IMPLICATIONS: During anastomosis of the left coronary artery branches and the left circumflex artery, in particular, we demonstrated that treatment with milrinone prevents increased mitral regurgitation and mean pulmonary artery pressures and decreased cardiac index in patients with mitral regurgitation undergoing off-pump coronary artery bypass.
IMPLICATIONS: In rabbits, abdominal aortic unclamping after a 20-min clamp caused an initial dilation followed by a sustained constriction of both large and small cerebral pial arterioles. Clinical doses of milrinone and colforsin daropate attenuated this vasoconstriction, an effect that may be favorable in the clinical setting.
IMPLICATIONS: Patients who develop atrial fibrillation after cardiac surgery/cardio pulmonary bypass (CPB) have increased morbidity. This study demonstrated that the monocyte inflammatory response during surgery/CPB was greater in patients who developed postoperative atrial fibrillation. Cellular inflammation may be a potential therapeutic target to prevent this complication.
IMPLICATIONS: One-hundred-forty-two patients undergoing mitral valve surgery were investigated. We found no difference in cardiac troponin and creatine kinase-MB levels after mitral valve surgery alone compared with surgery with concomitant radiofrequency ablation. Myocardial injury after cardiac surgery is not significantly increased by radiofrequency ablation of atrial fibrillation.
IMPLICATIONS: Because of shortages of cadaveric donor organs, living donation is an important option for patients awaiting liver transplantation. Living donation liver transplant recipients bypass the normal prioritization procedures and are transplanted with lower Model for End-stage Liver Disease scores, with better preserved coagulation function, and with reduced transfusion of red blood cells and component therapy compared with cadaveric donation liver transplant recipients.
IMPLICATIONS: Negative pressure pulmonary edema may occur secondary to high levels of negative pressure applied to the intrapleural space via chest tubes in the presence of partial large airway obstruction. Post-lung transplant patients may be especially at risk because of compromised lymphatic drainage.
IMPLICATIONS: Anesthetic management of conjoined twins when one has single ventricle physiology presents unique challenges to the anesthesia team. Because of the shared circulation in this case, isolating the physiological and pharmacological management of the two babies was not possible, and a synchronized dual anesthetic management strategy was essential to achieve and maintain a safe anesthetic state.
IMPLICATIONS: We describe a method of using available human simulation to test for actual latent errors (accidents waiting to happen). In this study, the rare event studied was that of apnea secondary to sedation. However, the implications go beyond sedation to represent a generic patient safety problem: that of suboptimal rescue capabilities.
IMPLICATIONS: Ondansetron oral disintegrating tablets were accepted by school-age children undergoing adenotonsillectomy and decreased the incidence of postoperative vomiting.
IMPLICATIONS: Orally administered glucose or sucrose is an effective means to decrease the pain response to mildly invasive procedures in newborns. Because sugar-solution analgesia is blocked by opioid receptor antagonists, we tested the hypothesis that glucose directly activates expressed opioid receptors. The hypothesis was not supported by the data.
IMPLICATIONS: The addition of opioids and non-opioids to local anesthetics can prolong the duration of pain relief of caudal epidural blocks. Each of the three non-opioids compared in this double-blind study prolonged the duration of analgesia. However, neostigmine and midazolam were more effective than ketamine.
IMPLICATIONS: We present a case of a patient successfully managed using lepirudin; however, we advise caution in the use of this drug because it is difficult to appropriately measure the degree of anticoagulation.
IMPLICATIONS: Comparing unilateral spinal block using 7.5 mg of 0.5% hyperbaric ropivacaine with 7.5 mg or 5 mg of 0.5% hyperbaric levobupivacaine, this prospective, randomized, double-blind study showed that 5 mg levobupivacaine and 7.5 mg ropivacaine provide adequate spinal block for outpatient knee arthroscopy with a faster home discharge as compared with 7.5 mg levobupivacaine.
IMPLICATIONS: Treatment before and after surgery with rofecoxib in patients with a local anesthetic field block decreased in-hospital recovery time, and reduced pain scores and analgesic use in the first 24 h after open inguinal hernia repair.
IMPLICATIONS: Acetaminophen (paracetamol) IV 1 g and propacetamol 2 g were superior to placebo regarding analgesic efficacy in this double-blind, randomized study in patients with moderate to severe pain after third molar surgery. Significantly more patients in the propacetamol group had pain at the infusion site.
IMPLICATIONS: Propofol enhances the dominance of parasympathetic activity, which is associated with decreased heart rate (HR) and arterial blood pressure (BP). Midazolam enhances the dominance of sympathetic activity, which is associated with increased HR and decreased BP. These differences in effects on cardiac autonomic nervous system activity during conscious sedation are important in patients at risk of cardiovascular complications.
IMPLICATIONS: In patients who received midazolam for premedication, listening to music during the preoperative period was associated with an increased level of sedation and lower bispectral index values.
IMPLICATIONS: The myelin sheaths made by oligodendrocytes at the nerve root entry zone into the spinal cord are highly vulnerable to large concentrations of tetracaine administered intrathecally in rabbits. This vulnerability might be related to the neurological symptoms observed clinically after spinal anesthesia.
