Journal of anesthesia
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Journal of anesthesia · Jan 2007
Randomized Controlled Trial Comparative StudyA comparison of intravenous-based and epidural-based techniques for anesthesia and postoperative analgesia in elderly patients undergoing laparoscopic cholecystectomy.
We wished to compare the effectiveness of intravenous-based (IV) and epidural-based (EPI) techniques for anesthesia and postoperative analgesia in elderly patients undergoing laparoscopic cholecystectomy. Effectiveness was compared in terms of reduction of postoperative pain and adverse events, and achieving a high level of patient satisfaction. ⋯ Modified neurolept anesthesia with pentazocine and postoperative i.v. analgesia with buprenorphine were superior to epidural-based techniques, in terms of hemodynamic stability and patient satisfaction, in elderly patients undergoing laparoscopic cholecystectomy.
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Journal of anesthesia · Jan 2007
ReviewAdvances in obstetric anesthesia: anesthesia for fetal intrapartum operations on placental support.
Fetal intrapartum operations on placental support (OOPS), also known as ex-utero intrapartum treatment (EXIT) procedures, are very rare (and often challenging) surgical techniques designed to allow partial delivery (cesarean section) of a fetus with a potentially difficult airway, with subsequent management of the neonatal airway (direct laryngoscopy, fiberoptic bronchoscopy, or tracheostomy) while oxygenation is continuously maintained via the placenta (on placental support). The peripartum management of pregnant women and their fetuses undergoing OOPS is very complex and multidisciplinary, and differs greatly from that of standard cesarean sections. The goal of this article is to review the current recommendations for the peripartum anesthetic management of pregnant women carrying fetuses with fetal congenital malformations undergoing OOPS.
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Journal of anesthesia · Jan 2007
Randomized Controlled Trial Comparative StudyEfficacy of a heat and moisture exchanger in inhalation anesthesia at two different flow rates.
In general anesthesia with endotracheal intubation, a circle system with a heat and moisture exchanger (HME) and a low total flow is often used to prevent hypothermia and to maintain inspired gas humidity. The purpose of the present study was to compare the inspired gas humidity and body temperature, in general anesthesia with or without an HME at two different total flow rates. Eighty patients (American Society of Anesthesiologists [ASA] I or II) scheduled to undergo either orthopedic or head and neck surgery were studied. ⋯ Group 4L had significantly lower absolute humidity than group 2L. The pharyngeal temperature did not decrease significantly for 2 h in any of the groups. During general anesthesia with a total flow of 2 lxmin(-1) in 2 h, HME might not be necessary, while with a total flow of 4 lxmin(-1), HME could be useful to maintain inspired gas humidity.
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Journal of anesthesia · Jan 2007
Case ReportsSedation for endoscopic retrograde cholangiopancreatography (ERCP) in a pregnant patient.
Anesthesiology management of endoscopic retrograde cholangiopancreatography (ERCP) in the twenty-first week of pregnancy of a woman patient is reported. The patient gave birth to a healthy male baby at 40 weeks of gestation.
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We compared jugular venous blood oxygen saturation (Sj(O) (2)) and the arterial-to-jugular-bulb venous oxygen content difference (AjD(O) (2)) between bispectral index (BIS) values of 40 and 60, adjusted by the infusion rate of propofol. Eighteen postoperative neurosurgical patients (Glasgow Coma Scale [GCS] scores, 11-15) were enrolled. Normocapnia, normothermia, and a mean arterial blood pressure greater than 70 mmHg were maintained. ⋯ Sj(O) (2) at BIS40 (58 +/- 9%) was significantly (P < 0.01) lower than that at BIS60 (63 +/- 10%), and AjD(O) (2) at BIS40 (6.3 +/- 1.5 ml.dl(-1)) was significantly (P < 0.01) higher than that at BIS60 (5.7 +/- 1.5 ml.dl(-1); mean +/- SD). At BIS40, status defined as Sj(O) (2) less than 50% was observed in 3 patients, while this status was observed in 1 patient at BIS60. In conclusion, in patients with postoperative neurosurgical surgery (GCS scores, 11-15), decreases of propofol infusion to adjust the BIS value from 40 to 60 increase the cerebral oxygen balance.