Journal of anesthesia
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Journal of anesthesia · Aug 2014
Randomized Controlled Trial Comparative StudyComparison of Siccoral(®) spray, Stomatovis (®) gargle, and Strefen (®) lozenges on postoperative sore throat.
Postoperative sore throat (POST) is a frequent complication caused by mucosal trauma to the pharyngeal, laryngeal, and tracheal airway after endotracheal intubation. We compared the effectiveness of Siccoral, Strefen, and Stomatovis treatments in alleviating POST. ⋯ Siccoral and Strefen can be effective in relieving POST in the early hours after extubation.
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Journal of anesthesia · Aug 2014
Comparative StudyComparison of nifekalant and amiodarone for resuscitation of out-of-hospital cardiopulmonary arrest resulting from shock-resistant ventricular fibrillation.
Nifekalant is a pure potassium channel blocker that has been used to treat ventricular tachyarrhythmias since 1999 in Japan. Intravenous amiodarone was approved later than nifekalant in Japan, and it is still unclear which of the two agents is superior. The aim of this study was to compare the efficacy of nifekalant and amiodarone for resuscitation of out-of-hospital cardiopulmonary arrest caused by shock-resistant ventricular fibrillation. ⋯ In this small sample size study, nifekalant, compared with amiodarone, is equally effective for ROSC and survival to discharge after shock-resistant ventricular fibrillation and can achieve ROSC more quickly. Further prospective studies are needed to confirm our results.
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Journal of anesthesia · Aug 2014
Randomized Controlled Trial Comparative StudyA randomised trial of oral versus intravenous opioids for treatment of pain after cardiac surgery.
Cardiac surgery and sternotomy are procedures accompanied by substantial postoperative pain which is challenging to treat. In general, intravenous (IV) opioids are used in the immediate postoperative phase, followed by oral opioids. Oral opioids are easier to use and generally less expensive. Our goal was thus to determine whether a new opioid preparation provides adequate analgesia after sternotomy. In particular, we tested the primary hypothesis that total opioid use (in morphine equivalents) is not greater with oral opioid compared with patient-controlled IV morphine. Our secondary hypothesis was that analgesic efficacy is similar with oral and IV opioids. ⋯ Analgesic quality was comparable with oral and IV opioids, suggesting that postoperative pain even after very painful procedures can be sufficiently managed with oral opioids.
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Journal of anesthesia · Aug 2014
Effect of decreased fetal perfusion on placental clearance of volatile anesthetics in a dual perfused human placental cotyledon model.
Placental transfer of volatile anesthetics is a critical issue in managing fetal distress during cesarean section under general anesthesia. Using dual perfused human placental cotyledons obtained from parturients undergoing elective cesarean section (n = 5), we investigated the effect of decreased fetal perfusion on placental clearance of sevoflurane and isoflurane. Keeping the maternal flow rate fixed, fetal flow rate was consecutively decreased from 3 ml/min (control perfusion) to 2 ml/min (intermediate perfusion) and to 1 ml/min (hypoperfusion). ⋯ Hypoperfusion resulted in a lower clearance of sevoflurane and isoflurane compared with control (P = 0.002, P < 0.001) and intermediate (P = 0.04, P = 0.018) perfusion. Clearances of sevoflurane and isoflurane were comparable during control perfusion (P = 0.93), intermediate perfusion (P = 1.00), and hypoperfusion (P = 0.88). Thus, maintenance of volatile anesthetics at a marginally low concentration may not be necessary when fetal distress is observed during emergency cesarean delivery because placental transfer of volatile anesthetics decreases with decreasing fetal perfusion.
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Journal of anesthesia · Aug 2014
Randomized Controlled TrialEffects of adding epinephrine on the early systemic absorption kinetics of local anesthetics in abdominal truncal blocks.
We evaluated the pharmacokinetics of ropivacaine following rectus sheath block (RSB) and transversus abdominis plane (TAP) block with or without epinephrine. A total of 26 adult patients undergoing lower abdominal surgery with RSB (=RSB trial) and another 26 adult patients undergoing open prostatectomy with TAP block (=TAP trial) were enrolled. ⋯ The peak concentration was significantly lower and time to peak concentration was significantly longer in the TAP-E(+) group than in the TAP-E(-) group (P < 0.05 and <0.01, respectively), while there were no significant differences in these parameters between the RSB-E(+) and RSB-E(-) groups. These results indicate that epinephrine attenuates the early phase of local anesthetic absorption from the injected site in TAP blocks, but not RSB.