Journal of anesthesia
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Journal of anesthesia · Dec 2013
Case ReportsIntravenous lidocaine and magnesium for management of intractable trigeminal neuralgia: a case series of nine patients.
Most patients suffering from trigeminal neuralgia (TN) benefit from medical therapy, for example carbamazepin, gabapentin, and pregabalin, individually or in combination. Nonetheless, some patients experience severe and intractable pain despite such medication, or the medication eliminates their pain but they experience intolerable side effects sufficient to warrant discontinuation. ⋯ All patients experienced sound pain relief after the combined intravenous infusion therapy. Two patients experienced short and mild dizziness after the therapy, but no severe side effects were reported.
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Journal of anesthesia · Dec 2013
ReviewAnesthetic management of the patient with amyotrophic lateral sclerosis.
Amyotrophic lateral sclerosis (ALS), with an incidence of 1.5-2.5 for 100 000 per year, is a rare but rapid progression neuromuscular degeneration disorder that poses unique perioperatively challenges to clinical anesthesiologists. The progressive degeneration of motor neurons causes a constellation of symptoms, including muscular weakness, atrophy, fasciculations, spasticity, and hyperreflexia. Therapeutic and experimental treatments, including riluzole, beta lactams, methylcobalamin, dexpramipexole, antiepileptics, antioxidant agents, neutrophin, antiinflammatory agents, and antiapoptosis drugs, are described. ⋯ Because of the inherent muscle weakness and associated respiratory insufficiency, certain precautions must be utilized during anesthetic care of ALS patients. In particular, certain neuromuscular agents are contraindicated and anesthetics that leave the body more rapidly present logical and attractive options in this population. A solid understanding of the disease process, therapeutic interventions, and anesthesia considerations are all paramount for the successful management of a patient with ALS in the perioperative setting.
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Journal of anesthesia · Dec 2013
Randomized Controlled TrialAntiemetic effect of naloxone in combination with dexamethasone and droperidol in patients undergoing laparoscopic gynecological surgery.
We examined the effects of dexamethasone, droperidol, naloxone, and a combination of these three agents on postoperative nausea and vomiting (PONV) in female patients. ⋯ A combination of naloxone, droperidol, and dexamethasone was effective for preventing PONV in patients receiving fentanyl for postoperative analgesia after laparoscopic gynecological surgery, although further investigations are required to examine the effect of adding naloxone to other antiemetics.
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Journal of anesthesia · Dec 2013
Assessing the efficacy of video versus direct laryngoscopy through retrospective comparison of 436 emergency intubation cases.
Video laryngoscopy has become a common practice for tracheal intubations. However, information on its efficacy in emergency intubations is minimal. The external video monitor may act as a means for assistance by present staff, heighten teaching ability, and improve intubation outcomes. ⋯ The presence of the attending anesthesiologist (while the resident intubates) had no effect on complication rates; the number of attempts required and the grade view obtained were nonsignificant (p = 0.91 and p = 0.34, respectively). Overall, use of the C-MAC video laryngoscope provided a better view of the airway structures during an emergency intubation. The success of the C-MAC laryngoscope in intubation after failed direct laryngoscopy suggests the importance of the video laryngoscope as the primary intubation approach during an emergency intubation.
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Journal of anesthesia · Dec 2013
Randomized Controlled TrialEfficacy of endotracheal lidocaine administration with continuous infusion of remifentanil for attenuating tube-induced coughing during emergence from total intravenous anesthesia.
Although attenuation of tube-induced coughing is necessary in specific types of surgery, the best method for such attenuation is still unclear. We studied the combined intervention of endotracheal lidocaine and intravenous remifentanil compared to intravenous remifentanil alone with respect to coughing during emergence from anesthesia. ⋯ This study is consistent with the finding that endotracheal lidocaine administration and continuous infusion of remifentanil before extubation is useful to prevent coughing on emergence from anesthesia.