Journal of anesthesia
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Journal of anesthesia · Oct 2010
Case ReportsRisk of aspiration during anesthesia in patients with congenital insensitivity to pain with anhidrosis: case reports and review of the literature.
Congenital insensitivity to pain with anhidrosis (CIPA) is a rare autosomal recessive disease, characterized by episodes of unexplained fever, anhidrosis, pain insensitivity despite intact tactile perception, self-mutilating behavior, mental retardation, and autonomic nervous system (ANS) abnormalities. We present a case series of three patients with CIPA who underwent semielective orthopedic surgery under general anesthesia complicated by intraoperative regurgitation, and subsequent aspiration in two of the three cases. All three patients were nil per os (NPO) for at least 8 h prior to surgery. ⋯ We review the perioperative complications typically observed in patients with CIPA and discuss the risks of using an LMA in these patients. We recommend that patients with CIPA always should be considered as having a "full stomach", regardless of the duration of their NPO status, due to their coexisting ANS abnormalities. Therefore, rapid-sequence induction with an ETT should be utilized for the anesthetic management in every patient with CIPA.
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Journal of anesthesia · Oct 2010
Randomized Controlled TrialLow-dose continuous infusion of landiolol can reduce adrenergic response during tracheal intubation in elderly patients with cardiovascular disease.
The objective of this study was to examine the effects of low-dose infusion of landiolol on hemodynamics during tracheal intubation in elderly patients with cardiovascular disease. The study population consisted of 30 patients with American Society of Anesthesiologists physical status II and III, aged 65-77 years, who were scheduled to undergo elective surgery under general anesthesia. Patients were randomly divided into two groups (n = 15 each): a control group, receiving normal saline, and a landiolol group, receiving landiolol at 30 μg/kg/min. ⋯ General anesthesia was induced and maintained with target-controlled infusion of propofol at a blood concentration of 4 μg/ml and tracheal intubation was performed 3 min after vecuronium injection. Heart rate, blood pressure, and bispectral index were measured before and after tracheal intubation. Results showed that low-dose continuous infusion of landiolol is an effective and relatively safe method of preventing an intubation-induced adrenergic response in elderly patients with cardiovascular disease.
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Journal of anesthesia · Oct 2010
Randomized Controlled TrialRemifentanil increases the incidence of mesenteric traction syndrome: preliminary randomized controlled trial.
The use of remifentanil is often associated with the observation of mesenteric traction syndrome (MTS) soon after manipulation of the intestine during abdominal surgery. MTS symptoms include facial flushing, hypotension, and tachycardia. In the study reported here, we prospectively investigated the effects of remifentanil on the incidence of MTS in abdominal surgery. ⋯ The results of this study suggest that the use of remifentanil in laparotomy facilitates MTS.
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Journal of anesthesia · Oct 2010
Randomized Controlled TrialAnalgesic efficacy of topical tramadol in the control of postoperative pain in children after tonsillectomy.
Pain control after tonsillectomy is still a controversial issue. Topical approaches have the advantage of pain control with good patient acceptability. Therefore, this study was conducted to evaluate the effects of topical tramadol on postoperative pain and morbidity in children undergoing tonsillectomy. ⋯ Topical 5% tramadol with its local anesthetic effect seems to be an easy, safe, and comfortable approach for pain management in children undergoing tonsillectomy.
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Journal of anesthesia · Oct 2010
Randomized Controlled Trial Comparative StudyComparison of paravertebral block versus fast-track general anesthesia via laryngeal mask airway in outpatient inguinal herniorrhaphy.
Outpatient inguinal herniorrhaphy (IH) can be successfully performed under general, regional, or local anesthesia. In this study recovery profile, postoperative pain scores, incidence of adverse effects, and patient and surgeon satisfaction were compared between paravertebral block (PVB) and fast-track general anesthesia (GA) via laryngeal mask airway (LMA) for outpatient IH. ⋯ In outpatient IH, PVB with 0.5% levobupivacaine provided improved recovery, long-lasting analgesia, shorter recovery room stays, and earlier home readiness time than fast-track GA via LMA.