Journal of anesthesia
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Journal of anesthesia · Jun 2014
Comparative StudyTidal volume and airway pressure under percutaneous transtracheal ventilation without a jet ventilator: comparison of high-flow oxygen ventilation and manual ventilation in complete and incomplete upper airway obstruction models.
Percutaneous transtracheal ventilation (PTV) can be life-saving in a cannot ventilate, cannot intubate situation. The aim of this study was to investigate the efficacy of PTV by measuring tidal volumes (VTs) and airway pressure (Paw) in high-flow oxygen ventilation and manual ventilation using a model lung. ⋯ High-flow ventilation tends to result in higher airway pressure despite a smaller VT, which is probably due to a PEEP effect caused by high flow.
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Journal of anesthesia · Jun 2014
Case ReportsSuspected migration of cervical epidural catheter into the brainstem after a difficult catheter insertion.
We report a case of diplopia during continuous epidural injection presumably caused by catheter migration. A 61-year-old woman underwent shoulder surgery under general anesthesia with cervical epidural anesthesia. The epidural catheter was placed in the C6-C7 epidural space with some difficulty before general anesthesia. ⋯ On POD 13, diplopia recurred, which improved gradually. On the 9-month radiologic follow-up, we considered that the symptoms on POD 2 were caused by migration of the epidural catheter into the pons and that her later diplopia was induced by intracranial hypotension syndrome. One should be aware that such an unexpected migration of the catheter can occur following a difficult insertion.
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Journal of anesthesia · Jun 2014
High-dose remifentanil suppresses stress response associated with pneumoperitoneum during laparoscopic colectomy.
Although laparoscopic surgery is minimally invasive, it produces stress responses to an extent similar to that of conventional laparotomy. Both epidural anesthesia and remifentanil intravenously (i.v.), combined with general anesthesia, provide stable hemodynamics during laparoscopic surgery. However, it has not been elucidated whether epidural anesthesia and remifentanil are associated with suppression of autonomic and neuroendocrine stress responses. This study aimed to clarify whether thoracic epidural anesthesia (TEA) or remifentanil suppresses stress responses during laparoscopic surgery. ⋯ Notwithstanding similar hemodynamic responses in all groups, only high-dose remifentanil suppressed both sympathetic responses and the hypothalamus-pituitary-adrenal axis. This result indicates that of these three anesthesia regimens, high-dose remifentanil seems most suited for laparoscopic surgery.