We studied the effect of auricular acupuncture on postoperative nausea and vomiting (PONV). One hundred female patients undergoing transabdominal hysterectomy were entered into the study. The patients were divided into two groups (auricular acupuncture treatment group and non-treatment group) in order to test the effectiveness of auricular acupuncture. There was no significant difference in age, weight, height or duration of anesthesia among the two groups of patients. There was a significant difference between the control and auricular acupuncture treatment groups in the incidence of vomiting 12 hours after surgery (68% and 30%, respectively, p < 0.01). No noteworthy side effects from treatment were observed. Auricular acupuncture is effective in reducing vomiting following transabdominal hysterectomy in female patients.

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Background and Objectives: We examined the association between the baseline perfusion index (PI) and changes in intraoperative body temperature during general anesthesia. The PI reflects the peripheral perfusion state. The PI may be associated with changes in body temperature during general anesthesia because the degree of redistribution of body heat from the central to the peripheral compartment varies depending on the peripheral perfusion state. Materials and Methods: Thirty-eight patients who underwent brain surgery were enrolled in this study. The baseline PI and body temperature of the patients were measured on entering the operating room. Body temperature was recorded every 15 min after induction of anesthesia using an esophageal temperature probe. Univariate and multivariate logistic regression analyses were performed to identify the risk factors for intraoperative hypothermia. Results: Eighteen patients (47 %) developed hypothermia intraoperatively. The baseline PI was significantly lower among patients in the hypothermia group (1.8 ± 0.7) than among those in the normothermia group (3.0 ± 1.2) (P < 0.001). The baseline PI and body temperature were independently associated with intraoperative hypothermia (PI: odds ratio [OR], 0.270; 95% confidence interval [CI], 0.105 - 0.697; P = 0.007, baseline body temperature: OR, 0.061; 95% CI, 0.005–0.743; P = 0.028). Conclusions: This study showed that low baseline PI was the factor most related to the development of intraoperative hypothermia. Future studies should consider the PI as a predictor of intraoperative hypothermia.

S erious complications with central venous catheter (CVC) placement include vascular perforation, arrhythmias, and hydrothorax or cardiac tamponade. If an anatomic topographic method for accurate CVC placement could be devised, then the course of the central veins could be used to estimate the approximate insertion depths of CVCs. The clavicular notch is an oval articular surface on each side of the sternal manubrium and can be identified by palpation. The internal jugular vein (IJV) and subclavian vein (SCV) lie beneath the ipsilateral clavicular notch. This study attempted to determine whether the measurement of surface landmarks along the course of central veins, including the IJV, SCV, brachiocephalic vein, and superior vena cava, can estimate the approximate insertion depths of both right-and leftsided CVCs via the IJV and SCV.A total of 200 patients scheduled for neurosurgery or abdominal surgery were assigned randomly to 1 of 4 groups: right IVJ, left IJV, right SCV, and left SCV. Central venous catheterization was performed using a double-lumen CVC with the Seldinger technique. The anterior approach, using the sternocleidomastoid muscle as a landmark, was used for IJV catheterization, and the infraclavicular approach was used for SCV. Topographic measurement was performed by placing the catheter naturally with its own curvature over the draped skin, starting from the insertion point of the needle through the ipsilateral clavicular notch and to the insertion point of the second right costal cartilage to the manubriosternal joint. The CVC was then inserted and secured to the depth determined by the topographic procedure. The position of the CVC tip in relation to the carina was confirmed, and the angle of the left-sided CVC tip to the vertical was measured on a postoperative chest radiograph. One centimeter away from the carina was considered as a safe CVC tip level.Each group had 50 patients who did not differ in age, height, or weight. Central venous catheter insertion depths for the right IJV, right SCV, left IJV, and left SCV were 12.3 T 1.0, 12.9 T 0.9, 16.3 T 1.2, and 16.1 T 0.9 cm, respectively. The CVC tip position of a CVC placed via the right IJV was 0.1 cm above the carina, and that for placement via the right SCV was 0.0 cm in relation to the carina. Central venous catheter tip positions placed via the left IVJ and left SCV were 0.3 cm above the carina and 0.2 cm below the carina, respectively. The CVC locations could be predicted with a margin of error between 2.2 cm below the carina and 2.3 cm above the carina in 95% of the patients. Steeper (Q40 degrees) angles to the vertical were seen in the leftsided CVCs whose tips were above the carina (17 of 54) than below the carina (2 of 46). These results show that the CVC tip can be inserted to a location near the carina level when the CVC is inserted via the right or left IVJ or right or left SCV to a catheter depth that is measured topographically. COMMENTThis study is focused on trying to identify safe placement of the catheter tip of central ven...

Penetrating neck injuries can be a fatal event and they are difficult to manage for both surgeons and anesthesiologists. So, adequate preoperative evaluation is important to improve the patients' outcomes, but this can not be done for hemodynamically unstable or uncooperative patient. Here we present our clinical experience with a patient with a penetrating neck injury and who was hemodynamically stable, but she was uncooperative and the knife was still embedded in her neck. The surgical exploration and bronchoscopic examination were successfully done under monitored anesthesia care.