Acta Anaesthesiologica Taiwanica

Publisher: Taiwan ma zui yi xue hui, Elsevier

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Other titles ScienceDirect
ISSN 1875-4597
OCLC 403625075
Material type Document, Periodical
Document type Journal / Magazine / Newspaper, Computer File

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Elsevier

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    • Publisher last contacted on 18/10/2013
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Publications in this journal

  • [Show abstract] [Hide abstract]
    ABSTRACT: Acute and chronic subdural hemorrhage in a 33 year old woman with severe headache from occipital to frontal regions and dull neck pain was diagnosed on magnetic resonance image, which revealed cerebrospinal fluid leakage at C2-3 with spontaneous intracranial hypotension. Successful treatment was performed by epidural blood patch from the level of T7-T8 with injection of 20 mL of autologous blood. Copyright © 2015. Published by Elsevier B.V.
    Acta Anaesthesiologica Taiwanica 06/2015; DOI:10.1016/j.aat.2015.06.003
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    ABSTRACT: Anesthetics and psychoactive drugs could relieve diseases, if used properly. However, they can cause dependency, and their misuse or abuse could adversely affect people's health and social stability. For a long time, the Chinese government has been reinforcing the regulation on anesthetics and psychoactive drugs to ensure their legal and proper usage, and to prevent abuse. The state council issued 'the regulations on the administration of anesthetic drugs and psychotropic drugs' in 2005, based on which a legal system was established for administration of anesthetics and psychoactive drugs with the objectives of ensuring their legitimate medical utilization, and preventing illegal abuse. Copyright © 2015. Published by Elsevier B.V.
    Acta Anaesthesiologica Taiwanica 06/2015; DOI:10.1016/j.aat.2015.05.007
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    ABSTRACT: In this commentary on the medical use and regulation of transdermal buprenorphine we bring together our complimentary perspectives on the neuropharmacology of analgesics (Dr. Henningfield) and clinical medicine to address the needs of people with pain (Dr. Sun). Together, the neuropharmacology of buprenorphine, the clinical and abuse deterring benefits of the 7-day transdermal formulation, the low rates of harmful use and abuse detected in post-marketing surveillance studies, and the desirable clinical benefits in the elderly, in persons with compromised kidney function, and other populations support the regulation of buprenorphine comparable to tramadol-like analgesics. We support this approach and believe that it strikes the right balance of control to provide appropriate access to people with pain and their health providers, while still providing the basis for deterring harmful use and abuse. Copyright © 2015. Published by Elsevier B.V.
    Acta Anaesthesiologica Taiwanica 06/2015; DOI:10.1016/j.aat.2015.05.002
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    ABSTRACT: There is a global crisis in access to pain management in the world. WHO estimates that 4.65 billion people live in countries where medical opioid consumption is near to zero. For 2010, WHO considered a per capita consumption of 216.7 mg morphine equivalents adequate, while Taiwan had a per capita consumption of 0.05 mg morphine equivalents in 2007. In Asia, the use of opioids is sensitive because of the Opium Wars in the 19th century and for this reason, the focus of controlled substances policies has been on the prevention of diversion and dependence. However, an optimal public health outcome requires that also the beneficial aspects of these substances are acknowledged. Therefore, WHO recommends a policy based on the Principle of Balance: ensuring access for medical and scientific purposes while preventing diversion, harmful use and dependence. Furthermore, international law requires that countries ensure access to opioid analgesics for medical and scientific purposes. There is evidence that opioid analgesics for chronic pain are not associated with a major risk for developing dependence. Barriers for access can be classified in the categories of overly restrictive laws and regulations; insufficient medical training on pain management and problems related to assessment of medical needs; attitudes like an excessive fear for dependence or diversion; and economic and logistical problems. The GOPI project found many examples of such barriers in Asia. Access to opioid medicines in Taiwan can be improved by analysing the national situation and drafting a plan. The WHO policy guidelines Ensuring Balance in National Policies on Controlled Substances can be helpful for achieving this purpose, as well as international guidelines for pain treatment. Copyright © 2015. Published by Elsevier B.V.
