Acta Anaesthesiologica Taiwanica

Publisher: Taiwan ma zui yi xue hui, Elsevier

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  • Other titles
    ScienceDirect
  • ISSN
    1875-4597
  • OCLC
    403625075
  • Material type
    Document, Periodical
  • Document type
    Journal / Magazine / Newspaper, Computer File

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Elsevier

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    • Publisher last contacted on 18/10/2013
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Publications in this journal

  • [Show abstract] [Hide abstract]
    ABSTRACT: Although the pathophysiology of sepsis has been elucidated with the passage of time, sepsis may be regarded as an uncontrolled inflammatory and procoagulant response to infection. The hemostatic changes in sepsis range from subclinical activation of blood coagulation to acute disseminated intravascular coagulation (DIC). DIC is characterized by widespread microvascular thrombosis, which contributes to multiple organ dysfunction/failure, and subsequent consumption of platelets and coagulation factors, eventually causing bleeding manifestations. The diagnosis of DIC can be made using routinely available laboratory tests, scoring algorithms, and thromboelastography. In this cascade of events, the inhibition of coagulation activation and platelet function is conjectured as a useful tool for attenuating inflammatory response and improving outcomes in sepsis. A number of clinical trials of anticoagulants were performed, but none of them have been recognized as a standard therapy because recombinant activated protein C was withdrawn from the market owing to its insufficient efficacy in a randomized controlled trial. However, these subgroup analyses of activated protein C, antithrombin, and thrombomodulin trials show that overt coagulation activation is strongly associated with the best therapeutic effect of the inhibitor. In addition, antiplatelet drugs, including acetylsalicylic acid, P2Y12 inhibitors, and glycoprotein IIb/IIIa antagonists, may reduce organ failure and mortality in the experimental model of sepsis without a concomitant increased bleeding risk, which should be supported by solid clinical data. For a state-of-the-art treatment of sepsis, the efficacy of anticoagulant and antiplatelet agents needs to be proved in further large-scale prospective, interventional, randomized validation trials.
    Acta Anaesthesiologica Taiwanica 12/2014;
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    ABSTRACT: Elderly patients (aged ≥ 80 years) undergo an increasing number of operations. Elderly patients undergoing operations usually develop more postoperative complications and have poorer outcomes. The aim of this study is to identify the relative importance between preoperative and intraoperative variables to predict adverse postoperative outcomes in these patients.Methods We retrospectively analyzed the records of 404 patients (aged ≥ 80 years and underwent a noncardiac surgery) collected from the quality assurance database in our department. We reviewed the patients' preoperative and intraoperative variables as well as postoperative complications and outcomes. Odds ratios of risk factors were then calculated by univariate and multivariate analyses. In addition, hazard ratios of incidence of discharge and mortality rates were analyzed.ResultsOverall, 26.4% of patients developed one or more postoperative complications, and the in-hospital mortality rate was 6.7%. The majority of these patients had pre-existing cardiovascular disorders such as hypertension (47.5%). Respiratory complication was the most common postoperative complication (12.9%). Multivariate analysis showed male sex, anesthesia method, and colloid infusion were risk factors for increased respiratory complication. Our results showed that patients who developed different kinds of postoperative complications had a different level of risks associated with prolonged hospital stay and mortality.Conclusion Patients over the age of 80 years, of male sex, under general anesthesia, and receiving colloid infusion were at a higher risk of developing respiratory complications. Postoperative respiratory complications occurred in most of the geriatric surgical patients. Efforts to improve the surgical outcomes must include measures to minimize in-hospital complications. Detailed evaluation and better communicating the aforementioned risk factors to these patients are suggested for improving anesthesia quality and surgical outcomes.
