Articles: postoperative.
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Anesthesia and analgesia · Apr 2014
Dexamethasone produces dose-dependent inhibition of sugammadex reversal in in vitro innervated primary human muscle cells.
Corticosteroids are frequently used during anesthesia to provide substitution therapy in patients with adrenal insufficiency, as a first-line treatment of several life-threatening conditions, to prevent postoperative nausea and vomiting, and as a component of multimodal analgesia. For these last 2 indications, dexamethasone is most frequently used. Due to the structural resemblance between aminosteroid muscle relaxants and dexamethasone, concerns have been raised about possible corticosteroid inhibition in the reversal of neuromuscular block by sugammadex. We thus investigated the influence of dexamethasone on sugammadex reversal of rocuronium-induced neuromuscular block, which could be relevant in certain clinical situations. ⋯ This is the first report in which the effects of rocuronium and sugammadex interactions with dexamethasone have been studied in a highly accessible in vitro experimental model of functionally innervated human muscle cells. Sugammadex reverses rocuronium-induced neuromuscular block; however, concomitant addition of high dexamethasone concentrations diminishes the efficiency of sugammadex. Further studies are required to determine the clinical relevance of these interactions.
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The aim of this study was to characterize patients readmitted following inpatient general surgery procedures. We hypothesized that a decreased length of stay would increase risk for readmission. ⋯ Contributors to postoperative readmissions are multifactorial. Perioperative factors predict risk for readmission and may help determine a target length of stay. Prevention of postoperative complications may reduce readmission rates.
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Comment
From the Journal archives: Be alert to the risk of unexpected prolonged postoperative hypoxemia!
In 1978, Drs. R Knill and A. Gelb published the results of a study to measure the effect of subanesthetic levels of halothane on the ability of fit volunteers to respond to sustained hypoxia, and to determine how long potentially hazardous levels of halothane persist after a brief non-complex surgical procedure in healthy patients. The purpose of this commentary is to highlight the historical context of their findings and the impact of their work on our modern day practice of anesthesia. ⋯ Subanaesthetic halothane: Its effect on regulation of ventilation and relevance to the recovery room. Can Anaesth Soc J 1978; 25: 488-94.
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Perphenazine is a treatment option in postoperative nausea and vomiting (PONV) prophylaxis. Chronic administration and high dose are known to cause extrapyramidal system (EPS) dysfunction at a frequency of 8%, but the incidence of acute EPS after a single 4 or 8 mg dose is unknown. ⋯ Given the infrequent side effects, this single, low dose of perphenazine should be encouraged as a low-risk adjunct to any multimodal PONV prophylaxis regimen, based on the selection criteria described.
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This article reports a case of massive postoperative pneumocephalus in a patient following general anesthesia for a urological procedure. The patient had sustained a severe head injury more than 10 years ago with long-term treatment in an intensive care unit (ICU) including decompressive craniectomy, tracheostomy followed by rehabilitation, decanulation and cranioplasty. The patient recovered but suffered severe hemiparesis and mild neurocognitive deficits. ⋯ A cranial computed tomography (CT) scan revealed massive intracranial air and frontobasal skull defects. After frontobasal reconstruction, removal of an old lumboperitonal shunt and placement of a ventriculoperitoneal shunt, intracranial air was no longer observed. In summary a frontobasal injury may become symptomatic many years after injury, especially when face mask ventilation with positive pressure is applied during surgical interventions.