Journal of anesthesia
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Journal of anesthesia · Oct 2011
Randomized Controlled TrialComparison of postoperative pharyngeal morbidity using the Macintosh laryngoscope or AirWay Scope after mastectomy.
We compared the characteristics of postoperative pharyngeal morbidity in intubation between the AirWay Scope (AWS) and Macintosh laryngoscope in 68 ASA I-II female patients aged 35-77 years in a randomized, double-blinded, controlled fashion. After induction of general anesthesia, the patient's trachea was intubated using the AWS or Macintosh laryngoscope by five anesthesiologists. Before leaving the operating room, postoperative sore throat, hoarseness, and dysphagia were assessed, and oral bleeding was evaluated by observation of the extubated tracheal tube. ⋯ Incidence of oral bleeding with the AWS (6.1%) was significantly lower than that with the Macintosh laryngoscope (23.5%). Pharyngeal morbidity on the day after surgery did not differ between groups, and no patient complained of delayed oral intake. In female patients, the AWS successfully reduced the incidence and severity of sore throat on the day of surgery in comparison with the Macintosh laryngoscope.
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Journal of anesthesia · Oct 2011
Randomized Controlled Trial Clinical TrialEffects of aminophylline on cognitive recovery after sevoflurane anesthesia.
Aminophylline accelerates the recovery from sevoflurane anesthesia. We studied the effects of escalating doses of aminophylline on cognitive and clinical recovery after sevoflurane anesthesia. ⋯ The administration of escalating doses of aminophylline accelerates postoperative cognitive recovery from sevoflurane anesthesia, as measured by the SOMCT, due to increased ventilatory elimination of sevoflurane.
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Epidural administration of local anesthetics or opioid during general anesthesia is a widespread method for postoperative analgesia. Despite the availability of this technique, inadvertent administration of nonepidural medications into the epidural space can be associated with serious neurological complications. We report a case of accidental epidural rocuronium injection.
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Journal of anesthesia · Oct 2011
Randomized Controlled TrialIntraoperative reversal of neuromuscular block with sugammadex or neostigmine during extreme lateral interbody fusion, a novel technique for spine surgery.
Extreme lateral interbody fusion (XLIF) is a method for stabilization of the lumbar spine. Intraoperatively, the surgeon identifies the lumbar nerve roots with a stimulator to prevent their injury. The objective of this study was to determine the extent to which shallow rocuronium-induced neuromuscular block must be intraoperatively reversed for reliable identification of nerve roots. ⋯ Intraoperative reversal of shallow rocuronium-induced block with either sugammadex or neostigmine is an efficient method. For reliable detection of lumbar nerve roots with a stimulating current of 10 mA, the block should be reversed to a TOF ratio of at least 0.70. For a current intensity of 5 mA, the TOF ratio should reach 0.90.
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Journal of anesthesia · Oct 2011
Review Historical ArticleThe role of Certified Registered Nurse Anesthetists in the United States.
Certified Registered Nurse Anesthetists (CRNAs) have been providing anesthesia care in the United States (US) for nearly 150 years. Historically, anesthesia care for surgical patients was mainly provided by trained nurses under the supervision of surgeons until the establishment of anesthesiology as a medical specialty in the US. Currently, all 50 US states utilize CRNAs to perform various kinds of anesthesia care, either under the medical supervision of anesthesiologists in most states, or independently without medical supervision in 16 states; the latter has become an on-going source of conflict between anesthesiologists and CRNAs. Understanding the history and current conditions of anesthesia practice in the US is crucial for countries in which the shortage of anesthesia care providers has become a national issue.