Acta anaesthesiologica Sinica最新文献

Background: Several anesthetic agents have been used successfully to provide optimal anesthetic maintenance in neurosurgery for supratentorial tumors. Due to longer surgical time that these procedures demand and thoughout avoidance of intracranial bleeding from a hastened emergence of anesthesia in the operating room, the neurosurgeons in our hospital favor a placid late emergence from anesthesia in the neurosurgical intensive care unit (NCU). Accordingly, we designed this clinical trial to compare the effects of volatile general anesthesia with or without fentanyl infusion on postoperative hemodynamics, Glasgow coma scale (GCS) score, extubation time, as well as neurological outcome in patients after craniotomy.

Methods: Forty-two patients undergoing elective surgery for supratentorial lesions were randomly divided into two anesthetic groups. In isoflurane group, after induction, anesthesia was maintained with isoflurane up to 1.2% end-tidal concentration. In fentanyl-isoflurane group, an infusion of fentanyl was started at a rate of 3 micrograms/kg/h after induction, and anesthesia was maintained with isoflurane up to 0.6% end-tidal concentration. All the anesthetics were discontinued once the surgical wound was dressed. We studied the postoperative hemodynamics and several recovery variables for 48 h after completion of anesthesia.

Results: The time from completion of surgery to extubation was shorter in isoflurane group (9.3 +/- 6.6 h) as compared with fentanyl-isoflurane group (14 +/- 3.5 h, P < 0.05). Better GCS score was seen in isoflurane group in the early recovery period. However, both groups did not differ in both average postoperative blood pressure and heart rate and there was no significant difference between 2 groups in total duration of the postoperative NCU stay.

Conclusions: In pursuance of the policy of late emergence, we are of the opinion that isoflurane anesthesia offers an earlier recovery than fentanyl-isoflurane anesthesia in patients undergoing supratentorial craniotomy.

The normally functioning of anesthetic circle system depends mainly on the integrity of both inspiratory and expiratory unidirectional valves which keep the inspiratory gas will not be contaminated by the expired CO2. In case there is a leakage defect in one or both of these valves, i.e. inability to keep tightly closed during the cycle, retrograde gas flow may happen and the exhaled CO2 may get into the inspiratory limb, resulting in rebreathing and hypercapnia with disastrous aftermath. Here we report a rather rare incident of unrecognized expiratory valve insufficiency that was not detected before anesthesia in a 40-year-old female patient who developed intraoperative hypercapnea during general anesthesia with mechanical ventilation. Discussions on the causes, management, and prevention of hypercapnia due to respiratory valve dysfunction are presented.

Background: The risk of cardiac patients undergoing noncardiac surgery is relatively high. Successful preoperative evaluation and perioperative anesthetic management of a patient require a good communication among the patient, the anesthesiologist and the surgeon as well as excellent cooperation between the surgeon and anesthesiologist with a tacit understanding of the peri-operative risks. Peri-operative risk factors have been readily investigated in Caucasians or Westerners. As different ethnic populations may have different risk factors for a same disease entity, understanding the uniqueness in this respect in Taiwanese is mandatory. The purpose of this study is to examine the risk factors, perioperative cardiac events and the qualities of preoperative preparation and post-operative intensive care in Taiwanese cardiac patients undergoing noncardiac surgery.

Methods: Two medical centers in Taiwan worked out a set of prospective questionnaire to evaluate the preoperative preparation, intraoperative events, and postoperative care of cardiac patients undergoing noncardiac surgery in these hospitals.

Results: Between March 2002 and May 2002, there were 196 cardiac patients undergoing noncardiac surgery out of a total of 10,129 anesthetized surgical patients in two medical centers. The risk factors of these patients included coronary artery disease, hypertension, diabetes mellitus, congestive heart failure, arrhythmia, and renal function impairment. In these 196 cases, only 26.5% (52) and 16.8% (33) had been preoperatively evaluated by cardiologist and anesthesiologist respectively through consultation. The number of pre-operation specific cardiac tests totaled 34, and 41 patients (20.9%) required post-operative intensive care. There were two peri-operative fatalities and fourteen peri-operative cardiac events.

Conclusions: The quality of care for preoperative evaluation and quality assurance need to be improved in Taiwan.

Positioning patients during the perioperative period is a common event to anesthesiologists. A variety of complications may arise during this cumbrous moment. We describe a rare circumstance that we came across immediately after changing the posture of a pediatric patient at the end of thoracic spinal surgery. A total occlusion of the combined heat-moisture exchanger (HME) and bacterial/viral filter was responsible for breathing circuit obstruction. The use of the combined HME and bacterial/viral filter is not entirely riskless during general anesthesia.

Automatic implantable cardioverter defibrillator (AICD) was commercially available for use in patients with malignant ventricular tachycardia and ventricular fibrillation since its meeting with FDA approval in 1985. The number of AICD implantation has increased year by year worldwide. It was allowed to be used in clinical setting in Taiwan by the Department of Health in April 1997. Physicians may come across patients with an implanted AICD undergoing surgery unrelated to cardiac issues more frequently. It is also a new challenge to anesthesiologists who must make pre-operative evaluation, maintenance during operative period and post-operative re-evaluation of the AICD function. We bring forward here for discussion a 72-year-old male patient who underwent non-cardiac surgery with AICD implantation under general anesthesia. The anesthetic precautions of patients with the device are also touched.