Journal of anesthesia
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Journal of anesthesia · Jan 2008
Membrane effect of lidocaine is inhibited by interaction with peroxynitrite.
Inflammation is clinically well known to decrease the efficiency of local anesthesia, an effect which has been explained mechanistically by tissue acidosis in the literature. However, recent studies offer no support to such a pharmacopathological background for anesthetic failure. Because inflammatory cells produce significant amounts of peroxynitrite, the peroxynitrite could interact with local anesthetics to decrease their effects. ⋯ Although lidocaine, at a clinically relevant concentration, fluidized liposomal membranes, its fluidizing potency was reduced to 43.6 +/- 4.4% and 58.4 +/- 7.5% of that in membranes without peroxynitrite when membranes were pretreated with 50 and 250 microM peroxynitrite, respectively, for 15 min. A significant inhibition of membrane fluidization of 27.5 +/- 6.8%, was also observed after reaction for 5 min. Peroxynitrite released by inflammatory cells may affect local anesthesia through a possible interaction with lidocaine, inhibiting its membrane-fluidizing effect.
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Journal of anesthesia · Jan 2008
Case ReportsSpinal epidural hematoma following epidural catheter removal during antiplatelet therapy with cilostazol.
A 90-year-old man underwent emergency thrombectomy for acute occlusion of the right femoral and popliteal arteries. After an epidural catheter (used for intraoperative/postoperative management) was removed, a spinal epidural hematoma involving the Th12 to L3 areas developed. ⋯ This case may be the first report of spinal epidural hematoma associated with both cilostazol and epidural anesthesia. From the time course in this patient, important knowledge of drug actions and follow-up may be gained for determining the timing of catheter removal in a patient receiving antiplatelet therapy with cilostazol.
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Journal of anesthesia · Jan 2008
Monitoring of vecuronium-induced neuromuscular blockade during one-lung ventilation.
We investigated the monitoring of neuromuscular blockade caused by vecuronium in patients receiving one-lung ventilation (OLV) anesthesia for lung surgery. ⋯ During OLV for lung surgery, recovery of T1/control is accelerated in anesthetized patients receiving vecuronium.
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Journal of anesthesia · Jan 2008
Case ReportsAnesthetic management of a pediatric patient with severe Williams-Campbell syndrome undergoing surgery for giant ovarian tumor.
We performed anesthetic management for a patient with severe Williams-Campbell syndrome, which is a congenital deficiency of cartilage in the subsegmental bronchial tree. An 11-year-old girl with this syndrome had labored breathing because of abdominal distension caused by a giant ovarian tumor, and removal of the tumor was scheduled. Because she had been receiving home oxygen therapy for 10 years due to hypoxia, it was possible that positive-pressure ventilation may have increased the risk of perioperative pulmonary complications. ⋯ We placed an epidural catheter and induced spinal anesthesia blockade under general anesthesia as the main analgesia technique, in order to maintain spontaneous breathing. The surgery was completed uneventfully and the patient emerged from anesthesia without dyspnea. She had an uneventful recovery and was discharged home.