IMPLICATIONS: We demonstrated that duration of dialysis (>10 yr) and duration of surgery (>8 h) were independent risk factors of prolonged mechanical ventilation (>24 h) postoperatively in dialysis-dependent patients who had undergone cardiac surgery with cardiopulmonary bypass.
IMPLICATIONS: Meta-analytic comparison indicates that preoperative stress echocardiography has better negative predictive characteristics than thallium scintigraphic imaging.
IMPLICATIONS: Infusion of small-dose epoprostenol during cardiopulmonary bypass may reduce systemic oxygen consumption and splanchnic oxygen extraction.
IMPLICATIONS: We did not find that SymmetryTM aortic connector devices, as part of off-pump coronary artery bypass surgery, reduce renal injury. Similarly, we found no benefit of off-pump coronary artery bypass with an aortic connector device over conventional on-pump surgery. These data suggest that reduction of renal risk alone should not be an indication for aortic connector devices in off-pump coronary artery bypass surgery.
IMPLICATIONS: The study demonstrates that the nature of underlying heart disease may influence some aspects of myocardial recovery when a failing heart is supported with a mechanical assist device.
IMPLICATIONS: The authors have found that sevoflurane depresses not only gain, but also the range of the cardiac baroreflex relation, indicating compromised buffering capacity of vagally mediated hemodynamic control. This may, in part, contribute to perioperative hemodynamic instability during sevoflurane anesthesia.
IMPLICATIONS: This study confirms the very infrequent incidence of complications associated with infant spinal anesthesia in a large patient population. Infant spinal anesthesia can be safely and successfully performed in a time-efficient manner. Spinal anesthesia should be considered as an alternative to general anesthesia for infants undergoing appropriate surgical procedures.
IMPLICATIONS: In neonatal mice, hypoglycemia and acidosis occurred during isoflurane anesthesia. Survival during brain hypoxia-ischemia with isoflurane required mechanical ventilation, and arterial blood pressure decreased during hypoxia-ischemia similarly in anesthetized and unanesthetized animals, suggesting that neurodegeneration after isoflurane exposure could be related to hypoglycemia and that isoflurane administration during hypoxia-ischemia requires mechanical ventilation.
IMPLICATIONS: Parental presence reduces children's anxiety during induction of anesthesia depending on the interaction between child and parent's baseline anxiety.
IMPLICATIONS: Tracheobronchomalacia can be latent without showing any clinical manifestations and may be incidentally found during anesthesia. We report a case of unexpected bronchomalacia that caused obstruction of the left main bronchus during open-heart surgery in a child. The use of a Fogarty(R) catheter allowed successful relief of the obstruction.
IMPLICATIONS: It is feasible to convert a subset of knee arthroplasty surgeries into an overnight-stay procedure using a continuous femoral nerve block as part of a multimodal analgesic regimen provided at home. Additional data are required to define the appropriate subset of patients and incidence of complications associated with this practice before its mainstream use.
IMPLICATIONS: Spectral entropy is a new electroencephalogram-derived value that may be useful for monitoring the effects of anesthetics. The purpose of the present study was to examine the relationship between sevoflurane concentration and spectral entropy of the electroencephalogram. We collected spectral entropy data during increasing and decreasing anesthesia from 20 patients.
IMPLICATIONS: Sevoflurane, but not propofol, prolonged QTc in guinea pig electrocardiogram recordings. The mechanisms of QT prolongation induced by sevoflurane include the inhibition of HERG channel current.
IMPLICATIONS: Frakefamide, a novel analgesic, did not depress hypercapnic or hypoxic ventilation, which indicates that it does not cause central depression and hence is not likely to cross the blood-brain barrier.
IMPLICATIONS: Postoperative morphine overconsumption occurred after large-dose remifentanil and propofol anesthesia for major abdominal surgery during the early postoperative period. Pretreatment with nefopam could be a useful strategy to prevent this pain sensitization induced by opioids.
IMPLICATIONS: The opioid receptor has been investigated in the nervous system. Opioids such as remifentanil interact with receptors to provide analgesia and other benefits. The results of this investigation attempt to better understand the role of opioid and histamine receptors in the lung vasculature and the effect of remifentanil at such receptors. Implications of this study include a better understanding of opioids in the pulmonary vasculature and anesthetic/critical care pharmacological strategies for patients with pulmonary hypertensive states.
