Masui. The Japanese journal of anesthesiology
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General anesthesia using remifentanil is accompanied with post-operative shivering at a high incidence. Post-operative shivering can be divided into thermoregulatory and non-thermoregulatory. Hypothermia causes thermoregulatory shivering. ⋯ Thus, opioid transition using fentanyl and/or morphine during anesthetic management is essential for the prevention of non-thermoregulatory shivering. It is also reported that magnesium, ketamine and pethidine have preventive effects on non-thermoregulatory shivering. The mechanism underlying post-operative shivering associated with general anesthesia using remifentanil is very complicated; therefore, we speculate that multimodal approach is required for its prevention.
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Ultrasound-guided neuraxial block has provided safe and accurate analgesia. Although the classic anatomical landmark technique is still standard for completing epidural or subarachnoid puncture, it is difficult to identify the anatomical structure in some cases such as pregnant women, obese patients and patients with spinal deformity. Preparatory ultrasound scanning enables to identify the midline and determine the point of insertion, which reduces the number of puncture attempts and failure rate of procedure. ⋯ Cerebrospinal puncture is an important procedure for diagnosis of some critical conditions such as subarachnoid hemorrhage and central nervous system infections. Ultrasound imaging contributes to smooth procedure and fewer complications. This review summarizes the basic ultrasound-guided technique for expected difficult neuraxial block patients, presenting recent findings.
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Ultrasound guidance for regional anesthesia has gained enormous popularity in the past decade. The usage of ultrasound guidance has reawaken many block techniques in daily clinical practice. In this review, the author described how the ultrasound guidance has changed the manner of intraoperative and postoperative analgesic methods. ⋯ Those success rates increased using sonography, whereas the complications decreased. Advanced sonography shows the clear images of the detailed nerve tissues, so that we can perform the more pin-pointed nerve block considering postoperative benefits of patients. However, it must never be forgotten that both the pre-scan examination before a needle insertion and the continuous watching of an advancing needle tip are essential to perform safer regional anesthesia techniques.
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We report on the development of a simulation-based sedation training course (SEDTC). Participants were doctors and medical staff, such as operating room nurses. During the course, we identified issues that medical staff confront in the operating room (OR). ⋯ At the end of the course, participants discussed problems associated with sedation and provided input regarding sedation safety. Participants commented not only on changes in their views regarding sedation, but also on general medical safety in the OR. Our findings suggest that the SEDTC may serve as a vehicle to promote safety with respect to sedation and analgesia.
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We examined the effects of preoperatively administered phenytoin and carbamazepine on rocuronium-induced neuromuscular block under sevoflurane anesthesia in this retrospective clinical study. When compared to patients without anticonvulsant therapy (n = 16), the recovery index (i.e., the time required from 25% of spontaneous return of T1 to 75% of spontaneous return of T1) was significantly lower in patients with anticonvulsant therapy using carbamazepine and/ or phenytoin (n = 17); however, no significant dose-dependent effects of carbamazepine as well as phenytoin on the recovery index were detected. Further studies are required to elucidate the mechanisms underlying the modifying effects of carbamazepine and phenytoin on pharmacokinetics and pharmacodynamics of rocuronium.