Impact of intraoperative goal-directed fluid therapy on major morbidity and mortality after transthoracic oesophagectomy: a multicentre, randomised controlled trial.

BACKGROUND: Transthoracic oesophagectomy is associated with major morbidity and mortality, which may be reduced by goal-directed therapy (GDT). The aim of this multicentre, RCT was to evaluate the impact of intraoperative GDT on major morbidity and mortality in patients undergoing transthoracic oesophagectomy. METHODS: Adult patients undergoing transthoracic oesophagectomy were randomised to receive either minimally invasive intraoperative GDT (stroke volume variation <8%, plus systolic BP maintained >90 mm Hg by pressors as necessary) or haemodynamic management left to the discretion of attending senior anaesthetists (control group; systolic BP >90 mm Hg alone). The primary outcome was the incidence of death or major complications (reoperation for bleeding, anastomotic leakage, pneumonia, reintubation, >48 h ventilation). A Cox proportional hazard model was used to examine whether the effects of GDT on morbidity and mortality were independent of other potential confounders. RESULTS: A total of 232 patients (80.6% male; age range: 36-83 yr) were randomised to either GDT (n=115) or to the control group (n=117). After surgery, major morbidity and mortality were less frequent in 22/115 (19.1%) subjects randomised to GDT, compared with 41/117 (35.0%) subjects assigned to the control group {absolute risk reduction: 15.9% (95% confidence interval [CI]: 4.7-27.2%); P=0.006}. GDT was also associated with fewer episodes of atrial fibrillation (odds ratio [OR]: 0.18 [95% CI: 0.05-0.65]), respiratory failure (OR: 0.27 [95% CI: 0.09-0.83]), use of mini-tracheotomy (OR: 0.29 [95% CI: 0.10-0.81]), and readmission to ICU (OR: 0.09 [95% CI: 0.01-0.67]). GDT was independently associated with morbidity and mortality (hazard ratio: 0.51 [95% CI: 0.30-0.87]; P=0.013). CONCLUSIONS: Intraoperative GDT may reduce major morbidity and mortality, and shorten hospital stay, after transthoracic oesophagectomy. CLINICAL TRIAL REGISTRATION: UMIN000018705.

The effect of sevoflurane on electrocorticographic spike activity in pediatric patients with epilepsy.

BACKGROUND: Electrocorticogram (ECoG) spike activity is enhanced under general anesthesia with 1.5 minimum alveolar concentration (MAC) sevoflurane compared with lower concentrations in adult patients with epilepsy. However, the effect of concentration of sevoflurane on ECoG in children with epilepsy is less known. AIMS: The primary endpoint was to investigate the effects of sevoflurane on ECoG spike activity in pediatric patients undergoing epilepsy surgery. The secondary endpoint was to examine its effects on baseline ECoG including burst suppression. METHODS: Children of age 3-18 years with medically intractable epilepsy undergoing corpus callosotomy or resection of the epileptic foci (n = 11) were enrolled. Electrodes were placed on the brain surface and ECoG was recorded under anesthesia with endtidal carbon dioxide tension at 30 mmHg and sevoflurane at 2.5%, followed by age-adjusted 1.5 MAC (3.1-3.4%) for 10 min. The number of leads with spikes, the average number of spikes per lead per minute, median frequency of ECoG, and duration of suppression of ECoG ≥ 1 s were compared between 2.5% and 1.5 MAC sevoflurane. RESULTS: The number of leads with spikes increased [11 vs 14, P = 0.003, difference in mean (95% CI) is 3 (2-5)], and the average number of spikes increased [9 vs 14·lead-1 ·min-1 , P = 0.003, difference in mean (95% CI) is 5 (2-8) lead-1 ·min-1 ] under anesthesia with 1.5 MAC compared with 2.5% sevoflurane. Median frequency was decreased [2.8 Hz vs 2.0 Hz, P = 0.003, difference in mean (95% CI) is 0.8 (0.4-1.2) Hz], and the duration of suppression was increased [105 s vs 262 s, P < 0.001, difference in mean (95% CI) is 156 (90-223) s] with 1.5 MAC compared with 2.5% sevoflurane. CONCLUSIONS: Sevoflurane at 1.5 MAC significantly increased the extent and the number of spikes, prolonged the duration of suppression, and decreased median frequency of ECoG compared with those at 2.5% sevoflurane.

