Masui. The Japanese journal of anesthesiology
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Myocardial ischemic preconditioning is a procedure giving powerful protection against myocardial ischemia and infarction. Clinical application of this property to anesthesia might improve anesthetic management of patients with cardiac diseases. ⋯ In addition, diabetes mellitus and hyperglycemia may abolish the protective effect of preconditioning by impairing K(ATP). From point of view of clinical application of preconditioning, anesthetic maintenance with volatile anesthetics instead of intravenous anesthetics, such as propofol, and administration of nicorandil throughout perioperative period, is recommended to patients with heart diseases and control of blood glucose is useful to maintain the protective effect of preconditioning.
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Men and women have different body compositions such as fat and fluid, and hormonal environments which affect both pharmacokinetics and pharmacodynamics of anesthesia-related drugs. The knowledge on gender differences in the effects of these drugs has been accumulated. ⋯ Then, gender differences in the effects of commonly used anesthesia-related agents are discussed. Although there have not been remarkable differences demonstrated, better understanding of the difference may lead to satisfying perioperative anesthetic cares for each sex.
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Postoperative nausea and vomiting (PONV) are two of the commonest and most distressing complications of general anesthesia and surgery. Factors affecting PONV are patient characteristics, surgical procedure, anesthetic technique, and postoperative care. Female patients have 1.5-3 times greater incidence of PONV than males, due to increased plasma progesterone levels during their menstrual cycles. ⋯ Most of published trials indicate improved prophylaxis against PONV by avoiding risk factors and/or by using effective antiemetic therapy (e. g., traditional and non-traditional antiemetics, serotonin receptor antagonists). Non-pharmacotherapy (e. g., P6 acupressure) is also important. Knowledge regarding prophylactic antiemetic therapy is necessary to management of PONV in female patients.