Masui. The Japanese journal of anesthesiology
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Comparative Study
[Remifentanil increases urine output in patients undergoing laparoscopic colectomy].
It has been reported that laparoscopic surgery increases stress response such as oliguria. We investigated whether anesthetic methods affect urine output during anesthesia in patients undergoing laparoscopic colectomy. ⋯ Adequate remifentanil injection might increase urine output by preventing stress response to laparoscopic colectomy.
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We experienced anesthesia for three cases of unilateral recurrent nerve palsy scheduled for thyroplasty type I requiring voice monitoring. The patients were sedated with dexmedetomidine and locally anesthetized. Dexmedetomidine provided sedation of high quality with natural sleep, good response to asking for phonation and very few respiratory depressions. We conclude that dexmedetomidine is an excellent sedative as a drug used for voice monitoring surgery.
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Surgical stress response affects the neuroendocrine system and depresses the immune function. Anesthetic induction drugs (except propofol), volatile anesthetics and opioids also have an immunosupressive effect. ⋯ Although some experimental studies and some clinical retrospective data show advantage of regional anesthesia over general anesthesia and opioid for postoperative analgesia, evidence level is still low and insufficient to prove its efficacy on postoperative mortality. Much more research and controlled clinical trials are needed to elucidate the advantage of the regional anesthesia in cancer operation.
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Anesthetic agents, especially, volatile anesthetics are considered to exert organ toxicity such as nephrotoxicity and hepatotoxicity; however, recent aggressive researches explored the beneficial effects of volatile anesthetics as an organ protectant. Ischemic preconditioning is a phenomenon in which single or multiple brief periods of ischemia have been shown to protect the myocardium and brain against prolonged ischemic insult. General anesthesia showed the protection against both ischemic myocardial and brain reperfusion injuries. ⋯ Neurotoxicities of anesthetic agents are very crucial problems for the patient and they are considered to be due to the activation of IP3 receptor in ER after exposure to volatile anesthetics. Massive release of Ca2+ from ER induces Ca2+ overload leading to mitochondria permeability transition (MPT) and induces apoptosis in the brain or aggravates the neurodegenerative disease. Susceptible mechanisms and beneficial treatment for the toxicity of general anesthesia is considered as a critical subject to discuss and challenge to solve for our future.
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Recent clinical studies suggest that intraoperative liberal crystalloid infusion causes postoperative edema and various systemic and local complications. Weight gain may be a promising predictor for postoperative complications. "No intravenous infusion should be continued simply because it is a 'routine' component of clinical care." as GIFTASUSP (British consensus of guidelines on intravenous fluid therapy for adult surgical patients) has suggested. Optimal titration of fluid infusion should be considered on the individual basis. ⋯ Unnecessary transfusion should be avoided and any effort to reduce transfusion should be recommended. Too-much or too-low infusion and transfusion causes adverse outcome. Optimizing the volume may be the key for ideal postoperative outcome.