Differences in midazolam premedication effects on recovery after short-duration ambulatory anesthesia with propofol or sevoflurane for gynecologic surgery in young patients: A randomized controlled trial.

BACKGROUND: Anxiolytic premedication requires careful consideration owing to potential side effects including delayed recovery after ambulatory anesthesia. We aimed to compare the effect of midazolam on recovery profiles postoperatively, depending on whether propofol or sevoflurane was the primary anesthetic. METHODS: We enrolled 226 patients (age, 18-50 years) undergoing ambulatory gynecologic laparoscopic surgery. Patients were categorized into propofol without midazolam (P), propofol with midazolam (MP), sevoflurane without midazolam (S), and sevoflurane with midazolam (MS) groups. As premedication, placebo or 0.02 mg/kg intravenous midazolam was used. The primary outcome was the difference in the time from anesthetic discontinuation to eye opening in response to verbal command. Secondary outcomes included postoperative nausea and pain occurrence and time to reach the discharge score. RESULTS: The time from anesthetic discontinuation to eye opening was longer in the MP group (n = 49) than in the P group (n = 50; P < .001) but was not significantly different between the MS (n = 50) and S groups (n = 49; P = .1). Midazolam premedication did not significantly affect postoperative nausea in the MP group compared with that in the P group (P = .3) but had a nausea prevention effect in the MS group compared with that in the S group (P < .001). The time to reach the discharge score was similar in all patients regardless of midazolam administration. CONCLUSION: In the recovery from short-duration ambulatory gynecologic surgery in young patients, intravenous midazolam premedication showed positive effects on postoperative nausea without affecting the time from anesthetic discontinuation to eye opening with sevoflurane-based anesthesia but prolonged the time from anesthetic discontinuation to eye opening with propofol-based anesthesia. Because this difference between the propofol groups is not clinically significant, the results support midazolam premedication in young women. Further studies assessing larger populations are needed.

Junctional rhythm with severe hypotension following infiltration of lidocaine containing epinephrine during dental surgery.

We experienced an unusual case of accelerated junctional rhythm with severe hypotension after infiltration of lidocaine containing epinephrine during dental surgery under general anesthesia. The patient's electrocardiogram exhibited retrograde P-waves following the QRS complex, which could be misinterpreted as ST-segment depression. As a temporary measure, administration of ephedrine restored the patient's blood pressure to normal levels. The importance of this case lies in its demonstration of an unexpected and serious side effect of commonly used epinephrine infiltration. This case also highlights the need for accurate interpretation of the electrocardiogram and comprehensive understanding of best practices for patient management.

Subjective rating scale for discourse: Evidence from the efficacy of subjective rating scale in amnestic mild cognitive impairments.

In clinical settings, the language ability of patients with neurologic communication disorders have been measured by quantitative parameters such as the total number of words in dialogue and picture description tasks. However, this quantitative analysis requires a long period of time in order to analyze the quantitative parameters, and results can differ according to discourse tasks. The purposes of this study are to explore whether SR-D may predict the quantitative measures of discourse tasks. Forty patients with amnestic MCI and 40 normal elderly participated in the study. We gathered responses to 10 items regarding SR-D and analyzed the quantitative measures of narrative discourse through 3 discourse tasks (i.e, picture description, dialogue, procedural discourse). We found significant differences in MLTW, CIU, and SR-D scores between the 2 groups. In particular, 4 items were significantly correlated with the performance of MLTW and CIU. Sensitivity and specificity of these 4 items were 100% and 75%, respectively. In terms of economic opportunity costs, objective measures cannot be evaluated to be practical, since it is used in research rather than clinical diagnosis in general. Therefore, evaluation of discourse using a few items proven in its sensitivity and specificity could allow a wide use of such measure in not only research but also in clinical diagnosis. These findings suggest that subjective measures of narrative discourse may be valid with objective language tests to predict individual discourse performance.

Optical separation of mechanical strain from charge doping in graphene.

Because of its superior stretchability, graphene exhibits rich structural deformation behaviours and its strain engineering has proven useful in modifying its electronic and magnetic properties. Despite the strain-sensitivity of the Raman G and 2D modes, the optical characterization of the native strain in graphene on silica substrates has been hampered by excess charges interfering with both modes. Here we show that the effects of strain and charges can be optically separated from each other by correlation analysis of the two modes, enabling simple quantification of both. Graphene with in-plane strain randomly occurring between -0.2% and 0.4% undergoes modest compression (-0.3%) and significant hole doping on thermal treatments. This study suggests that substrate-mediated mechanical strain is a ubiquitous phenomenon in two-dimensional materials. The proposed analysis will be of great use in characterizing graphene-based materials and devices.

Water-gated charge doping of graphene induced by mica substrates.

We report on the existence of water-gated charge doping of graphene deposited on atomically flat mica substrates. Molecular films of water in units of ~0.4 nm thick bilayers were found to be present in regions of the interface of graphene/mica heterostacks prepared by micromechanical exfoliation of kish graphite. The spectral variation of the G and 2D bands, as visualized by Raman mapping, shows that mica substrates induce strong p-type doping in graphene with hole densities of (9 ± 2) × 10(12) cm(-2). The ultrathin water films, however, effectively block interfacial charge transfer, rendering graphene significantly less hole-doped. Scanning Kelvin probe microscopy independently confirmed a water-gated modulation of the Fermi level by 0.35 eV, which is in agreement with the optically determined hole density. The manipulation of the electronic properties of graphene demonstrated in this study should serve as a useful tool in realizing future graphene applications.