IMPLICATIONS: We evaluated the effects of IV sildenafil in two animal models of acute pulmonary embolism. IV sildenafil selectively decreased pulmonary vascular resistance and pulmonary artery pressure and attenuated the increase in oxidative stress after acute pulmonary embolism in both models.
IMPLICATIONS: The results of this study show that clonidine possesses a concentration-dependent and time-dependent bactericidal activity on Staphylococcus aureus and Staphylococcus epidermidis. No bactericidal activity of clonidine was observed on Escherichia coli, and no bactericidal activity of neostigmine was observed on any tested strains.
IMPLICATIONS: We determined the effect-site concentration of remifentanil blocking the sympathetic responses to tracheal intubation and skin incision in 50% of patients. We found that during a bispectral index-guided target controlled infusion of propofol, effect-site concentrations of remifentanil of 5 ng/mL and 2 ng/mL are required to blunt sympathetic responses to tracheal intubation and skin incision in 50% of patients, respectively.
IMPLICATIONS: The photoactivable compound azietomidate has anesthetic properties similar to those of etomidate, and its potency is comparably sensitive to the N265M {beta}3 subunit point mutation in gamma-aminobutyric acid (GABA)A. This finding, and the capacity of azietomidate to photolabel, may make it useful in locating the binding site at which etomidate and similar compounds act to produce general anesthesia and enhancement of GABAA receptors.
IMPLICATIONS: The effects of volatile anesthetics on crossbridges i.e., ultimate contractile targets in airway smooth muscle (ASM), are unknown. Our results provide new insights into the intracellular effects of volatile anesthetics on ASM and showed that isoflurane modulated mechanics and crossbridge kinetics of isolated tracheal smooth muscle differently depending on the level of airway responsiveness.
IMPLICATIONS: Absence of the kainate subunit GluR6 does not affect the capacity of three inhaled anesthetics to produce immobility or of isoflurane to interfere with fear conditioning. A dominant negative mutation in this subunit may modulate minimum alveolar concentration.
IMPLICATIONS: Anaphylaxis involving any drug or substance used during surgery is possible. We diagnosed an anaphylactic reaction resulting from methylene blue instillation used for detection of tubal permeability. The diagnosis was supported by the recognition of clinical symptoms associated with biological assessment and cutaneous tests.
IMPLICATIONS: With a bellows leak in an O2-driven Ohmeda 7810 ventilator, room contamination occurred but inspired oxygen fraction (Fio2), airway pressure, and tidal volume (Vt) were unaffected. Room contamination is likely in designs without scavenging of drive gas. Fio2, airway pressure, and Vt results may not apply to ventilators, e.g., Drager AV-E, where drive gas contains entrained air.
IMPLICATIONS: Trauma or improper placement or anchorage of spinal subarachnoid catheterization introduces bias in ensuing experiments. We report a modified procedure for catheterization of the rat thoracic spinal subarachnoid space that compares favorably to previously reported methods and greatly reduces these confounding factors.
IMPLICATIONS: This paper presents a critical review of advanced display technologies to support anesthesia monitoring. We review laboratory, simulator, and clinical studies of configural graphic displays, head-mounted displays, and continuous auditory displays, noting the advantages and disadvantages of each technology for the anesthesiologist and pointing to further research needs.
IMPLICATIONS: In this case report, we describe a nonagenarian patient who could respond completely to verbal commands at a Bispectral Index (BIS) value of 52 after epidural lidocaine and IV propofol anesthesia. Intraoperative awareness can occur even in the recommended BIS range 40-60.
IMPLICATIONS: We investigated a modified subcutaneous approach using bilateral surgical leads for occipital nerve electrical stimulation and found improvements in visual analog scale pain scores and functional capacity in patients treated with this technique.
IMPLICATIONS: The efficacy of antineuropathic pain drugs varies from patient to patient. To understand the mechanism of this phenomenon, gabapentin and imipramine were tested in rats with neuropathic pain at various times after nerve injury. The results indicate that drug efficacy may depend on the length of time between injury and administration.
IMPLICATIONS: O-desmethyl tramadol is one of the main metabolites of tramadol. O-desmethyl tramadol inhibited M1 receptors functions, whereas it did not suppress that of M3 receptors. The present findings help to unveil the pharmacological basis of tramadol and O-desmethyl tramadol and to better understand its neuronal action and anticholinergic effects.
IMPLICATIONS: Budgeting based on transfer pricing for delivered anesthesia services is a new tool for economic steering of an academic anesthesia department. In this study, we show that such a transfer pricing system can lead to significant reductions of anesthesia process times in a large variety of different anesthesia techniques.
IMPLICATIONS: Academic anesthesia departments have provided faculty compensation in the form of rank-based salaries. Gradually, some departments have provided incentives and bonus systems. The authors' department (University of California, San Francisco) found that adding incentives and bonus payments, mostly based on clinical productivity, induced increased variability in total faculty compensation and narrowed the financial difference between assistant and full professors. The potential impact on the mission of the department is discussed.
