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Emergency anesthesia

G Magistro, C G Stief, C Gratzke
Novel minimally invasive treatment options for the management of male lower urinary tract symptoms (LUTS) due to bladder outlet obstruction (BOO) aim to provide equal efficacy compared to standard techniques with a more favourable safety profile. The preservation of all aspects of male sexual function including antegrade ejaculation is increasingly important to patients. It should be ideally performed in an outpatient setting under local anesthesia to assure a short recovery time. Novel injectables for intraprostatic application (botulinum neurotoxin A, NX-1207, PRX302) have emerged and first phase III results could not confirm the promising initial data...
October 19, 2016: Der Urologe. Ausg. A
Flavia Petrini, Ida Di Giacinto, Rita Cataldo, Clelia Esposito, Vittorio Pavoni, Paolo Donato, Antonella Trolio, Guido Merli, Massimiliano Sorbello, Paolo Pelosi
Proper management of obese patients requires a team vision and appropriate behaviors by all health care providers in hospital. Specialist competencies are fundamental, as are specific clinical pathways and good clinical practices designed to deal with patients whose body mass index is ≥30 kg/m2. Standards of care for bariatric and non-bariatric surgery and for the critical care management of this population exist but are not well defined nor clearly followed in every hospital. Thus every anesthesiologist is likely to deal with this challenging population...
October 19, 2016: Minerva Anestesiologica
Takaki Emura, Kenji Hosoda, Shota Harai, Noboru Oyachi, Takeyuki Suzuki, Ken Takada, Koji Kobayashi, Hisatake Ikeda
BACKGROUND: Massive gastrointestinal bleeding in children, mostly caused by esophageal varices secondary to chronic liver disease, is uncommon. Dieulafoy lesion in the gastrointestinal tract is a rare but important cause of gastrointestinal bleeding; massive bleeding from this lesion can be fatal unless adequate treatment is promptly initiated. We report a case of gastric Dieulafoy lesion in a 2-year old successfully treated with endoscopic hemoclipping. CASE PRESENTATION: A 2-year-old Japanese boy was admitted to our department with sudden massive hematemesis...
October 19, 2016: Journal of Medical Case Reports
Hiroshi Yonekura, Norie Murayama, Hiroshi Yamazaki, Kazuya Sobue
This case report describes a 71-year-old woman who experienced unusual delayed emergence from propofol, which lasted for 3 hours and resulted in admission to the intensive care unit. Because genetic variations of propofol-metabolizing enzymes are proposed to be causal factors, we explored genetic polymorphisms of cytochrome P450 2B6 (CYP2B6) and uridine 5'-diphospho-glucuronosyltransferase 1A9 (UGT1A9). Suggested high-risk factors (advanced age, CYP2B6 516 G/T, and UGT1A9 I399 C/C) were observed in this case of delayed propofol metabolism...
October 5, 2016: A & A Case Reports
Nikhil Kumar, Christopher A Troianos, Joshua S Baisden
In this report, we present the case of a patient with biventricular noncompaction cardiomyopathy, Ebstein anomaly, and a left atrial mass who required emergent placement of a left ventricular assist device. The noncompaction cardiomyopathy complicated the left ventricular assist device implantation procedure because the thickened, trabeculated myocardium made it difficult to place the inflow cannula. We discuss our perioperative management strategy, in which transesophageal echocardiography was used, to help the surgical team identify the proper cannula placement and provide a bridge to transplantation...
October 5, 2016: A & A Case Reports
Jenny Feldman Eskildsen, Brian D Thorp, Hemanth A Baboolal
Management of anesthesia for a child with an upper airway foreign body is fraught with particular challenges. We present the case of a 3-year-old girl who presented to the emergency department with a 12-cm sewing needle protruding from her mouth and unknown vascular involvement. We were faced with establishing a secure airway despite exclusion of mask ventilation or use of a laryngeal mask airway. Moreover, peripheral intravenous access was lost before adequate sedation. Ultimately, we were able to safely induce anesthesia and achieve endotracheal intubation...
October 5, 2016: A & A Case Reports
S Sachin, M C Rajesh, E K Ramdas
Surgical removal of the kidney tumor outside the body, (ex vivo renal bench surgery) followed by auto transplantation is an emerging and often done procedure to reconstruct the urinary tract. It possesses immense challenges to both the anesthesiologists and the surgeons. The risks are multiplied if you are performing the surgery on a solitary functioning kidney. Here, we are describing the anesthetic management of 70-year-old male post nephrectomy patient undergoing renal auto transplantation by bench surgery...
