Juniper Publishers Journal of Anesthesia and Intensive Care Medicine

Juniper Publishers - Journal of Anesthesia Abstract Background: Sufentanil has an outstanding place in clinical practice and one cannot think of surgery or intensive care therapy without it. However, the routine use of continuous sufentanil infusion may cause severe problems if stabilized patients are discharged from the ICU after surgical treatment and need to be converted to oral opioids. Aim & method: Here we report our experiences with a series of six patients that we have converted from intravenous sufentanil to oral morphine. Cases: In 6 cases, we report intensive care (ICU) patients after surgical or medical therapy, who received sufentanil infusion for analgosedation. The patients were between 45 and 68 years old. It can be demonstrated that the optimal dose of sufentanil can be converted to minor doses of oral medication than expected from the calculated equi-analgesic ratios. Despite of lower oral opioid medication pain levels did not increase

Juniper Publishers - Journal of Anesthesia Abstract Heerfordt’s syndrome is an unusual clinical manifestation (less than 5%) of sarcoidosis, characterized by parotitis, uveitis, and peripheral facial palsy, febrile syndrome is usually associated. Oral corticosteroid is the treatment of choice. We report a case of a patient in which the syndrome of Heerfordt was retained. Keywords: Heerfordt’s syndrome, parotitis, uveitis, sarcoidosis, facial palsy. Introduction The sarcoidosis is a systemic granulomatosis of unknown cause, characterized by its clinical polymorphism and a wide variety of its modes of presentation. The combination of fever, uveitis, parotitis and peripheral facial paralysis defines Heerfordt’s syndrome which presents an unusual manifestation of this disease. We report a case of a patient in which the syndrome of Heerfordt was found. Case Report A 49 year-old female followed i

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Juniper Publishers - Journal of Anesthesia News The economic burden of the opioid epidemic cost the US $78.5 billion a year. A person dies from an opioid overdose every 20 minutes which totaled 30,091 people last year. It is an epidemic that difficult to treat. Opioid overdoses now outnumber the number of deaths from gun violence and motor vehicle accidents per year. Over 90% of patients who overdose on prescription painkillers are prescribed opioids again. Currently in the US there are 100 million people in chronic pain who are dependent on prescription opioids, 1 million veterans from war who are dependent on prescription opioids, 20 million who abuse prescription opioids and there is 30,000 who die from prescription overdoses. Opioids are necessary to treat pain but the prescription opioid overdose has become a significant national problem. Life expectancy in the US has dropped to 73 years and 8 months largely because of it. The opioid epidemic was rooted by a U

Juniper Publishers - Journal of Anesthesia Introduction Persistent anesthesia problems may be summarized as over- and under-medication, pain management, and postoperative nausea and vomiting (PONV). Over- &Under-Medication Prior to the 1996 FDA approval of a direct cortical responsemonitor (DCRM), determination of anesthetic dose relied on body weight, medical & physical assessment (i.e. ASA status), and heart rate (HR) and blood pressure (BP) changes, especially thesevital signs changes occurring with initial incision. The cerebral cortexis the target of anesthetics. The adult brain weighs approximately 3-4 pounds and doesn't vary substantially with body weight.Average body weight doses based on the '70 kg' patient will likely over or under-medicate many patients. ASA status is also an unlikely guide to individual cortical responses to body weight based drug doses. Pharmacokinetics (PK) and pharmacodynamics (PD) as well as target controll

Juniper Publishers - Journal of Anesthesia Abstract Objectives: Intensive Care Units (ICU) in Hong Kong incorporated palliative care in the daily practice. We would like to evaluate the quality of end-of-life care (EoLC) in the ICU. Design, setting and participants: Quality indicators consist of 4 domains and 12 indicators were devised. The four domains were early identification of dying patients; communication and information; end-of-life care to the patient and care after death. Next, we applied these indicators to assess the EoLC of patients who died in a 20-beds mixed ICU from 1st Jul to 30th Sep 2012. Main outcome measures: The 12 EoL quality indicators Results: Out of the 38 patient records, 33 were included for analysis. There were no objective criteria to identify dying patients. All the studied families received an EoL physician-family conference. Although high documentation rate (90.9%) of the treatment plan and resuscitation status; only 3.0% of

Juniper Publishers - Journal of Anesthesia Introduction General anesthesia (GA) is defined as a drug-induced loss of consciousness during which patients are not arousable, even by painful stimulation [ 1 ]. GA takes an important role in surgical procedures where an anesthetic overdose may lead to drug-associated toxicities, coma and even death; on the other hand a light anesthetic dose may lead to the well-known event of intraoperative awareness, which can cause sleep disorders, depression, night terrors, hospitals fears and post-traumatic stress disorder [ 2 - 4 ]. In this context, monitoring depth of anesthesia has become an important issue in anesthesiology. Electroencephalographic signal (EEG) reflects the activity of the central nervous system and it has been widely used for monitoring depth of anesthesia. In general terms, the EEG of an anesthetized patient changes from high frequency, low amplitude when awake to low frequency, high amplitude when anesthetized