Publisher: Elsevier   (Total: 3201 journals)

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Showing 1 - 200 of 3201 Journals sorted alphabetically
Academic Pediatrics     Hybrid Journal   (Followers: 43, SJR: 1.655, CiteScore: 2)
Academic Radiology     Hybrid Journal   (Followers: 27, SJR: 1.015, CiteScore: 2)
Accident Analysis & Prevention     Hybrid Journal   (Followers: 107, SJR: 1.462, CiteScore: 3)
Accounting Forum     Hybrid Journal   (Followers: 30, SJR: 0.932, CiteScore: 2)
Accounting, Organizations and Society     Hybrid Journal   (Followers: 48, SJR: 1.771, CiteScore: 3)
Achievements in the Life Sciences     Open Access   (Followers: 10)
Acta Anaesthesiologica Taiwanica     Open Access   (Followers: 6)
Acta Astronautica     Hybrid Journal   (Followers: 479, SJR: 0.758, CiteScore: 2)
Acta Automatica Sinica     Full-text available via subscription   (Followers: 2)
Acta Biomaterialia     Hybrid Journal   (Followers: 31, SJR: 1.967, CiteScore: 7)
Acta Colombiana de Cuidado Intensivo     Full-text available via subscription   (Followers: 3)
Acta de Investigación Psicológica     Open Access   (Followers: 2)
Acta Ecologica Sinica     Open Access   (Followers: 11, SJR: 0.18, CiteScore: 1)
Acta Histochemica     Hybrid Journal   (Followers: 5, SJR: 0.661, CiteScore: 2)
Acta Materialia     Hybrid Journal   (Followers: 354, SJR: 3.263, CiteScore: 6)
Acta Mathematica Scientia     Full-text available via subscription   (Followers: 5, SJR: 0.504, CiteScore: 1)
Acta Mechanica Solida Sinica     Full-text available via subscription   (Followers: 9, SJR: 0.542, CiteScore: 1)
Acta Oecologica     Hybrid Journal   (Followers: 12, SJR: 0.834, CiteScore: 2)
Acta Otorrinolaringologica (English Edition)     Full-text available via subscription  
Acta Otorrinolaringológica Española     Full-text available via subscription   (Followers: 2, SJR: 0.307, CiteScore: 0)
Acta Pharmaceutica Sinica B     Open Access   (Followers: 3, SJR: 1.793, CiteScore: 6)
Acta Psychologica     Hybrid Journal   (Followers: 27, SJR: 1.331, CiteScore: 2)
Acta Sociológica     Open Access   (Followers: 1)
Acta Tropica     Hybrid Journal   (Followers: 6, SJR: 1.052, CiteScore: 2)
Acta Urológica Portuguesa     Open Access   (Followers: 1)
Actas Dermo-Sifiliograficas     Full-text available via subscription   (Followers: 3, SJR: 0.374, CiteScore: 1)
Actas Dermo-Sifiliográficas (English Edition)     Full-text available via subscription   (Followers: 2)
Actas Urológicas Españolas     Full-text available via subscription   (Followers: 3, SJR: 0.344, CiteScore: 1)
Actas Urológicas Españolas (English Edition)     Full-text available via subscription   (Followers: 1)
Actualites Pharmaceutiques     Full-text available via subscription   (Followers: 7, SJR: 0.19, CiteScore: 0)
Actualites Pharmaceutiques Hospitalieres     Full-text available via subscription   (Followers: 3)
Acupuncture and Related Therapies     Hybrid Journal   (Followers: 9)
Acute Pain     Full-text available via subscription   (Followers: 15, SJR: 2.671, CiteScore: 5)
Ad Hoc Networks     Hybrid Journal   (Followers: 11, SJR: 0.53, CiteScore: 4)
Addictive Behaviors     Hybrid Journal   (Followers: 20, SJR: 1.29, CiteScore: 3)
Addictive Behaviors Reports     Open Access   (Followers: 9, SJR: 0.755, CiteScore: 2)
Additive Manufacturing     Hybrid Journal   (Followers: 18, SJR: 2.611, CiteScore: 8)
Additives for Polymers     Full-text available via subscription   (Followers: 22)
Advanced Drug Delivery Reviews     Hybrid Journal   (Followers: 210, SJR: 4.09, CiteScore: 13)
Advanced Engineering Informatics     Hybrid Journal   (Followers: 14, SJR: 1.167, CiteScore: 4)
Advanced Powder Technology     Hybrid Journal   (Followers: 17, SJR: 0.694, CiteScore: 3)
Advances in Accounting     Hybrid Journal   (Followers: 10, SJR: 0.277, CiteScore: 1)
Advances in Agronomy     Full-text available via subscription   (Followers: 20, SJR: 2.384, CiteScore: 5)
Advances in Anesthesia     Full-text available via subscription   (Followers: 31, SJR: 0.126, CiteScore: 0)
Advances in Antiviral Drug Design     Full-text available via subscription   (Followers: 2)
Advances in Applied Mathematics     Full-text available via subscription   (Followers: 12, SJR: 0.992, CiteScore: 1)
Advances in Applied Mechanics     Full-text available via subscription   (Followers: 12, SJR: 1.551, CiteScore: 4)
Advances in Applied Microbiology     Full-text available via subscription   (Followers: 25, SJR: 2.089, CiteScore: 5)
Advances In Atomic, Molecular, and Optical Physics     Full-text available via subscription   (Followers: 16, SJR: 0.572, CiteScore: 2)
Advances in Biological Regulation     Hybrid Journal   (Followers: 4, SJR: 2.61, CiteScore: 7)
Advances in Botanical Research     Full-text available via subscription   (Followers: 2, SJR: 0.686, CiteScore: 2)
Advances in Cancer Research     Full-text available via subscription   (Followers: 36, SJR: 3.043, CiteScore: 6)
Advances in Carbohydrate Chemistry and Biochemistry     Full-text available via subscription   (Followers: 9, SJR: 1.453, CiteScore: 2)
Advances in Catalysis     Full-text available via subscription   (Followers: 6, SJR: 1.992, CiteScore: 5)
Advances in Cell Aging and Gerontology     Full-text available via subscription   (Followers: 7)
Advances in Cellular and Molecular Biology of Membranes and Organelles     Full-text available via subscription   (Followers: 15)
Advances in Chemical Engineering     Full-text available via subscription   (Followers: 29, SJR: 0.156, CiteScore: 1)
Advances in Child Development and Behavior     Full-text available via subscription   (Followers: 11, SJR: 0.713, CiteScore: 1)
Advances in Chronic Kidney Disease     Full-text available via subscription   (Followers: 11, SJR: 1.316, CiteScore: 2)
Advances in Clinical Chemistry     Full-text available via subscription   (Followers: 27, SJR: 1.562, CiteScore: 3)
Advances in Clinical Radiology     Full-text available via subscription   (Followers: 3)
Advances in Colloid and Interface Science     Full-text available via subscription   (Followers: 21, SJR: 1.977, CiteScore: 8)
Advances in Computers     Full-text available via subscription   (Followers: 15, SJR: 0.205, CiteScore: 1)
Advances in Cosmetic Surgery     Full-text available via subscription   (Followers: 2)
Advances in Dermatology     Full-text available via subscription   (Followers: 16)
Advances in Developmental Biology     Full-text available via subscription   (Followers: 15)
Advances in Digestive Medicine     Open Access   (Followers: 15)
Advances in DNA Sequence-Specific Agents     Full-text available via subscription   (Followers: 8)
Advances in Drug Research     Full-text available via subscription   (Followers: 26)
Advances in Ecological Research     Full-text available via subscription   (Followers: 46, SJR: 2.524, CiteScore: 4)
Advances in Engineering Software     Hybrid Journal   (Followers: 31, SJR: 1.159, CiteScore: 4)
Advances in Experimental Biology     Full-text available via subscription   (Followers: 10)
Advances in Experimental Social Psychology     Full-text available via subscription   (Followers: 55, SJR: 5.39, CiteScore: 8)
Advances in Exploration Geophysics     Full-text available via subscription   (Followers: 2)
Advances in Family Practice Nursing     Full-text available via subscription   (Followers: 1)
Advances in Fluorine Science     Full-text available via subscription   (Followers: 9)
Advances in Food and Nutrition Research     Full-text available via subscription   (Followers: 72, SJR: 0.591, CiteScore: 2)
Advances in Fuel Cells     Full-text available via subscription   (Followers: 19)
Advances in Genetics     Full-text available via subscription   (Followers: 20, SJR: 1.354, CiteScore: 4)
Advances in Genome Biology     Full-text available via subscription   (Followers: 12, SJR: 12.74, CiteScore: 13)
Advances in Geophysics     Full-text available via subscription   (Followers: 9, SJR: 1.193, CiteScore: 3)
Advances in Heat Transfer     Full-text available via subscription   (Followers: 26, SJR: 0.368, CiteScore: 1)
Advances in Heterocyclic Chemistry     Full-text available via subscription   (Followers: 11, SJR: 0.749, CiteScore: 3)
Advances in Human Factors/Ergonomics     Full-text available via subscription   (Followers: 26)
Advances in Imaging and Electron Physics     Full-text available via subscription   (Followers: 5, SJR: 0.193, CiteScore: 0)
Advances in Immunology     Full-text available via subscription   (Followers: 42, SJR: 4.433, CiteScore: 6)
Advances in Inorganic Chemistry     Full-text available via subscription   (Followers: 12, SJR: 1.163, CiteScore: 2)
Advances in Insect Physiology     Full-text available via subscription   (Followers: 2, SJR: 1.938, CiteScore: 3)
Advances in Integrative Medicine     Hybrid Journal   (Followers: 6, SJR: 0.176, CiteScore: 0)
Advances in Intl. Accounting     Full-text available via subscription   (Followers: 3)
Advances in Life Course Research     Hybrid Journal   (Followers: 11, SJR: 0.682, CiteScore: 2)
Advances in Lipobiology     Full-text available via subscription   (Followers: 2)
Advances in Magnetic and Optical Resonance     Full-text available via subscription   (Followers: 9)
Advances in Marine Biology     Full-text available via subscription   (Followers: 22, SJR: 0.88, CiteScore: 2)
Advances in Mathematics     Full-text available via subscription   (Followers: 17, SJR: 3.027, CiteScore: 2)
Advances in Medical Sciences     Hybrid Journal   (Followers: 10, SJR: 0.694, CiteScore: 2)
Advances in Medicinal Chemistry     Full-text available via subscription   (Followers: 6)
Advances in Microbial Physiology     Full-text available via subscription   (Followers: 5, SJR: 1.158, CiteScore: 3)
