Articles: postoperative.
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Acta Anaesthesiol Scand · Apr 2015
Case ReportsMagnesium-induced recurarisation after reversal of rocuronium-induced neuromuscular block with sugammadex.
A 61-year-old woman (57 kg, 171 cm) underwent surgery under general anaesthesia with desflurane 5.8-6.1 vol. % end-tidal, remifentanil 0.2-0.4 μg/kg/min and rocuronium 35 mg (0.61 mg/kg). On return of the second twitch in the train-of-four (TOF) stimulation measured by acceleromyography, sugammadex 120 mg (2.1 mg/kg) was given. After complete neuromuscular recovery, magnesium sulphate 3600 mg (60 mg/kg) was injected intravenously over 5 min to treat atrial fibrillation. ⋯ Desflurane and a small fraction of unbound rocuronium may amplify the known muscle relaxing effects of magnesium. Intravenous injection of magnesium sulphate is not recommended in patients after general anaesthesia with neuromuscular relaxants, particularly after sugammadex reversal. Quantitative neuromuscular monitoring should be used for reversing aminosteroid muscle relaxants with sugammadex--particularly in combination with magnesium injection--to prevent post-operative residual curarisation.
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Acta Anaesthesiol Scand · Apr 2015
Randomized Controlled TrialOptimising abdominal space with deep neuromuscular blockade in gynaecologic laparoscopy - a randomised, blinded crossover study.
Insufflation of the abdomen during laparoscopy improves surgical space, but may cause post-operative shoulder pain. The incidence of shoulder pain is reduced using a lower insufflation pressure, but this may, however, compromise the surgical space. We aimed at investigating whether deep neuromuscular blockade (NMB) would enlarge surgical space, measured as the distance from the sacral promontory to the trocar in patients undergoing gynaecologic laparoscopy. ⋯ Deep NMB enlarged surgical space measured as the distance from the sacral promontory to the trocar. The enlargement, however, was minor and the clinical significance is unknown. Moreover, deep NMB improved surgical conditions when suturing the abdominal fascia.
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Minerva anestesiologica · Apr 2015
Observational StudyUltra-early decompressive hemicraniectomy in aneurysmal intracerebral haemorrhage: a retrospective observational study.
The rupture of an intracranial aneurysm leading to subarachnoid hemorrhage (SAH) is frequently complicated by an extensive intracerebral hematoma (ICH). ICH represents a factor that worsens clinical outcome either due to early or delayed critical increase of intracranial pressure (ICP). Data on the management of aneurysmal ICH are lacking. Besides the securing of the ruptured aneurysm, there is the option of decompressive surgery to prevent secondary damage. The aim of this study was to analyze feasibility of decompressive hemicraniectomy (DHC) and the impact of timing in patients suffering from aneurysmal SAH with extensive ICH. ⋯ Our data demonstrate that DHC is feasible in aneurysmal ICH. Timing appears to be a crucial factor concerning early and long-term control of ICP and outcome. We are therefore in favor of ultra-early DHC to treat especially poor grade patients with intracerebral mass lesion in aneurysmal hemorrhage to facilitate the ICP management as well as care within the ICU.
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Comparative Study
Neuraxial anesthesia improves long-term survival after total joint replacement: a retrospective nationwide population-based study in Taiwan.
This study explored the effects of general (GA) and neuraxial (NA) anesthesia on the outcomes of primary total joint replacement (TJR) in terms of postoperative mortality, length of stay (LOS), and hospital treatment costs. ⋯ Our results support the use of NA for primary TJR. The improvements in hospital costs persist even when anesthesia costs are removed. The mechanism underlying the association between NA and long-term survival is unknown.
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Postoperative pulmonary complications (PPCs) occur frequently among general surgical patients. The spectrum of illness is broad and includes preventable causes of morbidity and death. Careful preoperative evaluation can identify undiagnosed and undertreated illness and allow for preoperative intervention. Optimization of patient, surgical, and anesthetic factors is crucial in the prevention of PPCs.