IMPLICATIONS: Admission of propofol during cardiopulmonary bypass in a dose larger than normally used in clinical practice decreases biochemical markers of myocardial damage after surgery, and it is associated with shorter intensive unit stay in patients undergoing elective coronary artery bypass surgery as compared with anesthetic maintenance with isoflurane or small-dose propofol.
IMPLICATIONS: A major shift of resting autonomic steadiness toward sympathetic dominance, vagal withdrawal, and decline in baroreflex reserve occurs after combined deep and superficial cervical plexus blockade for carotid endarterectomy.
IMPLICATIONS: Although unfractionated heparin is the standard anticoagulant in cardiac surgery, its use is associated with important drawbacks. The present study provides evidence that bivalirudin used according to the percutaneous coronary intervention protocol during off-pump coronary artery bypass graft surgery provides reliable plasma concentrations and effectively achieves target activated clotting time+ values.
IMPLICATIONS: We examined the effect of diabetes mellitus on the antiarrhythmic effect of sodium, potassium, and calcium channel blockers in halothane-epinephrine-induced arrhythmias in rats. Our results show that diabetes mellitus reduces the antiarrhythmic effect of ion channel blockers.
IMPLICATIONS: Relying on memory to treat a rare event can result in omissions and treatment missteps. We evaluated the use of cognitive aids in a simulated anesthetic crisis (malignant hyperthermia) to determine if their use improved performance.
IMPLICATIONS: Tako-tsubo-like left ventricular dysfunction was diagnosed after surgery. Whether this dysfunction partly accounts for changes in T-wave morphology, reported to average 19% after anesthesia and noncardiac surgery, warrants further evaluation.
IMPLICATIONS: Transient left ventricular apical ballooning syndrome causes reversible cardiac dysfunction. A relationship with physiologic and emotional stress and/or excessive catecholamine activity is suspected, but the pathophysiology remains unclear. We describe the anesthetic management of two patients with this syndrome associated with subarachnoid hemorrhage.
IMPLICATIONS: The incidence of and risk factors for potassium disturbances were retrospectively studied in 268 children undergoing liver transplantation. Hypokalemia was the predominant disturbance. Several risk factors for hypokalemia were identified in the preperfusion and postreperfusion periods.
IMPLICATIONS: Propofol significantly attenuated ovalbumin-induced contraction of ovalbumin-sensitized rat trachea, mainly by inhibiting both actions of 5-HT, i.e., the direct action on the smooth muscle and the indirect action on the parasympathetic nerve endings. Propofol should be a useful anesthetic for patients with immunoglobulin E-related asthma.
IMPLICATIONS: This study examined the suitability of the intratracheal route as an alternative route for the administration of vecuronium. Intratracheal administration appears to be effective, given the more rapid absorption and faster onset of drug action than IM administration.
IMPLICATIONS: Continuous exposure to small concentrations of tetracaine delayed neurite growth without destroying neurite and growth cone. This effect was associated with a reduction in the number of filopodia and a decreased actin content.
IMPLICATIONS: Primary sensory nerves transfer messages to the periphery and to the central nervous system and cause neurogenic inflammation via neuropeptide releases in the periphery. Because the effect of local anesthetics on neurogenic inflammation is a subject of controversy and current interest, we attempted to investigate the mechanism of the effect of local anesthetics on primary sensory nerves.
IMPLICATIONS: A strong correlation between arterial blood CO2 measurements and transcutaneous CO2 assessments in mice was observed. Bland-Altman analysis further confirmed the accuracy of PtcCO2 compared to Paco2 measurements. Application of this simple, noninvasive transcutaneous method in mice provides the means to rapidly, continuously, and comprehensively evaluate ventilatory depressive effects.
IMPLICATIONS: When dolphins sleep, often the electroencephalographic activity of only one cerebral hemisphere is altered. We demonstrate that the bispectral index monitor can detect hemispheric asymmetry in the species Tursiops truncatus. The dolphin, with its human-sized brain, may provide an animal model for study of unihemispheric effects in humans.
IMPLICATIONS: Elderly patients were randomized to lighter or deeper levels of anesthesia, as measured by Bispectral Index. The deeper anesthetic group had better cognitive function 4-6 weeks postoperatively.
IMPLICATIONS: Electroencephalographic bicoherence significantly changed with different concentrations of sevoflurane, which suggests that the distribution pattern of bicoherence values is likely to be a good indicator for assessing the sedative effect of sevoflurane during the surgery.
IMPLICATIONS: Data obtained from the National Practitioner Data Bank indicates that over the past 14 yr, whereas the number of anesthesia malpractice payments has decreased, the median payment of cases has increased.
IMPLICATIONS: In pressure-controlled ventilation, monitoring of tidal volume may fail to detect partial endotracheal tube obstruction, whereas monitoring of expiratory flow and fractional volume expired during the first 15% of expiration indicates obstruction.
