Acta anaesthesiologica Taiwanica : official journal of the Taiwan Society of Anesthesiologists
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Acta Anaesthesiol Taiwan · Dec 2004
ReviewTreatment of cerebral vasospasm after subarachnoid hemorrhage--a review.
Delayed cerebral ischemia as a result of cerebral vasospasm is the most common cause of death and disability after aneurysmal subarachnoid hemorrhage (SAH). It leads to death or permanent neurologic deficits in over 17-40% of SAH patients. The initial and main symptom of cerebral vasospasm is diffuse headache and may be accompanied with a slight increase in discomfort from neck stiffness and fever. ⋯ Newly recognized mediators of cerebral vasospasm after SAH include endothelium-derived mediators, vascular smooth-muscle-derived mediators, proinflammatory mediators involved in blood-brain barrier disruption, cytokines and adhesion molecules, stress-induced gene activation, and platelet-derived growth factors. Moreover, observations in the laboratory have, in many circumstances, matched those of reported small series. Larger, prospective, randomized trials are needed to verify several hypotheses of molecular pathophysiology and clinical treatment regimens.
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Acta Anaesthesiol Taiwan · Dec 2004
Randomized Controlled Trial Clinical TrialThe efficacy and safety of transnasal butorphanol for postoperative pain control following lower laparoscopic surgery.
The aim of the study was to evaluate the efficacy and safety of transnasal butorphanol for postoperative analgesia in adult female patients undergoing lower laparoscopic surgery. ⋯ In contrast with placebo transnasal butorphanol was effective in the treatment of postoperative pain in female patients undergoing lower laparoscopic surgery. It had minimum side effects.
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Acta Anaesthesiol Taiwan · Dec 2004
Case ReportsAnesthetic management of a patient undergoing segmental resection of trachea with an endotracheal neurofibroma and nearly total occlusion of trachea.
We report a case of endotracheal (ET) neurofibroma with resultant severe airway obstruction undergoing segmental resection of the trachea. After the extracorporeal membrane oxygenation system (ECMO) was set up handily for use and comprehensive monitoring system was established, ET intubation under fiberoptic bronchoscopy (FOB) was performed under mild sedation. ⋯ Thorough preoperative evaluation, comprehensively anesthetic planning, FOB-assisted ET intubation before induction of anesthesia were mandatory to achieve a safe and delicate anesthesia for such a patient. In critical situation, conduction of anesthesia after establishment of ECMO support would be another choice.
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Acta Anaesthesiol Taiwan · Dec 2004
Case ReportsMalignant hyperthermia with excellent response to small dose of dantrolene.
Malignant hyperthermia (MH) is an operative emergency associated with general anesthesia. Early diagnosis and prompt treatment are the keynotes in management of MH. ⋯ Nonetheless, the enormous expenditure on stockpile and 3-year validity make a large reserve of the drug to forestall MH, a disorder of rare occurrence, seems disputable, especially in small hospitals where general anesthesia is seldom practiced. We herein report two cases of MH with excellent response to small doses of dantrolene and then discuss the way of practicable management and debate on the question of whether fewer stock of dantrolene is an alternative way for hospitals of smaller scale.
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Acta Anaesthesiol Taiwan · Dec 2004
Case ReportsPneumothorax associated with tube exchanger-aided intubation following LMA-Fastrach placement in a patient during anesthesia induction.
The use of intubating laryngeal mask airway (LMA-Fastrach) is indicated to facilitate endotracheal intubation in a patient with cervical spine disorder or suspected difficult airway. A 65-year-old female patient was referred to our hospital for cervical spine surgery under general anesthesia. ⋯ As massive pneumothorax associated with subcutaneous emphysema was disclosed by chest roentgenography, a chest drainage was performed immediately. This article discourses the possible mechanism, diagnosis and treatment of pneumothorax during the course of general anesthesia and the prevention of lower airway injury by AEC is also touched.