Journal of anesthesia
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Journal of anesthesia · Oct 2015
The uses of laryngeal mask airway ProSeal™ and endobronchial blocker for one lung anesthesia.
The use of an endobronchial blocker in conjunction with a supraglottic device in elective thoracic cases has never been studied. The aim of this study was to report the success rate and time to placement of the endobronchial blocker in anaesthetized patients with a laryngeal mask airway (LMA)-ProSeal™ in place. ⋯ The use of LMA-ProSeal™ in conjunction with the COOPDECH Endobronchial Blocker Tube may be considered an alternative one-lung ventilation technique in selected cases. However, success rates and time required for placement of the blocker seem dependent on the operator's skill. Although postoperative sore throat and hoarseness of voice were reported, these improved in 24 h.
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Journal of anesthesia · Oct 2015
Observational StudyEstimation of the success rate of anesthetic management for thymectomy in patients with myasthenia gravis treated without muscle relaxants: a retrospective observational cohort study.
Although maintaining anesthesia for myasthenia gravis (MG) with minimal muscle relaxants (MR) is common, the success rate of anesthetic management for MG without MR is not clear. We therefore retrospectively examined the success rate of anesthetic management for MG without MR among 66 consecutive cases of thymectomy for MG performed at our hospital between January 2004 and April 2010, before approval of using sugammadex. A total of 60 patients (90.9 %) were treated without MR (N group). ⋯ The reasons for using MR included coughing at intubation in one case, bucking during surgery in two cases, and MR was considered to be safer by the attending anesthesiologist in three cases. The number of cases of impossible extubation requiring ventilation on that day was three in the N group and none in the R group. Finally, the success rate of anesthetic management for MG without MR was estimated to be 71.1 % (95 % CI: 65.9-77.5 %).
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Journal of anesthesia · Oct 2015
Effect of sevoflurane on human hepatocellular carcinoma HepG2 cells under conditions of high glucose and insulin.
Diabetes mellitus is associated with morbidity and progression of some cancers, such as hepatocellular carcinoma. It has been reported that sevoflurane, a volatile anesthetic agent commonly used in cancer surgery, can lead to lower overall survival rates than those observed when propofol is used to treat cancer patients, and sevoflurane increases cancer cell proliferation in in vitro studies. It has been also reported that glucose levels in rats anesthetized with sevoflurane were higher than those in rats anesthetized with propofol. ⋯ Subsequently, to mimic diabetic conditions observed during surgery, HepG2 cells were exposed to sevoflurane at 1 or 2 % concentration in high glucose concentrations at various concentrations of insulin for 6 h. One-percent sevoflurane exposure enhanced cell proliferation under conditions of high glucose, treated with 0.05 mg/l insulin. Our study implies that sevoflurane may affect cell proliferation in human hepatocellular carcinoma cells in a physiological situation mimicking that of diabetes.
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Levobupivacaine has been developed as a safer alternative to bupivacaine because of its reduced systemic toxicity. However, the effect of directly delivering levobupivacaine into tracheal smooth muscle has not been adequately explored. We performed this study to determine the in vitro effects of levobupivacaine on isolated rat tracheal smooth muscle. ⋯ Contraction inhibition was statistically significant when 10(-5) and 10(-4) M levobupivacaine were applied, compared with the contraction inhibition that occurred in the control groups (p < 0.01). A high dose of levobupivacaine also decreased the spike contraction induced by electrical field stimulation. This study indicated that high concentrations of levobupivacaine might antagonize the cholinergic receptors and inhibit parasympathetic function of the trachea.
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Journal of anesthesia · Oct 2015
Randomized Controlled TrialEffect of ondansetron on post-dural puncture headache (PDPH) in parturients undergoing cesarean section: a double-blind randomized placebo-controlled study.
One of the most exhausting complications of spinal anesthesia, especially in parturients, is post-dural puncture headache (PDPH). This headache is not responsive to the usual pain killers. Ondansetron is a 5-HT3 receptor antagonist which is generally used for the prophylactic management of nausea and vomiting; however, studies have found that ondansetron might decrease the incidence of PDPH. Therefore, we aimed to evalute the effect of ondansetron on decreasing the incidence of PDPH. ⋯ Ondansetron (0.15 mg/kg) appeared to reduce the incidence of PDPH, as well as the incidence of hypotension and PONV, in parturients undergoing spinal anesthesia for cesarean section.