Korean journal of anesthesiology
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Korean J Anesthesiol · Sep 2013
Optimal positive end-expiratory pressure during robot-assisted laparoscopic radical prostatectomy.
Increased intra-abdominal pressure during laparoscopic surgery causes cephalad displacement of the diaphragm, resulting in the formation of atelectasis, which can be overcome by positive end-expiratory pressure (PEEP). The aim of this prospective study was to investigate the level of optimal PEEP to maintain adequate arterial oxygenation and hemodynamics during robot-assisted laparoscopic radical prostatectomy (RLRP). ⋯ A PEEP of 7 cmH2O is associated with the greater improvement of PaO2 and AaDO2 without causing excessive PAP during RLRP.
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Delirium is a serious complication that commonly occurs in critically ill patients in the intensive care unit (ICU). Delirium is frequently unrecognized or missed despite its high incidence and prevalence, and leads to poor clinical outcomes and an increased cost by increasing morbidity, mortality, and hospital and ICU length of stay. Although its pathophysiology is poorly understood, numerous risk factors for delirium have been suggested. To improve clinical outcomes, it is crucial to perform preventive measures against delirium, to detect delirium early using valid and reliable screening tools, and to treat the underlying causes or hazard symptoms of delirium in a timely manner.
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Korean J Anesthesiol · Sep 2013
Pulse pressure variation and stroke volume variation to predict fluid responsiveness in patients undergoing carotid endarterectomy.
During carotid endarterectomy (CEA), hemodynamic stability and adequate fluid management are crucial to prevent perioperative cerebral stroke, myocardial infarction and hyperperfusion syndrome. Both pulse pressure variation (PPV) and stroke volume variation (SVV), dynamic preload indices derived from the arterial waveform, are increasingly advocated as predictors of fluid responsiveness in mechanically ventilated patients. The aim of this study was to evaluate the accuracy of PPV and SVV for predicting fluid responsiveness in patients undergoing CEA. ⋯ Both PPV and SVV values before volume loading are associated with increased CO in response to volume expansion. Therefore, PPV and SVV are useful predictors of fluid responsiveness in patients undergoing CEA.
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Korean J Anesthesiol · Sep 2013
Use of the i-gel™ supraglottic airway device in a patient with subglottic stenosis -a case report-.
The airway management of patients with subglottic stenosis poses many challenges for the anesthesiologists. Many anesthesiologists use a narrow endotracheal tube for airway control. ⋯ In this report, we present a case of failed intubation in a patient with subglottic stenosis successfully managed during an i-gel™ supraglottic airway device. The device provided a good seal, and allowed for controlled mechanical ventilation with acceptable peak pressures while the patient was in the beach-chair position.
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Korean J Anesthesiol · Sep 2013
Asymptomatic pneumomediastinum resulting from air in the epidural space -a case report-.
There are no reports regarding pneumomediastinum caused by thoracic epidural block complications. We believe that it is possible to experience an occurrence of pneumomediastinum caused by air in the epidural space after performing a thoracic epidural block using the loss of resistance (LOR) technique with air. ⋯ Although extremely rare, pneumomediastinum can be caused by an epidural block using LOR technique with air. In order to avoid the above danger, the use of saline or very minimal amount of air is required during a careful LOR technique.