Journal of anesthesia
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Journal of anesthesia · Dec 2011
Comparison of sequential organ failure assessment (SOFA) scoring between nurses and residents.
We aimed to evaluate differences in the interobserver reliability and accuracy of sequential organ failure assessment (SOFA) scoring between nurses and residents. ⋯ Interobserver reliability was good and mean SOFA scores were not significantly different between nurses and residents. The accuracy of SOFA scoring was moderate for both groups; however, although the difference was not statistically significant, the major error rate was higher for nurses than for residents.
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Journal of anesthesia · Dec 2011
Case ReportsA case of cardiopulmonary arrest caused by laxatives-induced hypermagnesemia in a patient with anorexia nervosa and chronic renal failure.
We report a case of laxatives induced severe hypermagnesemia complicated with cardiopulmonary arrest. A 55-year-old woman, with nephritic syndrome and anorexia nervosa, was later transported to our emergency room (ER) because of oliguria and consciousness disturbance. During transfer to the intensive care unit from the ER, cardiopulmonary arrest suddenly occurred. ⋯ Five days after starting CHDF, magnesium concentration was almost normalized and administration of catecholamine was stopped. It was thought that progression of renal dysfunction that occurred in the patient taking a magnesium product for chronic constipation caused reduction in magnesium excretion ability, resulting in hypermagnesemia-induced cardiopulmonary arrest. To avoid a rebound phenomenon following magnesium flux from cells, continuous blood purification seems to be an effective treatment for symptomatic hypermagnesemia.
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Journal of anesthesia · Dec 2011
Experience of lumbar epidural insertion in 573 anesthetized patients.
Performing regional blockade on anesthetized patients may increase the risk of postoperative neurologic complications, because these patients cannot respond to painful stimuli. In orthopedic patients, especially those with leg fracture, it is sometimes difficult to find a suitable position for epidural catheterization because of pain. This study evaluates the frequency of neurologic complications after lumbar epidural catheter placement in anesthetized adult patients undergoing orthopedic surgery. ⋯ In the remaining 573 patients, the catheter was inserted uneventfully under general anesthesia, and they received continuous local anesthetic infusion for postoperative analgesia. No neurologic complication related to epidural catheter was observed in these patients. This observation suggests that epidural puncture under general anesthesia may be acceptable in some conditions, for example obtaining appropriate consent, difficulty in positioning when awake, proper monitoring and vigilance, etc.
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Journal of anesthesia · Dec 2011
Role of the neurosteroid allopregnanolone in the hyperalgesic behavior induced by painful nerve injury in rats.
The neurosteroid allopregnanolone (AP) influences the excitability of the central nervous system by acting as a positive allosteric modulator of γ-aminobutyric acid type A (GABA(A)) receptors. Here, we investigated the role of AP and its therapeutic potential in rats that showed hyperalgesic behavior after undergoing spinal nerve ligation (SNL). AP levels measured in the spinal cord and brain of rats that underwent SNL were greater than the corresponding levels in control animals. ⋯ No differences in serum AP levels were observed among the groups. In addition, intrathecal exogenous administration of AP showed the antihyperalgesic effects in hyperalgesic rats after SNL. These findings suggest that changes in spinal AP biosynthesis are involved in the pathogenesis of neuropathic pain following peripheral nerve injury, and pharmacological manipulation of this phenomenon may provide a potential therapeutic target for neuropathic pain.