IMPLICATIONS: This is the first electrophysiological study to examine the interaction between isoflurane and norepinephrine at the rat spinal cord. The results demonstrate that both drugs facilitate the inhibitory synaptic transmission and may explain their antinociceptive effects.
IMPLICATIONS: Anesthesia was successfully induced in rats by IV emulsified isoflurane with a safety index and safety factor comparable to propofol. Recovery of anesthesia after IV emulsified isoflurane was faster than with propofol.
IMPLICATIONS: The finding that cyclooxygenase-1 inhibition decreases diazepam-induced loss of righting reflex in mice may warrant clinical trials to study the potential implications for the clinical use of benzodiazepines in patients taking nonsteroidal antiinflammatory drugs for a prolonged period of time.
IMPLICATIONS: The mechanism underlying ultralong analgesia by epidural butamben suspensions is poorly understood. T-type calcium channels have been linked to pain signaling. This patch-clamp study shows that T-type currents are inhibited by butamben and may therefore serve as targets in butamben's analgesic action.
IMPLICATIONS: Seven percent of Caucasians lack the P450 enzyme CYP2D6, which forms the active metabolite (+)-M1 from tramadol. (+)-M1 is an opioid. The effects of an IV injection of 100 mg of tramadol in human experimental pain models indicate that CYP2D6 is required to induce an opioid effect from tramadol.
IMPLICATIONS: Doses as large as 2.0 mg/kg of succinylcholine do not guarantee excellent intubating conditions within 60 s in 90% of patients. The calculated doses of succinylcholine (and their 95% confidence intervals) that are required to achieve excellent intubating conditions in 50% and 80% of patients at 60 s are 0.39 (0.29-0.51) mg/kg and 1.6 (1.2-2.0) mg/kg, respectively.
IMPLICATIONS: Lidocaine attenuated hemodynamic responses to intubation and decreased bispectral index after induction of anesthesia but did not prevent bispectral index increases in response to endotracheal intubation.
IMPLICATIONS: The electroencephalographic-based Entropy module seems to be a cost-equivalent alternative to the bispectral index (BIS) monitor for assessing the level of consciousness and also for titrating IV (e.g., propofol) and volatile (e.g., desflurane) anesthetics during general anesthesia. However, the Entropy module experienced less interference from electrosurgical artifact than the BIS monitor.
IMPLICATIONS: Self-inflating manual resuscitators can mislead caregivers because the bag reinflates even without patient exhalation and thus without effective ventilation. This simulator-based study suggests that, for novices and experts alike, real-time feedback of exhaled tidal volume such as an audible indicator may improve bag valve mask ventilation of patients.
IMPLICATIONS: We report on a fire that occurred in the operating room, review the components required to created fires, and outline some strategies to prevent them.
IMPLICATIONS: We examined the effects of perioperative oral gabapentin 1.2 g, rofecoxib 50 mg, and their combination on postoperative pain and morphine consumption, as well as recovery of bowel function, resumption of normal activities, and patient satisfaction. Gabapentin, 1.2 g per os, appears to be a possible alternative to rofecoxib, 50 mg per os, for use as an adjuvant to patient-controlled analgesia morphine after abdominal hysterectomy procedures. Analogous to the cyclooxygenase-2 inhibitor, the use of gabapentin reduced postoperative pain and the need for opioid analgesic medication, thereby facilitating recovery of bowel function and significantly increasing patient satisfaction with pain management.
IMPLICATIONS: Using a rat model of postoperative pain, this study explored the roles of adenosine triphosphate-sensitive K+ (KATP) channels, N-methyl-d-aspartic acid NMDA receptors, and Ca2+ channels in the antinociceptive action of intrathecal gabapentin. It is suggested that spinal N-type Ca2+ channels, but not KATP channels or NMDA receptors, might be involved in the gabapentin-induced analgesic effect.
IMPLICATIONS: The results of this clinical trial demonstrate the superiority of the fentanyl HCl patient-activated transdermal system compared with placebo for the control of acute postoperative pain.
IMPLICATIONS: Nonsteroidal antiinflammatory drugs reduced pain-related behaviors and plasma extravasation induced by intracolonic administration of mustard oil in mice but had little effect on referred hyperalgesia on the abdomen, foot and tail.
