Anesthesia and analgesia
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Anesthesia and analgesia · Apr 2005
Clinical TrialHyperglycemia in patients administered dexamethasone for craniotomy.
Hyperglycemia should be avoided during neurosurgery in order to decrease the risk of neurological injury. Dexamethasone has been associated with increased blood glucose during surgery. In this prospective, nonrandomized study, we documented the blood glucose concentration changes for 12 h in 34 nondiabetic patients undergoing craniotomy and compared patients who received intraoperative dexamethasone (10 mg IV on induction and 4 mg IV 6 h later), with or without preoperative dexamethasone, with patients who did not receive dexamethasone. ⋯ Patients not taking dexamethasone before surgery, but who were given it intra- and postoperatively, had the largest peak blood glucose concentrations (11.0 +/- 2.0 mmol/L, mean +/- sd; P < 0.01) compared with patients who received no dexamethasone (7.8 +/- 2.1 mmol/L) or those who had been taking dexamethasone before surgery and continued it during surgery (8.5 +/- 1.2 mmol/L). The peak blood glucose concentrations in this group occurred 9 +/- 2 h after the induction of anesthesia. We recommend that the blood glucose concentration be monitored for at least 12 h in nondiabetic patients having neurosurgery who are newly administered dexamethasone.
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Anesthesia and analgesia · Apr 2005
The effects of cricoid pressure, remifentanil, and propofol on esophageal motility and the lower esophageal sphincter.
Cricoid pressure is the gold standard during the induction of anesthesia when there is a risk of aspiration of gastric contents. However, the effect of cricoid pressure during the different steps of complete anesthesia induction has not been studied. The purpose of this study was to investigate the effects of cricoid pressure, remifentanil, and propofol on lower esophageal sphincter (LES) and esophageal motility. ⋯ In conclusion, cricoid pressure of 30 N induced a decrease of LESP and BrP in awake volunteers. These effects were not seen during the remifentanil infusion. This shows the importance of when to apply cricoid pressure during rapid-sequence induction.
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Anesthesia and analgesia · Apr 2005
Guillain-Barré syndrome in a patient with pancreatic cancer after an epidural-general anesthetic.
Guillain-Barre syndrome is a rare occurrence in medicine and is probably rarer still as a postoperative complication. We report an uneventful operative course, during epidural-general anesthesia, in a patient undergoing pancreatectomy who presented with acute paralysis mimicking an acute cervical spinal cord syndrome or brachial plexus neuropathy. The signs and symptoms of right upper extremity paralysis occurred within 2 h postoperatively. Immediate work-up, which included magnetic resonance imaging, electromyography, and nerve conduction velocity studies, provided the diagnosis.