Journal of anesthesia
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Journal of anesthesia · Jan 2009
Case ReportsCombination of oral ketamine and midazolam as a premedication for a severely autistic and combative patient.
Patients with impaired ability to understand and communicate can be difficult to manage perioperatively. They frequently require lateral thinking on the part of the anesthesiologists to make the induction process as smooth as possible. ⋯ A combination of oral ketamine and midazolam was mixed in the beverage Dr Pepper to mask the taste and the appearance of the drugs. The unique flavor of Dr Pepper is well suited to increase the palatibility and the acceptability of medications in children and patients with developmental delay.
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Journal of anesthesia · Jan 2009
Case Reports Comparative StudyPentax-AWS airway Scope as an alternative for awake flexible fiberoptic intubation of a morbidly obese patient in the semi-sitting position.
For anesthesia induction in a morbidly obese patient with a full stomach, awake flexible fiberoptic bronchoscope (FOB) intubation in the semi-sitting position may be a suitable choice. A new rigid indirect videolaryngoscope, the Pentax-AWS system, has a unique feature of an adjustable built-in monitor and is designed to be used in patients in various positions. However, the efficacy of its use in such situations has not been investigated or reported. ⋯ The patient's trachea was intubated with the Pentax-AWS by an anesthesiologist positioned at the patient's right and facing her. The Pentax-AWS offered easy intubation under good visualization of the glottic aperture as a consequence of its adjustable integrated monitor, in contrast to difficult intubation with other videolaryngoscopes which require an external monitor. This report illustrates that the Pentax-AWS is useful as an alternative for flexible fiberoptic intubation under these circumstances, as a consequence of its adjustable built-in monitor and integrated tube channel.
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Journal of anesthesia · Jan 2009
Randomized Controlled TrialPerineural morphine in patients with chronic ischemic lower extremity pain: efficacy and long-term results.
To compare the efficacy, safety, and impact on daily activity of peripherally administered morphine plus a local anesthetic with that of a local anesthetic alone in patients with chronic ischemic lower extremity pain. ⋯ A peripherally administered bupivacaine plus morphine combination provided better and longer analgesia for ischemic pain compared to bupivacaine alone for the short term, but not for the long term. On the other hand, our results show that continuous popliteal treatment is an effective, safe, and comfortable modality for long-term use in the home setting for patients with intractable chronic pain.
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Journal of anesthesia · Jan 2009
Randomized Controlled TrialPostoperative analgesia with minidose intrathecal morphine for bipolar hip prosthesis in extremely elderly patients.
It is known that an optimal dose of intrathecal morphine for analgesia after total hip arthroplasty in older patients is 0.1 mg. On the other hand, minidose intrathecal morphine (0.05 mg) is useful for analgesia after the transurethral resection of the prostate in elderly patients. We evaluated the postoperative analgesic effect of minidose intrathecal morphine after bipolar hip prosthesis in seniors (age 85 years or more) undergoing spinal anesthesia. ⋯ The results show that minidose intrathecal morphine provides a good analgesic effect without side effects, and it would be an effective and safe procedure for bipolar hip prosthesis in seniors.
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Journal of anesthesia · Jan 2009
ReviewComplexity of blood volume control system and its implications in perioperative fluid management.
The use of fluid therapy attempts to optimize blood circulation by manipulating the circulating blood volume (BV). BV may be a key intermediate parameter between fluid therapy and the blood circulation, and it has been assumed that BV can be controlled by fluid therapy. In order to construct a fluid therapy protocol, firstly, we have to confirm whether BV can actually be controlled by fluid therapy. ⋯ Because inflammation and some hormones control vascular permeability and the renal adjustment of solutes and fluids, such factors may readjust the BV even after interventional fluid therapy. Perioperative BV may be predominantly controlled by an internal regulatory system, regardless of whether "restrictive" or "liberal" fluid management strategies are employed. Recognizing this physiological control of BV may help us to develop individualized fluid management strategies.