Journal of anesthesia
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Journal of anesthesia · Apr 2011
Transcutaneous pressure at which the internal jugular vein is collapsed on ultrasonic imaging predicts easiness of the venous puncture.
Even though we use ultrasound guidance for central venous puncture, we sometimes experience difficulties. We infer that in such cases the vein is collapsed and that the transcutaneous ultrasound probe pressure at which the vein is collapsed (P (tc)) may predict the easiness of the venous puncture. We measured P (tc) and the diameter of the internal jugular vein in 47 adult patients in our ICU. ⋯ The easy group showed significantly higher P (tc) value (9.3 ± 3.8 vs. 3.5 ± 0.9 cmH(2)O, P < 0.0001) and larger vertical diameter (9.2 ± 3.1 vs. 6.8 ± 2.2 mm, P = 0.013) than the difficult group. We observed a clear border between the minimum P (tc) in the easy group (6 cmH(2)O) and the maximum value in the difficult group (5 cmH(2)O). In conclusion, venous collapsibility and vertical diameter determine difficulty in performing venous puncture.
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Journal of anesthesia · Apr 2011
Randomized Controlled TrialThe effect of ketamine on tracheal intubating conditions without neuromuscular blockade during sevoflurane induction in children.
The purpose of this study was to investigate the effect of ketamine on intubating conditions for tracheal intubation during anesthesia induction with sevoflurane and alfentanil in pediatric patients. ⋯ This study demonstrated that administration of ketamine 0.5 mg/kg could improve intubating conditions for tracheal intubation without neuromuscular blockade and preserve hemodynamic stability during sevoflurane inhalation induction with alfentanil in children.
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Journal of anesthesia · Apr 2011
Case ReportsEpiglottic prolapse induced by lighted stylet tracheal intubation.
We report a case of epiglottic prolapse induced by lighted stylet tracheal intubation perceived by following upper gastrointestinal endoscopy. A 68-year-old male was to undergo endoscopic mucosal resection (EMR) under general anesthesia for a superficial orolarynx cancer spreading over the root of the tongue. Because the mucosal change was so minimal, intubation was performed with a lighted stylet instead of a direct laryngoscope, to prevent its metal blade spoiling the delicate endoscopic findings. ⋯ The postoperative course was uneventful and he was discharged on the sixth postoperative day. Retrospective evaluation of preoperative gastrointestinal endoscopy showed the epiglottis was flat and thin enough to have a tendency to become attached to the posterior pharynx wall, even though the procedure was performed in the decubitus position. Epiglottic prolapse induced by lighted stylet tracheal intubation is a quite rare complication but we should be aware of it as a potential injury which could cause upper airway obstruction if not recognized before extubation.
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Journal of anesthesia · Apr 2011
Comparative StudyAccuracy of arterial pressure waveform analysis for cardiac output measurement in comparison with thermodilution methods in patients undergoing living donor liver transplantation.
The aim of this study was to assess the accuracy of the first and third versions of arterial pressure waveform cardiac output (APCO(v.1.0) and APCO(v.3.0)) measurements in comparison with thermodilution methods in patients undergoing living donor liver transplantation. ⋯ These data suggest that the accuracy of APCO(v.3.0) has improved compared to APCO(v.1.0) due to the updated algorithm, but additional improvements should be evaluated, especially in patients undergoing living donor liver transplantation with low systemic vascular resistance.
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Journal of anesthesia · Apr 2011
Randomized Controlled TrialA randomized trial to identify optimal precurarizing dose of rocuronium to avoid precurarization-induced neuromuscular block.
The aim of this study was to examine the safe precurarizing dose of rocuronium required to avoid neuromuscular block after precurarization. ⋯ Rocuronium at 0.06 mg/kg is an overdose for precurarization. The results of the present study demonstrate that a safe and effective precurarizing dose of rocuronium is 0.03 mg/kg.