Journal of anesthesia
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Although rare, a change in visual acuity after surgery for nonocular procedures has devastating consequences. Increased recognition and discussion of this complication is reported in recent literature, most notably following spinal and cardiac surgery. ⋯ Here we review the incidence of the problem, the anatomy and physiology of the ocular circulation, variants of POVL, and proposed predisposing factors. Potential perioperative methods to prevent this complication are discussed, and suggested treatment modalities are presented.
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Journal of anesthesia · Dec 2013
ReviewAnesthetic management of the patient with amyotrophic lateral sclerosis.
Amyotrophic lateral sclerosis (ALS), with an incidence of 1.5-2.5 for 100 000 per year, is a rare but rapid progression neuromuscular degeneration disorder that poses unique perioperatively challenges to clinical anesthesiologists. The progressive degeneration of motor neurons causes a constellation of symptoms, including muscular weakness, atrophy, fasciculations, spasticity, and hyperreflexia. Therapeutic and experimental treatments, including riluzole, beta lactams, methylcobalamin, dexpramipexole, antiepileptics, antioxidant agents, neutrophin, antiinflammatory agents, and antiapoptosis drugs, are described. ⋯ Because of the inherent muscle weakness and associated respiratory insufficiency, certain precautions must be utilized during anesthetic care of ALS patients. In particular, certain neuromuscular agents are contraindicated and anesthetics that leave the body more rapidly present logical and attractive options in this population. A solid understanding of the disease process, therapeutic interventions, and anesthesia considerations are all paramount for the successful management of a patient with ALS in the perioperative setting.
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Journal of anesthesia · Dec 2013
Randomized Controlled TrialApplication of PEEP using the i-gel during volume-controlled ventilation in anesthetized, paralyzed patients.
This prospective, randomized trial was designed to assess whether the i-gel supraglottic airway device is suitable for volume-controlled ventilation while applying positive end-expiratory pressure (PEEP) of 5 cmH(2)O under general anesthesia. It was believed that this device might improve arterial oxygenation. ⋯ The use of an i-gel during PEEP application at 5 cmH(2)O did not increase the incidence of a significant air leak, and a PEEP of 5 cmH(2)O failed to improve arterial oxygenation during controlled ventilation in healthy adult patients.
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Journal of anesthesia · Dec 2013
Randomized Controlled TrialAntiemetic effect of naloxone in combination with dexamethasone and droperidol in patients undergoing laparoscopic gynecological surgery.
We examined the effects of dexamethasone, droperidol, naloxone, and a combination of these three agents on postoperative nausea and vomiting (PONV) in female patients. ⋯ A combination of naloxone, droperidol, and dexamethasone was effective for preventing PONV in patients receiving fentanyl for postoperative analgesia after laparoscopic gynecological surgery, although further investigations are required to examine the effect of adding naloxone to other antiemetics.
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Journal of anesthesia · Dec 2013
Randomized Controlled TrialPostoperative analgesia after modified radical mastectomy: the efficacy of interscalene brachial plexus block.
In the present study, we evaluated the effects of interscalene brachial plexus block on postoperative pain relief and morphine consumption after modified radical mastectomy (MRM). ⋯ The optimal method has not been defined yet for acute pain palliation after MRM. Our study demonstrated that the use of interscalene block in patients undergoing MRM improved pain scores and reduced morphine consumption during the first 24 h postoperatively. The block can be a good alternative to other invasive regional block techniques used for postoperative pain management after MRM.