ABSTRACT
This article describes the anesthetic management of patients with traumatic brain injury (TBI) undergoing non-neurosurgery, primarily targeting intraoperative management for multiple-trauma surgery. The aim of this review is to promote the best clinical practice for patients with TBI in order to prevent secondary brain injury. Based on the current clinical guidelines and evidence, anesthetic selection and administration; maintenance of optimal cerebral perfusion pressure, oxygenation and ventilation; coagulation monitoring; glucose control; and temperature management are addressed. Neurological recovery, which is critical for improving the patient’s quality of life, is most important; therefore, future research needs to be focused on this aspect.
ABSTRACT
Background@#Remote ischemic postconditioning (RIPoC) is induced by several cycles of brief, reversible, mechanical blood flow occlusion, and reperfusion of the distal organs thereby protecting target organs. We investigated if RIPoC ameliorated liver injury in a lipopolysaccharide (LPS)-induced endotoxemic rats. @*Methods@#Protocol 1) Rats were administered LPS and samples collected at 0, 2, 6, 12, and 18 h. 2) After RIPoC at 2, 6, and 12 h (L+2R+18H, L+6R+18H, and L+12R+18H), samples were analyzed at 18 h. 3) RIPoC was performed at 2 h, analysis samples at 6, 12, 18 h (L+2R+6H, L+2R+12H, L+2R+18H), and RIPoC at 6 h, analysis at 12 h (L+6R+12H). 4) Rats were assigned to a control group while in the RIPoC group, RIPoC was performed at 2, 6, 10, and 14 h, with samples analyzed at 18 h. @*Results@#Protocol 1) Liver enzyme, malondialdehyde (MDA), tumor necrosis factor-α (TNF-α), and nuclear factor-κB (NF-κB) levels increased while superoxide dismutase (SOD) levels decreased over time. 2) Liver enzyme and MDA levels were lower while SOD levels were higher in L+12R+18H and L+6R+18H groups when compared with L+2R+18H group. 3) Liver enzyme and MDA levels were lower while SOD levels were higher in L+2R+6H and L+6R+12H groups when compared with L+2R+12H and L+2R+18H groups. 4) Liver enzyme, MDA, TNF-α, and NF-κB levels were lower while SOD levels were higher in RIPoC group when compared with control group. @*Conclusions@#RIPoC attenuated liver injury in the LPS-induced sepsis model by modifying inflammatory and oxidative stress response for a limited period.
ABSTRACT
Myringotomy and ventilation tube insertion are widely performed in pediatric patients with chronic otitis media. This procedure is performed under general anesthesia or sedation with local anesthesia infiltration in pediatric patients. In this case report, we report a case of transient facial paralysis in a pediatric patient who underwent myringotomy and ventilation tube insertion using sevoflurane inhalation and four-quadrant blocks with lidocaine.
ABSTRACT
We experienced an unusual case of accelerated junctional rhythm with severe hypotension after infiltration oflidocaine containing epinephrine during dental surgery under general anesthesia. The patient’s electrocardiogramexhibited retrograde P-waves following the QRS complex, which could be misinterpreted as ST-segment depression.As a temporary measure, administration of ephedrine restored the patient’s blood pressure to normal levels.The importance of this case lies in its demonstration of an unexpected and serious side effect of commonlyused epinephrine infiltration. This case also highlights the need for accurate interpretation of the electrocardiogramand comprehensive understanding of best practices for patient management.