Acta anaesthesiologica Sinica最新文献

{"title":"Lidocaine: the optimal timing of intravenous administration in attenuation of increase of intraocular pressure during tracheal intubation.","authors":"Yi-Ming Wang, Kwan-Chi Chung, Hsiao-Feng Lu, Yu-wei Huang, K. Lin, Lin-Cheng Yang, Chung‐Ren Lin","doi":"10.6955/AAS.200306.0071","DOIUrl":"https://doi.org/10.6955/AAS.200306.0071","url":null,"abstract":"BACKGROUND This study was designed to examine the optimal timing of intravenous lidocaine in attenuation of increase of intraocular pressure in response to laryngoscopy and tracheal intubation during induction of anesthesia. METHODS One hundred and thirty five adult patients of ASA class I, aged between 20-35 years, undergoing surgical procedures irrelevant to ophthalmology were enrolled for study. Patients were randomly assigned to one of five groups. In group II, III, IV and V the patients received intravenous injection of lidocaine (2 mg/kg), 1, 3, 5, 10 min before tracheal intubation, respectively. Group I in which patients did not receive lidocaine served as the control group. RESULTS In patients of groups I, IV and V, the intraocular pressure increased significantly after intubation, whereas in those of groups II and III, the intraocular pressure did not. All patients in the five groups showed concomitantly a surge of blood pressure, but the magnitude of increase was smallest in group III in comparison with the other groups. The values of systolic and diastolic pressures 1 min after intubation were significantly less in groups III and IV than in the control group. CONCLUSIONS In healthy patients aged between 20 and 35 the most optimal time of administration of intravenous lidocaine to attenuate the increase of intraocular pressure seemed to be the space between 1 to 3 min before laryngoscopy and tracheal intubation.","PeriodicalId":79312,"journal":{"name":"Acta anaesthesiologica Sinica","volume":"41 2 1","pages":"71-5"},"PeriodicalIF":0.0,"publicationDate":"2003-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71333445","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Epidural anesthesia does not increase the incidences of urinary retention and hesitancy in micturition after ambulatory hemorrhoidectomy.","authors":"Yi-Chuan Kau,&nbsp;Yu-Hao Lee,&nbsp;Jihn-Yih Li,&nbsp;Chit Chen,&nbsp;Shu-Yam Wong,&nbsp;Teresa Kit-Man Wong","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>This randomized, prospective study was designed to evaluate the role of various anesthesias in postoperative urinary retention and hesitancy in micturition in patients receiving hemorrhoidectomy on ambulatory basis.</p><p><strong>Methods: </strong>In a randomized order, 128 ambulatory patients, ASA physical status I or II, were divided into two groups to receive hemorrhoidectomy under epidural or local anesthesia. In all patients, the intraoperative intravenous fluid given was limited to 200 ml +/- 2 ml/kg/h of Ringer's lactate solution. Patients were requested to void urine voluntarily before discharge. The incidences of postoperative urinary retention and hesitancy in micturition were evaluated by telephone interview 24 hours after surgery.</p><p><strong>Results: </strong>Neither the incidence of urinary retention, nor the incidence of hesitancy in micturition was significantly different between the two groups. Patients with age over 50 had a significantly higher incidence of hesitancy in micturition than younger patients. The incidence of hesitancy in micturition seemed higher in male patients (31.3%) than that in females (15.6%), but the difference was not statistically different (P = 0.0585).</p><p><strong>Conclusions: </strong>With judicious intraoperative fluid restriction and voluntary voiding before discharge, epidural anesthesia does not increase the incidence of postoperative urinary retention or hesitancy in micturition following ambulatory hemorrhoidectomy.</p>","PeriodicalId":79312,"journal":{"name":"Acta anaesthesiologica Sinica","volume":"41 2","pages":"61-4"},"PeriodicalIF":0.0,"publicationDate":"2003-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"22542557","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Low-dose vasopressin infusion can be an alternative in treating patients with refractory septic shock combined with chronic pulmonary hypertension--a case report.","authors":"Hung-Jui Wang,&nbsp;Chih-Shung Wong,&nbsp;Chin-Yuan Chiang,&nbsp;Chun-Chang Yeh,&nbsp;Chen-Hwan Cherng,&nbsp;Shung-Tai Ho,&nbsp;Ching-Tang Wu","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Septic shock is still the major cause of death in surgical intensive care unit. Fluid support, inotropic agents, and broad spectrum antibiotics are still the mainstay of traditional therapy. Here, we present a case of septic shock arising from gangrenous ischemic bowel, complicated by chronic pulmonary hypertension, which was refractory to catecholamine vasoprerssors. We successfully stabilized the hemodynamics and reduce the pulmonary hypertension with low-dose vasopressin infusion.