Masui. The Japanese journal of anesthesiology
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Case Reports
[Right ventricular perforation and cardiac tamponade caused by a central venous catheter].
A 5 year old girl with ASD was scheduled for open heart surgery. A central venous catheter was placed via the right infraclavicular vein after induction of anesthesia. Thirty minutes after insertion of the catheter, a decrease in arterial pressure and pulse pressure, an increase in heart rate and central venous pressure were observed. ⋯ Gushing blood out of a hole in the right ventricular free wall was confirmed by pericardiotomy. The hemodynamics were stabilized by blood transfusion and surgical closure of the hole on the ventricle. This perforation was thought to be caused by careless insertion of a relatively stiff central venous catheter.
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We examined the relationship between the degree of difficulty in visualization of the larynx and the distance from the lower border of the mandible to the thyroid notch (M-T distance). Patients were examined and the M-T distance was measured with their neck fully extended during preoperative period. Difficulty of laryngoscopy was graded as reported previously. ⋯ These were significantly different with each other (P < 0.05). If the M-T distance is 4.5 cm or less, the difficulty in visualization of laryngoscope increases. Therefore, in the case in which the M-T distance is 4.5 cm or less, we recommend further examination and preparation for difficult laryngoscopy.
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We experienced a case of difficult endotracheal intubation. The patient was a 43 year-old female with congenital oropharyngeal wall stenosis. She was suffering from fibromyoma of uterus and an operation was scheduled under general anesthesia. ⋯ Ordinary endotracheal intubation was impossible because of the stenosis. In this case, fortunately we succeeded fiberoptic endotracheal intubation under spontaneous respiration. We conclude that the examination of the pharynx is very important during the perioperative period.
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We evaluated the preoperative and intraoperative general condition of 33 pediatric kidney recipients. Eighteen patients were anaesthetized with lumbar epidural anaesthesia. Ten patients were with nitrous oxide-oxygen-halothane, 5 cases were with NLA. ⋯ During operation we could not maintain the cardiovascular stability following intratracheal intubation and manipulation of vena cava or abdominal aorta under NLA or nitrous oxide-oxygen-halothane anesthesia. Epidural analgesia inhibited the cardiovascular fluctuation following these surgical stresses. We concluded that epidural analgesia is the best anaesthesia for pediatric renal transplantation and phentolamine or PGE1 are useful to maintain cardiovascular stability and transplanted kidney function.
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Comparative Study
[Haemodynamic effects of vasodilators in dogs--a comparison of prostaglandin E1, nicardipine and nitroglycerin].
Effects of vasodilation by prostaglandin E1 (PGE1), nicardipine (NIC) and nitroglycerin (TNG) were investigated separately in adult mongrel dogs. Mean arterial pressure was lowered and maintained at 90% and 70% of the control value. Cardiac output (CO), pulmonary arterial pressure (PAP), pulmonary capillary wedge pressure (PCWP) and right atrial pressure (RAP) were measured by a thermodilution pulmonary artery catheter and blood flow of hepatic artery (HABF), portal vein (PVBF) and mesenteric artery was measured by electromagnetic flowmetry. 1) PGE1: Heart rate (HR) and CO were unchanged and left ventricular stroke work (LVSW) decreased. ⋯ Though LVSW was unchanged, right ventricular stroke work (RVSW) increased with elevation of PAP. In the hepatic circulation, HABF and PVBF decreased slightly. 3) TNG: LVSW and RVSW decreased significantly. HABF increased slightly and PVBF increased significantly.