We compared the success rates of arterial cannulation with a wire-guided cannula (WGC) and the direct technique with a conventional non-wire-guided cannula (non-WGC). A total of 100 adult patients requiring an arterial line in the operating room were assigned randomly to undergo radial arterial cannulation either with the WGC or with the non-WGC. No significant difference in success rates and insertion times could be demonstrated between the WGC and the non-WGC (78.4% vs 67.3% and 22.6 +/- 13.2 s vs 23.0 +/- 19.3 s, respectively). Among the less experienced operators, insertion time was shorter with the WGC than with the non-WGC (27.7 +/- 11.9 s vs 39.8 +/- 20.4 s; P < 0.05), although the success rate was similar for the two types of cannula. Patient characteristics did not affect either the success rates or the insertion times for the two types of cannula. In conclusion, we have confirmed that the success rates of radial arterial cannulation for patients whose physical status is relatively good were similar with the use of the WGC and the non-WGC.
Background: Emergence agitation (EA) after sevoflurane anesthesia is common in children. When rapid intravenous induction of general anesthesia is indicated in a brief procedure, the induction agent can reduce the incidence of EA after sevoflurane anesthesia. The aim of this study was to compare the efficacy of intravenous induction with ketamine and propofol for reducing EA in children after short sevoflurane anesthesia. Methods: Children aged 2 to 6 years who were scheduled to undergo inguinal hernia repair were randomly divided into 3 groups to receive 2 mg/kg ketamine iv, 3 mg/kg propofol iv, or inspired concentration of 8% sevoflurane for induction of anesthesia. After a laryngeal mask airway (LMA) insertion, a caudal block was performed in all children. Anesthesia was maintained with 1.5% sevoflurane and 65% nitrous oxide in oxygen with spontaneous ventilation. The recovery characteristics were recorded and EA were evaluated by using the Pediatric Anesthesia Emergence Delirium (PAED) scale. Results: One hundred and twenty children were enrolled and randomized to treatment. Children who received ketamine induction had higher incidence of EA than those who received propofol (42% vs 16%, P < 0.05) and showed delayed recovery (32 ± 9 min) as compared with those who received propofol or sevoflurane (22 ± 8 min and 20 ± 7 min, respectively, P < 0.05). The mean peak PAED score was significantly lower in children who received propofol induction (6.8 ± 4.0, P < 0.05) than ketamine (11.8 ± 4.1) or sevoflurane (11.6 ± 3.8). Conclusions: Intravenous induction with ketamine does not prevent the incidence of EA and delays recovery. Induction with propofol improves the quality of recovery by reducing the incidence of EA and provides a safe and early recovery. S. Nakayama et al.
We investigated the problems and respiratory management during DLV with Broncho -cath(R) in 24 patients undergoing thoracic surgery .There were no critical complications, but 14 of 24 patients were marked by tube troubles (58%). Tube troubles included rupture of tracheal cuff, intubation into the opposite bronchus, tube dislodgment and obstruction of tracheal lumen. So, it should always be taken care of manipulation and condition of DLT.SaO2 monitoring by pulse-oxymetry and the surveillance by bronchofiberscopy were very effective to notice tubes troubles earlily. Also, it should always be paid attention to the feeling of respiratory bag during DLV with DLT.Low PEEP or HFJV was added to the upper lung with the lower lung receiving IPPV, so that respiratory condition could be maintained almost satisfactorily. It was thought that HFJV was superior to low PEEP with regard to gas exchange. Although, low PEEP was still effective for arterial oxygenation, furthermore it could be used very easily.
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