Journal of anesthesia
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Journal of anesthesia · Apr 2012
Randomized Controlled TrialUtility of longitudinal paramedian view of ultrasound imaging for middle thoracic epidural anesthesia in children.
The risk of nerve injury for pediatric thoracic epidural block increases stress for anesthesiologists. The purpose of this study was to investigate the usefulness of longitudinal ultrasound imaging for thoracic epidural block (T5-T6 or T6-T7) in anesthetized children scheduled for the Nuss procedure. ⋯ We concluded that longitudinal paramedian ultrasound imaging could reduce performance time and the difficulty for anesthesiologists during epidural block.
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Journal of anesthesia · Apr 2012
Case ReportsRegional anesthesia with a single spinal anesthesia using hyperbaric bupivacaine in a child with arthroglyposis multiplex congenita.
Arthrogryposis multiplex congenita (AMC) consists of complex congenital anomalies characterized by multiple contractures. Anesthetic management of these patients requires special care: as this disease often progresses until dysfunction of multiple organ systems occur, it may have an impact on the anesthetic management. Here, we report a case of AMC undergoing urgent surgery for open tibia fracture who had difficult airway management because of limited mouth opening. The anesthetic management of this patient is represented in light of the literature.
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Journal of anesthesia · Apr 2012
Case ReportsA high dose of dexmedetomidine using the BIS monitor™ for diagnostic and interventional cardiac catheterization in a toddler with congenital heart disease.
Dexmedetomidine (DEX) for sedation in diagnostic and interventional cardiac catheterization (DICC) has been reported to require other drugs or rescue drugs because of its insufficient sedative effect when used alone. We administered DEX and adjusted its dose according to the bispectral index (BIS) monitor™ for DICC in a toddler; consequently, a high dose of DEX had to be administered. The patient was a 1-year and 4-month-old boy who was scheduled to undergo DICC after intracardiac repair. ⋯ The maximum predicted plasma concentration (pCp) of DEX and mean pCp were calculated as 6.1 and 4.1 ng/mL, respectively. A high dose of DEX may be required for DICC sedation, as for MRI sedation, in many cases. Although further studies should be conducted to reveal the merits and demerits of DEX in cardiac catheterization, a high dose of DEX may be useful in some cases.
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Journal of anesthesia · Apr 2012
Randomized Controlled TrialLandiolol attenuates cardiovascular response at induction of general anesthesia for cesarean delivery.
General anesthesia for cesarean delivery is frequently associated with hypertension and tachycardia caused by tracheal intubation, which may lead to cardiac ischemia in susceptible patients or may cause harm due to increased intracranial pressure. To prevent these adverse events, we investigated the efficacy and safety of single-dose intravenous administration of landiolol, a short-acting selective β(1) receptor blocker, just prior to intubation. ⋯ In our study, landiolol reduced BP and HR changes during anesthesia induction, whereas no adverse effects on uterine contraction or the fetus were seen. These findings suggest landiolol provides adequate hemodynamic regulation during general anesthesia induction in patients undergoing cesarean delivery.