Anesthesia and analgesia
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Anesthesia and analgesia · Mar 2004
Case ReportsRetroperitoneal hematoma after spinal anesthesia with the paramedian approach.
We present a case of a patient who developed a retroperitoneal bleeding after spinal anesthesia using 22-gauge Quincke needle, with the paramedian approach. Two attempts were needed to accomplish the block. Four hours later the patient complained of back pain radiating to her left calf, with weakness of the quadriceps muscle. Computed tomography revealed a large retroperitoneal hematoma from bleeding lumbar artery. Angiography failed to demonstrate the vessel. The patient was transfused with packed red blood cells and recovered gradually. She had normal coagulation tests throughout the event. ⋯ We describe a case of a large retroperitoneal hematoma after the placement of an uneventful spinal block. The patient required four units of packed red blood cells despite having normal coagulation profiles throughout the event. The diagnosis and treatment of retroperitoneal hematoma are discussed.
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Anesthesia and analgesia · Mar 2004
Case ReportsTransesophageal echocardiographic diagnosis of a liver laceration accompanied by hemodynamic instability.
Transesophageal echocardiography (TEE) is a useful adjunct in the evaluation of trauma patients, particularly in the area of aortic injury and cardiac tamponade. Little has been written on the use of this modality in the evaluation of extra-cardiac injury. We present a case of a trauma patient in whom TEE was used to evaluate hemodynamic instability; during the course of the examination a previously undiagnosed liver laceration was identified. We report the diagnosis of a liver laceration in a trauma patient by novel use of the transesophageal echocardiographic imaging modality.
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Anesthesia and analgesia · Mar 2004
Randomized Controlled Trial Clinical TrialTreatment of hypoxemia during one-lung ventilation using intravenous almitrine.
We performed this prospective randomized double-blinded study to assess the ability of almitrine to treat hypoxemia during one-lung ventilation (OLV). Twenty-eight patients were anesthetized with propofol, sufentanil, and atracurium; lung separation was achieved with a double-lumen tube. A transesophageal Doppler probe was inserted to evaluate cardiac index. If SpO(2) was equal to or decreased to <95% during OLV (inspired fraction of oxygen of 0.6), patients were included in the study and received a placebo or almitrine (12 microg x kg(-1) x min(-1) for 10 min followed by 4 microg x kg(-1) x min(-1)) infusion until SpO(2) reached 90% or decreased to <90% (exclusion from the study). Eighteen of the 28 patients were included and received either almitrine (n = 9) or a placebo (n = 9). Treatment was discontinued in 1 patient in the almitrine group and 6 in the placebo group (P < 0.05). Treatment was successful (SpO(2) remaining >or=95% during OLV) in 8 patients in the almitrine group and 1 in the placebo group (P < 0.01). Heart rate, arterial blood pressure, and cardiac index did not change throughout the study, but we could obtain an adequate aortic blood flow signal in only half of the patients. Almitrine could be used to treat hypoxemia during OLV. ⋯ IV almitrine improves oxygenation during one-lung ventilation without hemodynamic modification. Such treatment could be used when conventional ventilatory strategy fails to treat hypoxemia or cannot be used.