Journal of anesthesia
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The radial artery is the preferred site for arterial cannulation because of consistent anatomic accessibility, ease of cannulation, and a low incidence of complications. One possible risk associated with cannulation is an injury to the superficial branch of the radial nerve. The radial nerve divides to the superficial branch and the deep branch at the top of the forearm, and the superficial branch lies behind the brachioradialis muscle close to the lateral side of the radial artery and terminates the lateral side of the radial artery about 7 cm proximal to the wrist. ⋯ We studied 100 volunteers to measure a "safe" segment (the length between the styloid process and the distal edge of the "run side-by-side segment), using an ultrasonograph. The 95%reference interval (which indicates the central 95% of a reference population) of the "safe" segment was 6.8-11.6 cm [with the mean 9.4 (standard variation: 1.7)] in men, and 5.4-11.0 [8.2 (1.4)] cm in women. In conclusion, we have shown that the margin of safety for needle puncture of a radial artery is about 6.8 cm from the wrist for in men, and 5.4 cm from the wrist for in women.
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Journal of anesthesia · Jun 2021
ReviewRespiratory characteristics and related intraoperative ventilatory management for patients with COVID-19 pneumonia.
A substantial proportion of patients with coronavirus disease 19 (COVID-19) develop severe respiratory failure. Although the exact pathophysiology of severe COVID-19 pneumonia remains unknown and the characteristics of these patients are heterogeneous, the acute respiratory failure often fulfills criteria for acute respiratory distress syndrome (ARDS) and the clinical characteristics are also consistent with what is previously known about ARDS. Cohort studies also report distinctively high association between perioperative COVID-19 and postoperative mortality. In this special article, we review several publications on the pathophysiology of COVID-19, and discuss intraoperative ventilatory management for patients with COVID-19 based on the respiratory characteristics of COVID-19 pneumonia in light of the ongoing controversy of clinical phenotypes.