Acta anaesthesiologica Sinica最新文献

{"title":"Fluid administration prevents renal dysfunction during hypotension under spinal anesthesia in a rat model.","authors":"Ya-Jung Cheng, C. Chien, Yong-Ping Wang, T. Fu, Ta-Liang Chen, Chau‐Fong Chen","doi":"10.6955/AAS.200303.0007","DOIUrl":"https://doi.org/10.6955/AAS.200303.0007","url":null,"abstract":"BACKGROUND\u0000Severe 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.\u0000\u0000\u0000METHODS\u0000A 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.\u0000\u0000\u0000RESULTS\u0000Severe 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.\u0000\u0000\u0000CONCLUSIONS\u0000Fluid 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.","PeriodicalId":79312,"journal":{"name":"Acta anaesthesiologica Sinica","volume":"41 1 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":"71333278","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, Yu‐Cheng Wu, Yi-Hung Chen","doi":"10.6955/AAS.200303.0043","DOIUrl":"https://doi.org/10.6955/AAS.200303.0043","url":null,"abstract":"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.","PeriodicalId":79312,"journal":{"name":"Acta anaesthesiologica Sinica","volume":"41 1 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":"71333498","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":"Performance evaluation of quality improvement team in an anesthesiology department.","authors":"Fu-Lan Wang,&nbsp;Li-Chuan Lee,&nbsp;Sheu-Hua Lee,&nbsp;Shang-Liang Wu,&nbsp;Chih-Shung Wong","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>In health care community, quality improvement pathway has always been treated as critical index to control cost, improve efficiency and promote service quality, particularly in the last decade. From theoretical standpoint, clinical practice as well as research data, quality improvement team has been demonstrated to play an important role in the adaptation to the changing health environment and enhancement of the competition through the improvement process. The purpose of this study was to explore members' job satisfaction, morale, organizational commitment and inventory management through quality improvement team intervention in a department of anesthesiology.</p><p><strong>Methods: </strong>This study was of a quasi-experimental and longitudinal design. The subjects involved 45 nurse anesthetists (the experiment group, intervention of quality improvement team) and 50 operation room nurses (control group) in a general hospital. The quality improvement team had been initiated and implemented pursuant to the quality improvement process for 8 months. GEEs (Generalized Estimating Equations) model was used to examine the differences in job satisfaction, morale, organizational commitment, and the inventory management was also examined between two groups.</p><p><strong>Results: </strong>After control of all variables, except education background, such as age, marital status, education, position and nursing experience, a natural growth effect was observed on quality improvement team. The results revealed that the experimental group showed significant positive effects on both job satisfaction and organizational commitment after the intervention. The morale scale did not differ significantly between two groups. In the inventory management, the experimental group successfully decreased the monthly consumable materials stock with a descending rate of 24.8%, while in the control group, the inventory was increased 16.9% in the basal stock instead.</p><p><strong>Conclusions: </strong>As other previous reports did, the present study also demonstrated that intervention of the quality improvement team improves the nurse anesthetists' job satisfaction, such as promotion of autonomy, organizational policy and positive member interaction. Moreover, it improves work efficiency, service quality as well as control of the stock inventory.</p>","PeriodicalId":79312,"journal":{"name":"Acta anaesthesiologica Sinica","volume":"41 1","pages":"13-9"},"PeriodicalIF":0.0,"publicationDate":"2003-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"22385939","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 ropivacaine for postoperative analgesia in Taiwanese patients.","authors":"Wai-Keung Lee,&nbsp;Chun-Hsuan Li,&nbsp;Lim-Shen Lee,&nbsp;Chung-Fai Au,&nbsp;Kwong-Leung Yu,&nbsp;Chao-Shun Tang","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Ropivacaine is the latest long-acting amide local anesthetic. As it is less cardiovasculotoxic and neurotoxic than bupivacaine it is an attractive anesthetic agent used in clinical anesthesia and postoperative analgesia. This study was undertaken to seek for a suitable dosage of ropivacaine in postoperative analgesia for Taiwanese patients whose average physicality is not entirely compatible with the pharmacopeially recommended dosage for western people.</p><p><strong>Methods: </strong>For assessment of epidural ropivacaine for postoperative analgesia 105 adult patients were enrolled and randomly allotted to three groups. Patients in Group A were given epidurally 0.15% ropivacaine, while those in Group B and Group C were given 0.125% and 0.10% ropivacaine respectively. Pain was evaluated with visual analogue scale (VAS) and modified Bromage scale, and adverse effects were recorded at the designated points of time during the postoperative 24-hour period.