Masui. The Japanese journal of anesthesiology
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A 36-year-old man with intractable epileptic seizures underwent insertion of subdural electrodes on bilateral temporal lobes under air-oxygen-sevoflurane anesthesia. After the completion of the operation, we measured electrocorticogram at end-tidal sevoflurane concentration of 2.5%, 1.5%, and 1.5% with 0.1 mg intravenous fentanyl. ⋯ When 0.1 mg fentanyl was intravenously administrated during 1.5% sevoflurane anesthesia, the frequency of the spike waves was further reduced. Caution should be taken when using sevoflurane-fentanyl anesthesia because this combination may interrupt identification of epileptic focus on intraoperative electrocorticogram.
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We measured the intracuff pressure of two different tracheal tubes, Portex Profile Soft-Seal Cuff with high N2O gas-barrier property and "high-volume, low-pressure" cuff (Mallincrodt Lo-Contour). Twenty adult patients undergoing elective abdominal surgery, were maintained with total intravenous anesthesia combined with epidural block, and ventilated with oxygen in air (FIO2 = 0.4). Initially, intracuff pressure was adjusted to 25 mmHg with air, and monitored over 180 min. ⋯ The decrease in intracuff pressure of Portex Profile Soft-Seal Cuff was significantly smaller than that of "high-volume, low-pressure" cuff 150-180 min later. We conclude that to prevent tracheobronchial aspiration during prolonged general anesthesia without N2O, tracheal tube cuff with gas-barrier property may be safer than usual "high-volume, low-pressure" cuff. We recommend to check the intracuff pressure especially during the first 30 min and at intervals of several hours.
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"Guidelines on Blood Products Use" published in 1999 recommends restricting the use of fresh frozen plasma (FFP) solely to correct multiple coagulation factor deficiencies. We retrospectively studied the use of FFP in patients with massive intraoperative bleeding before and after publication of the new guidelines. There were 22 patients whose blood loss was more than their circulating blood volume (7% of body weight) in the past two years. ⋯ FFP was given to all 22 patients. The mean dose of FFP decreased from 26.8 ml.kg-1 to 17.8 ml.kg-1 after publication of the new guidelines but the difference was not statistically significant. The volume infused was more than that recommended to improve blood coagulation in massive bleeding, i.e., 8-10 ml.kg-1.
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Case Reports
[Orotracheal intubation using a Styletscope in a patient with restricted opening of the mouth].
We used a Styletscope (FSS) for endotracheal intubation in a 61-year-old man with restricted mouth opening. The degree of mouth opening was only 1.5 cm. ⋯ After induction of anesthesia using propofol and vecuronium, orotracheal intubation was accomplished promptly and smoothly using this scope. The Styletscope is a useful device for orotracheal intubation in patients with restricted mouth opening.
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Oscillometric noninvasive arterial pressure monitoring devices frequently fail to measure pressure precisely in patients with arrhythmia, such as atrial fibrillation, because beat-by-beat changes in pulse pressure and mean pressure level distort the relation between cuff pressure and oscillometric wave amplitude. To overcome this problem, we developed a new algorithm for oscillometric measurement in which oscillometric wave amplitude is corrected according to changes in pulse pressure and mean arterial pressure level. In 7 patients with atrial fibrillation, we compared systolic pressure thus estimated with that simultaneously measured invasively in the radial artery and averaged during oscillometric measurement. ⋯ Correction based on plethysmographically estimated pulse pressure decreased unmeasurable cases to 6% (P < 0.01). Standard error of systolic pressure estimates was 6.44 +/- 1.83, 4.10 +/- 0.85, and 4.75 +/- 1.26 mmHg with no, invasive, and plethysmographical correction in this order (P < 0.01). We conclude that oscillometric wave amplitude correction based on beat-by-beat pulse pressure and mean arterial pressure level lessened the number of unmeasurable cases and improved measurement precision in patients with atrial fibrillation.