[Show abstract][Hide abstract] ABSTRACT: Perioperative ischemic stroke is an uncommon event associated with significant morbidity and mortality. The complexity of the surgical procedure and surgery induced hypercoagulable status also influence the incidence of stroke. The management of stroke involves a decision regarding the quickest suitable revascularization method. Endovascular mechanical thrombectomy, such as intra-arterial mechanical thrombectomy (IAMT), can restore vascular patency of the vessels, providing an alternative or synergistic method to restore blood flow. Although, there are no recommended treatment guidelines, IAMT is eligible to be a treatment of choice for perioperative ischemic stroke. We experienced a case of a patient who demonstrated hemiplegia and aphasia, the early symptom of acute ischemic stroke, in the post-anesthesia care unit and performed IAMT successfully. Thus we report the case with a review of the relevant literature.
Korean journal of anesthesiology 05/2014; 66(5):402-6.
[Show abstract][Hide abstract] ABSTRACT: Emergence agitation is associated with increased morbidity and hospital costs. However, there have been few reports in the medical literature on the occurrence of emergence agitation in adults. The aim of this study was to compare emergence agitation between sevoflurane and propofol anesthesia in adults after closed reduction of nasal bone fracture.
Forty adults (ASA I-II, 20-60 yr) undergoing closed reduction of nasal bone fracture were randomly assigned to either sevoflurane or propofol group and anesthesia was maintained with sevoflurane or propofol. The bispectral index (BIS) was monitored and maintained within 40-60. At the end of surgery, patients were transported to the post anesthetic care unit (PACU) and agitation state scale was checked by Aono's four-point scale (AFPS). Emergence agitation was defined as and AFPS score of 3 or 4. Pain score were measured by numeric rating scale (NRS) on arrival and peak value at PACU.
Nine (45.0%) patients in the sevoflurane group and 2 (10.0%) patients in the propofol group developed emergence agitation in the PACU (P = 0.031). There was no correlation between peak NRS and Aono's four-point scale.
Propofol may decrease incidence of emergence agitation compared to sevoflurane in adults undergoing closed reduction of nasal bone fracture.
Korean journal of anesthesiology 07/2012; 63(1):48-53.
[Show abstract][Hide abstract] ABSTRACT: Anemia is not rare in patients presenting for coronary artery bypass graft surgery (CABG) and as these patients are frequently on dual antiplatelet therapy (DAPT), the coexisting conditions could potentially increase the risk of bleeding and transfusion. The aim of this study was to evaluate the effect of tranexamic acid (TA) on blood loss and transfusion in preoperatively anemic patients who continued DAPT until within 5 days of off-pump CABG (OPCAB).
Seventy-six anemic patients were randomized into 2 groups: TA group receiving TA (1g bolus followed by infusion at 200mg/h) and a Control group receiving the same volume of saline. The amount of blood loss and transfusion requirement during, and at 4 and 24h after the operation were assessed. Patients' characteristics and operative data were similar between the groups. During the perioperative period, which combined the intraoperative and postoperative 24h data, the TA group received significantly smaller amounts of packed red blood cells and fresh frozen plasma. Total amount of perioperative blood loss was similar between the groups, although the blood loss during the postoperative 4h was significantly less in the TA group.
TA infusion could reduce the amount of transfusion during the perioperative period in patients with preoperative anemia who continue DAPT until within 5 days of OPCAB.
[Show abstract][Hide abstract] ABSTRACT: Although a brachial plexus block can be used to provide anesthesia and analgesia for upper extremity surgery, its effects using MgSO(4) on postoperative pain management have not been reported. The aim of this study was to evaluate brachial plexus block using MgSO(4) on postoperative analgesia.
Thirty-eight patients who were scheduled to undergo upper extremity surgery were randomly allocated into two groups: patients receiving axillary brachial plexus block with 0.2% ropivacaine 20 ml and normal saline 2 ml (group S) or 0.2% ropivacaine 20 ml and MgSO(4) 200 mg (group M). Before extubation, the blocks were done and patient controlled analgesia was started, and then, the patients were transported to a postanesthetic care unit. The postoperative visual analogue scale (VAS), opioid consumption, and side effects were recorded.
The two groups were similar regarding the demographic variables and the duration of the surgery. No differences in VAS scores were observed between the two groups. There was no statistically significant difference in opioid consumption between the two groups. Nausea was observed in three patients for each group.
Axillary brachial plexus block using MgSO(4) did not reduce the level of postoperative pain and opioid consumption.
[Show abstract][Hide abstract] ABSTRACT: Hydroxyethyl starch (HES) solutions are often used for maintaining intravascular volume and improving microperfusion, while a large amount of HES can cause adverse effects on coagulation. As the indications for clopidogrel expand, an increasing number of patients undergoing off-pump coronary artery bypass surgery (OPCAB) are also undergoing dual antiplatelet therapy (DAPT), with its higher risk of bleeding complications. The aim of the present study was to determine whether a moderate dose of 6% HES 130/0.4 significantly increases perioperative blood loss in patients with continued DAPT within 5 days of OPCAB.
Patients who received clopidogrel and aspirin within 5 days of OPCAB were randomly allocated to receive HES 130/0.4 (≤ 30 ml/kg) followed by crystalloid infusion (HES group, n=53), or crystalloid only (crystalloid group, n=53) perioperatively. The amount of perioperative blood loss (sum of bleeding during the intraoperative and postoperative 24-h period), transfusion requirements, modified thromboelastography and coagulation variables, hemodynamic parameters, and fluid balance were recorded. Perioperative blood loss and coagulation profiles were similar between the groups, but the postoperative hemoglobin level was higher in the crystalloid group.
Up to 30 ml·kg⁻¹·day⁻¹ of 6% HES 130/0.4 did not increase the perioperative blood loss compared to crystalloid in patients with recent exposure to DAPT undergoing OPCAB. HES 130/0.4 caused a similar degree and duration of coagulation impairment as observed when only crystalloid was given.