Masui. The Japanese journal of anesthesiology
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It is difficult to maintain well-balanced stability of respiratory and hemodynamic functions in critically ill patients. The PiCCO system (Pulsion Medical Systems, Munich, Germany) for hemodynamic and respiratory monitoring has been available clinically in Japan since 2000. ⋯ The PiCCO system is mainly used in intensive care for patients with sepsis, septic shock and cardiogenic shock. Further clinical investigations are required to confirm that estimating PiCCO parameters such as ITBVI, EVLWI and PVPI may help to better characterize, guide, and improve the treatment of critically ill patients.
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FloTrac is a recently introduced semi-invasive arterial pressure-based cardiac output (APCO) monitoring device. The accuracy of a new device is usually evaluated by Bland-Altman method, which shows graphically the mean value of differences between a new method and the reference method (bias), standard deviation of the differences (precision) and limits of agreement or 2 standard deviations. Critchley et al calculated the percentage errors which are two standard deviations divided by mean cardiac output, and proposed that percentage error should be less than 30% as a reliable new method. ⋯ APCO is less invasive and could rapidly respond to fast changes of hemodynamic state. FloTrac is expected to become a reliable cardiac output monitoring device even under hemodynamically unstable conditions. Further improvement of the algorithm is anticipated.
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Comparative Study
[Comparison of Cormack/Lehane classification grades decided by novice residents and those by board certified anesthesiologists].
Tracheal intubation training is one of the most important ones in anesthesia training. But it is difficult to evaluate from the outside whether the laryngeal view obtained with the laryngoscope is appropriate or not. ⋯ We considered it useful in the tracheal intubation training that certified anesthesiologists evaluate patients' Cormack/Lehane classification grades before novice residents do, because we can obtain necessary information on laryngeal view and intubation difficulty in advance.
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Development of pulse oximeter technology has made it possible to measure total hemoglobin noninvasively. The use of Radical-7 would improve patient care in emergency medicine and chronic internal medicine as well as perioperative medicine, and could reduce the burden of the patient.
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Randomized Controlled Trial
[Effects of the injection method of lidocaine on preventing injection pain during anesthesia induction by target controlled infusion with propofol].
We conducted a prospective randomized study to assess the effects of preceding lidocaine on the incidence and intensity of propofol-induced pain. ⋯ We conclude that pre-administration of lidocaine without infusion and restart infusion before propofol injecting into a dorsal hand vein is clinically useful.