Journal of anesthesia
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Journal of anesthesia · Jan 2009
Case ReportsLife-threatening spontaneous hemothorax in a patient with thrombotic thrombocytopenic purpura.
Spontaneous hemothorax in the left pleural space occurred suddenly in a patient with thrombotic thrombocytopenic purpura (TTP). In spite of massive blood transfusion, the hemorrhage could not be stopped. The patient suffered shock due to tension hemothorax and hypovolemia, resulting in cardiac arrest. ⋯ The main cause of the bleeding was rupture of the left intercostal vein. TTP is a severe microvascular occlusive thrombotic microangiopathy that can induce congestion, vasculitis, and ischemia. This mechanism is thought to have been involved in the rupture of the intercostal vein in the present patient.
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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
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.
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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
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.