Journal of anesthesia
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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
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
Case ReportsA new modification for safer submental orotracheal intubation.
In patients in whom a tracheal tube cannot be inserted through the nostrils due to multiple facial trauma or hypoplasty of the nose, submental orotracheal intubation (SOI) is performed to avoid tracheostomy. We report a new modification for SOI to minimize the risk of apnea. A 20-year-old man was scheduled for sagittal split ramus osteotomy. ⋯ A second tube that had been confirmed, in advance, to snugly fit into the proximal end of the first tube was passed into the submental tunnel via a polypropylene cylinder and connected between the first tube and the breathing circuit. After careful withdrawal of the second tube through the submental tunnel, the first tube was directly connected to the breathing circuit after removal of the second tube. Although this technique requires additional time, apnea time is minimal even in patients in whom withdrawal of the tracheal tube through the submental tunnel takes time, because the second tube forms a link between the first tube and the breathing circuit, making it possible to ventilate the patient throughout the procedure.
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Journal of anesthesia · Oct 2011
Direct assessment of the antioxidant properties of midazolam by electron spin resonance spectroscopy.
Some antioxidant anesthetics directly inhibit lipid peroxidation mediated via the generation of reactive oxygen species (ROS). To date, the scavenging effects of midazolam on ROS have not been directly assessed. We investigated the inhibitory effect of midazolam on ROS [hydroxyl radical (HO(·)) and superoxide (O (2) (·-) )] by in vitro X-band electron spin resonance with the spin-trapping agent 5,5-dimethyl-1-pyrroline-N-oxide. Our results indicated that HO(·) and O (2) (·-) were not affected by midazolam at clinically relevant concentrations, but were directly scavenged by midazolam at high concentrations (i.e., >4.6 and >1.5 mM, respectively).
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Journal of anesthesia · Oct 2011
Association between cerebrovascular carbon dioxide reactivity and postoperative short-term and long-term cognitive dysfunction in patients with diabetes mellitus.
Our intent was to identify whether cerebrovascular CO(2) reactivity in diabetic patients is a risk factor for postoperative cognitive dysfunction after coronary artery bypass graft (CABG) surgery. ⋯ We found that impaired cerebrovascular CO(2) reactivity was associated with postoperative short-term cognitive dysfunction in diabetic patients.