Evaluation of the use of the fourth version FloTrac system in cardiac output measurement before and after cardiopulmonary bypass.

The FloTrac system is a system for cardiac output (CO) measurement that is less invasive than the pulmonary artery catheter (PAC). The purposes of this study were to (1) compare the level of agreement and trending abilities of CO values measured using the fourth version of the FloTrac system (CCO-FloTrac) and PAC-originated continuous thermodilution (CCO-PAC) and (2) analyze the inadequate CO-discriminating ability of the FloTrac system before and after cardiopulmonary bypass (CPB). Fifty patients were included.

Comparison of right ventricular measurements by perioperative transesophageal echocardiography as a predictor of hemodynamic instability following cardiac surgery.

Background: The relationship between perioperative right ventricular (RV) performance and hemodynamic instability after cardiac surgery seemed less portrayed. Therefore, we sought to elucidate this relationship and compare the accuracy of different RV systolic indices in predicting outcome of cardiac surgery.

Methods: This study enrolled consecutive patients referred for cardiac surgeries.

An analysis of surgical outcomes in patients aged 80 years and older.

Objectives: Elderly patients (aged ≥ 80 years) undergo an increasing number of operations. Elderly patients undergoing operations usually develop more postoperative complications and have poorer outcomes. The aim of this study is to identify the relative importance between preoperative and intraoperative variables to predict adverse postoperative outcomes in these patients.

Predictive risk index and prognosis of postoperative reintubation after planned extubation during general anesthesia: a single-center retrospective case-controlled study in Taiwan from 2005 to 2009.

Objectives: Postoperative reintubation after planned extubation (RAP) following general anesthesia is a major anesthetic morbidity. A previous study on RAP identified the various risk factors for RAP, including chronic obstructive pulmonary disease (COPD), pneumonia, systemic inflammatory response syndrome (SIRS), and airway surgery. However, the prognosis and predictive risk index of RAP were not investigated.

Operation cancellation at Chang Gung Memorial Hospital.

Background: Roughly 60,000 operations are performed at our medical center every year, so making efficient use of operating rooms (OR) is an important issue. Decreasing the cancellation rate of surgery is one method that could increase efficiency. We reviewed all OR cancellations in 2007 to survey the cancellation rates and causes.

An analysis of perioperative eye injuries after nonocular surgery.

Objective: Perioperative eye injuries, although rare, often lead to great discomfort and anxiety for patients. The purpose of this study was to explore the incidence and related risk factors of perioperative eye injuries.

Methods: We retrospectively analyzed the records of inpatients who underwent nonocular surgery under general anesthesia with intubation between October 2006 and December 2008.

Quantification of urinary 8-iso-prostaglandin F2alpha using liquid chromatography-tandem mass spectrometry during cardiac valve surgery.

Oxidative stress is an unavoidable event during many complex surgical procedures. 8-iso-prostaglandin F(2alpha) (8-iso-PGF(2alpha)) is a reliable biomarker for the evaluation of oxidative stress in vivo. The aim of this study is to develop simple and accurate liquid chromatography-tandem mass spectrometry (LC-MS/MS) methods for the detection of urinary 8-iso-PGF(2alpha) in samples collected from patients who received a cardiopulmonary bypass (CPB) during cardiac valve surgery.

Neurological impairment following myocardial ischemia associated with postoperative epidural analgesia.

Although epidural analgesia reduces the postoperative stress response and provides good pain relief for patients, potential complications associated with the technique may decrease its acceptability for some patients. We describe a 76-year-old female who underwent surgery for carcinoma of the urinary tract. Postoperative epidural analgesia was performed at the postanesthesia care unit.

Labetalol pretreatment reduces blood pressure instability during surgical resection of pheochromocytoma.

Background: To evaluate the effect of pretreatment with the mixed alpha- and beta-adrenergic blocker, labetalol, on blood pressure instability during surgical resection of pheochromocytoma.

Methods: Blood pressure stability and surgical results were compared between patients in the saline (n = 11) and labetalol (n = 15) groups. Anesthesia was induced with fentanyl, sodium thiopental and atracurium, and maintained with isoflurane in a 50% oxygen/nitrous oxide mixture.

