Journal of anesthesia
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Journal of anesthesia · Aug 2013
Randomized Controlled TrialA pilot study to compare epidural identification and catheterization using a saline-filled syringe versus a continuous hydrostatic pressure system.
We are introducing a new continuous hydrostatic pressure system for identification and catheterization of epidural space in adults. One hundred and eight patients scheduled for elective endoscopic urological procedures were enrolled in this prospective randomized study. They were assigned to perform loss of resistance epidural technique by either the conventional saline-filled syringe (group C) or the new pressure technique (group P). ⋯ Significant reduction was found in group P versus group C concerning time to identify epidural space [20 (6-40) vs. 60.5 (23-75) s with p = 0.001], number of attempts [1 (1-2) vs. 1 (1-4) with p = 0.02] and motor block [1 (0-3) vs. 2 (0-2) with p = 0.02], respectively. No significant difference in epidural catheterization, sensory block, quality of anesthesia and incidence of side effects. We concluded that this new technique is an easy way to identify epidural space using available tools in the operating room.
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Journal of anesthesia · Aug 2013
Randomized Controlled TrialEffects of IgM-Enriched Immunoglobulin Therapy in Septic-Shock-Induced Multiple Organ Failure: Pilot Study.
Mortality due to septic-shock-induced respiratory failure remains high. A recent meta-analysis suggested that IgM-enriched immunoglobulin treatment may be beneficial in these patients. In this prospective randomised controlled pilot study we investigated the effects of IgM-enriched immunoglobulin treatment in patients with early septic shock accompanied by severe respiratory failure. 33 patients were randomly allocated to receive 5 ml/kg (predicted body weight) IgM-enriched immunoglobulin (16 patients) or placebo (17 patients), respectively, via 8 h IV-infusion for three consecutive days. ⋯ Median length of ICU stay, mechanical ventilation, vasopressor support during the ICU stay and 28-day mortality were nearly identical in the two groups. Serum PCT levels showed no significant difference between the two groups, however, CRP levels were significantly lower in the IgM-enriched immunoglobulin group on days 4, 5 and 6, respectively. In this study the use of IgM-enriched immunoglobulin preparation failed to produce any improvement in the organ dysfunction as compared to standard sepsis therapy.
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Journal of anesthesia · Aug 2013
ReviewAnesthetic considerations in pediatric mastocytosis: a review.
Mastocytosis is an orphan disease rarely encountered by practicing anesthesiologists. Children with mastocytosis often present for procedures or surgery requiring anesthesia. Because many of the medications commonly used in pediatric anesthesia have been reported to initiate mast cell activation, parents are often very anxious about their child's perioperative experience. ⋯ However, the pediatric literature suggests that children with disease limited to the skin rarely suffer serious side effects from anesthesia, and there are no reported fatalities. Preoperative prophylaxis is usually based on expert opinion and case reports. Detailed tables summarizing reports of anesthetic medications used for children with mastocytosis undergoing anesthesia, reported side effects, and suggested prophylaxis regimens are included in this review.
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Journal of anesthesia · Aug 2013
Randomized Controlled TrialVigilance of hemodynamic changes immediately after transferring patients is crucial.
A decrease in blood pressure is sometimes observed when a postsurgical patient is transferred to another bed after recovering from anesthesia. However, the mechanism behind this hypotension has not been completely elucidated. The purpose of this study was to investigate and compare changes in hemodynamic properties for possible causes of hypotension before and after transfer to another bed of postsurgical patients receiving general anesthesia, combined epidural and general anesthesia, or combined spinal and general anesthesia. ⋯ The decrease in blood pressure observed after transfer of a postsurgical patient to another bed after general, combined epidural and general, and combined spinal and general anesthesia was associated with a decrease in CO and no change in SVR, but HR decreased after combined spinal and general anesthesia, whereas it was unchanged after general and combined epidural and general anesthesia. The decrease in blood pressure is assumed to be caused by a decrease in venous return, and several reflexes might participate in this decrease of blood pressure, especially after combined spinal and general anesthesia.
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Journal of anesthesia · Aug 2013
Hippocampal volume reduction in elderly patients at risk for postoperative cognitive dysfunction.
Postoperative cognitive dysfunction (POCD) is a formidable public health issue, which would not only affect the quality of life among elderly patients but also lead to pulmonary infection and increased mortality. While, there is a lack of an effective indicator in predicting POCD. As one pivotal part of the limbic system in brain, hippocampus is associated with cognitive function. Hippocampal atrophy could indicate the degree of changes in cognitive function. ⋯ The MRI measurement of hippocampal volume is suggested to be valuable as a predictor of POCD in the elderly.