Journal of anesthesia
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Journal of anesthesia · Feb 2015
Case ReportsRole of intraoperative transesophageal echocardiography in detecting masked mitral regurgitation during left atrial myxoma surgery.
Myxomas are the most common type of cardiac tumor. Mobile or large left atrial (LA) myxomas frequently cause functional mitral stenosis, and can lead to mitral regurgitation (MR). ⋯ Repeated careful observations on TEE led to a confident diagnosis of MR and the selection of an additional appropriate procedure. This case study highlighted the importance of intraoperative TEE in supporting clinical decision-making for optimal mitral valve procedures during LA myxoma surgery.
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Journal of anesthesia · Feb 2015
Case ReportsRelationship between ventral lumbar disc protrusion and contrast medium leakage during sympathetic nerve block.
Ventral disc protrusions have been neglected because they are asymptomatic. Lumbar sympathetic nerve block (LSNB) is one of the clinical choices for refractory low back pain treatment. Leakage of the contrast medium may occur and lead to complications, especially when using a neurolytic agent. ⋯ Moreover, the incidence of contrast medium leakage was significantly higher at the vertebrae that had grade 2 protrusion than at those with less protrusion. We revealed a higher incidence of ventral disc protrusion of the lumbar vertebrae than previously reported, and that the incidence of leakage in LSNB increased when ventral disc protrusion was present. To avoid complications, attention should be paid to ventral disc protrusions before performing LSNB.
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Journal of anesthesia · Feb 2015
Plasma ropivacaine concentration following ultrasound-guided subcostal transversus abdominis plane block in adults.
Ultrasound-guided subcostal transversus abdominis plane block (TAPB) is widely used for abdominal surgery; however, arterial plasma concentration of the anesthetic ropivacaine after the blockade is still unclear. We evaluated ropivacaine concentration after subcostal TAPB in adult patients undergoing upper abdominal surgery. Twelve patients with American Society of Anesthesiologists physical status 1-2 were enrolled. ⋯ No adverse events or clinical symptoms indicating systemic toxicity were observed during this study. The study demonstrated that administration of ropivacaine at 3 mg/kg during subcostal TAPB led to rapid increases in plasma concentration of the anesthetic during the first 2 h after the blockade. C(max) nearly reached the threshold for systemic toxicity.
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There is no strong evidence to support ventilatory management for critical limitation of expiratory flow, such as bronchospasm during anesthesia or an acute exacerbation of severe asthma and chronic obstructive pulmonary disease (COPD). Animal models cannot be used to develop reproducible experimental models for conducting mechanical ventilation strategy research relating to these etiologies due to the resulting respiratory and hemodynamic instabilities. ⋯ These characteristics were found to improve upon narrowing the expiratory port. We believe that this device model will facilitate future mechanical ventilation experiments.
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Journal of anesthesia · Feb 2015
Comparative StudyComparison of epinephrine and felypressin pressure effects in 1K1C hypertensive rats treated or not with atenolol.
Epinephrine is considered the gold standard vasoconstrictor for hypertensive patients, but few studies report felypressin's effects. The present study aimed to analyze and compare the effects of these two vasoconstrictors, injected by the intravenous route, on the arterial pressure of normotensive, hypertensive and atenolol-treated hypertensive rats. ⋯ Our results suggest that felypressin has equipotent pressure responses when compared with epinephrine, showing a greater extent of action. Atenolol's reduction of hypertensive effects surprisingly suggests that atenolol β-blockade may also be important for felypressin's cardiovascular effect, as is widely known for epinephrine. Our data suggest that felypressin is safe for hypertensive subjects, in particular those receiving atenolol.