IMPLICATIONS: Elderly patients have an increased risk of excessive bleeding and reexploration after cardiac surgery. This may be caused by increased activation of the hemostatic system, in particular the increase in postoperative fibrinolysis.
IMPLICATIONS: Dexmedetomidine is a sedative drug with hemodynamic effects that is being used more frequently in anesthesia. This study addresses the suitability of dexmedetomidine supplementing regional anesthesia during awake carotid endarterectomy.
IMPLICATIONS: Using electrically stimulated right ventricular rat myocardium it was shown that diazepam enhances the effects of dopamine on contractility and cAMP tissue levels, producing a synergistic interaction.
IMPLICATIONS: Diazepam at a clinical concentration attenuates phenylephrine-induced contractions via an endothelium-dependent mechanism involving increased endothelial nitric oxide activity. This diazepam-induced attenuation does not occur via peripheral benzodiazepine receptor activation.
IMPLICATIONS: We compared Vasotrac(R) noninvasive arterial blood pressures to direct radial arterial blood pressures during liver transplantation. The Vasotrac(R) was not sufficiently accurate to substitute for direct arterial blood pressure monitoring.
IMPLICATIONS: Antifibrinolytic drugs have been associated with fatal intraoperative intracardiac/pulmonary thromboembolism during liver transplantation. We report the successful intraoperative resuscitation of a patient in cardiogenic shock with thrombolytic therapy.
IMPLICATIONS: In this meta-analysis of randomized controlled trials, aprotinin reduced the proportion of children who received blood transfusions during cardiac surgery. However, the sustained effect of aprotinin on reducing blood loss remains uncertain. Further rigorous clinical trials with clinically important outcomes are needed before aprotinin can be routinely recommended.
IMPLICATIONS: Cisatracurium was shown to provide safe muscle relaxation in children 1-6 yr old during propofol anesthesia by studying cisatracurium blood levels and depth of paralysis. Differences in pharmacokinetics/pharmacodynamics from adults highlight the need for pediatric studies to guide dosing and predict duration of action in children.
IMPLICATIONS: Continuous popliteal nerve block is an effective technique for analgesia after orthopedic podiatric surgery in children. The advantages of continuous popliteal block compared with continuous epidural block relate primarily to adverse events.
IMPLICATIONS: Using dynamic application of negative airway pressure, we determined the upper airway closing characteristics of anesthetized healthy children. During 1 MAC levels of inhaled anesthesia, halothane appears to cause less upper airway obstruction than sevoflurane at equipotent concentrations.
IMPLICATIONS: Preoperative piroxicam may provide improvements of postoperative analgesia with laparoscopic hernia repair procedures compared with postoperatively administered piroxicam.
IMPLICATIONS: We describe the derivation of an activity model for halogenated volatile anesthetics using molecular modeling. Pharmacophoric maps are derived that describe the molecular basis for the immobilizing activity of the anesthetics in terms of the spatial distribution of key electrostatic and steric regions.
IMPLICATIONS: We examined whether excitatory or inhibitory synapses are the major targets of anesthetic action. Sevoflurane and isoflurane inhibit mainly glutamate-mediated orthodromic pathways, whereas thiopental and propofol enhance {gamma}-aminobutyric acid-A-mediated recurrent inhibitory pathways in CA1 neurons, thus providing further evidence that mechanisms of general anesthetics are drug- and pathway-specific.
IMPLICATIONS: This study demonstrates that TASK potassium channels are plausible molecular targets for doxapram yet do not contribute to halothane-induced immobility (minimum alveolar anesthetic concentration).
IMPLICATIONS: Droperidol augments activity of adenosine triphosphate-sensitive K+ channels of vascular smooth muscle cells. It is unlikely that this augmentation of vasodilation is mediated by the inhibition of {alpha}-adrenergic receptors in the vascular smooth muscle.
IMPLICATIONS: We investigated the effects of racemic bupivacaine and its isomers on Ca2+ handling by ventricular myocytes of Wistar rats. Racemic bupivacaine and the isomers increased the sensitivity of the contractile system to Ca2+. The increase of intracellular Ca2+ concentration in cardiac myocytes was consequent to an increase of Ca2+ release from sarcoplasmic reticulum that was stereoselective for S(-) bupivacaine.
