Journal of anesthesia
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Over the years, a trend for very low numbers of scientific publications from Africa has emerged. There has been no evaluation of pain research publications from this region. This study was conducted to determine the African pain research spectrum over the last 10 years, to identify trends in the number of publications from different countries, to identify currently underexplored areas of pain research, and to stimulate renewed interest in quality pain research in Nigeria and Africa. ⋯ Pain research publications from Africa should be encouraged. Given the underexplored frontiers of pain research, there is a need to engage in rigorous research in this field to enhance the contribution of the African continent ("the African Voice") to worldwide advances in this respect.
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Journal of anesthesia · Aug 2014
Case ReportsTreatment of life-threatening hypercapnia with isoflurane in an infant with status asthmaticus.
We encountered a 2-year-old child with life-threatening hypercapnia, with a PaCO(2) of 238 mm Hg and severe respiratory and metabolic acidosis, due to status asthmaticus that was refractory to steroid and bronchodilator therapy. Suspecting ventilatory failure and excessive ventilation-induced obstructive shock, we started respiratory physiotherapy in synchrony with her respiration, to facilitate exhalation from her over-inflated lungs. Isoflurane inhalation was commenced in preparation for extracorporeal circulation, to reduce the hypercapnia. ⋯ In our patient with a severe asthmatic attack, decreased exhalation secondary to asthma and overventilation during artificial ventilation resulted in overinflation of the lungs, which in turn led to cerebral edema and obstructive cardiac failure. The favorable outcome in this case was due to the short duration of hypercapnia. Hence, we conclude that the duration of hypercapnia is an important determinant of the morbidity and mortality of status asthmaticus-induced severe hypercapnia.
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Journal of anesthesia · Aug 2014
Randomized Controlled TrialMethadone patient-controlled analgesia for postoperative pain: a randomized, controlled, double-blind study.
Postoperative pain is an important health-care issue. Patient-controlled analgesia (PCA) is considered the gold standard for systemic postoperative pain treatment. Methadone PCA is used for patients with chronic pain and those in the palliative care setting. However, its efficacy as a first-line drug for acute postoperative pain is unknown. This study evaluated the use of postoperative methadone PCA after total hip arthroplasty (THA) compared with morphine PCA. ⋯ This study demonstrated that methadone PCA prompted less opioid consumption and lower pain scores at rest and at motion in comparison with morphine PCA as postoperative analgesia after THA.
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Journal of anesthesia · Aug 2014
Randomized Controlled TrialPlasma ropivacaine concentrations after ultrasound-guided transversus abdominis plane block for open retropubic prostatectomy.
Ropivacaine-induced vasoconstriction may affect the early absorption speed of ropivacaine; however, the effects of dose on pharmacokinetics following transversus abdominis plane (TAP) block have not been studied. In this study, we have examined plasma ropivacaine concentrations following TAP block with various ropivacaine concentrations (0.25, 0.5, and 0.75 %). ⋯ Ropivacaine concentration did not alter pharmacokinetic profile following TAP blocks.
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Journal of anesthesia · Aug 2014
Co-existing liver disease increases the risk of postoperative thrombocytopenia in patients undergoing hepatic resection: implications for the risk of epidural hematoma associated with the removal of an epidural catheter.
A common surgical diagnosis for hepatic resection in Japan is hepatocellular carcinoma secondary to chronic viral hepatitis. It is known that chronic liver disease causes a decrease in blood platelet count. We retrospectively reviewed the perioperative changes in blood platelet count associated with hepatic resection at a Japanese institution and evaluated the incidence and risk factors for postoperative thrombocytopenia, which may increase the potential risk of epidural hematoma. ⋯ Hepatic resection can cause postoperative thrombocytopenia that may increase the potential risk of epidural hematoma associated with catheter removal, and the presence of co-existing liver disease heightens concerns for postoperative crucial thrombocytopenia.