Electroencephalographic effect of age-adjusted 1 MAC desflurane and sevoflurane in young, middle-aged, and elderly patients.

PURPOSE: We examined the hypothesis that 1 minimum alveolar concentration (MAC) of desflurane and sevoflurane provides different depth of anesthesia. METHODS: One hundred and twenty young (20-30 years), middle-aged (31-65 years), and elderly (66-80 years) patients were randomly allocated to receive either desflurane or sevoflurane (n = 20, each group). General anesthesia was induced with propofol 2 mg/kg bolus and remifentanil 0.25 µg/kg/min, which was stopped after tracheal intubation. Maintenance of anesthesia was started with an end-tidal concentration of desflurane or sevoflurane at age-adjusted 1 MAC and maintained for 10 min, followed by 1-min assessment of bispectral index (BIS), 95% spectral edge frequency (SEF95), and amplitude of the electroencephalogram taken at 10-s intervals. RESULTS: BIS and SEF95 in patients receiving 1 MAC desflurane were significantly lower than those receiving 1 MAC sevoflurane including all age groups [35 (29, 39) vs. 41 (38, 49); 12.53 (10.99, 13.95) Hz vs. 14.42 (12.99, 17.17) Hz median (25, 75 percentile), respectively, P < 0.001 for both]. Both BIS and SEF95 in young patients were lower than in middle-aged and elderly patients receiving either desflurane or sevoflurane (P < 0.001 for both). There were no differences in amplitude between patients receiving desflurane and sevoflurane. CONCLUSIONS: BIS as well as SEF95 were lower in patients receiving 1 MAC desflurane than those receiving 1 MAC sevoflurane, suggesting that desflurane provides higher depth of anesthesia than sevoflurane at 1 MAC.

[Repeated General Anesthesia for a Child with Saethre-Chotzen Syndrome].

An 11 day-old-girl was transferred to our hospital for surgical treatment of craniosynostosis. Either her fam- ily history or intrauterine growth was not remarkable. In addition to craniofacial deformities such as brachy- cephaly due to bicoronal craniosynostosis, high-arched palate, inferiorly positioned ears and midfacial defor- mity, she was accompanied with cardiovascular anom- alies including patent foramen ovale, patent ductus arteriosus, pulmonary artery stenosis as well as low anal atresia. She underwent general anesthesia for suture craniotomy at the age of one month. After induction of general anesthesia with sevoflurane and confirming adequate mask ventilation, fentanyl and rocuronium were administered. Direct laryngoscopy revealed Cormack-Lehane grade to be 1, followed by orotracheal intubation with a 3.5 mm uncuffed tube. A diagnosis of Saethre-Chotzen syndrome was made at the age of six months based on the result of genetic test She underwent general anesthesia for additional three times for fronto-orbital advancement, removal of the destruction devices and perineal anoplasty at 11, 15 and 16 months, respectively, which was performed uneventfully. She has no physical development disor- ders, with delay in language development at the age of 27 months.

Specialized operating room for cesarean section in the perinatal care unit: a review of the opening process and operating room management.