IMPLICATIONS: In this manikin study, a new basic life support technique designed for a single professional rescuer, over-the-head cardiopulmonary resuscitation (CPR), provided superior ventilation and was more effective than standard one-rescuer basic life support. Although two-rescuer CPR is considered optimal, the new technique could have advantages in situations where one professional rescuer has to start CPR alone.
IMPLICATIONS: Presently there is no clinical method for measuring the functional residual capacity (FRC) in mechanically ventilated patients with acute respiratory failure. We have developed a nitrogen washin/washout method for FRC measurements using standard monitors requiring only a 0.1 change in inspiratory oxygen fraction (Fio2). The method can be used up to an Fio2 of 1.0.
IMPLICATIONS: Both protease activity and oxidative stress are increased in neutrophil-dependent acute lung injury after acid aspiration. We studied the interaction of increased protease activity with innate antioxidant capacity of the lung (superoxide dismutase) as a potential therapeutic strategy to decrease the extent of the acute injury and pulmonary cytokine response.
IMPLICATIONS: Gabapentin, an antiepileptic and an adjuvant for pain management, offers better pain control and requires less supplemental fentanyl than the antiepileptic carbamazepine when used for pain management in Guillain-Barre syndrome patients.
IMPLICATIONS: L-arginine transport is crucial to the regulation of nitric oxide (NO) production. This study provides the first evidence to indicate that catecholamines enhance L-arginine transport and NO production through mechanisms that involve CAT-1 and CAT-2A but not CAT-2 or CAT-2B.
IMPLICATIONS: Although aortic dissection may present with transient neurological symptoms such as syncope, it rarely presents with coma or headache. This case shows that aortic dissection may mimic subarachnoidal hemorrhage. Because prompt diagnosis is essential in reducing mortality, aortic dissection should be considered in comatose patients until computed tomography has excluded it.
IMPLICATIONS: Bispectral Index (BIS) values recorded by a BIS monitor reflect the patient's level of sedation. These values are unaffected by injection of a short-acting barbiturate into the internal carotid artery if the patient's level of sedation is unimpaired even when the patient develops a hemiparesis and the electroencephalogram changes.
IMPLICATIONS: Spinal cord blood flow was measured by the hydrogen clearance method after IV administration of midazolam during isoflurane anesthesia in cats. Midazolam 1 mg/kg increased spinal cord blood flow without changes in blood pressure. Larger-dose midazolam (4 mg/kg) did not change spinal cord blood flow but caused decreased arterial blood pressure during isoflurane anesthesia.
IMPLICATIONS: We considered whether a verbal checklist would help in preparing to give a general anesthetic for Cesarean delivery. An anesthesia simulator was used. We found that a checklist may improve patient safety and that many anesthesiologists would be prepared to use them.
IMPLICATIONS: This trial tested the use of remifentanil for maternal sedation and fetal immobilization during endoscopic intrauterine surgery on the cord and placenta. Remifentanil was superior to diazepam for inducing adequate sedation and fetal immobilization and also facilitated faster surgery.
IMPLICATIONS: Winnie's and Capdevila's approaches for psoas compartment block both successfully anesthetize the lumbar plexus with similar postoperative analgesic efficacy. There is no difference between approaches in the incidence of bilateral anesthesia. Bilateral anesthesia occurs more frequently after psoas compartment block than previously reported.
IMPLICATIONS: Epidural analgesia prevented both endotoxin-induced functional and structural alterations of gut mucosa in rabbits without modulating injured endothelial cells. Although further investigation is warranted, epidural analgesia could be applied to critically ill patients at risk of gut barrier dysfunction as a therapeutic option to preserve its functional integrity.
IMPLICATIONS: An infraclavicular brachial plexus block technique, without needle insertion, was examined by magnetic resonance imaging in volunteers. Although the recommended needle direction is close to the target (the nerves), contact with the pleura or subclavian vessels may occur.
IMPLICATIONS: A Doppler ultrasound of the humeral artery was performed before, and 30 min after, interscalene block. After interscalene block, the resistance index decreased and humeral artery blood flow increased significantly.
IMPLICATIONS: We report a case of trismus caused by tetanus in a conscious patient who developed severe and painful masseter spasms during which she violently bit the tip of her tongue with her dentures. We performed bilateral mandibular nerve blocks via a lateral extraoral approach to successfully remove the dentures.
IMPLICATIONS: The Upper-Lip-Bite test (ULBT) is a bedside screening test to detect difficult laryngoscopy, which was evaluated and compared with the Mallampati score in 1425 patients. The ULBT did not sufficiently discriminate between patients presenting with easy and difficult laryngoscopy and was less sensitive than the Mallampati score.
IMPLICATIONS: Postoperative sore throat (POST) is a complication that remains to be resolved in patients undergoing endotracheal intubation. In this study we found that preoperative gargling with Azunol reduces POST after endotracheal intubation. This finding suggests that gargling with Azunol would be effective for attenuating POST with no adverse reactions
IMPLICATIONS: Life-threatening airway obstruction can occur after laryngeal mask airway insertion under general anesthesia as a result of a nematode migrating from the esophagus to the pharynx. The incidence is likely to increase with more people returning or migrating from endemic areas.
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