The musculoskeletal system is mainly composed of the bones, muscles, tendons, and ligaments, in addition to nerves and blood vessels. The greatest difficulty in an ultrasonographic freeze-frame created by the examiner is recognition of the targeted structures without indicators, since an elephant's trunk may not be easily distinguished from its leg. It is not difficult to find descriptive ultrasonographic terms used for educational purposes, which help in distinguishing features of these structures either in a normal or abnormal anatomic condition. However, the terms sometimes create confusion when describing common objects, for example, in Western countries, pears have a triangular shape, but in Asia they are round. Skilled experts in musculoskeletal ultrasound have tried to express certain distinguishing features of anatomic landmarks using terms taken from everyday objects which may be reminiscent of that particular feature. This pictorial review introduces known signature patterns of distinguishing features in musculoskeletal ultrasound in a normal or abnormal condition, and may stir the beginners' interest to play a treasure-hunt game among unfamiliar images within a boundless ocean.
ObjectiveBarbiturates have been demonstrated to reduce intracranial pressure (ICP), but adverse effects, which include hypotension and a long recovery time, make clinical applications difficult. Propofol is also known to have same effect. In the present study, we undertook coma therapy using propofol or barbiturate and compared clinical value in the practical point. MethodsFrom June 2014 to April 2017, 38 patients with severe traumatic brain injury underwent thiopental or propofol coma therapy for the 3 days following neurosurgery. Seventeen patients were treated with thiopental (group A) and 21 patients with propofol (group B). ResultsMean doses were 6.1 mg/kg/hr of thiopental and 4.4 mg/kg/hr of propofol. In group A, mean bispectral indexes were 29.4 on day 1, 27.4 on day 2, and 26.0 on day 3, and in group B, 31.4 on day 1, 29.9 on day 2, and 27.8 on day 3. Mean ICP was 16.8 cm on day 1, 24.4 cm on day 2 and 15.1 cm on day 3 in group A, and 18.3 cm on day 1, 25.4 cm on day 2 and 18.0 cm on day 3 in group B. To maintain systemic normotentsion, dopamine was infused continuously at mean doses of 10.2 μg/kg/min in group A and 4.4 μg/kg/min in group B. Mean times to stationary state were 32.9 hours in group A and 6.6 hours in group B. ConclusionThe present study suggest that propofol coma therapy has less systemic hypotension and shorter time to stationary state than thiopental therapy for achieving the same depth of anesthesia and ICP-reducing effect.
BackgroundThe goal of this study was to determine the optimal target-controlled concentration of remifentanil combined with desflurane, by using a more widely and decreasing end-tidal concentration of desflurane.MethodsNinety ASA I patients, who underwent general anesthesia for elective orthopedic or extremity surgeries, were registered and randomly allocated to receive either a target-controlled concentration of 1 ng/ml (group R1), 2 ng/ml (group R2) remifentanil, or desflurane only without remifentanil infusion (group D). Mean arterial pressure (MAP) and heart rate (HR) were recorded at 5-min intervals from after a 10-15 min period of surgical incision to before a 10-min period prior to the end of an operation. End-tidal concentration of desflurane was increased or decreased in proportion to the changes in MAP and HR. If the value of bispectral index (BIS) was from 60-62 for more than 2 min or systolic blood pressure would fall below 90 mmHg, the patient was excluded from the study to prevent a risk of "explicit awareness" and shock.ResultsThe end-tidal desflurane concentration was lower in the group receiving 1 ng/ml (5.2 ± 0.5 vol%; P < 0.001) and 2 ng/ml remifenanil (4.4 ± 0.5 vol%; P < 0.001) compared to patients in group D (7.9 ± 0.5 vol%).ConclusionsWe recommend the use of 2 ng/ml or less remifentanil combined with desflurane for decreasing concentrations of desflurane without significant side effects, during the "maintenance" phase, and not during the induction phase of general anesthesia.
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