Journal of anesthesia
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Journal of anesthesia · Jan 2009
Skin-traction method prevents the collapse of the internal jugular vein caused by an ultrasound probe in real-time ultrasound-assisted guidance.
Real-time ultrasound-assisted guidance for catheterization of the internal jugular vein (IJV) is known to be useful, especially for a small-sized vein, which is difficult to catheterize. However, one of the problems with real-time ultrasound-assisted guidance is that the ultrasound probe itself can collapse the vein. We have developed a novel "skintraction method (STM)", in which the puncture point of the skin over the IJV is stretched upwards with several pieces of surgical tape in the cephalad and caudal directions with the aim being to facilitate catheterization of the IJV. We examined whether this method increased the compressive force required to collapse the IJV. ⋯ With the STM, not only the cross-sectional area but also the compressive force required to collapse the IJV increased. Thus, the STM may facilitate real-time ultrasoundassisted guidance for catheterization of the IJV by maintaining the cross-sectional area of the vein during the guidance.
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Journal of anesthesia · Jan 2009
Increased fingertip vascular tone leads to a greater fall in blood pressure after induction of general anesthesia.
General anesthesia causes peripheral vasodilation. We thus hypothesized that patients with increased peripheral vascular tone would become more hypotensive after the induction of general anesthesia compared to those without increased peripheral vascular tone. To test this hypothesis, we compared the decrease in blood pressure after anesthetic induction between patients with increased peripheral vascular tone and those without increased peripheral vascular tone. ⋯ In each patient, the peripheral vascular tone was assessed by either the fingertip skin-surface temperature (FSST) or the forearm-fingertip skin-surface temperature gradient (FFSSTG; forearm skin-surface temperature minus FSST). The decrease in blood pressure 15 min after anesthetic induction was larger in patients with an FSST of 29 degrees C or less (FSST = 27.3 +/- 1.6 degrees C; FFSSTG = 5.2 +/- 1.6C) than in those with an FSST of more than 29 degrees C (FSST = 30.8 +/- 1.0 degrees C; FFSSTG = 1.6 +/- 1.2 degrees C). In conclusion, increased fingertip vascular tone (presumably due to thermoregulatory vasoconstriction) before anesthetic induction leads to a greater fall in blood pressure after anesthetic induction.
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Journal of anesthesia · Jan 2009
Case ReportsVolume manipulation by phlebotomy for cesarean section in a patient with pulmonary hypertension.
Pulmonary hypertension in a parturient is known for its high perioperative mortality. We describe a successful case of cesarean section performed under general anesthesia in a parturient with pulmonary hypertension. A distinctive feature of our management was active blood volume manipulation by phlebotomy and reinfusion of the blood. ⋯ The blood was slowly infused, with transesophageal echocardiography used to evaluate right ventricle filling. The patient was hemodynamically stable during the operation and had an uneventful postpartum period. Her baby's perioperative course was also uneventful.
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Journal of anesthesia · Jan 2009
Case ReportsAnesthetic management using total intravenous anesthesia with remifentanil in a child with osteogenesis imperfecta.
In patients with osteogenesis imperfecta (OI), general anesthetic management should be carefully implemented in consideration of difficult intubation and the potential risks of cervical or mandibular fracture associated with tracheal intubation, bone fracture during postural changes, and respiratory dysfunction due to thoracic deformity. To prevent temperature elevation, moreover, many reports have recommended anesthetic management using total intravenous anesthesia (TIVA) rather than inhalation anesthetics, which contribute to temperature elevation. In an 8-year-old boy with type II (fatal type) OI (height, 81 cm; body weight, 12.4 kg), we performed general TIVA with remifentanil and propofol, using a laryngeal mask airway for airway management. All possible intra- and postoperative complications were effectively prevented, and the remifentanil requirement was high, as shown by a mean dose of 0.36 microg x kg(-1) x min(-1).
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Journal of anesthesia · Jan 2009
Work stress and workload of full-time anesthesiologists in acute care hospitals in Japan.
The number of anesthesiologists per population in Japan is small compared with that in Europe and North America. While there is a growing concern that hard work causes anesthesiologists' fatigue and may compromise patient safety, the workload and physical stress, as well as the impact of staff support on physicians' stress have not been assessed in detail. The goal of this study was to evaluate the working environment, anesthesia workload, and occupational stress of anesthesiologists in Japan. ⋯ Our results provide a quantitative assessment of the duties of anesthesiologists and show that work stress among anesthesiologists is related to workload and other factors.