The Oxygen Reserve Index (ORi™) is a non-invasive variable that reflects oxygenation continuously. The aims of this study were to examine the relationship between arterial partial pressure of oxygen (PaO 2 ) and ORi during general anesthesia, and to investigate the usefulness of ORi as an indicator to avoid hyperoxia. Twenty adult patients who were scheduled for surgery under general anesthesia with arterial catheterization were enrolled. After induction of general anesthesia, inspired oxygen concentration (FiO 2 ) was set to 0.33, and arterial blood gas analysis was performed. The PaO 2 and ORi at the time of blood collection were recorded. After that, FiO 2 was changed to achieve an ORi around 0.5, 0.2, and 0, followed by arterial blood gas analysis. The relationship between ORi and PaO 2 was then investigated using the data obtained. Eighty datasets from the 20 patients were analyzed. When PaO 2 was less than 240 mmHg (n = 69), linear regression analysis showed a relatively strong positive correlation (r 2 = 0.706). The cut-off ORi value obtained from the receiver operating characteristic curve to detect PaO 2 ≥ 150 mmHg was 0.21 (sensitivity 0.950, specificity 0.755). Four-quadrant plot analysis showed that the ORi trending of PaO 2 was good (concordance rate was 100.0%). Hyperoxemia can be detected by observing ORi of patients under general anesthesia, and thus unnecessary administration of high concentration oxygen can possibly be avoided. KeywordsOxygen reserve index (ORi) • Arterial partial pressure of oxygen (PaO 2 ) • Hyperoxia • Hyperoxemia
The oxygen reserve index (ORi™) is a new parameter for monitoring oxygen reserve noninvasively. The aim of this study was to examine the usefulness of ORi for rapid sequence induction (RSI). Twenty adult patients who were scheduled for surgical procedures under general anesthesia were enrolled. After attaching a sensor capable of measuring ORi, oxygen (6 L/min) and fentanyl (2 μg/kg) were administered. After 3 min, propofol 2 mg/kg and rocuronium 1 mg/kg were administered without ventilation. Regardless of changes in ORi, tracheal intubation was performed either 2 min after administration of propofol or when percutaneous oxygen saturation (SpO) reached 98%. Ventilation was then provided with oxygen at 6 L/min, and trends in ORi and SpO during RSI were observed. Data from 16 of the 20 patients were analyzed. Before oxygen administration, the median SpO was 98% [interquartile range (IQR) 97-98] and ORi was 0.00 in all patients. At 3 min after starting oxygen administration, the median SpO was 100% (IQR 100-100) and the median ORi was 0.50 (IQR 0.42-0.57). There was an SpO decline of 1% or more from the peak value after propofol administration in 13 patients, and 32.5 s (IQR 18.8-51.3) before the SpO decrease, ORi began to decline in 10 of the 13 (77%) patients. The ORi trends enable us to predict oxygenation reduction approximately 30 s before SpO starts to decline. By monitoring ORi, the incidence related to hypoxemia during RSI could be reduced.
In diabetic patients receiving vecuronium, recovery of T1/control and TOF ratio are delayed during sevoflurane anesthesia, but not in association with total iv anesthesia.
We reconstructed a defect of nearly the entire lower vermilion using a buccal musculomucosal flap following resection of a malignant tumor of the lower lip and obtained satisfactory results. The buccal musculomucosal flap was semi-spindle shaped and pedicled at the angle of the mouth. A flap measuring as much as 1.5 cm in width and 5 cm in length could be raised while ensuring that fibers of the buccinator muscle extended over its entire length. Using this technique, it was possible to reconstruct a wide defect following tumor resection and removal of almost the entire lower vermilion by means of only a transposition of a unilateral buccal musculomucosal flap after about one-quarter of the lower lip had been excised and sutured primarily. Reconstruction with this technique is a two-stage operation, and a secondary minor touch-up operation is performed on the angle of the mouth at the same time as repair of the dog-ear of the pedicle. Advantages of this technique are that food can be taken orally soon after the operation, hemodynamics in the flap are maintained stably because the flap contains fibers of the buccinator muscle, and the vermilion is given a natural eminence. In addition, postoperative drooling is minimized, and sensation returns to the vermilion within the early postoperative period. Based on these advantages, we think our technique should be the first choice for carrying out reconstruction of defects that are located mainly in the lower lip vermilion because this is a safe and reliable method with which we performed 12 cases of vermilion reconstruction without flap necrosis and with satisfactory aesthetic and functional results.
SummaryReversal of vecuronium-induced neuromuscular blockade with neostigmine was compared in two groups of 16 subjects: patients with Type 2 diabetes mellitus and normal controls. When the first twitch of the train-of-four had returned to 25% of the control value, neostigmine 40 lg.kg )1 and atropine 20 lg.kg )1 were given to reverse the neuromuscular blockade. The train-of-four ratio was lower at 3 min, 6 min, 9 min, 12 min and 15 min after reversal in the diabetic group than in the control group but the differences did not reach statistical significance. Fifteen minutes after reversal, the number of patients in whom recovery from neuromuscular blockade was judged insufficient to guarantee good respiratory function (train-of-four ratio < 0.74) did not differ between the groups. However, 15 min after reversal, the number of patients with a train-of-four ratio < 0.9 was significantly higher in the Diabetic Group than in the Control Group (15 vs. 10, p = 0.033).
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