Journal of anesthesia
-
Journal of anesthesia · Jan 2009
ReviewComplexity of blood volume control system and its implications in perioperative fluid management.
The use of fluid therapy attempts to optimize blood circulation by manipulating the circulating blood volume (BV). BV may be a key intermediate parameter between fluid therapy and the blood circulation, and it has been assumed that BV can be controlled by fluid therapy. In order to construct a fluid therapy protocol, firstly, we have to confirm whether BV can actually be controlled by fluid therapy. ⋯ Because inflammation and some hormones control vascular permeability and the renal adjustment of solutes and fluids, such factors may readjust the BV even after interventional fluid therapy. Perioperative BV may be predominantly controlled by an internal regulatory system, regardless of whether "restrictive" or "liberal" fluid management strategies are employed. Recognizing this physiological control of BV may help us to develop individualized fluid management strategies.
-
Journal of anesthesia · Jan 2009
Case ReportsTransient lower limb pain following accidental thoracic subarachnoid insertion of an epidural catheter.
Transient sensory disturbances, including dysesthesia or neurologic deficits in the lower extremities or buttocks have been described as complications of neuraxial anesthesia. We report a case of transient lower limb pain following the accidental placement of an epidural catheter into the thoracic subarachnoid space. A 31-year-old woman was scheduled to undergo laparoscopic myomectomy. ⋯ All signs of allodynia had disappeared on postoperative day 25. Sagittal and axial T2-weighted magnetic resonance imaging (MRI) at the Th12 level revealed a small high-intensity area without mass effect in the ipsilateral dorsal column. The patient's clinical course and MRI diagnosis suggested the inhibition of descending inhibitory pathways resulting from a lesion of the spinal cord as the possible etiology of the transient lower limb pain and allodynia.
-
Journal of anesthesia · Jan 2009
Comparative StudyComparison of the effects of sevoflurane and isoflurane anesthesia on the maternal-fetal unit in sheep.
The aim of this study was to determine the hemodynamic and blood gas effects of inhalational anesthetics on the maternal-fetal sheep unit. The principal hypothesis, tested in chronically instrumented near-term pregnant ewes, was that sevoflurane anesthesia may be safe and useful for the mother and fetus during pregnancy, compared with isoflurane. ⋯ A "low-dose" concentration (0.5-1.0 MAC) of sevoflurane may be safe and useful for both mother and fetus during near-term pregnancy. However, a high concentration (1.5-2.0 MAC) of sevoflurane or isoflurane may induce hemodynamic instability in the mother and fetus when administered.
-
Journal of anesthesia · Jan 2009
Case ReportsThree-dimensional CT image analysis of a tracheal bronchus in a patient undergoing cardiac surgery with one-lung ventilation.
The incidence of a tracheal bronchus--that is, a congenitally abnormal bronchus originating from the trachea or main bronchi--is 0.1%-2%. Serious hypoxia and atelectasis can develop in such patients with intubation and one-lung ventilation. ⋯ A type I tracheal bronchus and segmental tracheal stenosis were identified on postoperative three-dimensional (3D) computed tomographic (CT) images. Preoperative examination of chest X-rays, CT images, and preoperative tracheal 3D images should preempt such complications and assist in securing safe and optimal one-lung ventilation.
-
Journal of anesthesia · Jan 2009
Case ReportsHyperkalemia during surgery: is it an early warning of propofol infusion syndrome?
We present a case of severe hyperkalemia in a 48-year-old man after short-term infusion of an average dose of propofol. We suspected that the hyperkalemia in this patient was a sign of propofol infusion syndrome. ⋯ There were no other evident causes of hyperkalemia as documented by laboratory data. The procedure was abandoned and the patient was taken to postoperative recovery, where his potassium levels returned to normal at the end of 10 h.