IMPLICATIONS: Preoperative use of epidural neostigmine for thoracotomy patients followed by continuous infusion during surgery and extended into the postoperative period (e.g., for 6 days) provided preemptive, preventive analgesia and an analgesic-sparing effect that improved postoperative analgesia without increasing the incidence of adverse effects.
IMPLICATIONS: This study compares recent policies for assessment of competence required by the Accreditation Council for Graduate Medical Education with a well established method used to assess the competence of anesthesiology residents. A more comprehensive evaluation of competence may be useful in providing better formative feedback to improve resident performance.
IMPLICATIONS: The incidence of cardiac arrests requiring full cardiopulmonary resuscitation (CPR) during diagnostic or interventional coronary artery procedures decreased after 1995. Of patients who received CPR in the cardiac catheterization lab, 56.1% survived to be discharged. Long-term survival of these patients is only minimally reduced.
IMPLICATIONS: This study demonstrates the efficacy of prophylactic simvastatin for reducing the severity of acute lung injury in a rat model of intestinal ischemia-reperfusion.
IMPLICATIONS: The use of an antiarrhythmic drug and {alpha}-adrenergic stimulation can unexpectedly unmask Brugada syndrome that has previously been asymptomatic. Brugada syndrome should be considered as a potential cause of lethal ventricular tachyarrhythmia in patients with sepsis.
IMPLICATIONS: The use of remifentanil and propofol when compared with fentanyl and propofol was not different in the ability to maintain adequate sedation, analgesia, and hemodynamic stability or in the incidence of complications during awake craniotomy for tumor surgery. Patient satisfaction was high for both techniques.
IMPLICATIONS: When the spinal component of combined spinal-epidural anesthesia for cesarean delivery is performed in the sitting position there is a decreased severity of hemodynamic change, possibly related to the more limited local anesthetic spread.
IMPLICATIONS: The use of continuous peripheral nerve block has been suggested in many small trials to potentially offer improved analgesia and decreased side effects compared with opioids. A meta-analysis of randomized clinical trials examining this comparison demonstrates decreased pain and decreased opioid-related side effects with continuous peripheral nerve block.
IMPLICATIONS: Stimulating catheter placement at the popliteal fossa increased analgesia after hallux valgus repair when compared with catheters placed without stimulation.
IMPLICATIONS: In evaluating the effect of dexamethasone added to lidocaine on the onset and duration of axillary brachial plexus block, we found that the addition of dexamethasone to lidocaine can prolong the duration of sensory and motor blockade without changing the onset time.
IMPLICATIONS: Applying continuous positive airway pressure during low-thoracic epidural injection of local anesthetics resulted in an increased number of segments blocked, primarily by a more caudad extension of sensory blockade.
IMPLICATIONS: A modest increase in cephalad spread of hyperbaric bupivacaine subarachnoid block was achieved by warming the solution to 37{degrees}C.
IMPLICATIONS: Topical application of the tricyclic antidepressant doxepin displays dose-dependent antinociception. When administered intrathecally at concentrations of 10 and 20 mM, doxepin has local anesthetic properties similar to bupivacaine at 23 mM (0.75%),but appears neurotoxic at 50 mM.
IMPLICATIONS: During a continuous interscalene brachial plexus block, we observed a transient neurological impairment of the ipsilateral lower limb that can be attributed to an epidural administration of local anesthetic.
IMPLICATIONS: Women recover faster from a general anesthetic than men. In this study we found that this may be because women are less sensitive to the hypnotic effects of anesthetic drugs than men.
IMPLICATIONS: The alveolar recruitment maneuver may effectively improve intraoperative oxygenation during bariatric surgery; however, these effects were limited to the intraoperative course and dissipated immediately after tracheal extubation.
IMPLICATIONS: The present study demonstrated that neuromuscular monitoring improved endotracheal intubating conditions. However, tracheal intubation at maximum intensity of neuromuscular block was not associated with a decrease in vocal cord injuries.
IMPLICATIONS: Hemostatic abnormalities have been reported for redheads, but we were unable to identify any abnormality using routine clinical coagulation testing.
IMPLICATIONS: The choice of airway device does not influence middle ear pressure during anesthesia among the orally inserted tracheal tube, classic laryngeal mask airway, ProSeal laryngeal mask airway and laryngeal tube suction with or without N2O in the gas mixture.
IMPLICATIONS: We present a case of a patient who had previous extensive neck dissection surgery and required emergent tracheostomy placement after surgery several years later.
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