Journal of anesthesia
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Journal of anesthesia · Dec 2014
Meta Analysis Comparative StudyKetamine does not increase intracranial pressure compared with opioids: meta-analysis of randomized controlled trials.
Ketamine is traditionally avoided in sedation management of patients with risk of intracranial hypertension. However, results from many clinical trials contradict this concern. We critically analyzed the published data of the effects of ketamine on intracranial pressure (ICP) and other cerebral hemodynamics to determine whether ketamine was safe for patients with hemodynamic instability and brain injuries. ⋯ The results of this study suggest that ketamine does not increase ICP compared with opioids. Ketamine provides good maintenance of hemodynamic status. Clinical application of ketamine should not be discouraged on the basis of ICP-related concerns.
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Journal of anesthesia · Dec 2014
Randomized Controlled TrialIntravenous dezocine pretreatment reduces the incidence and intensity of myoclonus induced by etomidate.
To evaluate the suppressive effect of intravenous dezocine on the incidence and severity of myoclonic movements induced by etomidate, a total of 80 patients, American Society of Anesthesiologists physical status I-II, were randomized into two equally sized groups (n = 40). These two groups were assigned to give either intravenous dezocine 0.1 mg/kg or a matching placebo (equal volume of 0.9% saline) 30 s before administration of etomidate. ⋯ Pretreatment with dezocine significantly reduced both the incidence and intensity of myoclonus. These results demonstrate that intravenous dezocine 0.1 mg/kg 30 s prior to induction was effective in suppressing myoclonic movements in our patients.
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Journal of anesthesia · Dec 2014
Randomized Controlled Trial Comparative StudyComparison of cognitive, ambulatory, and psychomotor recovery profiles after day care anesthesia with propofol and sevoflurane.
We compared the recovery profile of propofol and sevoflurane when used for maintenance of anesthesia in elective day care operative procedures. ⋯ Recovery from sevoflurane anesthesia, especially with regard to cognitive functions, may be slightly faster than from propofol, but the difference is not sufficiently significant to affect the time to "home-readiness" in patients undergoing day care surgery.
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Journal of anesthesia · Dec 2014
Case ReportsAnesthesia for aortic reconstruction in a child with PHACE syndrome.
PHACE syndrome is a neurocutaneous syndrome characterized by the association of large cutaneous hemangiomas and the cardiac and cerebral vascular anomalies. We report a 6-year-old female with PHACE syndrome presented with left facial hemangiomas, cystic lesion in the cerebral posterior fossa, coarctation of the aorta, aplasia of the left vertebral artery and stenosis of the left internal carotid artery. ⋯ A decrease of rSO2 ipsilateral to the cerebrovascular anomalies occurred during anastomosis of the aorta, which was treated by reducing the flow rate of left heart bypass and by increasing the inhalational oxygen concentration. As children with PHACE syndrome are frequently accompanied with cerebrovascular anomalies and at a risk of cerebral hypoperfusion, prevention of cerebral hypoperfusion is crucially important during general anesthesia.
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Journal of anesthesia · Dec 2014
The mu opioid receptor activation does not affect ischemia-induced agonal currents in rat spinal ventral horn.
Opioid-induced spastic paraplegia after transient spinal cord ischemia during aortic surgery has been reported. Opioids modulate neurotransmission through mu (μ) opioid receptors (MORs) in the spinal ventral horn. However, their effects during ischemic insult are not understood. ⋯ Activation of MORs does not influence ongoing ischemia-induced neuronal death. Our findings indicate that MOR agonist administration should be suitable as an anesthetic during aortic surgery.