IMPLICATIONS: During cardiopulmonary bypass, brain temperature, approximated by jugular bulb temperature, was over-estimated during cooling and under-estimated during rewarming by temperature measurements in commonly monitored body sites. Striking interpatient variability in temperature gradients prevented identification of a "best site." Only arterial outlet blood temperature provided a good approximation of brain temperature.
IMPLICATIONS: Bilateral internal mammary artery (BIMA) graft increases postoperative drainage. However, the clinical relevance of this risk remains low, since bleeding is moderate and does not lead to a higher transfusion requirement. Thus, the practice of BIMA should not be discouraged for fear of increased blood loss.
IMPLICATIONS: Perioperative amino acid infusion shortens the duration of postoperative mechanical ventilation, reduces intensive care unit stay, and decreases the length of postoperative hospitalization after off-pump coronary artery bypass grafting.
IMPLICATIONS: We examined the inflammatory response elicited in the airways during cardiopulmonary bypass (CPB) by measurements of interleukin (IL)-6, IL-8, and neutrophil elastase in epithelial lining fluid. A significant increase in neutrophil elastase, before that in IL-8 and IL-6, suggests that CPB triggered a neutrophil-related inflammatory process in the airways.
IMPLICATIONS: Inhibition of the proapoptotic tumor suppressor, protein p53, enhances protection against myocardial infarction by isoflurane, administered immediately before and during early reperfusion, after prolonged coronary artery occlusion via a mitochondrial permeability transition pore-dependent mechanism.
IMPLICATIONS: Parental preferences for scheduling elective pediatric procedures requiring anesthesia have not been studied. We found that parents ranked severity of the child's illness, earliest available time, and surgeon's suggested date as the three most important factors for pediatric case scheduling.
IMPLICATIONS: As more infants and children with congenital cardiovascular defects survive into adulthood, the population of adults that requires anesthetic care for surgery or other procedures continues to increase. Many of these patients continue to have abnormal cardiac structure or circulation that may increase the risks associated with anesthesia and surgery. This case report emphasizes some of the difficulties and challenges involved in the care of these patients.
IMPLICATIONS: In a large series of patients who received extensive perioperative education, outpatient management of continuous peripheral nerve block catheters placed using ultrasound guidance required few interventions by the anesthesiologist.
IMPLICATIONS: This prospective, placebo-controlled, randomized, double-blind study indicates that IV ketamine 100 g/kg is effective for reducing the incidence and intensity of propofol-induced pain without significant adverse effects, and that its administration after midazolam premedication is more efficient for reducing pain.
IMPLICATIONS: Melatonin premedication given approximately 50 min before induction of anesthesia reduces the propofol and thiopental doses required for loss of responses to verbal commands and eyelash stimulation.
IMPLICATIONS: Isoflurane and propofol have similar effects on neuronal windup in the spinal cord. Because windup partly depends on the N-methyl-d-aspartate receptor, action at this receptor is not critical to immobility produced by these anesthetics. When propofol and isoflurane are administered in equipotent doses, similar effects on nociceptive responses should occur.
IMPLICATIONS: We demonstrated that nitrous oxide and xenon are distinct in their effect on extracellular dopamine levels in the nucleus accumbens, and explained why xenon exhibits fewer neuropsychological effects than nitrous oxide. The data also suggests that xenon can be used to mitigate the unfavorable effects and toxicity produced by ketamine.
IMPLICATIONS: We report an inadvertent overdose of IV lidocaine in a patient monitored with BIS. BIS decreased to 0 for approximately 15 min, indicating that lidocaine and sevoflurane interact to decrease BIS.
IMPLICATIONS: Serotonin syndrome is a potentially lethal adverse drug reaction that may occur in patients taking proserotoninergic medications. These drugs should be used with extreme caution in postoperative patients receiving other serotonin-enhancing drugs, and the patients should be closely monitored for manifestations of serotonin syndrome.
