Journal of anesthesia
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Journal of anesthesia · Jan 2005
Randomized Controlled Trial Clinical TrialEffect of flumazenil on recovery from sevoflurane anesthesia in children premedicated with oral midazolam before undergoing herniorrhaphy with or without caudal analgesia.
Oral midazolam is frequently used to treat children, but its effect on recovery from anesthesia is controversial. This study was designed to evaluate the effect of flumazenil on reversal of midazolam during recovery from sevoflurane-induced anesthesia in children who underwent caudal analgesia compared to those who did not. ⋯ Caudal analgesia and avoiding the use of flumazenil synergistically resulted in the emergence from anesthesia in a less agitated state for children who underwent herniorrhaphy after oral midazolam premedication.
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Journal of anesthesia · Jan 2005
Randomized Controlled Trial Comparative Study Clinical TrialEffects of fentanyl on emergence characteristics from anesthesia in adult cervical spine surgery: a comparison of fentanyl-based and sevoflurane-based anesthesia.
To evaluate the effects of different anesthesia regimens on bucking, awareness, and pain during the emergence from anesthesia, which may affect neck stabilization and neurological assessment immediately after cervical spine surgery. ⋯ The quality of emergence from anesthesia in patients with cervical spine surgery is improved with fentanyl-based anesthesia, but there is no difference between the use of propofol TCI and less than 1% sevoflurane as a concomitant sedative agent with fentanyl.
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Journal of anesthesia · Jan 2005
Clinical TrialCombined neurolytic block of celiac, inferior mesenteric, and superior hypogastric plexuses for incapacitating abdominal and/or pelvic cancer pain.
Thirty-five patients with extensive abdominal or pelvic cancer who suffered uncontrolled, diffuse, extensive, and incapacitating pain were treated with a combination of neurolytic celiac plexus block (CPB), inferior mesenteric plexus block (IMPB), and superior hypogastric plexus block (SHGPB). The combination of neurolytic CPB, IMPB, and SHGPB was performed with alcohol, mainly using a transintervetebral disc approach. The combination neurolysis produced effective immediate pain relief in all the patients (visual analog scale (VAS), reduced from 8.8 +/- 0.2 to 0). ⋯ No serious complications were observed to have been caused by the neurolytic procedure on the three sympathetic plexuses. Our preliminary clinical results suggest that the combination of neurolytic CPB, IMPB, and SHGPB improves the quality of life of patients who have incapacitating cancer pain, by reducing both the intensity of the pain and their opioid consumption, without serious complications. This combination procedure may provide a new therapeutic option for pain relief in patients with advanced cancer.
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Journal of anesthesia · Jan 2005
Case ReportsUndisrupted pulse wave on pulse oximeter display monitor at cardiac arrest in a surgical patient.
We have encountered a case of cardiac arrest during anesthesia care in which an application of a new-generation pulse oximetry technology led to a misleading interpretation of the patient's true condition. Just after manipulation of the peritoneum, the heart rhythm suddenly became asystole, while the ECG showed a standstill and an arterial pressure wave was absent. However, the Datex-Ohmeda AS/3 Patient Monitor connected to the Masimo SatShare Waveform Generator feature continued to display a pulse wave with a reading of 99%. ⋯ However, the ECG standstill and flattened arterial wave lasted for about 10 s, with no pulse at the common carotid artery; thus, 0.5 mg atropine and 4 mg ephedrine were given and chest compression performed using ventilation with oxygen. About 20 s later, the heart rhythm reappeared, which was monitored by the ECG and arterial pulse wave. This incident demonstrates the importance of becoming familiar with a new technology; otherwise, we will fall into medical errors.
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Journal of anesthesia · Jan 2005
Comparative Study Clinical TrialAnalgesic effect of intravenous ATP on postherpetic neuralgia in comparison with responses to intravenous ketamine and lidocaine.
No study has been performed on the analgesic effect of adenosine 5'-triphosphate (ATP) on postherpetic neuralgia (PHN). We conducted an open-label trial of ATP in patients with PHN, and compared ATP with ketamine and lidocaine. ⋯ Intravenous ATP exerted slowly developing and long-lasting analgesic effects in half of patients with PHN. Patients with ketamine-responsive PHN were likely to respond to ATP.