IMPLICATIONS: Substitution of Brown Norway chromosome 13 (but not 16) into an otherwise unchanged Dahl Salt Sensitive genetic background significantly reduced the vascular smooth muscle hyperpolarization produced by sodium pentobarbital. This reduction correlated with an increase in the maximum cumulative dose tolerated before the onset of cardiovascular collapse.
IMPLICATIONS: Ketamine has sympathomimetic actions, although the underlying mechanism remains unclear. We used an in vitro neonatal rat splanchnic nerve-spinal cord preparation to demonstrate that ketamine reduces tonic sympathetic activity by mechanisms independent of N-methyl-d-aspartate receptor activity.
IMPLICATIONS: The purpose of this study was to investigate whether c-fos expression of the dorsal horn is affected by licking in the formalin test. Restriction of licking decreased c-fos expression to 59% of that in the unrestricted rats. Thus, licking plays an important role in c-fos expression after formalin injection.
IMPLICATIONS: Desflurane anesthesia often results in delayed onset of malignant hypothermia (MH) symptoms. We describe an unusual case of MH in which a negative value of (a-ET) Pco 2 gradient has been used as a diagnostic and monitoring tool.
IMPLICATIONS: This study is the first to provide an evidence-based foundation for selection of the most sensitive model for prediction of unanticipated difficult tracheal intubation.
IMPLICATIONS: Achieving an adequate depth of anesthesia is of major importance for anesthesiologists. Multichannel electroencephalography recorded during administration of routine clinical anesthesia demonstrated a wake-up (arousal) phenomenon during tracheal intubation. Quantitative electroencephalography is discussed as a sensitive method to measure anesthetic depth.
IMPLICATIONS: An affective component must be studied to improve behavioral measures during animal models of pain. The present study tested formalin concentrations to induce ultrasonic vocalization (USV) in the formalin test and the effects of opioids on USV during the interphase of the formalin test. This is a demonstration of USV emission during the formalin test and the influence of opioids on this behavior.
IMPLICATIONS: This study introduces psychophysical markers of enhanced short-term sensitization in chronic musculoskeletal pain to differentially indicate and control the adjuvant treatment with the N-methyl-d-aspartate receptor antagonist amantadine sulfate, showing that pharmacological blockade of this type alters sensitization and might be related to clinical pain improvement.
IMPLICATIONS: Catheter-associated granuloma is a recognized complication of intrathecal drug delivery that has not previously been associated with isolated baclofen infusion. This report suggests that the possibility of catheter-associated granuloma must be considered in all patients receiving intrathecal baclofen presenting with altered neurological function or significant increase in drug requirement.
IMPLICATIONS: Simulation-based objective structured clinical evaluation can be incorporated into the National Board Examination in Anesthesiology.
IMPLICATIONS: Residents and program directors generally agree about the barriers to resident research. Seventy-five percent of residents would prefer to spend time in alternate academic activities rather than undertaking a research project during residency training.
IMPLICATIONS: Residents showed deficiency in managing simulated oxygen failure. The majority of the participants did not recognize the problem and did not know how to change the oxygen cylinder. The delegation of gas machine maintenance to perioperative personnel may have created this new gap in equipment knowledge.
IMPLICATIONS: In a randomized and nonblinded study, centrally monitored continuous pulse oximetry did not alter the rate of admission to the intensive care unit from a postsurgical care floor, mortality, or total hospital estimated cost. Use of continuous pulse oximetry did result in reduced estimated cost and length of intensive care unit stay, possibly by allowing for earlier intervention in pulmonary complications.
IMPLICATIONS: The antitransit effect of fentanyl is increased during acute systemic inflammation in experimental sepsis, but no decrease in gastrointestinal transit is obtained with tramadol. This is a consideration in the choice of an appropriate analgesic regimen for patients with sepsis in the intensive care unit.
