Journal of anesthesia
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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
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
Effects of neostigmine on bronchoconstriction with continuous electrical stimulation in rats.
When neostigmine is used to reverse muscle relaxants in patients with asthma without signs of airway inflammation, asthma attack is occasionally encountered. It is likely that abnormally increased electrical impulses traveling from the brain through cholinergic nerves to airway smooth muscles may be one of the pathogeneses of asthma attack. We applied continuous electrical field stimulation (c-EFS) or continuous electrical stimulation (c-ES) of low frequency to the vagal nerve of the rat in vitro and in vivo to determine the role of cholinergic nerve activation in inducing airway constriction. ⋯ The contractile response of the tracheal ring to c-EFS is potentiated by neostigmine. P (max) is increased by c-ES of the vagal nerve, and is potentiated by neostigmine. These data suggest that increased activity of the cholinergic nerve could be involved in asthma attack.
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Journal of anesthesia · Feb 2012
Vascular reactivity in human arteries: from experimental study to clinical application.
The principal function of VSM cells in mature animals is contraction. The endothelium is now recognized to elaborate various vasoactive factors and to play a critical part in regulation of vascular tone. ⋯ In humans,systemic, pulmonary, and various organ circulation(s) are maintained by an intricate and complex cardiovascular system. We expect future studies to clarify the sophisticated but complex mechanisms of VSM in humans.