We have opened an operating room in the perinatal care unit (PNCU), separate from our existing central operating rooms, to be used exclusively for cesarean sections. The purpose is to meet the increasing need for both emergency cesarean sections and non-obstetric surgeries. It is equipped with the same surgical instruments, anesthesia machine, monitoring system, rapid infusion system and airway devices as the central operating rooms. An anesthesiologist and a nurse from the central operating rooms trained the nurses working in the new operating room, and discussed solutions to numerous problems that arose before and after its opening. Currently most of the elective and emergency cesarean sections carried out during the daytime on weekdays are performed in the PNCU operating room. A total of 328 and 347 cesarean sections were performed in our hospital during 2011 and 2012, respectively, of which 192 (55.5 %) and 254 (73.2 %) were performed in the PNCU operating room. The mean occupancy rate of the central operating rooms also increased from 81 % in 2011 to 90 % in 2012. The PNCU operating room was built with the support of motivated personnel and multidisciplinary teamwork, and has been found to be beneficial for both surgeons and anesthesiologists, while it also contributes to hospital revenue.

[Anesthetic Management of a Parturient with Eclampsia, Posterior Reversible Encephalopathy Syndrome and Pulmonary Edema due to Pregnancy-induced Hypertension].

A 27-year-old woman with mental retardation was admitted to a nearby hospital for an abrupt onset of seizure. Physical examination revealed remarkable hypertension and pregnancy with estimated gestational age of 28th week. Severe pulmonary edema and hypoxia led to a diagnosis of pregnancy-induced hypertension (PIH) accompanied by eclampsia. She was orotracheally intubated because of refractory seizure and hypoxemia, and transferred to our hospital for further treatment. Besides severe hypoxia and hypercapnea, an enhanced lesion was detected in the left posterior cerebrum by brain MRI. No abnormal findings were detected in the fetus, with heart rate of 150 beats x min. She was diagnosed with posterior reversible encephalopathy syndrome (PRES) caused by PIH and emergency cesarean section under general anesthesia was scheduled. A male newborn was delivered with Apgar score of 1/4 (1/5 min), followed by starting continuous infusion of nicardipine for controlling hypertension. Chest X-P on completion of surgery revealed remarkably alleviated pulmonary edema. She received intensive treatment and continued positive pressure ventilation for four days after delivery. She recovered with no neurological deficits and her child was well without any complications.

Anesthesia for aortic reconstruction in a child with PHACE syndrome.

PHACE syndrome is a neurocutaneous syndrome characterized by the association of large cutaneous hemangiomas and the cardiac and cerebral vascular anomalies. We report a 6-year-old female with PHACE syndrome presented with left facial hemangiomas, cystic lesion in the cerebral posterior fossa, coarctation of the aorta, aplasia of the left vertebral artery and stenosis of the left internal carotid artery. Surgical repair of the aorta with left heart bypass under beating heart was scheduled. We monitored regional cerebral oxygen saturation (rSO2) with infrared spectroscopy in order to detect cerebral hypoperfusion. A decrease of rSO2 ipsilateral to the cerebrovascular anomalies occurred during anastomosis of the aorta, which was treated by reducing the flow rate of left heart bypass and by increasing the inhalational oxygen concentration. As children with PHACE syndrome are frequently accompanied with cerebrovascular anomalies and at a risk of cerebral hypoperfusion, prevention of cerebral hypoperfusion is crucially important during general anesthesia.

A randomized comparison of the i-gel and the ProSeal laryngeal mask airway in pediatric patients: performance and fiberoptic findings.

PURPOSE: We compared the insertion performance of the pediatric size 1.5-3 i-gel airway device with that of the ProSeal laryngeal mask airway (PLMA) in anesthetized children in a prospective, randomized, controlled manner. METHODS: We included 134 children, aged 3 months to 15 years, scheduled for elective surgery under general anesthesia. They were randomly divided into the i-gel and the PLMA groups according to the airway device used. The primary outcome variable was oropharyngeal leak pressure. Other outcome variables were ease of insertion, required time for insertion, fiberoptic view, and first-attempt and overall success rates. RESULTS: There were no differences in the ease of insertion, insertion time, or leak pressure between the devices. Fiberoptic view was significantly better with the i-gel than with the PLMA (P = 0.002). The view was significantly better with the sizes 2, 2.5, and 3 i-gel than with the size 1.5 i-gel (P = 0.02, 0.004 and 0.002, respectively), and the view was significantly better with the sizes 2.5 and 3 PLMA than with the size 1.5 PLMA (P = 0.02 and 0.005, respectively). The first-attempt success rates were 94 and 97 % in the i-gel and the PLMA groups, respectively; the success rates including the second attempt were 100 % in both groups. No children developed side effects requiring treatment with either device. CONCLUSION: Both the pediatric i-gel and the PLMA were successfully inserted in children. The fiberoptic view was better with the i-gel than with the PLMA.

