Journal of anesthesia
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Journal of anesthesia · Apr 2019
Prophylactic sivelestat for esophagectomy and in-hospital mortality: a propensity score-matched analysis of claims database.
Transthoracic esophagectomy is an invasive surgery, and the excessive surgical stress produces inflammatory cytokines, which provoke acute respiratory distress syndrome (ARDS). Sivelestat sodium hydrate-a selective neutrophil elastase inhibitor-is used to treat or prevent ARDS in patients undergoing esophagectomy, although clear evidence is lacking. We investigated the benefits and risk of prophylactic sivelestat. ⋯ Because mortality and postoperative complications were similar, our findings do not support prophylactic sivelestat administration for patients undergoing esophagectomy.
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Journal of anesthesia · Apr 2019
ReviewBrain white matter lesions and postoperative cognitive dysfunction: a review.
Postoperative cognitive dysfunction (POCD) is a serious complication of anesthesia and surgery, and the major risk factor of POCD is aging. Although the exact pathophysiology of POCD remains unknown, two possible and reliable mechanisms have been proposed: neuroinflammation and neurodegeneration, i.e., amyloid β accumulation and/or tau protein phosphorylation, by surgery and/or general anesthetics. White matter lesions (WML) are produced by chronic cerebral hypoperfusion, frequently observed in elderly people, and closely related to cognitive decline. As recent studies have revealed that WML are a significant risk factor for POCD in humans, and we previously also demonstrated that persistent hypocapnea or hypotension caused neuronal damage in the caudoputamen or the hippocampus in a rat model of chronic cerebral hypoperfusion, which features global cerebral WML without neuronal damage and is recognized as a good model of human vascular dementia especially in elderly people, we hypothesize that in addition to those two previously proposed mechanisms, perioperative vital sign changes that cause reductions in cerebral blood flow might contribute to POCD in patients with WML, whose cerebral blood flow is already considerably decreased.
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Journal of anesthesia · Apr 2019
Randomized Controlled Trial Comparative StudyInfluence of intraoperative sevoflurane or desflurane on postoperative sore throat: a prospective randomized study.
Tracheal intubation for general anesthesia causes postoperative sore throat. The purpose of this study was to evaluate the effect of sevoflurane and desflurane on prevalence of postoperative sore throat in patients after general anesthesia. ⋯ We have shown that sevoflurane was associated with less frequent sore throat than desflurane in patients undergoing orthopedic lower extremity surgery.
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Journal of anesthesia · Apr 2019
Randomized Controlled TrialThe analgesic efficacy and duration of lidocaine on vascular pain induced by hypertonic saline infusion: a double-blinded, randomized control trial.
To determine the analgesic efficacy and analgesic duration of lidocaine 20 mg and 40 mg on eliminating the vascular pain associated with hypertonic saline infusion. ⋯ A single bolus of Lidocaine was effective in eliminating the pain induced by hypertonic saline infusion, but just for a short period of time. Lidocaine (without venous occlusion) only provides a short analgesic duration for local vein.
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Journal of anesthesia · Apr 2019
Comparative StudyComparison of interscalene block, general anesthesia, and intravenous analgesia for out-patient shoulder reduction.
Shoulder dislocation is often associated with intense pain, and requires urgent pain therapy and reduction. Interscalene block, general anesthesia, or intravenous analgesia alone are applied procedures that facilitate shoulder reduction by the surgeon and ease patients' pain. This study was conducted to compare procedure times, patient satisfaction, side-effects, and clinical outcome of these clinical procedures. ⋯ Out-patient shoulder reduction can be accomplished no matter whether general anesthesia, regional anesthesia, or intravenous analgesia alone was administered. Clinical outcome as measured by SF-36 and DASH was comparable among the three groups, but the shortest overall procedure time and greater patient satisfaction were found in patients with interscalene block.