Advances in Molecular and Cell Biology     Full-text available via subscription   (Followers: 28)
Advances in Molecular and Cellular Endocrinology     Full-text available via subscription   (Followers: 8)
Advances in Molecular Pathology     Hybrid Journal   (Followers: 2)
Advances in Molecular Toxicology     Full-text available via subscription   (Followers: 7, SJR: 0.182, CiteScore: 0)
Advances in Nanoporous Materials     Full-text available via subscription   (Followers: 4)
Advances in Oncobiology     Full-text available via subscription   (Followers: 3)
Advances in Ophthalmology and Optometry     Full-text available via subscription   (Followers: 1)
Advances in Organ Biology     Full-text available via subscription   (Followers: 3)
Advances in Organometallic Chemistry     Full-text available via subscription   (Followers: 19, SJR: 1.875, CiteScore: 4)
Advances in Parallel Computing     Full-text available via subscription   (Followers: 7, SJR: 0.174, CiteScore: 0)
Advances in Parasitology     Full-text available via subscription   (Followers: 7, SJR: 1.579, CiteScore: 4)
Advances in Pediatrics     Full-text available via subscription   (Followers: 27, SJR: 0.461, CiteScore: 1)
Advances in Pharmaceutical Sciences     Full-text available via subscription   (Followers: 21)
Advances in Pharmacology     Full-text available via subscription   (Followers: 18, SJR: 1.536, CiteScore: 3)
Advances in Physical Organic Chemistry     Full-text available via subscription   (Followers: 11, SJR: 0.574, CiteScore: 1)
Advances in Phytomedicine     Full-text available via subscription   (Followers: 1)
Advances in Planar Lipid Bilayers and Liposomes     Full-text available via subscription   (Followers: 3, SJR: 0.109, CiteScore: 1)
Advances in Plant Biochemistry and Molecular Biology     Full-text available via subscription   (Followers: 10)
Advances in Plant Pathology     Full-text available via subscription   (Followers: 7)
Advances in Porous Media     Full-text available via subscription   (Followers: 5)
Advances in Protein Chemistry     Full-text available via subscription   (Followers: 19)
Advances in Protein Chemistry and Structural Biology     Full-text available via subscription   (Followers: 21, SJR: 0.791, CiteScore: 2)
Advances in Psychology     Full-text available via subscription   (Followers: 74)
Advances in Quantum Chemistry     Full-text available via subscription   (Followers: 7, SJR: 0.371, CiteScore: 1)
Advances in Radiation Oncology     Open Access   (Followers: 3, SJR: 0.263, CiteScore: 1)
Advances in Small Animal Medicine and Surgery     Hybrid Journal   (Followers: 3, SJR: 0.101, CiteScore: 0)
Advances in Space Biology and Medicine     Full-text available via subscription   (Followers: 7)
Advances in Space Research     Full-text available via subscription   (Followers: 452, SJR: 0.569, CiteScore: 2)
Advances in Structural Biology     Full-text available via subscription   (Followers: 6)
Advances in Surgery     Full-text available via subscription   (Followers: 12, SJR: 0.555, CiteScore: 2)
Advances in the Study of Behavior     Full-text available via subscription   (Followers: 37, SJR: 2.208, CiteScore: 4)
Advances in Veterinary Medicine     Full-text available via subscription   (Followers: 21)
Advances in Veterinary Science and Comparative Medicine     Full-text available via subscription   (Followers: 15)
Advances in Virus Research     Full-text available via subscription   (Followers: 6, SJR: 2.262, CiteScore: 5)
Advances in Water Resources     Hybrid Journal   (Followers: 59, SJR: 1.551, CiteScore: 3)
Aeolian Research     Hybrid Journal   (Followers: 6, SJR: 1.117, CiteScore: 3)
Aerospace Science and Technology     Hybrid Journal   (Followers: 420, SJR: 0.796, CiteScore: 3)
AEU - Intl. J. of Electronics and Communications     Hybrid Journal   (Followers: 8, SJR: 0.42, CiteScore: 2)
African J. of Emergency Medicine     Open Access   (Followers: 6, SJR: 0.296, CiteScore: 0)
Ageing Research Reviews     Hybrid Journal   (Followers: 13, SJR: 3.671, CiteScore: 9)
Aggression and Violent Behavior     Hybrid Journal   (Followers: 494, SJR: 1.238, CiteScore: 3)
Agri Gene     Hybrid Journal   (Followers: 1, SJR: 0.13, CiteScore: 0)
Agricultural and Forest Meteorology     Hybrid Journal   (Followers: 18, SJR: 1.818, CiteScore: 5)
Agricultural Systems     Hybrid Journal   (Followers: 32, SJR: 1.156, CiteScore: 4)
Agricultural Water Management     Hybrid Journal   (Followers: 47, SJR: 1.272, CiteScore: 3)
Agriculture and Agricultural Science Procedia     Open Access   (Followers: 4)
Agriculture and Natural Resources     Open Access   (Followers: 3)
Agriculture, Ecosystems & Environment     Hybrid Journal   (Followers: 60, SJR: 1.747, CiteScore: 4)
Ain Shams Engineering J.     Open Access   (Followers: 7, SJR: 0.589, CiteScore: 3)
Air Medical J.     Hybrid Journal   (Followers: 8, SJR: 0.26, CiteScore: 0)
AKCE Intl. J. of Graphs and Combinatorics     Open Access   (SJR: 0.19, CiteScore: 0)
Alcohol     Hybrid Journal   (Followers: 12, SJR: 1.153, CiteScore: 3)
Alcoholism and Drug Addiction     Open Access   (Followers: 12)
Alergologia Polska : Polish J. of Allergology     Full-text available via subscription   (Followers: 2)
Alexandria Engineering J.     Open Access   (Followers: 3, SJR: 0.604, CiteScore: 3)
Alexandria J. of Medicine     Open Access   (Followers: 1, SJR: 0.191, CiteScore: 1)
Algal Research     Partially Free   (Followers: 10, SJR: 1.142, CiteScore: 4)
Alkaloids: Chemical and Biological Perspectives     Full-text available via subscription   (Followers: 2)
Allergologia et Immunopathologia     Full-text available via subscription   (Followers: 1, SJR: 0.504, CiteScore: 1)
Allergology Intl.     Open Access   (Followers: 5, SJR: 1.148, CiteScore: 2)
Alpha Omegan     Full-text available via subscription   (SJR: 3.521, CiteScore: 6)
ALTER - European J. of Disability Research / Revue Européenne de Recherche sur le Handicap     Full-text available via subscription   (Followers: 12, SJR: 0.201, CiteScore: 1)
Alzheimer's & Dementia     Hybrid Journal   (Followers: 60, SJR: 4.66, CiteScore: 10)
Ambulatory Pediatrics     Hybrid Journal   (Followers: 5)
American Heart J.     Hybrid Journal   (Followers: 62, SJR: 3.267, CiteScore: 4)
American J. of Cardiology     Hybrid Journal   (Followers: 71, SJR: 1.93, CiteScore: 3)
American J. of Emergency Medicine     Hybrid Journal   (Followers: 52, SJR: 0.604, CiteScore: 1)
American J. of Geriatric Pharmacotherapy     Full-text available via subscription   (Followers: 13)
American J. of Geriatric Psychiatry     Hybrid Journal   (Followers: 18, SJR: 1.524, CiteScore: 3)
American J. of Human Genetics     Hybrid Journal   (Followers: 45, SJR: 7.45, CiteScore: 8)
American J. of Infection Control     Hybrid Journal   (Followers: 36, SJR: 1.062, CiteScore: 2)
American J. of Kidney Diseases     Hybrid Journal   (Followers: 42, SJR: 2.973, CiteScore: 4)
American J. of Medicine     Hybrid Journal   (Followers: 50)
American J. of Medicine Supplements     Full-text available via subscription   (Followers: 3, SJR: 1.967, CiteScore: 2)
American J. of Obstetrics & Gynecology MFM     Hybrid Journal   (Followers: 3)
American J. of Obstetrics and Gynecology     Hybrid Journal   (Followers: 291, SJR: 2.7, CiteScore: 4)
American J. of Ophthalmology     Hybrid Journal   (Followers: 71, SJR: 3.184, CiteScore: 4)
American J. of Ophthalmology Case Reports     Open Access   (Followers: 6, SJR: 0.265, CiteScore: 0)
American J. of Orthodontics and Dentofacial Orthopedics     Full-text available via subscription   (Followers: 6, SJR: 1.289, CiteScore: 1)
American J. of Otolaryngology     Hybrid Journal   (Followers: 25, SJR: 0.59, CiteScore: 1)
American J. of Pathology     Hybrid Journal   (Followers: 33, SJR: 2.139, CiteScore: 4)
American J. of Preventive Medicine     Hybrid Journal   (Followers: 30, SJR: 2.164, CiteScore: 4)
American J. of Surgery     Hybrid Journal   (Followers: 41, SJR: 1.141, CiteScore: 2)
American J. of the Medical Sciences     Hybrid Journal   (Followers: 12, SJR: 0.767, CiteScore: 1)
Ampersand : An Intl. J. of General and Applied Linguistics     Open Access   (Followers: 8)
Anaerobe     Hybrid Journal   (Followers: 4, SJR: 1.144, CiteScore: 3)
Anaesthesia & Intensive Care Medicine     Full-text available via subscription   (Followers: 72, SJR: 0.138, CiteScore: 0)
Anaesthesia Critical Care & Pain Medicine     Full-text available via subscription   (Followers: 28, SJR: 0.411, CiteScore: 1)
Anales de Cirugia Vascular     Full-text available via subscription   (Followers: 1)
Anales de Pediatría     Full-text available via subscription   (Followers: 3, SJR: 0.277, CiteScore: 0)
Anales de Pediatría (English Edition)     Full-text available via subscription  
Anales de Pediatría Continuada     Full-text available via subscription  
Analytic Methods in Accident Research     Hybrid Journal   (Followers: 7, SJR: 4.849, CiteScore: 10)
Analytica Chimica Acta     Hybrid Journal   (Followers: 44, SJR: 1.512, CiteScore: 5)
Analytica Chimica Acta : X     Open Access  
Analytical Biochemistry     Hybrid Journal   (Followers: 239, SJR: 0.633, CiteScore: 2)
Analytical Chemistry Research     Open Access   (Followers: 14, SJR: 0.411, CiteScore: 2)
Analytical Spectroscopy Library     Full-text available via subscription   (Followers: 14)
Anesthésie & Réanimation     Full-text available via subscription   (Followers: 2)
Anesthesiology Clinics     Full-text available via subscription   (Followers: 25, SJR: 0.683, CiteScore: 2)
Angiología     Full-text available via subscription   (SJR: 0.121, CiteScore: 0)
Angiologia e Cirurgia Vascular     Open Access   (Followers: 1, SJR: 0.111, CiteScore: 0)