    Acta Anaesthesiologica Taiwanica 11/2014;
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    ABSTRACT: It is aimed to evaluate whether there is a difference in regional cerebral saturation of newborns measured by near infrared spectroscopy born either by general anesthesia or combined spinal epidural anesthesia during elective cesarean deliveries.Methods After approval of the Ethical Committee of our hospital, and informed consents of the parturients were taken, 68 patients were included in the study. The regional cerebral oxygen saturations (RcSO2) of newborns were measured by near infrared spectroscopy (NIRS) measurements at 1st, 5th min after birth. In group I (n=32), general anesthesia was performed for the cesarean operation and in group II (n=36), combined spinal epidural anesthesia (CSEA) was the anesthetic management. The age of the mother, gestation, the problems related to the pregnancy, heart rate, blood pressure, oxygen saturation (SpO2) of the mother had been recorded. The measurements of the newborn were; SpO2 of right hand, RcSO2 measured by NIRS, the delivery time (from incision to the cessation of circulation in the placental cord), Apgar score. Data were analyzed using GraphPad Prism 5.0 (GraphPad Software, La Jolla, California) and presented as mean +/− SD. Results obtained in different groups were compared using upaired t-test. Differences were statistically significant at p < 0.05.ResultsThere were no significant differences between the groups related to the mother's age, gestation week and baseline blood pressure. Both the systolic and diastolic blood pressures measured at 1st and 5th min after induction or start of the spinal block were significantly lower in the mothers who had undergone combined spinal epidural anesthesia. The heart rates of the mothers who had been under CSEA were significantly higher than the general anesthesia group. The Apgar at the 1st min were observed significantly higher in Group II. Oxygen saturation of the newborns were significantly higher in Group II. Regional cerebral oxygenation measured by NIRS were significantly higher in CSEA group.Conclusion Combined spinal epidural anesthesia, besides other known advantages, had been shown to be superior to general anesthesia as a means of regional cerebral oxygenation of the newborns.
    Acta Anaesthesiologica Taiwanica 11/2014;
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    ABSTRACT: Ebstein's anomaly is an uncommon congenital heart defect with an extremely variable natural history due to a wide spectrum of pathological features. We report on the anesthetic management of a 24-year-old primigravida woman with Ebstein's anomaly with recurrent supraventricular tachycardia for emergency cesarean section.
    Acta Anaesthesiologica Taiwanica 11/2014;
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    ABSTRACT: The practice of anesthetic premedication embarked upon soon after ether and chloroform were introduced as general anesthetics in the middle of the 19th century. By applying opioids and anticholinergics prior to surgery, the surgical patients could achieve a less anxious state, and more importantly, they would acquire a smoother course during the tedious and dangerous induction stage. Premedication with opioids and anticholinergics was not a routine practice in the 20th century when intravenous anesthetics were primarily used as induction agents that significantly shorten the induction time. The current practice of anesthetic premedication has evolved into a generalized scheme that incorporates several aspects of patient care: decreasing preoperative anxiety, dampening intraoperative noxious stimulus and its associated neuroendocrinological changes, and minimizing postoperative adverse effects of anesthesia and surgery. Rational use of premedication in modern anesthesia practice should be justified by individual needs, the types of surgery, and the anesthetic agents and techniques used. In this article, we will provide our readers with updated information about premedication of surgical patients with a focus on the recent application of second generation serotonin type 3 antagonist, antidepressants, and anticonvulsants.
    Acta Anaesthesiologica Taiwanica 10/2014;
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    ABSTRACT: The review demonstrates the unique advantages of ultrasonography in pain control. Several imaging modalities can be used to guide pain control, such as computed tomography, magnetic resonance imaging, and radiography. Ultrasonography has unique advantages over these other modalities in terms of its non-ionizing radiation, real-time imaging, portability, and cost-effectiveness. Ultrasonography with color Doppler and elastography can provide safer guidance to avoid blood vessels and the nerve trunk when using steroid or xylocaine infusions to encase the nerve trunk. This review focuses on the control of chronic pain in the upper limbs, lower limbs, and trunk.
