Journal of anesthesia
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Journal of anesthesia · Apr 2012
Randomized Controlled TrialUtility of longitudinal paramedian view of ultrasound imaging for middle thoracic epidural anesthesia in children.
The risk of nerve injury for pediatric thoracic epidural block increases stress for anesthesiologists. The purpose of this study was to investigate the usefulness of longitudinal ultrasound imaging for thoracic epidural block (T5-T6 or T6-T7) in anesthetized children scheduled for the Nuss procedure. ⋯ We concluded that longitudinal paramedian ultrasound imaging could reduce performance time and the difficulty for anesthesiologists during epidural block.
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Journal of anesthesia · Apr 2012
Case ReportsA high dose of dexmedetomidine using the BIS monitor™ for diagnostic and interventional cardiac catheterization in a toddler with congenital heart disease.
Dexmedetomidine (DEX) for sedation in diagnostic and interventional cardiac catheterization (DICC) has been reported to require other drugs or rescue drugs because of its insufficient sedative effect when used alone. We administered DEX and adjusted its dose according to the bispectral index (BIS) monitor™ for DICC in a toddler; consequently, a high dose of DEX had to be administered. The patient was a 1-year and 4-month-old boy who was scheduled to undergo DICC after intracardiac repair. ⋯ The maximum predicted plasma concentration (pCp) of DEX and mean pCp were calculated as 6.1 and 4.1 ng/mL, respectively. A high dose of DEX may be required for DICC sedation, as for MRI sedation, in many cases. Although further studies should be conducted to reveal the merits and demerits of DEX in cardiac catheterization, a high dose of DEX may be useful in some cases.
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Journal of anesthesia · Apr 2012
Case ReportsRegional anesthesia with a single spinal anesthesia using hyperbaric bupivacaine in a child with arthroglyposis multiplex congenita.
Arthrogryposis multiplex congenita (AMC) consists of complex congenital anomalies characterized by multiple contractures. Anesthetic management of these patients requires special care: as this disease often progresses until dysfunction of multiple organ systems occur, it may have an impact on the anesthetic management. Here, we report a case of AMC undergoing urgent surgery for open tibia fracture who had difficult airway management because of limited mouth opening. The anesthetic management of this patient is represented in light of the literature.
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Journal of anesthesia · Apr 2012
The impact of hyperlactatemia on postoperative outcome after adult cardiac surgery.
To evaluate the value of blood lactate value in predicting postoperative mortality (primary outcome), duration of ventilation, and length of stay in an intensive care unit (ICU) and hospital (secondary outcomes). ⋯ Hyperlactatemia is common after cardiac surgery. Maximal lactate threshold ≥4.4 mmol/l in the first 10 h after operation accurately predicts postoperative mortality.
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Journal of anesthesia · Apr 2012
Case ReportsPropofol use for sedation or sedation for propofol use?
A large amount of pharmacological and clinical evidence supports the abuse potential of propofol. Although previous case reports have indicated that recreational use of propofol is primarily by medical professionals, its spread among the general public has recently been highlighted. This is the first case report to show that cravings for propofol can be quite intense in some people, and thus propofol can be wrongfully used by clinicians who are enticed by the promise of monetary gain. Illicit diversion of propofol in hospitals has been confirmed; thus, propofol has been designated as a controlled substance in South Korea as of February 2011.