Journal of anesthesia
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Journal of anesthesia · Feb 2014
Controlled Clinical TrialTo assess the changes of tracheal cuff pressure after a calibrating orogastric tube insertion.
Insertion of a medical instrument into the esophagus may affect tracheal tube pressure. This study evaluated the potential effect of a calibrating orogastric tube insertion on tracheal cuff pressure in patients undergoing laparoscopic bariatric surgery. Adult patients who were scheduled for elective bariatric surgery requiring insertion of a calibrating orogastric tube were assessed for eligibility for this study. ⋯ The change of tracheal cuff pressure was recorded after the calibrating orogastric tube had been left in situ for 3 min. After insertion of the calibrating orogastric tube, the median tracheal cuff pressure increased from 28 [27-28 (25-30)] to 36 [30-42 (26-64)] cmH2O (P < 0.001) and was greater than 35 cmH2O in 30 of 60 patients (50 %). Our results suggest that the tracheal cuff pressure should be routinely monitored in patients undergoing laparoscopic bariatric surgery requiring insertion of a calibrating orogastric tube.
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Journal of anesthesia · Feb 2014
Case ReportsSuspected intraoperative formation of left atrial thrombus in a patient with atrial fibrillation receiving bridging anticoagulation therapy.
We present a patient with atrial fibrillation (AF) in whom a left atrial (LA) thrombus might have formed during laparotomy despite bridging anticoagulation therapy. No evidence of thrombus was detected by transesophageal echocardiography (TEE) at the start of surgery; however, a thrombus measuring 13 × 10 mm was found in the LA appendage by the end of the procedure, suggesting that thrombus might develop intraoperatively in patients with AF even when bridging anticoagulation is properly established. Intraoperative TEE can assist in detecting intracardiac thrombus in patients with AF regardless of their anticoagulation status and provides a tool for intervention to prevent systemic embolization.
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Journal of anesthesia · Feb 2014
Case ReportsCervical spinal cord compression after thyroidectomy under general anesthesia.
Cervical spinal cord injury is a rare but serious complication after general anesthesia. The risk factors include traumatic cervical injury, cervical spine instability, and difficult airway management. It has also occurred in the absence of cervical instability. ⋯ She developed progressive tingling and numbness in her limbs after thyroidectomy under general anesthesia. Magnetic resonance imaging showed a cervical disc protruding into the canal at C5-C6, which was considered to be induced by surgical positioning. She recovered after anterior cervical decompression and internal fixation surgery.
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Journal of anesthesia · Feb 2014
Comparative StudyThe inhibitory effects of bupivacaine, levobupivacaine, and ropivacaine on K2P (two-pore domain potassium) channel TREK-1.
Bupivacaine, levobupivacaine, and ropivacaine are amide local anesthetics. Levobupivacaine and ropivacaine are stereoisomers of bupivacaine and were developed to circumvent the bupivacaine's severe toxicity. The recently characterized background potassium channel, K(2P) TREK-1, is a well-known target for various local anesthetics. The purpose of study is to investigate the differences in inhibitory potency and stereoselectivity among bupivacaine, levobupivacaine, and ropivacaine on K(2P) TREK-1 channels overexpressed in COS-7 cells. ⋯ Inhibitory effects on TREK-1 channels by bupivacaine, levobupivacaine, and ropivacaine demonstrated stereoselectivity: bupivacaine was more potent than levobupivacaine and ropivacaine. Inhibition of TREK-1 channels and consecutive depolarization of the cell membrane by bupivacaine, levobupivacaine, and ropivacaine may contribute to the blockade of neuronal conduction and side effects.