Journal of anesthesia
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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.
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Journal of anesthesia · Jan 2009
Jugular bulb desaturation during off-pump coronary artery bypass surgery.
Off-pump coronary artery bypass grafting surgery (OPCAB) frequently results in significant jugular bulb desaturation. Although jugular bulb desaturation during OPCAB may be associated with postoperative cerebral injury, routine jugular bulb oximetry appears to be invasive and expensive. We hypothesized that intraoperative hemodynamic compromise during OPCAB due to cardiac displacement is associated with jugular bulb desaturation which correlates with specific hemodynamic and physiological changes. ⋯ Changes in S(VO2) and Pa(CO2) were associated with jugular bulb oxygen saturation, and S(VO2)
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Journal of anesthesia · Jan 2009
Increased fingertip vascular tone leads to a greater fall in blood pressure after induction of general anesthesia.
General anesthesia causes peripheral vasodilation. We thus hypothesized that patients with increased peripheral vascular tone would become more hypotensive after the induction of general anesthesia compared to those without increased peripheral vascular tone. To test this hypothesis, we compared the decrease in blood pressure after anesthetic induction between patients with increased peripheral vascular tone and those without increased peripheral vascular tone. ⋯ In each patient, the peripheral vascular tone was assessed by either the fingertip skin-surface temperature (FSST) or the forearm-fingertip skin-surface temperature gradient (FFSSTG; forearm skin-surface temperature minus FSST). The decrease in blood pressure 15 min after anesthetic induction was larger in patients with an FSST of 29 degrees C or less (FSST = 27.3 +/- 1.6 degrees C; FFSSTG = 5.2 +/- 1.6C) than in those with an FSST of more than 29 degrees C (FSST = 30.8 +/- 1.0 degrees C; FFSSTG = 1.6 +/- 1.2 degrees C). In conclusion, increased fingertip vascular tone (presumably due to thermoregulatory vasoconstriction) before anesthetic induction leads to a greater fall in blood pressure after anesthetic induction.
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Journal of anesthesia · Jan 2009
Prediction of postoperative delirium after abdominal surgery in the elderly.
Indications for the surgical treatment of elderly patients have been increasing. Postoperative central nervous system dysfunction, including delirium, is one of the most common complications in elderly surgical patients. The relationship between patient factors, including cerebral oxygen saturation, and the incidence of postoperative delirium was evaluated. ⋯ Patients' age, low preoperative kana-hiroi test score, and low preoperative rSO2 were important risk factors for postoperative delirium.
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Journal of anesthesia · Jan 2009
Work stress and workload of full-time anesthesiologists in acute care hospitals in Japan.
The number of anesthesiologists per population in Japan is small compared with that in Europe and North America. While there is a growing concern that hard work causes anesthesiologists' fatigue and may compromise patient safety, the workload and physical stress, as well as the impact of staff support on physicians' stress have not been assessed in detail. The goal of this study was to evaluate the working environment, anesthesia workload, and occupational stress of anesthesiologists in Japan. ⋯ Our results provide a quantitative assessment of the duties of anesthesiologists and show that work stress among anesthesiologists is related to workload and other factors.