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Acta Anaesthesiologica Taiwanica
Number of Followers: 6  

  This is an Open Access Journal Open Access journal
ISSN (Print) 1875-4597 - ISSN (Online) 1875-452X
Published by Elsevier Homepage  [3201 journals]
  • Measuring and reducing perioperative anesthetic-related mortality: View
           from East Asia

    • Authors: James L. Reynolds; Wei-Zen Sun; Yang Chen-Hsien
      Pages: 41 - 43
      Abstract: Publication date: June 2016
      Source:Acta Anaesthesiologica Taiwanica, Volume 54, Issue 2
      Author(s): James L. Reynolds, Wei-Zen Sun, Yang Chen-Hsien


      PubDate: 2016-09-16T04:06:59Z
      DOI: 10.1016/j.aat.2016.06.004
      Issue No: Vol. 54, No. 2 (2016)
       
  • Comparison of the Supreme and the ProSeal laryngeal mask airway in
           patients undergoing laparoscopic cholecystectomy: A randomized controlled
           trial

    • Authors: Lakesh K. Anand; Nitika Goel; Manpreet Singh; Dheeraj Kapoor
      Pages: 44 - 50
      Abstract: Publication date: Available online 19 April 2016
      Source:Acta Anaesthesiologica Taiwanica
      Author(s): Lakesh K. Anand, Nitika Goel, Manpreet Singh, Dheeraj Kapoor
      Objective The single-use LMA Supreme (Teleflex, Inc., Wayne, PA, USA) and the LMA ProSeal (Teleflex, Inc., Wayne, PA, USA) laryngeal mask airway (LMA) have similar characteristics. To date, studies have not achieved a consensus regarding the oropharyngeal leak pressure (OLP) of the LMA Supreme and LMA ProSeal, and there is little information on their efficacy in laparoscopic cholecystectomy. This study compared the safety and efficacy of the LMA Supreme and LMA ProSeal devices in patients undergoing laparoscopic cholecystectomy. Method Eighty-four eligible consenting patients were randomly allocated to the LMA Supreme group or the LMA ProSeal group. Both groups received the standard anesthesia technique. The Supreme or ProSeal LMA was inserted, the cuff was inflated to 60 cmH2O, and the LMA position was confirmed. Anesthesia was maintained using propofol and 50% oxygen in air. A gastric tube was inserted through the drain tube of the LMA to deflate the stomach, and the first attempt success rate and insertion time were recorded. During surgery, the intra-abdominal pressure was maintained at 12 mmHg. The fiberoptic view of the larynx was determined by passing a flexible fiberoptic bronchoscope. The OLPs, success rate, insertion time, hemodynamic and respiratory parameters, and complications were recorded at different time points. Results The mean OLP was significantly lower in the LMA Supreme group than in the LMA ProSeal group (24.9 ± 5.3 cmH2O vs. 28.4 ± 5.8 cmH2O; p < 0.01). The first attempt success rate and ease of insertion grading for LMA were higher in the Supreme group. The insertion time was lower in the Supreme group than in the ProSeal group (p < 0.01). The fiberoptic view was better with the ProSeal LMA. The hemodynamic and ventilatory parameters and postoperative sore throat were comparable in both groups. Conclusion The LMA ProSeal has a higher OLP than the LMA Supreme. The success rate of first attempt insertion and ease of insertion were better for the LMA Supreme group and the insertion time was lower in the LMA Supreme group. The Supreme and ProSeal LMAs were both effective for positive pressure ventilation in laparoscopic cholecystectomy.

      PubDate: 2016-04-23T13:15:06Z
      DOI: 10.1016/j.aat.2016.03.001
      Issue No: Vol. 54, No. 2 (2016)
       
  • Key opioid prescription concerns in cancer patients: A nationwide study

    • Authors: Chih-Peng Lin; Chih-Hung Hsu; Wen-Mei Fu; Ho-Min Chen; Ying-Hui Lee; Mei-Shu Lai; Yu-Yun Shao
      Pages: 51 - 56
      Abstract: Publication date: Available online 15 June 2016
      Source:Acta Anaesthesiologica Taiwanica
      Author(s): Chih-Peng Lin, Chih-Hung Hsu, Wen-Mei Fu, Ho-Min Chen, Ying-Hui Lee, Mei-Shu Lai, Yu-Yun Shao
      Background Opioids are crucial in cancer pain management. We examined the nationwide prescription patterns of opioids in Taiwan cancer patients to find the potential concerns. Methods We reviewed the claims database of the National Health Insurance of Taiwan for patients diagnosed with cancer from 2003 to 2011. The use and cost of analgesics were analyzed. Opioids were classified into recommended strong opioids (morphine and transdermal fentanyl), recommended weak opioids (tramadol, buprenorphine, and codeine), and unrecommended opioids (propoxyphene, nalbuphine, and meperidine). Results We enrolled 1,424,048 patients with cancer, and ∼50% of them took analgesics. Among analgesic users, patients who used opioids increased from 48.2% in 2003 to 52.0% in 2010. Approximately 92% of the opioid use came from recommended opioids, either strong (51%) or weak opioids (41%). The ratio of the use of short-acting strong opioids to that of long-acting opioids increased from 0.41 in 2003 to 0.63 in 2011. Transdermal fentanyl accounted for > 50% of the use of strong opioids. Among weak opioids, the use of tramadol gradually increased to 71% in 2011. On average, opioids contributed to 0.79‰ of all medical expenditures and 2.94‰ of all medication costs. Conclusion The use of short-acting strong opioids increased during the study period. Instead of oral opioids, transdermal fentanyl was the most commonly used opioid among Taiwan cancer patients. The use of weak opioids, particularly tramadol, was high. These concerns should be the focus of pain management education.

      PubDate: 2016-06-18T18:09:23Z
      DOI: 10.1016/j.aat.2016.05.002
      Issue No: Vol. 54, No. 2 (2016)
       
  • Evaluation of cardiac output by bioreactance technique in patients
           undergoing liver transplantation

    • Authors: Po-Yuan Shih; Wen-Ying Lin; Ming-Hui Hung; Ya-Jung Cheng; Kuang-Cheng Chan
      Pages: 57 - 61
      Abstract: Publication date: June 2016
      Source:Acta Anaesthesiologica Taiwanica, Volume 54, Issue 2
      Author(s): Po-Yuan Shih, Wen-Ying Lin, Ming-Hui Hung, Ya-Jung Cheng, Kuang-Cheng Chan
      Background This study compared the cardiac output (CO) obtained from PiCCO with that obtained from the noninvasive NICOM method. Methods Twenty-one cirrhotic patients receiving liver transplantation were enrolled. During the operation, their CO was measured by the PiCCO system via the thermodilution method as the standard and by the NICOM method. Two parameters including cardiac index (CI) and stroke volume index (SVI) were collected simultaneously at three phases during the surgery including the dissection phase (T1), the anhepatic phase (T2), and the reperfusion phase (T3). Correlation, Bland and Altman methods, and linear mixed model were used to evaluate the monitoring ability of both systems. Results Poor correlation was noted between the data measured by NICOM and PiCCO; the correlation coefficients for CI and SVI measured between the two systems were 0.32 and 0.39, respectively. Bland and Altman analysis showed the percentage error of CI as 63.7%, and that of SVI as 66.6% for NICOM compared to PiCCO. Using the linear mixed model, the CI and SVI measured using NICOM were significantly higher than those using PiCCO (estimated regression coefficient 0.92 and 10.77, both p < 0.001). Mixed model analysis showed no differences between the trends of CI and SVI measured by the two methods. Conclusions NICOM provided a comparable CI and SVI trend when compared to the gold standard PiCCO, but it raises concerns as an effective CO monitor because of its tendency to overestimate CI and SVI especially during the state of high cardiac output.

      PubDate: 2016-09-16T04:06:59Z
      DOI: 10.1016/j.aat.2016.06.001
      Issue No: Vol. 54, No. 2 (2016)
       
  • Magnesium sulfate for postoperative analgesia after surgery under spinal
           anesthesia

    • Authors: Prerana N. Shah; Yamini Dhengle
      Pages: 62 - 64
      Abstract: Publication date: June 2016
      Source:Acta Anaesthesiologica Taiwanica, Volume 54, Issue 2
      Author(s): Prerana N. Shah, Yamini Dhengle
      Background Magnesium has been proven to have antinociceptive effects in animal and human models of pain. Its effect is primarily based on the regulation of calcium influx into the cell, which is natural physiological calcium antagonism and N-methyl-d-aspartate (NMDA) receptor antagonism. Methods One hundred and eight patients undergoing surgery with spinal anesthesia received either 250 mg of intravenous magnesium sulfate followed by an infusion of 500 mg magnesium sulfate (25 mg/mL) at the rate of 20 mL/hour; or the same volume of normal saline (control group) as bolus and infusion. The primary end-points in the study were to evaluate the analgesic effect and duration of sensory and motor blockade. The secondary end-points included assessment of hemodynamic effects of intravenous magnesium sulfate and rescue analgesia requirement. Results Sensory and motor blockade, respectively, were 25 minutes and 34 minutes shorter in the control group. Less patients in the magnesium group (33% vs. 53.7%) than in control group required rescue analgesia in the postoperative period. The control group required rescue analgesia nearly 3 hours earlier than the magnesium group. Only one patient in the control group experienced bradycardia. There was no event of intraoperative hypotension in either of the groups. Conclusion Intravenous magnesium sulfate when given as a bolus, followed by an infusion, delayed and decreased the need of rescue analgesics after spinal anesthesia.

