IMPLICATIONS: Larger and older Langendorff-prepared guinea pig hearts are less susceptible to cardioprotection against ischemia/reperfusion injury by preconditioning with volatile anesthetics than are smaller and younger hearts. This may have important implications for further basic science research on anesthetic preconditioning and its possible clinical applicability in humans.
IMPLICATIONS: Ischemic preconditioning improves hepatic energy metabolism during cold ischemia. Rats receiving a liver transplant from an obese rat demonstrate improved survival when ischemic preconditioning is used.
IMPLICATIONS: We have shown that isoflurane produces pharmacological preconditioning against renal ischemia/reperfusion injury in the rat kidney similar to that in the heart. Inhibition of the protein kinases, JNK and ERK, appears to be one of the mechanisms involved. Isoflurane might therefore be beneficial in patients at risk of renal ischemia/reperfusion.
IMPLICATIONS: Inhibition of the mitochondrial permeability transition pore enhances, whereas opening abolishes, reductions in myocardial infarct size produced by isoflurane when this volatile anesthetic is administered immediately before and during early reperfusion in rabbits. This isoflurane-induced inhibition of mitochondrial permeability transition is dependent on activation of mitochondrial KATP channels.
IMPLICATIONS:Cardiac output measurement using the transesophageal Doppler method is as accurate as thermodilution, although it is less accurate at a higher Paco2 level. The present study has shown that both methods of measurement agree with each other at 30 mm Hg of Paco2, but the thermodilution method provides higher cardiac output values than the transesophageal Doppler method at 40 mm Hg of Paco2.
IMPLICATIONS: A meta-analysis of 13 randomized controlled trials showed that aprotinin reduces intraoperative and perioperative blood loss and blood transfusion requirements but is not associated with an increased risk of deep vein thrombosis in the presence of prophylaxis.
IMPLICATIONS: These four case reports add to the 23 previously reported cases of cardiopulmonary thromboembolism during liver transplantation. These devastating events occurred without the use of an antifibrinolytic drug.
IMPLICATIONS: Some of the upper airway troubles during anesthesia are related to airway protective reflexes evoked from the larynx. Sevoflurane should modify these reflexes; however, systematic studies have never been performed in children. Fiberoptic visual observation was combined with conventional pressure measurements to evaluate detailed responses of the larynx in sevoflurane-anesthetized children.
IMPLICATIONS: The administration of IV clonidine to children anesthetized with sevoflurane reduces the incidence of agitation at emergence.
IMPLICATIONS: This study showed that patient-controlled analgesia (PCA) by proxy for children with cancer is a safe practice with infrequent respiratory and neurological complications. Patient selection criteria, educational programs for parents, and specific documentation are described as steps to ensure the safety of PCA by proxy.
IMPLICATIONS: Congenital afibrinogenemia is a rare autosomal recessive disorder characterized by unmeasurable fibrinogen, inability of blood to clot, and confounded by reports of thrombosis. Cardiopulmonary bypass can be effectively managed by heparinization and aprotinin to preserve clotting factors and cryoprecipitate as a source for fibrinogen.
IMPLICATIONS: This meta-analysis suggests that regional anesthesia offers several advantages over general anesthesia for ambulatory surgery, such as decreased postanesthesia care unit use, nausea, and postoperative pain. Although these advantages are thought to hasten patient recovery, patients were not discharged sooner from the ambulatory surgical unit.
IMPLICATIONS: Postdischarge minor morbidity in 2732 outpatients was found to be common during the first postoperative week. The identification of postoperative problems and related risk factors may aid anesthesiologists in choosing appropriate preventive strategies and to plan future research for the evaluation of the patients' functional impairment after ambulatory surgery.
IMPLICATIONS: Either remifentanil 1.0 {micro}g/kg or magnesium sulfate (MgSO4) 30 mg/kg may be used as part of a standard general anesthetic technique to attenuate the systolic arterial blood pressure response to electroconvulsive therapy. Remifentanil, but not MgSO4, suppressed the increase in heart rate. Neither drug influenced seizure duration.
IMPLICATIONS: Total IV anesthesia (TIVA), general anesthesia with isoflurane and fentanyl, 5 mg of bupivacaine 0.5%, and 2.5 mg of bupivacaine 0.5% plus 25 {micro}g of fentanyl spinal techniques are suitable for transperineal brachytherapy for prostate cancer in the day-surgery setting. TIVA allows for the earliest discharge home because of its allowing for earlier voiding. Between the two spinal techniques, the combination of spinal bupivacaine plus fentanyl allows for earlier voiding and home readiness.