Analysis of prehospital endotracheal intubation performed by emergency physicians: retrospective survey of a single emergency medical center in Japan.

OBJECTIVES: Advanced airway management in the prehospital setting is a serious issue in Japan because emergency medical technicians are not authorized to perform such management, whereas physicians-who are authorized to perform advanced airway management-do not usually engage in prehospital emergency medical activity. The purpose of this investigation was to investigate the success rate for endotracheal intubation (ETI) procedures and other methods of airway management employed by physicians in the prehospital setting in a single institution, as well as to examine the risk factors associated with difficult or failed endotracheal intubation (D/F ETI). METHODS: We performed a retrospective survey of patients treated in the prehospital setting by emergency physicians of the Hyogo Emergency Medical Center from 2004 to 2011. Patients were divided into two groups: a cardiopulmonary arrest (CPA) group and a non-CPA group. Data on cases of D/F ETI were obtained, and risk factors for these two groups were identified using univariate and statistical analysis. RESULTS: During the investigation period, ETI was attempted in the prehospital setting on 742 eligible patients; in 30 (4.04 %) of these cases, the attempts at ETI proved difficult or failed. Of those 30 patients, 13 patients received a surgical airway (attempts to provide a surgical airway failed in two patients), a blind ETI was performed in four, a video-assisted airway device was used in another four, and esophageal intubation was performed in four patients. Bag-valve ventilation alone was performed in one patient. The incidence of D/F ETI was higher in the non-CPA group than in the CPA group (6.27 vs. 2.63 %: p < 0.05). Facial or neck injury was a risk factor for D/F ETI in the prehospital setting in the CPA group (odds ratio 7.855; 95 % CI 1.754-36.293: p = 0.042). On the other hand, no risk factors for D/F ETI in the prehospital setting in the non-CPA group were identified. CONCLUSION: The success rate for ETI performed by physicians in the prehospital setting at a single emergency medical center was high, and the incidence of D/F ETI was 4.31 %. The success rate for ETI in the CPA group was greater than that in the non-CPA group.

Antiemetic effect of naloxone in combination with dexamethasone and droperidol in patients undergoing laparoscopic gynecological surgery.

PURPOSE: We examined the effects of dexamethasone, droperidol, naloxone, and a combination of these three agents on postoperative nausea and vomiting (PONV) in female patients. METHODS: In this randomized, controlled study, 120 female patients with ASA PS I or II undergoing laparoscopic gynecological surgery were randomly allocated into four groups. Patients received dexamethasone 8 mg (Dx group) or droperidol 1 mg (Dr group) before induction of general anesthesia. Anesthesia was induced and maintained with propofol and remifentanil. Postoperative analgesia was provided by intravenous patient-controlled analgesia using a disposable infusion pump filled with fentanyl 20 µg/kg alone (Dx group), fentanyl 20 µg/kg with droperidol 2 mg (Dr group), fentanyl 20 µg/kg with naloxone 0.1 mg (Nx group), or fentanyl 20 µg/kg with droperidol 2 mg and naloxone 0.1 mg (Cm group) in a total volume of 80 ml, with a constant infusion rate of 4 ml/h and a bolus dose 2 ml with a 30-min lockout time. RESULTS: The number of patients who developed PONV and required a rescue antiemetic was significantly less in the Cm group than in the Nx group (p < 0.001 for all). The incidence of PONV was 43, 43, 70, and 17 % in the Dx, Dr, Nx, and Cm groups, respectively. CONCLUSION: A combination of naloxone, droperidol, and dexamethasone was effective for preventing PONV in patients receiving fentanyl for postoperative analgesia after laparoscopic gynecological surgery, although further investigations are required to examine the effect of adding naloxone to other antiemetics.

