Journal of anesthesia
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Journal of anesthesia · Jan 2009
Before-after study of a restricted fluid infusion strategy for management of donor hepatectomy for living-donor liver transplantation.
Intraoperative fluid infusion strategy remains controversial. Many animal model studies have shown that restricted fluid infusion reduces blood loss, though reports on this topic in humans are rare. The purpose of this study was to determine the effects on volume of blood loss of a restricted fluid infusion strategy for hepatectomy in donors for living donor liver transplantation. ⋯ Our restricted-volume strategy reduced blood loss and had no adverse effects during living-donor hepatectomy.
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Journal of anesthesia · Jan 2009
Case ReportsA plantar flexion response to nerve stimulation indicates needle misplacement in the epidural/spinal space during psoas compartment block.
We report two cases of plantar flexion due to epidural misplacement of the needle during psoas compartment block, providing a response feedback for needle position during this procedure. In one case, the response occurred contralaterally, and in the other bilaterally. ⋯ At this point, 3 ml of radiopaque medium was injected, and it diffused throughout the epidural space. Subsequently, single-shot epidural anesthesia was achieved by injection through this needle.
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Journal of anesthesia · Jan 2009
Case ReportsVolume manipulation by phlebotomy for cesarean section in a patient with pulmonary hypertension.
Pulmonary hypertension in a parturient is known for its high perioperative mortality. We describe a successful case of cesarean section performed under general anesthesia in a parturient with pulmonary hypertension. A distinctive feature of our management was active blood volume manipulation by phlebotomy and reinfusion of the blood. ⋯ The blood was slowly infused, with transesophageal echocardiography used to evaluate right ventricle filling. The patient was hemodynamically stable during the operation and had an uneventful postpartum period. Her baby's perioperative course was also uneventful.
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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
Comparative StudyComparison of Parker-tipped and Murphy-tipped tracheal tubes in Airway Scope-assisted intubation in a manikin.
We tested our hypothesis that a Parker-tipped tracheal tube could improve the reliability of tracheal tube passage as compared to a Murphy-tipped tracheal tube during Airway Scope-assisted intubation in a manikin. ⋯ When the advancement of a conventional tracheal tube during Airway Scope-assisted intubation is likely to result in collision with the glottis or other laryngeal structures, the selection of a Parker-tipped tracheal tube is a better option.