Background: Various methods have been used to reduce postoperative pain after thoracic surgery. However, these methods may affect the patient's respiratory response and delay recovery from anesthesia. We aimed to evaluate the effects of fentanyl and remifentanil during extubation after video-assisted thoracic surgery (VATS). Methods: This study included 45 randomly-selected male patients who underwent VATS for pneumothorax between July 2011 and August 2012. We divided the participants into 3 groups: the F group, which received a bolus injection of 1.0 µg/kg of fentanyl; the R1 group, which received a 0.04 µg/kg/min remifentanil infusion; and the R2 group, which received a 0.08 µg/kg/min remifentanil infusion. Hemodynamics, pain, cough, consciousness level, and nausea were assessed for each group. Results: The number and severity of coughs were lower in the R1 and R2 groups than in the F group, and there were no differences between the R1 and R2 groups. Respiratory depression and loss of consciousness were not observed in any of the patients, and there were no differences in hemodynamics. Conclusion: In comparison with fentanyl, remifentanil did not result in a wide fluctuation of blood pressure and heart rate upon emergence from general anesthesia. Moreover, remifentanil contributed to cough suppression and postoperative pain control. Remifentanil seems to be a safe and effective analgesic after VATS.
Multi‐resonant thermally activated delayed fluorescent (MR‐TADF) materials are blooming for high‐resolution organic light‐emitting diodes (OLEDs). However, boron/nitrogen (B/N)‐integrated MR‐TADF emitters suffer severe efficiency roll‐off from their strong inter‐molecular π–π interactions. Herein, versatile narrowband pure blue emitters (mono‐mx‐CzDABNA and tri‐mx‐CzDABNA) are demonstrated featuring a ring‐fused extended π‐skeleton: a classic steric hindrance and rigidity accessed by integrating with meta‐xylene (mx) rotors. tri‐mx‐CzDABNA shows a narrowband (FWHM, 26 nm) pure blue emission (λmax, 462 nm) with substantial hypsochromic shift (12 nm) while maintaining MR‐TADF characteristics. The key solid‐state analyses conclude that they conceivably suppress the non‐radiative energy loss, thus improving the photoluminescence quantum yield (PLQY > 90%) and rate of reverse intersystem crossing (RISC) (kRISC ≈2.85 × 105 s−1). The integration of tri meta‐xylene significantly leads to an enhanced horizontal dipole ratio (HDR) from 65% to 85%. Hyperfluorescent‐OLEDs are fabricated using designed MR‐TADF as terminal emitter, achieving a narrowband (FWHM, 34 nm) pure blue electroluminescence (λmax, 472 nm) and maximum external quantum efficiency (EQEmax) of 26.97% with magnificently suppressed efficiency roll‐off (7.8%) at 1000 cd m−2. So, it is believed that regulation of internal efficiencies and high color purity can amplify the route to achieving a narrowband pure blue emission through new synthetic MR‐TADF approaches.
Background: This study was conducted to compare the efficacy of intravenous alfentanil and lidocaine as a pretreatment for the prevention of withdrawal movements following a rocuronium injection and hemodynamic change following tracheal intubation.Methods: This study evaluated 180 patients that were divided into the following 3 pretreatment groups: group C: normal saline, group L: lidocaine 1 mg/kg, group A: alfentanil 10μg/kg. Anesthesia was induced using 5 mg/kg thiopental sodium, after which the test drug was injected. Rocuronium (1 mg/kg) was then administered 1 minute after the test drug was injected over 5 seconds and the response was characterized as one of the following: no movement, movement limited to the wrist, to the elbow or to the shoulder. Intubation was performed 1 minute later. Systolic blood pressure (SBP), diastolic blood pressure (DBP) and heart rate (HR) were then recorded at each of the following points: T1: preinduction, T2: immediately prior to rocuronium injection, T3: immediately after rocuronium injection, T4: immediately prior to intubation, T5: immediately after intubation, T6: 1 minute after intubation, T7: 5 minutes after intubation.Results: The incidence of withdrawal movement was significantly lower in group A than groups C and L (P < 0.05). In addition, SBP, DBP and HR following intubation were significantly lower in group A than group C and group L (P < 0.05).Conclusions: Pretreatment with 10μg/kg of alfentanil effectively reduced the incidence of withdrawal movement in response of rocuronium injection and caused minimal hemodynamic changes following intubation.
Neurogenic pulmonary edema (NPE) in brain dead organ donors occurring after an acute central nervous system insult threatens organ preservation of potential organ donors and the outcome of organ donation. Hence the active and immediate management of NPE is critical. In this case, a 50-year-old male was admitted to the intensive care unit (ICU) for organ donation. He was hypoxic due to NPE induced by spontaneous intracerebral hemorrhage and intraventricular hemorrhage. Protective ventilatory management, intermittent recruitment maneuvers, and supportive treatment were maintained in the ICU and the operating room (OR). Despite this management, the hypoxemia worsened after the OR admission. So inhaled nitric oxide (NO) therapy was performed during the operation, and the hypoxic phenomena showed remarkable improvement. The organ retrieval was successfully completed. Therefore, NO inhalation can be helpful in the improvement of hypoxemia caused by NPE in brain dead organ donors during anesthesia for the organ donation.
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