</p>","PeriodicalId":79312,"journal":{"name":"Acta anaesthesiologica Sinica","volume":"41 2","pages":"77-80"},"PeriodicalIF":0.0,"publicationDate":"2003-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"22542560","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Closed-circuit anesthesia prolongs the neuromuscular blockade of rocuronium.","authors":"C. Yeh, S. Kong, F. Chang, Go-Shine Huang, S. Ho, Ching-Tang Wu, Chih-Shung Wong","doi":"10.6955/AAS.200306.0055","DOIUrl":"https://doi.org/10.6955/AAS.200306.0055","url":null,"abstract":"BACKGROUND\u0000Volatile anesthetics are known to potentiate the neuromuscular blocking effect of nondepolarizing muscle relaxants. The influences of anesthetic techniques, closed-circuit anesthesia (CCA) and high flow semi-closed anesthesia (SCA), on the neuromuscular blockade of rocuronium has not yet been studied in detail. This study was purposed to compare the effects of isoflurane conveyed in minimal flow (CCA) and in high flow (SCA) on the neuromuscular blockade of rocuronium.\u0000\u0000\u0000METHODS\u0000Fifty females scheduled for elective laparoscopic gynecological surgery were enrolled for study and randomly assigned to receive either CCA (n = 25) or SCA (n = 25). Anesthesia was induced with fentanyl 2 micrograms/kg, thiopental 5 mg/kg and rocuronium 0.6 mg/kg. Two percent isoflurane in high O2 flow (3 l/min) was given for 10 min to all patients initially to wash isoflurane in the functional residual capacity of both lungs and the breathing circuit. After the wash in, for CCA group, the O2 flow was reduced to 300 ml/min with isoflurane vaporizer setting adjusted to 3-5% for anesthesia maintenance, while for SCA group, anesthesia was maintained with 1.5-2% isoflurane in 3 l/min O2 flow throughout the surgery. Electromyogram was used to determine neuromuscular blockade. Rocuronium (0.15 mg/kg) was given to maintain muscle relaxation when T1 reached 25% of control. We maintained the anesthetic depth until the recordings of T1 twitch response which reached 75% was completed. Onset time, duration, recovery index and intubating conditions were recorded. The hemodynamic parameters and the inhaled/exhaled concentrations were also measured every 15 min after skin incision in both groups.\u0000\u0000\u0000RESULTS\u0000The onset time and intubating conditions were similar in both groups. In comparison with SCA group, longer clinical durations (54.1 +/- 14.4 vs. 45.4 +/- 9.2 min, P < 0.05), longer durations of maintained dose (41.1 +/- 11.1 vs. 30.2 +/- 8.6 min, P < 0.01) and longer recovery index (34.2 +/- 10.7 vs. 20.9 +/- 5.4 min, P < 0.0001) were observed in CCA group.\u0000\u0000\u0000CONCLUSIONS\u0000We conclude that CCA may further prolong the neuromuscular blocking effect of rocuronium than SCA.","PeriodicalId":79312,"journal":{"name":"Acta anaesthesiologica Sinica","volume":"41 2 1","pages":"55-60"},"PeriodicalIF":0.0,"publicationDate":"2003-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71333384","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anesthetic management of dental procedures in mentally handicapped patients.","authors":"W. Hung, S. Liao, Wen-Ru Ko, Ming-Yung Chau","doi":"10.6955/AAS.200306.0065","DOIUrl":"https://doi.org/10.6955/AAS.200306.0065","url":null,"abstract":"BACKGROUND\u0000Providing dental care to a mentally handicapped patient is a challenge to both dentist and anesthesiologist. This study was aimed to describe the anesthetic methods which were used to facilitate dental treatments in mentally handicapped patients at a medical university hospital in Taiwan during a three-year period.\u0000\u0000\u0000METHODS\u0000The data referring to anesthetic techniques to facilitate dental treatments during the period from Dec. 1, 1997 to Nov. 30, 2000 were retrospectively collected. In the period, there were four different anesthetic techniques in application: nasal mask technique combined with intravenous sedation, total intravenous anesthesia, laryngeal mask intubating general anesthesia and endotracheal intubating general anesthesia. Basic characteristics of patients were compared with student t-test between groups according to anesthetic technique used. Intraoperative and postoperative complications and complaints collected were analyzed by chi-square test between anesthetic techniques. P value less than 0.05 was considered statistically significant.\u0000\u0000\u0000RESULTS\u0000The anesthetic records of 1201 mentally handicapped patients who underwent dental procedures over the three-year period were reviewed. Anesthesia was accomplished with nasal mask technique combined with intravenous sedation in 10 patients, with intravenous anesthesia in 112 patients, with endotracheal intubation anesthesia in 249 patients and with reinforced laryngeal mask anesthesia in 826 patients. Four patients were excluded from study because of changing of anesthetic method during the dental procedure. The use of nasal mask combined with intravenous sedation and intravenous anesthesia caused a higher incidence of intraoperative hypoxemia (P < 0.05) in comparison with the groups of endotracheal intubation anesthesia and reinforced laryngeal mask anesthesia. Although patients anesthetized by intravenous anesthetics had less postoperative complaints or complications but the difference was not statistically significant (P > 0.05) when group comparison was made. Patients who were anesthetized by volatile agents through endotracheal tube had the highest rate of postoperative complication although the difference was of no significance (P > 0.05) when comparison between groups was made.