Journal of anesthesia
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Journal of anesthesia · Jan 2009
Case ReportsDexmedetomidine facilitates induction of noninvasive positive pressure ventilation for acute respiratory failure in patients with severe asthma.
Noninvasive positive pressure ventilation (NPPV) has been reported to be effective for acute respiratory failure in patients with severe asthma. Although NPPV requires less sedative than invasive mechanical ventilation, agitated patients with severe asthma should be given the minimum sedation necessary to facilitate the induction of NPPV. Two asthmatic patients (a 65-year-old man and a 32-year-old woman) separately presented to the intensive care unit with exacerbating respiratory failure. ⋯ While the Ramsay sedation scale was maintained at 2 or 3 during the continuous dexmedetomidine infusion, we successfully weaned the patients from NPPV by reducing the inspiratory PAP. Dexmedetomidine helped the agitated patients cooperate with mask ventilation without inducing respiratory depression. We conclude that dexmedetomidine may be a valuable sedative to facilitate the induction of NPPV.
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Journal of anesthesia · Jan 2009
Case ReportsBronchoscope-guided intubation through a Laryngeal Mask Airway Supreme in a patient with a difficult-to-manage airway.
We report a case of an obese patient who presented with laryngeal edema and difficult ventilation after failed attempts to intubate. A Laryngeal Mask Airway Supreme (LMA Supreme) reestablished the ventilation and allowed bronchoscope- guided intubation of the trachea. The case suggests that the LMA Supreme may be useful in patients with a difficult airway.
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Journal of anesthesia · Jan 2009
Desflurane requirements for laryngeal mask airway insertion during inhalation induction.
We hypothesized that the simultaneous use of low concentrations (<6%) of desflurane, nitrous oxide (N(2)O), and fentanyl would allow a laryngeal mask airway (LMA) to be inserted safely with inhalation induction of desflurane, even in nonparalyzed patients. This prospective, observational study was performed to determine the 50% effective concentration (EC(50)) of desflurane for LMA insertion in such patients. ⋯ We demonstrated that N(2)O-desflurane inhalation induction with a normal tidal breathing technique after premedication with fentanyl can be used safely without any adverse airway events in nonparalyzed patients. In such patients, the EC(50) of desflurane for successful LMA insertion was 3.61 +/- 0.31% (95% CI, 3.13-3.90).
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Journal of anesthesia · Jan 2009
Case ReportsUse of Intralipid in an infant with impending cardiovascular collapse due to local anesthetic toxicity.
Local anesthetic-associated cardiac toxicity following caudal epidural blockade is, fortunately, a rare event. Prompt recognition and early treatment is the key to successful resuscitation. Early use of the lipid emulsion Intralipid in bupivacaine-induced cardiac toxicity may lead to a good outcome.
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Journal of anesthesia · Jan 2009
Recovery of dynamic balance after general anesthesia with sevoflurane in short-duration oral surgery.
Recovery of dynamic balance, involving adjustment of the center of gravity, is essential for safe discharge on foot after ambulatory anesthesia. The purpose of this study was to assess the recovery of dynamic balance after general anesthesia with sevoflurane, using two computerized dynamic posturographies. ⋯ The recovery times for dynamic balance and psychomotor function seem to be within 150 min after emergence from general anesthesia with sevoflurane in patients undergoing oral surgery of less than 2-h duration.