Journal of anesthesia
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Journal of anesthesia · Dec 2013
ReviewAnesthetic management of the patient with amyotrophic lateral sclerosis.
Amyotrophic lateral sclerosis (ALS), with an incidence of 1.5-2.5 for 100 000 per year, is a rare but rapid progression neuromuscular degeneration disorder that poses unique perioperatively challenges to clinical anesthesiologists. The progressive degeneration of motor neurons causes a constellation of symptoms, including muscular weakness, atrophy, fasciculations, spasticity, and hyperreflexia. Therapeutic and experimental treatments, including riluzole, beta lactams, methylcobalamin, dexpramipexole, antiepileptics, antioxidant agents, neutrophin, antiinflammatory agents, and antiapoptosis drugs, are described. ⋯ Because of the inherent muscle weakness and associated respiratory insufficiency, certain precautions must be utilized during anesthetic care of ALS patients. In particular, certain neuromuscular agents are contraindicated and anesthetics that leave the body more rapidly present logical and attractive options in this population. A solid understanding of the disease process, therapeutic interventions, and anesthesia considerations are all paramount for the successful management of a patient with ALS in the perioperative setting.
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Although rare, a change in visual acuity after surgery for nonocular procedures has devastating consequences. Increased recognition and discussion of this complication is reported in recent literature, most notably following spinal and cardiac surgery. ⋯ Here we review the incidence of the problem, the anatomy and physiology of the ocular circulation, variants of POVL, and proposed predisposing factors. Potential perioperative methods to prevent this complication are discussed, and suggested treatment modalities are presented.
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Journal of anesthesia · Oct 2013
ReviewDevelopmental anesthetic neurotoxicity: from animals to humans?
Several animal studies have demonstrated that most routinely used general anesthetics induce widespread neuroapoptosis and long-term neurocognitive impairment in the immature brain. These findings have generated great interest among pediatric anesthesiologists and other practitioners regarding the safe use of general anesthetics in pediatric patients. Several human retrospective studies failed to confirm whether or not anesthesia exposure during the crucial phase of brain development induces long-term neurocognitive deficits in humans. ⋯ Clearly, additional prospective randomized controlled trials are needed in humans to determine the effects of general anesthesia on neurodevelopment. In this review, we summarize currently available laboratory and clinical evidence for anesthetic neurotoxicity. Furthermore, we discuss the implications of these results for clinical anesthesia.
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Journal of anesthesia · Oct 2013
Review Meta AnalysisPharmacological prevention of rocuronium-induced injection pain or withdrawal movements: a meta-analysis.
Rocuronium is reported to be associated with injection pain or withdrawal movement (IPWM). This meta-analysis assessed the efficacy of different pharmacological treatments used to decrease the incidence of the rocuronium-induced IPWM. We searched the Cochrane Library, Embase and PubMed for randomized controlled trials comparing a pharmacological drug with a placebo to prevent the rocuronium-induced IPWM and found 37 studies with 5,595 patients. ⋯ Indirect comparison shows that the RR of NaHCO3 admixture and pretreatment with opioids were lower than that of the other four interventions (pretreatments of ketamine or lidocaine, and lidocaine or opioids with venous occlusion). This meta-analysis suggests that opioids, lidocaine, ketamine, and NaHCO3 are effective in decreasing rocuronium-induced IPWM. Considering the efficacy and convenience, pretreatment with opioids without venous occlusion is recommended for reducing rocuronium-induced IPWM.
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Journal of anesthesia · Oct 2013
ReviewCan anesthetic techniques or drugs affect cancer recurrence in patients undergoing cancer surgery?
Despite the development of effective chemotherapy and radiotherapy, surgery remains the mainstay treatment of many cancers, requiring anesthesia. Almost all cancer deaths after primary surgery are attributable to recurrence or metastases. ⋯ This review summarizes available experimental information on the potential effects of common anesthetic agents and techniques on cancer metastases and the conflicting retrospective clinical data on regional anesthesia in various types of cancer. A number of prospective, randomized, multicenter, clinical trials are in progress, and their results are eagerly awaited.