IMPLICATIONS: Monitoring the electroencephalogram with Bispectral Index or spectral entropy during sevoflurane-sufentanil anesthesia reduces sevoflurane consumption by 29%.
IMPLICATIONS: Photoplethysmographic dynamic indices can noninvasively assess fluid responsiveness as accurately as arterial indices. Accordingly, pulse oximetry waveform analysis could be a convenient tool for guiding fluid administration in hypotensive, mechanically ventilated patients.
IMPLICATIONS: Our study clarified that electromagnetic interference at public train stations does not cause mock shockable heart rhythms in the presence of sinus rhythm.
IMPLICATIONS: None of the monitors used today in the operating room has proved effective for the detection of one-lung intubation (OLI). In this study, selective one-lung ventilation sounds were collected from patients intubated with a double-lumen tube, to investigate the efficacy of acoustic analysis for OLI detection.
IMPLICATIONS: The numbers of cases starting during each 12-h period of a holiday are a statistically valid end point for operating room (OR) managers to use when evaluating how busy holidays are relative to weekend days. The statistic is designed to be combined with mathematically valid assessments of appropriate weekend staffing.
IMPLICATIONS: This tutorial considers the impact of operating room (OR) management on anesthesia group and OR labor productivity and costs. The tutorial reviews the steps required for refining OR allocations using data collected during patient care. Reducing surgical and/or turnover times and delays in first-case-of-the-day starts, generally provides small reductions in anesthesia group and OR labor costs.
IMPLICATIONS: We describe our process used to improve antibiotic administration. During this time, the surgical site infection rate has been significantly reduced.
IMPLICATIONS: Using a two-dimensional breakdown of proteins combined with mass spectrometry, we screened serum from patients with sepsis to elucidate possible differences between survivors and non-survivors. We found that the protein expression profiles of survivors and non-survivors differ at an early stage.
IMPLICATIONS: Propofol did not reduce lesion volume or the number of eosinophilic cells in the hippocampus when infused at two different electroencephalogram-targeted concentrations in a rat model of focal traumatic brain injury.
IMPLICATIONS: In early labor, the analgesic effect from epidural neostigmine plus sufentanil, a combination that provides selective neuraxial analgesia, is significantly enhanced by the use of a traditional lidocaine plus epinephrine test dose. However, the lidocaine test dose reduces the parturient's ability to ambulate.
IMPLICATIONS: Spinal block from a combined spinal epidural technique results in a spread of local anesthetic in the subarachnoid space similar to that from the single spinal shot technique when administered to laboring parturients for cesarean delivery. A dose adjustment is not necessary to achieve a similar level of block.
IMPLICATIONS: If acute normovolemic hemodilution is used, patients with blood type O may be at increased risked for coagulopathy and increased blood loss.
IMPLICATIONS: Amino acids were infused to establish a perioperative positive protein balance during surgery in patients receiving either an epidural blockade with light general anesthesia or general anesthesia alone. Epidural anesthesia provided no additional benefit beyond the anabolism obtained with amino acids.
IMPLICATIONS: The immune system not only contributes to inflammation, it also provides localized analgesia. The means by which this analgesia is provided within inflamed tissue is not fully understood. These studies demonstrate evidence for the direct adhesion between neurons and immune cells in vitro and the role this adhesion may have in immune-derived analgesia. This has implications on new therapeutics that might enhance this binding interaction to improve analgesic effects.
IMPLICATIONS: For total knee arthroplasty, there seems to be no significant advantage for the use of stimulating catheters over traditional nonstimulating catheters in continuous femoral nerve blocks.
IMPLICATIONS: Sciatic nerve block with the posterior popliteal approach, 10 cm from the popliteal skin crease using a double stimulation technique, provides similar onset time and success rate when compared with a single-injection technique.
IMPLICATIONS: Our magnetic resonance imaging study defines the anatomical variation of the infraclavicular brachial plexus. We suggest an anatomical location that, on average, is closest to all cords and therefore may be suitable for a single-injection technique for a brachial plexus block.
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