IMPLICATIONS: Female rabbits demonstrated smaller myocardial infarct size concomitant with upregulation of endothelial nitric oxide synthase as compared to their male counterparts. However, remote isoflurane exposure before ischemia and reperfusion did not produce additional cardioprotection in female in contrast to male rabbits. These data suggest that isoflurane-induced delayed preconditioning is gender-specific.
IMPLICATIONS: Extracellular signal-related kinases (Erk1/2) trigger isoflurane preconditioning in rats. Isoflurane also produces time-dependent upregulation of phospho-Erk, hypoxia-inducible factor-1{alpha} and vascular endothelial growth factor protein expression, suggesting that the cardioprotective effects of the volatile anesthetic occur, in part, as a result of favorable alterations in gene expression.
IMPLICATIONS: The use of a volatile anesthetic in aortic valve surgery was associated with a better early postoperative recovery of myocardial function and a reduced release of troponin I.
IMPLICATIONS: In 80 patients undergoing carotid endarterectomy under regional anesthesia, supplemental clonidine infusion (1 {micro}g {middle dot}kg-1 {middle dot}h-1) suppressed the hyperadrenergic stress responses without affecting neurological monitoring of the patient and decreased development of perioperative neurological deficits.
IMPLICATIONS: We describe the perioperative management of a patient who was a heterozygous carrier of Glanzmann's thrombasthenia and who submitted to cardiac surgery with cardiopulmonary bypass. The case was complicated by early, excessive postoperative bleeding.
IMPLICATIONS: In this case we report that congenital absence of the right pulmonary artery can alter sevoflurane uptake rate and ETco2 levels in different lungs, and we discuss the anesthesia care for such patients.
IMPLICATIONS: In a study of 56 children under general anesthesia, younger children required higher stimulating threshold voltage to obtain myogenic motor evoked potential (MEP) responses. This compromises the ability to use MEP monitoring in young children and may mandate the use of less depressing anesthetics or better MEP stimulating techniques.
IMPLICATIONS: This randomized study evaluates the efficacy and incidence of side effects of epidural clonidine compared with epidural fentanyl. Clonidine induces significantly fewer side effects, compared with fentanyl, and has a similar analgesic profile.
IMPLICATIONS: The clinical experience of combining ultrasound guidance and nerve stimulation for the insertion of subgluteal sciatic stimulating catheters in 10 children is described. Excellent perioperative and postoperative pain relief was obtained in all children.
IMPLICATIONS: Pain-related behavior and the cerebrospinal fluid (CSF) and tissue prostaglandin E2 (PGE2) increase after surgery in rats can all be attenuated by cyclooxygenase inhibitors. Choice of surgical anesthesia greatly influences CSF PGE2, as postoperative CSF PGE2 concentration increased most (threefold) with spinal anesthesia and not at all with propofol.
IMPLICATIONS: A new intranasal midazolam formulation provides rapid, reliable, and clinically relevant blood levels and sedative effects. Intranasal midazolam is a therapeutic alternative to injectable and oral dosage forms for preprocedural sedation and anxiolysis for children and adults.
IMPLICATIONS: Isoflurane markedly retarded compensatory intravascular volume expansion in sheep after withdrawal of 15% and 45% of the blood volume. Isoflurane affected both the first phase, which is governed by hydrostatic forces, and the second, which is driven by oncotic forces. This might be relevant to fluid administration during inhaled anesthesia.
IMPLICATIONS: We have developed an animal model in mechanically ventilated rabbits that may be used in studies of propofol tolerance, a phenomenon that may develop in critically ill patients and subsequently lead to the usually fatal propofol infusion syndrome.
IMPLICATIONS: Tramadol, at supraclinical concentrations, stereoselectively attenuates endothelium-dependent relaxation via an inhibitory effect at levels proximal to nitric oxide synthase activation on a pathway involving nonspecific endothelial receptor activation in rat aorta. This attenuation does not occur through opioid receptor activation.
IMPLICATIONS: The photoplethysmograph can be used to measure the effects of ventilation on the pulse. As measured by spectral analysis the effect of ventilation was 10 times stronger in the ear and forehead compared with the finger and may be preferable for monitoring respiratory rate and changes in intravascular volume status.
IMPLICATIONS: The use of a bispectral-index-guided regimen for the provision of sedation in interventional radiological procedures resulted in significantly longer optimal sedation as well as fewer remifentanil and propofol doses than a clinically guided regimen. The targeted BIS range of 80-85 provided a sufficient functional level of sedation.
IMPLICATIONS: Bispectral index may be thus of little value for assessing the depth of sedation during nitrous oxide sedation. Monitoring with clinical instruments such as OAA/S is, and should remain, the standard of care and cannot be replaced by using a bispectral index monitor.
IMPLICATIONS: Completion rates of quality assurance documentation can be easily monitored by using an anesthesia information system. Education, improved workflow integration, and providing individual feedback increased the completion rate from 48% to 94%. Anesthesia information systems can facilitate behavioral changes in two ways. Specific tasks can be integrated into the users' workflow by modifying the user interface, and continuous monitoring is possible with minimal resources.
