IMPLICATIONS: A delayed window of volatile anesthetic preconditioning limits intracellular Na+ and Ca+2, prevents the depletion of adenosine triphosphate, and improves function after ischemia in isolated rat hearts. A 48-h delay provided better protection than a 24-h delay.
IMPLICATIONS: A unique mathematical model was developed to predict the effect of acute normovolemic hemodilution on selected constituents of sequestered whole blood. This model provides an objective method of comparing blood sequestration techniques and clinical outcome in studies using hemodilution as a blood conservation method.
IMPLICATIONS: Gelatin and hydroxyethyl starch, 15 mL kg-1 after on-pump cardiac surgery, significantly impair blood coagulation as assessed by thromboelastometry.
IMPLICATIONS: In graft replacement of an abdominal aortic aneurysm, hypercoagulability and inflammatory reaction were observed. Antithrombin could inhibit these hypercoagulability and inflammatory reactions, which may decrease perioperative adverse events.
IMPLICATIONS: A history of excessive bleeding and blood transfusion in the first cardiac surgery is significantly associated with excessive bleeding and blood transfusion in a subsequent cardiac surgery.
IMPLICATIONS: In rats, moderate hypothermic cardiopulmonary bypass with a hemodilution is associated with CA1 hippocampus bax and bcl-2 gene expression and neuronal apoptosis during the early postcardiopulmonary bypass recovery period.
IMPLICATIONS: Frequency domain measures of heart rate variability do not recover to the preoperative level 1 yr after coronary artery bypass graft surgery. Approximate entropy decreases significantly a year after surgery, indicating more predictable heart rate dynamics. The possible impact of these findings remains to be studied.
IMPLICATIONS: We examined whether and how the Frank-Starling effect influences the logistic time constant {tau}L proposed as an index of the rate of relaxation or lusitropism. We showed that left ventricular volume loading did not affect {tau}L but did slightly affect the conventional monoexponential time constant {tau}E.
IMPLICATIONS: We report a case in which hemodynamic collapse occurred because of severe compression of the right pulmonary artery and left mainstem bronchus by an aneurysm of the ascending aorta.
IMPLICATIONS: This study evaluated the effectiveness of 2 methadone-weaning strategies, 5 versus 10 days, in pediatric critical care patients with physical dependence on opioid medications.
IMPLICATIONS: The transient hyperemic response test can be used in young children. The transient hyperemic response is preserved in children undergoing sevoflurane anesthesia at clinically relevant concentrations, suggesting preservation of cerebral autoregulation under these conditions.
IMPLICATIONS: Small doses of ketamine or nalbuphine, administered at the end of a magnetic resonance imaging scan to patients anesthetized with sevoflurane anesthesia, reduce emergence agitation without delaying discharge. Nalbuphine offers the highest benefit/risk ratio.
IMPLICATIONS: This clinical trial describes neonates with hypoplastic left heart syndrome undergoing stage I reconstruction pharmacokinetics of milrinone in this population and characterizes drug disposition during cardiopulmonary bypass, modified ultrafiltration, and in the postoperative period. Future clinical investigation will be required to explore whether the achievable milrinone concentrations are optimal with respect to individual patient outcomes.
IMPLICATIONS: This study assessed whether giving toys to children decreases anxiety about taking premedication before anesthesia. One-hundred children were randomized into toy and no-toy groups. Anxiety to receive midazolam was assessed using the Modified Yale Preoperative Anxiety Scale, and it was significantly reduced in the toy group.
IMPLICATIONS: In outpatients undergoing inguinal herniorrhaphy, regional anesthesia (paravertebral blocks) provided faster recovery than general anesthesia.
IMPLICATIONS: Peribulbar block combined with general anesthesia for retinal detachment surgery reduced perioperative bleeding and the incidence of oculocardiac reflex and improved postoperative analgesia compared with general anesthesia alone.
IMPLICATIONS: The blood concentration associated with loss of response to command in 50% of subjects is an important measure of anesthetic potency. In this study, nitrous oxide decreased propofol requirement for loss of response to command in healthy surgical patients. The bispectral index predicted response to command.
