IMPLICATIONS: This study examines the effect of glycopyrrolate on perioperative adverse events in children presenting for elective surgery with an upper respiratory tract infection. Results showed that routine intraoperative administration of glycopyrrolate to these children seems to have no clinical benefit.
IMPLICATIONS: Low-dose intrathecal morphine was not associated with adverse outcomes in pediatric patient.
IMPLICATIONS: This randomized controlled trial indicates that clinically relevant sevoflurane concentrations do not increase transmural dispersion of repolarization as measured by the peak and end of the T-wave interval, implying a low risk of inducing torsades des pointes, despite prolonging the corrected QT interval in healthy children.
IMPLICATIONS: This randomized clinical study in anesthetized children demonstrated that there are fewer circulatory responses during nasal fiberoptic intubation than during oral fiberoptic intubation.
IMPLICATIONS: A growing multibillion dollar industry markets magnetic devices for pain relief, although there is little evidence for their efficacy. This double-blind, randomized, controlled trial demonstrated that magnetic therapy lacks efficacy and should not be recommended for acute pain relief.
IMPLICATIONS: Previous reports have suggested that auricular acupuncture can be used for the treatment of situational anxiety. In this randomized, controlled trial it was shown that auricular acupuncture is as useful as the anxiety-reducing medication, midazolam, and seems to be superior to placebo auricular acupuncture for the treatment of acute dental anxiety.
IMPLICATIONS: Acupuncture is widely used for pain relief, although the mechanisms of its effects are not completely understood. The present study demonstrates that acupuncture increases the levels of nitric oxide in treated regions, thereby increasing local circulation. Our findings may facilitate elucidation of the complex mechanisms underlying the effects of acupuncture.
IMPLICATIONS: To minimize the influence of exogenous factors, manual acupuncture of LI-4 was performed in anesthetized healthy humans. Regional cerebral blood flow, measured with positron emission tomography, was decreased in the putamen and in the medial frontal gyrus. During false acupuncture, cerebral blood flow was decreased in the medial frontal gyrus only.
IMPLICATIONS: We investigated the effect of acupressure on the "extra 1" acupoint in volunteers. Acupressure applied for 10 min on the extra 1 point reduced the bispectral index values and stress when compared with a sham point and with no pressure application, but melatonin and {beta}-endorphin did not change significantly.
IMPLICATIONS: Molecular modeling and analysis reveal that anesthetic binding within several well-characterized anesthetic-protein complexes involves both polar and nonpolar interactions. The nonpolar nature of the interacting components may serve to explain a large component of the Meyer-Overton correlation. The polar nature of such interactions serves to explain the exceptions to the Meyer-Overton correlation, as well as to demonstrate the polarizing effect such interactions with the protein have on the otherwise nonpolar anesthetics.
IMPLICATIONS: The EC50 of propofol to lower the Bispectral Index (BIS) to 50 or less varied between 2.4 and 2.9 {micro}g/mL in 72 adult patients and was not reduced by remifentanil. BIS monitoring is recommended if propofol target-controlled infusion concentrations are reduced during simultaneous remifentanil infusion.
IMPLICATIONS: Using stopped-flow and calcium titration techniques, this study demonstrates that halothane, isoflurane, and sevoflurane specifically affect Ca2+ interactions with low-affinity Ca2+ binding site II of labeled human cardiac troponin C, leading to increased Ca2+ sensitivity and an altered rate of conformational change after Ca2+ dissociation.
IMPLICATIONS: Orexinergic neurons may mediate emotional changes, and benzodiazepines produces anxiolytic effects. However, the present study suggests that there is no interaction between orexinergic neurons and benzodiazepine receptors in the cerebral cortex, although clinically relevant concentrations of midazolam significantly inhibited orexin-evoked norepinephrine release that could not be antagonized by flumazenil.
IMPLICATIONS: Noninvasive infrared spectroscopy, an attractive method for measuring cerebral oxygenation, may not be reliable during cardiopulmonary bypass as hemodilution has the effect of increasing the optical pathlength.
IMPLICATIONS: Quantitative prediction of interstitial fluid sequestration in injured tissue may foster a better understanding of the relationship between fluid administered and the resulting balance between intra- and extravascular fluid. Our model shows that increasing the fluid replacement rate above 10 mL {middle dot} kg-1 {middle dot} h-1 does not have the desired effect on plasma volume but instead increases the interstitial volume.
