Journal of anesthesia
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Journal of anesthesia · Jan 2007
Impact of Sonoclot hemostasis analysis after cardiopulmonary bypass on postoperative hemorrhage in cardiac surgery.
The Sonoclot Analyzer provides a functional test of whole blood coagulation by measuring the viscous property of the blood sample. In this study, we used a modified Sonoclot assay, using cuvettes with a glass bead activator containing heparinase, and compared the Sonoclot data before and after cardiopulmonary bypass (CPB) to assess the usefulness in predicting postoperative hemorrhage. ⋯ Our results suggest that abnormal postoperative hemorrhage can be predicted by Sonoclot analysis with a new glass bead-activated heparinase test performed after CPB.
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Journal of anesthesia · Jan 2007
Case ReportsRopivacaine-induced toxicity with overdose suspected after axillary brachial plexus block.
Ropivacaine has a high threshold for systemic toxicity. We report and highlight a rare case in which an overdose of ropivacaine was suspected of leading to a generalized convulsion following the injection of this agent for axillary brachial plexus block (ABPB). A 25-year-old woman (height, 153 cm; weight, 48 kg; American Society of Anesthesiologists physical status I) was scheduled for finger surgery with ABPB. ⋯ She recovered with no sequelae. Limited cases have indicated high efficacy and sufficient safety for the use of 300 mg ropivacaine for ABPB. However, the toxic threshold of ropivacaine remains unclear, and the dose should be calculated in relation to the weight of the patient to prevent severe toxic complications.
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We report a case of pneumocephalus during continuous epidural infusion. A 52-year-old malnourished man with rectal cancer had been treated with continuous epidural block for the relief of pain in the left thigh. Eleven days after catheter insertion, a dull, persistent headache occurred in the frontal region, and it worsened gradually. ⋯ The catheter was removed and the patient maintained bed-rest. The headache disappeared 2 days later. It is speculated that the air was sucked in through the space along the epidural catheter.
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Journal of anesthesia · Jan 2007
Case ReportsProlonged cardiac arrest unveiled silent sick sinus syndrome during general and epidural anesthesia.
Patients who have silent sick sinus syndrome (SSS) can show various unexpected arrhythmias during surgery. The severity of these bradyarrythmias is affected by anesthetic methods. We report a unique case of a patient with silent SSS who developed 40 s of asystole under combined general and epidural anesthesia. ⋯ During surgery, severe bradycardia, triggered by peritoneal manipulation, occurred, leading to 40 s of asystole. She was diagnosed as having SSS by a postoperative 24-h Holter electrocardiogram. We propose that the possible existence of SSS should be kept in mind even in a patient who shows no abnormalities on routine preoperative examination, especially in those in whom vagomimetic anesthetic methods are used.
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Journal of anesthesia · Jan 2007
Effects of nicardipine-induced hypotension on cerebrovascular carbon dioxide reactivity in patients with diabetes mellitus under sevoflurane anesthesia.
The purpose of this study was to examine the effects of nicardipine-induced hypotension on cerebrovascular CO2 reactivity in patients with diabetes mellitus under sevoflurane anesthesia. ⋯ We concluded that cerebrovascular CO2 reactivity in insulin-dependent patients is impaired during nicardipine-induced hypotension under sevoflurane anesthesia.