Journal of clinical anesthesia
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Controlled Clinical Trial
Effects of mild hypoalbuminemia on the pharmacokinetics and pharmacodynamics of dexmedetomidine in patients after major abdominal or thoracic surgery.
To explore the effects of mild hypoalbuminemia on pharmacokinetics and pharmacodynamics of dexmedetomidine in patients after major abdominal or thoracic surgery. ⋯ Sedation and adverse reactions of dexmedetomidine infusion did not differ significantly between patients with mild hypoalbuminemia and normoalbuminemia, although its volume of distribution at steady state increased and elimination half-life shortened in patients with hypoalbuminemia. This suggests that dexmedetomidine infusion can safely be used in mild hypoalbuminemia patients after major abdominal or thoracic surgery.
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We report the case of a 6-year-old boy who developed a supraventricular tachycardia during an upper endoscopy while under general anesthesia. A noninvasive electrical cardiometry device was applied to the patient, and cardiac index and stroke volume were measured before and after the administration of adenosine. Cardiac index fell 41% (P < .0001) after adenosine was given, highlighting the known interdependence between cardiac output and heart rate in the pediatric patient. Stroke volume decreased 9% (P = .0002) after adenosine arrested the tachycardia, lending support to an increasing body of data that suggests that heart rate itself can augment contractility.
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To assess whether the use of intraoperative opioids is associated with poor recurrence-free survival (RFS) and overall survival (OS) after lung cancer surgery. ⋯ Our study demonstrates a very weak association between the use of intraoperative opioids and cancer recurrence after laryngeal squamous cell carcinoma surgery.
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Accidental dural puncture (ADP) is known as a complication of epidural anesthesia. Although puncture site and advanced age have been reported to increase the risk of ADP, all related factors have not been fully investigated. We retrospectively investigated factors related to ADP in patients undergoing surgery. ⋯ Accidental dural puncture occurred in 0.49% of all surgical patients undergoing epidural anesthesia and was significantly related to those who received a puncture in lower thoracic and lumbar intervertebral spaces, whereas age was also an independent factor.
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Outpatient continuous interscalene brachial plexus blocks containing bupivacaine or ropivacaine are commonly used to control pain after shoulder surgery. Interscalene blocks cause hemidiaphragmatic paresis. Because ropivacaine preferentially blocks sensory fibers, it may cause less blockade of the phrenic nerve. The purpose of this study was to evaluate the effects of 2 common continuous interscalene brachial plexus infusions: 0.125% bupivacaine vs 0.2% ropivacaine. The study hypothesis is that respiratory function will be less attenuated using ropivacaine than bupivacaine without affecting pain relief. ⋯ There was no difference in respiratory dysfunction or opioid requirements between interscalene continuous peripheral nerve blocks with 0.125% bupivacaine or 0.2% ropivacaine. Further study is required to identify anesthetic infusates that will control pain while decreasing the attenuation of pulmonary function.