Journal of anesthesia
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Journal of anesthesia · Jun 2016
ReviewMinimally invasive or noninvasive cardiac output measurement: an update.
Although cardiac output (CO) by pulmonary artery catheterization (PAC) has been an important guideline in clinical management for more than four decades, some studies have questioned the clinical efficacy of CO in certain patient populations. Further, the use of CO by PAC has been linked to numerous complications including dysrhythmia, infection, rupture of pulmonary artery, injury to adjacent arteries, embolization, pulmonary infarction, cardiac valvular damage, pericardial effusion, and intracardiac catheter knotting. The use of PAC has been steadily declining over the past two decades. ⋯ Thoracic electrical bioimpedance (TEB) and electric bioreactance (EB) are totally noninvasive CO monitoring. Nexfin HD and the newer ClearSight systems are examples of noninvasive CO monitoring devices currently being marketed by Edwards Lifesciences. The developing focus in CO monitoring devices appears to be shifting to tissue perfusion and microcirculatory flow and aimed more at markers that indicate the effectiveness of circulatory and microcirculatory resuscitations.
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Journal of anesthesia · Jun 2016
Case ReportsA case of delayed respiratory depression caused by accidental subcutaneous opioid infusion.
We report a case of delayed respiratory depression due to accidental subcutaneous opioid infusion. A healthy 33-year-old woman underwent orthopedic surgery under general anesthesia. ⋯ The patient recovered with the use of jaw lift together with bag-valve-mask ventilation. We believe that accidental subcutaneous opioid accumulation may have caused the respiratory depression.
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Journal of anesthesia · Jun 2016
Feasibility of eye-tracking technology to quantify expertise in ultrasound-guided regional anesthesia.
Ultrasound-guided regional anesthesia (UGRA) requires an advanced procedural skill set that incorporates both sonographic knowledge of relevant anatomy as well as technical proficiency in needle manipulation in order to achieve a successful outcome. Understanding how to differentiate a novice from an expert in UGRA using a quantifiable tool may be useful for comparing educational interventions that could improve the rate at which one develops expertise. Exploring the gaze pattern of individuals performing a task has been used to evaluate expertise in many different disciplines, including medicine. ⋯ The purpose of this preliminary study is to establish the feasibility of applying such technology as a measurement tool for comparing procedural expertise in UGRA. eye-tracking data were collected from one expert and one novice utilizing Tobii Glasses 2 while performing a simulated ultrasound-guided thoracic paravertebral block in a gel phantom model. Area of interest fixations were recorded and heat maps of gaze fixations were created. Results suggest a potential application of eye-tracking technology in the assessment of UGRA learning and performance.
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Journal of anesthesia · Jun 2016
Evaluation of lead aprons and their maintenance and management at our hospital.
Lead aprons are worn by medical workers to reduce the effects of the radiation doses to which they are exposed during radiography and surgery performed with radioscopic apparatus. Regarding the management of such aprons, the Radiation Protection Section of the Japanese Society of Radiological Technology issued the "Guidelines for the Management of Lead Aprons" in 2000, and common management criteria have been set for all institutions. ⋯ Although no abnormality was detected upon visual and tactile inspections, CT images revealed that protective aprons used for 6 years or more had damaged internal radiation shields, thus risking radiation exposure. In response to these results, we fully realized the need to examine the date of the initial use of currently used lead aprons, to routinely perform visual and tactile inspections, and to regularly evaluate the extent of damage to the internal radiation shields via fluoroscopy in cooperation with the radiation management section.
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Journal of anesthesia · Jun 2016
Intranasal midazolam administration enhances amnesic effect in rats.
Intranasal (i.n.) administration of midazolam has been shown to be effective and safe for its sedative, anxiolytic, and anticonvulsant effects. However, there has been no investigation on the influence of i.n. administration on midazolam-induced anterograde amnesia. In addition, although the potential of direct drug delivery from the nose to the central nervous system (CNS) has recently become a topic of great interest, it remains unclear whether this pathway is also involved after i.n. midazolam. ⋯ Furthermore, in rats with disrupted electrical input from the olfactory epithelium after an olfactotoxicant 3-methylindole administration, the i.n.-mediated enhanced amnesic effect of midazolam was not observed. Our findings indicate that i.n midazolam could probably generate olfactory signals to the brain via benzodiazepine receptors and, compared with i.m. administration, can produce a more significant amnesic effect without alteration in sedative levels. Further clinical studies are warranted.