Usefulness of transesophageal echocardiography for transcatheter closure of ostium secundum atrial septum defect with the amplatzer septal occluder.

Background: Transcatheter closure of ostium secundum atrial septum defect (ASDII) using the new self-centering occluder, Amplatzer Septal Occluder (ASO), has been well developed in recent years. We describe the importance and role of transesophageal echocardiography (TEE) in the selection and closure of such defects.

Methods: Thirty patients referred for transcatheter closure of ASDII by ASO were enrolled in this study.

The effects of continuous axillary brachial plexus block with ropivacaine infusion on skin temperature and survival of crushed fingers after microsurgical replantation.

Background: Continuous axillary brachial plexus block with local anesthetic has been shown to improve tissue perfusion after replantation surgery of the extremity. The present study aimed to investigate whether continuous axillary brachial plexus block with ropivacaine infusion can improve the survival of the reconstructive fingers secondary to an increase in its skin temperature in patients receiving replantation surgery of the crushed fingers.

Methods: Under general anesthesia, 18 patients received replantation or toe-to-hand transplantation of their crushed digits.

Use of the Arndt wire-guided endobronchial blocker via nasal for one-lung ventilation in patient with anticipated restricted mouth opening for esophagectomy.

Functional separation of the lungs may be accomplished by several methods. Patient with restricted mouth opening has limited options for one-lung ventilation. We report the use of wire-guided endobronchial blockade, a new tool for achieving one-lung ventilation in a patient with restricted mouth opening requiring nasotracheal, fiberoptic intubation for esophagectomy and reconstruction with gastric tube substitution.

Use of the Arndt wire-guided endobronchial blocker to facilitate one-lung ventilation for pediatric empyema during video-assisted thoracoscopy.

Background: Video-assisted thoracoscopic surgery (VATS) has emerged as an innovative and popular procedure for the management of postpneumonic empyema in children refractory to a medical response. One-lung ventilation is required during VATS. In this study, we evaluated the efficacy of intraoperative wire-guided endobronchial blockade (WEB) for achieving 1-lung ventilation during a thoracoscopic procedure for pediatric empyema.

Usefulness of intraoperative transesophageal echocardiography in the assessment of surgical repair of pediatric ventricular septal defects with video-assisted endoscopic techniques in children.

Background: Mini cardiac operative procedures with video-assisted endoscopic techniques for closure of ventricular septal defects (VSDs) in pediatric patients have become quite popular for cardiac surgery. A precise diagnosis is very important for determining the surgical approach, and evaluation by intraoperative transesophageal echocardiography (TEE) plays a major role in confirmation of the preoperative diagnosis, residual defects, and the need to return to the bypass after repair.

Methods: Sixty-five patients (30 boys and 35 girls; aged 8.

Folding of the epiglottis - an unusual complication to be recognized after laryngoscopic endotracheal intubation.

We report a case of folding of the epiglottis during endotracheal intubation, an unusual complication of intubation. A 36-year-old female patient underwent laryngeal microsurgery for a vocal polyp. Following anesthesia induction, an endotracheal tube (ID = 6.

A two-center survey of cardiac events and peri-operative managements of cardiac patients undergoing non-cardiac surgery in Taiwanese population.

Background: The risk of cardiac patients undergoing noncardiac surgery is relatively high. Successful preoperative evaluation and perioperative anesthetic management of a patient require a good communication among the patient, the anesthesiologist and the surgeon as well as excellent cooperation between the surgeon and anesthesiologist with a tacit understanding of the peri-operative risks. Peri-operative risk factors have been readily investigated in Caucasians or Westerners.

Stroke after intraaortic balloon counterpulsation associated with mobile atheroma in thoracic aorta diagnosed using transesophageal echocardiography.

We describe a patient who developed embolic stroke after coronary artery bypass grafting (CABG) associated with intraaortic balloon pump (IABP) insertion. Intraoperative transesophageal echocardiography (TEE) revealed marked irregular mass and disruption of the intimal surface of the thoracic aorta with overlying shaggy echogenic material on the intimal surface of the descending thoracic aortic lumen. This case of stroke after IABP insertion suggested that the balloon inflation fragmented some mobile components on the inner surface of the aorta, and this floating debris entered the systemic circulation.