September 2016: Anesthesia, Essays and Researches
P Rani, V R Hemanth Kumar, M Ravishankar, T Sivashanmugam, R Sripriya, M Trilogasundary
BACKGROUND: Fentanyl and dexmedetomidine have been tried to attenuate airway and circulatory reflexes during emergence and extubation individually but have not been compared with respect to the level of sedation to evolve a reliable technique for rapid and smooth extubation. AIM: To compare the effects of fentanyl and dexmedetomidine in attenuating airway and circulatory reflexes during emergence and extubation of the endotracheal tube. SETTING AND DESIGN: This double-blind, randomized, controlled study was done in patients undergoing surgery under general anesthesia belonging to the American Society of Anesthesiologists physical status 1 or 2...
September 2016: Anesthesia, Essays and Researches
Shruti Jain, Nazia Nazir, Rashid M Khan, Syed M Ahmed
INTRODUCTION: Extubation in deep plane of anesthesia followed by Guedel's oropharyngeal airway (OPA™) insertion is a routine method to avoid hemodynamic changes associated with tracheal extubation. Exchange of endotracheal tube (ETT) with Classic laryngeal mask airway (LMA™) prior to emergence from anesthesia also serves similar purpose. We had compared the hemodynamic changes involved during this ETT/LMA™ and ETT/OPA™ exchange technique. MATERIAL AND METHODS: This was a randomized prospective study on ASA I and 2 patients undergoing elective surgery under general anesthesia...
September 2016: Anesthesia, Essays and Researches
Khaled Elbahrawy, Alaa El-Deeb
BACKGROUND: Acute mesenteric ischemia is a life-threatening vascular emergency that requires early diagnosis, immediate anticoagulation, and intervention to restore mesenteric blood flow adequately. AIMS: To investigate the effect of rectus sheath block (RSB) for postoperative analgesia in patients with mesenteric vascular occlusion. SETTINGS AND DESIGN: Forty patients with mesenteric vascular occlusion, American Society of Anesthesiologists physical status I or II or III, scheduled for laparotomy were enrolled in this study...
September 2016: Anesthesia, Essays and Researches
Kristen Jijelava, Hongvan Le, Jack Parker, Jeffrey Yee
BACKGROUND: Ocular chemical injuries due to accidental exposure or application of cyanoacrylate, commonly known as "superglue," have increased over the past 30 years. However, current treatment options to relieve eyelid adhesions due to cyanoacrylate applications are difficult to successfully execute and can require sedation or general anesthesia. Here we describe a simple technique to release eyelid adhesions due to cyanoacrylate, or other adhesive agents, that can be successfully performed at bedside without sedation...
October 13, 2016: Journal of Emergency Medicine
Akwugo A Eziefule, Solafa Elshatanoufy, Mili Thakur, Frederico G Rocha
Background Propofol is a widely known, commonly used drug. Complications can occur with the use of this drug, including propofol-related infusion syndrome (PRIS). PRIS, in the obstetric population, has not been documented; however, we report a case of a patient who developed PRIS after an emergent cesarean delivery of a preterm infant. Case Study A 35-year-old multigravida woman presented complaining of leakage of fluid and decreased fetal movement. Her pregnancy was complicated by methadone maintenance therapy due to a history of opioid abuse...
October 2016: American Journal of Perinatology Reports
Erhan Gökçek, Ayhan Kaydu, Mehmet Salim Akdemir, Ferit Akil, Ibrahim Ozkan Akıncı
PURPOSE: To compared the effects of sevoflurane and desflurane on early anesthesia recovery in patients undergoing to craniotomy for intracranial lesions. METHODS: After IRB approval, the study included 50 patients aged 18-70 years who had ASA physical statuses of I-II and were scheduled for intracranial surgery. Patients were randomly divided into two groups: sevoflurane and desflurane. Anaesthesia was routinely induced in all patients followed by desflurane 5%-6% or sevoflurane 1%-2%...
September 2016: Acta Cirúrgica Brasileira
Lei Xia, Ming-Xing Liu, Jun Zhong, Ning-Ning Dou, Bin Li, Hui Sun, Shi-Ting Li
Although the microvascular decompression (MVD) surgery has become an effective remedy for cranial nerve rhizopathies, it is still challengeable and may result in a fatal sequel sometimes. Therefore, the operative skill needs to be further highlighted with emphasis on the safety and a preplan for management of postoperative fatal complications should be established. We retrospectively analyzed 6974 cases of MVD. Postoperatively, 46 patients (0.66 %) presented decline in consciousness with a positive finger-nose test (or failure to be tested) after wake up from the anesthesia, whom were focused on in this study...
