BMC anesthesiology
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Local infiltration analgesia (LIA) is a crucial component of multimodal analgesia that enhances recovery after total hip arthroplasty (THA) and knee arthroplasty (TKA). However, LIA can cause fatal local anesthetic systemic toxicity (LAST). The incidences of LIA-induced LAST in different surgeries and anesthetic agents have not been well investigated. ⋯ LIA was associated with a significantly higher risk of LAST in the THA group than in the TKA group. Propofol maintenance reduces the likelihood of seizures and tremors compared with sevoflurane inhalation. Exploring strategies to reduce the incidence of LIA-induced LAST is essential to improve perioperative patient safety.
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In oral maxillofacial surgery, the nasal tracheal tube is mostly used to provide a better surgical field for oral, head and neck operations. Postoperative sore throat and hoarseness are common following tracheal intubation, with an incidence of 11-55%. Then, we previously reported advantage technique of fiberoptic scope to decrease the risk which the tip of the tube is visualized as the tube is advanced which helps avoid impingement of the tube. However, the extent to which this technique causes postoperative complications is unknown compared to traditional technique. The aim of this study was retrospectively to determine the effect of postoperative sore throat following nasotracheal intubation by tip of the tube is visualized by fiberoptic scope. ⋯ We found that postoperative sore throat and recovery were not influenced by observative fiberoptic scope for nasotracheal intubation.
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Review Case Reports
Thyroid storm in a patient with unknown hyperthyroidism during nonthyroidal surgery-a case report and literature review.
Thyroid storm (TS) is a critical manifestation of hyperthyroidism. In recent years, the risk of perioperative TS is significantly decreased in patients with hyperthyroidism undergoing thyroid surgeries with adequate preoperative preparations. However, those who undergo non-thyroidal operations have higher risk of TS due to easily ignoring the evaluation of thyroid function. The purpose of this case report is to present a patient with TS during nonthyroidal surgery and review similar cases in the literature. ⋯ We recommend that a comprehensive history collection is warranted. The clinical manifestations of TS during operation could be versatile and atypical. Any abnormalities during an operation like abnormal heart rate, blood pressure, body temperature, or even the unusual anesthetics needed, should not be ignored. In surgeries with general anesthesia, it is necessary to be cautious about TS with an atypical manifestation of tachycardia. Once suspected, supportive and resuscitative treatment along with antithyroid medication should be promptly initiated.
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Randomized Controlled Trial
Erythropoietin for the prevention of postoperative neurocognitive disorder in older adult patients undergoing total joint arthroplasty: a randomized controlled study.
Post-operative delirium (PD) is a common post-operative complication with significant clinical and financial impacts on patients. Erythropoietin (EPO), a multi-functional glycoprotein hormone, exhibits erythropoietic and non-erythropoietic anti-inflammatory properties. This study aimed to determine the role of perioperative EPO administration in the development of postoperative delirium in older adult patients undergoing total joint arthroplasty. ⋯ Perioperative EPO reduced the incidence of post-operative delirium, although not statistically significant, with no differences in post-operative cognitive function and inflammatory responses.
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Case Reports
Pharmacogenotyping disproves genetic cause of drug-related problems in family history: a case report.
In clinical practice, family medication history is not routinely assessed as part of a patient's family health history (FHH). The information is self-reported and can depend on the individual's subjective perception. To illustrate how pharmacogenetic (PGx) testing results could be used to validate self-reported family medication history on drug-related problems (DRP), as well as to inform medication-related decisions, we herein present a case involving ten members of the same family. ⋯ The original trigger for PGx testing was the self-reported, conspicuous family medication history of DRP reported by the grandmothers. However, the girl's genotype predicted phenotypes of CYP2B6 IM and CYP2D6 PM, differed from the grandmothers'. With this exemplary case, we propose that hereditary concerns based on self-reported information on DRP should be verified by a PGx panel test, when the respective drug exhibits a PGx association. Also, the girl's PGx testing results provided important medication recommendations, which were considered perioperatively by the anesthetist suggesting to use PGx testing results preemptively to inform medication-related decisions.