      PubDate: 2016-09-16T04:06:59Z
      DOI: 10.1016/j.aat.2016.06.003
      Issue No: Vol. 54, No. 2 (2016)
       
  • A new pharmacological role for thalidomide: Attenuation of
           morphine-induced tolerance in rats

    • Authors: Kambiz Hassanzadeh; Bashir Khodadadi; Mohammad Raman Moloudi; Hassan Amini; Mohammad Reza Rahmani; Esmael Izadpanah
      Pages: 65 - 69
      Abstract: Publication date: June 2016
      Source:Acta Anaesthesiologica Taiwanica, Volume 54, Issue 2
      Author(s): Kambiz Hassanzadeh, Bashir Khodadadi, Mohammad Raman Moloudi, Hassan Amini, Mohammad Reza Rahmani, Esmael Izadpanah
      Objective Tolerance to the analgesic effect is the main side effect of chronic administration of opioids. Several drugs have been studied to try to find agents to prevent the development of this phenomenon. In the present study we aimed to evaluate the effect of thalidomide on morphine-induced tolerance to the analgesic effect. Methods Groups of male rats were randomly rendered and received daily morphine in combination with thalidomide vehicle or thalidomide (2.5 mg/kg, 5 mg/kg, or 10 mg/kg, intraperitoneally). Nociception was measured using the plantar test apparatus. Latency time was recorded when the animal reacted to the light stimulus; licking or raising its hind paw. Treatments and evaluations continued until completion of tolerance to the analgesic effect of morphine. Results Our findings indicated that tolerance was achieved following 11 days of morphine administration, while thalidomide postponed the day of tolerance completion for 4 days (2.5 mg/kg and 5 mg/kg thalidomide) or 10 days (10 mg/kg thalidomide). Moreover, thalidomide prevented the morphine-induced shift to the right of the ED50 in the dose–response curve. Conclusion It was concluded that thalidomide attenuated the morphine-induced tolerance to the analgesic effect.

      PubDate: 2016-09-16T04:06:59Z
      DOI: 10.1016/j.aat.2016.06.002
      Issue No: Vol. 54, No. 2 (2016)
       
  • A review of nationwide population study of organ transplantation in Taiwan

    • Authors: Hsin-I Tsai; Huang-Ping Yu
      Pages: 70 - 74
      Abstract: Publication date: Available online 8 June 2016
      Source:Acta Anaesthesiologica Taiwanica
      Author(s): Hsin-I Tsai, Huang-Ping Yu
      Solid organ transplantation has become the therapy of choice for patients with end-stage organ disease. The frequently transplanted organs in Taiwan include liver, kidney, heart, and lung, and the success rate has improved significantly worldwide for the past decades. However, organ recipients are known to be at a higher risk of post-transplant infections and de novo cancer due to immunosuppression and oncogenic viral infections. Organ recipients are known to be at a two- to fourfold increased risk of cancer and the risks are particularly high for malignancies caused by viral infections, including post-transplant lymphoproliferative disorders via Epstein-Barr virus, Kaposi sarcoma via Kaposi sarcoma herpesvirus, anogenital cancers via human papillomavirus, and hepatocellular carcinoma via hepatitis B and C virus. Population-based cohort studies may help better understand the pattern of infection and cancer risk in transplant recipients and clarify the role of the immune system, infection, and risk factors in the development of malignancy. Improvement of surgical techniques, advancement of immunosuppressant therapy in addition to early detection and prevention of infection, and regular surveillance of de novo cancer after transplantation have become the mainstay of successful organ transplantation.

      PubDate: 2016-06-09T16:41:03Z
      DOI: 10.1016/j.aat.2016.05.003
      Issue No: Vol. 54, No. 2 (2016)
       
  • Continuous interscalene brachial plexus block

    • Authors: Yasuhiro Morimoto
      First page: 75
      Abstract: Publication date: Available online 25 April 2016
      Source:Acta Anaesthesiologica Taiwanica
      Author(s): Yasuhiro Morimoto


      PubDate: 2016-04-27T13:40:11Z
      DOI: 10.1016/j.aat.2016.02.002
      Issue No: Vol. 54, No. 2 (2016)
       
  • Mirtazapine, in orodispersible form, for patients with preoperative
           psychological distress: A pilot study

    • Authors: Wei-Han Chou; Feng-Sheng Lin; Chih-Peng Lin; Wen-Ying Lin; Jr-Chi Yie; Wei-Zen Sun
      Pages: 16 - 23
      Abstract: Publication date: Available online 10 February 2016
      Source:Acta Anaesthesiologica Taiwanica
      Author(s): Wei-Han Chou, Feng-Sheng Lin, Chih-Peng Lin, Wen-Ying Lin, Jr-Chi Yie, Wei-Zen Sun
      Background Perioperative psychological distress is associated with preoperative anxiety, depression, and postoperative pain. Mirtazapine is effective as an antidepressant, anxiolytic agent, and sleep enhancer. Moreover, mirtazapine can be made as orodispersible tablets with a fast onset for patients in nil per os status. This study is to determine whether mirtazapine can help psychologically distressed patients reduce perioperative anxiety, depression, and postoperative pain. Materials and methods Patients with preoperative psychological distress, undergoing major abdominal surgery, were inquired and assigned to two groups according to their own choice. In the treatment group, patients could choose to take orodispersible mirtazapine 30 mg at each night from Preoperative Day 0 to Postoperative Day 3. There was no other intervention in the nontreatment group. Hospital Anxiety and Depression Scale (HADS), Athens Insomnia Scale (AIS), and pain scores were accessed on the day before operation (Day 0), and on the 1st day (Day 2) and 3rd day (Day 4) after operation. We compared the HADS, AIS, and pain scores, and morphine consumptions between the two groups on a daily basis. Marginal regression models were fitted to our correlated longitudinal data alone with the generalized estimating equations method to estimate the population average effects of time-varying mirtazapine usage on the mean values of HADS, AIS, and pain scores, and daily morphine consumptions. Results From September 2007 to December 2008, 86 patients agreed to be enrolled and 79 of them completed the study. Propensity scores and multivariate analysis showed that mirtazapine reduced HADS scores of patients in 2 days. Trial results indicated that mirtazapine lowered the AIS day index and tended to decrease night index as well. Mirtazapine may reduce patients' morphine consumption, but this effect was not statistically significant (p = 0.2). Conclusion Mirtazapine helps reduce anxiety, depression, and insomnia scores for patients with perioperative psychological distress.

      PubDate: 2016-02-10T19:17:28Z
      DOI: 10.1016/j.aat.2015.12.002
      Issue No: Vol. 54, No. 1 (2016)
       
  • Pharmacogenomics for personalized pain medicine

    • Authors: Tai-Ming Ko; Chih-Shung Wong; Jer-Yuarn Wu; Yuan-Tsong Chen
      Pages: 24 - 30
      Abstract: Publication date: Available online 11 March 2016
      Source:Acta Anaesthesiologica Taiwanica
      Author(s): Tai-Ming Ko, Chih-Shung Wong, Jer-Yuarn Wu, Yuan-Tsong Chen
      Pharmacogenomics aims to unravel the way that human genetic variation affects drug efficacy and toxicity. Genome-wide association studies and candidate gene findings suggest that genetic approaches may help choose the most appropriate drug and dosage while preventing adverse drug reactions (ADRs). Pain is an unpleasant feeling that usually results from tissue damage. The management of different types of pain (acute, chronic, inflammatory, neuropathic, or cancer) is challenging. Currently, drug intervention is the first-line therapy for resolving pain. However, differences in drug efficacy between individuals are common with pain medications. Moreover, some patients experience ADRs after being treated with specific pain drugs. This review discusses the use of drugs for pain management in the context of the recent pharmacogenomic studies on ADRs and drug efficacy.

      PubDate: 2016-03-14T00:35:09Z
      DOI: 10.1016/j.aat.2016.02.001
      Issue No: Vol. 54, No. 1 (2016)
       
  • A novel technique to prevent damage to inflation tube of the cuffed
           endotracheal tube during air-QTM guided intubation

    • Authors: Renu Sinha; Kanil Ranjith Kumar; Ravindran Chandiran
      Pages: 33 - 34
      Abstract: Publication date: Available online 2 January 2016
      Source:Acta Anaesthesiologica Taiwanica
      Author(s): Renu Sinha, Kanil Ranjith Kumar, Ravindran Chandiran


      PubDate: 2016-01-04T11:20:28Z
      DOI: 10.1016/j.aat.2015.12.001
      Issue No: Vol. 54, No. 1 (2016)
       
  • Subcutaneous emphysema and pneumothorax secondary to subclavian vein
           catheterization via supraclavicular approach

    • Authors: Chih-Dou Chou; Yu-Chi Tsung; Fwu-Lin Yang
      Pages: 35 - 36
      Abstract: Publication date: Available online 6 January 2016
      Source:Acta Anaesthesiologica Taiwanica
      Author(s): Chih-Dou Chou, Yu-Chi Tsung, Fwu-Lin Yang


      PubDate: 2016-01-08T13:54:57Z
      DOI: 10.1016/j.aat.2015.12.003
      Issue No: Vol. 54, No. 1 (2016)
       
  • Incidence of postoperative nausea and vomiting following gynecological
           laparoscopy: A comparison of standard anesthetic technique and propofol
           infusion

    • Authors: Pradipta Bhakta; Bablu Rani Ghosh; Umesh Singh; Preeti S. Govind; Abhinav Gupta; Kulwant Singh Kapoor; Rajesh Kumar Jain; Tulsi Nag; Dipanwita Mitra; Manjushree Ray; Vikash Singh; Gauri Mukherjee
      Abstract: Publication date: Available online 23 December 2016
      Source:Acta Anaesthesiologica Taiwanica
      Author(s): Pradipta Bhakta, Bablu Rani Ghosh, Umesh Singh, Preeti S. Govind, Abhinav Gupta, Kulwant Singh Kapoor, Rajesh Kumar Jain, Tulsi Nag, Dipanwita Mitra, Manjushree Ray, Vikash Singh, Gauri Mukherjee
      Objective To determine the safety, efficacy, and feasibility of propofol-based anesthesia in gynecological laparoscopies in reducing incidences of postoperative nausea and vomiting compared to a standard anesthesia using thiopentone/isoflurane. Design Randomized single-blind (for anesthesia techniques used) and double-blind (for postoperative assessment) controlled trial. Setting Operation theater, postanesthesia recovery room, teaching hospital. Patients Sixty ASA (American Society of Anesthesiologists) I and II female patients (aged 20–60 years) scheduled for gynecological laparoscopy were included in the study. Interventions Patients in Group A received standard anesthesia with thiopentone for induction and maintenance with isoflurane–fentanyl, and those in Group B received propofol for induction and maintenance along with fentanyl. All patients received nitrous oxide, vecuronium, and neostigmine/glycopyrrolate. No patient received elective preemptive antiemetic, but patients did receive it after more than one episode of vomiting. Measurements Assessment for incidence of postoperative nausea and vomiting as well as other recovery parameters were carried out over a period of 24 hours. Main Results Six patients (20%) in Group A and seven patients (23.3%) in Group B experienced nausea. Two patients (6.66%) in Group B had vomiting versus 12 (40%) in Group A (p <0.05). Overall, the incidence of emesis was 60% and 30% in Groups A and B, respectively (p <0.05). All patients in Group B had significantly faster recovery compared with those in Group A. No patient had any overt cardiorespiratory complications. Conclusion Propofol-based anesthesia was associated with significantly less postoperative vomiting and faster recovery compared to standard anesthesia in patients undergoing gynecological laparoscopy.

