Acta anaesthesiologica Taiwanica : official journal of the Taiwan Society of Anesthesiologists
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Acta Anaesthesiol Taiwan · Mar 2012
ReviewReview of interscalene block for postoperative analgesia after shoulder surgery in obese patients.
In recent years, the prevalence of obesity has significantly increased in developed countries, a trend that has been just as apparent in France as elsewhere. Obesity may predispose to osteoarthritis, which may subject a high percentage of patients to shoulder surgery. Interscalene block remains one of the most efficient technique for postoperative analgesia after shoulder surgery. ⋯ In obese patients undergoing shoulder surgery, the goal of postoperative pain management is to provide comfort, early mobilization, and improved respiratory function without the worry of inadequate sedation and respiratory compromise. The ongoing debate on the relevance of obesity, for example in terms of obstructive sleep apnea syndrome, obesity hypoventilation syndrome, and other related respiratory disturbances, in relation to the choice of analgesic techniques, especially interscalene block, patient-controlled intravenous analgesia and patient monitoring, demands large-scale, well-designed studies to resolve it. Nevertheless, obesity per se should not dissuade patients from undergoing shoulder surgery under interscalene block.
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Acta Anaesthesiol Taiwan · Mar 2012
Poincaré plot indexes of heart rate variability detect dynamic autonomic modulation during general anesthesia induction.
Beat-to-beat heart rate variability (HRV) is caused by the fluctuating balance of sympathetic and parasympathetic tone. The Poincaré plot has been used to evaluate HRV. In this study, we validate that this new method may qualitatively and quantitatively assess the sympathovagal fluctuation in patients during induction of anesthesia with sevoflurane. ⋯ Poincaré plot and power spectral analysis of HRV during tilt test and sevoflurane induction significantly correlate. Poincaré plot analysis is easier and more sensitive at evaluating the sympathovagal balance and observing the beat-to-beat HRV.
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Acta Anaesthesiol Taiwan · Mar 2012
Randomized Controlled Trial Comparative StudyComparison of postoperative analgesic effect of intrathecal magnesium and fentanyl added to bupivacaine in patients undergoing lower limb orthopedic surgery.
To compare the analgesic efficacy and side effects of magnesium and fentanyl as an additive to intrathecal bupivacaine. ⋯ Addition of intrathecal magnesium sulfate to spinal anesthesia induced by bupivacaine significantly prolonged the onset of both sensory and motor blockade compared with fentanyl. Although magnesium failed to prolong the time to first analgesic requirement as seen with fentanyl, it reduced the total consumption of opioids in the first 12 hours postoperatively compared with the control group.
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Acta Anaesthesiol Taiwan · Mar 2012
Direct endotracheal intubation using a novel detachable optic probe (Sunscope) by emergency medical technicians with various training backgrounds.
Effective airway management requires both proper technique and the appropriate devices. With the widespread implementation of advanced life-support techniques in emergency medical services (EMS), orotracheal intubation is now performed not only by professional practitioners but, in many occasions, nonprofessionals. With extensively diversified skill equipped, we tested whether the Sunscope, a patented tracheal intubation device with a digital display, is able to facilitate tracheal intubation by naïve EMS personnel with various training backgrounds. ⋯ Our research demonstrates that professional practitioners are able to use the Sunscope on their first attempt. Despite a lack of training in conventional endotracheal intubation, emergency medical technicians (EMT-I and -II) were able to complete intubation on their first attempt; a significant reduction in the time required to intubate was noted after repeated practice. All levels of naïve EMTs were able to readily visualize the vocal cords through Sunscope and, thereby, reliably insert the endotracheal tube in less than 1 minute, regardless of their skills before testing.
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Acta Anaesthesiol Taiwan · Mar 2012
Case ReportsAnesthetic breathing circuit obstruction mimicking severe bronchospasm: an unusual manufacturing defect.
We report an unexpected ventilation difficulty with an anesthetic breathing circuit in a pediatric patient receiving left herniorrhaphy. A manufacturing defect in a limb of the anesthetic breathing circuit caused this problem. This defect induced a high-pitched, wheezing-like sound, which was difficult to differentiate from a hyper-reactive airway, commonly seen in pediatric patients with recent upper respiratory tract infection. We recommend that the patency of the anesthetic breathing circuit should routinely be examined before connecting it to the anesthesia machine.