Masui. The Japanese journal of anesthesiology
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Sodium bicarbonate has been standard therapy for the treatment of acidosis. In lactic acidosis and hypercapnic acidosis, however, there is no clinical data supporting its effectiveness. We reviewed the literature of the efficacy of sodium bicarbonate on lactic acidosis and hypercapnic acidosis. ⋯ Conversely, acidosis or hypercapnia might be protective in acute lung and systemic organ injury. Therefore, the unprepared use of bicarbonate might be harmful in terms of fluid and sodium overload and excess lactate concentrations. According to current literature, we cannot recommend sodium bicarbonate administration for patients with lactic acidosis and hypercapnic acidosis.
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Frequency of using nitrous oxide (N2O) in anesthetic field decreased recently by the influence of the environmental problems and the widespread use of intravenous agents. In dental treatment, however, inhalation sedation using low concentration of N2O has been effectively used to relax dental patients. Nitrous oxide inhalation sedation for dental treatment generally involves the use of a combination of low-dose N2O and high-dose oxygen. ⋯ Also, high-dose oxygen would contribute to manage "(pre) syncope" due to pain stimuli. Thus, N2O inhalation sedation is effective for the dental treatment, although the leak of N2O affects the health of dental staffs. The present review described the advantage and harmful effects of N2O in dental management.
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For religious reasons, Jehovah's Witnesses do not accept homologous blood transfusions. Instead, they request alternative medical care that does not involve such transfusions. A 58-year-old woman, a Jehovah's Witness, was scheduled for pancreaticoduodenectomy for pancreatic carcinoma under general and epidural anesthesia. ⋯ Lactated Ringer's solution 3,300 ml, physiological saline 200 ml, and hydroxyethylated starch 500 ml were infused during the operation. Although her postoperative Hb and Ht dropped to 8.7 g x dl(-1) and 26.8%, respectively, no transfusion was performed. Anesthesiologists should respect the demands of Jehovah's Witnesses, and should attempt to manage surgery without transfusion.
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GlideScope videolaryngoscope (GVL) is a novel indirect laryngogoscope for tracheal intubation. Both mid-size and large blades of the GVL are available for adult patients. The distortion of the anterior airway anatomy and cervical spine motion using the mid-size GVL is unknown. We compare the degree of anterior airway distortion and cervical spine movement during the use of the mid-size GVL compared with the large GVL. ⋯ The tip of the mid-size GVL during laryngoscopy is anteriorly positioned and the distortion of the anterior airway was greater with the mid-size GVL than with the large GVL.
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Case Reports
[Infectious endocarditis with aortic annular abscess detected by intraoperative transesophageal echocardiography].
We experienced a case of an endocarditis with persistent fever despite appropriate antibiotic therapy. Intraoperative transesophageal echocardiography showed bicuspid aortic valve with vegetations which caused a severe aortic regurgitation. ⋯ Patients with bicuspid valve infectious endocarditis incur high risk of abscess formation. It is important to have frequent observation of the infected valve preoperatively and careful observation during operation to detect further abnormalities which may cause alteration of the procedure.