Masui. The Japanese journal of anesthesiology
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Case Reports
[Multiple difficulties for central venous access required the distal femoral vein catheterization: a case report].
The low femoral approach for catheterization of the central venous line is a difficult procedure because the surface landmark technique is not helpful. We report a case of patient who required the distal femoral cannulation. Re-catheter cannulation was planned for the patient after the major cardiovascular surgery. ⋯ The right subclavian and right femoral regions were scarred with the surgical procedure. Finally, we performed the distal femoral cannulation using real time ultrasound guidance. When multiple difficulties for venous access are present, ultrasound-guided low approach of femoral vein might be one of the solutions.
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Pulse oximeter expressed by SpO2 is used for monitoring respiratory state during operation and in ICU. Perfusion index (PI) and pleth variability index (PVI) as new indexes are calculated from pulse oximeter (Masimo SET Radical-7, Masimo Corp., USA, 1998) waveforms. And these indices were used as parameters to evaluate the circulatory state. ⋯ It might thus be of future value in assessment of perioperative changes in peripheral perfusion. PVI is a measure of a dynamic change in PI that occurs during complete respiratory cycle. It might be thought that PVI, an index automatically derived from the pulse oximeter waveform analysis, had potentially clinical applications for noninvasive hypovolemia detection and fluid responsiveness monitoring.
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Noninvasive monitoring of regional cerebral oxygen saturation has been introduced in clinical settings for estimation of cerebral perfusion and cerebral blood flow. In this article, I have described several issues regarding the usefulness and clinical limitations associated with the use of these monitors, as well as relevant information on basic principles of monitoring. At present, there is not enough clinical data concerning critical levels of measured variables that are essential for safe perioperative management of patients susceptible for cerebral ischemia.
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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.