Journal of clinical anesthesia
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Randomized Controlled Trial
Preoperative paracetamol improves post-cesarean delivery pain management: a prospective, randomized, double-blind, placebo-controlled trial.
To evaluate the analgesic effect of preoperative single dose intravenous paracetamol on postoperative pain and analgesic consumption within 24hours after elective cesarean surgery. ⋯ Preoperative use of single-dose intravenous 1g paracetamol was found to be effective in reducing the severity of pain and opioid requirements within 24hours after cesarean section.
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Observational Study
Recovery of laryngeal nerve function with sugammadex after rocuronium-induced profound neuromuscular block.
The aim of this study was to evaluate the efficacy of sugammadex in reversing profound rocuronium-induced neuromuscular block at the laryngeal adductor muscles using motor-evoked potentials (mMEPs). ⋯ Recovery from profound rocuronium-induced block on the larynx is fast and complete with sugammadex. In urgent scenarios, "early" extubation can be performed, even with a TOF ratio ≤0.9. However, all procedures to prevent postoperative residual curarization should still be immediately undertaken.
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Case Reports
Disseminated Staphylococcus aureus infection following spinal anesthesia: a case report.
We here presented a 65-year-old woman with disseminated Staphylococcus aureus infection following spinal anesthesia. The patient underwent spinal anesthesia for great saphenous vein stripping. Twenty days after the procedure, the patient developed hydrocephalus, pulmonary infection, and epidural abscess. ⋯ Appropriate antibiotic therapy and prompt surgical abscess drainage were associated with good outcome. Hydrocephalus is thought to be associated with arachnoiditis caused by S aureus infection, which provides new insights into the pathophysiology of arachnoiditis. Here we reported a case of disseminated S aureus infection following spinal anesthesia, implicating that appropriate interventions should not be delayed for waiting for the microbiological results.
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Case Reports
Cardiac arrest during radical nephrectomy due to a mass in the right ventricular outflow tract.
We report cardiac arrest due to obstruction of the right ventricular outflow tract (RVOT) caused by an RVOT mass that was not identified preoperatively. A 62-year-old woman with renal cell carcinoma (RCC) experienced deteriorating hypotension and bradycardia during radical nephrectomy. Hemodynamic stability was maintained on extracorporeal membrane oxygenation, and after surgery, she was transferred to the intensive care unit. ⋯ Our findings suggest that it may be necessary to perform additional tests if RCC has invaded the renal vein and inferior vena cava or if a patient with RCC has abnormal cardiovascular symptoms without definite etiology for exclusion of cardiac metastasis or tumor thrombus. In addition, intraoperative transesophageal echocardiography might be the procedure of choice for the evaluation of these conditions because other diagnostic tests are difficult to perform during surgery. In conclusion, for patients with acute hemodynamic instability for whom other possible causes have been excluded, we recommend that anesthesiologists use transesophageal echocardiography to detect outflow tract obstruction or pulmonary thromboembolism and perform anesthetic management.
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Randomized Controlled Trial
Efficacy of premedication with intranasal dexmedetomidine on inhalational induction and postoperative emergence agitation in pediatric undergoing cataract surgery with sevoflurane.
This study aimed to test the hypothesis that premedication with a single dose of intranasal dexmedetomidine (DEX) could not only reduce preoperative anxiety but also minimize the emergence agitation in children undergoing cataract surgery with sevoflurane anesthesia. ⋯ Intranasal DEX (1 or 2 μg/kg) dose independently improves the incidences of mask acceptance and prevents the incidences of postoperative emergency agitation mainly from sevoflurane without delaying the emergency time or inducing severe adverse events.