Journal of anesthesia
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Journal of anesthesia · Dec 2010
Case ReportsComplications with massive sacrococcygeal tumor resection on a premature neonate.
Resection of large sacrococcygeal teratomas (SCT) in neonates can pose many anesthetic challenges. The pathophysiology of the SCT determines the varying management. We present a case report of a 34-week newborn with a massive Altman type 3 SCT. ⋯ We also had difficulty in maintaining the temperature. This patient did well after the surgery and was discharged home. We address here the anesthetic issues involved in the perioperative care management of a premature infant with a massive SCT.
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Journal of anesthesia · Dec 2010
Randomized Controlled Trial Comparative StudyAnalysis of the cost-effectiveness of remifentanil-based general anesthesia: a survey of clinical economics under the Japanese health care system.
Remifentanil has been available in Japan for 3 years. The use of this new opioid is considered a useful adjuvant to general anesthesia. Knowing the exact cost-effectiveness of remifentanil should lead to improved anesthetic outcomes with a reasonable cost. ⋯ This study shows that remifentanil-based general anesthesia is no more expensive than conventional fentanyl-based anesthesia under the Japanese health care system because of the small difference in price between remifentanil and fentanyl.
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Journal of anesthesia · Dec 2010
Evaluation of performance of two high-frequency oscillatory ventilators using a model lung with a position sensor.
High-frequency oscillatory ventilation (HFOV) is thought to protect the lungs of acute respiratory distress syndrome (ARDS) patients. The performance and mechanical characteristics of high-frequency oscillatory ventilators, especially with regard to delivering appropriate tidal volume (V(T)) to compromised lungs, might affect the outcome of patients. We evaluated the performance of two such ventilators using a model lung with a position sensor. ⋯ Because it is able to deliver comparably greater V(T), R100 may be a better choice for HFOV in critical ARDS patients. Better proportionality may be a result of more effective amplitude titration for adjusting PaCO₂ during oscillation.
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Journal of anesthesia · Dec 2010
Case ReportsDexmedetomidine was safely used for sedation during spinal anesthesia in a very elderly patient.
We safely administered dexmedetomidine (DEX) for sedation during spinal anesthesia in a very elderly patient. The patient was a 98-year-old woman who had hypertension, renal failure, and first-grade atrioventricular block. She was scheduled to undergo internal fixation for fracture of the femoral neck. ⋯ Percutaneous oxygen saturation was maintained at 98% or more; respiratory rate was within 15-21 tpm, and no ventilatory assistance was required. The maximum predicted plasma concentration (pCp) of DEX was 1.56 ng/mL, and the mean pCp of DEX during surgery was approximately 0.45 ng/mL. We found that DEX can be safely used for sedation during spinal anesthesia in a very elderly patient.