Anesthesia and analgesia
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Anesthesia and analgesia · Feb 2009
Case ReportsPosterior reversible encephalopathy syndrome after combined general and spinal anesthesia with intrathecal morphine.
We describe a patient who was in a stupor for several days after combined general-spinal anesthesia. Both clinical manifestations and magnetic resonance imaging findings were consistent with posterior reversible encephalopathy syndrome and resolved after the patient recovered spontaneously.
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Anesthesia and analgesia · Feb 2009
The ability of stroke volume variations obtained with Vigileo/FloTrac system to monitor fluid responsiveness in mechanically ventilated patients.
Respiratory variations in arterial pulse pressure (DeltaPP) are accurate predictors of fluid responsiveness in mechanically ventilated patients. The aim of our study was to assess the ability of a novel algorithm for automatic estimation of stroke volume variation (SVV) to predict fluid responsiveness in mechanically ventilated patients. ⋯ SVV predicts fluid responsiveness with an acceptable sensitivity and specificity and is also a potential surrogate for continuous monitoring of DeltaPP.
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Anesthesia and analgesia · Feb 2009
Diagnostic predictor of difficult laryngoscopy: the hyomental distance ratio.
We evaluated the usefulness of the hyomental distance (HMD) ratio (HMDR), defined as the ratio of the HMD at the extreme of head extension to that in the neutral position, in predicting difficult visualization of the larynx (DVL) in apparently normal patients, by examining the following preoperative airway predictors, alone and in combination: the modified Mallampati test, HMD in the neutral position, HMD and thyromental distance at the extreme of head extension and HMDR. ⋯ The HMDR with a test threshold of 1.2 is a clinically reliable predictor of DVL.
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Anesthesia and analgesia · Feb 2009
Intracranial pressure monitoring during percutaneous tracheostomy "percutwist" in critically ill neurosurgery patients.
Tracheostomy is commonly required as part of the management of patients with severe brain damage. Percutaneous dilation tracheostomy is increasingly used in intensive care unit as an alternative to standard surgical tracheostomy. However, this procedure carries the risk of neurological complications, particularly in patients with intracranial hypertension. In this study, we sought to quantify the effects of Percutwist(R) tracheostomy (Rusch-Teleflex Medical) on intracranial pressure (ICP), cerebral perfusion pressure (CPP), arterial CO(2) tension (Paco(2)), and arterial O(2) tension (Pao(2)), in 65 consecutive critically ill patients admitted to the neurosurgical intensive care unit, undergoing bedside percutaneous tracheostomy. ⋯ Percutwist tracheostomy is a single-step method which allows for effective ventilation during the procedure, thus reducing the risk of hypercarbia and development of intracranial hypertension. The technique did not cause secondary pathophysiological insult and could be considered safe in a selected population of brain-injured patients.
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Anesthesia and analgesia · Feb 2009
Airway management in children: ultrasonography assessment of tracheal intubation in real time?
Pediatric tracheal intubation requires considerable expertise and can represent a challenge to many anesthesiologists. Confirmation of correct tracheal tube position relies on direct visualization or indirect measures, such as auscultation and capnography. These methods have varying sensitivity and specificity, especially in the infant and young child. Ultrasonography is noninvasive and is becoming more readily available to the anesthesiologist. In this study, we investigated the characteristic real-time ultrasonographic findings of the normal pediatric airway during tracheal intubation and its suitability for clinical use. ⋯ This study describes characteristic ultrasonographic findings of the pediatric airway during tracheal intubation. It suggests that ultrasonography may be useful for airway management in children.