Masui. The Japanese journal of anesthesiology
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Recent studies have suggested that the brain preconditioning could induce tolerance to ischemia in humans. It has been believed that newly synthesized proteins are required for the acquisition of delayed tolerance in the brain and spinal cord. However, the mechanism other than the synthesis of neuroprotective proteins may also play a pivotal role. ⋯ In addition, the intravenous administration of erythropoietin has been shown to be safe and beneficial for acute stroke in humans. Therefore, erythropoietin is now one of the most promising neuroprotective agents. The research in the brain and spinal cord preconditioning will contribute to the elucidation of the mechanism of ischemic injury and to the establishment of new therapies for neuroprotection.
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After the ingestion or infusion of nutrients, there is an increase in energy expenditure which has been referred to as dietary or nutrient-induced thermogenesis. This thermogenesis induced by protein or amino acids is well known to be largest and most prolonged. ⋯ Amino acid infusion was observed to shift upward the threshold core temperature for thermoregulatory vasoconstriction as well as to increase energy expenditure. Fructose also prevents perioperative hypothermia during surgery by the same mechanisms.
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TruViewEVO2 videolaryngoscope (Truphatek, Israel) is a modified version of the Truphatek 1. We used this device in four patients with difficult airways. A 77-year-old obese woman, scheduled for nasal surgery, had short neck and small jaw. ⋯ A full view of the glottis was obtained when the TruView was used, and the trachea was easily intubated. In another two patients, in whom laryngoscopy with a Macintosh blade had failed, and in one patient with limited mouth opening, the TruView allowed us to see the glottis and to intubate the trachea without difficulty. Therefore, we believe that the TrueViewEVO2 videolaryngoscope is useful in patients with difficult airways.
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Epidural anesthesia and spinal anesthesia are very popular anesthetic techniques used for surgery in elderly patients. Aging i s associated withanatomical changes and a loss of functional reserve in all organ systems. ⋯ However, previous studies have demonstrated only a slight effect of age on the anesthetic levels as well as the reduction in functions with these blocks. In elderly patients, both anesthetic techniques have been shown to decrease intraoperative blood loss, perioperative cardiac ischemic events, post-operative hypoxic episodes and arterial and venous thrombosis, and so forth.
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Central venous catheterization is a procedure with a high success rate. However, life-threatening complications are occasionally caused by mechanical injury during the catheterization process. ⋯ We herein review and discuss the mechanical complications previously reported to have occurred in association with central venous catheterization. Comprehensive knowledge about various complication-inducing factors, the ability to make a quick and accurate diagnosis of such complications, and sufficient skill to prevent worsening of these complications can thus help patients from suffering lethal complications due to central venous catheterization.