Journal of clinical anesthesia
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Case Reports
Presentation of dapsone-induced methemoglobinemia in a patient status post small bowel transplant.
Methemoglobinemia, an uncommon hemoglobinopathy, affects oxygen transport, causing tissue hypoxia. In the perioperative period, methemoglobinemia is often overlooked as a cause of low oxygen saturation, often mistaken for the more common causes of hypoxia, such as atelectasis, pulmonary edema, or pulmonary embolus, among other causes of respiratory failure. Most cases of methemoglobinemia in the perioperative period are precipitated by local anesthetics, especially benzocaine. ⋯ It is commonly used in organ transplant patients, especially those intolerant to sulfa. With the expansion of organ transplantation and improved long-term survival of these patients, presentation of status post organ transplant patients for surgery will inevitably increase. We report a case of dapsone-induced methemoglobinemia observed in a status post small bowel transplant patient in the postanesthesia care unit.
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Randomized Controlled Trial Comparative Study
Comparison of conscious sedation for oocyte retrieval between low-anxiety and high-anxiety patients.
To investigate the correlation among the level of anxiety, the intravenous propofol requirement for conscious sedation, and recovery profile in in vitro fertilization patients. ⋯ The high-anxiety group needs more sedative requirement of propofol for conscious sedation than the low-anxiety group. Thus, we suggest that propofol dose for such sedation must take into account the individual patient's anxiety level when propofol is administered by an anesthesiologist for oocyte retrieval.
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Randomized Controlled Trial
Choice of volatile anesthetic for the morbidly obese patient: sevoflurane or desflurane.
Morbid obesity is associated with significant comorbidities. Desflurane has a low fat-blood solubility coefficient and may be better suited in this population to achieve a rapid emergence; however, sevoflurane has favorable cardiorespiratory properties that might also prove advantageous in the morbidly obese (MO) patient. This study used careful drug titration to determine if emergence differences between sevoflurane and desflurane could be minimized in MO patients. ⋯ There were no differences in emergence and recovery profiles in MO patients receiving desflurane or sevoflurane when anesthetic concentration was carefully titrated.
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Randomized Controlled Trial
The effect of tramadol on serum cytokine response in patients undergoing pulmonary lobectomy.
To investigate the effect of tramadol on the production of serum interleukin (IL) 6, IL-10, and IL-2 and soluble (s) IL-2 receptor (R), thereby evaluating its effects on the proinflammatory and anti-inflammatory responses and immune function in cancer patients undergoing conventional pulmonary lobectomy. ⋯ IV infusion of tramadol does not seem to alter IL-6/IL-10 cytokine response to pulmonary lobectomy. As tramadol was associated with increased IL-2 and delayed enhancement of sIL-2R in our study, it may attenuate to some extent an impaired immune response in pulmonary lobectomy.