</p><p><strong>Results: </strong>The demographic profiles were comparable among three groups. In VAS score, Group A (3.20 +/- 0.47) and B (3.11 +/- 0.41) did not differ much, while Group C (3.97 +/- 0.71) the score was signally higher than Group A and Group B (P < 0.05). Adverse effects, such as paraesthesia, nausea and urinary retention were observed more in Group A.</p><p><strong>Conclusions: </strong>From the results of this study, we are of the opinion that 0.125% ropivacaine could provide a postoperative analgesia in Taiwanese patients to their satisfaction with less adverse effects.</p>","PeriodicalId":79312,"journal":{"name":"Acta anaesthesiologica Sinica","volume":"41 1","pages":"21-5"},"PeriodicalIF":0.0,"publicationDate":"2003-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"22385940","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":"Volume-dependent or pressure-dependent effect on renal function after spinal anesthesia.","authors":"Wei-Zen Sun","doi":"10.6955/AAS.200303.0001","DOIUrl":"https://doi.org/10.6955/AAS.200303.0001","url":null,"abstract":"","PeriodicalId":79312,"journal":{"name":"Acta anaesthesiologica Sinica","volume":"41 1 1","pages":"1-2"},"PeriodicalIF":0.0,"publicationDate":"2003-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71333218","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":"Pearls and pitfalls in the airway management.","authors":"Ta-Liang Chen","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":79312,"journal":{"name":"Acta anaesthesiologica Sinica","volume":"40 4","pages":"157-8"},"PeriodicalIF":0.0,"publicationDate":"2002-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"22255146","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":"Tracheal intubation condition--a comparison between one minute after rocuronium alone, one minute after rocuronium combined with atracurium and one minute after atracurium with rocuronium at one minute priming interval.","authors":"Tien-Tien Man,&nbsp;Jen-Kun Cheng,&nbsp;Kar-lok Wong,&nbsp;Chien-Chuan Chen,&nbsp;Ruey-Horng Rau,&nbsp;Kuo-Hwa Wu,&nbsp;Ching-Rong Cheng","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Rocuronium, a monoquaternary steroid analogue of vecuronium, is designed to provide a rapid onset of action. Experimentally, it has been shown that two non-depolarizing neuromuscular relaxants administered together can produce either a neuromuscular block of a size expected to be the sum of the individual doses (additive effect) or a larger neuromuscular block (synergistic effect). Experimental observations have suggested that during onset rocuronium acts synergistically with other nondepolarizing agents, but that at a steady state the combined action is additive.</p><p><strong>Methods: </strong>To investigate whether rocuronium can speed up the onset of atracurium for intubation, 120 patients who consented to receive elective surgery requiring tracheal intubation were randomly assigned to 3 equally divided groups to receive one of the following three different combinations of muscle relaxants: twice ED95 of rocuronium (0.6 mg/kg group 1), an equipotent mixture of ED95 of rocuronium and atracurium (0.3 mg/kg and 0.25 mg/kg respectively, group 2), and rocuronium 0.1 mg/kg to prime atracurium 0.42 mg/kg at 1 min interval. Intubation conditions were assessed 1 minute after intravenous muscle relaxant injection, and scored as good, acceptable and poor based on four clinical evaluators: the ease of laryngoscopy (score of 1-3), the relaxation of vocal cord (1-3), the degree of coughing (1-3), and movement of extremity (1-3). Adding up together, intubation condition that scored 4-5 was considered to be good, 6-7 acceptable, and 8-12 poor.</p><p><strong>Results: </strong>The conditions produced in the rocuronium and the mixture groups were similar and both were moderately better than those of the priming group. Good intubation conditions were achieved in 58% patients of the rocuronium group, 63% of the mixture group and 43% of the priming group. By Pearson Chi-square test, the comparisons did not show statistical significance between groups.</p><p><strong>Conclusions: </strong>Statistically, rocuronium alone, mixture of equipotent atracurium and rocuronium, and using rocuronium to prime atracurium all provided similar onset for satisfactory intubation.</p>","PeriodicalId":79312,"journal":{"name":"Acta anaesthesiologica Sinica","volume":"40 4","pages":"179-83"},"PeriodicalIF":0.0,"publicationDate":"2002-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"22255150","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 tracheal detecting-bulb: a new device to distinguish tracheal from esophageal intubation.","authors":"You-Liang Tong,&nbsp;Ming Sun,&nbsp;Wen-Hao Tang,&nbsp;Jiang-yan Xia","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>The tracheal detecting-bulb (TDB) is a diagnostic tool for confirmation of tracheal intubation. Capnography is also accepted as a standard way for such confirmation. The purpose of this investigation was to determine whether the results by TDB agreed with those by capnography.</p><p><strong>Methods: </strong>Four hundred patients were allocated to three separate studies. In 200 consecutive patients of study 1, tracheal intubation was first confirmed with the TDB followed by capnography. In study 2, 100 patients had the esophagus intentionally intubated, and confirmation was performed likewise as in study 1. The tube was then removed, the trachea was intubated, and confirmation tests followed. Study 3 involved 100 patients and was carried out in a double-blind, randomized manner. The tube was intentionally inserted into either the esophagus (n = 42) or trachea (n = 58), and confirmation tests immediately followed.