      PubDate: 2016-12-27T13:43:16Z
      DOI: 10.1016/j.aat.2016.10.002
       
  • Quadratus lumborum block intramuscular approach for pediatric surgery

    • Authors: Takeshi Murouchi
      Abstract: Publication date: Available online 9 December 2016
      Source:Acta Anaesthesiologica Taiwanica
      Author(s): Takeshi Murouchi


      PubDate: 2016-12-12T09:39:53Z
      DOI: 10.1016/j.aat.2016.10.003
       
  • Preincisional and postoperative epidural morphine, ropivacaine, ketamine,
           and naloxone treatment for postoperative pain management in upper
           abdominal surgery

    • Authors: Hou-Chuan Lai; Chung-Bao Hsieh; Chih-Shung Wong; Chun-Chang Yeh; Zhi-Fu Wu
      Abstract: Publication date: Available online 3 December 2016
      Source:Acta Anaesthesiologica Taiwanica
      Author(s): Hou-Chuan Lai, Chung-Bao Hsieh, Chih-Shung Wong, Chun-Chang Yeh, Zhi-Fu Wu
      Objective(s) Previous studies have shown that preincisional epidural morphine, bupivacaine, and ketamine combined with epidural anesthesia (EA) and general anesthesia (GA) provided pre-emptive analgesia for upper abdominal surgery. Recent studies reported that ultralow-dose naloxone enhanced the antinociceptive effect of morphine in rats. This study investigated the benefits of preincisional and postoperative epidural morphine + ropivacaine + ketamine + naloxone (M + R + K + N) treatment for achieving postoperative pain relief in upper abdominal surgery. Methods Eighty American Society of Anesthesiology I–II patients scheduled for major upper abdominal surgery were allocated to four groups in a randomized, single-blinded study. All patients received combined GA and EA with a continuous epidural infusion of 2% lidocaine (6–8 mL/h) 30 minutes after pain regimen. After GA induction, in Group I, an epidural pain control regimen (total 10 mL) was administered using 1% lidocaine (8 mL) + morphine (2 mg) + ropivacaine (20 mg; M + R); in Group II, 1% lidocaine 8 (mL) + morphine (2 mg) + ropivacaine (20 mg) + ketamine (20 mg; M + R + K); in Group III, 1% lidocaine (8 mL) + morphine (2 mg) + ropivacaine (20 mg) + naloxone (2 μg; M + R + N); and in Group IV, 1% lidocaine (8 mL) + morphine (2 mg) + ropivacaine (20 mg) + ketamine (20 mg) + naloxone (2 μg; M + R + K + N), respectively. All patients received patient-controlled epidural analgesia (PCEA) with different pain regimens to control subsequent postoperative pain for 3 days following surgery. During the 3-day period following surgery, PCEA consumption (mL), numerical rating scale (NRS) score while cough/moving, and analgesic-related adverse effects were recorded. Results Total PCEA consumption for the 3-day observation period was 161.5±17.8 mL, 103.2±21.7 mL, 152.4±25.6 mL, and 74.1±16.9 mL for Groups I, II, III, and IV, respectively. (p < 0.05). The cough/moving NRS scores were significantly lower in Group IV patients than Groups I and III patients at 4 hours, 12 hours, and on Days 1 and 2 following surgery except for Group II (p < 0.05). Conclusion Preincisional and postoperative epidural M + R + K + N treatment provides an ideal postoperative pain management than preincisional and postoperative epidural M + R, M + R + K, and M + R + N treatments in upper abdominal surgery.

      PubDate: 2016-12-05T08:06:40Z
      DOI: 10.1016/j.aat.2016.10.004
       
  • Severe acute peripheral edema induced by noninvasive blood pressure cuff
           in an elderly patient with hypoalbuminemia under general anesthesia.

    • Authors: Chia-Chun Chuang; Jen-Yin Chen; Chien-Ching Lee
      Abstract: Publication date: Available online 1 December 2016
      Source:Acta Anaesthesiologica Taiwanica
      Author(s): Chia-Chun Chuang, Jen-Yin Chen, Chien-Ching Lee


      PubDate: 2016-12-05T08:06:40Z
      DOI: 10.1016/j.aat.2016.11.001
       
  • Respiratory acidosis in obese gynecologic patients undergoing laparoscopic
           surgery independently of the type of ventilation.

    • Authors: Sergey S. Simakov; Xenia I. Roubliova; Alexey A. Ivanov; Anar K. Kaptaeva; Madina I. Mazitova; Ospan A. Mynbaev
      Abstract: Publication date: Available online 1 December 2016
      Source:Acta Anaesthesiologica Taiwanica
      Author(s): Sergey S. Simakov, Xenia I. Roubliova, Alexey A. Ivanov, Anar K. Kaptaeva, Madina I. Mazitova, Ospan A. Mynbaev


      PubDate: 2016-12-05T08:06:40Z
      DOI: 10.1016/j.aat.2016.11.004
       
  • Reply to: Respiratory acidosis in obese gynecologic patients undergoing
           laparoscopic surgery independently of the type of ventilation

    • Authors: W.P. Zhang; S.M. Zhu
      Abstract: Publication date: Available online 1 December 2016
      Source:Acta Anaesthesiologica Taiwanica
      Author(s): W.P. Zhang, S.M. Zhu


      PubDate: 2016-12-05T08:06:40Z
      DOI: 10.1016/j.aat.2016.11.003
       
  • Perioperative medicine and Taiwan National Health Insurance Research
           Database

    • Authors: C.C. Chang; C.C. Liao; T.L. Chen
      Abstract: Publication date: Available online 18 November 2016
      Source:Acta Anaesthesiologica Taiwanica
      Author(s): C.C. Chang, C.C. Liao, T.L. Chen
      “Big data”, characterized by ‘volume’, ‘velocity’, ‘variety’, and ‘veracity’, being routinely collected in huge amounts of clinical and administrative healthcare-related data are becoming common and generating promising viewpoints for a better understanding of the complexity for medical situations. Taiwan National Health Insurance Research Database (NHIRD), one of large and comprehensive nationwide population reimbursement databases in the world, provides the strength of sample size avoiding selection and participation bias. Abundant with the demographics, clinical diagnoses, and capable of linking diverse laboratory and imaging information allowing for integrated analysis, NHIRD studies could inform us of the incidence, prevalence, managements, correlations and associations of clinical outcomes and diseases, under the universal coverage of healthcare used. Perioperative medicine has emerged as an important clinical research field over the past decade, moving the categorization of the specialty of “Anesthesiology and Perioperative Medicine”. Many studies concerning perioperative medicine based on retrospective cohort analyses have been published in the top-ranked journal, but studies utilizing Taiwan NHIRD were still not fully visualized. As the prominent growth curve of NHIRD studies, we have contributed the studies covering surgical adverse outcomes, trauma, stroke, diabetes, and healthcare inequality, etc., to this ever growing field for the past five years. It will definitely become a trend of research using Taiwan NHIRD and contributing to the progress of perioperative medicine with the recruitment of devotion from more research groups and become a famous doctrine.

      PubDate: 2016-11-20T20:27:36Z
      DOI: 10.1016/j.aat.2016.08.002
       
  • Alvimopan for post-operative ileus: What we should know?

    • Authors: Abhijit Nair
      Abstract: Publication date: Available online 5 November 2016
      Source:Acta Anaesthesiologica Taiwanica
      Author(s): Abhijit Nair
      Alvimopan is an US-FDA approved, peripherally acting mu opioid receptor antagonist which when started pre-operatively has been shown to hasten intestinal motility and reduce the duration of post-operative ileus. However the logistics involved in procuring, storing and dispensing the drug and the cost of the drug for fifteen doses as approved by FDA prohibits the use of it on a regular basis.

      PubDate: 2016-11-07T15:40:52Z
      DOI: 10.1016/j.aat.2016.10.001
       
  • The risk of postoperative nausea and vomiting between surgical patients
           received propofol and sevoflurane anesthesia: A matched study

    • Authors: Hideki Matsuura; Satoki Inoue; Masahiko Kawaguchi
      Abstract: Publication date: Available online 4 November 2016
      Source:Acta Anaesthesiologica Taiwanica
      Author(s): Hideki Matsuura, Satoki Inoue, Masahiko Kawaguchi
      Objectives The current consensus guidelines for managing postoperative nausea and vomiting (PONV) suggest that one of anesthetic risk factors is the use of volatile anesthetics. However, in clinical settings, it is rare to perceive propofol to be superior to volatile anesthetics for the prevention of PONV. To assess whether PONV is related to the type of anesthetic delivered, we compared the incidence and duration of PONV between propofol anesthesia and sevoflurane anesthesia. Methods We performed a retrospective review of an institutional registry containing 21606 general anesthesia cases conducted following ethics board approval. Anesthesia for all patients was managed with propofol or sevoflurane. To avoid channeling bias, a propensity score analysis was used to generate a set of matched cases (propofol anesthesia) and controls (sevoflurane anesthesia), yielding 2554 matched patient pairs. The incidence and sustained rate of symptoms were compared as the primary outcomes. Results In the unmatched population, a higher incidence of PONV occurred following propofol anesthesia compared to sevoflurane anesthesia (propofol vs. sevoflurane anesthesia: 18.9% vs. 15.3%, respectively, p < 0.0001). The sustained rate of PONV over the course after propofol anesthesia was also higher than that following sevoflurane anesthesia (p < 0.001). Conversely, less PONV occurred after propofol compared to sevoflurane after propensity matching (propofol vs. sevoflurane anesthesia: 20.4% vs. 23.3%, respectively, p = 0.01). However, the sustained rate of PONV over the course after propofol anesthesia did not differ from that following sevoflurane anesthesia (p = 0.09). Conclusions Propofol could decrease the incidence of PONV compared with sevoflurane, although the duration of PONV was not affected as found in previous reports.