IMPLICATIONS: During isoflurane and sevoflurane anesthesia, addition of nitrous oxide decreased the frequency of electroencephalogram and bispectral index (BIS) but did not suppress hemodynamic changes in response to tracheal intubation. These electroencephalographic changes with a decrease of BIS are caused by paradoxical arousal.
IMPLICATIONS: Topical local anesthetics are used for cancer pain relief and may suppress the proliferation of cancer cells. We investigated the effects of lidocaine on proliferation of the human tongue cancer cell line CAL27. A clinical concentration of lidocaine suppressed the proliferation of CAL27 with inhibition of the activity of the epidermal growth factor receptor.
IMPLICATIONS: Injury to the vascular system is an important cause of morbidity and mortality. This study indicates that certain local anesthetics may protect vascular cells from injury.
IMPLICATIONS: The modulatory effects of thiopental on {gamma}-aminobutyric acid (GABA)A receptor function were examined in acutely dissociated rat spinal dorsal horn neurons using whole cell patch-clamp recording. Thiopental enhanced GABAA receptor function and GABAergic inhibitory transmission, suggesting that the spinal cord is a potential site for thiopental to exert its anesthetic action.
IMPLICATIONS: We examined the effects of Rho-kinase inhibitors on anticholinesterase-induced contractile and phosphatidylinositol responses of rat trachea. Neostigmine- and pyridostigmine-induced contractions were almost completely inhibited by the Rho-kinase inhibitors, Y-27632 and fasudil. The results suggest that anticholinesterases cause airway smooth muscle contraction, in part, through activation of the Rho-kinase pathway.
IMPLICATIONS: Administration of granisetron, 1 mg IV, and dolasetron, 12.5 mg IV, was equally effective in preventing postoperative nausea and vomiting in the postanesthesia care unit. Administration of granisetron achieved a more frequent complete response rate in the 24-h postdischarge period than administration of dolasetron. In subjects receiving dolasetron, carriers of the duplication of the CYP2D6 allele predicting ultrarapid metabolizer status had more vomiting episodes than patients in the granisetron group.
IMPLICATIONS: Moderate hypoxia (oxygen 8% for 1 hour) transiently impairs performance of adult mice in a spatial memory task. Isoflurane 1.2% prevented the deterioration of working memory.
IMPLICATIONS: Accidental epidural administration of succinylcholine has not been previously reported. This case report describes accidental injection of succinylcholine in the epidural space, the side effects, and how to deal with this situation.
IMPLICATIONS: Autoregressive modeling with exogenous input of middle-latency auditory evoked potentials has recently been developed for monitoring anesthesia depth. We investigated the prediction of recovery and dose-response relationship of desflurane concentrations and the A-Line AEP index or bispectral index values. The correlation between bispectral index monitoring and clinical end-points of anesthesia or the desflurane effect compartment concentration is better than for the A-Line AEP index. The opening of eyes was best predicted by the calculated desflurane effect-site concentration.
IMPLICATIONS: IV drug infusion has the potential for dosing errors, arising from interactions between carrier flows and the infusion set dead volume. Computational models showed the mass of drug stored in the dead volume, which is available for accidental bolus, and the impact of abruptly stopping or altering carrier flows on drug delivery.
IMPLICATIONS: We describe the malfunction of a common drug infusion pump in which the pump falsely detected a smaller syringe size and consequently delivered an increased infusion rate and overdose of propofol to the patient.
IMPLICATIONS: Postoperative analgesia and side effects of intrathecal morphine versus epidural naropine were compared after liver resection. Pain relief in the intrathecal group was not inferior to the epidural group, but pruritus and nausea were more frequent. A single dose of intrathecal morphine provides satisfactory postoperative analgesia after liver surgery.
IMPLICATIONS: Magnetic resonance spectroscopy can detect brain biochemical changes associated with pain. Combined with a pattern recognition strategy for analysis, it was possible to discriminate between subjects with chronic pain and control subjects with accuracies approaching 100%. This technique may be useful as an objective method of detecting changes associated with pain.
IMPLICATIONS: Etomidate depressed lumbar neuronal responses to noxious thermal stimulation applied to the hindpaw of isoflurane-anesthetized rats. These data suggest that etomidate might exert an analgesic action in the spinal cord.
IMPLICATIONS: We evaluated and compared the analgesic efficacy of bilateral superficial cervical plexus block and local anesthetic wound infiltration after thyroid surgery in this randomized, double-blind and controlled study and concluded that neither of the regional techniques decreased postoperative opioid requirement.
