Journal of anesthesia
-
Journal of anesthesia · Aug 2010
Randomized Controlled TrialThe effects of intravenous dexmedetomidine on spinal hyperbaric ropivacaine anesthesia.
In this study we investigated the effects of intravenously administered dexmedetomidine on the duration of hyperbaric ropivacaine in spinal anesthesia, and the side effects. ⋯ Our results show that intravenously administered dexmedetomidine prolonged the duration of spinal anesthesia, provided sufficient sedation, and had few side effects. Therefore, dexmedetomidine is appropriate during spinal anesthesia, if the anesthesiologist is alert for development of bradycardia.
-
Journal of anesthesia · Aug 2010
Case ReportsMonitored anesthesia care with dexmedetomidine of a patient with severe pulmonary arterial hypertension for inguinal hernioplasty.
The presence of severe pulmonary arterial hypertension (PAH) is a significant risk factor of major perioperative cardiovascular complications in patients undergoing even non-cardiac surgery under anesthetic management. The most important aspect of perioperative care of PAH patients is to avoid pulmonary hypertensive crisis, which can be induced by alveolar hypoxia, hypoxemia, hypercarbia, metabolic acidosis, airway manipulations, and activation of the sympathetic nervous system by noxious stimuli. We report a case of successful monitored anesthesia care supplemented by dexmedetomidine for inguinal hernioplasty of a patient with severe PAH secondary to congenital heart disease.
-
Journal of anesthesia · Aug 2010
Case ReportsTracheal intubation using Airway Scope in two patients with difficult airway during cardiopulmonary resuscitation.
The Airway Scope AWS-S100 (AWS, Pentax, Tokyo), a rigid video laryngoscope with integrated tube guidance that has recently become commercially available, helped the authors to establish airways in two patients with in-hospital cardiopulmonary arrest, after failed attempts to intubate the patients using the Macintosh laryngoscope (that only commanded the Cormack-Lehane grade 4 glottic views), the laryngeal mask airway, and even surgical cricothyroidotomy for the second case. This showed the utility of the AWS in the management of difficult airway cases even in emergency settings.
-
Journal of anesthesia · Aug 2010
Case ReportsSuperficial venous thrombophlebitis caused by rocuronium.
Pain is one of the major disadvantages of rocuronium, which is used during induction of anesthesia. Even at subparalyzing doses, 50-100% of patients complain of intense pain. ⋯ However, in both of our cases, visible reactions occurred and both patients were diagnosed with venous superficial thrombophlebitis. Therefore, we believe that rocuronium-related pain may, in part, be because of direct venous injury.
-
Journal of anesthesia · Aug 2010
Case ReportsDexmedetomidine for anesthetic management of anterior mediastinal mass.
Anesthetic management of anterior mediastinal masses (AMM) is challenging. We describe the successful anesthetic management of two patients with AMM in which dexmedetomidine was used at supra-sedative doses. Our first case was a 41-year-old man who presented with a 10 x 9 x 11 cm AMM, a pericardial effusion, compression of the right atrium, and superior vena cava syndrome. ⋯ Both patients were fiberoptically intubated awake under sedation using a dexmedetomidine infusion, followed by general anesthesia (mainly using higher doses of dexmedetomidine), thus maintaining spontaneous ventilation and avoiding muscle relaxation during a very stimulating procedure. The amnestic and analgesic properties of dexmedetomidine were particularly helpful. Maintaining spontaneous ventilation with dexmedetomidine as almost the sole anesthetic could be very advantageous and may reduce the risk of complete airway obstruction in the anesthetic management of AMMs.