    Acta Anaesthesiologica Taiwanica 10/2014;
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    ABSTRACT: Acute kidney injury (AKI) secondary to ischemia-reperfusion injury (IRI) is a major cause of patient morbidity and mortality in the perioperative period. It can lead to new onset of chronic kidney disease and accelerate its progression. Patients with risk factors undergoing cardiac, vascular, and liver transplantation surgeries, which may inevitably involve IRI, are more susceptible to AKI. Anesthetic agents have been postulated to possess renoprotective properties. Thus, exploring the utilization of selective perioperative anesthetic agents with renoprotective properties may be a promising avenue to reduce the risk of AKI. This review discusses the effects and mechanisms of dexmedetomidine, inhalational and intravenous anesthetics, and xenon-mediated renoprotection. Although the renoprotective effects of these agents obtained in the laboratory are promising, much work especially via clinical trials is required to determine the translational value from the bench to the bedside. Copyright © 2014. Published by Elsevier B.V.
    Acta Anaesthesiologica Taiwanica 10/2014;
  • Acta Anaesthesiologica Taiwanica 09/2014;
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    ABSTRACT: Background Postdural puncture headache (PDPH) is one of the common complications of spinal anesthesia; it is observed in 1–40% of cases involving spinal anesthesia. It can cause considerable morbidity and 40% of cases may require invasive treatments such as epidural blood patch. With the exception of invasive treatments such as an epidural blood patch, current standard treatment modalities have not proved efficacious. There had been some research done that indicated successful prophylaxis and/or treatment of PDPH by administration of intravenous steroids. Based on those findings, we hypothesize that a direct injection of corticosteroids to the anesthesia puncture site could increase the amount of corticosteroid that accumulates in the puncture site, and will be more effective in decreasing dural inflammation and incidence of PDPH than that of parenteral steroids. We formulated our study to evaluate the effect of dexamethasone directly injected into spinal anesthesia puncture sites. Methods A total of 268 patients undergoing spinal anesthesia were randomly allocated into two groups; one group received a prophylactic epidural injection of dexamethasone (2 mL, 8 mg) and the other group received 2 mL of normal saline. The incidence and intensity of PDPH and puncture site backache were each measured at 24 hours, 72 hours, and 7 days after spinal anesthesia. The intensity of the headache was graded according to the meningeal headache index. Results The overall incidence of headache during the 7-day period was 5 patients (3.7%) in the control group and 11 patients (8.2%) in the study group, which is not statistically significant (X2 = 2.393 and p = 0.122. The severity of headache also shows no statistical significance (2.2% in cases versus 6% in controls; z = 1.53, p = 0.126). The intensity of headache reported at the 24 hours (z = 0.698; p = 0.485), 72 hours (z = 0.849; p = 0.396), and 7 days (z = 0.008; p = 0.994) was not different. There also was no difference in the incidence of backache in the two groups. Conclusion In contrast to other studies that showed the efficacy of intravenous dexamethasone in the prevention and treatment of PDPH, our study did not show any significant effect of prophylactic epidural injection of dexamethasone in prevention of PDPH. However regarding the low number of PDPH in routine cases, evaluation of this intervention in groups with a high incidence of PDPH by using of particulate steroids is recommended to confirm these preliminary findings.
    Acta Anaesthesiologica Taiwanica 09/2014;
  • Acta Anaesthesiologica Taiwanica 09/2014;
  • Acta Anaesthesiologica Taiwanica 08/2014;
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    ABSTRACT: Objective Sugammadex rapidly reverses neuromuscular blockade (NMB) induced by rocuronium. NMB induced by rocuronium is prolonged in patients with liver dysfunction, because the drug is mainly excreted into the bile. However, the efficacy and safety of sugammadex in terms of reversing rocuronium-induced NMB in patients with liver dysfunction undergoing hepatic surgery have not been evaluated. This observational study investigated the efficacy and safety of sugammadex after continuous infusion of rocuronium in patients with liver dysfunction undergoing hepatic surgery. Methods Remifentanil/propofol anesthesia was administered to 31 patients: 15 patients in the control group, and 16 patients from a group with liver dysfunction. Rocuronium (0.6 mg/kg) was administered, followed by continuous infusion. The enrolled patients were then subdivided into two groups according to the dose of sugammadex. In the first group a single dose of sugammadex (2.0 mg/kg) was given at the reappearance of the second twitch (T2). In the second group a single dose of sugammadex (4.0 mg/kg) was given at the first twitch response if T2 did not reappear in 15 minutes after stopping rocuronium. The primary outcome was time from administration of sugammadex to recovery of a train-of-four ratio to 0.9. Results The dose of rocuronium required in the liver dysfunction group was lower than that in the control group (6.2 vs. 8.2 μg/kg/min, p = 0.002). The mean time from the administration of sugammadex to recovery of the train-of-four ratio to 0.9 was not significantly different between the liver dysfunction group and the control group (2.2 minutes vs. 2.0 minutes in the 2 mg/kg administration group, p = 0.44 and 1.9 minutes vs. 1.7 minutes in the 4 mg/kg administration group, p = 0.70, respectively). No evidence of recurarization was observed in any of the patients. Most of the adverse events were found to be mild and such events were not related to the use of sugammadex. None of the patients was eliminated from the study because of an adverse event. One patient died due to cholestatic liver cirrhosis because of repeated hepatic surgery. Conclusion Sugammadex can rapidly reverse NMB after continuous infusion of rocuronium in patients with liver dysfunction undergoing hepatic surgery. Sugammadex was found to be safe and well tolerated. However, further studies of sugammadex under similar conditions should be conducted involving a large number of patients with liver dysfunction undergoing hepatic surgery.
