Journal of anesthesia
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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
Case ReportsDifficult laryngoscopy caused by massive mandibular tori.
Mandibular tori, defined as bony protuberances located along the lingual aspect of the mandible, are a possible cause of difficult intubation. We describe a case of mandibular tori that resulted in difficult intubation. A 62-year-old woman who had speech problems was diagnosed with mandibular tori, and was scheduled for surgical resection. ⋯ The massive tori prevented insertion of the tip of the blade into the oropharynx, and neither the epiglottis nor the arytenoids could be visualized, i.e., Cormack and Lehane grade IV. Blind nasotracheal intubation was successful and the surgery proceeded uneventfully. The anesthesiologist should examine any space-occupying lesion of the oral floor and should be vigilant for speech problems in order to detect mandibular tori that might impede intubation.
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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
A review of perioperative complications during frameless stereotactic surgery: our institutional experience.
Frameless stereotactic neurosurgery is increasingly being used for the biopsy of intracranial tumors and the resection of deep-seated lesions where reliance on surface anatomic landmarks can be misleading, as well as in movement disorders, psychiatric disorders, seizure disorders, and chronic refractory pain. Nascent biological approaches, including gene therapy and stem-cell and tissue transplants for movement disorders, also utilize neuronavigational techniques. These procedures are complex and involve understanding of the basic principles and factors affecting neuronavigation. The procedure may appear to be simple, but serious complications may occur. ⋯ Awareness and vigilance can help in the early identification and better management of the above intraoperative complications.
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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.