[Anesthesia for living donor renal transplantation in a patient with Goodpasture's syndrome with a history of repeated alveolar hemorrhage].

A 20-year-old woman was scheduled for living renal transplantation from her mother. She was diagnosed with Goodpasture's syndrome at 8 years of age and had a previous history of alveolar hemorrhage 5 times. She developed renal failure, hypertension and required hemodialysis. She had no history of surgery. Blood test was not remarkable except anemia and elevated blood urea nitrogen and serum creatinine levels. General anesthesia was induced and maintained with fentanyl, remifentanil and propofol. After tracheal intubation, the lungs were mechanically ventilated with a pressure control mode and the peak airway pressure was initially adjusted to 9 cmH2O for maintaining airway pressure at a low level to prevent alveolar injury, which was increased to 12 cmH2O at the end of surgery for maintaining a tidal volume of approximately 250 ml. No hemorrhage was detected in the airway during anesthesia, blood gas data were within the normal range, and the tracheal tube was removed after surgery in the operating room. Postoperative course was uneventful. Antihypertensive agents were discontinued and she was successfully weaned from hemodialysis.

Landiolol attenuates cardiovascular response at induction of general anesthesia for cesarean delivery.

PURPOSE: General anesthesia for cesarean delivery is frequently associated with hypertension and tachycardia caused by tracheal intubation, which may lead to cardiac ischemia in susceptible patients or may cause harm due to increased intracranial pressure. To prevent these adverse events, we investigated the efficacy and safety of single-dose intravenous administration of landiolol, a short-acting selective ß(1) receptor blocker, just prior to intubation. METHODS: Patients scheduled for cesarean delivery under general anesthesia were randomized into two groups: landiolol (group L, n = 32); and nontreated (group N, n = 32) patients. After patients entered the operating room, blood pressure (BP), heart rate (HR), and fetal heart beats were monitored to ensure no problems were present, then thiopental 5 mg/kg and rocuronium 0.9 mg/kg were given. In addition, group L received a single dose of landiolol 0.2 mg/kg. After tracheal intubation, anesthesia was maintained in both groups using sevoflurane. From before starting anesthesia to the time of delivery, BP, HR, need for additional treatment with uterotonic or vasopressor agents, and neonatal Apgar scores were recorded. Data were compared between groups. RESULTS: Group L showed significantly lower percentage changes in BP and HR than group N (p < 0.05 each). Intraoperative blood loss, frequency of decreased uterine contraction, and fetal Apgar scores did not differ significantly between groups. CONCLUSIONS: In our study, landiolol reduced BP and HR changes during anesthesia induction, whereas no adverse effects on uterine contraction or the fetus were seen. These findings suggest landiolol provides adequate hemodynamic regulation during general anesthesia induction in patients undergoing cesarean delivery.

Anesthetic management of three pediatric cases with Pena-Shokeir syndrome.

Pena-Shokeir syndrome is a rare, early lethal disease. It is characterized by fetal growth restriction; craniofacial deformities, for example micrognathia and microcephaly; multiple ankyloses; and pulmonary hypoplasia. For patients with this syndrome, maintenance of airway and control of perioperative respiratory complications are important for anesthetic management. We report 3 pediatric cases of Pena-Shokeir syndrome undergoing tracheostomy and arthrolysis under general anesthesia using sevoflurane, nitrous oxide, fentanyl, and vecuronium bromide. Anesthetic procedures including mask ventilation, tracheal intubation, and extubation were successfully performed without complications during and after surgery. In patients with Pena-Shokeir syndrome, inhalational anesthetics can be safely used for induction and maintenance of anesthesia, although it is important to assume that difficult airway management might be encountered.

Anesthesia in an adult patient with tracheal hemangiomas: one-lung ventilation for lung lobectomy.

