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Canadian Journal of Anaesthesia-journal Canadien D Anesthesie | 2001

Anterior mediastinal tumour identified by intraoperative transesophageal echocardiography.

Chun-Ming Lin; Jee-Ching Hsu

Purpose: To report a child with anterior mediastinal tumour misdiagnosed as pericardial effusion who had been sent to the operating theatre for drainage. After induction of general anesthesia she developed cardio-respiratory collapse. The diagnosis was made with the aid of transesophageal echocardiography (TEE).Clinical features: A 14-yr-old girl suffered from cough and intermittent fever for one month before admission. Four days before admission, she became orthopneic and was admitted to the intensive care unit. Precordial echocardiography showed an anterior and posterior echolucent space between the pericardium and epicardium that was thought to be a pericardial effusion. She was sent to the operating room for emergency drainage.After induction of general anesthesia, breath sounds were not heard on the left side of the chest. The patient developed increasing hypoxemia and hypotension despite cardiocentesis. A TEE determined that an anterior mediastinal mass was the cause of her hypoxemia and hypotension. The tumour was debulked and the patient made an uneventful postoperative recovery.Conclusion: In this case, the correct diagnosis of an anterior mediastinal mass was made with TEE. The place of TEE may be indicated in patients with unexplained hypoxemia and hypotension.RésuméObjectif: Présenter le cas d’une enfant atteinte d’une tumeur médiastinale antérieure, diagnostiquée à tort comme un épanchement péricardique, et qui a été dirigée vers la salle d’opération pour y subir un drainage. Après l’induction de l’anesthésie générale, elle a présenté un collapsus cardio-respiratoire. Le diagnostic a été fait à l’aide de l’échocardiographie transoesophagienne (ETO).Éléments cliniques: Une fillette de 14 ans souffrait de toux et de fièvre intermittente depuis un mois. Quatre jours avant son entrée à l’hôpital, elle est devenue orthopnéique et a été admise à l’unité des soins intensifs. L’échocardiographie précordiale a démontré un espace entre le péricarde et l’épicarde qui a fait penser à un épanchement péricardique. Elle a été dirigée vers la salle d’opération pour un drainage d’urgence.Après l’induction de l’anesthésie, le murmure vésiculaire n’était pas audible du côté gauche du thorax. La patiente a présenté une hypoxémie et une hypotension croissantes malgré la cardiocentèse. Une ETO a identifié une masse médiastinale antérieure comme cause de l’hypoxémie et de l’hypotension. La tumeur a été réséquée et la patiente a connu une récupération postopératoire sans incident.Conclusion: Le bon diagnostic de masse médiastinale antérieure a été fait ici grâce à l’ETO. L’utilisation de l’ETO est indiquée dans les cas d’hypoxémie et d’hypotension inexpliquées.


Acta Anaesthesiologica Taiwanica | 2003

Chemical Burn Caused by Providone-iodine Alcohol Solution-A Case Report

Fu-Chao Liu; Jiin-Tarng Liou; Yu-Ling Hui; Jee-Ching Hsu; Ching-Yue Yang; Huang-Ping Yu; Ping-Wing Lui

Burns associated with chemical disinfectants for skin preparation are rare. Skin irritation and maceration associated with pressure factors may contribute to its occurrence. We report a 24-year-old female with thyroid tumor who was admitted for subtotal thyroidectomy. After anesthetic induction, the patient was placed in the supine position with the trunk elevated to 20 degree. The skin over the anterior neck was sterilized with 10% Povidone-iodine (PI) alcohol solution. After a 3-hour surgery, the patient complained of burning pain over the back at the recovery room. Physical examination revealed a 9 x 11 cm area of skin lesion partially thickened amid on the middle of the back suggestive of chemical burn. After conservative treatment, she was discharged uneventfully 4 days later. Upon follow-up, the wound was seen to heal with minimal scarring within 3 weeks.