IMPLICATIONS: The benefit of adding clonidine 75 {micro}g to ropivacaine 225 mg (7.5 mg/mL) for ilioinguinal-iliohypogastric block in adult patients operated on for inguinal hernia repair is to reduce motion pain on the third postoperative day. This benefit must be balanced with an awareness of an increasing risk of orthostatic hypotension in the immediate postoperative period.
IMPLICATIONS: Sufentanil has a dose-dependent, direct, vasodilatory effect on human vascular tissue.
IMPLICATIONS: Our findings suggest that anesthetics may affect lower esophageal sphincter motility by modulating nitric oxide-mediated physiological relaxation through peripheral N-methyl-d-aspartate receptors in clinical situations.
IMPLICATIONS: Imidazoline receptors in the central nervous system are subclassified as I1 and I2 subtypes. We examined which imidazoline receptor subtype is involved in the halothane-epinephrine-induced arrhythmias. Our results show that central I1, but not I2, receptors play an important role in inhibition of halothane-epinephrine arrhythmia.
IMPLICATIONS: Dantrolene is the drug of choice for treatment of malignant hyperthermia and malignant neuroleptic syndrome. Current dosing recommendations are based on noncompartmental analyses. This study determines the compartmental pharmacokinetics of dantrolene, models current dosing recommendations, and proposes an infusion regime to maintain constant plasma concentrations.
IMPLICATIONS: Intraoperative stress is one of the key factors of outcome. We compared intraoperative stress during balanced and total IV anesthesia using plasma levels of stress hormones and heart rate variability for assessment. The results indicate a higher sympathetic outflow during balanced anesthesia.
IMPLICATIONS: Hypnotic duration of ketamine, pentobarbital, propofol, midazolam, and ethanol showed significant dosing-time dependency in mice.
IMPLICATIONS: We report a case of a patient suffering cardiovascular decompensation during four nonconsecutive perioperative periods, ultimately found to have an allergy to hetastarch, while also manifesting a very highly positive latex radioallergosorbent test.
IMPLICATIONS: During light anesthesia, electromyographic activity is high and myorelaxant bolus administration decreases bispectral index and response entropy values.
IMPLICATIONS: The cognitive ability of the clinician has been overloaded by the exponential growth of physiological monitoring devices and a large percentage of false alarms in an operating room. This study investigated the possibility of using a vibro-tactile display to replace visual and audio alarms for conveying physiological information.
IMPLICATIONS: Anesthesiologists are at risk for occupational exposure to radiation during a number of diagnostic and therapeutic procedures. This study reports on the increase in radiation exposure to a small department of anesthesiology subsequent to the introduction of an electrophysiology laboratory.
IMPLICATIONS: Long-term morphine administration causes hypersensitivity sensory stimuli, which presents as behavioral signs indicative of enhanced pain. Morphine-induced hyperesthesias may drive antinociceptive tolerance. A L-type calcium channel blocker, amlodipine, abolishes these morphine-induced hypersensitivities and antinociceptive tolerance and may represent a therapeutic advantage in the treatment of chronic pain states.
IMPLICATIONS: Systemic administration of local anesthetics is superior to placebo and as effective as other analgesics commonly used for neuropathic pain. This benefit is greatest for pain from trauma, diabetes, and central pain.
IMPLICATIONS: A single intrathecal injection of morphine in rats produced a delayed and sustained hyperalgesia linked to the development of opioid-induced pain sensitivity. The noncompetitive N-methyl-d-aspartate-receptor antagonist ketamine almost completely prevented morphine-induced hyperalgesia.
IMPLICATIONS: Neuropathic pain is poorly understood at the molecular level. Using chronic constriction injury of rat sciatic nerve, we show that the vasoactive hormone endothelin (ET)-1 is involved in establishing pain, which can be treated acutely by blockade of ETA receptor activity. ETA antagonism may be a novel therapy for neuropathic pain.
IMPLICATIONS: The present work assesses, for the first time, the antiallodynic effects of diacerhein, a drug used clinically in some countries for the treatment of osteoarthritis, in inflammatory and neuropathic animal models of nociception. In all experiments, the effects of diacerhein were compared to those of gabapentin.
IMPLICATIONS: Bromide is compared with two new tracers, iohexol and sodium dilution, for measurement of the extracellular fluid volume. The new methods are more easily applied in the clinical environment.
IMPLICATIONS: Sepsis originating from infected intravascular devices is a major cause of morbidity and extra costs. Antiseptic-impregnated central venous catheters (CVC) could not prevent catheter colonization when compared with standard catheters in a critical care setting with infrequent catheter colonization rates and CVC left in place for >10 days.
