Journal of anesthesia
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Journal of anesthesia · Aug 2016
Difficult airway management resources and capnography use in Japanese intensive care units: a nationwide cross-sectional study.
The availability of difficult airway management (DAM) resources and the extent of capnometry use in Japanese intensive care units (ICUs) remained unclear. The purpose of this study was to clarify whether: (1) DAM resources were adequate, and (2) capnometry was routinely applied in Japanese ICUs. ⋯ In Japanese ICUs, SGAs and dedicated DAM carts were less available, and capnometry was not universally applied either to confirm tube placement, or for continuous monitoring of ventilated patients. Our study revealed areas in need of improvement.
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Journal of anesthesia · Aug 2016
Preoperative serum lactate cannot predict in-hospital mortality after decompressive craniectomy in traumatic brain injury.
Despite the utility of serum lactate for predicting clinical courses, little information is available on the topic after decompressive craniectomy. This study was conducted to determine the ability of perioperative serum lactate levels to predict in-hospital mortality in traumatic brain-injury patients who received emergency or urgent decompressive craniectomy. ⋯ Preoperative lactate level is not an independent predictor of in-hospital mortality after decompressive craniectomy in traumatic brain-injury patients.
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Journal of anesthesia · Aug 2016
Observational StudyRelationship between regional cerebral blood volume and oxygenation and blood pressure during spinal anesthesia in women undergoing cesarean section.
During spinal anesthesia for cesarean section, cerebral oxygenation decreases may be related to an abrupt drop in cerebral blood flow due to hypotension. We measured the changes in maternal regional cerebral blood volume (rCBV) and oxygenation (rCBO) using near-infrared spectroscopy (NIRS) to evaluate whether a decrease in arterial blood pressure during spinal anesthesia diminishes rCBV and rCBO. ⋯ Maternal rCBV and rCBO decrease significantly during spinal anesthesia for cesarean section. Reductions in rCBV and rCBO may be associated with the severity of hypotension induced by subarachnoid sympathetic block with bupivacaine.
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Journal of anesthesia · Aug 2016
Case ReportsAlteration of fatal 1:1 conducted atrial flutter to less conducted ratio by landiolol infusion.
An 84-year-old male patient with a past history of atrial-flutter-fibrillation and dementia underwent an urgent femoral neck fracture surgery. Preoperative electrocardiography demonstrated atrial flutter (AFL) with ventricular conduction at a ratio of 2:1-4:1, and transthoracic echocardiography showed severe left ventricular dysfunction with Ejection Fraction of 14.6 %. Femoral nerve block and Lateral femoral cutaneous nerve block with sedation was planned for the surgery. ⋯ A further episode of 1:1 conducted AFL occurred when the pin was inserted to the thighbone, which caused circulatory collapse. Additional bolus dose of landiolol immediately altered it to 2:1 before operating cardioversion and stabilized the hemodynamics. He maintained AFL with 2:1 conduction thereafter, and 1:1 conduction was never seen postoperatively even after discontinuation of landiolol.
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Journal of anesthesia · Aug 2016
Case ReportsManagement of three cardiogenic pulmonary edemas occurring in a patient scheduled for left ventricular assist device implantation: indicators for determining left ventricular assist device pump speed.
A male patient with Marfan syndrome underwent aortic root replacement and developed left ventricular (LV) failure. Four years later, he underwent aortic arch and aortic valve replacement. Thereafter, his LV failure progressed, and cardiogenic pulmonary edema (CPE) appeared, which we treated with extracorporeal LV assist device (LVAD) placement. ⋯ Additionally, systolic pulmonary artery pressure (sPAP), left atrial diameter (LAD), RV end-diastolic diameter (RVEDD) and estimated RV systolic pressure (esRVP) changed with PAWP changes. In this patient, LV failure and hyperdynamic RV caused the CPEs, which we treated by adjusting the LVAD output to the RV output. Determining LVAD output, RV function and LV end-diastolic diameter are typically referred, and PAWP, LAD, RVEDD, and sPAP could be also referred.