Journal of anesthesia
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Journal of anesthesia · Dec 2015
ReviewClinical applications of intravenous lipid emulsion therapy.
Intravenous lipid emulsion (ILE; Intralipid) therapy, a standard treatment in local anesthetic toxicity, has demonstrated therapeutic efficacies for a number of different drug class-mediated toxicities. Some of these varied drug groups include antipsychotics, antidepressants, antiarrhythmics, and calcium channel blockers. ⋯ These case reports included 49 separate drug overdose cases involving ten separate drug classes which were successfully reversed with Intralipid. The education of clinicians regarding the beneficial and varied roles of Intralipid therapy in different clinical settings is warranted, particularly in terms of the potential for Intralipid therapy to reverse the toxicities of non-local anesthetic drugs.
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Journal of anesthesia · Dec 2015
ReviewAirway management in patients undergoing emergency Cesarean section.
Special care is required for airway management of patients undergoing emergency Cesarean section. Although the incidence of difficult intubation and difficult ventilation is similar between pregnant and non-pregnant women, the severity of complications in pregnant patients would be much greater than in non-pregnant patients, if tracheal intubation is found to be difficult: increased risk of pulmonary aspiration, hypoxia, airway obstruction due to laryngeal edema, and a "sleeping baby" being taken out. ⋯ The technique has been evolving, without losing the key premise of minimizing the period of the airway being not protected from pulmonary aspiration, and of permitting rapid wake up if tracheal intubation fails. In this review, I describe the appropriate airway management, based on the current state of knowledge, in a patient undergoing emergency Cesarean section under general anesthesia.
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Journal of anesthesia · Oct 2015
Review Meta AnalysisAssociation between childhood exposure to single general anesthesia and neurodevelopment: a systematic review and meta-analysis of cohort study.
Many studies have been done to seek the relationship between general anesthesia and neurodevelopment in pediatrics. However, there is no unified conclusion, especially single anesthesia affecting a child before 3 and 4 years. The association between anesthesia and neurodevelopment is studied using a meta-analysis. ⋯ The current evidence suggests a modestly elevated risk of neurodevelopmental disorders exists in children near 3 years of age. A single general anesthesia is relatively safe after 3 years, as the outcome is very close before 3 and 4 years old.
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Dextrocardia, a term used to describe all varieties of developmental malformations resulting in the positioning of the heart in the right hemithorax, is linked to a number of highly significant cardiac disorders. Current estimates vary tremendously in the literature. Only about 10 % of patients with diagnosed dextroversion show no substantial cardiac pathology; however, the incidence of congenital heart defects associated with dextrocardia is close to 100 %. ⋯ In summary, heart malposition is a group of complex pathologic associations within the human body, rather than just a single congenital defect. Clinicians such as anesthesiologists have unique challenges managing patients with dextrocardia. An appreciation of associated pathogenesis, appropriate diagnosis, and management is paramount in ensuring the best outcome for these patients perioperatively.
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Journal of anesthesia · Oct 2015
ReviewHistory of T-cain: a local anesthetic developed and manufactured in Japan.
In many anesthesia textbooks written in English, lidocaine, tetracaine, bupivacaine, ropivacaine, and chloroprocaine are listed as useful local anesthetics for spinal anesthesia. In contrast, T-cain is not included in these lists, even though it has been reported to be suitable for spinal anesthesia in Japan. T-cain was developed as a local anesthetic in the early 1940s by Teikoku Kagaku Sangyo Inc. in Itami, Japan, by replacing a methyl group on tetracaine (Pantocaine(®)) with an ethyl group. ⋯ Other than the side effects generally known for all local anesthetics, serious side effects have not been reported for T-cain. In fact, several articles have reported that T-cain decreases the neurotoxicity of dibucaine. In this historical review, the characteristics of T-cain and its rise to become a major spinal anesthetic in Japan are discussed.