Acta anaesthesiologica Taiwanica : official journal of the Taiwan Society of Anesthesiologists
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Acta Anaesthesiol Taiwan · Mar 2006
Case ReportsDifficult oral endotracheal intubation in an acromegalic patient receiving transsphenoidal surgery--a case report.
Patients suffering from acromegaly are associated with increased risks of difficult airway management. We report a case of acromegaly scheduled for transsphenoidal resection of pituitary adenoma under general anesthesia in whom all possible means failed us in the insertion of the endotracheal tube (ET) through the mouth, a procedure essential for transsphenoidal surgery. ⋯ Five days later, awake oral fiberoptic intubation was successful under topical anesthesia. We suggest that oral endotracheal intubation performed awake under topical anesthesia with the aid of a fiberoptic bronchoscope is a choice approach in acromegalic patients with predicated difficult airway who are to receive surgery.
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Acta Anaesthesiol Taiwan · Mar 2006
Case ReportsCardiac arrest during spinal anesthesia: a report of two cases.
Spinal anesthesia is a widely practiced technique for both elective and emergency procedures. It is so recommended because of its efficacy and safety. ⋯ We report here two instances of cardiac arrest during spinal anesthesia in young healthy people. Discussions on the causes, management, and prevention of cardiac arrest following spinal anesthesia are also brought forward in the text.
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Acta Anaesthesiol Taiwan · Mar 2006
Case ReportsCardioversion corrects cardiac arrhythmia and reverts the resultant reversed shunt flow direction during transcatheter closure of atrial septal defect--a case report.
Closure of atrial septal defect (ASD) is critically dependent on the shunt flow direction. However, shunt flow direction through ASD may change under variable clinical conditions. ⋯ The cardiac arrhythmia and altered shunt direction simultaneously reverted to the old state after cardioversion. A successful placement of Amplatzer septal occluder was successfully performed afterward and she recovered uneventfully.
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Acta Anaesthesiol Taiwan · Dec 2005
Randomized Controlled TrialBolus injection of adenosine before cardioplegic induction improves postischemic global function in coronary artery bypass grafting.
Alternative strategies to optimize preexisting cardioplegia during myocardial preservation are currently under extensive investigation. Adenosine, an endogenous purine nucleoside, has been approved for its cardioprotective potential against ischemic-reperfusion injury. Yet, little information is available with respect to the use of adenosine for cardioplegic induction in humans. The purpose of the present study was, therefore, to assess the clinical relevance of intra-aortic administration of adenosine following aortic cross-clamping with respect to the exertion of additional protection in routine coronary artery bypass surgery. ⋯ Immediate administration of 250 microg/kg adenosine via the aortic root following aortic cross-clamping could optimize the myocardial protective effect of conventional cardioplegia, quicken cardiac standstill, and offer better postoperative myocardial performance after CPB.
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Acta Anaesthesiol Taiwan · Dec 2005
Cell saver does not increase pro-inflammatory cytokine levels and expression of adhesive molecules in the salvaged blood of patients undergoing off-pump coronary artery bypass surgery.
Autotransfusion has been developed to avoid the risks of contaminating with infectious diseases and susceptivity to other complications of allogeneic blood transfusion. Previous studies have shown significant pro-inflammatory cytokine release and complement activation during blood salvage with cell saver (CS) in the course of on-pump coronary artery bypass grafting (CABG) surgery. Because both extracorporeal pump and CS machine are possible to induce the adverse cytokines release, thus, in this study, we investigated the influence of CS alone on the levels of pro-inflammatory cytokines and the expression of leukocyte surface antigens in patients undergoing off-pump CABG. ⋯ Our investigation indicated that the blood processing in cell saver alone did not increase the expression of either CD11b, CD18, or CD62P, and the levels of TNF-alpha, IL-6 and IL-8. The results suggest that cell saver seems not to significantly activate the leukocytes or cause inflammatory responses in the salvaged blood.