IMPLICATIONS: We performed a retrospective chart review of awake craniotomies for epilepsy at a single, large-volume center and examined the incidence of complications when using a uniform anesthetic protocol with unprotected airways. Clinically significant respiratory, hemodynamic, or other complications were uncommon.
IMPLICATIONS: The effects of different stimulation patterns and different concentrations of sevoflurane on intraoperative motor-evoked potentials were investigated in a prospective, randomized study. High frequency repetitive stimulation overcame the suppressive effects of sevoflurane and, thus, allowed intraoperative monitoring of motor-evoked potentials during inhaled anesthesia with sevoflurane and remifentanil.
IMPLICATIONS: Anterior cervical discectomy entails a small but finite risk of cerebral ischemia related to carotid compression. This risk may be increased in sporadic patients with an incomplete circle of Willis, a normal anatomic variant. This report reaffirms the importance of intraoperative measures to confirm the patency of the carotid artery and suggests that hypotension that is not essential to the conduct of the procedure should be avoided.
IMPLICATIONS: Emesis is a major adverse effect during cesarean delivery under spinal anesthesia. We showed that prophylactic use of bilateral acupressure bands on the P6 acupoint was ineffective in preventing nausea and vomiting during elective cesarean delivery under spinal anesthesia.
IMPLICATIONS: Programmed intermittent epidural bolus provided similar analgesia with a smaller bupivacaine dose and better patient satisfaction compared with a continuous epidural infusion for maintenance of labor analgesia.
IMPLICATIONS: This case report indicates that a successful neuraxial anesthesia in parturients with myasthenia gravis and severe respiratory compromise is possible with a noninvasive ventilatory support.
IMPLICATIONS: This study showed that infraclavicular brachial plexus block resulted in less discomfort during block placement than humeral block in trauma patients.
IMPLICATIONS: This study shows that the addition of IV nitroglycerin to a local anesthetic (lidocaine) may influence the extent of sensorial and motor blockade and tourniquet pain during IV regional anesthesia and maintains better postoperative analgesia without side effects.
IMPLICATIONS: The epinephrine test dose for intravascular epidural needle/catheter misplacement can only be recommended for nonpregnant adult patients and children. More studies are required to determine the best strategies to detect intrathecal and subdural needle/catheter misplacement for adult nonpregnant patients, pregnant women, and children.
IMPLICATIONS: Large concentrations of intrathecal local anesthetics increase glutamate concentrations in the cerebrospinal fluid and cause neuronal injury. The current study suggests that {alpha}-amino-3-hydroxy-5-methylisoxazole-4-propionic acid (AMPA) receptor activation is involved, at least in part, in the tetracaine-induced neurotoxicity in the spinal cord.
IMPLICATIONS: A combination of train-of-four (TOF) monitoring with other monitoring methods, e.g., forced vital capacity fade or testing the ability to swallow normally, may increase the ability to detect "outliers," i.e., patients with persistent effects of neuromuscular blockade on upper airway integrity despite recovery of the TOF ratio.
IMPLICATIONS: We tested the hypothesis that a rapid-sequence induction with succinylcholine would lead to less vocal cord injuries than with rocuronium. Intubating conditions were significantly better in the succinylcholine group compared with the rocuronium group. However, the rate of adverse airway effects was not different between groups. Succinylcholine should be used if excellent intubating conditions are mandatory.
IMPLICATIONS: Neurologic complications after total knee arthroplasty were associated with younger age, the presence of a flexion contracture preoperatively, and longer total tourniquet time. Identification of risk factors may theoretically improve patient care by allowing optimization of surgical and anesthetic techniques to avoid nerve injury, as well as early diagnosis and intervention to improve neurologic recovery.
IMPLICATIONS: We investigated the effect of general anesthesia with 1.2% isoflurane-70% nitrous oxide-30% on life expectancy in aged Fischer 344 rats. We found no differences in long-term survival between the anesthetized and control groups, indicating that general anesthesia does not reduce life expectancy in rodents.
IMPLICATIONS: This report highlights the importance of reviewing the most recent radiographs for potential airway compromise before anesthetizing patients presenting for revision of cervical instrumentation.
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