Journal of anesthesia
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Journal of anesthesia · Feb 2012
Randomized Controlled TrialEffects of sevoflurane and propofol on pulmonary inflammatory responses during lung resection.
Pulmonary inflammatory reactions are affected by one-lung ventilation (OLV) and anesthetic agents. However, the effects of anesthetic agents on pulmonary inflammatory reactions may vary. Our previous investigations suggested that inflammatory reactions were more pronounced in the dependent lung during lung resection under general anesthesia with propofol and remifentanil. Therefore, in the present study we attempted to determine the difference in pulmonary inflammatory reaction using either sevoflurane or propofol in both dependent and nondependent lungs during OLV. ⋯ One-lung ventilation induced inflammatory responses of the bronchial epithelia in the dependent lung and the nondependent lung during lung resection. Moreover, this inflammatory response was significantly suppressed by sevoflurane compared with propofol. Furthermore, the antiinflammatory effect of sevoflurane was more pronounced in the dependent lung than in the nondependent lung during OLV.
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Journal of anesthesia · Feb 2012
Apolipoprotein E e4 allele does not increase the risk of early postoperative delirium after major surgery.
A relationship between patients with a genetic predisposition to and those who develop postoperative delirium has not been yet determined. The aim of this study was to determine whether there is an association between apolipoprotein E epsilon 4 allele (APOE4) and delirium after major surgery. ⋯ Apolipoprotein e4 carrier status was not associated with an increased risk for early postoperative delirium. Age, congestive heart failure, and emergency surgery were independent risk factors for the development of delirium after major surgery.
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Journal of anesthesia · Feb 2012
Randomized Controlled TrialRecovery of psychomotor function after total intravenous anesthesia with remifentanil-propofol or fentanyl-propofol.
Total intravenous anesthesia (TIVA) with propofol combined with remifentanil or fentanyl has commonly been used to achieve general anesthesia. The purpose of this study was to examine recovery of psychomotor function, by use of the Trieger dot test, after TIVA with remifentanil-propofol or with fentanyl-propofol. ⋯ Recovery of psychomotor function in TIVA with remifentanil-propofol is faster than that in TIVA with fentanyl-propofol.
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Journal of anesthesia · Feb 2012
Case ReportsA case of posterior reversible encephalopathy syndrome after emergence from anesthesia.
Posterior reversible encephalopathy syndrome (PRES) is a relatively new clinical entity characterized by reversible neurological symptoms with findings indicating leukoencephalopathy on imaging studies. Reports of PRES in the field of anesthesiology have been quite limited. A patient with therapeutic anticoagulant developed PRES immediately after emergence from anesthesia, in which her status was initially recognized as delayed recovery from anesthesia with transient hypertension because an emergent head computed tomography (CT) scan was almost normal. ⋯ MRI showed subcortical increased T(2) and fluid-attenuated inversion recovery (FLAIR) intensity in the occipitoparietal regions bilaterally with slight increase in the apparent diffusion coefficient signal on diffusion-weighted imaging, which confirmed a diagnosis of PRES. Gradually, the patient regained consciousness and became responsive with antihypertensive therapy. A prompt and accurate diagnosis of PRES is important to avoid irreversible brain damage, for example, intracranial hemorrhage, especially in a patient receiving anticoagulation therapy.
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Journal of anesthesia · Feb 2012
Case ReportsCardiac arrest after spinal anesthesia in a patient with neurally mediated syncope.
We present the case of cardiac arrest in a patient with neurally mediated syncope (NMS). A 66-year-old male patient was scheduled to undergo right inguinal hernioplasty. He had a history of syncope, which occurred a few times a year in childhood and once a year recently. ⋯ Four months later, right inguinal hernioplasty was performed, uneventfully, under general anesthesia. High sympathetic blockade due to spinal anesthesia and transient withdrawal of sympathetic tone and increase in vagal discharge due to NMS could be the main causes of the cardiac arrest. If the patient has any possibility of NMS, anesthesiologists should consider the possibility of cardiac arrest after spinal anesthesia.