      PubDate: 2016-11-07T15:40:52Z
      DOI: 10.1016/j.aat.2016.09.002
       
  • Chronic intrathecal infusion of T-type calcium channel blockers attenuates
           CaV3.2 upregulation in nerve-ligated rats

    • Authors: Sheng-Jie Shiue; Chi-Hsu Wang; Tao-Yeuan Wang; Yi-Chun Chen; Jen-Kun Cheng
      Abstract: Publication date: Available online 17 October 2016
      Source:Acta Anaesthesiologica Taiwanica
      Author(s): Sheng-Jie Shiue, Chi-Hsu Wang, Tao-Yeuan Wang, Yi-Chun Chen, Jen-Kun Cheng
      Objective T-type channel (TCC) CaV3.2 plays a pivotal role in pain transmission. In this study, we examined the effects of intrathecal TCC blockers on CaV3.2 expression in a L5/6 spinal nerve ligation (SNL) pain model. The neurotoxicity of TCC blockers were also evaluated. Methods Male Sprague-Dawley rats (200–250 g) were used for right L5/6 SNL to induce neuropathic pain. Intrathecal infusion of saline or TCC blockers [mibefradil (0.7 μg/h) or ethosuximide (60 μg/h)] was started after surgery for 7 days. Fluorescent immunohistochemistry and Western blotting were used to determine the expression pattern and protein level of CaV3.2. Hematoxylin–eosin and toluidine blue staining were used to evaluate the neurotoxicity of tested agents. Results Seven days after SNL, CaV3.2 protein levels were upregulated in ipsi-lateral L5/6 spinal cord and dorsal root ganglia (DRG) in immunofluorescence and Western blotting studies. Compared with the saline-treated group, rats receiving mibefradil or ethosuximide showed significant lower CaV3.2 expression in the spinal cord and DRG. No obvious histopathologic change in hematoxylin–eosin and toluidine blue staining were observed in all tested groups. Conclusion In this study, we demonstrate that SNL-induced CaV3.2 upregulation in the spinal cord and DRG was attenuated by intrathecal infusion of mibefradil or ethosuximide. No obvious neurotoxicity effects were observed in all the tested groups. Our data suggest that continuous intrathecal infusion of TCC blockers may be considered as a promising alternative for the treatment of nerve injury-induced pain.

      PubDate: 2016-10-31T12:40:33Z
      DOI: 10.1016/j.aat.2016.09.001
       
  • Adductor canal block and lateral approach of sciatic nerve block at the
           midthigh level

    • Authors: Yasuhiro Morimoto; Tatsunori Haruoka
      Abstract: Publication date: Available online 1 October 2016
      Source:Acta Anaesthesiologica Taiwanica
      Author(s): Yasuhiro Morimoto, Tatsunori Haruoka


      PubDate: 2016-10-03T17:39:46Z
      DOI: 10.1016/j.aat.2016.08.001
       
  • Intraoperative multiple intercostal nerve blocks exert anesthetic-sparing
           effect: A retrospective study on the effect-site concentration of propofol
           infusion in nonintubated thoracoscopic surgery

    • Authors: Man-Ling Wang; Ming-Hui Hung; Kuang-Cheng Chan; Jin-Shing Chen; Ya-Jung Cheng
      Abstract: Publication date: Available online 23 August 2016
      Source:Acta Anaesthesiologica Taiwanica
      Author(s): Man-Ling Wang, Ming-Hui Hung, Kuang-Cheng Chan, Jin-Shing Chen, Ya-Jung Cheng
      Objective(s) Less general anesthetic is required in patients with regional blocks than in those without, as assessed through commonly used anesthesia monitoring parameters such as blood pressure, heart rate, and bispectral index (BIS). Although intraoperative regional anesthesia has become more widely adopted, few studies have confirmed or monitored its anesthetic-sparing effects. Using recent reports of nonintubated video-assisted thoracoscopic surgery (VATS) by BIS-targeted propofol infusion and intraoperative multilevel thoracoscopic intercostal nerve blocks (TINBs), this retrospective study investigated whether the anesthetic-sparing effect can be realized by reducing the effect-site concentration (Ce) to the targeted BIS level or by reducing the blood pressure at the onset of regional blocks. Methods A retrospective study of a prospectively collected case series of non-intubated VATS. Results Data on 56 adult patients who underwent nonintubated VATS were collected and analyzed. The mean operative time was 121 ± 32 minutes. BIS levels before and after one-lung ventilation/TINBs and surgery were 48% ± 11% and 47% ± 12%, respectively. The Ce of propofol infusion decreased significantly from 3.4 ± 0.8 μg/mL to 3.0 ± 0.7 μg/mL (p < 0.01) after surgery with TINBs. Blood pressure did not change significantly, whereas the heart rate increased moderately but significantly (77 ± 14 beats/minute to 82 ± 15 beats/minute, p < 0.01). Conclusion With comparable BIS and blood pressure in the subsequent surgical procedure, the adequacy of anesthesia and the anesthetic component provided by intraoperative TINBs and vagal nerve could be monitored adequately. The anesthetic-sparing effect of intraoperative nerve blocks can be realized when the Ce of propofol infusion was reduced to the target BIS level.

      PubDate: 2016-09-16T04:06:59Z
      DOI: 10.1016/j.aat.2016.07.001
       
  • Observation of ultrasound-guided thoracic paravertebral block using
           thoracoscopy

    • Authors: Tasuku Fujii; Yasuyuki Shibata; Kimitoshi Nishiwaki
      Abstract: Publication date: Available online 24 June 2016
      Source:Acta Anaesthesiologica Taiwanica
      Author(s): Tasuku Fujii, Yasuyuki Shibata, Kimitoshi Nishiwaki


      PubDate: 2016-09-16T04:06:59Z
      DOI: 10.1016/j.aat.2016.05.004
       
  • The law of Yin and Yang for controlled drugs ecosystem: Maximal analgesia
           with minimal abuse

    • Authors: Wei-Zen Sun
      Pages: 117 - 118
      Abstract: Publication date: Available online 26 November 2015
      Source:Acta Anaesthesiologica Taiwanica
      Author(s): Wei-Zen Sun


      PubDate: 2015-11-26T23:45:36Z
      DOI: 10.1016/j.aat.2015.10.003
      Issue No: Vol. 53, No. 4 (2015)
       
  • Efficacy of transverse abdominis plane block in reduction of postoperation
           pain in laparoscopic cholecystectomy

    • Authors: Alireza Saliminia; Omid Azimaraghi; Shiva Babayipour; Kamelia Ardavan; Ali Movafegh
      Pages: 119 - 122
      Abstract: Publication date: Available online 15 August 2015
      Source:Acta Anaesthesiologica Taiwanica
      Author(s): Alireza Saliminia, Omid Azimaraghi, Shiva Babayipour, Kamelia Ardavan, Ali Movafegh
      Objective Transversus abdominis plane (TAP) block is a recently introduced regional anesthesia technique that is used for postoperative pain reduction in some abdominal surgeries. The present study evaluated the efficacy of the TAP block on the post laparoscopic cholecystectomy pain intensity and analgesic consumption. Methods Fifty-four patients were enrolled in three groups: TAP block with normal saline (Group 1, n = 18); TAP block with bupivacaine (Group 2, n = 18); and TAP block with bupivacaine plus sufentanil (Group 3, n = 18). The time to the first fentanyl request, fentanyl consumption in the 24 hours following surgery, and postoperative pain intensity at 30 minutes, 1 hour, 6 hours, 12 hours, and 24 hours following discharge for recovery were measured and recorded. Results The total amount of 24-hour fentanyl consumption was higher in Group 1 (877.8 ± 338.8 μg) than either Group 2 (566.7 ± 367.8 μg) or Group 3 (555.5 ± 356.8 μg; p = 0.03). Postoperative pain score was higher in Group 1 than intervention groups (p = 0.006); however, there was no significant difference in intervention groups. The time to the first fentanyl request in Group 1 (79.44 ± 42.2) was significantly lower than Group 3 (206.38 ± 112.7; p = 0.001). Conclusion The present study demonstrated that bilateral TAP block with 0.5% bupivacaine reduces post laparoscopic cholecystectomy pain intensity and fentanyl request and prolongs time to the first analgesic request. Adding sufentanil to the block solution reduced neither pain intensity nor fentanyl further consumption.

      PubDate: 2015-08-17T16:27:43Z
      DOI: 10.1016/j.aat.2015.07.003
      Issue No: Vol. 53, No. 4 (2015)
       
  • Clinical study to evaluate the role of preoperative dexmedetomidine in
           attenuation of hemodynamic response to direct laryngoscopy and tracheal
           intubation

    • Authors: Kamlesh Kumari; Satinder Gombar; Dheeraj Kapoor; Harpreet Singh Sandhu
      Pages: 123 - 130
      Abstract: Publication date: Available online 26 October 2015
      Source:Acta Anaesthesiologica Taiwanica
      Author(s): Kamlesh Kumari, Satinder Gombar, Dheeraj Kapoor, Harpreet Singh Sandhu
      Objectives Dexmedetomidine, an α2 agonist, has been evaluated for its hypnotic, analgesic, and anxiolytic properties in the intraoperative period and critical care setting. However, data on the effect of dexmedetomidine on attenuation of pressor response to direct laryngoscopy and tracheal intubation are limited. We studied the effect of a single preinduction intravenous dose of dexmedetomidine of 0.5 μg/kg on hemodynamic responses to tracheal intubation, and dose requirements of anesthetics for induction and their adverse effects. Methods Eighty adult patients scheduled for elective surgery under general anesthesia requiring tracheal intubation were included. Patients were randomized into two groups: dexmedetomidine and placebo (n = 40 each). The study drug was administered intravenously over a period of 10 minutes prior to induction. Direct laryngoscopy and endotracheal intubation were performed. Hemodynamic parameters, the total dose of propofol, and adverse effects were recorded during induction and postintubation periods for 15 minutes. Results The maximum percentage increase in the heart rate after intubation was 19.6% less in the dexmedetomidine group than that in the placebo group (12.96% vs. 32.57%). The maximum percentage increases in systolic blood pressure, diastolic blood pressure, and mean blood pressure after intubation were significantly lower in the dexmedetomidine group than in the placebo group (12.38% vs. 45.63%, 19.36% vs. 60.36%, and 15.34% vs. 50.33%, respectively). There was a significant reduction of the mean total dose of propofol required for induction, 1.04 mg/kg in the dexmedetomidine group versus 2.01 mg/kg in the placebo group (p < 0.001). No serious side effects or adverse reactions were observed in either group. Conclusion Administration of a single preinduction intravenous dose of dexmedetomidine of 0.5 μg/kg resulted in significant attenuation of the rise in the heart rate, systolic blood pressure, diastolic blood pressure, and mean blood pressure, until 5 minutes postintubation. It significantly reduced the dose requirements of propofol for induction and caused minimal side effects.

