Anesthesia and analgesia
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Anesthesia and analgesia · Jul 2013
Technical communication: the effect of the double mask on anesthetic waste gas levels during pediatric mask inductions in dental offices.
A significant portion of office-based general anesthesia for pediatric patients is performed in dental offices and involves mask inductions with inhaled drugs. This can lead to significant pollution with waste gases. ⋯ Levels of sevoflurane decreased from a median of 4.60 ppm (IQR = 3.10-7.00 ppm, n = 9) to 0 ppm (IQR = 0-0.39 ppm, n = 9, P = 0.0024) and exceeded 2 ppm in 0% of the 9 offices (upper 95% confidence limit 34%) when using the double mask. We demonstrated in our study that the double-mask system, when used with dental "high-volumes" suctions (high-volume evacuators producing approximately 12 m(3)/h) in freestanding dental offices, was sufficient to decrease the exposure to anesthetic waste gas during pediatric mask induction in at least two thirds of offices when compared with the traditional mask.
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Anesthesia and analgesia · Jul 2013
Case ReportsCase report: anterior mediastinal central line malposition.
Central venous catheter (CVC) placement is a routine procedure in the management of critically ill patients. It is important to ensure correct positioning of the catheter tip just above the junction of the superior vena cava and the right atrium, to reduce associated complications and to optimize catheter function. The incidence of catheter misplacement is approximately 3%-4% for both subclavian and internal jugular vein access procedures. CVC placement in the right subclavian vein is associated with a higher risk of malposition.(1) We report an unexpected secondary malposition of a right subclavian CVC in the anterior mediastinum, with resultant vena caval perforation in a patient admitted to the neuro-critical care unit after undergoing a craniotomy procedure.
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Anesthesia and analgesia · Jul 2013
Special article: airway management in reconstructive surgery for noma (cancrum oris).
Noma (cancrum oris) is a disease of poverty and malnutrition, which predominantly affects children younger than 10 years in developing countries. Although the majority of sufferers die of sepsis at the time of the initial infection, or of subsequent starvation due to severe trismus and an inability to eat, a small minority of patients survive and require reconstructive surgery for severe facial scarring and deformity. ⋯ We show that airway management, while challenging, can be performed safely and successfully by using individualized airway plans but may require advanced techniques and equipment. Traditional tests focusing on the anterior/superior airway are helpful in assessing patients with facial deformity due to noma.
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Anesthesia and analgesia · Jul 2013
An assessment of global end-diastolic volume and extravascular lung water index during one-lung ventilation: is transpulmonary thermodilution usable?
The thermodilution curve assessed by transpulmonary thermodilution is the basis for calculation of global end-diastolic volume index (GEDI) and extravascular lung water index (EVLWI). Until now, it was unclear whether the method is affected by 1-lung ventilation. Therefore, aim of our study was to evaluate the impact of 1-lung ventilation on the thermodilution curve and assessment of GEDI and EVLWI. ⋯ Configuration of the thermodilution curve and therefore assessment of GEDI and EVLWI are significantly affected by 1-lung ventilation.