Journal of anesthesia
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Journal of anesthesia · Dec 2011
Randomized Controlled TrialEffects of adjunct intrathecal magnesium sulfate to bupivacaine for spinal anesthesia: a randomized, double-blind trial in patients undergoing lower extremity surgery.
The aim of this study was to evaluate the effect of additional magnesium sulfate (MgSO(4)) 100 mg to intrathecal (IT) isobaric 0.5% bupivacaine 3 ml on spinal anesthesia in patients undergoing lower extremity orthopedic surgery. ⋯ In patients undergoing lower extremity surgery with spinal anesthesia, the addition of 100 mg IT MgSO(4) to 15 mg bupivacaine without opioid supplement, prolonged the duration of the sensory block, decreased postoperative analgesic consumption, and significantly prolonged the onset of spinal anesthesia.
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Journal of anesthesia · Dec 2011
Review Meta AnalysisAccuracy of stroke volume variation in predicting fluid responsiveness: a systematic review and meta-analysis.
Stroke volume variation (SVV) appears to be a good predictor of fluid responsiveness in critically ill patients. However, a wide range of its predictive values has been reported in recent years. We therefore undertook a systematic review and meta-analysis of clinical trials that investigated the diagnostic value of SVV in predicting fluid responsiveness. ⋯ SVV is of diagnostic value in predicting fluid responsiveness in various settings.
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Journal of anesthesia · Dec 2011
Case ReportsInternal jugular vein thrombosis associated with venous hypoplasia and protein S deficiency revealed by ultrasonography.
A 41-year-old woman, who had no thrombotic risk factors and past history except congenital scoliosis, underwent central venous catheterization (CVC) before correction of the scoliosis. When internal jugular vein (IJV) catheterization using the anatomical landmark technique failed, CVC under ultrasound guidance was tried. As a consequence, thrombosis and hypoplasia of the right IJV were incidentally detected by ultrasonography. ⋯ Also, after examinations to rule out the possibility of pulmonary embolism and to clarify the causes of the IJV thrombosis, the patient was found to have protein S deficiency. CVC under ultrasound guidance should be recommended to prevent the failure of cannulation and complications such as thromboembolism in patients who could possibly have anomalies of vessels as a result of anatomical deformities caused by severe scoliosis, even if patients do not have thrombotic risk factors such as a history of central catheter insertion or intravenous drug abuse, cancer, advanced age, cerebral infarction, and left ventricular dysfunction. Also, if venous thrombosis is found in patients without predisposing risk factors, one should ascertain the cause of the hypercoagulable state, for example protein S deficiency, and perform appropriate treatment and prevention of venous thromboembolism.
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Journal of anesthesia · Dec 2011
Randomized Controlled TrialRetrospective analysis of spontaneous recovery from neuromuscular blockade produced by empirical use of rocuronium.
A train-of-four ratio (TOF ratio) of >0.9 should be the clinical cut-off to avoid residual paralysis. However, it is not rare to extubate patients without measurement of the TOF ratio, although the safe interval from the last administration of rocuronium assuring a TOF ratio of >0.9 has not been established in the daily clinical setting. In this study, to estimate the safe interval to avoid residual paralysis, we retrospectively selected patients in whom the TOF ratio was measured during remifentanil administration before extubation, and we studied the characteristics of recovery from the neuromuscular blockade produced by the empirical use of rocuronium. ⋯ Because of the large variation in the recovery from rocuronium-induced paralysis, TOF-based evaluation of residual paralysis is essential to determine the appropriate indication for reversal, especially for elderly patients.
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Journal of anesthesia · Dec 2011
Comparative StudyComparison of Pentax-AWS Airwayscope video laryngoscope, Airtraq optic laryngoscope, and Macintosh laryngoscope during cardiopulmonary resuscitation under cervical stabilization: a manikin study.
The 2010 American Heart Association or European Resuscitation Council guidelines for cardiopulmonary resuscitation emphasize that rescuers should minimize interruption of chest compressions, even for endotracheal intubation. Cervical stabilization should also be maintained during traumatic cardiac arrest. The utility of the Pentax-AWS Airwayscope (AWS) video laryngoscope and Airtraq (ATQ) optic laryngoscope for airway management has been reported under cervical stabilization. We first evaluated ATQ utility during chest compression with or without cervical stabilization and then compared the AWS, ATQ, and Macintosh laryngoscope (McL) during chest compressions under cervical stabilization in a manikin. ⋯ The AWS was superior to McL and ATQ for endotracheal intubation during simulated cervical stabilization and chest compression.