Anesthesia and analgesia
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Anesthesia and analgesia · Aug 2002
Clinical TrialThoracic epidural catheter placement via the caudal approach in infants by using electrocardiographic guidance.
We examined the success of inserting epidural catheters via the caudal route in infants by using electrocardiographic guidance. A case series of 20 patients with thoracic epidural analgesia was studied. After the induction of general anesthesia, an 18-gauge IV catheter was inserted into the caudal space to allow threading of a 20-gauge epidural catheter. The electrocardiogram (ECG) tracings via the epidural catheter, as well as the surface ECG at the target spine level, were recorded simultaneously with a modified two-channel five-lead ECG system. The epidural catheter was advanced from the caudal space until the tip reached the target level as demonstrated by a match in the configuration of the epidural ECG tracing to that of the surface ECG tracing at the target level. The catheter tip location was verified by postoperative radiographs. All catheter tips were located within two vertebrae of the target level, and satisfactory intraoperative epidural anesthesia was achieved in all subjects. ⋯ Epidural electrocardiography may be used to guide the positioning of the thoracic epidural catheter tip via the caudal approach to the appropriate dermatome for optimum analgesia.
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Anesthesia and analgesia · Aug 2002
Case ReportsSuccessful one-lung ventilation in a patient with aberrant tracheal bronchus.
We report a 47-yr-old patient who underwent surgery for esophageal cancer. Because of the isolated ventilation of the right upper lobe after occlusion of the right mainstem bronchus, bronchoscopic re-confirmation exposed an aberrant tracheal bronchus. A Fogarty tube was introduced to block the tracheal bronchus and provide one-lung ventilation.
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Anesthesia and analgesia · Aug 2002
The construction of learning curves for basic skills in anesthetic procedures: an application for the cumulative sum method.
This study aimed at constructing learning curves for basic procedural skills in anesthesiology using the cumulative sum method. We recorded 1234 peripheral venous cannulations, 895 orotracheal intubations, 688 spinals, and 344 epidurals performed by residents during the first 10 mo of training. Learning curves for each procedure were constructed by using the cusum method. The number of procedures performed until attainment of acceptable failure rates was calculated. All residents mastered peripheral venous cannulation after 79 +/- 47 procedures. Four of 7 residents attained acceptable failure rates at orotracheal intubation after 43 +/- 33 proce- dures. Seven of 11 residents attained acceptable failure rates at spinal anesthesia after 36 +/- 20 procedures. At epidural anesthesia, 5 of 11 residents attained acceptable failure rates after 21 +/- 11 procedures. The cusum method is a useful tool for objectively measuring performance during the learning phase of basic procedures. The wide interindividual variability in the number of procedures required to be performed before attaining acceptable failure rates suggests that performance should be followed on an individual basis. ⋯ Learning curves for peripheral venous cannulation, tracheal intubation, and spinal and epidural anesthesia were constructed using the cumulative sum (cusum) method. There was a wide variability in the number of procedures performed until attainment of acceptable failure rates. The cusum method may improve our means of evaluating residents' technical skills.
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Anesthesia and analgesia · Aug 2002
Case ReportsManaging ergot-induced gangrene: the anesthesiologist as a key player.
We discuss the successful management of gangrene of the upper and lower limbs after ergot-induced abortion by unlicensed medical charlatans in a developing country. Our purpose is to highlight the dangerous means adopted by unlicensed medical charlatans to induce abortion as well as to emphasize the key role played by anesthesiologists in the management of such cases.