Journal of anesthesia
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Journal of anesthesia · Jan 2009
Case ReportsSuccessful treatment with hydrocortisone for heat stroke with critical illness-related corticosteroid insufficiency: transitional changes in serum cytokine and cortisol concentrations.
A 37-year-old man was transferred to our emergency center because of heat stroke with circulatory shock. Despite aggressive body cooling, massive intravenous transfusion, and supply of inotropic agents, shock was persistent. To evaluate adrenal function, an adrenocorticotropic hormone stimulation test was conducted and the results indicated that he had critical illness-related corticosteroid insufficiency (CIRCI) as a result of adrenal insufficiency. ⋯ He was discharged on the thirty-seventh hospital day. Serum cortisol and cytokine concentrations were initially high and the cytokines decreased subsequent to hydrocortisone administration. It is speculated that CIRCI is an exacerbating factor in heat stroke, and hydrocortisone may be a potential therapeutic approach in such patients.
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Journal of anesthesia · Jan 2009
Skin-traction method prevents the collapse of the internal jugular vein caused by an ultrasound probe in real-time ultrasound-assisted guidance.
Real-time ultrasound-assisted guidance for catheterization of the internal jugular vein (IJV) is known to be useful, especially for a small-sized vein, which is difficult to catheterize. However, one of the problems with real-time ultrasound-assisted guidance is that the ultrasound probe itself can collapse the vein. We have developed a novel "skintraction method (STM)", in which the puncture point of the skin over the IJV is stretched upwards with several pieces of surgical tape in the cephalad and caudal directions with the aim being to facilitate catheterization of the IJV. We examined whether this method increased the compressive force required to collapse the IJV. ⋯ With the STM, not only the cross-sectional area but also the compressive force required to collapse the IJV increased. Thus, the STM may facilitate real-time ultrasoundassisted guidance for catheterization of the IJV by maintaining the cross-sectional area of the vein during the guidance.
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Journal of anesthesia · Jan 2009
Serum concentration of lidocaine after transversus abdominis plane block.
We measured the serum concentration of lidocaine after transversus abdominis plane (TAP) block with 40 ml of 1% lidocaine in 12 patients under general anesthesia, using a fluorescence polarization immunoassay. The peak mean serum concentration of lidocaine occurred 30 min after the block (3.6 +/- 0.7 microg x ml(-1)). ⋯ These results indicate that a TAP block can potentially cause systemic toxicity of a local anesthetic. The analgesic effect of the TAP block may partially depend on the rise in serum concentration of the local anesthetic.
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Journal of anesthesia · Jan 2009
Gradient of bronchial end-tidal CO2 during two-lung ventilation in lateral decubitus position is predictive of oxygenation disorder during subsequent one-lung ventilation.
Hypoxemia is one of the major problems during one-lung ventilation (OLV). During two-lung ventilation (TLV) using a double-lumen bronchial tube, bronchial endtidal carbon dioxide partial pressure (ETbr(CO2)) can be determined on both sides, independently. The ETbr(CO2) is mainly dependent on the pulmonary perfusion to each lung. If the degree of oxygenation disorder during OLV were to be predictable before starting OLV, this could provide time to prepare for any subsequent hypoxemia. The aim of this study was to investigate whether the difference of ETbr(CO2) (D-ETbr(CO2)) between the dependent and the nondependent lungs during TLV in the lateral decubitus position (LP) could be a predictive factor for the severity of oxygenation disorder under subsequent OLV. ⋯ The D-ETbr(CO2) predetermined during TLV in LP could be a predictive factor for the severity of oxygenation disorder after starting OLV in LP.
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Journal of anesthesia · Jan 2009
Low bispectral index values following electroconvulsive therapy associated with memory impairment.
It has been reported some patients have opened eyes with low bispectral index (BIS) values immediately following electroconvulsive therapy (ECT). We investigated the time course of the recovery from amnesia and BIS values. ⋯ The present study demonstrated a high frequency of patients falling asleep and the frequent occurrence of prolonged periods of low BIS values following ECT. The results of memory testing showed that ECT procedures resulted in amnesia. The ROC curve findings suggest a strong association of memory disturbance with BIS values. In conclusion, patients generally fell asleep, with low BIS values, for 1-2 h after ECT, and a prolonged period of impairment of memory formation was associated with low BIS values.