      PubDate: 2015-10-29T10:55:58Z
      DOI: 10.1016/j.aat.2015.09.003
      Issue No: Vol. 53, No. 4 (2015)
       
  • Age correlates with hypotension during propofol-based anesthesia for
           endoscopic retrograde cholangiopancreatography

    • Authors: Chong-Sun Khoi; Jen-Jeng Wong; Hao-Chin Wang; Cheng-Wei Lu; Tzu-Yu Lin
      Pages: 131 - 134
      Abstract: Publication date: Available online 25 November 2015
      Source:Acta Anaesthesiologica Taiwanica
      Author(s): Chong-Sun Khoi, Jen-Jeng Wong, Hao-Chin Wang, Cheng-Wei Lu, Tzu-Yu Lin
      Objective Endoscopic retrograde cholangiopancreatography (ERCP) is a procedure used for diagnostic and therapeutic purposes. Most of the patients may feel pain, anxiety, and discomfort during this procedure, so conscious sedation is usually used during ERCP. General anesthesia would be considered if conscious sedation fails to achieve the requirement of the endoscopists. Several studies showed that propofol-based sedation could provide a better recovery profile. However, propofol has a narrow therapeutic window and complications may occur beyond this window. The present study aimed to find out the complications and the associated risk factors during ERCP procedure under propofol-based deep sedation. Methods We retrospectively reviewed data from anesthetic and procedure records of the patients who underwent ERCP under propofol-based deep sedation from January 2006 to July 2010 at Far Eastern Memorial Hospital, Taipei, Taiwan. All propofol-based deep sedations were conducted by anesthesiologists. The incidence of complications was determined and the independent risk factors identified by the multivariable logistic regression model. Result Propofol-based deep sedation was provided for 552 patients who received ERCP procedure. The majority of the patients were male, the mean age was 60 ± 16 years and American Society of Anesthesiologists physical status II–III. Almost 30% of patients experienced hypotension during the procedure, although no mortality or morbidity was associated with this complication. Sex, age, anesthetic time, American Society of Anesthesiologists status, hypertension, and arrhythmia were significantly different (p < 0.05) between patients with hypotension and without hypotension during the procedure. Multivariable logistic regression identified sex and age to be the independent predictors of hypotension. Conclusion Hypotension was the most frequent anesthetic complication during procedure under propofol-based deep sedation, but this method was safe and effective under appropriate monitoring. Age is the strongest predictor of hypotension and therefore propofol-based deep sedation should be conducted with caution in the elderly.

      PubDate: 2015-11-26T23:45:36Z
      DOI: 10.1016/j.aat.2015.10.002
      Issue No: Vol. 53, No. 4 (2015)
       
  • Codeine consumption from over-the-counter anti-cough syrup in Taiwan: A
           useful indicator for opioid abuse

    • Authors: Ming-Yu Lo; Ming Wei Ong; Jaung-Geng Lin; Wei-Zen Sun
      Pages: 135 - 138
      Abstract: Publication date: Available online 29 November 2015
      Source:Acta Anaesthesiologica Taiwanica
      Author(s): Ming-Yu Lo, Ming Wei Ong, Jaung-Geng Lin, Wei-Zen Sun
      Objective Over-the-counter (OTC) anti-cough preparations, many of which contain codeine (an opioid) or dextromethorphan (an opioid-like), are widely available in Taiwan and thus susceptible to overuse or abuse. We aimed to investigate whether opioids in the form of OTC antitussives play a significant role in medication abuse in Taiwan. Methods Data on the consumption of codeine and dextromethorphan in antitussives and expectorants from 2011 through 2014 in Taiwan were provided by IMS Health (Intercontinental Marketing Services). These data were then analyzed for trends and variance according to availability, as prescription or OTC, and according to drug type, as codeine or dextromethorphan, in order to form four primary sectors under opioid-containing anti-cough syrup consumption. Results From 2011 to 2014, use of opioid-containing cough syrup fluctuated between 6% and 9% from year to year for all cough syrup consumption, with an overall declining trend (11.3% per year relative to 2011). Within the underlying sectors, mean consumption for prescription dextromethorphan (61.4%) outstripped the other three sectors, followed in decreasing order by OTC codeine (20.2%), OTC dextromethorphan (10.5%), and prescription codeine (8.0%). However, movement in consumption corresponded mainly with OTC codeine, whose variance greatly exceeded that of the other sectors, which follow in order of decreasing variance as OTC dextromethorphan, prescription dextromethorphan, and prescription codeine. Conclusion The fairly low and stable consumption of prescription codeine suggested that physicians in Taiwan were careful in prescribing codeine, and that the medical demand for codeine was stable. The large variance in OTC codeine consumption suggested that a minority of consumers purchased significant quantities of codeine for non-medical purposes. Although opioids in cough syrup were not a large part of overall consumption and thus not widely abused, the data revealed that OTC codeine-containing cough syrup may serve as an indicator of potential drug abuse in the population as compared to prescription codeine.

      PubDate: 2015-12-01T02:53:48Z
      DOI: 10.1016/j.aat.2015.10.001
      Issue No: Vol. 53, No. 4 (2015)
       
  • Response surface models in the field of anesthesia: A crash course

    • Authors: Jing-Yang Liou; Mei-Yung Tsou; Chien-Kun Ting
      Pages: 139 - 145
      Abstract: Publication date: Available online 28 August 2015
      Source:Acta Anaesthesiologica Taiwanica
      Author(s): Jing-Yang Liou, Mei-Yung Tsou, Chien-Kun Ting
      Drug interaction is fundamental in performing anesthesia. A response surface model (RSM) is a very useful tool for investigating drug interactions. The methodology appeared many decades ago, but did not receive attention in the field of anesthesia until the 1990s. Drug investigations typically start with pharmacokinetics, but it is the effects on the body clinical anesthesiologists really care about. Typically, drug interactions are divided into additive, synergistic, or infra-additive. Traditional isobolographic analysis or concentration-effect curve shifts are limited to a single endpoint. Response surface holds the complete package of isobolograms and concentration effect curves in one equation for a given endpoint, e.g., loss of response to laryngoscopy. As a pharmacodynamic tool, RSM helps anesthesiologists guide their drug therapy by navigating the surface. We reviewed the most commonly used models: (1) the Greco model; (2) Reduced Greco model; (3) Minto model; and (4) the Hierarchy models. Each one has its unique concept and strengths. These models served as groundwork for researchers to modify the formula to fit their drug of interest. RSM usually work with two drugs, but three-drug models can be constructed at the expense of greatly increasing the complexity. A wide range of clinical applications are made possible with the help of pharmacokinetic simulation. Pharmacokinetic-pharmcodynamic modeling using the RSMs gives anesthesiologists the versatility to work with precision and safe drug interactions. Currently, RSMs have been used for predicting patient responses, estimating wake up time, pinpointing the optimal drug concentration, guide therapy with respect to patient's well-being, and aid in procedures that require rapid patient arousal such as awake craniotomy or Stagnara wake-up test. There is no other model that is universally better than the others. Researches are encouraged to find the best fitting model for different occasions with an objective measure.

      PubDate: 2015-08-31T03:10:36Z
      DOI: 10.1016/j.aat.2015.06.005
      Issue No: Vol. 53, No. 4 (2015)
       
  • Using a modified syringe technique to adjust the intracuff pressure
           of a laryngeal mask airway

    • Authors: Kuo-Chuan Hung; Wei-Hung Chen; Yu-Hsuan Shih; Li-Ren Yeh
      Pages: 146 - 147
      Abstract: Publication date: Available online 8 May 2015
      Source:Acta Anaesthesiologica Taiwanica
      Author(s): Kuo-Chuan Hung , Wei-Hung Chen , Yu-Hsuan Shih , Li-Ren Yeh
      Limiting the intracuff pressure of a laryngeal mask airway (LMA) to <60 cmH2O is recommended in clinical practice. This report aimed to assess the efficacy of a modified syringe technique to adjust the intracuff pressure of an LMA. In a preclinical study, commercially available 20-mL syringes were attached to the pilot balloon of LMAs with different preset intracuff pressures (40 cmH2O, 50 cmH2O, 60 cmH2O, 70 cmH2O, 80 cmH2O, 100 cmH2O, and 120 cmH2O). After attachment, the syringe plunger was allowed to passively rebound. If no rebound of the plunger was observed after attachment, 1 mL of air was withdrawn and the plunger was allowed to passively rebound again. This technique allowed the plunger to overcome static friction and avoid excessive deflation of the LMA cuffs. The intracuff pressure was measured using a manometer after the plunger ceased moving. In the preclinical study, the intracuff pressure was always less than or close to 60 cmH2O after adjustment using this modified syringe technique. After evaluating the performance and characteristics of the syringe in the preclinical study, we concluded that the modified syringe technique may be useful for adjusting LMA intracuff pressure effectively.

      PubDate: 2015-05-12T04:27:01Z
      DOI: 10.1016/j.aat.2015.03.004
      Issue No: Vol. 53, No. 4 (2015)
       
  • Anaesthetic management of a pregnant patient with cerebral angioma
           scheduled for caesarean section

    • Authors: Pradipta Bhakta; Ashfaq Hussain; Vikash Singh; Amisha Bhakta
      Pages: 148 - 149
      Abstract: Publication date: Available online 9 October 2015
      Source:Acta Anaesthesiologica Taiwanica
      Author(s): Pradipta Bhakta, Ashfaq Hussain, Vikash Singh, Amisha Bhakta
      Pregnancy can be rarely complicated with cerebral angioma. Such patient can pose problem to the anaesthesiologist and can present for caesarean section. The main anaesthetic challenge is prevention of rupture of angioma and subsequent bleed due to intraoperative surge of blood pressure. Both general and regional anaesthesia have been used in such patients. Spinal anaesthesia has the advantage of safety, lesser hypertensive surge and better analgesia as well as lesser blood loss. We hereby present successful anaesthetic management of such a case presented for emergency caesarean section done under spinal anaesthesia.