Canadian Journal of Anaesthesia-journal Canadien D Anesthesie | 2005

Propofol ensures a more stable A-line ARX index than thiopental during intubation

Jee-Ching Hsu; Ching-Yue Yang; Lai-Chu See; Jiin-Tarng Liou; Fu-Chao Liu; Jong-Jang Hwang; Wun-Chin Wu; Ping-Wing Lui

BackgoundThe A-line autoregressive modelling with exogenous input index (AAI) is a new method of assessing depth of anesthesia. We examined the effects of tracheal intubation on the AAI and hemodynamics during induction of anesthesia with propofol compared with thiopental in patients aged over 50 yr. Methods: 40 patients scheduled for a laminectomy, posterior spinal fusion, vertebroplasty, or total hip replacement, ASA physical status I or II and aged over 50 yr, were randomly divided into two groups. Thiopental 5 mg·kg-1 iv, fentanyl 2.5 μg·kg-1 iv, and rocuronium 0.7 mg·kg-1 iv were used in the thiopental group (n = 20) for anesthetic induction; the same protocol was used in the propofol group (n = 20) except that 2 mg·kg-1 propofol iv was given instead of thiopental. The AAI, non-invasive blood pressure, and heart rate were measured every minute before induction for three minutes, at 1.5 min post-induction, and then each minute post-intubation for eight minutes.ResultsThe AAI increased significantly at one and two minutes after intubation in the thiopental group (to 56.5 ± 18.6 at 1 min and 44.7 ± 18.7 at 2 min after intubation vs 19.9 ± 7.5 at 1.5 min after induction; P < 0.05). Thereafter, AAI values gradually decreased three minutes after intubation. The AAI was inhibited continuously after intubation in the propofol group, and no significant elevation was seen.ConclusionOur results, using the AAI to monitor anesthetic depth during induction and tracheal intubation, suggest that at equipotent doses propofol provided a more stable level of anesthesia than did thiopental.RésuméObjectifLa modélisation autorégressive A-line avec index des potentiels évoqués (AAI) est une nouvelle méthode ďévaluation de la profondeur ďanesthésie. Nous avons vérifié les effets de ľintubation endotrachéale sur ľAAI et ľhémodynamique pendant ľinduction de ľanesthésie au propofol ou au thiopental chez des patients de plus de 50 ans.MéthodeQuarante patients, ďétat physique ASA I ou II et de plus de 50 ans, devant subir une laminectomie, une arthrodèse vertébrale postérieure, une vertébroplastie ou une arthroplastie totale de la hanche, ont été divisés au hasard en deux groupes. On a utilisé: 5 mg·kg-1 iv de thiopental, 2,5 μg·kg-1 de fentanyl iv et 0,7 mg·kg-1 iv de rocuronium dans le groupe thiopental (n = 20) pour ľinduction de ľanesthésie; le même protocole a été utilisé dans le groupe propofol (n = 20) sauf que 2 mg·kg-1 de propofol iv ont remplacé le thiopental. ĽAAI, la tension artérielle par mesure non effractive et la fréquence cardiaque ont été notés toutes les minutes avant ľinduction pendant trois minutes, à 1,5 min après ľinduction et à chaque minute après ľintubation pour huit minutes.RésultatsĽAAI s’est élevé significativement à une et deux minutes après ľintubation avec le thiopental (56,5 ± 18,6 à 1 min et 44,7 ± 18,7 à 2 min après ľintubation vs 19,9 ± 7,5 à 1,5 min après ľinduction, P < 0,05). Puis, les valeurs de ľAAI ont graduellement diminué trois minutes après ľintubation. ĽAAI a été inhibé de façon continue après ľintubation dans le groupe propofol et aucune élévation significative n’a été signalée.ConclusionAvec ľusage de ľAAI pour évaluer la profondeur de ľanesthésie pendant ľinduction et ľintubation endotrachéale, nous avons constaté qu’à doses équivalentes, le propofol fournit un niveau ďanesthésie plus stable que le thiopental.


