Journal of anesthesia
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Journal of anesthesia · Oct 2011
Randomized Controlled Trial Multicenter StudyAdjuvant dexamethasone with bupivacaine prolongs the duration of interscalene block: a prospective randomized trial.
Dexamethasone added to bupivacaine significantly prolongs the duration of interscalene analgesia and motor blockade.
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Journal of anesthesia · Oct 2011
Randomized Controlled TrialComparison of postoperative pharyngeal morbidity using the Macintosh laryngoscope or AirWay Scope after mastectomy.
We compared the characteristics of postoperative pharyngeal morbidity in intubation between the AirWay Scope (AWS) and Macintosh laryngoscope in 68 ASA I-II female patients aged 35-77 years in a randomized, double-blinded, controlled fashion. After induction of general anesthesia, the patient's trachea was intubated using the AWS or Macintosh laryngoscope by five anesthesiologists. Before leaving the operating room, postoperative sore throat, hoarseness, and dysphagia were assessed, and oral bleeding was evaluated by observation of the extubated tracheal tube. ⋯ Incidence of oral bleeding with the AWS (6.1%) was significantly lower than that with the Macintosh laryngoscope (23.5%). Pharyngeal morbidity on the day after surgery did not differ between groups, and no patient complained of delayed oral intake. In female patients, the AWS successfully reduced the incidence and severity of sore throat on the day of surgery in comparison with the Macintosh laryngoscope.
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Journal of anesthesia · Oct 2011
Review Historical ArticleThe role of Certified Registered Nurse Anesthetists in the United States.
Certified Registered Nurse Anesthetists (CRNAs) have been providing anesthesia care in the United States (US) for nearly 150 years. Historically, anesthesia care for surgical patients was mainly provided by trained nurses under the supervision of surgeons until the establishment of anesthesiology as a medical specialty in the US. Currently, all 50 US states utilize CRNAs to perform various kinds of anesthesia care, either under the medical supervision of anesthesiologists in most states, or independently without medical supervision in 16 states; the latter has become an on-going source of conflict between anesthesiologists and CRNAs. Understanding the history and current conditions of anesthesia practice in the US is crucial for countries in which the shortage of anesthesia care providers has become a national issue.
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Journal of anesthesia · Oct 2011
Case ReportsSuccessful treatment of acute respiratory distress syndrome after hysterectomy for life-threatening atonic bleeding by inhaled nitric oxide.
We report a case of a 33-year-old female who developed severe acute respiratory distress syndrome (ARDS) after emergency hysterectomy for life-threatening atonic bleeding. A marked decline in pulmonary oxygenation was observed during the surgery, which led to a diagnosis of ARDS. ⋯ Inhaled nitric oxide (NO 10 ppm) was administered to the patient as a rescue treatment, resulting in a gradual but dramatic improvement in pulmonary oxygenation. Although several randomized trials have failed to confirm the beneficial effects of NO on morbidity in patients with ARDS, NO administration is worth consideration as treatment prior to invasive treatments, such as extracorporeal membrane oxygenation, for patients with acute lung injury/ARDS.
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Journal of anesthesia · Oct 2011
Prognostic factors associated with mortality in patients undergoing emergency surgery for abdominal aortic aneurysms.
Surgical mortality rates following emergency surgery for ruptured abdominal aortic aneurysms (AAAs) remain high. This study investigated the mortality rate and identified prognostic factors affecting mortality in patients undergoing emergency repair of AAAs in our hospital. ⋯ The authors clarified that certain features such as age, persistent preoperative shock, and greater amounts of transfusion associated with greater blood loss and anemia were factors affecting the mortality in patients undergoing emergency surgery for AAAs. It might be of great importance to correct preoperative shock and anemia caused by massive bleeding before the onset of hemodynamic deterioration.