Journal of anesthesia
-
In this review, we describe the current consensus surrounding general anesthetic management for cesarean section. For induction of anesthesia, rapid-sequence induction using thiopental and suxamethonium has been the recommended standard for a long time. In recent years, induction of anesthesia using propofol, rocuronium, and remifentanil have been gaining popularity. ⋯ After the delivery of a fetus, switching from volatile anesthetics to intravenous anesthetics has been recommended to avoid uterine atony. At the same time, intraoperative awareness should be avoided. The rate of persistent wound pain is higher when only general anesthesia was used during cesarean section than with regional anesthesia, and thus it is necessary to provide a sufficient postoperative analgesia using multimodal analgesia, including intravenous patient-controlled analgesia (IV-PCA), transversus abdominis plane (TAP) block, non-steroidal inflammatory drugs, and acetaminophen.
-
Journal of anesthesia · Apr 2016
Case ReportsManagement of pudendal neuralgia using ultrasound-guided pulsed radiofrequency: a report of two cases and discussion of pudendal nerve block techniques.
Pudendal neuralgia is characterized by chronic pain or discomfort in the area innervated by the pudendal nerve, with no obvious cause. A successful pudendal nerve block is crucial for the diagnosis of pudendal neuralgia. ⋯ This report describes two cases of pudendal neuralgia that were successfully managed using ultrasound-guided pulsed radiofrequency and presents a literature review of pudendal nerve block techniques. However, in the management of chronic neuropathic pain, physicians should keep in mind that the placebo effect related to invasive approaches must not be neglected.
-
Journal of anesthesia · Apr 2016
ReviewReview of crisis resource management (CRM) principles in the setting of intraoperative malignant hyperthermia.
The practice of medicine is characterized by routine and typical cases whose management usually goes according to plan. However, the occasional case does arise which involves rare catastrophic emergencies, such as intraoperative malignant hyperthermia (MH), which require a comprehensive, coordinated, and resource-intensive treatment plan. ⋯ However, physicians can become expert in the global process of managing emergencies by using the principles of crisis resource management (CRM). In this article, we review the key concepts of CRM, using a real life example of a team who utilized CRM principles to successfully manage an intraoperative MH crisis, despite there being no one on the team who had ever previously encountered a true MH crisis.
-
Journal of anesthesia · Apr 2016
Response to intravenous fentanyl infusion predicts subsequent response to transdermal fentanyl.
Prediction of the response to transdermal fentanyl (FENtd) before its use for chronic pain is desirable. We tested the hypothesis that the response to intravenous fentanyl infusion (FENiv) can predict the response to FENtd, including the analgesic and adverse effects. ⋯ The analgesic and side effects after intravenous fentanyl infusion can be used to predict the response to short-term transdermal treatment with fentanyl.
-
Journal of anesthesia · Apr 2016
A detailed evaluation of the new acute kidney injury criteria by KDIGO in critically ill patients.
Two previous classifications of acute kidney injury (AKI) have shown that AKI is associated with increased mortality. In 2012, Kidney Disease Improving Global Outcomes (KDIGO) created new AKI criteria by combining the two previous classifications. However, such combination might cause inconsistency among each definition in the criteria. We have investigated all the definitions in the new KDIGO criteria. ⋯ AKI defined by the new KDIGO criteria was associated with increased hospital mortality. Although definitions in the KDIGO criteria seem to be appropriate because of the clear relationship between mortality and stage progression on the whole, several limitations may exist, especially in stage 3. Further research should be needed to clarify the validity of the KDIGO criteria and the detailed categories.