Acta Anaesthesiologica Sinica | 2001

Inadvertent Hypothermia Causes Pulseless Electrical Activity in a Patient during Cervical Spine Surgery- A Case Report

Hui-Ling Lee; Chun-Ming Lin; Jee-Ching Hsu; Shih-Jen Hwang; Ching-Yue Yang; Chung-Yuan Wu; Ping-Wing Lui

Recent studies have shown that hypothermia triples the incidence of major cardiac events. We present a happening in which a 71-year-old patient developed pulseless electrical activity (PEA) while he was undergoing cervical laminectomy for spinal stenosis in the sitting position. Thromboembolism or venous air embolism and acute myocardial infarction were respectively excluded by transesophageal echocardiography and cardiac enzymes analysis to be the causes of the cardiac event. The abnormal finding that stood out was low nasopharyngeal temperature (31 degrees C) during the procedure, which was thought to contribute to the development of the PEA episode.


Acta Anaesthesiologica Sinica | 2001

Pneumopericardium after Bronchoscopic Carbon Dioxide Laser Surgery-A Case Report

Shih-Jen Huang; Chung-Ming Lin; Jong-Jang Hwang; Ching-Yue Yang; Jee-Ching Hsu

A female baby sustained pneumopericardium after bronchoscopic CO2 laser surgery for tracheal stenosis. Perioperative pneumopericardium though rare is a life-threatening condition in babies. The symptoms are usually not specific such as hypotension, bradycardia, muffled heart sound, cardiovascular collapse, etc. The causes and clinical findings of pneumopericardium were reviewed, as are the radiographic features so as to differentiate the condition from pneumomediastinum. Early recognition of pneumopericardium is important, because emergent pericardiocentesis may be required if there is clinical evidence of cardiac tamponade.


Chang Gung medical journal | 2002

Rocuronium-induced generalized spontaneous movements cause pulmonary aspiration.

Lui Jt; Huang Sj; Ching-Yue Yang; Jee-Ching Hsu; Ping-Wing Lui


Anesthesia & Analgesia | 2003

Pretreatment with small-dose ketamine reduces withdrawal movements associated with injection of rocuronium in pediatric patients.

Jiin-Tarng Liou; Jee-Ching Hsu; Fu-Chao Liu; Daniel Ching-Wah Sum; Ping-Wing Lui


Acta Anaesthesiologica Taiwanica | 2004

Fatal Ischemia Stroke in a Patient with an Asymptomatic Carotid Artery Occlusion after Lumbar Spine Surgery - A Case Report

Liang-Chieh Wang; Jiin-Tarng Liou; Fu-Chao Liu; Jee-Ching Hsu; Ping-Wing Lui


Chang Gung medical journal | 2001

Hemodynamic responses of thiopental and propofol in different-aged patients during endotracheal intubation.

Ching-Yue Yang; Jee-Ching Hsu; Lin Cm; Huang Sj; Chung Hs; Shyr Mh


Chang Gung medical journal | 2005

Airway obstruction by a metastatic mediastinal tumor during anesthesia.

Chen Sh; Jee-Ching Hsu; Ping-Wing Lui; Chen Ch; Ching-Yue Yang

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Ching-Yue Yang

Memorial Hospital of South Bend

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Ping-Wing Lui

National Yang-Ming University

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Fu-Chao Liu

Memorial Hospital of South Bend

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Jiin-Tarng Liou

Memorial Hospital of South Bend

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Jong-Jang Hwang

Memorial Hospital of South Bend

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Chun-Ming Lin

Memorial Hospital of South Bend

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Huang-Ping Yu

Memorial Hospital of South Bend

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Ping-Wing Lui

National Yang-Ming University

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Yu-Ling Hui

Memorial Hospital of South Bend

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