Journal of anesthesia
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As the result of a locking phenomenon that may occur in a guidewire inside a metal puncture needle when using the Seldinger technique to insert a central venous catheter, the guidewire can break and cause an embolism. To counter this possibility we devised a guidewire with a structure that made it difficult for locking to occur and compared it to conventional guidewires. Conventional guidewires are wound lengthways with a spring. ⋯ We then compared the frequency of locking and the frequency of bending of the guidewire tips that have been withdrawn. In group A, locking occurred in 72% of the cases where the guidewire was unable to be inserted, but this figure was 0% in group B. The improved guidewire has the advantage of reducing the risk of locking and of guidewire breakage.
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Journal of anesthesia · Jan 2006
Case ReportsTwo cases of spinal epidural abscess with granulation tissue associated with epidural catheterization.
Two cases of spinal epidural abscess are reported whose abscesses became granulated after epidural catheterization. Although emergency surgical intervention was performed almost within 24 h after the diagnosis of epidural abscess in case 1, the patient revealed a poor outcome. After laminoplasty, case 2 received lumbar epidural catheterization, and he had a complete recovery. ⋯ Those findings suggest the midpoint of the abscess is the puncture site and that MSSA is found in or around the catheter. Infection at epidural catheterization seems to be caused by catheter insertion or skin contamination after catheterization. As those catheterizations were completed in the outpatient theater, we conclude that epidural catheterization should be performed in the operating room or with a restricted aseptic technique.
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Journal of anesthesia · Jan 2006
Clinical effects of a neutrophil elastase inhibitor, sivelestat, in patients with acute respiratory distress syndrome.
We assessed the effects of a neutrophil elastase inhibitor, sivelestat, on respiratory and organ functions as well as on the mortality of patients with acute respiratory distress syndrome (ARDS) associated with systemic inflammatory response syndrome (SIRS). ⋯ Our results suggested that sivelestat has a beneficial effect only on the pulmonary function of ARDS patients with SIRS.
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Journal of anesthesia · Jan 2006
Review Meta AnalysisThe benefits of adding epidural analgesia to general anesthesia: a metaanalysis.
The purpose of this metaanalysis was to determine the benefits of postoperative epidural analgesia in patients operated on under general anesthesia. By searching the American National Library of Medicine's Pubmed database from 1966 to July 10, 2004, 70 studies were identified. These included 5402 patients, of which 2660 had had epidural analgesia. ⋯ It also reduces the first 24-h morphine consumption, OR = -13.62 mg (95%CI = -22.70, -4.54, P = 0.003), and improves the forced vital capacity (FVC), OR = 0.23 l (95%CI = 0.09, 0.37, P = 0.001) at 24 h. A thoracic epidural containing a local anesthetic reduces the incidence of renal failure: OR = 0.34 (95%CI = 0.14, 0.81, P = 0.01). Epidural analgesia may thus offer many advantages over other modes of postoperative analgesia.
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Journal of anesthesia · Jan 2006
Randomized Controlled Trial Comparative StudyNocturnal episodic hypoxemia after ambulatory breast cancer surgery: comparison of sevoflurane and propofol-fentanyl anesthesia.
To study the incidence and severity of nocturnal episodic hypoxemia after ambulatory breast cancer surgery and its differences with sevoflurane and propofol anesthesia. ⋯ Nocturnal episodic hypoxemia occurs frequently after ambulatory breast cancer surgery. The incidence was not different between SEV and TIVA. Hypoxic patients had a higher BMI and needed oxygen therapy in PACU more frequently.