IMPLICATIONS: This survey of the American Society of Clinical Directors evaluates the role of anesthesiologists in the selection and administration of perioperative antibiotics. The data indicate limited involvement in selection but an intense level of involvement in administration. In addition, the results indicate that antibiotic administration in general is poorly monitored and that roles are poorly defined.
IMPLICATIONS: A patient tracking system, based on radio frequency/infrared indoor positioning, enables automatic documentation of timestamps. Automatic documentation is more accurate and precise than manual documentation. An indoor positioning system is technically suitable for automatic documentation of timestamps in the operating room environment.
IMPLICATIONS: This study shows that regional variables of microvascular function and vascular reactivity assessed by different measurement techniques do not reflect the severity of multiple organ dysfunction syndrome in hemodynamically stable, resuscitated, surgical intensive care patients with different mortality rates.
IMPLICATIONS: Dilutional coagulopathy, which is often seen after severe bleeding, can be successfully reversed in vitro by administration of fibrinogen concentrate. In comparison with crystalloid solutions, hydroxyethyl starch molecules inhibit fibrin polymerization and thereby significantly reduce the benefit of fibrinogen replacement.
IMPLICATIONS: This study shows that mode and settings of mechanical ventilation affect regional diaphragmatic blood flow in rabbits. At higher levels of pressure-supported ventilation, increases in diaphragmatic blood flow may be associated with animal-ventilator asynchrony.
IMPLICATIONS: These experimental data indicate that neuraxial morphine, even at a small dose, can induce spastic paraparesis in the presence of a K+ channel opener when rats are exposed to mild spinal cord ischemia.
IMPLICATIONS: Sevoflurane requirement is reduced by 20%-39% to maintain the Bispectral index at 40-50 in spinal cord-injured patients during surgery below the level of injury, in association with blunted stress hormone responses.
IMPLICATIONS: The current ASA Physical Status Classification does not consistently address the physiological changes of pregnancy. The use of a modifier, G (for gravid), reduces inconsistency in assigning the ASA Physical Status Classification.
IMPLICATIONS: Within a standardized clinical pathway, continuous femoral nerves blocks significantly improve postoperative analgesia after total knee arthroplasty compared with single-injection femoral nerve blocks but do not decrease hospital length of stay or improve long-term functional recovery.
IMPLICATIONS: Combined continuous femoral and sciatic nerve blocks were accompanied by fewer side effects than continuous epidural analgesia on the first postoperative day after total knee replacement. Analgesic efficacy, rehabilitation indices, and the duration of hospital stay were similar.
IMPLICATIONS: An increase of skin temperature (Ts) is a reliable, but late, sign of successful sciatic nerve block. Therefore it is of limited clinical value. The increase in Ts after femoral block is negligible and late.
IMPLICATIONS: Supraclavicular block is highly successful in the obese and non-obese populations without any apparent difference in acute complications.
IMPLICATIONS: The current systematic review demonstrates that there are only a few clinical trials that compare opioid analgesics or analgesic modalities. Meperidine appears to be the only drug that should clearly be avoided. Whether an IV or epidural method of postoperative analgesia is more desirable cannot be convincingly answered at this point.
IMPLICATIONS: Our study demonstrates that pain and pain management strategies are important factors related to the development of postoperative delirium in elderly patients. These results suggest that elderly surgical patients with substantial preoperative baseline pain should be targeted for more intensive pain control or addition of adjuvant analgesia postoperatively.
IMPLICATIONS: Crystalloids, smaller molecular weight hydroxyethyl starch, and balanced electrolyte IV fluid preparations lead to less thrombelastograph(R) coagulation derangement than larger molecular weight and saline-based solutions.
IMPLICATIONS: The effect of the test temperature on platelet aggregation depends on the platelet agonist used and the blood storage condition until platelet analysis. Although the response to the routine platelet agonists, adenosine diphosphate and collagen, varies considerably with storage temperature, arachidonic acid and ristocetin can be considered as robust agonists.
IMPLICATIONS: This is the first report regarding an anesthetic experience with the patients of Gerstmann-Straussler-Scheinker syndrome, which is related to a mutated prion protein.
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