Journal of anesthesia
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Journal of anesthesia · Aug 2020
Review Case ReportsInterpreting the results of early skin tests after perioperative anaphylaxis requires special attention: a case report and review of literature.
Skin tests are the gold standard for detecting the culprit drug of anaphylaxis, and should ideally be performed after an interval of 4-6 weeks after the reaction to avoid false-negative results. However, when re-operation cannot be delayed and early allergy tests are necessary, special attention is required during subsequent anesthesia, because early skin tests tend to produce false-negative results. This report presents a case of rocuronium-induced anaphylaxis in which early skin tests showed negative results for all the drugs tested. ⋯ In this report, we also discuss interpretation of the results of early skin tests and subsequent selection of drugs for anesthesia. After postponement of surgery due to anaphylaxis, we are often required to perform allergy tests at an early stage if re-operation cannot be delayed. In such cases, skin test results alone should not be used to guide subsequent anesthesia management to avoid recurrent anaphylaxis.
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Surgical smoke generated by use of electrosurgical units (ESUs), lasers, and ultrasonic scalpels constitutes a physical, chemical, and biological hazard for anesthesia personnel. Inhalation of particulate matter with inflammatory consequences, pulmonary injury from products of tissue pyrolysis, exposure to mutagens and carcinogens, and the transmission of human papillomavirus (HPV) and possibly other pathogens represent a spectrum of adverse effects associated with the occupational exposure to surgical plume. ⋯ SED use is relatively infrequent in most surgeries, and this condition reflects surgeons' reluctance to employ these devices, likely resulting from lack of education and less than optimal technology. Anesthesia societies and academic centers can serve critical roles in advocating employment of SEDs in much the same way that they have supported perioperative smoking cessation.
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Journal of anesthesia · Aug 2020
Randomized Controlled Trial Multicenter StudySafety and efficacy of remimazolam in induction and maintenance of general anesthesia in high-risk surgical patients (ASA Class III): results of a multicenter, randomized, double-blind, parallel-group comparative trial.
The ultra-short-acting benzodiazepine remimazolam, may be an acceptable alternative to propofol for induction and maintenance of anaesthesia in high-risk patients.
pearl -
Journal of anesthesia · Aug 2020
Review Case ReportsAnesthesia and protection in an emergency cesarean section for pregnant woman infected with a novel coronavirus: case report and literature review.
Careful planning and preparation before emergency cesarean section for COVID-19 infected parturient is essential to reduce healthcare worker infection and ensure mother & infant safety.
pearl -
Journal of anesthesia · Aug 2020
Randomized Controlled Trial Multicenter StudyEfficacy and safety of remimazolam versus propofol for general anesthesia: a multicenter, single-blind, randomized, parallel-group, phase IIb/III trial.
This trial was conducted to confirm the non-inferiority of remimazolam versus propofol in the induction and maintenance of general anesthesia in surgical patients. ⋯ This trial is registered with the Japan Pharmaceutical Information Center - Clinical Trials Information (JapicCTI). JapicCTI number: 121973.