\u0000\u0000\u0000CONCLUSIONS\u0000We provided four different anesthetic methods for 1197 mentally handicapped patients who underwent dental procedures in three years. All anesthetic methods had their advantages and disadvantages. Using reinforced laryngeal mask or endotracheal intubation for general anesthesia to facilitate dental procedures for such patients had greater intraoperative safety than other two methods. However, less postoperative complaints or complications were revealed with the methods of nasal mask combined with intravenous sedation and intravenous anesthesia.","PeriodicalId":79312,"journal":{"name":"Acta anaesthesiologica Sinica","volume":"41 2 1","pages":"65-70"},"PeriodicalIF":0.0,"publicationDate":"2003-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71333430","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Esophageal perforation after tracheal intubation, spontaneous or iatrogenic?--a case report.","authors":"Khosrou Naghibi,&nbsp;Hashemi Seyed Jalal","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Esophageal perforation is a rare but life-threatening complication associated with tracheal intubation, especially after difficult intubation. Esophageal perforation after anesthesia is rare and usually secondary to esophageal instrumentation. Spontaneous esophageal perforation following forceful vomiting (Boerhaave's syndrome) is also extremely rare and has some risk factors. We present a case of perforation of esophagus after cataract surgery under general anesthesia with gentle orotracheal intubation and discuss the possible mechanisms responsible for this unusual disease entity. The patient underwent successful surgical repair and was still alive 4 years after the operation.</p>","PeriodicalId":79312,"journal":{"name":"Acta anaesthesiologica Sinica","volume":"41 1","pages":"33-5"},"PeriodicalIF":0.0,"publicationDate":"2003-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"22386459","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Accidental subdural catheterization due to complication of epidural anesthesia--a case report.","authors":"Hui-Wen Huang, W. Ho, Ei-Ru Shih, S. Lee, Ching-Hui Shen","doi":"10.6955/AAS.200303.0037","DOIUrl":"https://doi.org/10.6955/AAS.200303.0037","url":null,"abstract":"Although accidental subdural injection is a well-recognized complication of epidural block, only a mere handful cases have been substantially proven by radiological evidence. Here we report a case of subdural catheterization during the attempt of epidural anesthesia for a gynecological procedure. Its clinical course and radiological findings are compared with those of the cases previously reported in literature. Whenever there is the occurrence of widespread of sensory block together with respiratory distress and hemodynamic unstability following epidural injection of local anesthetic, a subdural injection should be considered in spite of a negative confirmation. Repeated subdural injection of a local anesthetic at the same site may predispose patients to serious morbidity. Therefore, we recommend that when a subdural injection is evident or suspected, reinsertion of the catheter in the epidural space via another entry or contemplation of a switch to another anesthetic technique is mandatory.","PeriodicalId":79312,"journal":{"name":"Acta anaesthesiologica Sinica","volume":"41 1 1","pages":"37-41"},"PeriodicalIF":0.0,"publicationDate":"2003-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71333490","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fluid administration prevents renal dysfunction during hypotension under spinal anesthesia in a rat model.","authors":"Ya-Jung Cheng,&nbsp;Chiang-Ting Chien,&nbsp;Yong-Ping Wang,&nbsp;Tsu-Ching Fu,&nbsp;Ta-Liang Chen,&nbsp;Chau-Fong Chen","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Severe hypotension deteriorates renal functions and renal hemodynamics especially renal cortical blood flow. Systemic hypotension following high level spinal anesthesia may impair renal functions in spite of the blockade of renal sympathetic nerves that may help prevent vasoconstriction. Fluid loading is clinically applied for preventing hypotension but the effects on the changes of renal functions have not been studied. This study was designed to investigate the effects of fluid loading on systemic hemodynamics, renal hemodynamics and functions especially the blood distribution to renal cortex.