Journal of anesthesia
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Journal of anesthesia · Oct 2013
ReviewDevelopmental anesthetic neurotoxicity: from animals to humans?
Several animal studies have demonstrated that most routinely used general anesthetics induce widespread neuroapoptosis and long-term neurocognitive impairment in the immature brain. These findings have generated great interest among pediatric anesthesiologists and other practitioners regarding the safe use of general anesthetics in pediatric patients. Several human retrospective studies failed to confirm whether or not anesthesia exposure during the crucial phase of brain development induces long-term neurocognitive deficits in humans. ⋯ Clearly, additional prospective randomized controlled trials are needed in humans to determine the effects of general anesthesia on neurodevelopment. In this review, we summarize currently available laboratory and clinical evidence for anesthetic neurotoxicity. Furthermore, we discuss the implications of these results for clinical anesthesia.
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Journal of anesthesia · Oct 2013
Randomized Controlled TrialRandomized evaluation of the size 2 laryngeal tube and classical laryngeal mask airway in different head and neck positions in children under positive pressure ventilation.
The aim of this study was to evaluate the applicability of the laryngeal tube (LT) size 2 and the classical laryngeal mask airway (LMA) size 2 in different head-neck positions under positive pressure ventilation in children by measuring leak pressures, peak pressures and the achievable tidal volumes under positive pressure ventilation. ⋯ Based on our results, we suggest that in anaesthetized children, the size 2 LT, compared to the size 2 LMA, may be more suitable for positive pressure ventilation due to favorable leak and peak pressures. Both devices can be safely used in head-neck positions other than neutral. Most disadvantageous with regards to the measured parameters was the anteflection position, especially for the LT.
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Journal of anesthesia · Oct 2013
Ultrasound and electrical nerve stimulation-guided S1 nerve root block.
A selective lumbosacral nerve root block is generally is performed under X-ray fluoroscopy, which has the disadvantage of radiation exposure and the need for fluoroscopy equipment. In this study, we assessed the effectiveness of ultrasound and nerve stimulation-guided S1 nerve root block on 37 patients with S1 radicular syndrome. With the patient in a prone position, an ultrasound scan was performed by placing the probe parallel to the body axis. ⋯ After nerve block, decreased sensation at the S1 innervated region and pain relief was achieved in all patients. No significant difference was noted in the effect of the block between perineural and paraneural patterns. In conclusion, this technique provided reliable S1 nerve root block in patients with S1 radicular syndrome and minimized radiation exposure.
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Journal of anesthesia · Oct 2013
Case ReportsPostoperative neuroleptic malignant syndrome-like symptoms improved with intravenous diazepam: a case report.
A 75-year-old man who had undergone left upper lobectomy of the lung exhibited fever and insomnia on postoperative day (POD) 1 and muscle rigidity, autonomic instability, and somnolence on POD2 after epidural administration of droperidol and withdrawal of oral etizolam. He had not been known to have any neuromuscular diseases or psychiatric diseases, with the exception of anxiety disorder. Brain computed tomography did not show cerebrovascular disorders. ⋯ Subsequently, oral administration of lorazepam (1 mg/day) was started, and his symptoms disappeared within 2 days (POD5). Although NMS-like symptoms are rarely seen in clinical practice, some factors may induce it during the perioperative period, such as the administration of dopamine antagonists and the cessation of benzodiazepines. Intravenous diazepam is an effective treatment in cases with suspected gamma-aminobutyric acid (GABA) hypoactivity at the GABA(A) receptor induced by the cessation of benzodiazepines.
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Journal of anesthesia · Oct 2013
Is microvascular decompression surgery a high risk for postoperative nausea and vomiting in patients undergoing craniotomy?
Patients undergoing microvascular decompression surgery often experience postoperative nausea and vomiting (PONV). However, there is little information about the incidence of PONV after microvascular decompression. We hypothesized that microvascular decompression is an especially high-risk procedure for PONV in patients undergoing neurosurgery, and investigated risk factors related to PONV after neurosurgery. ⋯ In this retrospective study, microvascular decompression surgery was an especially high-risk factor for PONV in patients undergoing craniotomy. It may be necessary to adopt a combination of prophylactic methods to reduce the incidence of PONV after microvascular decompression.