Journal of anesthesia
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Journal of anesthesia · Apr 2010
Randomized Controlled Trial Comparative StudyComparison between ketamine and fentanyl-droperidol for rectal premedication in children: a randomized placebo controlled trial.
A common concern of anesthesiologists is the management of children involved in stressful scenarios, and premedication is considered, in most situations, as useful to reduce the stress responses. This randomized placebo-controlled study was designed to evaluate two premedicants, ketamine versus a combination of fentanyl-droperidol, rectally administered, in pediatric surgical outpatients. ⋯ In this study, premedication with rectal ketamine showed significantly better overall results in the preoperative period than premedication with either fentanyl-droperidol or placebo.
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Journal of anesthesia · Apr 2010
Randomized Controlled TrialEffect of remifentanil on cardiovascular and bispectral index responses following the induction of anesthesia with midazolam and subsequent tracheal intubation.
We examined the hypothesis that remifentanil decreases the bispectral index (BIS) as well as blunts cardiovascular responses to tracheal intubation during anesthesia with midazolam. ⋯ In our patient cohort, remifentanil 0.5 microg kg(-1) min(-1) effectively decreased the BIS after the induction of general anesthesia with midazolam 0.2 mg/kg and suppressed the increase of MAP and HR in response to subsequent laryngoscopy and tracheal intubation.
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Journal of anesthesia · Apr 2010
Comparative StudyTracheal fluid leakage in benchtop trials: comparison of static versus dynamic ventilation model with and without lubrication.
Longitudinal folds in tracheal tube (TT) cuffs cause leakage of pooled secretions past the tube cuff, and the most common in vitro method to test the efficacy of a new tube is a benchtop model using an artificial rigid trachea. This study compared the potential of a static and dynamic ventilation benchtop model and cuff lubrication in testing the tracheal sealing properties of a given TT cuff. ⋯ Gel lubrication, PEEP alone, and PPV + PEEP in the benchtop model had a much stronger protective effect than PPV alone on fluid leakage. Studies testing the fluid sealing efficiency of tube cuffs might be more conclusive in a static benchtop model without lubrication than in a dynamic model.
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Journal of anesthesia · Apr 2010
Case ReportsUnexpectedly difficult intubation caused by subglottic stenosis in Wegener's granulomatosis.
A 76-year-old woman was scheduled to undergo abdominal aortic repair for progressive abdominal aortic aneurysm. After inducing general anesthesia, the 7.5-mm internal diameter (ID) tracheal tube could not be advanced below the level of the vocal cords because of resistance, and intubation was re-attempted several times using smaller tubes. An otolaryngologist was consulted and subglottic stenosis of unknown origin was suggested. ⋯ She was diagnosed with Wegener's granulomatosis 46 days after the operation because she developed symptoms of renal dysfunction, hemoptysis, gastrointestinal bleeding, and presence of anti-neutrophil cytoplasmic autoantibodies (c-ANCA). The patient was treated with steroids but died 89 days after the operation because of pulmonary bleeding and renal dysfunction. Tracheal stenosis is a rare presenting feature of Wegener's granulomatosis that usually occurs late in the disease; however, anesthesiologists around the world need to bear in mind that the disease can present airway symptoms and can be the cause of airway obstruction.
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Journal of anesthesia · Apr 2010
Successful management of a patient with Marfan syndrome complicated with acute aortic dissection using landiolol during Cesarean section.
Aortic dissection is a lethal complication in pregnant women with Marfan syndrome. To decrease arterial wall stress, beta-blockers have been used as standard treatment, although uterine contractions caused by beta-2-adrenergic receptor antagonism may result. Herein, we report a patient with Marfan syndrome who was given landiolol, a selective beta-1-adrenergic receptor antagonist with a short half-life, for management during a Cesarean section procedure following development of acute aortic dissection. ⋯ Hemodynamic state, uterine contraction, and the extent of aortic dissection remained stable. The postoperative course was uneventful, and the patient and her baby were discharged safely. Landiolol was useful for reduction of HR without affecting BP or uterine contractions during a Cesarean section procedure in our patient with aortic dissection.