Journal of anesthesia
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Journal of anesthesia · Feb 2015
ReviewIntensive care unit-related generalized neuromuscular weakness due to critical illness polyneuropathy/myopathy in critically ill patients.
Thirty to fifty percent of critically ill patients admitted to the intensive care unit suffer from generalized neuromuscular weakness due to critical illness polyneuropathy, critical illness myopathy, or a combination of them, thus prolonging mechanical ventilation and their intensive care unit stay. A distinction between these syndromes and other neuromuscular abnormalities beginning either before or after ICU admission is necessary. These intensive care unit-related diseases are associated with both elevated mortality rates and increased morbidity rates. ⋯ The dose and duration of the administration of neuromuscular blocking drugs should be limited, and their concurrent administration with corticosteroids should be avoided. Intensive insulin therapy has also been proven to reduce their incidence. Finally, early mobilization via active exercise or electrical muscle stimulation plays a significant role in their prevention.
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Journal of anesthesia · Feb 2015
Association of thoracic epidural analgesia with risk of atrial arrhythmias after pulmonary resection: a retrospective cohort study.
Atrial arrhythmias are common after non-cardiac thoracic surgery. We tested the hypothesis that TEA reduces the risk of new-onset atrial arrhythmias after pulmonary resection. ⋯ TEA was not associated with reduced occurrence of postoperative atrial arrhythmia. Although postoperative pulmonary complications were similar with and without TEA, TEA patients tended to experience fewer cardiovascular complications.
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Journal of anesthesia · Feb 2015
Comparative StudyContinuous transversus abdominis plane block catheter analgesia for postoperative pain control in renal transplant.
Continuous transversus abdominis plane (TAP) block using a catheter has proven its usefulness in reducing opioid requirements and pain scores after lower abdominal surgery. However, there are no reports of its successful use after renal transplant. We tested the hypothesis that continuous TAP block would retrospectively reduce opioid requirement, nausea score and hospital stay after renal transplant surgery. ⋯ The use of continuous TAP analgesia for postoperative analgesia after renal transplant was effective in reducing the morphine-equivalent requirements.
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Journal of anesthesia · Feb 2015
Plasma ropivacaine concentration following ultrasound-guided subcostal transversus abdominis plane block in adults.
Ultrasound-guided subcostal transversus abdominis plane block (TAPB) is widely used for abdominal surgery; however, arterial plasma concentration of the anesthetic ropivacaine after the blockade is still unclear. We evaluated ropivacaine concentration after subcostal TAPB in adult patients undergoing upper abdominal surgery. Twelve patients with American Society of Anesthesiologists physical status 1-2 were enrolled. ⋯ No adverse events or clinical symptoms indicating systemic toxicity were observed during this study. The study demonstrated that administration of ropivacaine at 3 mg/kg during subcostal TAPB led to rapid increases in plasma concentration of the anesthetic during the first 2 h after the blockade. C(max) nearly reached the threshold for systemic toxicity.
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Journal of anesthesia · Feb 2015
Case ReportsRelationship between ventral lumbar disc protrusion and contrast medium leakage during sympathetic nerve block.
Ventral disc protrusions have been neglected because they are asymptomatic. Lumbar sympathetic nerve block (LSNB) is one of the clinical choices for refractory low back pain treatment. Leakage of the contrast medium may occur and lead to complications, especially when using a neurolytic agent. ⋯ Moreover, the incidence of contrast medium leakage was significantly higher at the vertebrae that had grade 2 protrusion than at those with less protrusion. We revealed a higher incidence of ventral disc protrusion of the lumbar vertebrae than previously reported, and that the incidence of leakage in LSNB increased when ventral disc protrusion was present. To avoid complications, attention should be paid to ventral disc protrusions before performing LSNB.