Journal of anesthesia
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Journal of anesthesia · Jan 2007
The skin-traction method increases the cross-sectional area of the internal jugular vein by increasing its anteroposterior diameter.
We developed a novel "skin-traction method" in which the puncture point of the skin over the internal jugular vein (IJV) is stretched upward with several pieces of surgical tape in the cephalad and caudad directions to facilitate cannulation of the IJV. We investigated whether this method increases the cross-sectional area of the IJV. ⋯ This method significantly increased the cross-sectional area of the RIJV by increasing the anteroposterior diameter of the RIJV. Even in the flat position, this method was almost as efficacious as the Trendelenburg position. This method thus appears to facilitate IJV cannulation.
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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
Case ReportsAnesthetic management of a patient with mitochondrial myopathy, encephalopathy, lactic acidosis, and stroke-like episodes (MELAS) during laparotomy.
A 53-year-old man with mitochondrial myopathy, encephalopathy, lactic acidosis, and stroke-like episodes (MELAS) underwent a gastrectomy. We administered bicarbonated Ringer's solution, which has a physiological concentration of bicarbonate. ⋯ Aggressive warming was needed to maintain normothermia, presumably because the mitochondrial respiratory chain, which is responsible for thermogenesis, is impaired in MELAS patients. It is important to maintain normothermia in MELAS patients in order to avoid further mitochondrial metabolic depression.
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Journal of anesthesia · Jan 2007
Case ReportsPulmonary atelectasis manifested after induction of anesthesia: a contribution of sinobronchial syndrome?
A 31-year-old man underwent general anesthesia for sinus surgery. Anesthesia was induced with midazolam and butorphanol, and an endotracheal tube was orally placed with a bronchoscope, due to difficulty with temporomandibular joint opening. Ventilation difficulty and increased peak inspiratory pressure were noticed shortly after tracheal intubation, and bronchoscopy was performed for diagnosis. ⋯ A diagnosis of sinobronchial syndrome was made postoperatively. The etiology of the acutely developed atelectasis was unclear. However, the latent syndrome may have induced excessive airway secretion with stimuli such as endotracheal intubation.
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We compared jugular venous blood oxygen saturation (Sj(O) (2)) and the arterial-to-jugular-bulb venous oxygen content difference (AjD(O) (2)) between bispectral index (BIS) values of 40 and 60, adjusted by the infusion rate of propofol. Eighteen postoperative neurosurgical patients (Glasgow Coma Scale [GCS] scores, 11-15) were enrolled. Normocapnia, normothermia, and a mean arterial blood pressure greater than 70 mmHg were maintained. ⋯ Sj(O) (2) at BIS40 (58 +/- 9%) was significantly (P < 0.01) lower than that at BIS60 (63 +/- 10%), and AjD(O) (2) at BIS40 (6.3 +/- 1.5 ml.dl(-1)) was significantly (P < 0.01) higher than that at BIS60 (5.7 +/- 1.5 ml.dl(-1); mean +/- SD). At BIS40, status defined as Sj(O) (2) less than 50% was observed in 3 patients, while this status was observed in 1 patient at BIS60. In conclusion, in patients with postoperative neurosurgical surgery (GCS scores, 11-15), decreases of propofol infusion to adjust the BIS value from 40 to 60 increase the cerebral oxygen balance.