Journal of anesthesia
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Journal of anesthesia · Jan 2009
Decreased incidence of headache after unintentional dural puncture in patients with cesarean delivery administered with postoperative epidural analgesia.
To investigate how subsequent placement of a catheter into the epidural space after unintentional dural puncture for postoperative analgesia for 36-72 h affected the incidence of post-dural puncture headache (PDPH). ⋯ Subsequent catheter placement into the epidural space after unintentional dural puncture in cesarean delivery and leaving the catheter for postoperative analgesia for 36-72 h may reduce the incidence of PDPH.
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Journal of anesthesia · Jan 2009
Comparative StudyAuditory evoked potentials index versus bispectral index during propofol sedation in spinal anesthesia.
It is still controversial whether an electroencephalogram could be a useful monitor of sedation levels. The present study was performed to compare the bispectral index (BIS) and the auditory evoked potentials index (AAI) during light sedation with propofol infusion in spinal anesthesia. ⋯ The AAI, but not the BIS, could discriminate slight changes of consciousness during light sedation with propofol infusion in patients with spinal anesthesia.
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Journal of anesthesia · Jan 2009
Skin-traction method prevents the collapse of the internal jugular vein caused by an ultrasound probe in real-time ultrasound-assisted guidance.
Real-time ultrasound-assisted guidance for catheterization of the internal jugular vein (IJV) is known to be useful, especially for a small-sized vein, which is difficult to catheterize. However, one of the problems with real-time ultrasound-assisted guidance is that the ultrasound probe itself can collapse the vein. We have developed a novel "skintraction method (STM)", in which the puncture point of the skin over the IJV is stretched upwards with several pieces of surgical tape in the cephalad and caudal directions with the aim being to facilitate catheterization of the IJV. We examined whether this method increased the compressive force required to collapse the IJV. ⋯ With the STM, not only the cross-sectional area but also the compressive force required to collapse the IJV increased. Thus, the STM may facilitate real-time ultrasoundassisted guidance for catheterization of the IJV by maintaining the cross-sectional area of the vein during the guidance.
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Journal of anesthesia · Jan 2009
Serum concentration of lidocaine after transversus abdominis plane block.
We measured the serum concentration of lidocaine after transversus abdominis plane (TAP) block with 40 ml of 1% lidocaine in 12 patients under general anesthesia, using a fluorescence polarization immunoassay. The peak mean serum concentration of lidocaine occurred 30 min after the block (3.6 +/- 0.7 microg x ml(-1)). ⋯ These results indicate that a TAP block can potentially cause systemic toxicity of a local anesthetic. The analgesic effect of the TAP block may partially depend on the rise in serum concentration of the local anesthetic.
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Journal of anesthesia · Jan 2009
Gradient of bronchial end-tidal CO2 during two-lung ventilation in lateral decubitus position is predictive of oxygenation disorder during subsequent one-lung ventilation.
Hypoxemia is one of the major problems during one-lung ventilation (OLV). During two-lung ventilation (TLV) using a double-lumen bronchial tube, bronchial endtidal carbon dioxide partial pressure (ETbr(CO2)) can be determined on both sides, independently. The ETbr(CO2) is mainly dependent on the pulmonary perfusion to each lung. If the degree of oxygenation disorder during OLV were to be predictable before starting OLV, this could provide time to prepare for any subsequent hypoxemia. The aim of this study was to investigate whether the difference of ETbr(CO2) (D-ETbr(CO2)) between the dependent and the nondependent lungs during TLV in the lateral decubitus position (LP) could be a predictive factor for the severity of oxygenation disorder under subsequent OLV. ⋯ The D-ETbr(CO2) predetermined during TLV in LP could be a predictive factor for the severity of oxygenation disorder after starting OLV in LP.