided, continuous interscalene regional analgesia, which was used in a 36-year-old woman undergoing left total elbow arthroplasty. Possible advantages of this novel technology over current two-dimensional methods include a larger area of available scan information that enables multiple planes of view without having to reposition the ultrasound probe, and three-dimensional visualization of local anesthetic deposition perineurally. Current technological limitations include an upper frequency of 7 MHz, which decreases the resolution of superficial scanning.
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Journal of anesthesia · Jan 2009
Serum concentration of lidocaine after transversus abdominis plane block.
We measured the serum concentration of lidocaine after transversus abdominis plane (TAP) block with 40 ml of 1% lidocaine in 12 patients under general anesthesia, using a fluorescence polarization immunoassay. The peak mean serum concentration of lidocaine occurred 30 min after the block (3.6 +/- 0.7 microg x ml(-1)). ⋯ These results indicate that a TAP block can potentially cause systemic toxicity of a local anesthetic. The analgesic effect of the TAP block may partially depend on the rise in serum concentration of the local anesthetic.