Masui. The Japanese journal of anesthesiology
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Dexmedetomidine, a potent and highly selective alpha2-agonist, provides a unique "conscious sedation" (patients appear to be asleep, but are readily roused), analgesia, without respiratory depression. In order to provide a comfortable sedation to the ICU patients, careful evaluation of sedation and analgesia level, and the consistent treatment by medical teams are necessary. ⋯ The major problem with dexmedetomidine is its hemodynamic effects. Because this drug often causes hypotension, hypertension and bradycardia, it should be used under the control by skilled medical teams.
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Sugammadex, a chemically modified gamma-cyclodextrin, was synthesized as a selective reversal agent for rocuronium, a steroidal neuromuscular blocking agent. The lipophilic cavity of sugammadex molecule encapsulates the lipophilic steroid rings of rocuronium and forms 1:1 host-guest complex. Additionally, negatively charged carboxyl groups around the rim of cyclic sugammadex easily attract a positively charged quaternary nitrogen of rocuronium. ⋯ Therefore, undesired side effects attendant with anticholinesterases are not seen. No recurarization was also observed. The majority of the complexes is excreted via the kidney, but the reversal effects are complete even in patients with renal failure.
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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.
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It is important "to obtain cooperation of a patient" and "to practice efficiently" in paramedic intubation practice. In our hospital, we distribute a pamphlet at the time of informed consent acquisition and we present a letter of thanks after the practice. ⋯ By the time 5 paramedics have completed the practice period, the average time is 36.4 days, the rate of patient consent is 94% and the successful rate of intubation is 99%. The paramedic intubation practice is implemented relatively smoothly.