    Acta Anaesthesiologica Taiwanica 06/2014;
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    ABSTRACT: The causes of obstructive jaundice are varied, but it is most commonly due to choledocholithiasis; benign strictures of the biliary tract; pancreaticobiliary malignancies; and metastatic disease. Surgery in patients with obstructive jaundice is generally considered to be associated with a higher incidence of complications and mortality. Therefore, it poses a considerable challenge to the anesthesiologist, surgeons, and the intensive care team. However, appropriate preoperative evaluation and optimization can greatly contribute to a favorable outcome for perioperative jaundiced patients. This article outlines the association between obstructive jaundice and perioperative management, and reviews the clinical and experimental studies that have contributed to our knowledge of the underlying pathophysiologic mechanisms. Pathophysiology caused by obstructive jaundice involving coagulopathies, infection, renal dysfunction, and other adverse events should be fully assessed and reversed preoperatively. The depressed cardiovascular effects of obstructive jaundice are worth noticing because it has complicated mechanisms and needs to be further explored. Alterations of anesthesia-related drugs induced by obstructive jaundice are varied and clinicians should be aware of the possible need for a decrease in the anesthetic dose. Recommendations concerning the perioperative management of the patients with obstructive jaundice including preoperative biliary drainage, anti-infection, nutrition support, coagulation reversal, cardiovascular evaluation, perioperative fluid therapy, and hemodynamic optimization should be taken.
    Acta Anaesthesiologica Taiwanica 03/2014;
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    ABSTRACT: Current literature lacks systematic data on acute perioperative pain management in neonates and mainly focuses only on procedural pain management. In the current review, the neurophysiological basis of neonatal pain perception and the role of different analgesic drugs and techniques in perioperative pain management in neonates are systematically reviewed. Intravenous opioids such as morphine or fentanyl as either intermittent bolus or continuous infusion remain the most common modality for the treatment of perioperative pain. Paracetamol has a promising role in decreasing opioid requirement. However, routine use of ketorolac or other nonsteroidal anti-inflammatory drugs is not usually recommended. Epidural analgesia is safe in experienced hands and provides several benefits over systemic opioids such as early extubation and early return of bowel function.
    Acta Anaesthesiologica Taiwanica 01/2014;
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    ABSTRACT: Aneurysmal subarachnoid hemorrhage (aSAH) is a serious and debilitating condition that leads to the development of many complications, which are followed by mortality and morbidity. As anesthesiologists, we may require to manage aSAH at various settings such as in the perioperative period or in a nonoperative setting such as the neuroradiology suite for diagnostic and therapeutic interventions. Therefore, it is important to understand the pathophysiology of aSAH and anesthetic management for operations and interventions. For decades, early brain injury and cerebral vasospasm have played major roles in the outcome following aSAH. The purpose of this article is to review recent advances and future perspectives in the treatment of aSAH, early brain injury, and cerebral vasospasm.
    Acta Anaesthesiologica Taiwanica 01/2014;