Current Issue : October - December Volume : 2012 Issue Number : 4 Articles : 5 Articles
Ankylosing spondylitis is always thought to be posing difficulty in securing the airway. But here is one case report of complete fixed cervical spine having no flexion, extension or lateral movements due to fusion of facets (ankylosing spondylits) which was a real challenge for internal jugular vein cannulation before going for anaesthesia and surgery....
passage and malpositioning of the tube to the hook are some of the potential problems related with left-sided\r\nCarlens double lumen tube (DLT). This article reports an amputation of the hook during a difficult selective\r\nintubation and aimed at calling the attention to complications associated with DLTs and the importance of\r\nfiberoptic bronchoscopy.\r\nCase presentation: A 68 year-old woman was scheduled for right-sided thoracotomy in whom blind DLT insertion\r\nwas performed. Narrowed trachea causes difficulty in rotating the DLT 90�° counter-clockwise. After carinal hook\r\nwas noticed upon visual inspection of the DLT, fiberoptic bronchoscopy was used to remove the missing part\r\n(with the use of forceps) from the right mainstem bronchus.\r\nConclusion: Insertion of DLTs with carinal hook is associated with technical problems and potentially lifethreatening\r\nhazards have discouraged their use. Fiberoptic evaluation and repositioning solves most of the\r\nproblems. Although amputation of the carinal hook has not been previously reported, clinicians should be alert.\r\nThis case report emphasizes the utility of the fiberoptic bronchoscopy in the operating theatre for placement,\r\npositioning and inspection of the carinal hook DLT....
Background: Our aim was to assess the efficacy of thoracic epidural anesthesia (EA) followed by postoperative\r\nepidural infusion (EI) and patient-controlled epidural analgesia (PCEA) with ropivacaine/fentanyl in off-pump\r\ncoronary artery bypass grafting (OPCAB).\r\nMethods: In a prospective study, 93 patients were scheduled for OPCAB under propofol/fentanyl anesthesia and\r\nrandomized to three postoperative analgesia regimens aiming at a visual analog scale (VAS) score < 30 mm at rest.\r\nThe control group (n = 31) received intravenous fentanyl 10 �µg/ml postoperatively 3-8 mL/h. After placement of\r\nan epidural catheter at the level of Th2-Th4 before OPCAB, a thoracic EI group (n = 31) received EA intraoperatively\r\nwith ropivacaine 0.75% 1 mg/kg and fentanyl 1 �µg/kg followed by continuous EI of ropivacaine 0.2% 3-8 mL/h and\r\nfentanyl 2 �µg/mL postoperatively. The PCEA group (n = 31), in addition to EA and EI, received PCEA (ropivacaine/\r\nfentanyl bolus 1 mL, lock-out interval 12 min) postoperatively. Hemodynamics and blood gases were measured\r\nthroughout 24 h after OPCAB.\r\nResults: During OPCAB, EA decreased arterial pressure transiently, counteracted changes in global ejection fraction\r\nand accumulation of extravascular lung water, and reduced the consumption of propofol by 15%, fentanyl by 50%\r\nand nitroglycerin by a 7-fold, but increased the requirements in colloids and vasopressors by 2- and 3-fold,\r\nrespectively (P < 0.05). After OPCAB, PCEA increased PaO2/FiO2 at 18 h and decreased the duration of mechanical\r\nventilation by 32% compared with the control group (P < 0.05).\r\nConclusions: In OPCAB, EA with ropivacaine/fentanyl decreases arterial pressure transiently, optimizes myocardial\r\nperformance and influences the perioperative fluid and vasoactive therapy. Postoperative EI combined with PCEA\r\nimproves lung function and reduces time to extubation....