IMPLICATIONS: We evaluated the neuroprotective effect of four different {beta}-adrenoreceptor antagonists in the rat after transient focal cerebral ischemia. Both IV and intrathecal administration of {beta}-adrenoreceptor antagonists improved neurological and histological outcomes.
IMPLICATIONS: Nonsteroidal antiinflammatory drugs improve postoperative pain after cesarean delivery. No previous study has determined the analgesic efficacy of cyclooxygenase (COX)-2 inhibitors after cesarean delivery. Valdecoxib did not significantly reduce pain or opioid consumption in the 72 h after cesarean delivery. The addition of COX-2 inhibitors to improve post-cesarean pain is not supported at this time.
IMPLICATIONS: Half of the patients undergoing abdominal surgery showed a reduction of cardiac output in response to IV fluid administration. This was associated with less plasma volume expansion and more peripheral accumulation of the fluid.
IMPLICATIONS: Wound and tissue oxygenation are critically low in morbidly obese patients, even with supplemental oxygen administration. Mild hypercapnia combined with supplement oxygen during the perioperative period significantly increased tissue oxygenation in obese patients.
IMPLICATIONS: Many trials assessing the benefits of intraperitoneal local anesthetics in laparoscopic cholecystectomy have been performed. This systematic review and meta-analysis of randomized controlled trials synthesizes the available evidence and suggests that this technique results in a significant reduction in early postoperative pain.
IMPLICATIONS: Using a model of abdominal surgery in rats, spinal administration of a cyclooxygenase 1 inhibitor was found to be more effective in restoring exploratory behavior in rats after surgery than a cyclooxygenase 2 inhibitor. These data suggest that selective cyclooxygenase 1 inhibitors may be useful for certain pain modalities.
IMPLICATIONS: Human experimental pain models have been used to study drug effects on pain. The IM injection of capsaicin produces a reliable muscular hyperalgesia that is unresponsive to a single dose of IV ketorolac.
IMPLICATIONS: In addition to providing acute postoperative pain relief, preoperative paravertebral block (PVB) decreases the prevalence and intensity of chronic pain as late as 1 yr after breast cancer surgery. The acute and long-term analgesic benefits should encourage the use of PVB before breast cancer surgery.
IMPLICATIONS: Capsicum plaster at a classical Chinese acupoint may be a simple, inexpensive alternative to acupuncture for decreasing the need for opioid analgesics in the postoperative period. In this study, application of capsicum plaster at Zusanli (ST-36) acupoints reduced postoperative opioid analgesic requirements and opioid-related side effects in patients undergoing abdominal hysterectomy.
IMPLICATIONS: Chronic morphine administration via intermittent lumbar puncture in rats induced analgesic tolerance while avoiding catheter-associated morbidity. This novel method should prove useful in the experimental study of spinal opioid tolerance.
IMPLICATIONS: Long after recovery from inflammatory hyperalgesia, its central nervous system imprint can be clearly observed. Selective blockade of nociceptive fibers with resiniferatoxin prevents formation of hyperalgesia-related memory.
IMPLICATIONS: This study investigates experimental heat pain processing using functional magnetic resonance imaging during infusion of 3 different S-(+)-ketamine doses and placebo in volunteers.
IMPLICATIONS: We demonstrated that nitrous oxide showed significantly less antinociceptive action and induced less c-Fos expression in nociceptin receptor knockout mice than in wild-type mice. These results suggest that the nociceptin receptor is involved in the antinociceptive action of nitrous oxide.
IMPLICATIONS: Ondansetron is normally extruded from the central nervous system and other tissues by P-glycoproteins (P-gp). Direct application of ondansetron to the spinal cord increases pain sensitivity. Similarly, systemic ondansetron enhances pain sensitivity in mice that do not express P-gp. Attention should be paid to substrates of P-gp.
IMPLICATIONS: Specific molecular interactions of morphine at human 5-HT3A receptors were found. The findings confirm results from studies on rat 5-HT3 receptors and might help to elucidate the broad spectrum of side effects of this analgesic, including emesis.
IMPLICATIONS: Halothane and isoflurane dose-dependently inhibited dorsal horn neuronal windup in the 0-0.8 minimum alveolar anesthetic concentration (MAC) range, consistent with their ability to reduce temporal summation for pain. Halothane, but not isoflurane, further depressed windup at 1.2 MAC, suggesting different sites of immobilizing action for these anesthetics.
IMPLICATIONS: The incidence of postoperative neurological symptoms is similar after shoulder arthroscopy under interscalene block using either the mechanical paresthesia or the electrical stimulation techniques of nerve localization. Furthermore, there is no difference in the success rate, onset time, or level of patient satisfaction with either technique.
IMPLICATIONS: When administered for combined sciatic-femoral nerve blocks in patients undergoing knee arthroplasty, ropivacaine and bupivacaine have the same onset time for sensory and motor blockade but recovery is faster with ropivacaine. A new method of scoring sciatic and femoral nerve blockade is proposed.
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