Primary tracheal tumors are rare in adults, and careful airway management is required during anesthesia for affected patients. We report the case of a patient with tracheal hemangiomas undergoing nontracheal operation. A 61-year-old woman was scheduled for a lung operation. During preoperative examination, hemangiomas were detected on the tracheal mucosa. As she was asymptomatic and the degree of airway stenosis was small, treatment was not required for the hemangiomas, and left upper lobectomy for lung cancer was scheduled. After induction of general anesthesia, a regular tracheal tube was inserted under fiberoptic bronchoscopy, with care taken to prevent damage to the hemangiomas. An endobronchial blocker was inserted for one-lung ventilation. The operation was performed uneventfully, and the tracheal tube was replaced postoperatively with a laryngeal mask airway while the patient was under deep anesthesia and neuromuscular blockade. The mask was removed after confirming lack of bleeding from the hemangiomas. No hypoxia or other complications occurred during or after the operation.

Anesthetic management during tracheotomy in a child with respiratory distress caused by severe intubation-induced glottic stenosis.

We provided anesthetic management during a tracheotomy procedure for a child who demonstrated labored respiration during inspiration because of severe glottic stenosis and bilateral vocal cord paralysis caused by tracheal intubation. A 4-year-old boy developed acute respiratory depression associated with influenza pneumonia and had been under respiratory management with mechanical ventilation with tracheal intubation for 3 days. Following extubation, an upper-airway obstruction immediately appeared. The symptoms later worsened because of development of a common cold, and the patient underwent an emergency tracheotomy. For anesthetic management, we used a combination of ketamine with low-concentration sevoflurane inhalation. The tracheotomy was performed safely without respiratory complications by employing manual-assisted ventilation, while spontaneous breathing was preserved by use of a face mask.

Asystole developed during total gastrectomy under general anesthesia combined with thoracic epidural anesthesia.

We report a 73-year-old woman who developed sudden bradycardia and asystole due to vagal reflex during transabdominal total gastrectomy under general anesthesia with thoracic epidural analgesia. General anesthesia was induced with propofol, fentanyl and maintained with sevoflurane and epidural infusion of lidocaine. Severe bradycardia, followed by asystole was detected on electrocardiography 10 minutes after starting surgery, triggered by the retraction of the abdominal wall and intestines. Blood pressure and heart rate recovered in response to atropine, ephedrine and chest compressions in 10 seconds. Surgery was completed uneventfully and the patient was discharged without complications. For preventing life-threatening bradycardia and asystole by vagal reflex, we suggest the use of atropine prior to the operations in patients undergoing abdominal or ophthalmic surgery, where vagal reflex may occur.

Influence of tidal volume for stroke volume variation to predict fluid responsiveness in patients undergoing one-lung ventilation.

We designed this study to determine the predictive value for fluid responsiveness of stroke volume variation (SVV) in patients undergoing one-lung ventilation (OLV), ventilated at different tidal volumes. All patients scheduled for pulmonary lobectomy were randomized into two groups according to their tidal volume [group H: tidal volume 8 ml/kg (n = 36); group L: tidal volume 6 ml/kg (n = 37)]. After starting OLV, volume loading was performed by administration of 500 ml 6% hydroxyethylated starch for 30 min. Hemodynamic variables were measured before and after volume loading using the Vigileo-FloTrac system. Patients in both groups were divided into fluid responders and non-responders, and responders were defined as those who demonstrated an increase in cardiac index ≥15% after volume expansion. The area under the receiver operating characteristic curve for SVV to discriminate between responders and non-responders was 0.776 in group H and 0.648 in group L. The optimal threshold value of SVV was 10.5% (sensitivity, 85.7%; specificity, 66.7%) in group H and 8% (sensitivity, 69.5%; specificity, 64.3%) in group L. We found that SVV could predict fluid responsiveness in patients undergoing OLV with acceptable levels of sensitivity and specificity only when tidal volume is at least 8 ml/kg.

