Masui. The Japanese journal of anesthesiology
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The incidence of perioperative pulmonary thromboembolism (PTE) is reported not to be low in Japan. The aim of this study is to investigate the incidence and characteristics of perioperative PTE in Japan in 2004. ⋯ The incidence of perioperative PTE was not low and its mortality was high in Japan in 2004. In particular, the incidence of perioperative PTE was found to be high in females, the elderly, patients with malignancy, and patients who had undergone orthopedic surgery.
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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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Review
[New ultra-short-acting beta-blockers: landiolol and esmolol--the effects on cardiovascular system].
Esmolol and landiolol are ultra-short-acting intravenous beta-blockers. Both drugs have high cardioselectivity (beta1/beta2 selectivity of esmolol : 33, landiolol: 255) and short elimination half time (esmolol : 9 min, landiolol : 4 min). Since the duration of beta-adrenergic blockade is short and cardioselectivity is high compared with traditional intravenous beta-blocker propranolol, both drugs are titrated easily. ⋯ There are not many clinical trials on landiolol. However, since landiolol has higher cardioselectivity and tends to have less cardiodepressant effect than esmolol, clinical indication of landiolol may be extended. Additional data from large studies are required to evaluate the clinical efficacy and safety of landiolol for a variety of diseases.
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Randomized Controlled Trial Multicenter Study
[Randomized, multicenter study of interaction between Org 9426 (rocuronium bromide) and anesthetic agents in Japanese population].
The purpose of this randomized, multi-center phase III trial was to investigate the influence of sevoflurane and propofol on the neuromuscular blocking effects and pharmacokinetic parameters of Org 9426 (rocuronium bromide) in Japanese population. ⋯ The duration of Org 9426-induced neuromuscular blockade was significantly increased under sevoflurane anesthesia compared to propofol anesthesia. This difference may be attributed to pharmacodynamic change.
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For many years, much effort has been done to develop non-depolarizing neuromuscular blocking agents of rapid onset and short duration. It has been shown that rocuronium bromide is a nondepolarizing, steroidal muscle relaxant with fast onset and short-to-intermediate duration of action. In addition, rocuronium-induced neuromuscular blockade can be readily and consistently reversed following the administration of reversal agents. The pharmacology and pharmacodynamics of rocuronium bromide are summarized in this review.