Masui. The Japanese journal of anesthesiology
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Randomized Controlled Trial Clinical Trial
[The antiemetic effect of dexamethasone during continuous subcutaneous infusion of morphine for postoperative pain relief].
Dexamethasone is known to reduce the incidence of postoperative nausea and vomiting, associated with perioperative intrathecal, epidural, or intravenous morphine. However, the effect of dexamethasone on subcutaneous morphine is unclear. Therefore, we evaluated the antiemetic effect of intravenous dexamethasone during continuous subcutaneous infusion of morphine for postoperative pain relief. ⋯ Our results suggest that the single dose of dexamethasone (8 mg) does not reduce postoperative nausea and vomiting associated with continuous subcutaneous infusion of morphine after spinal surgery.
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Intracranial subdural haematoma has been reported to be an exceptionally rare complication of accidental dural puncture. An accidental lumbar dural puncture occurred in a 36-yr-old male undergoing orthopedic knee surgery. On the morning after the operation, the patient complained of severe occipital headache, although this was relieved with loxoprofen and rest. ⋯ The patient was managed conservatively with bed rest and intravenous fluids. His condition improved without surgical decompression and was discharged on the 40 th day after the operation. Severe and prolonged PDPH shoud be considered as a warning sign of an intracranial complication.
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Recently, a national survey in France including 35,439 patients who had received spinal anesthesia showed that the incidences of cardiac arrest and mortality associated with spinal anesthesia were 2.5 and 0.8 per 10,000 anesthetics, respectively. In this study, we investigated these values using data obtained from annual surveys conducted by the Japanese Society of Anesthesiologist (JSA). ⋯ The incidence of cardiac arrest and mortality associated with spinal anesthesia in Japan was shown to be in the same order as in France by analyzing a larger population. In patients with good ASA-PS, critical incidents occurred more often under regional anesthesia than under general anesthesia. Inadvertent high spinal anesthesia should be carefully avoided. We should also pay much attention to subclinical deep vein thrombosis in patients who were scheduled for hip or lower extremity surgery, and tourniquet- or bone cement-associated pulmonary embolism in these patients.
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There are some reports on the incidence of awareness during general anesthesia that is usually stable at the maintenance period. The aim of this study is to evaluate the incidence of awareness during the induction period of general anesthesia in which the effects of anesthetics are unstable. ⋯ The incidence of awareness during the induction was 0.36%. We have to pay more attention to the disappearance of the hypnotic effect at the induction period.
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It is important to control heart rate for coronary artery bypass grafting. The purpose of this study was to evaluate the effects of landiolol hydrochloride, ultra-short-acting beta-blocker, on cardiohemodynamics in 10 patients who underwent coronary artery bypass grafting. ⋯ These results suggest that landiolol hydrochloride possesses less negative inotropic action than negative chronotropic action. Landiolol hydrochloride did not affect both systemic and pulmonary vascular resistances because of high cardioselectivity.