Acta anaesthesiologica Scandinavica
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Acta Anaesthesiol Scand · Oct 2014
Case ReportsHigh-dose rocuronium for rapid-sequence induction and reversal with sugammadex in two myasthenic patients.
The anesthetic management of patients affected by myasthenia gravis is usually challenging in elective surgery and even more so in emergency procedures. The difficulties involved are several-fold, ranging from the choice of an appropriate muscle relaxant (i.e. one that enables safe and rapid airway management) to neuromuscular monitoring and normal muscular recovery. Additionally, optimizing patient conditions - either pharmacologically or with plasmapheresis - before intervention is well beyond the realm of possibility. ⋯ In both cases, we opted for rapid-sequence induction with high-dose rocuronium to prevent inhalation of gastric contents. We also report on the implication of neuromuscular monitoring. We found that the rocuronium-sugammadex combination was a useful and effective option in the emergency setting.
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Acta Anaesthesiol Scand · Oct 2014
Pain management following the Nuss procedure: a survey of practice and review.
Pectus excavatum is the most common congenital chest wall deformity. The Nuss procedure is frequently used for surgical correction and this technique has been associated with severe and prolonged post-operative pain. At the present time, the optimal analgesic strategy for managing patients following this procedure has not been determined. ⋯ Post-operative pain management following the Nuss procedure is variable and poorly characterized. Clinical trials or large observational registries comparing the safety and efficacy of primary modalities and long-term outcomes are needed to enable evidence-based decision-making for the management of these patients.
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Acta Anaesthesiol Scand · Oct 2014
Plasma concentration of ketorolac after local infiltration analgesia in hip arthroplasty.
Local infiltration analgesia (LIA) with local anaesthetic (ropivacaine), a nonsteroidal anti-inflammatory drug (ketorolac) and epinephrine after lower extremity arthroplasty has gained increasing popularity during the last decade. This method has certain advantages, which include minimal systemic side effects, faster post-operative mobilization, earlier post-operative discharge from hospital and less opioid consumption. However, information regarding plasma concentrations of ketorolac after LIA mixture is insufficient to predict the risk of renal impairment in patients subjected to arthroplasty. ⋯ Exposure to ketorolac after LIA may be comparable to an intramuscular injection of the same dose. Decision of dose reduction should be based on clinical assessment of risk factors.
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Acta Anaesthesiol Scand · Oct 2014
Case ReportsLong-term allergic dermatitis caused by sevoflurane: a clinical report.
Allergy to volatile anaesthetics is extremely rare, but capable of damaging the professional career. ⋯ The report aims to warn about the potential aetiological relationship between exposure to inhaled anaesthetics and allergic manifestations with cutaneous symptoms.