Kaohsiung J Med Sci
-
Kaohsiung J Med Sci · Dec 2007
Lateral rotation of the lower extremity increases the distance between the femoral nerve and femoral artery: an ultrasonographic study.
Femoral nerve block (FNB) is by far the most useful lower extremity regional anesthetic technique for the anesthesiologist, and high-resolution ultrasonography is a useful tool with which to guide the performance of FNB. However, the relationships between the femoral nerve and the femoral artery in different lower extremity positions have rarely been discussed. The purpose of this study was to evaluate the relative positions of the femoral nerve and artery at different lateral rotational angles of the lower extremities using ultrasonographic imaging. ⋯ The results of our ultrasound study revealed that the more lateral the rotation of both lower extremities, the closer the femoral nerve was to the skin and the farther away it was from the femoral artery. In order to increase the success rate and decrease the rate of complications, a suggested lateral 45 rotation of both lower extremities is strongly recommended when performing FNB using the peripheral nerve stimulator technique or the field block technique. In any situation, individual ultrasound guidance is recommended for FNB whenever possible.
-
Kaohsiung J Med Sci · Nov 2007
Pre-hospital and in-hospital delays after onset of acute ischemic stroke: a hospital-based study in southern Taiwan.
The biggest hurdle for early hospital presentation is the narrow therapeutic window after stroke. The aims of our study were to investigate the time lags and the factors causing pre-hospital and emergency department (ED) delay during acute ischemic stroke attack. Between June 2004 and October 2005, we prospectively studied 129 acute ischemic stroke patients who presented to the ED of the study hospital within 4 hours after symptom onset. ⋯ This study indicates that 2 hours of pre-hospital delay is the cutoff point for thrombolytic therapy. Organization of a stroke team and standardized stroke pathways may help to shorten in-hospital time consumption. Educational efforts should not only focus on the public, but also on the training of ED physicians and other medical personnel.
-
Kaohsiung J Med Sci · Oct 2007
Randomized Controlled TrialLightwand-guided endotracheal intubation performed by the nondominant hand is feasible.
The aim of this study was to evaluate the efficiency of lightwand-guided endotracheal intubation (LWEI) performed using either the right (dominant) or left (nondominant) hand. Two hundred and forty patients aged 21-64 years, with a Mallampati airway classification grade of I-II and undergoing endotracheal intubation under general anesthesia, were enrolled in this randomized and controlled study. Induction of anesthesia was initiated by intravenous administration of fentanyl (2 microg/kg) and thiopentone (5 mg/kg), and tracheal intubation was facilitated by intravenous atracurium (0.5 mg/kg). ⋯ A higher incidence of intubation-related oral injury and ventricular premature contractions (VPC) was found in group D compared with groups L and R (oral injury: group D 8.5%, group L 1.3%, group R 0%, p = 0.005; VPC: group D 16.3%, group L 5%, group R 7.5%, p = 0.04). We concluded that LWEI performed by either dominant or nondominant hands resulted in similar efficiency, and could be a suitable alternative to traditional laryngoscopy. It is both feasible and logical for an experienced anesthesiologist to use the nondominant hand to perform LWEI.
-
Kaohsiung J Med Sci · Sep 2007
Case ReportsBiloma following transcatheter arterial chemoembolization with microspheres: a case report.
We report a case of intrahepatic biloma following transcatheter arterial chemoembolization (TACE) with microspheres in a 44-year-old male patient. He was diagnosed with hepatocellular carcinoma with satellite nodules and intrahepatic duct invasion in August 2004. TACE was performed with a mixture of lipiodol, epirubicin hydrochloride, and mitomycin followed by microspheres as devascularizing material. ⋯ However, fever and diarrhea developed 2 weeks after the third TACE. Biloma with infection was diagnosed and was then treated successfully with percutaneous drainage and antibiotics. Embolization using microspheres at the proximal right hepatic artery was considered to have been the jeopardizing etiologic factor of biloma formation.
-
Kaohsiung J Med Sci · Sep 2007
Transesophageal echocardiography and laryngeal mask airway for placement of permanent central venous catheter in cancer patients with radiographically unidentifiable SVC-RA junction: effectiveness and safety.
In patients who require a permanent central venous catheter (PCVC), the usual aim is to put the catheter tip at the superior vena cava and right atrium (SVC-RA) junction. However, there is no study regarding how to guide the positioning of the catheter tip when the SVC-RA junction cannot be identified on chest radiograph. The objectives of this prospective study were: (1) to investigate the incidence and etiologies of radiographically undetermined SVC-RA junctions in cancer patients undergoing PCVC implantation; and (2) to evaluate the feasibility, effectiveness and safety of combined transesophageal echocardiography (TEE) and laryngeal mask airway (LMA) to guide the positioning of catheters during implantations in patients without this radiographic landmark. ⋯ All had the catheter tip positioned in the anatomic SVC-RA junction under TEE guidance. In conclusion, 16% of cancer patients requiring PCVC implantation had no identifiable SVC-RA junction on chest radiograph and most causes were cancer-unrelated. In patients without a radiographically identifiable SVC-RA junction, guidance by TEE under LMA general anesthesia is a feasible, safe and effective management to position a PCVC at the SVC-RA junction.