Journal of anesthesia
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Journal of anesthesia · Aug 2011
Case ReportsA case of nonsustained ventricular tachycardia immediately following modified electroconvulsive therapy in a depressive patient.
Modified electroconvulsive therapy (mECT) with the use of hypnotics and muscle relaxants is an optional and prevailing treatment for depression in patients who have failed on antidepressant regimens. We describe a patient who developed ventricular tachycardia (VT) immediately after mECT. A 64-year-old man with no remarkable past history underwent a course of mECT for drug-resistant depression. ⋯ The patient recovered from anesthesia without complications. Postoperatively, close examination was unable to definitively determine the cause of VT, resulting in the cancellation of subsequent mECT sessions. It is important to bear in mind that mECT can induce life-threatening arrhythmias such as VT.
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Journal of anesthesia · Aug 2011
Evaluation of estimation of physiologic ability and surgical stress to predict in-hospital mortality in cardiac surgery.
Prediction of postoperative risk in cardiac surgery is important for cardiac surgeons and anesthesiologists. We generated a prediction rule for elective digestive surgery, designated as Estimation of Physiologic Ability and Surgical Stress (E-PASS). This study was undertaken to evaluate the accuracy of E-PASS in predicting postoperative risk in cardiac surgery. ⋯ E-PASS may accurately predict postoperative risk in cardiac surgery. Because the variables are different between cardiac-specific models and E-PASS, patients' risks can be double-checked by cardiac surgeons using cardiac-specific models and by anesthesiologists using E-PASS.
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Journal of anesthesia · Aug 2011
The quality of defibrillation performance among students of the University of Medical Sciences.
The major objective was to assess the time period from a witnessed ventricular fibrillation (VF) to the first defibrillation (DEF) in a simulated manikin scenario, while the minor objective was to analyze the most common errors that occurred during DEF and the maintenance of 2-min intervals during resuscitation. We examined 210 students (medical faculty students, MF; and paramedic faculty students, PF) who had to treat a patient with VF. In the study we used the Laerdal(®) Training Manikin and the Zoll M Series(®) defibrillator. ⋯ The problems observed during the study were technical and educational. We concluded that the option "Monitor" should be removed from the equipment because it seems to be redundant. The teaching problems were a lack of constant ECG monitoring, incorrect handling of the defibrillator, and not keeping to 2-min loops of CPR.
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Journal of anesthesia · Aug 2011
Propofol increases the rate of albumin-unbound free midazolam in serum albumin solution.
Propofol and midazolam have a synergistic anesthetic action. One of the reasons for this is thought to be the inhibitory effect of propofol on midazolam metabolism. However, because both drugs bind strongly to serum protein, their interaction may not only involve the effects of propofol on midazolam metabolism, but may also involve propofol's effects on serum protein-binding. ⋯ The albumin-unbound rate of midazolam was evaluated and compared with the rate in the control solution (only midazolam). Propofol significantly raised the rate of albumin-unbound free midazolam, while ketamine had no effect on the binding of midazolam to serum albumin. These findings suggest that the increase in albumin-unbound free midazolam brought about by propofol is involved in the synergistic effect of these two agents.
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Journal of anesthesia · Aug 2011
Case ReportsIntrathecal neurolytic block in a patient with refractory cancer pain.
We report the successful treatment of refractory cancer pain by bilateral intrathecal neurolysis using phenol-glycerol. A 60-year-old man had recurrent sigmoid cancer and metastases to the lumbar (L4-5) and sacral bones. He complained of refractory pain in the lower back and lower extremities despite high-dose opioid treatment based on the WHO ladder. ⋯ His analgesia was greatly improved and high-dose intravenous opioid was retitrated and ceased. He remained comfortable and lucid at home for 2 months, until 2 days before his death at hospital. Intrathecal neurolytic block may be appropriate for some patients suffering from refractory pain that is resistant to conventional opioid analgesic treatment.