Journal of anesthesia
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Journal of anesthesia · Feb 2010
Comparative Study Clinical TrialBuccal administration of dexmedetomidine as a preanesthetic in children.
The objective of this study was to evaluate the efficacy and safety of buccal dexmedetomidine as a preanesthetic in children, to compare it with diazepam, and to investigate the optimal dosage for buccal dexmedetomidine administration by measuring its serum concentration. ⋯ These results suggest that the buccal administration of dexmedetomidine (3-4 microg/kg) 1 h before the operation can be safely and effectively applied as a preanesthetic in children.
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Journal of anesthesia · Feb 2010
Clinical TrialCompressing the non-dependent lung during one-lung ventilation improves arterial oxygenation, but impairs systemic oxygen delivery by decreasing cardiac output.
We have previously found that compression of the non-dependent lung improves arterial oxygenation during one-lung ventilation (OLV) in patients undergoing esophagectomy. The purpose of this study was to investigate the effects of compression of the non-dependent lung on hemodynamic indices and oxygen delivery using a minimally invasive cardiac output (CO) monitor. ⋯ Although non-dependent lung compression may be a potentially effective measure to treat hypoxemia during OLV, it should be noted that CO and systemic oxygen delivery may be decreased by this maneuver.
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Journal of anesthesia · Feb 2010
Retrospective analysis of predictors of cerebral vasospasm after ruptured cerebral aneurysm surgery: influence of the location of subarachnoid blood.
The amount of blood on computed tomography (CT) has been shown to be a predictor of cerebral vasospasm after subarachnoid hemorrhage (SAH). However, the influence of the location of the blood on the incidence of vasospasm remains unclear. We retrospectively assessed the association of the blood volumes in the individual components (cisterns and fissures) of CT scans with angiographic vasospasm after SAH. ⋯ The results indicated that the amount of blood in the right sylvian fissure was significantly associated with the development of angiographic vasospasm after SAH.
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Journal of anesthesia · Feb 2010
Case ReportsDisplacement of the epiglottis during intubation with the Pentax-AWS Airway Scope.
The Pentax-AWS system is a rigid indirect video laryngoscope with integrated tube guidance. Complications associated with this device are not well understood. We report two cases of epiglottis malposition during intubation with the Pentax-AWS. ⋯ Consequently, the view of the epiglottis from the camera may be impeded by the blade tip and may result in undiagnosed epiglottis malposition. The AWS's structural feature and its approach to the larynx can be associated with increased chance of unexpected epiglottis folding. It is particularly important to confirm normal position of the epiglottis during withdrawal of the device to prevent this complication.
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Journal of anesthesia · Feb 2010
Case ReportsSuccessful use of spinal anesthesia in a patient with severe Klippel-Trénaunay syndrome associated with upper airway abnormalities and chronic Kasabach-Merritt coagulopathy.
Klippel-Trénaunay syndrome is a rare disorder characterized by the triad of capillary or cavernous hemangiomas, venous varicosities or malformations, and soft tissue or bone hypertrophy. Neuraxial anesthesia in patients with Klippel-Trénaunay syndrome has been infrequently described and has not been previously reported when accompanied by consumptive coagulopathy with thrombocytopenia (Kasabach-Merritt syndrome). The authors describe their clinical management of a 23 year-old woman with Klippel-Trénaunay syndrome who presented for elective total knee arthroplasty. ⋯ Kasabach-Merritt coagulopathy was corrected preoperatively by administration of cryoprecipitate. These interventions allowed the authors to safely perform a spinal anesthetic for the operation. The current case illustrates that major conduction anesthesia may be safely performed in patients with Klippel-Trénaunay disease provided that preoperative imaging studies exclude neurovascular involvement and coexisting coagulopathy is appropriately corrected.