Journal of anesthesia
-
Journal of anesthesia · Oct 2020
ReviewAn overview of management of intracranial hypertension in the intensive care unit.
Intracranial hypertension (IH) is a clinical condition commonly encountered in the intensive care unit, which requires immediate treatment. The maintenance of normal intracranial pressure (ICP) and cerebral perfusion pressure in order to prevent secondary brain injury (SBI) is the central focus of management. SBI can be detected through clinical examination and invasive and non-invasive ICP monitoring. ⋯ To control elevated ICP refractory to maximum standard medical and surgical treatment, at first, high-dose barbiturate administration and then decompressive craniectomy as a last step are recommended with unclear and probable benefit on outcomes, respectively. The therapeutic strategy should be based on a staircase approach and be individualized for each patient. Since most therapeutic interventions have an uncertain effect on neurological outcome and mortality, future research should focus on both studying the long-term benefits of current strategies and developing new ones.
-
Journal of anesthesia · Oct 2020
Case ReportsAnesthetic management in MAO-A and MAO-B deficiency: a case report.
Monoamine oxidase (MAO) deficiency is an X-linked hereditary disease characterized by spontaneous deletion of MAO-A and/or MAO-B on the X chromosome. Here, we describe the first reported case of a patient with MAO-A and MAO-B deficiency managed under general anesthesia in dental treatment. The patient was aged 11 years old when he was scheduled for dental treatment. ⋯ End-tidal CO2 concentration was maintained at around 35 mmHg throughout the procedure. We administered sugammadex 92 mg (4 mg/kg) for reversal of neuromuscular blockade and the patient was extubated. We achieved successful anesthetic management without any appreciable clinical signs of fatal arrhythmias in this patient with MAO-A and MAO-B deficiency.
-
Journal of anesthesia · Oct 2020
Comparison of 1-year recurrence-free survival between sevoflurane and propofol use for general anesthesia management in primary breast cancer surgery.
We evaluated the influence of anesthetic management with sevoflurane or propofol on recurrence in patients undergoing breast cancer surgery. ⋯ In patients undergoing primary breast cancer surgery, the use of either sevoflurane or propofol without regional anesthesia did not appear to affect the risk of recurrence after 1 year.
-
Journal of anesthesia · Oct 2020
Case ReportsEvaluating coagulation status with thromboelastography in a woman with antiphospholipid syndrome and sepsis: a case report.
This study presents the case of a pregnant woman with antiphospholipid syndrome (APS) who developed septic shock after labor induction. Prolonged coagulation times suggested a hypocoagulable state and contraindication to anticoagulation. Thromboelastography (TEG) similarly indicated hypocoagulation. ⋯ The patient's coagulation state significantly improved. Based on these findings, anesthesiologists and obstetricians should be aware that TEG might not be a reliable method of correcting coagulation parameters in patients with sepsis in the presence of aPL. If necessary, a mixing test can be performed to correctly define a patient's coagulation status.
-
This study examined the association between smoking and perioperative complications of laparoscopic abdominal surgery and whether these complications were reduced with ≥ 4 weeks of preoperative smoking cessation. ⋯ Providing more than 4 weeks of smoking cessation before gastrointestinal surgery can reduce the duration of hospitalization and rate of suture failure.