Masui. The Japanese journal of anesthesiology
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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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Hyperglycemia is common in critically ill patients with approximately 90% of patients treated in an intensive care unit (ICU) developing blood glucose concentrations greater than 110 mg x dl(-1). Recently the international multicentre NICE-SUGAR study reported increased mortality with adopting intensive glucose control for critically ill patients and recent meta-analyses do not support this approach. ⋯ Unresolved issues include whether increased blood glucose variability is inherently harmful and whether even moderate hypoglycemia can be tolerated in the quest for tighter blood glucose control. Until another level I evidence will be available, clinicians would be well advised to hasten slowly and abide by the age-old adage to "first, do no harm".
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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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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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GlideScope videolaryngoscope (GVL) is a novel indirect laryngogoscope for tracheal intubation. Both mid-size and large blades of the GVL are available for adult patients. The distortion of the anterior airway anatomy and cervical spine motion using the mid-size GVL is unknown. We compare the degree of anterior airway distortion and cervical spine movement during the use of the mid-size GVL compared with the large GVL. ⋯ The tip of the mid-size GVL during laryngoscopy is anteriorly positioned and the distortion of the anterior airway was greater with the mid-size GVL than with the large GVL.