Journal of anesthesia
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Journal of anesthesia · Feb 2014
Comparative Study Controlled Clinical TrialPreoperative oral rehydration solution intake volume does not affect relative change of mean arterial blood pressure and crystalloid redistribution during general anesthesia in low-risk patients: an observational cohort study.
Despite the implementation of liberal preoperative fasting routines, it is unclear whether preoperative oral rehydration solution intake volume affects blood pressure during general anesthesia. We enrolled 60 patients (American Society of Anesthesiologists status I/II) undergoing tympanoplasty. Patients drank 200-1,000 ml oral rehydration solution until 2-3 h before anesthesia induction. ⋯ Mean arterial blood pressure (MAP) and whole-body bioelectrical resistance for extracellular fluid (R e) during anesthesia were compared between retrospectively classified intake groups of oral rehydration solution. There were no differences in mean MAP during the 30-90 min period relative to baseline [0.67 (0.60-0.74), 0.65 (0.61-0.76), 0.64 (0.60-0.70), P = 0.96] and relative R e at 90 min [0.945 (0.018), 0.944 (0.021), 0.943 (0.021), P = 0.95] between the small (n = 14), intermediate (n = 29), and large (n = 17) intake groups. The intake volume of preoperative oral rehydration solution does not affect the magnitude of hypotension during general anesthesia in low-risk patients undergoing minor surgery.
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Journal of anesthesia · Feb 2014
Review Case ReportsDexmedetomidine-induced atrioventricular block followed by cardiac arrest during atrial pacing: a case report and review of the literature.
Sinus bradycardia is a well-known consequence of stimulation of presynaptic α2 adrenergic receptors due the adminstration of dexmedetomidine. One of the most serious adverse effects of dexmedetomidine is cardiac arrest. Some cases demonstrating such an arrest due to the indiscriminate use of this drug were recently reported. ⋯ The PQ interval in electrocardiography gradually prolonged during the infusion; finally, complete atrioventricular block and subsequent cardiac arrest occurred. Immediate cardiopulmonary resuscitation was carried out, including re-intubation, and recovery of spontaneous circulation was attained 15 min after the event. The patient was discharged from hospital on the 25th postoperative day without any neurological complications.
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Journal of anesthesia · Feb 2014
Randomized Controlled Trial Comparative StudyDoes the addition of magnesium to bupivacaine improve postoperative analgesia of ultrasound-guided thoracic paravertebral block in patients undergoing thoracic surgery?
Magnesium is a plentiful intracellular cation that has been reported to possess analgesic effect. The present study was aimed to see whether addition of magnesium to bupivacaine in thoracic paravertebral block (TPVB) improved the analgesic effect after thoracic surgery. ⋯ Addition of magnesium to bupivacaine in TPVB improved the analgesic effect of bupivacaine in patients undergoing thoracic surgery.
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Although pain after craniotomy is a clinically significant problem that has a continuously expanding literature, it is still a source of concern and controversy. Postcraniotomy headache (PCH) has been neglected for years. It is assessed regularly by only a few neurosurgical centers, and its frequency and severity tend to be underestimated by medical staff; hence, PCH is often undertreated and poorly managed. ⋯ NSAIDs seem to have inadequate analgesic effects, whereas opioids have a wide range of drawbacks; nevertheless, both types of medicaments are regarded as cornerstones of a balanced and adequate multimodal therapy. The purpose of this review is to collect the currently available knowledge about the incidence, assessment, pathophysiological mechanism, and predictors of acute and chronic PCH. Therefore, a broad search of the literature has been carried out to collect evidence of potential prevention and treatment strategies.
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Journal of anesthesia · Feb 2014
ReviewCT-guided nerve block: a review of the features of CT fluoroscopic guidance for nerve blocks.
Nerve blocks are an attractive interventional therapy in pain medicine. Several image guidance methods are available to secure the safety, accuracy, and selectivity of the nerve block. Computed tomography (CT) guidance provides a clear view of the vital viscera and vessels that should be avoided by the needle, and accurate placement of the needle tip before neuro-destructive procedures. ⋯ Preliminary CT scanning with excellent spatial resolution may facilitate the application of CT fluoroscopic guidance to various types of nerve blocks. Here we review celiac plexus and splanchnic nerve blocks, trigeminal nerve block, neurolytic sympathectomy, and spinal intervention performed under CT guidance. Additional large-scale studies are needed to optimize the use of image guidance, especially CT fluoroscopy guidance, for nerve blocks.