IMPLICATIONS: Pigs in hemorrhagic shock (severe enough to induce lactic acidosis) were resuscitated either with a synthetic oncotic solution of hydroxyethyl starch (colloid) or with an ionic isotonic solution (crystalloid). Variables expressing circulatory and tissue perfusion recovery demonstrated better performance of colloid when compared with crystalloid.
IMPLICATIONS: In this prospective study two consecutive adrenocorticotropic hormone (ACTH) stimulation tests were performed in 60 critically ill patients. In a subgroup of septic shock patients the test results were poorly reproducible. This suggests that the ACTH stimulation test is not a sensitive method to diagnose adrenal insufficiency in septic shock patients.
IMPLICATIONS: Inhibition of poly (adenosine diphosphate [ADP]-ribose) synthetase improves pulmonary arterial endothelium-dependent relaxation after ischemic-reperfusion injury of the splanchnic artery.
IMPLICATIONS: The objective of this laboratory ex vivo study was to investigate the effects of drotrecogin alfa (activated, a recombinant human activated protein C) for the first time on intracellular expression of interleukin-6 and tumor necrosis factor α of lipopolysaccharide-stimulated human monocytes in a whole blood system assessed by flow cytometry.
IMPLICATIONS: Small-dose theophylline might be an interesting adjunct for the treatment of spinal cord injury-evoked bradycardia and respiratory dysfunction.
IMPLICATIONS: Impaired growth and development of the upper airway in male hypogonadism patients, caused by delayed sexual maturation during puberty, can cause problems in securing the airway for the conduct of general anesthesia.
IMPLICATIONS: Mature adrenomedullin is a potent vasodilating peptide. We demonstrated that plasma-mature adrenomedullin concentration increased and that increased plasma-mature adrenomedullin is associated with increased blood volume during pregnancy.
IMPLICATIONS: Factor V Leiden has significant anesthetic implications throughout pregnancy.
IMPLICATIONS: In this study, femoral nerve infusions and epidural infusions provided equivalent analgesia and postoperative rehabilitation after total knee replacement. Femoral nerve blockade was associated with less nausea and vomiting.
IMPLICATIONS: We prospectively compared 2 different tests that predict whether an epidural catheter insertion will be successful to see if one was better. The epidural stimulation test and the epidural pressure wave analysis were found to be equivalent.
IMPLICATIONS: The addition of 100 {micro}g fentanyl to 1% ropivacaine solution accelerated the onset of sensory and motor blocks during epidural ropivacaine anesthesia without significant fentanyl-related side effects.
IMPLICATIONS: Tissue toxicity of tricyclic antidepressants was studied in a rat model of sciatic nerve blockade. It was found that amitriptyline and doxepin cause severe local tissue injury.
IMPLICATIONS: Nerve trauma remains a major concern of regional anesthesia. Results from this pilot study in pigs suggest that very low current stimulation (<0.2 mA) before injection of bupivacaine might be associated with an increased risk of inflammatory response compared with a motor response achieved with a current between 0.3 and 0.5 mA.
IMPLICATIONS: A case of persistent cauda equina syndrome after uneventful single intrathecal administration of bupivacaine, in the absence of any predisposing factors, is reported. This report suggests the need to follow up all patients undergoing regional anesthesia procedures to assess infrequent complications, including unexpected persistent neurologic deficit.
IMPLICATIONS: Postoperative shivering can be predicted with acceptable accuracy using the four risk factors identified in the present study. The presented model may serve as a clinical tool to help clinicians to rationally administer prophylactic antishivering drugs.
IMPLICATIONS: Up to 35% of patients scheduled for elective surgery are found to be anemic (hemoglobin <13.0 g/dL) on preadmission testing. There are no guidelines for the evaluation and management for these patients. To address this unmet medical need, a panel of multidisciplinary experts was convened. A clinical care pathway for the screening, evaluation, and management of anemia in the elective surgery patient is presented.
IMPLICATIONS: The clinical performance and safety of the new, disposable Ambu laryngeal mask airway was evaluated in an international multicenter study of 118 patients. This device is easy to insert and provides an efficient seal during positive pressure ventilation in nonparalyzed elective surgical patients under general anesthesia.
IMPLICATIONS: To determine the efficacy of salivary biomarkers for assessing mental stress, we examined the relationship between State Anxiety Inventory score and salivary chromogranin-A, α-amylase, and cortisol during a mental arithmetic task. Because there was a significant correlation with α-amylase only, this marker may be a useful indicator of mental stress.
IMPLICATIONS: This case report describes the technical features and technical use of a new tip-deflecting endobronchial blocker that can be used during lung surgery to exclude the operative lung from the ventilation.
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