• Journal of Dental Anesthesia and Pain Medicine
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• v.20 no.3
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• pp.129-135
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• 2020

Background: Postoperative fluid retention is a factor that causes delay in recovery and unexpected adverse events. It is important to prevent intraoperative fluid retention, which is putatively caused by intraoperative release of stress hormones, such as ADH (anti-diuretic hormone) or others. We hypothesized that intraoperative analgesia may prevent pathological fluid retention. We retrospectively explored the relationship between analgesics and in-out balance in surgical patients from anesthesia records. Methods: Anesthetic records of 80 patients who had undergone orthognathic surgery were checked in this study. Patients were anesthetized with either TIVA (propofol and remifentanil) or inhalational anesthesia (sevoflurane and remifentanil). During surgery, acetated Ringer's solution was infused for maintenance at a rate of 3-5 ml/kg/h at the discretion of the anesthetist. The perioperative parameters, including the amount of crystalloid and colloid infused, and the amount of urine and bleeding were checked. Furthermore, we checked the amount and administration rate of remifentanil during the surgical procedure. The correlation coefficient between the remifentanil dose and the in-out balance or the urinary output was analyzed using the Pearson correlation coefficient. The contributing factor to fluid retention, including urinary output, was statistically examined by means of multivariate logistic regression analysis. Results: A significant positive correlation was found between remifentanil dose and urinary output. Urinary output less than 0.04 ml/kg/min was suggested to cause positive fluid balance. Although in-out balance approaches zero balance with increase in remifentanil administration rate, no contributing factor for near-zero fluid balance was statistically picked up. The remifentanil administration rate was statistically picked up as the significant factor for higher urinary output (> 0.04 ml/kg/min) (OR, 2,644; 95% CI, 3.2-2.2 × 10⁶) among perioperative parameters. Conclusions: In conclusion, remifentanil contributes in maintaining the urinary output during general anesthesia. Although further prospective study is needed to confirm this hypothesis, it was suggested that fluid retention could be avoided through suppressing intraoperative stress response by means of appropriate maintenance of remifentanil infusion rate.

• Journal of Chest Surgery
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• v.55 no.2
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• pp.118-125
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• 2022

Background: A time course analysis was undertaken to evaluate how perioperative process-of-care and outcome measures evolved after implementation of an enhanced recovery after thoracic surgery (ERATS) program. Methods: Outcome and process-of-care measures were compared between patients undergoing major elective thoracic surgery during a 9-month pre-ERATS implementation period to those at 1-3, 4-6, and 7-9 months post-ERATS implementation. Outcome measures included length of stay, the 30-day readmission rate, 30-day emergency department visits, and minor and major adverse events. Process measures included first time to activity, out-of-bed, ambulation, fluid diet, diet as tolerated, as well as removal of the first and last chest tube, epidural, patient-controlled analgesia, and Foley and intravenous catheters. Results: In total, 704 patients (352 pre-ERATS, 352 post-ERATS) were included. Mobilization-related process measures, including time to first activity (16.5 vs. 6.8 hours, p<0.001), out-of-bed (17.6 vs. 8.9 hours, p<0.001), and ambulation (32.4 vs. 25.4 hours, p=0.04) saw statistically significant improvements by 1-3 months post-ERATS implementation compared to pre-ERATS. Time to Foley removal improved by 4-6 months post-ERATS (19.5 vs. 18.2 hours, p=0.003). Outcome measures, including the 30-day readmission rate and emergency department visits, steadily decreased post-ERATS. By 7-9 months post-ERATS, both minor (18.2% vs. 7.9%, p=0.009) and major (13.6% vs. 4.4%, p=0.007) adverse events demonstrated statistically significant improvements. Length of stay trended towards improvement from 6.2 days pre-ERATS to 4.8 days by 7-9 months post-ERATS (p=0.06). Conclusion: The adoption of ERATS led to improvements in multiple process-of-care measures, which may collectively and gradually achieve optimization of clinical outcomes.

• Journal of Veterinary Clinics
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• v.20 no.1
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• pp.33-41
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• 2003

The cardiopulmonary and anesthetic effects of tiletamine/zolazepam(TZ, 10 mg/kg IV), xylazine-tiletamine /zolazepam(XTZ, X: 1.1 mg/kg IM, TZ: 10 mg/kg IV) and medetomid-ine-tiletamine/zolazepam(MTZ, M: 30$\mu\textrm{g}$/kg IM, TZ: 10 mg/kg IV) were evaluated to 15 healthy mongrel dogs (4.16$\pm$0.65 kg). These dogs were randomly assigned to the three treatment groups(Control, XTZ, MTZ) with 5 dogs in each group. All experimental animals were premedicated with atropine(0.03 mg/kg, IM). Xylazine or medetomidine were administered to dogs in XTZ group and MTZ group 10 minutes after atropine injection. TZ was administered 20 minutes after atropine injection in all groups. The loss of pain response at pedal reflex and ear pinching tests in XTZ and MTZ groups were much longer compared with those of Control group(P < 0.01). All dogs in this study showed head rocking and hypersalivation during recovery time. Body temperature decreased progressively during experimental period in all groups, but it was not significant. After TZ injection, heart beat rate significantly increased 10 and 20 minutes in Control group, and 20 and 40 minutes in XTZ group(P < 0.05). Respiratory rate significantly decreased 0,10,20 and 40 minutes after 72 injection in XTZ and MTZ groups. In Control group, systolic arterial pressure (SAP) 20 minutes. diastolic arterial pressure(DAP) 10 minutes and mean arterial pressures (MAP) 10 and 20 minutes after 72 injection significantly decreased(P < 0.05). In XTZ group, SAP, DAP and MAP significantly decreased 20 and 40 minutes after 72 injection(P < 0.05). Thus, it was considered that XTZ and MTZ were useful in a canine surgical treatment that requires long anesthetic duration and deep analgesia.