Masui. The Japanese journal of anesthesiology
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Intraoperative transesophageal echocardiography (TEE) has a wide range of applications including monitoring of left ventricular (LV) function, evaluation of natural and prosthetic valves, detection of intracardiac thrombus, mass and vegetation, assessment of surgical repair of cardiac disease, visualization of intracardiac air, positioning of an intraaortic balloon and a coronary sinus catheter, evaluation of thoracic aortic lesions, and so on. Complications are very rare with TEE, but damage of the esophagus or stomach can occur. Gentle manipulation of the TEE probe is always required. ⋯ Assessment of RWMAs is thus very useful for diagnosis of ischemia. Although RWMAs are not always caused by acute ischemia, a new onset of RWMAs, as seen during surgery, almost certainly indicates myocardial ischemia. TEE also allows evaluation of LV diastolic function by analyzing the transmittal flow velocity.
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A new programmable syringe infusion pump, Auto Syringe Model AS 40 A, was evaluated for infusion of muscle relaxants, vasodilators and opioids in 4 surgical patients. Every drug mentioned above was easily adjusted according to surgical requirement in these patients. ⋯ Its major advantages lie in the mechanisms for delivery of a bolus dose and automated delivery of intermittent doses, automatic rate calculation, and the applicability to various sizes of syringes. Auto Syringe Model AS40A was found to be very useful for intravenous infusion of drugs.
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According to the roentgenographically confirmed intervertebral space at which an epidural catheter was placed, 241 patients who underwent abdominal or orthopedic hip surgery were allocated into 3 groups. Groups A, B, and C received epidural catheterization at Th7-10, Th10-L1, and L1-4, respectively. In each group, we examined the intervertebral space, which the anesthesiologist who had placed epidural catheter had determined, and the one which had been confirmed roentgenographically. ⋯ In contrast, when we counted down from the cervical prominent vertebra, a landmark of C7, the agreement was better in group A (55%) than in group C (33%). In the postoperative period, catheters came out more frequently in groups A and B than in group C, resulting from the early ambulation in abdominal surgery groups. There results suggest that, to place the epidural catheter more properly, (1) we should start to count from the landmark which is close to the puncture point and (2) we should keep it in mind that catheters come out accidently in patients who are encouraged to ambulate in the early postoperative period.
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A 45 year old woman undergoing a removal of cerebral arterio-venous malformation, suffered an unexpected massive bleeding. With transfusion of plasma constituents, her hemoglobin concentration decreased to about 5 g.dl-1, but her hemodynamic parameters remained unchanged. ⋯ With rapid transfusion of concentrated red cell and whole blood, hemodynamic parameters as well as ECG change were restored to normal. With hemodilutional myocardial ischemia which is caused by acute massive bleeding, hemoglobin concentration of about 2 g.dl-1 would be critical.
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For two cases of cardiac tamponade following cardiac surgery, the approaches for pericardial drainage were determined by the transesophageal echocardiography under general anesthesia. In most cases of cardiac tamponade after cardiac surgery the pericardial effusion is regional and localized due to adhesions of pericardium. Therefore subxiphoid incision approach of pericardial drainage cannot often be accomplished. In these cases transesophageal echocardiography can image the presence, location and size of the pericardial effusion and is an available method to determine the approach of pericardial drainage.