Journal of anesthesia
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Journal of anesthesia · Dec 2016
Case ReportsMetabolic acidosis with hemodilution due to massive absorption of normal saline as bladder irrigation fluid following holmium laser enucleation of prostate.
Holmium laser enucleation of prostate (HoLEP) is being performed with increasing frequency as a minimally invasive alternative to transurethral resection of the prostate (TURP) for the surgical management of benign prostatic hyperplasia (BPH). HoLEP offers the advantage of use of normal saline for irrigation, instead of glycine which is utilized in TURP, decreasing the likelihood of fluid absorption and effects on serum electrolytes. We describe a patient who underwent HoLEP for BPH and subsequently developed non-ion gap metabolic acidosis and hemodilution associated with volume overload.
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Journal of anesthesia · Dec 2016
Case ReportsProlonged drug-induced myoclonus: is it related to palonosetron?
We report a case of drug-induced myoclonus possibly related to palonosetron, a second-generation 5-hydroxytryptamine-3 receptor antagonist which was administered as a prophylaxis for postoperative nausea and vomiting in a 28-year-old female. The recurrent episodes of myoclonus jerk involving the head, neck and shoulder persisted for a period of 4 days. The patient also exhibited an episode of severe bradycardia leading to hypotension 7 h after surgery. To our knowledge, this is the first report presenting these adverse events potentially associated with the use of palonosetron.
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Cesarean sections under spinal anesthesia are now a daily occurrence in most tertiary hospitals. We report the first published case of inadvertent spinal injection of ondansetron without any neurological sequelae in a patient undergoing elective Cesarean section under spinal anesthesia. She did not experience any permanent neurological sequelae, and also did not exhibit any central neuraxial opioid side effects-nausea, vomiting or pruritus. Vigilance is essential to reduce the risk of wrong route delivery of drugs, especially when presented in very similar-looking 2 mL ampules as in our institution.
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Journal of anesthesia · Dec 2016
Case ReportsClinical usefulness of pectoral nerve block for the management of zoster-associated pain: case reports and technical description.
The recently introduced pectoral nerve (Pecs) block is a simple alterative to the conventional thoracic paravertebral block or epidural block for breast surgery. It produces excellent analgesia and can be used to provide balanced anesthesia and as a rescue block in cases where performing a neuraxial blockade is not possible. ⋯ However, this can be challenging for physicians due to the increased risk of hemodynamic instability in the upper thoracic level, and comorbid and contraindicated medical conditions such as coagulopathy. Here, we introduce an ultrasound-guided Pecs block for the management of herpes zoster-associated pain, which could be an effective alternative to other interventional options in the thoracic region.
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Journal of anesthesia · Dec 2016
The effect of single low-dose dexamethasone on vomiting during awake craniotomy.
Intraoperative vomiting leads to serious respiratory complications that could influence the surgical decision-making process for awake craniotomy. However, the use of antiemetics is still limited in Japan. The aim of this study was to investigate the effect of prophylactically administered single low-dose dexamethasone on the incidence of vomiting during awake craniotomy. The frequency of hyperglycemia was also examined. ⋯ A single low-dose of dexamethasone prevents intraoperative vomiting for awake craniotomy cases. However, as even a small dose of dexamethasone increases the risk for hyperglycemia, antiemetic prophylaxis with dexamethasone should be administered after careful consideration. Monitoring of perioperative blood glucose concentration is also necessary.