Journal of anesthesia
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Journal of anesthesia · Apr 2010
Monitoring masseter muscle evoked responses enables faster tracheal intubation.
The aim of this study was to investigate whether monitoring neuromuscular block at the masseter muscle (MM) would allow faster tracheal intubation when compared with that at the adductor pollicis muscle (APM). ⋯ Tactual evaluation of muscle paralysis of the MM during induction of anesthesia is clinically useful since it leads to faster tracheal intubation.
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Journal of anesthesia · Apr 2010
Comparative StudyComparison of tracheal intubation by the Macintosh laryngoscope and Pentax-AWS (Airway Scope) during chest compression: a manikin study.
To compare tracheal intubation with the Pentax Airway Scope (AWS) and the Macintosh laryngoscope (McL) during chest compression, 25 anesthesiologists (including 12 specialists having >5 years of experience and 13 trainees having <2 years of experience) performed tracheal intubation using either the McL or the AWS, with or without chest compression, on a manikin. Using the McL, both specialists and trainees took a significantly longer time (P < 0.01) to secure the airway with chest compression (17.3 +/- 3.7 and 22.5 +/- 8.0, respectively) and than without chest compression (11.3 +/- 2.9 and 13.9 +/- 4.4 s, respectively). ⋯ In contrast, the difference in time to complete intubation with the AWS during chest compression was not significantly different between the two groups. Based on these results, we conclude that the use of the AWS may reduce the time needed to secure the airway during chest compression.
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Journal of anesthesia · Apr 2010
Five-day pain management regimen using patient-controlled analgesia facilitates early ambulation after cardiac surgery.
Excessive pain may interrupt early rehabilitation after cardiac surgery. The purpose of this study was to evaluate the efficacy of a longer patient-controlled analgesia (PCA) regimen for early ambulation after cardiac surgery. ⋯ Pain management using a PCA system can be recommended for patients during the ambulation period after cardiac surgery. Subcutaneous PCA with fentanyl is a safe and effective analgesic regimen for this purpose.
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Journal of anesthesia · Apr 2010
Sevoflurane postconditioning prevents activation of caspase 3 and 9 through antiapoptotic signaling after myocardial ischemia-reperfusion.
Volatile anesthetic postconditioning reduces apoptosis through antiapoptotic signaling. Whether sevoflurane postconditioning prevents activation of caspase 9 and 3, which are implicated in the initiation and execution step of apoptosis, is not known. ⋯ Sevoflurane postconditioning prevents activation of caspase 3 and 9, mediators of apoptosis in ischemia-reperfusion injury. This caspase activation is mediated by phosphorylation of Akt and ERK.
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Journal of anesthesia · Apr 2010
Successful management of a patient with Marfan syndrome complicated with acute aortic dissection using landiolol during Cesarean section.
Aortic dissection is a lethal complication in pregnant women with Marfan syndrome. To decrease arterial wall stress, beta-blockers have been used as standard treatment, although uterine contractions caused by beta-2-adrenergic receptor antagonism may result. Herein, we report a patient with Marfan syndrome who was given landiolol, a selective beta-1-adrenergic receptor antagonist with a short half-life, for management during a Cesarean section procedure following development of acute aortic dissection. ⋯ Hemodynamic state, uterine contraction, and the extent of aortic dissection remained stable. The postoperative course was uneventful, and the patient and her baby were discharged safely. Landiolol was useful for reduction of HR without affecting BP or uterine contractions during a Cesarean section procedure in our patient with aortic dissection.