Journal of clinical anesthesia
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Randomized Controlled Trial
Anticholinergic premedication to prevent bradycardia in combined spinal anesthesia and dexmedetomidine sedation: a randomized, double-blind, placebo-controlled study.
When dexmedetomidine is used in patients undergoing spinal anesthesia, high incidence of bradycardia in response to parasympathetic activation is reported. Therefore, we aimed to evaluate the effectiveness of atropine premedication for preventing the incidence of bradycardia and the hemodynamic effect on patients undergoing spinal anesthesia with sedation by dexmedetomidine. ⋯ Prophylactic atropine reduces the incidence of bradycardia in patients undergoing spinal anesthesia with dexmedetomidine sedation. However, DBP and MBP showed significant increases in patients when prophylactic atropine was administrated. Therefore, atropine premedication should be administered cautiously.
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To review the clinical and basic science literature regarding Zika viral illness and highlight relevant findings for obstetric anesthesiologists. This review provides a global review of Zika viral illness, transmission patterns, pathophysiology of disease, and anesthetic management of the parturient with Zika viral illness and associated comorbidities. ⋯ With the rapid spread of Zika virus and expected increase of spread in the summer of 2016, this review provides anesthesiologists with current recommendations, physiologic alterations, and anesthetic considerations in regard to the parturient with Zika viral illness and associated diseases.
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Review Case Reports
Acute, unanticipated, and prolonged superior vena cava occlusion during pneumonectomy.
Acute, unanticipated superior vena cava (SVC) occlusion during thoracic surgery can have profound hemodynamic consequences and lead to devastating neurologic injury. We describe the successful anesthetic management of a pneumonectomy complicated by prolonged intraoperative SVC occlusion lasting a total of 290 minutes. To our knowledge, this represents the longest reported SVC occlusion time with no subsequent neurologic sequelae. Based on our favorable outcome and a review of the relevant literature, we offer a discussion of strategies for anesthetic management.
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Anesthetic gases have been used for a long time. Adverse effects of anesthetic gases to occupationally exposed people have been well documented in the literature. Due to low solubility, these gases are rapidly eliminated from the human body. Nevertheless, neurotoxic, immunosuppressive, hepatotoxic and reproductive toxicological effects have been shown in many of the scientific works. However, there is no detailed systematic bio-monitoring review about genotoxicity risk among occupationally exposed people. We herein performed systematic review based on relevant studies. ⋯ Health care workers are exposed to wide variety of agents including biological, physical and chemical factors. Among them anesthetic gases seems to be deserve special attentions since their genotoxic, mutagenic activities. In addition, chronic exposure to all anesthetic gases instead of alone induces cumulative genotoxic effects.
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Randomized Controlled Trial Comparative Study
Operating room discharge after deep neuromuscular block reversed with sugammadex compared with shallow block reversed with neostigmine: a randomized controlled trial.
To determine if reversing a deep or moderate block with sugammadex, compared with a shallow block reversed with neostigmine, reduces the time to operating room discharge after surgery and the time spent in the postanesthesia care unit. ⋯ Maintaining a deep neuromuscular block during laparoscopic hysterectomy reversed at the end of the procedure with sugammadex enabled a faster and more predictable time till operating room discharge than did the classical combination of a shallower block reversed with neostigmine.