IMPLICATIONS: In a model of burn injury followed at 24 h by sepsis (Escherichia coli), ketamine given immediately after E. coli inoculation significantly increased survival and decreased interleukin-6 production. Because ketamine is effective when given at the onset of sepsis, it may have clinical applicability.
IMPLICATIONS: Even brief periods of cardiac arrest in which blood flow to the brain is interrupted result in the death of nerve cells, which is accompanied by impaired short-term memory, attention, and learning.
IMPLICATIONS: The clinical presentation of acute poisoning resulting from the ingestion of an insecticide containing an unauthorized mixture of organophosphate and pyrethroid is similar to that of organophosphate alone. The ingestion of such a mixture may cause significant diagnostic difficulty and jeopardize the safety profile (complete elimination from mammals with little tissue accumulation) of the pyrethroid group of insecticides.
IMPLICATIONS: The dose-dependent effects of isoflurane were examined in a rat model of severe forebrain ischemia. Outcome across a range of variables was better in rats receiving <1.5 MAC isoflurane.
IMPLICATIONS: The mechanisms by which isoflurane protects hypoxic neurons remains incompletely defined. In cortical neurons cultured from mice, we show that isoflurane activates a series of neuroprotective intracellular signaling events that include moderate increases in intracellular calcium concentration, phosphorylation of several MAP kinase families, and phosphorylation of transcription factors.
IMPLICATIONS: Postischemic administration of a sigma-1 receptor agonist decreases stroke size. Efficacy of sigma-1 receptor agonists for preventing ischemia-induced brain injury may be linked to their ability to prevent activation of inducible nitric oxide activity during reperfusion.
IMPLICATIONS: We investigated electrocardiograph-guided placement of the right atrial air aspiration catheter in 20 patients. When compared with transesophageal echocardiography, we found positioning to be inaccurate in some patients. For procedures with high risk of air embolism, echocardiography may provide superior catheter placement as well as detect significant intracardiac pathology.
IMPLICATIONS: Reduced oxygen conditions (hypoxemia) increased fetoplacental arterial blood pressures (FAP) in a well established laboratory model of the human placenta. The smaller the oxygen concentration the larger the increase in FAP. Our results suggest that the physiological reaction to a decrease in oxygen availability at the mother/baby placental boundary, known as hypoxemic fetoplacental vasoconstriction (HFPV), is a graduated response. These findings contribute to a better understanding of HFPV and may help us determine its role in health and disease.
IMPLICATIONS: Volatile anesthetics, including sevoflurane, desflurane, isoflurane, and halothane, inhibit spontaneous contractility of gravid human uterine muscle in a dose-dependent manner. These effects are unlikely to be related to modulation of BKCa or KATP channels, except for the action of isoflurane, which is in part mediated through activation of KATP channels.
IMPLICATIONS: This is a prospective randomized study of 32 patients who had undergone pancreaticoduodenectomy. We studied their coagulation tests after the surgery and found a significant correlation between positive intravascular fluid balance and deterioration of International Normalized Ratio.
IMPLICATIONS: The percutaneous tracheostomy technique is becoming a common alternative to traditional open tracheostomy. The purpose of this study was to confirm the safety and effectiveness of the Laryngeal Mask Airway compared with an endotracheal tube for airway management during the guidewire dilating forceps tracheostomy technique.
IMPLICATIONS: Laryngoscope-guided, gum elastic bougie-guided insertion of the ProSeal laryngeal mask airway is superior to conventional laryngoscope-guided tracheal intubation for airway management by first-month anesthesia residents after brief manikin-only training. It has potential as a tool for resuscitation and field studies are warranted.
IMPLICATIONS: Radiofrequency ablation uses needle electrodes to destroy tumors through localized heating, but damage to nearby important structures can occur. We discuss the steps that can be taken in the anesthetic management of patients undergoing radiofrequency ablation of lung lesions to minimize the risk of such damage.
IMPLICATIONS: Pain in cancer patients due to oral mucositis significantly affects quality of life. We found that topical doxepin rinse provided significant pain reduction with longer pain relief for patients with higher baseline pain, more severe baseline erythema, or those with a large relative reduction in pain after rinsing.
IMPLICATIONS: Localized peripheral administration of analgesics is one alternative for pain control. We investigated the role of adrenergic receptor subtypes on peripheral transmission of pain. The activation of {alpha}-1 adrenoceptors by intradermal noradrenaline and phenylephrine produce local thermal hyperalgesia. In contrast, the activation of {alpha}-2 adrenoceptors by intradermal clonidine and agmatine, an imidazoline receptor agonist, produced a local antinociceptive action.
IMPLICATIONS: Propofol sufficient to produce immobility did not prevent increased activation (c-fos expression) of spinal neurons by intraplantar formalin injection, a finding consistent with propofol lacking analgesic properties. Mice with a mutation of the gamma-aminobutyric acid type A receptor were resistant to propofol anesthesia, supporting the importance of this receptor for propofol's action.
IMPLICATIONS: In this pilot study, Orthogonal Polarization Spectral imaging was used to examine the microcirculatory effects of acute hypervolemic hemodilution and thoracic epidural injection of lidocaine. The two study interventions produced consistent effects on heart rate and arterial blood pressure but not on the microcirculation of vaginal mucosa.
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