October 12, 2016: Neurosurgical Review
Edyta K Bichler, Courtney C Elder, Paul S García
Antibiotics are used in the treatment and prevention of bacterial infections, but effects on neuron excitability have been documented. A recent study demonstrated that clarithromycin alleviates daytime sleepiness in hypersomnia patients (Trotti et al. 2014). To explore the potential application of clarithromycin as a stimulant, we performed whole cell patch clamp recordings in rat pyramidal cells from the CA3 region of hippocampus. In the presence of the antibiotic, rheobase current was reduced by 50%, F-I relationship (number of action potentials as a function of injected current) was shifted to the left, and the resting membrane potential was more depolarized...
October 12, 2016: Journal of Neurophysiology
Fernanda Pacella, Enzo Agostinelli, Sandra Cinzia Carlesimo, Marcella Nebbioso, Roberto Secondi, Michele Forastiere, Elena Pacella
BACKGROUND: Ozurdex is a 700 mcg dexamethasone intravitreal implant, approved for the management of macular edema secondary to retinal vein occlusion, and other related pathoglogiesAnterior chamber dislocation of Ozurdex represents an uncommon complication of the intravitreal injection, which can be managed by repositioning the implant into the vitreous cavity. We describe the case of a successful repositioning of an Ozurdex implant by mobilization and subsequent balanced saline solution injection in the anterior chamber...
October 13, 2016: Journal of Medical Case Reports
Joel M Fahling, L Kendall McKenzie
BACKGROUND: The oculocardiac reflex is a decrease in heart rate caused by ocular compression or traction upon the extraocular musculature. Multiple instances of this phenomenon have been described in anesthesia, trauma, craniofacial, and ophthalmology literature, but there is a sparsity of documentation in the emergency medicine literature. CASE REPORT: We describe the observation and management of the oculocardiac reflex in a 26-year-old man with retrobulbar hematoma and intraocular trauma caused by a self-inflicted gunshot wound...
October 8, 2016: Journal of Emergency Medicine
O M Okur, A Şener, H Ş Kavakli, G K Çelik, N Ö Doğan, F Içme, G P Günaydin
PURPOSE: We aimed to compare two digital nerve block techniques in patients due to traumatic digital lacerations. METHODS: This was a randomized-controlled study designed prospectively in the emergency department of a university-based training and research hospital. Randomization was achieved by sealed envelopes. Half of the patients were randomised to traditional (two-injection) digital nerve block technique while single-injection digital nerve block technique was applied to the other half...
October 5, 2016: European Journal of Trauma and Emergency Surgery: Official Publication of the European Trauma Society
Tjokorda Gde Agung Senapathi, I Made Gede Widnyana, Made Wiryana, I Gusti Ngurah Mahaalit Aribawa, I Wayan Aryabiantara, I Gusti Agung Gede Utara Hartawan, I Ketut Sinardja, I Putu Pramana Suarjaya, I Ketut Wibawa Nada, Aa Gde Putra Semara Jaya
PURPOSE: Cesarean section is a surgical procedure. Surgical procedures will induce stress responses, which may have negative impact on postoperative recovery. Ketamine plays a role in the homeostatic regulation of inflammatory response in order to attenuate stress response. We tried to determine the effectiveness of low-dose intravenous ketamine to attenuate stress response in patients undergoing emergency cesarean section with spinal anesthesia. PATIENTS AND METHODS: Thirty-six pregnant women undergoing emergency cesarean section with spinal anesthesia were randomly divided into two groups (n=18)...
2016: Journal of Pain Research
Karen Müller Ramalho, Lárissa Marcondes Paladini de Souza, Isabel Peixoto Tortamano, Carlos Alberto Adde, Rodney Garcia Rocha, Carlos de Paula Eduardo
This randomized placebo-blind study aimed to evaluate the effect of laser phototherapy (LPT) on pain caused by symptomatic irreversible pulpitis (SIP). Sixty patients diagnosed with SIP were randomly assigned to treatment groups (n = 15): G1 (control), G2 (laser placebo-sham irradiation), G3 (laser irradiation at 780 nm, 40 mW, 4 J/cm(2)), and G4 (laser irradiation at 780 nm, 40 mW, 40 J/cm(2)). Spontaneous pain was recorded using a VAS score before (T0), immediately after (T1), and 15 min after treatment (T2)...
October 1, 2016: Lasers in Medical Science
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