Masui. The Japanese journal of anesthesiology
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Most general anesthetics, opioids, sedatives and local anesthetics perturb thermoregulatory responses. Accordingly the core temperatures triggering sweating, thermoregulatory vasoconstriction and shivering are varied in perioperative periods. Redistribution hypothermia is a quite common phenomenon during not only general anesthesia but epidural/spinal anesthesia. ⋯ However, obtaining effective decrease of core temperature is sometimes difficult because of thermoregulatory vasoconstriction. Subsequently, vasodilation therapy with appropriate drugs is now under investigation. Hypothermia per se causes critical complications in patients, and the maintenance and warming method to maintain normothermia is important in perioperative period.
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Recent reports of cauda equina syndrome following continuous spinal anesthesia have generated concern regarding the safety of not only this particular technique but also of the local anesthetic agent itself. This concern has been reinforced by data suggesting that similar injuries have occurred with repeated injection after a "failed spinal", and by reports of transient radicular irritation following single subarachnoid injection. ⋯ These experiments suggest that the recent injuries resulted from a direct effect of the local anesthetic and that anesthetic-induced impairment does not result from blockade of the sodium channel, per se. These experiments also suggest that development of a safer anesthetic is a realistic goal.