Masui. The Japanese journal of anesthesiology
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Acute Respiratory Distress Syndrome (ARDS) is a life threatening condition. There are several randomized placebo controlled trials (RCT) that tested ventilated and non-ventilated patient managements. Among them, only ARMA trial that compared mortality and ventilator free-days between low tidal volume ventilation and conventional ventilation (6 and 12 ml x kg(-1) predicted body weight, respectively) showed differences (31.0% vs., 39.8%, P = 0.007 and 12 +/- 11 vs. 10 +/- 11 days, P = 0.007, respectively). ⋯ Methylprednisolone iv administration starting between 7 and 13 days of the onset of ARDS increased the number of ventilator-free days and shock-free days; whereas, methylprednisolone treatment starting more than two weeks after the onset of ARDS increased the risk of death. There are no RCTs that positively showed the improvement in mortality by using any therapeutic agent. Based on basic science studies, molecules that enhance epithelial and endothelial cell proliferation and the therapies targeting on septic pathophysiology would be the target for future strategies.
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Frequency of using nitrous oxide (N2O) in anesthetic field decreased recently by the influence of the environmental problems and the widespread use of intravenous agents. In dental treatment, however, inhalation sedation using low concentration of N2O has been effectively used to relax dental patients. Nitrous oxide inhalation sedation for dental treatment generally involves the use of a combination of low-dose N2O and high-dose oxygen. ⋯ Also, high-dose oxygen would contribute to manage "(pre) syncope" due to pain stimuli. Thus, N2O inhalation sedation is effective for the dental treatment, although the leak of N2O affects the health of dental staffs. The present review described the advantage and harmful effects of N2O in dental management.
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Sodium bicarbonate has been standard therapy for the treatment of acidosis. In lactic acidosis and hypercapnic acidosis, however, there is no clinical data supporting its effectiveness. We reviewed the literature of the efficacy of sodium bicarbonate on lactic acidosis and hypercapnic acidosis. ⋯ Conversely, acidosis or hypercapnia might be protective in acute lung and systemic organ injury. Therefore, the unprepared use of bicarbonate might be harmful in terms of fluid and sodium overload and excess lactate concentrations. According to current literature, we cannot recommend sodium bicarbonate administration for patients with lactic acidosis and hypercapnic acidosis.
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Bad anesthesia management easily causes mal-temperature situation. Main consequence of it is hypothermia as defined core temperature less than 36 degrees C and the other one is hyperthermia. ⋯ Other than that, hypothermia may provoke many complications after surgery including higher rate of wound infection, longer duration of hospitalization, more morbid cardiac events, prolongation of drug effects, more postoperative shivering, and delayed post anesthetic recovery. This review article discusses the mal-temperature management during surgery.
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To prevent catheter-related bloodstream infections (CRBSI), the use of maximal sterile barrier precautions (MSBP) during central venous catheter insertion, using a cap, mask, sterile gown, sterile gloves, and a large sterile sheet, was recommended in the Centers for Disease Control and Prevention Guidelines. However, this recommendation is based on the evidence obtained by only one randomized controlled trial (RCT) in which the subject patients were outpatients for chemotherapy. Nevertheless, the recommendation is applied to any kind of clinical settings. ⋯ There were 5 out of 211 cases (2.4%) of CRBSI in the MSBP group and 6 out of 213 cases (2.8%) in the SSBP group (P = 0.77). These results suggest that further RCTs should be necessary in many clinical settings to reach a conclusion on this issue. We also address other evidences regarding prevention of CRBSI in this review.