    Acta Anaesthesiologica Taiwanica 06/2015; DOI:10.1016/j.aat.2015.05.004
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    ABSTRACT: Pain management is typically more developed in western countries compared to Asia. From the accreditation standard of the Joint Commission International (JCI), there is a broad scope for pain management. In 2008, our medical center established the pain management policy, and the goal is to be a pain-free medical facility. The Framework of Pain Management Policy including: 1. the rights of patients and family members 2. Employee education 3. Assessment of pain (screening, evaluating, monitoring) 4. Patient care of pain. After implementation of pain management program, the compliance of pain assessment, the analysis of pain score before and after pain management and the analysis of Pain Management Index (PMI), all showed improvement in pain management program. The consumption of opioids usage steadily increased from 2010 to 2014. The success of our pain management program implementation could be attributed to the clear pain management policy, the firm support of higher leadership, the cooperation of IT department, and the quality control. Copyright © 2015. Published by Elsevier B.V.
    Acta Anaesthesiologica Taiwanica 06/2015; DOI:10.1016/j.aat.2015.05.006
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    ABSTRACT: Pain is a burdensome symptom that can commonly exist chronically along the cancer trajectory. Uncontrolled pain will impact on cancer patients' quality of life, even further negatively affect cancer survivors' employment. Based on systemic reviews of studies for past 10 years, the paper reported that although there is enormous advancement on the knowledge of cancer pain and pain management, studies still documented undertreatment of cancer pain globally. Additionally, pain distress a significant portion of cancer survivors. The pain in cancer survivors distinct from the pain related with cancer, instead emphasize on pain related with cancer treatment, such as neuropathic pain, muscular syndrome. Evidence-based pain management with common pain problems in cancer survivors is lacking. Further studies are needed to understand the pain in cancer survivors and to develop effective strategies in helping cancer survivors to manage their pain. Copyright © 2015. Published by Elsevier B.V.
    Acta Anaesthesiologica Taiwanica 06/2015; DOI:10.1016/j.aat.2015.05.005
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    ABSTRACT: In order to strengthen the management system of medical and scientific use of controlled drugs, Taiwan government referred to the three major drug control treaties of United Nation to formulate the "Controlled Drugs Act" in 1999. There are three kinds of system to manage controlled drugs, including (1) Schedule Management, (2) Licensing Regulation Management and (3) Diversion Control Management, such as the reporting and auditing systems. In this article, the management system of controlled drugs will be discussed thoroughly. Under the "Controlled Drugs Act", the controlled drugs are scheduled by the tendency of their habitual use, drug dependency, abuse, and social hazard. If violating the rule, the administrative sanction is applied. Cases of violations will also be given in this article. Copyright © 2015. Published by Elsevier B.V.
    Acta Anaesthesiologica Taiwanica 06/2015; DOI:10.1016/j.aat.2015.05.003
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    ABSTRACT: This study was aimed to explore the pharmacoepidemiology of chronic noncancer pain (CNCP) patients who required chronic opioid therapy (COT) in the Taiwanese population. Using the Taiwan National Health Insurance Research Database during 2008-2009, COT-requiring CNCP patients were identified by the inclusion criteria of both chronic analgesic requirement for > 3 months per year and long-term use of controlled opioids for > 28 therapeutic days during any 3-month period in ambulatory visits with malignancy-related pain excluded. Their demographic data and pharmacoepidemiological characteristics of opioid consumption and opioid prescriptions issued in ambulatory visits were analyzed. In total, 159 patients were enrolled as COT-requiring CNCP patients, and the prevalence was calculated at 0.016% in a 2-year period. Females were outnumbered by males (45.3% vs. 54.7%). Almost 60% of them were of working age and 93.7% belonged to low-income households, as in the health insurance claims, probably implying socioeconomic disadvantages associated with CNCP. The leading three diagnoses were unspecified myalgia and myositis, lumbago, and abdominal pain of unspecified site. The most common department from where these 159 CNCP patients obtained their opioid prescriptions was the emergency department (27.6%), ensued by a pain clinic (25.3%), but they could acquire only a few opioid therapeutic days through emergency department visits. Moreover, pain clinic satisfied the majority of opioid therapeutic days. Among all opioids, morphine was the most frequently prescribed in opioid-obtaining ambulatory visits, accounting for most of the opioid therapeutic days as well as opioid consumption. COT-requiring CNCP patients were easily associated with adverse socioeconomic liabilities and often visited emergency department as well as pain clinics. Morphine was the main opioid used for their chronic pain. Transfer of COT-requiring CNCP patients to appropriate departments is strongly recommended for efficient long-term pharmacotherapy for their chronic pain. Copyright © 2015. Published by Elsevier B.V.
