Journal of anesthesia
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Journal of anesthesia · Oct 2011
Case ReportsMultilevel nerve stimulator-guided paravertebral block as a sole anesthetic technique for breast cancer surgery in morbidly obese patients.
In this case series, we present the effectiveness of multilevel nerve stimulator-guided paravertebral block (PVB) technique in obese women of body mass index ≥30 kg/m(2) undergoing breast cancer surgery with or without axillary dissection. Twenty-six obese women were included in this case series. Block classification, hemodynamics and complication rate, postoperative nausea and vomiting, postoperative analgesic consumption, post-anesthesia care unit (PACU) stay, and hospital stay were recorded. ⋯ Confirmation of the landmark was established from the initial attempt in 61.5%. Surgical PVB was achieved in 76.9% of the patients; the failure rate of the technique was 11.5%. This case series suggested that the multilevel nerve stimulator-guided PVB may be an effective technique for obese patients undergoing breast cancer surgery, although further studies are needed to compare PVB and general anesthesia.
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Journal of anesthesia · Oct 2011
Influence of tidal volume for stroke volume variation to predict fluid responsiveness in patients undergoing one-lung ventilation.
We designed this study to determine the predictive value for fluid responsiveness of stroke volume variation (SVV) in patients undergoing one-lung ventilation (OLV), ventilated at different tidal volumes. All patients scheduled for pulmonary lobectomy were randomized into two groups according to their tidal volume [group H: tidal volume 8 ml/kg (n = 36); group L: tidal volume 6 ml/kg (n = 37)]. After starting OLV, volume loading was performed by administration of 500 ml 6% hydroxyethylated starch for 30 min. ⋯ The area under the receiver operating characteristic curve for SVV to discriminate between responders and non-responders was 0.776 in group H and 0.648 in group L. The optimal threshold value of SVV was 10.5% (sensitivity, 85.7%; specificity, 66.7%) in group H and 8% (sensitivity, 69.5%; specificity, 64.3%) in group L. We found that SVV could predict fluid responsiveness in patients undergoing OLV with acceptable levels of sensitivity and specificity only when tidal volume is at least 8 ml/kg.
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Journal of anesthesia · Oct 2011
Case ReportsEpidural anesthesia with intravenous dexmedetomidine sedation in the successful anesthetic management of MRI-guided focused ultrasound ablation of early prostatic cancer.
We report on five patients who underwent MRI-guided focused ultrasound ablation of prostatic cancer under epidural anesthesia with intravenous dexmedetomidine sedation. This pioneering procedure requires an immobile therapeutic field with adequate sedation and analgesia provided to the patients. ⋯ In combination with epidural anesthesia, dexmedetomidine was used to provide moderate levels of sedation without causing respiratory depression or hemodynamic instability, and was useful in preventing shivering. The pharmacological properties of dexmedetomidine contribute to make this technique safe and effective.
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Journal of anesthesia · Oct 2011
Randomized Controlled TrialComparison of postoperative pharyngeal morbidity using the Macintosh laryngoscope or AirWay Scope after mastectomy.
We compared the characteristics of postoperative pharyngeal morbidity in intubation between the AirWay Scope (AWS) and Macintosh laryngoscope in 68 ASA I-II female patients aged 35-77 years in a randomized, double-blinded, controlled fashion. After induction of general anesthesia, the patient's trachea was intubated using the AWS or Macintosh laryngoscope by five anesthesiologists. Before leaving the operating room, postoperative sore throat, hoarseness, and dysphagia were assessed, and oral bleeding was evaluated by observation of the extubated tracheal tube. ⋯ Incidence of oral bleeding with the AWS (6.1%) was significantly lower than that with the Macintosh laryngoscope (23.5%). Pharyngeal morbidity on the day after surgery did not differ between groups, and no patient complained of delayed oral intake. In female patients, the AWS successfully reduced the incidence and severity of sore throat on the day of surgery in comparison with the Macintosh laryngoscope.
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Journal of anesthesia · Oct 2011
Randomized Controlled Trial Clinical TrialEffects of aminophylline on cognitive recovery after sevoflurane anesthesia.
Aminophylline accelerates the recovery from sevoflurane anesthesia. We studied the effects of escalating doses of aminophylline on cognitive and clinical recovery after sevoflurane anesthesia. ⋯ The administration of escalating doses of aminophylline accelerates postoperative cognitive recovery from sevoflurane anesthesia, as measured by the SOMCT, due to increased ventilatory elimination of sevoflurane.