Biomedical subjects

Jui-An Lin

Publications and source records attributed to Jui-An Lin.

5 recordsLinked to original sources

PubMed2006

Anesthetic management of an AAI pacemaker patient with paroxysmal atrial fibrillation during colorectal surgery.

Perioperative management of patients with cardiac pacemakers may be challenging because of the increasing sophistication of these devices. We report a case of a patient with paroxysmal atrial fibrillation (PAF) and with a permanent AAIR (bipolar atrial-inhibited adaptive rate) pacemaker who suffered life-threatening episodes of arrhythmias during operation. The first episode was vagally induced PAF during bowel manipulation; the second, induced by the increased pacing threshold from the external electric cardioversion and hyperkalemia. Transcutaneous pacing provided cardiac pacing and stabilized the patient during the second episode. Thorough preoperative evaluation and prophylactic placement of temporary pacing or at least transcutaneous pacing are important for the avoidance and minimization of intraoperative complications in patients with sick sinus syndrome and with an AAI (atrial inhibited) pacemaker.

Aged↗

PubMed2005

Attenuation of morphine tolerance by intrathecal gabapentin is associated with suppression of morphine-evoked excitatory amino acid release in the rat spinal cord.

This study was designed to investigate the effect of acute and chronic intrathecal (i.t.) injection of gabapentin (GBP) on the antinociceptive effect of morphine and tolerance development using a tail-flick latency test. Levels of excitatory amino acids (EAA) in i.t. CSF dialysates were also measured by high performance liquid chromatography. Male Wistar rats were implanted with either one or two i.t. catheters for drug injection or pump infusion and with a microdialysis probe for CSF dialysate collection. The effect of acute GBP (10 microg i.t.) injection on the morphine dose response was examined in both naïve rats and rats made tolerant by continuous infusion of morphine (15 microg/h i.t.) for 5 days. At such a low dose (10 microg i.t.), GBP did not enhance morphine's antinociception in naïve rats. In morphine-tolerant rats, however, acute GBP (10 microg i.t.) injection potentiated morphine's antinociception and yielded a 14.6-fold shift in morphine's dose-response curve. When GBP (10 microg/h i.t.) was co-infused with morphine (15 microg/h i.t.) to examine its effect on the development of morphine tolerance, GBP attenuated the development of morphine tolerance. The effect of GBP and morphine on CSF glutamate and aspartate levels was examined in naïve rats, and the effect of morphine challenge on CSF glutamate and aspartate levels was examined in rats previously infused for 5 days with morphine alone or morphine plus GBP. Acute injection of GBP (10 microg i.t.), morphine (50 microg i.t.), or GBP (10 microg i.t.) followed by morphine (50 microg i.t.) 30 min later had no significant effect on CSF EAA concentration in naïve rats; however, in tolerant rats, morphine challenge (50 microg i.t.) increased aspartate and glutamate levels to 221 +/- 22% and 296 +/- 43%, respectively, of those before morphine challenge, and this phenomenon was inhibited by GBP co-infusion. Our results show that GBP, at a dose without enhanced effect on morphine's antinociception in naïve rats, not only potentiates morphine's antinociceptive effect in morphine-tolerant rats but also attenuates the development of morphine tolerance. The mechanism of the effect of GBP on morphine tolerance might be via suppression of the EAA concentration in spinal CSF dialysate.

Amines↗

PubMed2005

Prolonged injection time and light smoking decrease the incidence of fentanyl-induced cough.

We designed this study to evaluate the effect of injection time and smoking on fentanyl-induced cough. Four-hundred-fifty ASA class I-II patients, aged 18-80 yr and weighing 40-90 kg, scheduled for elective surgery were included. All patients received fentanyl (100 microg for patients weighing 40-69 kg and 150 microg for patients weighing 70-90 kg for clinical convenience) via the proximal port of a peripheral IV line on the forearm. Patients were randomly assigned to 3 groups of 150 patients each. Patients in Group I received fentanyl injection over 2 s, whereas for patients in Groups II and III the fentanyl was injected at a constant rate over 15 s and 30 s, respectively. We recorded the number of coughs of each patient during and 30 s after fentanyl injection. The incidence of cough was 18% in group I, 8% in Group II, and 1.3% in Group III, significantly less (P < 0.05) with a longer injection time. Current smokers had a less frequent incidence of cough than nonsmokers; however, this effect was only significant in light smokers (<10 cigarettes per day or <10 smoking years or <10 pack-years). In conclusion, a longer injection time reduces the incidence of fentanyl-induced cough, and light smoking may be a protective factor against fentanyl-induced cough.

Adolescent↗

PubMed2005

Unexpected blood clot-induced acute airway obstruction in a patient with inactive pulmonary tuberculosis during lumbar spine surgery in the prone position--a case report.

Airway obstruction is always a life-threatening event, and it must be recognized and managed immediately. We report an instance of acute airway obstruction associated with hemoptysis in an elderly patient with inactive advanced pulmonary tuberculosis (TB) while undergoing spine surgery. Airway obstruction was highly suspected in consequence of postural change because immediate resolution was rewarded after reversion of the position from prone to supine. The chest surgeon consulted intraoperatively did a fiberoptic bronchoscopy and found that the blood was mainly surging from the branching bronchus of right lower lobe, and thus the source of bleeding was confirmed. Hence, in this presentation we discuss the contributory factors which led to the occurrence of hemoptysis and the appropriate perioperative management of this kind of airway obstruction.

Acute Disease↗

PubMed2004

Pneumothorax associated with tube exchanger-aided intubation following LMA-Fastrach placement in a patient during anesthesia induction.

The use of intubating laryngeal mask airway (LMA-Fastrach) is indicated to facilitate endotracheal intubation in a patient with cervical spine disorder or suspected difficult airway. A 65-year-old female patient was referred to our hospital for cervical spine surgery under general anesthesia. During anesthesia induction, an LMA-Fastrach was used to facilitate intubation and an airway exchange catheter (AEC) was used to exchange the accompanying armored silicone endotracheal tube for a polyvinyl chloride (PVC) endotracheal tube. However, the pulse oximeter showed a fall of oxygen saturation (SpO2) after insertion of the AEC. As massive pneumothorax associated with subcutaneous emphysema was disclosed by chest roentgenography, a chest drainage was performed immediately. This article discourses the possible mechanism, diagnosis and treatment of pneumothorax during the course of general anesthesia and the prevention of lower airway injury by AEC is also touched.

Aged↗