    Acta Anaesthesiologica Taiwanica 05/2015; DOI:10.1016/j.aat.2015.04.002
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    ABSTRACT: Limiting the intracuff pressure of a laryngeal mask airway (LMA) to <60 cmH2O is recommended in clinical practice. This report aimed to assess the efficacy of a modified syringe technique to adjust the intracuff pressure of an LMA. In a preclinical study, commercially available 20-mL syringes were attached to the pilot balloon of LMAs with different preset intracuff pressures (40 cmH2O, 50 cmH2O, 60 cmH2O, 70 cmH2O, 80 cmH2O, 100 cmH2O, and 120 cmH2O). After attachment, the syringe plunger was allowed to passively rebound. If no rebound of the plunger was observed after attachment, 1 mL of air was withdrawn and the plunger was allowed to passively rebound again. This technique allowed the plunger to overcome static friction and avoid excessive deflation of the LMA cuffs. The intracuff pressure was measured using a manometer after the plunger ceased moving. In the preclinical study, the intracuff pressure was always less than or close to 60 cmH2O after adjustment using this modified syringe technique. After evaluating the performance and characteristics of the syringe in the preclinical study, we concluded that the modified syringe technique may be useful for adjusting LMA intracuff pressure effectively. Copyright © 2015. Published by Elsevier B.V.
    Acta Anaesthesiologica Taiwanica 05/2015; DOI:10.1016/j.aat.2015.03.004
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    ABSTRACT: For this guidance article, the Ethics Review Task Force (ERTF) of the Journal reviewed and discussed the ethics issues related to publication of human research in the field of anesthesia. ERTF first introduced international ethics principles and minimal requirements of reporting of ethics practices, followed by discussing the universal problems of publication ethics. ERTF then compared the accountability and methodology of several medical journals in assuring authors' ethics compliance. Using the Taiwan Institutional Review Board system as an example, ERTF expressed the importance of institutional review board registration and accreditation to assure human participant protection. ERTF presented four major human research misconducts in the field of anesthesia in recent years. ERTF finally proposed a flow-chart to guide journal peer reviewers and editors in ethics review during the editorial process in publishing. Examples of template languages applied in the Ethics statement section in the manuscript are expected to strengthen the ethics compliance of the authors and to set an ethical culture for all the stakeholders involved in human research. Copyright © 2015. Published by Elsevier B.V.
    Acta Anaesthesiologica Taiwanica 04/2015; 53(1). DOI:10.1016/j.aat.2015.03.001
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    ABSTRACT: Cytokines are key modulators of inflammatory responses, and play an important role in the defense and repair mechanisms following trauma. After traumatic injury, an immuno-inflammatory response is initiated immediately, and cytokines rapidly appear and function as a regulator of immunity. In pathologic conditions, imbalanced cytokines may provide systemic inflammatory responses or immunosuppression. Expression of perioperative cytokines vary by different intensities of surgical trauma and types of anesthesia and anesthetic agents. Inflammatory cytokines play important roles in postoperative organ dysfunction including central nervous system, cardiovascular, lung, liver, and kidney injury. Inhibition of cytokines could protect against traumatic injury in some circumstances, therefore cytokine inhibitors or antagonists might have the potential for reducing postoperative tissue/organ dysfunction. Cytokines are also involved in wound healing and post-traumatic pain. Application of cytokines for the improvement of surgical wound healing has been reported. Anesthesia-related immune response adjustment might reduce perioperative morbidity because it reduces proinflammatory cytokine expression; however, the overall effects of anesthetics on postoperative immune-inflammatory responses needs to be further investigated. Copyright © 2015. Published by Elsevier B.V.