</p><p><strong>Methods: </strong>A rat model was used in our study. Intravenous normal saline infusion was started in both control group (5 ml/kg/h, 8 rats) and fluid loading group (15 ml/kg/h, 8 rats) 30 min before spinal anesthesia. A high level (above T4) spinal anesthesia was conducted via a preset intrathecal catheter with 0.5% hyperbaric bupivacaine. Blood pressure, heart rate and renal cortical microvascular blood flow (CMBF) were measured via a laser Doppler probe firmly contacted on renal cortex and recorded continuously after spinal anesthesia. Renal functions including glomerular filtration rates (GFR, by inulin clearance), effective renal plasma flow (ERPF, by P-aminohippurate clearance), urine flow rate (UFR) and electrolytes excretion were measured every 30 min after spinal anesthesia.</p><p><strong>Results: </strong>Severe hypotension was notable within 5-10 min after intrathecal anesthesia and recovered with 30 min in both groups but the difference was not significant between groups. In the control group, GFR and ERPF decreased significantly in the first 30 min by 51.9 +/- 19.8% and 44.3 +/- 13.7% respectively (P < 0.05) and recovered after 60 min. Also the deteriorations of UFR and CMBF were significantly longer (over 60 min). In fluid loading group, ERPF, UFR and CMBF could maintain throughout the experiment but only GFR was affected in the first 30 min.</p><p><strong>Conclusions: </strong>Fluid administration did not prevent hypotension following high level spinal anesthesia but might have beneficial effects on renal hemodynamics especially on the renal cortical circulation and urine flow rate.</p>","PeriodicalId":79312,"journal":{"name":"Acta anaesthesiologica Sinica","volume":"41 1","pages":"7-12"},"PeriodicalIF":0.0,"publicationDate":"2003-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"22385938","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Postoperative pulmonary edema, transfusion-related?--a case report.","authors":"Yung-Tai Chung,&nbsp;Yu-Cheng Wu,&nbsp;Yi-Hung Chen","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Transfusion-related acute lung injury (TRALI) is a severe reaction between leukocyte antigen and antibody during transfusion of plasma-containing components. Recently, biologically active lipids have been also suggested to cause the disorder. It is a rare, but rather benign pulmonary edema. We report a postoperative pulmonary edema, which was temporally and clinically compatible with TRALI. Because the patient received blood products from 3 or 4 donors and the disorder was not recognized right away, the laboratory task for the definite diagnosis was difficult. Nevertheless, the patient had fully recovered in 36 hours after supportive therapies. Without identifying the blood donor implicated in the disorder, transfusion reactions or TRALI will be inevitable.</p>","PeriodicalId":79312,"journal":{"name":"Acta anaesthesiologica Sinica","volume":"41 1","pages":"43-6"},"PeriodicalIF":0.0,"publicationDate":"2003-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"22386461","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The analgesic effect of oral morphine or pentazocine for extracorporeal shock wave lithotripsy.","authors":"Yin-Yi Han, Hsueh-Chia Lu, H. Tsai, S. Hseu, Kwok‐Hon Chan, S. Tsai","doi":"10.6955/AAS.200303.0027","DOIUrl":"https://doi.org/10.6955/AAS.200303.0027","url":null,"abstract":"BACKGROUND\u0000Extracorporeal shock wave lithotripsy (ESWL) in these days is usually carried out on ambulatory or outpatient basis. With the application of a lithotriptor of modern version an appropriate yet cost-effective analgesia with minimal side effects for ESWL is mandatory.\u0000\u0000\u0000METHODS\u0000The analgesic effect of oral morphine (30 mg) was compared with that of pentazocine (100 mg) in a prospective study comprising 100 patients undergoing ESWL with a lithotripter of improved version for urinary tract stones. All patients received orally lorazepam 1 mg as sedative together with the appointed tested drug 30 min before the procedure. The analgesic effects of both drugs were assessed having recourse to the pain scale and efficacy scale.\u0000\u0000\u0000RESULTS\u0000There were 94% of patients in the pentazocine (mixed agonist-antagonist) group who felt satisfied with the regimen and stood the procedure well without resort to supplemental drug, as compared with the morphine (potent mu-agonist) group in which only 70% of patients did so. Although the adverse effect such as dizziness was found in the pentazocine group, the degree of sleepiness produced by its deeper sedation effect was to the advantage of patients during the lithotripsy procedure. There were no significant changes in intergroup mean blood pressure (MBP), but heart rate (HR) was higher and O2 saturation (SpO2) was lower in the pentazocine group after treatment. Both narcotics did not induce renal colic in our study. Also, pentazocine 100 mg plus lorazepam 1 mg given orally did not induce psychotomimetic reaction intraoperatively or postoperatively.\u0000\u0000\u0000CONCLUSIONS\u0000We concluded that oral pentazocine at 100 mg plus lorazepam 1 mg, could offer satisfactory analgesia in patients undergoing ESWL for urinary tract stones with a lithotripter of improved version.","PeriodicalId":79312,"journal":{"name":"Acta anaesthesiologica Sinica","volume":"41 1 1","pages":"27-32"},"PeriodicalIF":0.0,"publicationDate":"2003-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71333334","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}