[Incidence of venous air embolism in parturients during cesarean section with regional anesthesia]

The purpose of the study is to probe the situation of venous air embolism (VAE) and the accompanying complications occurring in Chinese parturients in Taiwan during Cesarean section. Sixty ASA physical status class I-II parturients who were subjected to cesarean section under regional anesthesia were evaluated. The sensor of the Doppler device was placed on the anterior chest to detect the rumbles of air when it came to pass, and simultaneously the signs and symptoms following VAE were observed. Our results demonstrated that the usual or normal Doppler heart sound changed in 38 parturients out of 60 (63.3%), and the alteration occurred very often when the uterus was being incised (81.6%), or sutured (97.4%), and concurred strong correlation with such signs and symptoms such as chest tightness or precordial pain (78.9%), shortness of breath (60.5%), and change of heart rate or blood pressure (86.8%). The method of anesthesia (spinal or epidural block) did not have effect on the occurrence of VAE, but different surgical approaches and different positions in which the patients were posed during operation did apparently bring about VAE of variable degree. Besides, supplying of oxygen could mitigate the symptoms produced by VAE. Consequently, the application of Doppler monitor during Cesarean section can detect VAE earlier and more efficiently and thus provides information timely treatment.

Comparison of lower concentrations of lidocaine to suppress bucking before extubation during recovery of general anesthesia

Thirty females, aged 25-50 years old, scheduled for abdominal total hysterectomy were randomly divided to two groups. For patients in group I, 2 mL 1% lidocaine solution was injected through the catheter on the tube to desensitize the trachea while surgeon started to close the peritoneum. In group II, 2 mL 2% lidocaine was used. The peak cuff pressures generated in the awakening group I patients were 49.0 +/- 2.5 cmH2 O (mean +/- SD) which shows greater than that in group II (27.9 +/- 7.2 cmH2 O), p less than 0.01. Bucking before awakening was also evaluated clinically. One hundred % (15/15) in group I patients bucked compared with 13.3% (2/15) in group II patients (p less than 0.01). Gag reflex was preserved in all patients and none suffered from aspiration postoperatively. Intratracheal administration of two mL 2% lidocaine through the catheter of modified endotracheal tube showed significant effect for suppressing bucking during recovery of general anesthesia.