Journal of anesthesia
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Journal of anesthesia · Aug 2013
Quantitative measurement of blood remifentanil concentration: development of a new method and clinical application.
We have developed a new detection method of blood remifentanil concentration using a gas chromatography-mass spectrometry(GC-MS) with fentanyl as the internal standard(IS). The detection was performed at m/z 168 and 245 for remifentanil and fentanyl, respectively. In addition, the retention times of remifentanil and fentanyl were 5 min 45 s and 6 min 51 s, respectively. ⋯ Measured blood remifentanil concentration was 3.59 ± 0.74 ng/ml at the end of remifentanil infusion, and the ime for a decrease in blood remifentanil concentration by half was ~2 min. Remifentanil concentration was below the detection limit 30 min after the cessation. Thus, we have confirmed that this new method is clinically applicable.
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Journal of anesthesia · Aug 2013
Corrected right ventricular end-diastolic volume and initial distribution volume of glucose correlate with cardiac output after cardiac surgery.
Appropriate adjustment of cardiac preload is essential to maintain cardiac output (CO), especially in patients after cardiac surgery. This study was intended to determine whether index of right ventricular end-diastolic volume (RVEDVI), corrected RVEDVI using ejection fraction (cRVEDVI), index of initial distribution volume of glucose (IDVGI), or cardiac filling pressures are correlated with cardiac index (CI) following cardiac surgery in the presence or absence of arrhythmias. ⋯ Our results demonstrated that cRVEDVI and IDVGI were correlated with CI in the presence or absence of arrhythmias. cRVEDVI and IDVGI have potential as indirect cardiac preload markers following cardiac surgery.
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Journal of anesthesia · Aug 2013
Case ReportsAxillary arteriovenous fistula after axillary plexus block.
This report presents the case of a 51-year-old man who had an axillary arteriovenous fistula (AVF) as a complication of an axillary plexus block that was performed for internal fixation for a right forefinger phalanx fracture 4 years previously. While performing the axillary plexus block, a 22-gauge needle was placed inside the axillary sheath by observing the pulsations of the axillary artery. A pulsatile mass was found in the right axilla 1 day after the block was performed. ⋯ The false aneurysm sac was excised and lateral repair of the axillary artery and vein was carried out under general anesthesia. Postoperative recovery was uneventful. The possible occurrence of an AVF after axillary plexus block should be kept in mind, because early diagnosis and treatment are necessary to avoid development of AVF and false aneurysm.
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Journal of anesthesia · Aug 2013
Letter Case ReportsMisdiagnosis of an early postoperative upper limb deficit.
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Journal of anesthesia · Aug 2013
Observational StudyChest anteroposterior diameter affects difficulty of laryngoscopy for non-morbidly obese patients.
This prospective, observational study was performed to examine the hypothesis that if conventional 7-cm head elevation is applied, laryngoscopy is more difficult for patients with anteroposterior chest diameter (chest AP diameter) outside the average range (≥17.7 or ≤14.7 cm). ⋯ When using a standard pillow size of 7 cm, chest AP diameter above or below the average range (≥17.7 or ≤14.7 cm) was a strong predictor of DVL for apparently normal-sized patients. In such cases, modification of pillow height should be considered.