One-lung ventilation in a patient with stenting for tracheobronchial stenosis caused by esophageal cancer.

We have provided general anesthesia for a 53-year-old man scheduled to undergo lymph node removal for right mediastinal lymph node metastases caused by esophageal cancer. One year prior, acute respiratory failure occurred because of stenosis of the carinal bifurcation resulting from advanced esophageal cancer with tracheal invasion. The patient underwent placement of tracheobronchial stents (Spiral Z Stent) in two locations (left main bronchus and trachea/right main bronchus), followed by radiotherapy and chemotherapy. In the present case, after an 8.5-mm-ID tracheal tube was placed under bronchoscopic guidance, a 7.0 Fr. bronchial blocker (Arndt Endobronchial Blocker; Cook, Bloomington, IN, USA) was carefully inserted into the stent in the right main bronchus. Next, 3 ml air was injected into the blocker cuff, and left-sided one-lung ventilation was performed. After surgery was completed, the bronchial blocker was removed under bronchoscopic guidance. We confirmed there was no tracheobronchial injury nor stent displacement or deformation, then removed the tracheal tube. Even in patients with tracheobronchial stent placement, one-lung ventilation can be safely and reliably performed by selecting an appropriate bronchial blocker, along with careful insertion into the stent and frequent checking of the blocker position.

[Anesthetic management of a patient with congenital myopathy complicated with severely impaired pulmonary function].

A 17-year-old man, who had received a diagnosis of congenital myopathy, was scheduled for superficial temporal artery to middle cerebral artery anastomosis procedure. Preoperative respiratory examinations showed the breathing capacity of 450 ml because of a scoilosis, deformity of a thorax and severe muscular atrophy. Anesthesia was maintained with propofol, fentanyl, remifentanil and vecuronium to avoid malignant hyperthermia (MH). Endotracheal intubation was performed with a gum elastic bougie for difficult airway management (DAM). After intubation, we checked the positioning of the tracheal tube by a chest X ray and bronchofiber findings. During perioperative period, no symptom of MH and respiratory dysfunction was noticed. In the anesthesia for patients with congenital myopathy, deterioration of respiratoy function, prevention for MH, and possibility of DAM should be considered.

Stroke volume variation as a predictor of fluid responsiveness in patients undergoing one-lung ventilation.

OBJECTIVES: To investigate the ability of stroke volume variation (SVV) calculated by the Vigileo-FloTrac system (Edwards Lifescience, Irvine, CA) to predict fluid responsiveness in patients undergoing one-lung ventilation (OLV). DESIGN: Prospective, observational study. SETTING: Clinical hospital. PARTICIPANTS: Thirty patients scheduled for a pulmonary lobectomy requiring OLV for at least 1 hour under combined epidural/general anesthesia. INTERVENTIONS: After starting OLV, hydroxyethyl starch, 500 mL, was administered for 30 minutes. MEASUREMENTS AND MAIN RESULTS: Hemodynamic variables including heart rate, mean arterial pressure, cardiac index, stroke volume index (SVI), and SVV were measured before and after volume loading. SVV before volume loading was significantly correlated with the absolute changes in SVV (ΔSVV) and percentage changes in stroke volume index (ΔSVI) after volume loading (ΔSVV: p < 0.05, r = -0.893; ΔSVI: p < 0.05, r = 0.866). Of the 30 patients, 15 (50%) were responders to intravascular volume expansion (an increase in SVI ≥ 25%), and 15 (50%) were nonresponders (an increase in SVI <25%). The area under the ROC curve was 0.900 for SVV (95% confidence interval, 0.809-0.991), whereas the optimal threshold value of SVV to discriminate between responders and nonresponders was 10.5% (sensitivity: 82.4%, specificity: 92.3%). CONCLUSIONS: The authors found that SVV measured by the Vigileo-FloTrac system was able to predict fluid responsiveness in patients undergoing surgery with OLV with acceptable levels of sensitivity and specificity.