Journal of anesthesia
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Journal of anesthesia · Apr 2013
Comparative StudyAnalysis of expert consultation referrals to the Korean Society of Anesthesiologists (KSA): a comparison of procedural sedation and general anesthesia.
Procedural sedation during diagnostic or therapeutic procedures is currently widely used by clinicians across a broad range of specialties. However, procedural sedation is a poorly controlled practice in many countries, often performed in potentially unsafe environments. ⋯ Our analysis of procedural sedation based on anesthesia-related adverse events compiled in the national database revealed a high severity of patient injury similar to that due to general anesthesia. Most procedural sedations were shown to be poorly controlled without adequate pre-procedural patient evaluation or intraoperative monitoring. Thus, it is essential to establish proper practical guidelines for procedural sedation and ensure strict adherence to these guidelines, especially during the NAAP.
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Journal of anesthesia · Apr 2013
Randomized Controlled Trial Comparative StudyDexmedetomidine versus remifentanil sedation during awake fiberoptic nasotracheal intubation: a double-blinded randomized controlled trial.
Awake fiberoptic nasotracheal intubation is usually performed in patients with an anticipated difficult airway. This study compares dexmedetomidine and remifentanil for conscious sedation during fiberoptic intubation. ⋯ Both dexmedetomidine and remifentanil were effective as sedatives in patients undergoing awake fiberoptic nasotracheal intubation. Compared with remifentanil, dexmedetomidine offered better endoscopy scores, lower recall of intubation, and greater patient satisfaction, with minor hemodynamic side effects.
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Sepsis is one of the leading causes of death in the critically ill. Early diagnosis is important to avoid delay in instituting appropriate treatment. ⋯ This article reviews the application of readily available biomarkers for diagnosis of sepsis, for predicting prognosis, and for antibiotic stewardship. 178 biomarkers are described in the literature--ranging from specimen cultures, which lack sensitivity and specificity for early diagnosis of sepsis, to biomarkers such as C-reactive protein, procalcitonin, and genetic biomarkers, which have their own limitations. Future research will mainly focus on use of more than one biomarker, but the main problem in sepsis biomarker research seems to be a lack of a recommended biomarker.
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Journal of anesthesia · Apr 2013
Randomized Controlled Trial Comparative StudyA comparison of the Trachway intubating stylet and the Macintosh laryngoscope in tracheal intubation: a manikin study.
The Trachway intubating stylet (Trachway(®)), when used by experienced anesthesiologists, has been shown to be effective for difficult airway management. We evaluated the efficacy of this intubating stylet for tracheal intubation in a manikin when used by experienced laryngoscopists with little experience using this device. ⋯ We concluded that the Trachway intubating stylet, when used by novices, is effective in both easy and difficult laryngoscopy scenarios. In difficult laryngoscopy scenarios, this device provided faster, easier, and less traumatic intubation than the Macintosh laryngoscope.
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Journal of anesthesia · Apr 2013
Changes in plasma and cerebrospinal fluid biomarkers in aged patients with early postoperative cognitive dysfunction following total hip-replacement surgery.
We hypothesized that different patterns of biomarkers of brain injury and inflammation exist in aged patients with postoperative cognitive dysfunction (POCD) after total hip-replacement with spinal anesthesia. ⋯ The POCD patients were associated with higher postoperative plasma levels of MDA, and higher IL-1β and lower Aβ1-42 levels in preoperative CSF that might predispose the development of POCD in aged patients following total hip-replacement surgery with spinal anesthesia.