Masui. The Japanese journal of anesthesiology
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Besides its cardioinhibitory effects, short-acting beta1-adrenergic receptor antagonists, landiolol and esmolol are reported to exert antinociceptive and anesthetic sparing effects in animal and human subjects. For example, esmolol reduces the anesthetic requirements for skin incision during propofol/N2O and morphine anesthesia in human and inhibits nociceptive responses following formalin injection in rats. It is also suggested that landiolol decreases BIS response to tracheal intubation during sevoflurane anesthesia. ⋯ The merits to use short-acting beta1-adrenergic receptor antagonists as anesthetic adjuvants could be to reduce anesthetic and opioid requirements (thus, to avoid its side effects such as nausea and vomiting), to maintain hemodynamic stability, and to achieve early recovery from anesthesia. Administration of a sufficient dose of a short-acting beta1-adrenergic receptor antagonist, for example by neuraxial route, may potentially be a new treatment strategy for the perioperative pain, although further study is necessary to establish its efficacy and toxicity. Short-acting beta1-adrenergic receptor antagonists will be used as agents for antinociception in future.
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Occasionally emergence from anesthesia is delayed. We examined the factors which exert influence on the emergence time. ⋯ When the anesthesiologists keep in mind early emergence and become accustomed to this balanced anesthesia, the emergence time will be shorter, and the extubated cases in the operating room will increase.
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Remifentanil is a potent mu-opioid receptor agonist and has some unique pharmacokinetic characteristics compared to other anilidopiperidine opioids (e.g. fentanyl, alfentanil, and sufentanil). As remifentanil is metabolised rapidly by nonspecific esterases that are widespread throughout the plasma and tissuses, its duration of action is very short. It is cleared very rapidly, and its clearance is not affected by renal and hepatic function. ⋯ Consequently, emergence is quick even after anesthesia of long duration. As other piperidine opioids, remifentnil has some adverse effects such as respiratory depression, muscle rigidity, bradycardia, and nausea as well as vomiting. Because of the rapid dissipation of analgesic effect following remifentanil discontinuation, postoperative analgesia should be provided before or soon after anesthesia using longer-acting opioid analgesics, non-opioid analgesics, or local as well as regional anesthesia.