ABSTRACT
Placement of a pulmonary artery catheter is associated with various complications, including catheter knotting. Fluoroscopy can be used to visualize and confirm catheter knotting. Transesophageal echocardiography is readily available to detect knot formation in the operating room or intensive care unit. We present a case in which pulmonary artery catheter knotting was detected by transesophageal echocardiography. This method may be useful in the operating room or in the intensive care unit to identify the presence and location of catheter knotting.
Subject(s)
Catheters , Echocardiography, Transesophageal , Fluoroscopy , Intensive Care Units , Operating Rooms , Pulmonary ArteryABSTRACT
BACKGROUND: Coughing during emergence from general anesthesia is a common clinical problem and results in a number of undesirable side effects. Remifentanil stimulate micron-opioid peptide receptor known to be related to antitussive effect. The goal of this study was to evaluate the effect of remifentanil on coughing after general anesthesia with desflurane. METHODS: Fifty one ASA physical status I and II patients undergoing elective oral and maxillofacial surgery were randomly assigned to receive either remifentanil with 1 ng/ml effect site concentration or normal saline until extubation. The number and intensity of coughs were monitored during emergence and the recovery time was recorded. RESULTS: The incidence and number of coughing during emergence was significant less frequent in the remifentanil group (P < 0.05). The intensity of coughing was significant milder in the remifentanil group (P < 0.05). There was no significant difference between two groups in the recovery time. CONCLUSIONS: Continuous remifentanil infusion with 1 ng/ml effect site concentration during emergence from general anesthesia with desflurane decrease the incidence of coughing without delaying the recovery time.
Subject(s)
Humans , Anesthesia, General , Cough , Incidence , Isoflurane , Piperidines , Receptors, Peptide , Surgery, OralABSTRACT
BACKGROUND: Age-related differences in response to pain stimuli remain a controversial issue. The purpose of this study was to evaluate the effect of age on pain response using the formalin treated rats and streptozotocin-induced diabetic rats tested for mechnical, cold allodynia and thermal hyperalgesia. METHODS: We divided Sprague-Dawley rats into 3 groups by age, 5 weeks old (n = 10), 8 weeks old (n = 10), 12 weeks old (n = 10). Each group was divided into 2 subgroups (n = 5). One was formalin tested and the other was injected with streptozotocin 75 mg intraperitoneally for succesive two days. On the 3rd day after injection, we examined mechnical allodynia using a von Frey filament, and tested thermal hyperalgesia using a tail immersion test in 50degrees C or 5degrees C water. RESULTS: In the formalin test, pain response was higher in the younger age group (P < 0.05) in phase 2. In the streptozotocin-induced diabetic rats, no difference in mechanical allodynia was observed between the subgroups. In the 50degrees C water thermal hyperalgesia test, withdrawal latency decreased in each group after streptozotocin injection (P < 0.05) and 5-week animals had a lower withdrawal latency than the 12-week animals (P <0.05). In the 5degrees C water cold allodynia test, the 5-week animals showed a lower withdrawal latency than the other age groups (P < 0.05). CONCLUSIONS: In this study, the effect of age on the response to a pain stimulus depends upon the stimulus. This is important when designing the pain models. The mechnisms involved require further investigation.
Subject(s)
Animals , Humans , Rats , Formaldehyde , Hyperalgesia , Immersion , Pain Measurement , Rats, Sprague-Dawley , Streptozocin , WaterABSTRACT
BACKGROUND:We performed spectral analysis and determined the 1/f noise of heart rate variability during enflurane anaesthesia in order to assess the effect of the activity of the autonomic nervous system. METHODS: Data were acquired from 15 patients (ASA I-II) who received gynecological surgery under general anesthesia using enflurane, nitrous oxide and oxygen. We analyzed the spectral components of heart rate variability (HRV) according to the following five periods: 1) before premedication, 2) after induction, 3) during skin incision, 4) during recovery, and 5) after surgery. For each power spectrum the density and frequency components were identified as follows: (1) low frequency (LF) component (0.04-0.15 Hz) was associated with parasympathetic and sympathetic tone, and was affected by body temperature, the renin-angiotensin system, baroreceptor and vasomotor sympathetic modulation, (2) high frequency (HF) component (0.15-0.5 Hz) was mediated parasympathetic tone and reflected the mechanical influence of the ventilation. In addition the LF/HF ratio, which reflected cardiac sympathovagal balance was monitored. RESULTS: The LF/HF ratio, which reflects the balance of the autonomic nervous system increased remarkably during skin incision and recovery. Also, the beta index, which is related to body activity decreased during skin incision and recovery. CONCLUSIONS: Increased LF/HF was found to be caused by mechanical stimulation, which reflects autonomic nervous system balance, and the beta index was useful for the assessment of body activity.