    Acta Anaesthesiologica Taiwanica 03/2015; 53(1). DOI:10.1016/j.aat.2015.03.002
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    ABSTRACT: Platonin possesses potent anti-inflammatory and antioxidative capacities. Because systemic inflammation and oxidative stress are crucial in mediating sepsis-induced blood-brain barrier (BBB) integrity loss, this study elucidated the effects of platonin on preserving BBB integrity in septic rats. A total of 72 adult male rats (200-250 g) were randomized to receive cecal ligation and puncture (CLP), CLP plus platonin, sham operation, or sham operation plus platonin (n = 18 in each group). Systemic inflammation and oxidation levels and BBB integrity in the surviving rats were determined after 24-hour monitoring. Plasma levels of interleukin-6 (IL-6) and malondialdehyde (MDA)-markers of systemic inflammation and oxidation-and the grading of Evans blue staining of the brains, BBB permeability to Evans blue dye, and brain edema levels-markers of BBB integrity-in rats that received CLP were significantly higher than rats that received sham operation (all p < 0.001). By contrast, the plasma levels of IL-6 (p < 0.001) and MDA (p < 0.001), and the grading of Evans blue staining (p = 0.015), BBB permeability to Evans blue dye (p = 0.043), and brain edema levels (p = 0.034) in rats that received CLP plus platonin were significantly lower than rats that received CLP. Experimental data further revealed that the concentration of tight junction protein claudin-5, a major structural component of BBB, in rats that received CLP was significantly lower than rats that received CLP plus platonin (p = 0.023). Platonin could attenuate sepsis-induced BBB integrity loss in rats. Copyright © 2015. Published by Elsevier B.V.
    Acta Anaesthesiologica Taiwanica 03/2015; 53(1). DOI:10.1016/j.aat.2015.02.001
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    ABSTRACT: This study aimed to investigate different types of regional anesthesia for cesarean section (CS) following epidural labor analgesia that could lead to various perioperative and postoperative outcomes. We retrospectively included those parturients who received epidural labor analgesia but needed subsequent CS under regional anesthesia in our institution from January 2008 to June 2012. In all, 2341 of 6609 parturients underwent painless labor, and 334 of them converted to CS. Spinal anesthesia (SA) was used with 163 parturients, and epidural anesthesia (EA) with 96; the two groups were then compared. No high-level block or total SA was noted. The primary outcome revealed that the time from anesthesia to surgical incision and the total anesthesia time were shorter, hypotension episodes were more frequent, the rate of perioperative ephedrine administration was higher, and the rate of midazolam was lower in the SA group. With regard to secondary outcomes, the Apgar scores of the neonates recorded at 1 minute and 5 minutes and maternal satisfaction were similar. The neuraxial morphine dose was converted to parenteral morphine equivalent dose (MED), which revealed that the parturients in the spinal morphine group had lower dosages and visual analog scale (VAS) pain scores on postoperative Day 1. For parturients with labor epidural analgesia needing CS, the use of SA led to shorter anesthetic time and lower postoperative pain scores, with lower morphine doses compared with EA. However, the high failure rate with both neuraxial techniques needs to be addressed. Copyright © 2015. Published by Elsevier B.V.
