Journal of anesthesia
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Journal of anesthesia · Jan 2008
Comparative StudyAnatomical features of the right internal jugular vein in infants and young children undergoing heart surgery for congenital disease: comparison between cyanotic and noncyanotic patients.
It has been reported that children with cyanotic heart disease have elevated systemic levels of vascular endothelial growth factor, which may be related to the development of vessels. However, it is unknown whether the anatomical features of the internal jugular vein (IJV) differ between cyanotic and noncyanotic children. In this study, we compared anatomical information about the IJV of these two groups of patients. ⋯ The anatomical features of the right IJV in infants and young children with congenital heart disease were not different in cyanotic and noncyanotic patients, except for the relationship between diameter and the demographic data. In the small patients examined in our study (72% of them were infants), the diameter of the IJV was not sufficiently enlarged by the Trendelenburg position, regardless of whether the patients were cyanotic or noncyanotic.
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Journal of anesthesia · Jan 2008
Comparative StudyLower intracuff pressure of laryngeal mask airway in the lateral and prone positions compared with that in the supine position.
We compared the intracuff pressure (ICP) of a laryngeal mask airway (LMA) in the lateral and prone positions with that in the supine position. One hundred and eight patients, weighing 50-70 kg, scheduled for elective orthopedic and plastic surgery, were assigned to three groups, based on their body position during surgery. General anesthesia was induced and then a size 4 deflated LMA was inserted in each patient in the supine (group 1; n = 42), lateral (group 2; n = 45), or prone position (group 3; n = 21). ⋯ ICP in groups 2 and 3 was significantly lower than that in group 1 from immediately after insertion to the end of surgery. After surgery, turning from the lateral (group 2) or prone (group 3) position to the supine position significantly raised the ICP. Because the ICP is related to the seal pressure of the LMA and postoperative pharyngolaryngeal morbidity, we recommend evaluating and adjusting the ICP appropriately in each body position.
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Journal of anesthesia · Jan 2008
Comparative StudyChanges in polymorphonuclear leukocyte elastase concentrations and hemolysis parameters in patients transfused with different blood preparations, and in the blood preparations themselves.
Massive blood transfusion induces hemolysis and increases polymorphonuclear leukocyte elastase (PMNE) concentration. The purpose of this study was to compare hemolysis and PMNE concentrations in massive blood transfusions with three different preparations. ⋯ During the storage of MAP-CRC, CPD-CRC, and WB, CPD-CRC had the greatest hemolysis and WB had the highest concentration of PMNE. Patients who received massive blood transfusion of MAP-CRC had the least hemolysis and the lowest concentration of PMNE.
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Journal of anesthesia · Jan 2008
Case ReportsCalcineurin-inhibitor-induced pain syndrome after bone marrow transplantation.
Calcineurin-inhibitor-induced pain syndrome (CIPS), a rare complication seen in patients with organ transplants, is associated with the use of calcineurin inhibitors (CIs) such as cyclosporine (CSP) and tacrolimus (FK). Patients with this syndrome usually present with severe leg pain. This case report demonstrates the successful pain control of this pain syndrome in a 42-year-old female patient who had been given CIs (FK and CSP) as an immunosuppressive agent after a bone marrow transplant. ⋯ Due to the presence of allodynia, our patient's pain had neuropathic pain-like characteristics, unlike the pain in previously reported patients with other organ transplants. Her pain was successfully relieved by the administration of oral amytriptyline, clonazepam, oxycodone, and intravenous lidocaine, all of which ordinarily have an analgesic effect on neuropathic pain. CIPS in patients with hematopoietic stem cell transplants treated with FK may have a mechanism by which neuropathic pain may develop that is different from that in patients with other organ transplants.
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Journal of anesthesia · Jan 2008
Case ReportsOrotracheal intubation with an AirWay Scope in a patient with Treacher Collins syndrome.
Treacher Collins syndrome (TCS) is a congenital malformation of craniofacial development; in these patients conventional direct laryngoscopy is very difficult and often unsuccessful because of the upper airway malformation. A 20-year-old man with TCS was scheduled for elective tympanoplasty. The patient showed the characteristic facial appearance of TCS, and a difficult airway was anticipated. ⋯ Next, the AirWay Scope was easily inserted, and his glottic opening was clearly visualized. An 8.0-mm-internal-diameter tracheal tube was then advanced into the trachea without any difficulty. The AirWay Scope is a very useful airway device for orotracheal intubation; it provides an excellent view of the glottis without requiring alignment of the oral, pharyngeal, and laryngeal axes, and appears to be promising for use in patients with a difficult airway.