ABSTRACT
BACKGROUND: The safety of real-time ultrasound-guided subclavian and axillary vein cannulation as opposed to ultrasound-guided internal jugular vein cannulation has not received much attention. We retrospectively compared the safety and value of real-time ultrasound-guided cannulation in the subclavian and axillary veins with those of the landmark method. METHODS: We divided 355 patients who had undergone central venous cannulation of the subclavian and axillary vein under local anesthesia into a group that had undergone real-time ultrasound-guided cannulation (Group U), and another group cannulated using the landmark method (Group L). We compared rates of complications and cannulation success as well as average procedural durations between the two groups. RESULTS: The complication rate was significantly lower in Group U (P=0.005). Most of the complications were arterial puncture. Five patients who developed pneumothorax and nerve damage were in Group L. The success rates and average procedural duration did not significantly differ. CONCLUSIONS: Real-time ultrasound-guided subclavian and axillary vein cannulation is associated with a low incidence of complications similar to that of the internal jugular vein when competent individuals with appropriate training apply the technique.
Subject(s)
Axillary Vein , Catheterization, Central Venous/methods , Safety , Subclavian Vein , Ultrasonography/methods , Aged , Aged, 80 and over , Axillary Vein/diagnostic imaging , Catheterization, Central Venous/adverse effects , Female , Humans , Jugular Veins , Male , Middle Aged , Retrospective Studies , Subclavian Vein/diagnostic imagingABSTRACT
We present a case of continuous epidural anesthesia for a pregnant woman with uterine myoma. A 35-year-old pregnant woman at 16 weeks of pregnancy became aware of pain in the right lower abdomen. She was diagnosed with painful degenerating uterine myoma. Acetaminophen failed to control pain, and intramuscular pentazocine was only weakly effective. To avoid increasing the analgesic dose, we resorted to continuous epidural anesthesia starting at 18 weeks of pregnancy. The pain was improved remarkably by continuous epidural anesthesia with 0.2% ropivacaine. The epidural catheter was removed 6 days after the initiation of treatment. Since then there was no recurrence of pain. Besides providing good analgesic effect, the epidural anesthesia can help suppress uterine contractions and improve blood flow to the myomatous parts of the uterus. Therefore, it can be a suitable method of pain control in women with uterine myomas in mid-pregnancy.
