Journal of anesthesia
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Journal of anesthesia · Jan 2009
A simple, lightweight CPAP-delivery device, composed of a three-way stopcock, for the nondependent lung.
We aimed to introduce a simple, lightweight continuous positive airway pressure (CPAP)-delivery device for the nondependent lung during one-lung ventilation, to investigate how the type of three-way stopcocks, and the compliance and resistance of a test lung affect the relationship between the oxygen flow rate and CPAP level produced, and to examine how the device works in a clinical setting. ⋯ The lightweight CPAP delivery-device can provide variable CPAP levels by adjusting the oxygen-flow rate without real-time monitoring of the pressure.
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Journal of anesthesia · Jan 2009
Case ReportsManagement of difficult airway in pediatric patients with right ventricular outflow tract obstruction.
We present two cases of difficult airway management for patients with Pierre Robin syndrome and right ventricular outflow tract obstruction in infants. To prevent the exacerbation of right ventricular outflow tract obstruction, adequate oxygenation and ventilation are mandatory in this population. This rule needs to be followed even while dealing with a difficult airway. ⋯ Through both cases, we highlight options of difficult airway management in the pediatric population. Although we can approach a difficult airway with or without spontaneous breathing, the important point is how we will prepare the methods to oxygenate and ventilate patients throughout the procedure. Patients with difficult airway and right ventricular outflow tract obstruction are good examples to make us realize this point.
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Journal of anesthesia · Jan 2009
Evaluation of the applicability of sevoflurane during post-tetanic myogenic motor evoked potential monitoring in patients undergoing spinal surgery.
Recent evidence has indicated that post-tetanic motor evoked potentials (p-MEPs) can be used to improve the reliability of the monitoring of motor function during spinal surgery. However, data on p-MEP monitoring are limited to those in subjects under propofol anesthesia. The present study was conducted to assess the applicability of sevoflurane during p-MEP monitoring in patients undergoing spinal surgery. ⋯ Although the application of tetanic stimulation prior to transcranial stimulation did not significantly increase the success rates of MEP recording, it significantly enlarged MEP amplitude under sevoflurane anesthesia in patients without preoperative motor deficits.
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Journal of anesthesia · Jan 2009
Case ReportsAnesthetic management using total intravenous anesthesia with remifentanil in a child with osteogenesis imperfecta.
In patients with osteogenesis imperfecta (OI), general anesthetic management should be carefully implemented in consideration of difficult intubation and the potential risks of cervical or mandibular fracture associated with tracheal intubation, bone fracture during postural changes, and respiratory dysfunction due to thoracic deformity. To prevent temperature elevation, moreover, many reports have recommended anesthetic management using total intravenous anesthesia (TIVA) rather than inhalation anesthetics, which contribute to temperature elevation. In an 8-year-old boy with type II (fatal type) OI (height, 81 cm; body weight, 12.4 kg), we performed general TIVA with remifentanil and propofol, using a laryngeal mask airway for airway management. All possible intra- and postoperative complications were effectively prevented, and the remifentanil requirement was high, as shown by a mean dose of 0.36 microg x kg(-1) x min(-1).
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Journal of anesthesia · Jan 2009
Bispectral index during epidural puncture predicts anterograde amnesia in patients given midazolam premedication.
We hypothesized anterograde amnesia could be predicted by the bispectral index (BIS) during epidural puncture in patients premedicated with intramuscular midazolam. ⋯ BIS assessment during epidural puncture is informative for the anesthesiologist to predict amnesia following midazolam premedication.