Journal of clinical anesthesia
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To evaluate the clinical use of a new ECG-guided central venous catheter with regard to positioning in the superior vena cava (SVC). ⋯ Use of this wire-conducted intravascular ECG signal is a reliable tool for positioning the central venous catheter via various insertion sites. The technique proved to be an inexpensive, easy, and clear method. When a p-atriale is seen, uncomplicated insertions do not require radiologic guidance to control catheter tip position.
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A case of a hemothorax that occurred after thoracic epidural anesthesia is described. This situation might have been caused by accidental puncture of the intercostal vessel and visceral pleura by a Tuohy needle. The risk of causing a pneumothorax and/or hemothorax must be kept in mind when attempting thoracic epidural anesthesia.
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Case Reports
EEG-controlled "overdosage" of anesthetics in a patient with a history of intra-anesthetic awareness.
In spite of the ever-growing pharmacologic arsenal available for induction and maintenance of anesthesia, to our knowledge no treatment regimen exists that will provide full protection against intraoperative awareness. To date, no single monitoring technique is able to detect awareness or predict recall. Although the frequency of these complications is rare, the occurrence of any such event can be very distressful for the patient. Based on our clinical experience with a patient with a history of recall and a marked resistance to benzodiazepines, we present electroencephalogram-based anesthetic management as a technique to address this difficult problem.