Journal of anesthesia
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Journal of anesthesia · Dec 2011
Case ReportsCase report of a cervical intraspinal misplacement of a central venous line.
A case of cervical spinal misplacement of a central venous line via the right jugular vein is reported. A review of the literature resulted in eight similar cases. Only two further adults are described. Children and patients suffering from malnutrition seem to have a higher risk for intraspinal malpositioning of central venous catheters.
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Journal of anesthesia · Dec 2011
Randomized Controlled TrialAmino acid infusions started after development of intraoperative core hypothermia do not affect rewarming but reduce the incidence of postoperative shivering during major abdominal surgery: a randomized trial.
Previous studies have demonstrated that amino acid infusions exert enhanced thermogenic effects during general anesthesia. This study was conducted to investigate whether amino acid infusions started after development of intraoperative core hypothermia can accelerate rewarming. ⋯ Amino acid infusions started after development of intraoperative core hypothermia failed to accelerate rewarming. However, amino acid infusions reduced the incidence of postoperative shivering. Use of amino acid infusions to reduce thermoregulatory vasoconstriction at emergence might contribute to a decrease in the development of postoperative shivering.
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Journal of anesthesia · Dec 2011
Case ReportsUltrasound guided obturator nerve block: a single interfascial injection technique.
We describe a new technique of single interfascial injection for 25 patients scheduled for transurethral bladder tumor resection. An ultrasound probe was placed at the midline of inguinal crease and moved medially and caudally to visualize the fascial space between the adductor longus (or pectineus) and adductor brevis muscles. We injected 20 mL 1% lidocaine containing epinephrine into the interfascial space using a transverse plane approach to make an interfascial injection, not an intramuscular swelling pattern. ⋯ Adductor muscle strength, which was measured with a sphygmomanometer, decreased in all patients, from 122 ± 26 mmHg before blockade to 63 ± 11 mmHg 5 min after blockade. No movement or palpable muscle twitching occurred in 23 cases, slight movement of the thigh not interfering with the surgical procedure was observed in 1 case, thus the obturator reflex was successfully inhibited in 96% of cases. Ultrasound-guided single interfascial injection is an easy and successful technique for obturator nerve block.
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Journal of anesthesia · Dec 2011
Comparison of sequential organ failure assessment (SOFA) scoring between nurses and residents.
We aimed to evaluate differences in the interobserver reliability and accuracy of sequential organ failure assessment (SOFA) scoring between nurses and residents. ⋯ Interobserver reliability was good and mean SOFA scores were not significantly different between nurses and residents. The accuracy of SOFA scoring was moderate for both groups; however, although the difference was not statistically significant, the major error rate was higher for nurses than for residents.
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Journal of anesthesia · Dec 2011
Experience of lumbar epidural insertion in 573 anesthetized patients.
Performing regional blockade on anesthetized patients may increase the risk of postoperative neurologic complications, because these patients cannot respond to painful stimuli. In orthopedic patients, especially those with leg fracture, it is sometimes difficult to find a suitable position for epidural catheterization because of pain. This study evaluates the frequency of neurologic complications after lumbar epidural catheter placement in anesthetized adult patients undergoing orthopedic surgery. ⋯ In the remaining 573 patients, the catheter was inserted uneventfully under general anesthesia, and they received continuous local anesthetic infusion for postoperative analgesia. No neurologic complication related to epidural catheter was observed in these patients. This observation suggests that epidural puncture under general anesthesia may be acceptable in some conditions, for example obtaining appropriate consent, difficulty in positioning when awake, proper monitoring and vigilance, etc.