Journal of anesthesia
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Journal of anesthesia · Oct 2010
Randomized Controlled TrialRemifentanil increases the incidence of mesenteric traction syndrome: preliminary randomized controlled trial.
The use of remifentanil is often associated with the observation of mesenteric traction syndrome (MTS) soon after manipulation of the intestine during abdominal surgery. MTS symptoms include facial flushing, hypotension, and tachycardia. In the study reported here, we prospectively investigated the effects of remifentanil on the incidence of MTS in abdominal surgery. ⋯ The results of this study suggest that the use of remifentanil in laparotomy facilitates MTS.
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Journal of anesthesia · Oct 2010
ReviewPerioperative ischemic stroke in non-cardiovascular surgery patients.
Perioperative ischemic stroke occurs in approximately 0.08-0.7% of patients after non-cardiovascular surgery and confers a significant risk of morbidity and mortality. The mortality rate of this major complication is similar in non-cardiovascular and cardiovascular surgery. Its incidence appears to be similar in Japan, Europe, and the United States. ⋯ The 2009 Japanese guidelines for the management of stroke recommend using the appropriate intravenous infusions to avoid dehydration and consideration of anticoagulation in the patients who are at high risk for thrombosis and embolism while antithrombotic agents are discontinued. Understanding how to prevent perioperative ischemic stroke remains a challenge. In this article, we review the incidence, timing of the occurrence, mortality, risk factors, and pathophysiology of perioperative ischemic stroke in the non-cardiovascular surgery patient.
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Journal of anesthesia · Oct 2010
ReviewAnesthetic considerations in diabetic patients. Part II: intraoperative and postoperative management of patients with diabetes mellitus.
Some studies have reported that tight glycemic control in diabetic patients undergoing major surgery improves perioperative morbidity and mortality rates. Recently, however, large randomized studies have shown such control increases the mortality rate, since aggressive glycemic control induces more frequent incidences of hypoglycemia. Diabetic patients have cerebral complications during the perioperative period more often than their nondiabetic counterparts. ⋯ Hence, anesthesiologists should have adequate knowledge about anesthetic agents that maintain the integrity of the cerebral circulation. Patients with diabetes mellitus (DM) have an increased susceptibility to perioperative infections. Recent work confirmed that a combination of intravenous and subcutaneous insulin as a glucose management strategy had beneficial effects identical with intravenous insulin therapy alone on the reduction of infection rates during the postoperative period.
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Journal of anesthesia · Oct 2010
Randomized Controlled Trial Comparative StudyComparison of paravertebral block versus fast-track general anesthesia via laryngeal mask airway in outpatient inguinal herniorrhaphy.
Outpatient inguinal herniorrhaphy (IH) can be successfully performed under general, regional, or local anesthesia. In this study recovery profile, postoperative pain scores, incidence of adverse effects, and patient and surgeon satisfaction were compared between paravertebral block (PVB) and fast-track general anesthesia (GA) via laryngeal mask airway (LMA) for outpatient IH. ⋯ In outpatient IH, PVB with 0.5% levobupivacaine provided improved recovery, long-lasting analgesia, shorter recovery room stays, and earlier home readiness time than fast-track GA via LMA.
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Journal of anesthesia · Oct 2010
Randomized Controlled TrialLow-dose continuous infusion of landiolol can reduce adrenergic response during tracheal intubation in elderly patients with cardiovascular disease.
The objective of this study was to examine the effects of low-dose infusion of landiolol on hemodynamics during tracheal intubation in elderly patients with cardiovascular disease. The study population consisted of 30 patients with American Society of Anesthesiologists physical status II and III, aged 65-77 years, who were scheduled to undergo elective surgery under general anesthesia. Patients were randomly divided into two groups (n = 15 each): a control group, receiving normal saline, and a landiolol group, receiving landiolol at 30 μg/kg/min. ⋯ General anesthesia was induced and maintained with target-controlled infusion of propofol at a blood concentration of 4 μg/ml and tracheal intubation was performed 3 min after vecuronium injection. Heart rate, blood pressure, and bispectral index were measured before and after tracheal intubation. Results showed that low-dose continuous infusion of landiolol is an effective and relatively safe method of preventing an intubation-induced adrenergic response in elderly patients with cardiovascular disease.