Journal of anesthesia
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Journal of anesthesia · Apr 2014
Breathing movements of the chest and upper abdomen in mechanically ventilated paralyzed patients.
Assessment of breathing on clinical examination requires visualization of "chest" wall movement. However, in mechanically ventilated paralyzed patients, chest expansion is smaller than that of the abdomen. The aim of this study was to determine chest and upper abdominal movements in mechanically ventilated patients under general anesthesia. ⋯ Upper abdominal wall excursions were significantly larger than those of the chest wall in mechanically ventilated paralyzed patients, regardless of BMI. Assessment of breathing by clinical examination should avoid emphasis on "chest" wall movement alone, and instead include upper abdominal wall movement.
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Journal of anesthesia · Apr 2014
Extent of sympathectomy affects postoperative compensatory sweating and satisfaction in patients with palmar hyperhidrosis.
Endoscopic thoracic sympathectomy (ETS) for the treatment of palmar hyperhidrosis is generally performed at one or two levels ranging between T2 and T4; however, compensatory sweating (CS) is an occasional bothersome side effect. The aim of our study was to evaluate the association between the extent of ETS and the degree of postoperative CS and palmar sweating, as well as patient satisfaction. ⋯ Compared to ETS at two levels, single-level ETS of T2 or T3 reduces postoperative palmar sweating to a milder degree, and causes CS to a less severe degree. The severity of CS is inversely correlated with the degree of patient satisfaction.
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Journal of anesthesia · Apr 2014
Case ReportsA temporary decrease in twitch response following reversal of rocuronium-induced neuromuscular block with a small dose of sugammadex in a pediatric patient.
We report a temporary decrease in twitch response following reversal of rocuronium-induced neuromuscular block with a small dose of sugammadex in our dose-finding study in pediatric patients. A 19-month-old female infant (9.6 kg, 80 cm) was scheduled for elective cheiloplasty surgery. Anesthesia was induced with nitrous oxide 50% and sevoflurane 5% and maintained with air, oxygen, sevoflurane 3%, and fentanyl (total, 3 μg/kg). ⋯ Twitch responses recovered to their control values after additional doses of 3.5 mg/kg sugammadex (4 mg/kg in total). Time from sugammadex administration to maximum decreases in twitch responses is earlier than has been reported in adults (20-70 min). It is demonstrated that following neuromuscular block reversal with insufficient dose of sugammadex, there is a possibility of the recurrence of residual paralysis within less than 20 min in pediatric patients.
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Journal of anesthesia · Apr 2014
Observational StudyRelationship of abdominal circumference and trunk length with spinal anesthesia level in the term parturient.
We hypothesized that body shape metrics influence the anatomy of spinal canal and intraabdominal pressure in three dimensions. We explored the effects of abdominal circumference, trunk length, and their combination on the level of spinal anesthesia in the term parturient in this study. ⋯ TL/AC2, which simulated the ratio of the long axis and transection area of the abdomen, was correlated with maximal spinal level, and parturients with low TL/AC2 values tended to have higher dermatomal levels during spinal anesthesia.
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Journal of anesthesia · Apr 2014
Antinociceptive effect of intracerebroventricular administration of D-serine on formalin-induced pain.
In a previous study using the tail-flick test, we found that intracerebroventricular administration of D-serine, an endogenous co-agonist at the glycine sites of N-methyl-D-aspartate (NMDA) receptors, elicited an antinociceptive effect on thermal nociception. The purpose of the present study was to evaluate the effect of intracerebroventricular administration of D-serine on nociception induced by tissue damage or inflammation using the formalin test. ⋯ The present data suggest that activation of NMDA receptors via glycine sites at the supraspinal level induces an antinociceptive effect on both acute and tonic pain.