Arterial Puncture Unrecognized by Pressure Waveform Monitoring after Central Venous Catheterization: A case report / 대한마취과학회지

Central venous catheters are useful for acute hemodynamic monitoring, fluid resuscitation, drug administration, the aspiration of air embolism and total parenteral nutrition. However, various complications may occur during central venous catheterization and the most common complication of the internal jugular approach is arterial puncture. Arterial puncture can be easily identified by a pulsatile blood flow and the bright red color of blood. It is usually confirmed by connecting catheter to a pressure transducer and observing venous waveforms and venous pressure. We experienced a patient in whom arterial cannulation was unrecognized by pressure recording, but was confirmed by blood gas analysis.

The Radiological Measurement of Cervical Spine Extension during Bullard or Direct Laryngoscopy / 대한마취과학회지

Background: Conventional laryngoscopy with Macintosh blade requires a movement of the head, neck and cervical spine. The Bullard laryngoscope is an anatomically shaped, potentially eliminating the need for cervical spine extension. Bullard and Macintosh laryngoscopes were compared by measuring the degree of cervical spine extension by radiological measurement. Methods: Eighteen patients requiring endotracheal intubation were studied. Anesthesia was induced in neutral head position followed by laryngoscopy. Each patients was intubated two times by Macintosh and Bullard laryngoscope in random order. Radiographic evaluation was performed to determine the degree of cervical spine extension on four occasions; before induction, during facial mask ventilation, and during Bullard and Macintosh laryngoscopy. Results: The extension of cervical spine was significantly less following Bullard laryngoscopy than Macintosh laryngoscopy for best view (p<0.05). Conclusions: The Bullard laryngoscope can be used with less cervical spine extension than Macintosh laryngoscope. It may be useful in patients in whom cervical spine movement is limited or undesirable.