Masui. The Japanese journal of anesthesiology
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Agitation during the emergence from general anesthesia is a great post-operative problem that often injures the patients themselves and requires the medical staff to restrain and calm the patients. The predisposing factors for emergence agitation include anesthesia, operation, and patient. Sevoflurane anesthesia results in higher incidence of emergence agitation than halothane, because of the rapid emergence, and its effects on central nervous system inducing convulsion and post-operative behavioral changes. ⋯ The change from sevoflurane to propofol during anesthesia maintenance is a contributing factor to reduce incidence of emergence agitation. The medications including opioids, midazolam, alpha-2 agonists, ketamine, non-steroidal anti-inflammatory drugs, nitrous oxide, and propofol, and aggressive nerve block such as caudal epidural block for post-operative sedation and analgesia are effective to avoid incidence of emergence agitation. The calm emergence following general anesthesia would decrease the self-injuring behavior, and enhance the parent and caregiver satisfaction in general anesthesia and surgery.
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Frequency of using nitrous oxide (N2O) in anesthetic field decreased recently by the influence of the environmental problems and the widespread use of intravenous agents. In dental treatment, however, inhalation sedation using low concentration of N2O has been effectively used to relax dental patients. Nitrous oxide inhalation sedation for dental treatment generally involves the use of a combination of low-dose N2O and high-dose oxygen. ⋯ Also, high-dose oxygen would contribute to manage "(pre) syncope" due to pain stimuli. Thus, N2O inhalation sedation is effective for the dental treatment, although the leak of N2O affects the health of dental staffs. The present review described the advantage and harmful effects of N2O in dental management.
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Sodium bicarbonate has been standard therapy for the treatment of acidosis. In lactic acidosis and hypercapnic acidosis, however, there is no clinical data supporting its effectiveness. We reviewed the literature of the efficacy of sodium bicarbonate on lactic acidosis and hypercapnic acidosis. ⋯ Conversely, acidosis or hypercapnia might be protective in acute lung and systemic organ injury. Therefore, the unprepared use of bicarbonate might be harmful in terms of fluid and sodium overload and excess lactate concentrations. According to current literature, we cannot recommend sodium bicarbonate administration for patients with lactic acidosis and hypercapnic acidosis.
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Bad anesthesia management easily causes mal-temperature situation. Main consequence of it is hypothermia as defined core temperature less than 36 degrees C and the other one is hyperthermia. ⋯ Other than that, hypothermia may provoke many complications after surgery including higher rate of wound infection, longer duration of hospitalization, more morbid cardiac events, prolongation of drug effects, more postoperative shivering, and delayed post anesthetic recovery. This review article discusses the mal-temperature management during surgery.
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Hemorrhage is the leading cause of maternal death. Pregnant woman can tolerate a larger amount of blood loss than non-pregnant woman, but obstetric hemorrhage is characterized by a high incidence of coagulopathy. The Japanese Society of Anesthesiologists and four related academic societies published "Guidelines for management of critical bleeding in obstetrics" in April 2010. ⋯ Declaration of an emergency is also essential for calling supportive medical personnel. To deal rapidly with critical bleeding, hospital actions to be taken should be prepared, and simulation exercise should be performed to correct inappropriate actions prior to an actual crisis. A systematic, not individual, approach is required to save the life of a bleeding pregnant woman.