Journal of clinical anesthesia
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Observational Study
Evaluation of pH on removed tracheal tubes after general anesthesia: a prospective observational study.
Aspiration pneumonia is a complication of tracheal intubation and mechanical ventilation. We hypothesized that tracheal tubes removed after anesthesia that have an acidic pH may reflect latent regurgitation of gastric fluid. ⋯ Acidic pH was found on about 2.5% of removed tracheal tubes. These tubes were used in patients who were in the prone or head-down position during general anesthesia, although they did not exhibit significant aspiration symptom. Anesthesiologists should be aware of the inherent risk of gastric fluid regurgitation when their patients undergo general anesthesia in these positions.
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Randomized Controlled Trial Comparative Study
Quality of recovery from anesthesia of patients undergoing balanced or total intravenous general anesthesia. Prospective randomized clinical trial.
The aim of the present study was to assess the quality of recovery from anesthesia of patients subjected to otorhinolaryngological (ORL) surgery under balanced or total intravenous general anesthesia by means of Quality of Recovery-40 (QoR-40) questionnaire. ⋯ The quality of recovery from anesthesia assessed based on the patients' perception did not differ between the ones subjected to either inhalation or intravenous general anesthesia for ORL surgery based on QoR-40 questionnaire assessment.
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Randomized Controlled Trial Comparative Study
Postoperative analgesic efficacy of fascia iliaca block versus periarticular injection for total knee arthroplasty.
This study evaluated the postoperative analgesic efficacies of fascia iliaca block and periarticular drug injection techniques after TKA (total knee arthroplasty) surgeries. ⋯ Fascia iliaca block may be used as an alternative method to periarticular injection, and it effectively reduces the amount of morphine used to relieve post-TKA pain.
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Observational Study
Preoperative depressed mood and perioperative heart rate variability in patients with hepatic cancer.
How perioperative heart rate variability (HRV) indices differ according to the anxiety or depressed mood of patients scheduled to undergo a major surgical procedure for cancer. ⋯ HRV decreased significantly immediately before anesthesia and recovered to baseline with anesthetic induction. Preoperative, more depressed patients showed increased sympathetic tone at baseline and blunted response to impending anesthesia on the HRV measurements.
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The purpose of this case report is to educate fellow anesthesiologists of a complicated differential diagnosis for sudden cardiovascular collapse after spinal anesthesia. We report a case where anaphylaxis occurred while under spinal anesthesia and resulted in difficult resuscitation. A 58-year-old woman undergoing bilateral knee replacements under spinal anesthesia experienced sudden seizure and cardiovascular collapse from acute anaphylactic shock while administering a cephalosporin. ⋯ Anaphylactic shock under spinal anesthesia is an acute and life-threatening complication, worsened by the spinal-induced sympathectomy, and aggressive resuscitation is warranted. Despite the presence of overlapping symptoms of differential diagnoses, rapid identification of the cause of cardiovascular collapse is crucial given that resuscitation treatment modalities may conflict. Timing of antibiotic administration should be adjusted for spinal anesthesia cases to allow time to detect possible anaphylaxis.