Journal of anesthesia
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Journal of anesthesia · Feb 2020
The history of transesophageal echocardiography: the role of inspiration, innovation, and applications.
Transesophageal echocardiography (TEE), which is commonly used for monitoring and diagnostic imaging during cardiovascular surgery, was originally developed by a strong desire to know what was taking place in the heart in the dark ages of cardiac surgery. The author was fortunate to be present in the midst of the development of TEE and have an opportunity to take a close look at the history of this innovation. ⋯ This article describes the history of TEE based on the reports in the early stage of development and discuss how inspiration and innovation was generated by a strong wish and passion to overcome problems. The development of TEE was based on the collaboration of colleagues in different fields, and an intense desire to convert ideas into reality.
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Journal of anesthesia · Feb 2020
Differential effects of sevoflurane on the growth and apoptosis of human cancer cell lines.
There have been contradictory findings regarding the effects of sevoflurane on the oncogenic properties of cancer cells. This study was conducted to gain insights into the fundamental rules governing the differential effects of sevoflurane exposure on various cancer cells derived from multiple origins. ⋯ Sevoflurane augmented or hampered cell proliferation and Matrigel invasion depending on the cancer cell line examined. Loss of sevoflurane-induced apoptosis occurring in cancer cell lines is likely to be correlated with their enhanced proliferation after sevoflurane exposure.
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Journal of anesthesia · Feb 2020
Placement of TOF-Cuff® on the lower leg for neuromuscular and blood pressure monitoring during anesthetic induction for shoulder surgeries.
The aim of this study was to compare two devices for neuromuscular monitoring during anesthetic induction. TOF-Cuff® was installed on the lower leg stimulating the tibial nerve, while the more conventional TOF-Scan® was installed over the ulnar nerve at the wrist. Methods Twenty adult patients were enrolled in this prospective, controlled study. ⋯ For MAP, mean difference was 1.4 (95% confidence interval - 2.4 to 5.2) with 95% limits of agreement of - 22.7 to 25.5. Conclusion The time from administration of a common dose of atracurium to a TOF ratio of 0% assessed with TOF-Cuff® stimulating the tibial nerve compared to TOF-Scan® stimulating the ulnar nerve showed large limits of agreement in Bland-Altman analysis. There was a high failure rate with TOF-Cuff® measurements on the lower leg.
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Journal of anesthesia · Feb 2020
An endotracheal tube providing "pressurized sealing" prevents fluid leakage in mechanically ventilated critically ill patients: a pilot study.
Microaspiration of bacteriologically contaminated oropharyngeal secretions alongside the cuff of an endotracheal tube (ETT) is a key mechanism for development of ventilator-associated pneumonia. We have constructed a prototype double-cuffed ETT equipped with a supplemental port in-between the cuffs through which continuous positive airway pressure (CPAP) is delivered. Pressure in the intercuff space propels secretions upwards and produces 100% tracheal sealing in an in vitro model. ⋯ Overall, pressures in the intercuff space remained between 10 and 15 cmH2O. Excessive pressure swings were swiftly corrected by the CPAP system. A double-cuffed ETT, offering "pressurized sealing" of the trachea, safely and effectively prevented leakage during 24 h mechanical ventilation.