Background: Levosimendan has pharmacologic and hemodynamic advantages over conventional intravenous\r\ninotropic agents. It has been used mainly as a rescue drug in the pediatric intensive care unit or in the operating\r\nroom. We present the largest single-center experience of levosimendan in children.\r\nMethods: Retrospective analysis of all children who received levosimendan infusions between July 5, 2001 and\r\nJuly 4, 2010 in a pediatric intensive care unit. The results of a questionnaire for physicians (anesthesiologist/\r\nintensivists, cardiologists and cardiac surgeons) concerning their clinical perceptions of levosimendan are evaluated\r\nResults: During the study period a total of 484 infusions were delivered to 293 patients 53% of whom were male.\r\nThe median age of the patients was 0.4 years (4 hours-21.1 years) at the time of levosimendan administration.\r\nA majority of levosimendan infusions were administered to children who were undergoing cardiac surgery (72%),\r\n14% to children with cardiomyopathy and 14% to children with cardiac failure. Eighty-nine out of the 293 patients\r\n(30.4%) received repeated doses of levosimendan (up to 11 infusions). The most common indication for the use of\r\nlevosimendan (94%) was when the other inotropic agents were insufficient to maintain stable hemodynamics.\r\nLevosimendan was especially used in children with cardiomyopathy (100%) or with low cardiac output syndrome\r\n(94%). A majority (89%) of the respondents believed that levosimendan administration postponed the need for\r\nmechanical assist devices in some children with cardiomyopathy. Moreover, 44% of respondents thought that the\r\nmechanical support was totally avoided in some patients undergoing cardiac surgery after receiving levosimendan.\r\nConclusion: Levosimendan is widely used in our institution and many physicians believe that its use could decrease\r\nthe need for mechanical support in children undergoing cardiac surgery or in children with decompensated heart\r\nfailure. However, there is a lack of good empirical evidence in children to support this perception....
Background: Predicted difficult airway is a definite indication for awake intubation and spontaneous ventilation.\r\nAirway regional blocks which are commonly used to facilitate awake intubation are sometimes impossible or\r\nforbidden. On the other hand deep sedation could be life threatening in the case of compromised airway.\r\nThe aim of this study is evaluating ââ?¬Å?Subcutaneous Dissociative Conscious Sedationââ?¬Â (sDCS) as an alternative method\r\nto airway regional blocks for awake intubation.\r\nMethods: In this prospective, non-randomized study, 30 patients with predicted difficult airway (laryngeal tumors),\r\nwho were scheduled for direct laryngoscopic biopsy (DLB), underwent ââ?¬Å?Subcutaneous Dissociative Conscious\r\nSedationââ?¬Â (sDCS) exerted by intravenous fentanyl 3-4ug/kg and subcutaneous ketamine 0.6-0.7 mg/kg. The tongue\r\nand pharynx were anesthetized with lidocaine spray (4%). 10 minutes after a subcutaneous injection of ketamine\r\ndirect laryngoscopy was performed. Extra doses of fentanyl 50-100 ug were administered if the patient wasnââ?¬â?¢t\r\ncooperative enough for laryngoscopy.\r\nPatients were evaluated for hemodynamic stability (heart rate and blood pressure), oxygen saturation (Spo2),\r\npatient cooperation (obedient to open the mouth for laryngoscopy and the number of tries for laryngoscopy),\r\npatient comfort (remaining moveless), hallucination, nystagmus and salivation (need for aspiration before\r\nlaryngoscopy).\r\nResults: Direct laryngoscopy was performed successfully in all patients. One patient needed extra fentanyl and\r\nthen laryngoscopy was performed successfully on the second try. All patients were cooperative enough during\r\nlaryngoscopy. Hemodynamic changes more than 20% occurred in just one patient. Oxygen desaturation (spo2<\r\n90%) didnââ?¬â?¢t occur in any patient.\r\nConclusions: Subcutaneous Dissociative Conscious Sedation (sDCS) as a new approach to airway is an acceptable\r\nand safe method for awake intubation and it can be suggested as a noninvasive substitute of low complication\r\nrate for regional airway blocks....
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