    Acta Anaesthesiologica Taiwanica 02/2015; 53(1). DOI:10.1016/j.aat.2015.01.003
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    ABSTRACT: To evaluate and compare the Truview picture capture device (PCD) and C-MAC laryngoscope to the standard Macintosh laryngoscope in pediatric patients. One hundred and fifty patients with American Society of Anesthesiology status Grade I-II (ASA I-II) who were 1-6 years old (10-20 kg) were scheduled for elective surgery. They were randomized into three equal groups for laryngoscopy and intubation by either the Truview PCD (Group T), C-MAC (Group C), or Macintosh laryngoscope (Group M) under general anesthesia. The percentage of glottic opening (POGO) score, application of external laryngeal maneuver, time to intubation, number of attempts at intubation, failed intubations, episodes of desaturation, and trauma were recorded and statistically analyzed. A value of p < 0.05 was considered significant. The POGO scores were significantly better with the Truview PCD (94.7 ± 12.91) than with the C-MAC and Macintosh laryngoscopes (82 ± 24.97 and 85.1 ± 17.07, respectively; p < 0.01). There were no failures, episodes of desaturation, or trauma in any of the patients. It took 19.24 seconds to intubate with the Truview PCD, compared to 12.32 seconds with the C-MAC laryngoscope and 10.7 seconds with the Macintosh laryngoscope (p < 0.01). An external laryngeal maneuver was required in 42% of patients in group C, compared to 38% in Group M and 16% in group T (p < 0.01). The Truview PCD offers the best laryngeal view, although it takes a longer time for intubation. The C-MAC laryngoscope provides similar laryngeal views as the Macintosh blade, and is an excellent teaching aid. Copyright © 2015. Published by Elsevier B.V.
    Acta Anaesthesiologica Taiwanica 02/2015; DOI:10.1016/j.aat.2015.01.001
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    ABSTRACT: Both pneumocephalus and pneumorrhachis are rare but serious complications following epidural anesthesia. We report a rare case of simultaneous pneumocephalus and pneumorrhachis in a patient after undergoing epidural anesthesia. The patient lost consciousness and received emergent external ventricular drainage for pneumocephalus in another medical center. The patient was clear after external ventricular drain placement until 4 days later, when sudden onset of subdural hemorrhage occurred and an emergent craniectomy was performed. The patient passed away 2 days after craniectomy, due to multiorgan failure. Pneumocephalus with or without pneumorrhachis should be kept in mind when there is a sudden change of consciousness or persistent convulsions after epidural anesthesia. Copyright © 2015. Published by Elsevier B.V.
    Acta Anaesthesiologica Taiwanica 02/2015; 53(1). DOI:10.1016/j.aat.2015.01.002
  • Acta Anaesthesiologica Taiwanica 02/2015; 53(1). DOI:10.1016/j.aat.2015.02.002
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    ABSTRACT: This study evaluated the visibility of echogenic needles with older ultrasound devices in an in vitro phantom study.
    Acta Anaesthesiologica Taiwanica 02/2015; 53(1). DOI:10.1016/j.aat.2014.11.004
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    ABSTRACT: From September 2012 to March 2013, a total of 63 adult-to-adult living donor liver transplantations were performed at our institution. All the patients were monitored for their coagulation functions using rotation thromboelastometry (ROTEM, Tem Innovations GmbH) during the procedure at the following points: preoperative baseline, 5 minutes, 30 minutes, and 120 minutes, respectively, after reperfusion of the liver graft. A total of 84.13% of cases (n = 53) revealed fibrinolysis after reperfusion of the graft and the condition was reversed after 30 minutes without any need for additional treatment. No significant coagulopathy was observed during this period in all of the cases. The result of the ROTEM finding must correlate with the clinical situation before instituting any management to avoid the risk of thrombosis of the hepatic artery.
    Acta Anaesthesiologica Taiwanica 01/2015; 53(1). DOI:10.1016/j.aat.2014.12.001
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    ABSTRACT: Air in the scrotum is an unusual clinical finding and a thorough search should be done in order to locate the air leak or source of gas production. We report an 81-year-old patient who developed severe acute respiratory failure after fiberoptic bronchoscopy and was intubated immediately. After tracheal intubation, excessive subcutaneous emphysema from the head to the scrotum was obvious. Chest tube thoracostomies were placed to treat pneumothorax. The emphysema was absorbed after 13 days without any sequela. Air or gas inside the scrotum may originate from intraperitoneal, extraperitoneal, or local sources. The majority of the cases can be managed conservatively, but emergent intervention is needed in life-threatening situations.
    Acta Anaesthesiologica Taiwanica 01/2015; 53(1). DOI:10.1016/j.aat.2014.09.005