      PubDate: 2015-10-11T14:13:34Z
      DOI: 10.1016/j.aat.2015.08.002
      Issue No: Vol. 53, No. 4 (2015)
       
  • One-hand maneuver to facilitate flexible fiber-optic bronchoscope-guided
           nasotracheal intubation in sedated patients

    • Authors: Chih-Kai Shih; Chia-Ching Wu; Tsai-Tsen Ji
      Pages: 150 - 151
      Abstract: Publication date: Available online 28 September 2015
      Source:Acta Anaesthesiologica Taiwanica
      Author(s): Chih-Kai Shih, Chia-ching Wu, Tsai-Tsen Ji


      PubDate: 2015-09-30T00:31:43Z
      DOI: 10.1016/j.aat.2015.08.001
      Issue No: Vol. 53, No. 4 (2015)
       
  • Local Anesthetics exacerbate antibiotic-induced Anaphylactic Shock

    • Authors: Pin-Yang Hu; Po-Nien Chen; Kuang-I Cheng
      Pages: 152 - 153
      Abstract: Publication date: Available online 8 October 2015
      Source:Acta Anaesthesiologica Taiwanica
      Author(s): Pin-Yang Hu, Po-Nien Chen, Kuang-I. Cheng
      Anaphylactic shock is a severe form of allergic reaction that begins suddenly and may cause death. We describe a male patient with rectal cancer who was undergoing low anterior resection and transverse colostomy developed anaphylactic shock following ultrasound-guided transversus abdominis plane (TAP) block and prophylactic antibiotics injection. The acidosis and hypoxia due to shock markedly potentiate the cardiotoxicity of local anesthetics which may exacerbate the anaphylactic shock. Besides the treatment for the shock episode, immediate using lipid emulsion in the patient developing antibiotics related anaphylactic shock with local anesthetics administration maybe helpful.

      PubDate: 2015-10-11T14:13:34Z
      DOI: 10.1016/j.aat.2015.09.002
      Issue No: Vol. 53, No. 4 (2015)
       
  • Corrigendum to “Undertreatment of cancer pain”
           [Acta Anaesthesiol Taiwanica 53 (2015) 58–61]

    • Authors: Shiu-Yu C. Lee; Cheng-Hsu Wang
      First page: 154
      Abstract: Publication date: December 2015
      Source:Acta Anaesthesiologica Taiwanica, Volume 53, Issue 4
      Author(s): Shiu-Yu C. Lee, Cheng-Hsu Wang


      PubDate: 2015-12-15T20:38:25Z
      DOI: 10.1016/j.aat.2015.09.001
      Issue No: Vol. 53, No. 4 (2015)
       
  • Cepharanthine alleviates liver injury in a rodent model of limb
           ischemia–reperfusion

    • Authors: Yin-Kuang Chang; Su-Cheng Huang Ming-Chang Kao Chun-Jen Huang
      Abstract: Publication date: Available online 19 December 2015
      Source:Acta Anaesthesiologica Taiwanica
      Author(s): Yin-Kuang Chang, Su-Cheng Huang, Ming-Chang Kao, Chun-Jen Huang
      Objectives Limb ischemia–reperfusion (I/R) causes remote organ injury (e.g., liver injury). Oxidation and inflammation are crucial mechanisms. We investigated the effects of cepharanthine, a potent antioxidative and anti-inflammatory drug, on alleviating liver injury induced by limb I/R. Methods Twenty-four adult male Sprague-Dawley rats were randomized to receive sham operation (Sham), Sham plus cepharanthine, I/R, or I/R plus cepharanthine and designated as the Sham, Sham+Cep, I/R, or I/R+Cep group, respectively (n = 6 in each group). I/R was induced by applying rubber band tourniquets high around each hind limb for 3 hours followed by reperfusion for 24 hours. Results The plasma levels of aspartate aminotransferase (AST) and alanine aminotransferase (ALT) of the Sham and Sham+Cep groups were low, and the levels of AST and ALT of the I/R group were significantly higher than those of the Sham group (both p <0.001). By contrast, the AST and ALT of the I/R+Cep group were significantly lower than those of the I/R group (both p <0.001). The hepatic levels of nitric oxide (NO), malondialdehyde (MDA), macrophage inflammatory protein 2 (MIP-2), interleukin-6 (IL-6), and cyclooxygenase-2 (COX-2)/prostaglandin E2 (PGE2) of the Sham and Sham+Cep groups were also low. As expected, the NO, MDA, MIP-2, IL-6, and COX-2/PGE2 of the I/R group were significantly higher than those of the Sham group (all p <0.001). By contrast, the NO, MDA, MIP-2, IL-6, and COX-2/PGE2 of the I/R+Cep group were significantly lower than those of the I/R group (all p <0.05). Conclusion Cepharanthine alleviates liver injury in a rodent model of limb I/R. The mechanisms may involve reducing oxidation and inflammation.

      PubDate: 2015-12-23T06:23:12Z
       
  • Proximal approach for ultrasound-guided infraclavicular brachial plexus
           block

    • Authors: Takayuki Yoshida; Yoshiko Watanabe Kenta Furutani
      Abstract: Publication date: Available online 19 December 2015
      Source:Acta Anaesthesiologica Taiwanica
      Author(s): Takayuki Yoshida, Yoshiko Watanabe, Kenta Furutani


      PubDate: 2015-12-23T06:23:12Z
       
  • The effects of inverse ratio ventilation on cardiopulmonary function and
           inflammatory cytokine of bronchoaveolar lavage in obese patients
           undergoing gynecological laparoscopy

    • Authors: W.P. Zhang; S.M. Zhu
      Abstract: Publication date: Available online 13 December 2015
      Source:Acta Anaesthesiologica Taiwanica
      Author(s): W.P. Zhang, S.M. Zhu
      Background High peak airway pressure (Ppeak) and high end-tidal carbon dioxide tension (PETCO2) are the common problems encountered in the obese patients undergoing gynecological laparoscopy with conventional volume-controlled ventilation. This study was designed to investigate whether volume-controlled inverse ratio ventilation (IRV) with inspiratory to expiratory (I:E) ratio of 2:1 could reduce Ppeak or the plateau pressure (Pplat), improve oxygenation, and alleviate lung injury in patients with normal lungs. Methods Sixty obese patients undergoing gynecological laparoscopy were enrolled in this study. After tracheal intubation, the patients were randomly divided into the IRV group (n = 30) and control group (n = 30). They were ventilated with an actual tidal volume of 8 mL/kg, respiratory rate of 12 breaths/min, zero positive end-expiratory pressure and I:E of 1:2 or 2:1. Arterial blood samples, hemodynamic parameters, and respiratory mechanics were recorded before and during pneumoperitoneum. The concentrations of tumor necrosis factor-α, and interleukins 6 and 8 in bronchoalveolar lavage fluid were measured immediately before and 60 minutes after onset of CO2 pneumoperitoneum. Results IRV significantly increased arterial partial pressure of oxygen, mean airway pressure, and dynamic compliance of respiratory system with concomitant significant decreases in Ppeak and Pplat compared to conventional ventilation with I:E of 1:2 (p < 0.05). Additionally, the levels of tumor necrosis factor-α, and interleukins 6 and 8 were significantly lower than those in control group (p < 0.05). Conclusion Volume-controlled IRV not only reduces Ppeak, Pplat, and the release of inflammatory cytokines, but also increases mean airway pressure, and improves oxygenation and dynamic compliance of respiratory system in obese patients undergoing gynecologic laparoscopy without adverse respiratory and hemodynamic effects. It is superior to conventional ratio ventilation in terms of oxygenation, respiratory mechanics and inflammatory cytokine in obese patients undergoing gynecologic laparoscopy.

      PubDate: 2015-12-15T20:38:25Z
       
  • The effect of propofol and sevoflurane on antioxidants and proinflammatory
           cytokines in a porcine ischemia–reperfusion model

    • Authors: Hung-Tsung Hsiao; Hung Pei-Chi Huang Yu-Chuang Tsai Yen-Chin Liu
      Abstract: Publication date: Available online 11 December 2015
      Source:Acta Anaesthesiologica Taiwanica
      Author(s): Hung-Tsung Hsiao, Hung Wu, Pei-Chi Huang, Yu-Chuang Tsai, Yen-Chin Liu
      Objectives Ischemia–reperfusion (IR) features massive oxidative stress of tissues and cytokine response. Propofol and sevoflurane, both of which are commonly used anesthetics, are thought to have different antioxidant activities. The aim of this study is to delineate the influence of these two drugs on the production of free radicals and proinflammatory cytokines in IR conditions via in vitro and in vivo models. Methods An in vitro IR model was performed by incubating porcine cells (including mononuclear cells, and coronary and aortic smooth muscle cells) with either propofol 25 μM or sevoflurane 2% in the hypoxia chamber (1% O2, 37°C) for 1 hour, followed by room temperature air for 2 hours. Reactive oxygen species (ROS) and tumor necrosis factor-α (TNF-α) were also measured via flow cytometry and enzyme-linked immunosorbent assay methods, respectively. Ten pigs were used for the in vivo study. After anesthesia with either propofol (10–15 mg/kg/h) or sevoflurane (2%), internal carotid and femoral arterial catheters were inserted for direct blood pressure monitoring and blood sampling. The IR models were produced via descending thoracic aorta clamping for 1 hour and declamping for 2 hours during the procedure for left ventricular assist device implantation. Blood serum was sampled from upper and lower body vessels for ROS and TNF-α evaluation via thiobarbituric acid reacting substances method and enzyme-linked immunosorbent assay, respectively. Results The results showed significant reduction of both ROS and TNF-α levels in the propofol group in vitro IR model. However, there was no difference in lipid peroxidation and TNF-α level between propofol and sevoflurane for the in vivo IR model. Conclusion We concluded that propofol, compared with sevoflurane, can significantly inhibit ROS formation on a cell level. In addition, propofol can significantly inhibit TNF-α formation of monocytes and coronary smooth muscle cells but not aortic smooth muscle cells.

      PubDate: 2015-12-15T20:38:25Z
       
  • Title Index

    • Abstract: Publication date: December 2015
      Source:Acta Anaesthesiologica Taiwanica, Volume 53, Issue 4


      PubDate: 2015-12-15T20:38:25Z
       
  • Joint assembly of suction catheter and endotracheal tube- Aid for
           Tracheostomy Tube Exchange

    • Authors: Kiranpreet Kaur; Asha Anand Mamta Bhardwaj S.K. Singhal
      Abstract: Publication date: Available online 2 December 2015
      Source:Acta Anaesthesiologica Taiwanica
      Author(s): Kiranpreet Kaur, Asha Anand, Mamta Bhardwaj, S.K. Singhal
      Various authors have suggested the use of various instruments such as suction catheter, urethral catheter, fiberoptic bronchoscopy, stylet, endotracheal tube exchange and gum-elastic bougie for exchange of endotracheal or tracheostomy tube. In an emergency we used joint assembly of suction catheter and endotracheal tube for exchange of tracheostomy tube.

      PubDate: 2015-12-06T07:18:50Z
       
  • Pneumorrhachis as a result of epidural anesthesia

    • Authors: Shivinder Singh; Haneesh Thakur
      Abstract: Publication date: Available online 14 August 2015
      Source:Acta Anaesthesiologica Taiwanica
      Author(s): Shivinder Singh, Haneesh Thakur


      PubDate: 2015-08-17T16:27:43Z
       
 
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