Journal of clinical anesthesia
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Review Case Reports
Acute, unanticipated, and prolonged superior vena cava occlusion during pneumonectomy.
Acute, unanticipated superior vena cava (SVC) occlusion during thoracic surgery can have profound hemodynamic consequences and lead to devastating neurologic injury. We describe the successful anesthetic management of a pneumonectomy complicated by prolonged intraoperative SVC occlusion lasting a total of 290 minutes. To our knowledge, this represents the longest reported SVC occlusion time with no subsequent neurologic sequelae. Based on our favorable outcome and a review of the relevant literature, we offer a discussion of strategies for anesthetic management.
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Anesthetic gases have been used for a long time. Adverse effects of anesthetic gases to occupationally exposed people have been well documented in the literature. Due to low solubility, these gases are rapidly eliminated from the human body. Nevertheless, neurotoxic, immunosuppressive, hepatotoxic and reproductive toxicological effects have been shown in many of the scientific works. However, there is no detailed systematic bio-monitoring review about genotoxicity risk among occupationally exposed people. We herein performed systematic review based on relevant studies. ⋯ Health care workers are exposed to wide variety of agents including biological, physical and chemical factors. Among them anesthetic gases seems to be deserve special attentions since their genotoxic, mutagenic activities. In addition, chronic exposure to all anesthetic gases instead of alone induces cumulative genotoxic effects.
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Randomized Controlled Trial Comparative Study
Operating room discharge after deep neuromuscular block reversed with sugammadex compared with shallow block reversed with neostigmine: a randomized controlled trial.
To determine if reversing a deep or moderate block with sugammadex, compared with a shallow block reversed with neostigmine, reduces the time to operating room discharge after surgery and the time spent in the postanesthesia care unit. ⋯ Maintaining a deep neuromuscular block during laparoscopic hysterectomy reversed at the end of the procedure with sugammadex enabled a faster and more predictable time till operating room discharge than did the classical combination of a shallower block reversed with neostigmine.
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Randomized Controlled Trial
Effects of low-dose propofol vs ketamine on emergence cough in children undergoing flexible bronchoscopy with sevoflurane-remifentanil anesthesia: a randomized, double-blind, placebo-controlled trial.
To determine the effects of low-dose ketamine and propofol on cough during emergence and the recovery period when administered at emergence in children undergoing fiberoptic bronchoscopy for bronchoalveolar lavage (FOBL) with sevoflurane-remifentanil anesthesia. ⋯ Ketamine or propofol given at the end of sevoflurane-remifentanil general anesthesia in children undergoing FOBL did not decrease cough more than normal saline during the emergence period. Ketamine and propofol, compared to normal saline, had a beneficial effect on decreasing the incidence of emergence delirium. Ketamine lengthened recovery time.
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Observational Study
Preoperative depressed mood and perioperative heart rate variability in patients with hepatic cancer.
How perioperative heart rate variability (HRV) indices differ according to the anxiety or depressed mood of patients scheduled to undergo a major surgical procedure for cancer. ⋯ HRV decreased significantly immediately before anesthesia and recovered to baseline with anesthetic induction. Preoperative, more depressed patients showed increased sympathetic tone at baseline and blunted response to impending anesthesia on the HRV measurements.