RESUMEN
An 83-year-old woman was admitted to our hospital with fracture of the T11 vertebral body and paraplegia. Complications included ankylosing spondylitis and osteoporosis. The vertebra was acutely deviated and thus at risk of being crushed had manual correction of the dislocation been attempted. Instead, we predicted that placing the patient in an appropriate posture during surgery would allow the dislocation to correct spontaneously. Three possible postures were proposed by the orthopedic surgeon at a conference that was also attended by operative nurses. A Hastings posture was finally used intraoperatively. No complications arising from the posture itself were noticed during or after surgery. We concluded that a preoperative conference among doctors and nurses can eliminate unnecessary confusion in cases when special postures are utilized during surgery.
Asunto(s)
Anestesia , Osteoporosis/complicaciones , Postura/fisiología , Fracturas de la Columna Vertebral/cirugía , Fusión Vertebral/métodos , Espondilitis Anquilosante/complicaciones , Anciano de 80 o más Años , Femenino , Humanos , Grupo de Atención al Paciente , Fracturas de la Columna Vertebral/complicacionesRESUMEN
BACKGROUND: The ultra-short-acting beta1-selective blocker, landiolol, is widely used in Japan. We investigated the effects of landiolol on intubation-induced adrenergic response in 88 patients. METHODS: General anesthesia was induced and maintained with target-controlled infusion of propofol at an effect-site concentration of 5 microg/mL. Muscle relaxation was obtained with 0.1 mg/kg vecuronium, and endotracheal intubation was performed 4 min after vecuronium injection. We first investigated the optimal time point for landiolol to be administered before intubation in 43 normotensive patients. Then we examined whether landiolol was as effective as fentanyl to prevent tachycardia after intubation in 45 hypertensive patients. RESULTS: Landiolol at 0.1 mg/kg was most effective against intubation-induced tachycardia when infused 4 min before intubation in normotensive patients. However, 0.2 mg/kg landiolol was necessary to prevent tachycardia after intubation in hypertensive patients. Landiolol had no significant effects on arterial blood pressure or bispectral index at any dose throughout the study period. In contrast, 2 mug/kg fentanyl frequently caused hypotension just before and 5 min after intubation. CONCLUSION: Low doses of landiolol can effectively prevent tachycardia after intubation without significant effects on arterial blood pressure.
Asunto(s)
Antagonistas Adrenérgicos beta/uso terapéutico , Hipertensión/fisiopatología , Intubación Intratraqueal , Morfolinas/uso terapéutico , Receptores Adrenérgicos beta 1/fisiología , Urea/análogos & derivados , Adulto , Anciano , Artroplastia de Reemplazo de Cadera , Presión Sanguínea/efectos de los fármacos , Femenino , Fentanilo/farmacología , Frecuencia Cardíaca/efectos de los fármacos , Humanos , Hipotensión/inducido químicamente , Masculino , Persona de Mediana Edad , Receptores Adrenérgicos beta 1/efectos de los fármacos , Taquicardia/prevención & control , Urea/uso terapéuticoRESUMEN
Terumo's Surshield Surflow II i.v. catheter automatically engages a stainless steel clip to shield its needle tip when the needle goes out from the catheter hub. However, in our experience the safety clip of Surshield Surflow II remains in the catheter hub in a high proportion of cases when the catheter hub is held with a pair of forceps. The hub wall is so thin that the force existed to hold the hub can be easily transmitted to the safety clip. Another factor is the loose attachment of the safety clip to the needle tip. To prevent needle stick injury, further improvement of safety i.v. catheters is necessary to lead their increased use.