Anesthesia and analgesia
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Anesthesia and analgesia · Mar 1997
Clinical TrialEfficacy of the self-inflating bulb in differentiating esophageal from tracheal intubation in the parturient undergoing cesarean section.
We studied the efficacy of the self-inflating bulb (SIB) in differentiating tracheal from esophageal intubation in 40 parturients undergoing elective cesarean section under general anesthesia. After induction and muscle relaxation, the trachea was intubated under direct vision with cuffed tube. In 20 parturients, the esophagus was also intubated with an identical tube. ⋯ The incidence of false positive results immediately after induction was 30% with T1 and 35% with T2. The mechanism of false negative responses may be attributed to decreased functional residual capacity leading to reduced caliber of intrathoracic airways and terminal airway closure; whereas false positive responses may be related to an incompetent gastroesophageal junction. We conclude that the SIB is unreliable for differentiating tracheal from esophageal intubation in the parturient undergoing cesarean section.
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Anesthesia and analgesia · Mar 1997
The association between Doppler transmitral flow variables measured by transesophageal echocardiography and pulmonary capillary wedge pressure.
The association between Doppler transmitral flow variables, measured by transesophageal echocardiography (TEE), and pulmonary capillary wedge pressure (PCWP) was studied in 88 patients undergoing coronary artery surgery. The Doppler flow variables and PCWP were measured after sternotomy by blinded investigators. In the first part of the study, patients were divided into two groups according to left ventricular (LV) ejection fraction (EF): Group A, EF > 35% (n = 38) and Group B, EF < or = 35% (n = 34). ⋯ When the relationship between DCT-E and PCWP was tested prospectively in a third group of patients [Group C; EF < or = 35% (n = 16)], a close agreement between the calculated and measured PCWP (bias = -0.55 +/- 3.87 mm Hg) was noted. The sensitivity, specificity, and positive predictive value of DCT-E > or = 150 ms for PCWP < 10 mm Hg were 93.3%, 100%, and 100%, respectively. In summary, patients with decreased left ventricular systolic function undergoing coronary artery surgery demonstrated high, statistically significant, correlations between PCWP and the deceleration time or deceleration slope of early diastolic filling as measured by transesophageal Doppler echocardiography.
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Anesthesia and analgesia · Mar 1997
Magnetic resonance imaging of cerebrospinal fluid leak and tamponade effect of blood patch in postdural puncture headache.
This prospective study examined the efficacy of magnetic resonance imaging (MRI) in visualizing cerebrospinal fluid (CSF) leak in patients with postdural puncture headache (PDPH) and determining the spread of the blood patch in the epidural space and the extent of tamponade on the thecal sac. After obtaining institutional review board approval, five patients with symptomatic PDPH after 3 days of failed conservative treatment were included in this study. MRI using proton density (PD) and T2-weighted imaging was performed on all patients and CSF flow studies were done on one patient. ⋯ The tamponade effect of the blood patch was observed on PD, T2-weighted, and CSF flow images. All patients experienced immediate resolution of their symptoms. This study suggests that using MRI, the site of the CSF leak, the tamponade effect of the blood patch, and its spread in the epidural space can be documented.
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Anesthesia and analgesia · Mar 1997
Peripherally administrated morphine attenuates capsaicin-induced mechanical hypersensitivity in humans.
We examined the hypothesis that peripheral morphine can modulate pain and hyperalgesia/allodynia in the human capsaicin model. Subcutaneous injections of 1 mL morphine (1 mg/mL) in one arm and of 1 mL 0.9% saline in the other arm were made prior to bilateral intradermal injections of 50 microL (6 mg/mL) capsaicin. All injections were made on the volar aspect of the arm. ⋯ Capsaicin injection resulted in spontaneous pain on the saline-injected side not significantly different from that on the morphine-injected side. However, capsaicin injections gave rise to significantly less pain evoked by mechanical stimuli, as well as to a significantly smaller area of mechanical hypersensitivity, on the morphine-injected side compared with the saline-injected side. These results suggest that morphine can modulate sensitization mechanisms involved in the development of capsaicin-induced mechanical hypersensitivity.
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The incidence of difficulty in tracheal intubation in the presence of goiter was investigated. Data were collected in a series of 4742 consecutive adult patients undergoing general anesthesia. The prevalence of goiter was 6.8%. ⋯ There was no difference in probability of difficulty in tracheal intubation between patients who presented for thyroidectomy and patients with goiter estimated as a random finding. Statistical analysis revealed an increased risk of difficult intubation amongst goiter patients compared with patients with no evidence of any risk factor (6.8% vs 0.9%, P < 10(-8), relative risk = 7.4). We conclude that goiter, when accompanied by airway deformity, constitutes an aggravating factor for difficult intubation.