</p><p><strong>Results: </strong>In study 1, the rhythmic expansion-contraction of TDB was evident in 173 patients, and always agreed with capnographic reading; In 27 instances, the latex bulb of TDB remained collapsed or was scantily filled without the turning-up of capnographic reading as counterchecked, indicating esophageal intubation. In study 2, regardless of esophageal or tracheal intubation, agreement between TDB and capnogram was 100%. In study 3, the agreement between the two detecting instruments was 100% too. In the 400 patients studied, the results from the TDB were in complete accord with those of capnogram. The sensitivity, specificity, and predictive value of the TDB in all of these studies were 100%.</p><p><strong>Conclusions: </strong>The TDB is a valuable diagnostic technique for confirming tracheal intubation as it could correctly detect esophageal or tracheal intubation of the tracheal tube in all our 400 patients. The results of using TDB agree with the results of using capnography.</p>","PeriodicalId":79312,"journal":{"name":"Acta anaesthesiologica Sinica","volume":"40 4","pages":"159-63"},"PeriodicalIF":0.0,"publicationDate":"2002-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"22255147","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":"Fentanyl-induced coughing and airway hyperresponsiveness.","authors":"Chih-Hsiang Tsou,&nbsp;Hsiang-Ning Luk,&nbsp;Shu-Chiung Chiang,&nbsp;Shih-Tai Hsin,&nbsp;Jia-Horng Wang","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>The tussive effect of fentanyl, in sharp contrast to the antitussive effect that common opioids have, is not rarely seen in clinical anesthesia. Pretreatment with beta 2 agonist inhalation could dramatically suppress fentanyl-induced coughing. We hypothesized that airway hyperresponsiveness might exist in large proportion of the subjects who had experienced fentanyl-induced coughing during previous anesthesia.</p><p><strong>Methods: </strong>We designed a case-controlled matching study to investigate the correlation between fentanyl-induced coughing and airway hyperresponsiveness. Twenty-six consecutive subjects (ASA I-III), who experienced fentanyl-induced coughing during anesthesia in our hospital from 1999 to 2000, were enrolled in this study as the fentanyl-cough group. In all the subjects baseline spirometry was first obtained. Airway responsiveness was evaluated with either PC20 of methacholine challenge test or bronchodilator test. After matching age and sex, another 26 subjects without history of fentanyl-induced coughing during previous anesthesia were also enrolled in the study as the control group.</p><p><strong>Results: </strong>The proportion of airway hyperresponsiveness in fentanyl-cough group and control group was 30.77% and 19.23% respectively. After pairing of these two groups, McNemar test revealed no significant difference in the proportion of airway hyperresponsiveness between these two groups (P = 0.257).</p><p><strong>Conclusions: </strong>From the analysis of the present study, we cannot prove that there is a direct correlation between fentanyl-induced coughing and airway hyperresponsiveness.</p>","PeriodicalId":79312,"journal":{"name":"Acta anaesthesiologica Sinica","volume":"40 4","pages":"165-72"},"PeriodicalIF":0.0,"publicationDate":"2002-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"22255148","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 effect of acupuncture on the acute withdrawal symptoms from rapid opiate detoxification.","authors":"Kamran Montazeri,&nbsp;Mehdi Farahnakian,&nbsp;Mahmood Saghaei","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Rapid Opiate Detoxification (ROD) is among the best treatments for substance abuse. Unfortunately this method is associated with severe withdrawal reaction. The effect of body acupuncture has not been clearly identified during ROD. This study was designed to evaluate the effect of acupuncture on the severity of withdrawal reaction during ROD.</p><p><strong>Methods: </strong>Forty adult male subjects addicted to opioids and scheduled for ROD by naloxone were randomly divided into acupuncture and control groups. In the acupuncture group during three consecutive days immediately before induction of ROD, body acupuncture was performed while in the control group it was exempted. Severity of withdrawal reaction was assessed having recourse to Clinical Institute Narcotic Assessment (CINA) Score and compared between two groups.</p><p><strong>Results: </strong>After induction of ROD, CINA score raised significantly during the consecutive days in both groups compared with baseline values but the rise was significantly lower in acupuncture group.</p><p><strong>Conclusions: </strong>The result of this study shows that body acupuncture reduces the severity of withdrawal symptoms associated with rapid opiate detoxification and it is recommended that this nonpharmacologic method of treatment should be included in ROD program.</p>","PeriodicalId":79312,"journal":{"name":"Acta anaesthesiologica Sinica","volume":"40 4","pages":"173-7"},"PeriodicalIF":0.0,"publicationDate":"2002-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"22255149","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}