Journal of anesthesia
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Journal of anesthesia · Jan 2009
Case ReportsLife-threatening spontaneous hemothorax in a patient with thrombotic thrombocytopenic purpura.
Spontaneous hemothorax in the left pleural space occurred suddenly in a patient with thrombotic thrombocytopenic purpura (TTP). In spite of massive blood transfusion, the hemorrhage could not be stopped. The patient suffered shock due to tension hemothorax and hypovolemia, resulting in cardiac arrest. ⋯ The main cause of the bleeding was rupture of the left intercostal vein. TTP is a severe microvascular occlusive thrombotic microangiopathy that can induce congestion, vasculitis, and ischemia. This mechanism is thought to have been involved in the rupture of the intercostal vein in the present patient.
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Journal of anesthesia · Jan 2009
Effect of posture on mouth opening and modified Mallampati classification for airway assessment.
Several bedside airway assessment methods have been proposed for preoperatively identifying patients who are difficult to intubate. To date, the Mallampati grading remains a time-tested technique for difficult airway assessment. Both Mallampati and the further modification by Samsoon and Young assessed patients in the seated position. ⋯ Eighty adult patients of American Society of Anesthesiologists (ASA) physical status I and II, aged 18-65 years, admitted to our neurosurgical ward were enrolled and assessed for airway. Our study revealed that change in posture produced a significant change in the mouth openings and Mallampati grades of the patients. This change was always toward a higher grade when the patient was turned supine from the sitting position.
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Journal of anesthesia · Jan 2009
Acid-base variables in patients with acute kidney injury requiring peritoneal dialysis in the pediatric cardiac care unit.
We aimed to clarify the acid-base abnormalities of patients with acute kidney injury (AKI) requiring peritoneal dialysis (PD) in pediatric cardiac care units. ⋯ Patients with AKI requiring PD in a pediatric cardiac care unit had significant metabolic acidosis compared to controls matched by the type of surgery and body weight. Hyponatremia and hypoalbuminemia were characteristics of these patients. The calculated SIDa was smaller in the PD than in the control group. Only the serum albumin had a significant prognostic value.
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Journal of anesthesia · Jan 2009
Case ReportsAnesthetic management of a patient with hyperthyroidism due to hydatidiform mole.
Secondary hyperthyroidism can often complicate gestational trophoblastic disease, a malignant uterine cancer. We report here the perioperative management of hyperthyroidism due to hydatidiform mole. A 53-year-old woman underwent emergency surgery due to suspicion of hydatidiform mole. ⋯ Intraoperative events included hypotension and tachycardia, although in general, tachycardia was prevented with antiarrhythmic agents and transfusion with a plasma expander and crystalloid fluid. Hyperthyroidism was highly suspected from the patient's clinical course and was confirmed by high levels of preoperative serum free triiodothyronine (T3) and thyroxine (T4). The patient became euthyroid within a few days after mole evacuation and did not require an antiarrhythmic agent after her return to the inpatient ward.
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Journal of anesthesia · Jan 2009
Case ReportsReal-time three-dimensional ultrasound for continuous interscalene brachial plexus blockade.
Two-dimensional ultrasound guidance is used commonly for regional anesthetic techniques. This report describes the novel use of three-dimensional, ultrasound-guided, continuous interscalene regional analgesia, which was used in a 36-year-old woman undergoing left total elbow arthroplasty. Possible advantages of this novel technology over current two-dimensional methods include a larger area of available scan information that enables multiple planes of view without having to reposition the ultrasound probe, and three-dimensional visualization of local anesthetic deposition perineurally. Current technological limitations include an upper frequency of 7 MHz, which decreases the resolution of superficial scanning.