IMPLICATIONS: The methods explain how a hospital can use published caseload data from other hospitals, surgical rates from public federal websites, and its own caseload data to judge the potential for performing additional inpatient surgery for specific specialties.
IMPLICATIONS: Resolution of experimental acute lung injury (ALI) can be enhanced through lipoxins. This finding can be used to develop new therapeutic strategies for the treatment of ALI.
IMPLICATIONS: Lipid A, the toxic moiety of endotoxin, is linked to complications after cardiac surgery. We studied the safety and efficacy of eritoran (a lipid A antagonist) in a Phase II, double-blind, multicenter, clinical trial. Blocking lipid A with eritoran does not appear to confer any clear benefit in this setting.
IMPLICATIONS: Postoperative atelectasis after cardiac surgery can be treated with recruitment maneuvers. Brief application of high positive end-expiratory pressure during controlled mechanical ventilation has fewer hemodynamic adverse effects when compared with sustained high positive airway pressure.
IMPLICATIONS: Both the magnitude and duration of applied inspiratory pressure contribute to the development of bacterial translocation. In this study, positive end-expiratory pressure failed to prevent bacterial translocation when inspiratory pressure was prolonged.
IMPLICATIONS: Four hours of maternal general anesthesia (in the absence of any surgical manipulation) did not produce changes in preterm fetal cerebral oxygenation (or other variables) that could be construed as injurious.
IMPLICATIONS: Our study showed that in the presence of left lateral tilt, patients with multiple gestation pregnancy exhibit no greater hemodynamic instability when compared with patients with singleton pregnancy during spinal anesthesia for cesarean delivery.
IMPLICATIONS: We compared epidural bupivacaine 0.125% (w/v) and 0.25% (w/v) for labor pain relief and showed that bupivacaine 0.125% produced equivalent analgesia with a 50% increase in volume, but with a 25% reduction in dose.
IMPLICATIONS: This study establishes pregnancy reference ranges for platelet activity for two benchtop hemostasis analyzers (Thromboelastograph(R) and PFA-100(R)), provides evidence for an intrinsic platelet defect in preeclampsia, and demonstrates differences between the devices in their registration of impaired platelet activity. This may be useful in determining the safety of regional anesthesia in preeclampsia.
IMPLICATIONS: Pruritus is the most common side effect of subarachnoid morphine. We evaluated the prophylactic administration of ondansetron and granisetron to patients receiving subarachnoid morphine for pain relief after cesarean delivery, and found neither drug was effective in reducing the incidence or severity of pruritus.
IMPLICATIONS: In vitro hemodilution was performed with a new hydroxyethylstarch (HES) solution prepared in a balanced solution or a conventional HES prepared in saline. Hemodilution with the balanced HES resulted in fewer coagulation derangements, as measured by thrombelastography, and less platelet function alterations, as assessed by whole blood aggregometry, than hemodilution using conventional HES.
IMPLICATIONS: The new single-use streamlined pharynx airway liner is as easy to use as a conventional laryngeal mask airway. However, there is an increased risk of gastric inflation with the device, which may increase the risk of aspiration.
IMPLICATIONS: Prevention of an imbalance in the serum bilirubin to serum albumin molar ratio by appropriate drug selection avoids the neurologic sequelae (kernicterus) associated with Crigler-Najjar syndrome.
IMPLICATIONS: Skin biopsy, immunolabeled to reveal axonal endings, permitted diagnosis of small-fiber polyneuropathy in a young man with severe, acute erythromelalgia. High dose corticosteroids and IV lidocaine were effective treatments for this apparently autoimmune condition. Testing and treatment for autoimmune small-fiber neuropathy should be considered in adolescents with acute erythromelalgia.
IMPLICATIONS: In patients undergoing shoulder surgery, continuous interscalene block through a stimulating catheter did not significantly improve postoperative pain control 48 h after surgery, but it did enhance functional improvement of the shoulder 6 wk postoperatively compared with a nonstimulating technique.
IMPLICATIONS: Infraclavicular brachial plexus block performed using double-stimulation with initial block of the musculocutaneous nerve, and subsequent injection on a radial response, resulted in a better success rate than injection with the ulnar or median response.
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