Journal of anesthesia
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Journal of anesthesia · Apr 2014
Letter Case ReportsDiscrete subaortic stenosis diagnosed intraoperatively.
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Journal of anesthesia · Apr 2014
ReviewKidney function after the intraoperative use of 6 % tetrastarches (HES 130/0.4 and 0.42).
Concerns about the nephrotoxicity of tetrastarches have recently increased with the accumulation of new evidence, particularly in relationship to septic patients. Two meta-analyses in 2011 and early 2012 also raised concerns about nephrotoxicity in surgical patients and prompted the present review of the nephrotoxicity of tetrastarches solely in the surgical setting. ⋯ Six of the seven studies did not show any adverse renal outcomes following the intraoperative use of tetrastarch, although their data are not robust enough to confirm definitive safety. Moreover, balanced electrolyte solutions are strongly recommended as a carrier solution for tetrastarches to reduce adverse outcomes.
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Journal of anesthesia · Apr 2014
Randomized Controlled TrialKnee strength retention and analgesia with continuous perineural fentanyl infusion after total knee replacement: randomized controlled trial.
Despite providing adequate pain relief, a femoral nerve block can induce postoperative muscle weakness after total knee arthoplasty (TKA). Fentanyl has been shown to have peripheral effects but has not been used as a perineural infusate alone after TKA. ⋯ A continuous perineural infusion of fentanyl produced greater strength retention than ropivacaine post-TKA.
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Journal of anesthesia · Apr 2014
Randomized Controlled TrialStroke volume-directed administration of hydroxyethyl starch (HES 130/0.4) and Ringer's acetate in prone position during neurosurgery: a randomized controlled trial.
General anesthesia in the prone position is associated with hypotension. We studied stroke volume (SV)-directed administration of hydroxyethyl starch (HES 130 kDa/0.4) and Ringer’s acetate (RAC) in neurosurgical patients operated on in a prone position to determine the volumes required for stable hemodynamics and possible coagulatory effects. ⋯ The amount of RAC needed in the prone position was 25 % greater. The cumulative dose of 440 ml HES induced a slight disturbance in fibrin formation and clot strength. We suggest cautious administration of HES during neurosurgery.
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Journal of anesthesia · Apr 2014
Case ReportsA temporary decrease in twitch response following reversal of rocuronium-induced neuromuscular block with a small dose of sugammadex in a pediatric patient.
We report a temporary decrease in twitch response following reversal of rocuronium-induced neuromuscular block with a small dose of sugammadex in our dose-finding study in pediatric patients. A 19-month-old female infant (9.6 kg, 80 cm) was scheduled for elective cheiloplasty surgery. Anesthesia was induced with nitrous oxide 50% and sevoflurane 5% and maintained with air, oxygen, sevoflurane 3%, and fentanyl (total, 3 μg/kg). ⋯ Twitch responses recovered to their control values after additional doses of 3.5 mg/kg sugammadex (4 mg/kg in total). Time from sugammadex administration to maximum decreases in twitch responses is earlier than has been reported in adults (20-70 min). It is demonstrated that following neuromuscular block reversal with insufficient dose of sugammadex, there is a possibility of the recurrence of residual paralysis within less than 20 min in pediatric patients.