Masui. The Japanese journal of anesthesiology
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Randomized Controlled Trial Comparative Study
[Postoperative management of carotid endarterectomy with dexmedetomidine--a comparison with propofol].
We compared dexmedetomidine (DEX) with propofol (PRO) in patients requiring sedation after carotid endarterectomy (CEA) in the intensive care unit (ICU). Incidence of hyperperfusion syndrome, the sedative and analgesic properties, cardiovascular responses, and ventilation characteristics were discussed. ⋯ DEX is a safe and acceptable sedative agent for patients requiring sedation after CEA in the ICU; however, further studies are needed to assess the appropriate sedative doses of DEX.
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We experienced anesthesia care for two patients taking methylphenidate (Ritalin), which is a central nervous system stimulant of amphetamine analogues, usually administered for narcolepsy or refractory depression. The proper dose of methylphenidate is 20-60 mg per day. ⋯ Both cases needed more anesthetics than usual on induction, but very stable condition could be maintained during and after the operations. We consider that it is possible to perform general anesthesia safely for patients taking a usual dose of methylphenidate.
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A 22-year-old male patient with autism and epilepsy was scheduled to undergo impacted third molar extractions at an outpatient setting. Oral preanesthetic medication with dexmedetomidine and subsequent midazolam with ketamine was acceptable and effective to place intravenous cannula. ⋯ He recovered from postoperative sedation and was discharged home without significant problems. Oral and intravenous dexmedetomidine was useful for anesthetic care in the uncooperative patient.
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The Macintosh laryngoscope has been a gold standard for endotracheal intubation over 60 years. However, even with optimum technique used, the glottis can not be seen in 1-3% of the cases with Macintosh blade resulting in difficult intubation. ⋯ Recently, supported by advancement of optical technology, many intubation devices combined with endoscope, fiber optics or video system have become commercially available. These devices can visualize the vocal cord to facilitate intubation These new video/endoscopy assisted airway devices are introduced in this review.
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Dexmedetomidine (DEX) is a selective alpha-2 adrenergic agonist that has been used clinically for its analgesic and sedative effects. We report a case of awake intubation with DEX. A 38-year-old male patient with 130 kg in weight, 170 cm in height and with a body mass index of 45 presented with thoracic myelopathy and progressive bladder and bowel control difficulties. ⋯ At the start of laryngoscopy, the patient had a Ramsay sedation score of 6. It was found by pharmacokinetic simulation analysis that the plasma concentration of DEX at intubation was 5.6 ng x ml(-1). We concluded that DEX is a reasonable medication during awake intubation, although further investigations with regard to its safety are required.