Journal of anesthesia
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Journal of anesthesia · Jan 2005
Clinical TrialCombined neurolytic block of celiac, inferior mesenteric, and superior hypogastric plexuses for incapacitating abdominal and/or pelvic cancer pain.
Thirty-five patients with extensive abdominal or pelvic cancer who suffered uncontrolled, diffuse, extensive, and incapacitating pain were treated with a combination of neurolytic celiac plexus block (CPB), inferior mesenteric plexus block (IMPB), and superior hypogastric plexus block (SHGPB). The combination of neurolytic CPB, IMPB, and SHGPB was performed with alcohol, mainly using a transintervetebral disc approach. The combination neurolysis produced effective immediate pain relief in all the patients (visual analog scale (VAS), reduced from 8.8 +/- 0.2 to 0). ⋯ No serious complications were observed to have been caused by the neurolytic procedure on the three sympathetic plexuses. Our preliminary clinical results suggest that the combination of neurolytic CPB, IMPB, and SHGPB improves the quality of life of patients who have incapacitating cancer pain, by reducing both the intensity of the pain and their opioid consumption, without serious complications. This combination procedure may provide a new therapeutic option for pain relief in patients with advanced cancer.
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Journal of anesthesia · Jan 2005
Clinical TrialThe incidence and risk factors of difficult mask ventilation.
The ability to ventilate and oxygenate a patient using a bag-mask breathing system may be lifesaving in the case of failure of the initial intubation attempt. In this study, we aimed to determine the incidence of difficult mask ventilation (DMV) and to find preoperative risk factors for this procedure. ⋯ Mallampati class 4, male patients, history of snoring, increasing age, and increasing weight were found to be risk factors for DMV in our study.
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Journal of anesthesia · Jan 2005
Risk factors for prolonged ICU stay in patients following coronary artery bypass grafting with a long duration of cardiopulmonary bypass.
Risk factors for prolonged stay in the intensive care unit (ICU) in patients following coronary artery bypass grafting (CABG) have been reported in many previous studies. However few have focused on circulatory and respiratory status as immediate postoperative risk factors. Therefore we examined immediate postoperative risk factors for prolonged ICU stay after CABG with a long duration of cardiopulmonary bypass (CPB). ⋯ Advanced age, increased MPAP, and decreased PF ratio on admission to the ICU were significant risk factors for a prolonged ICU stay of more than 3 days.
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Journal of anesthesia · Jan 2005
Clinical TrialPlasma concentration for optimal sedation and total body clearance of propofol in patients after esophagectomy.
The present study investigated plasma propofol concentration for optimal sedation and total body clearance in patients who required sedation for mechanical ventilation after esophagectomy. Seven patients after esophagectomy were enrolled in this study. ⋯ Total body clearance was calculated from the steady-state concentration. The infusion rate of propofol for achieving the sedation score of level 3 (drowsy, responds to verbal stimulation) was 1.74 +/- 0.82 mg kg(-1) h(-1) (mean +/- SD, n = 7) when the plasma propofol concentration and the total body clearance were 0.85 +/- 0.24 microg ml(-1) and 1.83 +/- 0.54 l min(-1) (mean +/- SD, n =7), respectively.
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Journal of anesthesia · Jan 2005
Case ReportsUndisrupted pulse wave on pulse oximeter display monitor at cardiac arrest in a surgical patient.
We have encountered a case of cardiac arrest during anesthesia care in which an application of a new-generation pulse oximetry technology led to a misleading interpretation of the patient's true condition. Just after manipulation of the peritoneum, the heart rhythm suddenly became asystole, while the ECG showed a standstill and an arterial pressure wave was absent. However, the Datex-Ohmeda AS/3 Patient Monitor connected to the Masimo SatShare Waveform Generator feature continued to display a pulse wave with a reading of 99%. ⋯ However, the ECG standstill and flattened arterial wave lasted for about 10 s, with no pulse at the common carotid artery; thus, 0.5 mg atropine and 4 mg ephedrine were given and chest compression performed using ventilation with oxygen. About 20 s later, the heart rhythm reappeared, which was monitored by the ECG and arterial pulse wave. This incident demonstrates the importance of becoming familiar with a new technology; otherwise, we will fall into medical errors.