Journal of anesthesia
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Journal of anesthesia · Oct 2011
Randomized Controlled TrialFlurbiprofen axetil enhances analgesic effect of fentanyl associated with increase in β-endorphin levels.
To examine the analgesic effect of preoperative administration of flurbiprofen axetil and that of postoperative administration of a combination of flurbiprofen axetil and fentanyl, as well as perioperative plasma β-endorphin (β-EP) levels in patients undergoing esophagectomy. ⋯ These results show that flurbiprofen axetil enhances the analgesic effect of fentanyl associated with increase in β-EP levels.
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Journal of anesthesia · Oct 2011
Influence of bupivacaine injection dose rate on cardiovascular depression, subsequent hemodynamic course, and related bupivacaine plasma levels in piglets.
Systemic local anesthetic (LA) toxicity resulting from inadvertent intravascular injection of LA is a rare but potentially fatal event. Early recognition of intravascular injection and approaches to improve therapeutic safety are required. This study investigated the influence of intravascular injection dose rate of bupivacaine on bupivacaine plasma levels and timing of LA-induced cardiovascular compromise. ⋯ Higher dose rates of bupivacaine showed much higher plasma bupivacaine levels related to absolute infused dose at MAP 50% and were associated with an increased mortality. Slow administration of LA is recommended to allow timely detection and stopping of inadvertent intravascular administration.
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Journal of anesthesia · Oct 2011
Case ReportsTracheomalacia after reoperation for an adenomatous goiter located in a unique position.
Tracheomalacia after thyroidectomy is a life-threatening situation. However, it is difficult to predict postoperative tracheal obstruction with certainty. A case of a 74-year-old woman with a long-standing adenomatous goiter (98 g) is reported. ⋯ The present case suggests that the occurrence of tracheomalacia could be attributed to reoperation and retrotracheal extension. Thus far, six preoperative predictive factors for the development of severe postoperative respiratory obstruction have been reported: goiter for more than 5 years, preoperative recurrent laryngeal nerve palsy, significant tracheal narrowing and/or deviation, retrosternal extension, difficult endotracheal intubation, and thyroid cancer. Two more factors, reoperation and retrotracheal extension of tumor, may also be risks for airway obstruction after thyroidectomy.
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Journal of anesthesia · Oct 2011
Influence of tidal volume for stroke volume variation to predict fluid responsiveness in patients undergoing one-lung ventilation.
We designed this study to determine the predictive value for fluid responsiveness of stroke volume variation (SVV) in patients undergoing one-lung ventilation (OLV), ventilated at different tidal volumes. All patients scheduled for pulmonary lobectomy were randomized into two groups according to their tidal volume [group H: tidal volume 8 ml/kg (n = 36); group L: tidal volume 6 ml/kg (n = 37)]. After starting OLV, volume loading was performed by administration of 500 ml 6% hydroxyethylated starch for 30 min. ⋯ The area under the receiver operating characteristic curve for SVV to discriminate between responders and non-responders was 0.776 in group H and 0.648 in group L. The optimal threshold value of SVV was 10.5% (sensitivity, 85.7%; specificity, 66.7%) in group H and 8% (sensitivity, 69.5%; specificity, 64.3%) in group L. We found that SVV could predict fluid responsiveness in patients undergoing OLV with acceptable levels of sensitivity and specificity only when tidal volume is at least 8 ml/kg.