IMPLICATIONS: Combined use of rFVIIa, cryoprecipitate, and antithrombin concentrate successfully treated cardiopulmonary bypass-induced coagulopathy in two Jehovah's Witness patients. Clinicians should be aware that selected blood components in addition to drugs can be used for managing this patient population.
IMPLICATIONS: Levosimendan improves cardiac function by a novel mechanism of action compared to currently available drugs. In cardiac surgery patients with a low preoperative left ventricular ejection fraction, stroke volume was better maintained after surgery with the combination of dobutamine with levosimendan than with the combination of dobutamine with milrinone.
IMPLICATIONS: We compared sleep disturbances in infants anesthetized with sevoflurane compared with a propofol-remifentanil combination.
IMPLICATIONS: We prospectively analyzed pre- and postoperative patient variables in children undergoing tonsillectomy and adenoidectomy (T&A) for their absolute and relative impact on length of stay in postanesthesia recovery. The most significant factors contributing to prolonged recovery in children after T&A are postoperative nausea and vomiting and oxygen desaturation (Spo2< 95%).
IMPLICATIONS: Parents of children undergoing surgery have misconceptions about pain and analgesics. Several personality characteristics have been identified as predictors for these misconceptions. Future educational efforts should address this issue.
IMPLICATIONS: This study, performed on fetal lambs, describes the effects of nociceptive stimulation on the fetal pulmonary circulation and the mechanisms of this pain-induced pulmonary vasoconstriction. Our results indicate that the fetal pulmonary vasoconstrictive response to pain involves {alpha}1-adrenoceptors activation.
IMPLICATIONS: A prophylactic dose of IV dexamethasone 2 or 4 mg, with ondansetron 2 or 4 mg, prevents nausea and vomiting in two-thirds of patients having day-surgical gynecologic laparoscopy. Combinations did not differ in efficacy, except that patients receiving 2 mg dexamethasone were more likely to have nausea from 0 to 24 h.
IMPLICATIONS: After 2 h of isoflurane or sevoflurane anesthesia, the time to limb movement in 11 pigs was shortened by 65% when hyperventilation was used to rapidly remove anesthetic from the lungs and hypercapnia was induced using feedback-controlled infusion of CO2 or CO2 rebreathing. Rebreathing, as described in the study, might provide a practical means of applying hypercapnic hyperventilation in a clinical setting.
IMPLICATIONS: We investigated the immobilizing effects of hexafluorobenzene and o-difluorobenzene, aromatic anesthetics that differ greatly in their ability to block N-methyl-d-aspartate receptors, using a goat model that allowed selective delivery of anesthetics to the brain. Our results support the spinal cord as the primary site at which inhaled anesthetics produce immobility.
IMPLICATIONS: We investigated, in rats, whether nitrous oxide (N2O) depresses spinal neuronal responses to noxious stimulation. We found that the responses depended on the depth of the spinal neurons, suggesting that the anesthetic effects of N2O converge to depress a final common pathway, such as the motorneuron or premotor interneuron.
IMPLICATIONS: Release of 5-HT in rat brain decreased during isoflurane anesthesia when compared with the waking state. Loss of righting reflex occurred at significantly higher isoflurane concentrations in fluoxetine-treated rats. These results suggest that changes in serotonergic system activity may be involved in the hypnotic action of isoflurane.
IMPLICATIONS: Low doses of barbiturates have been suggested to affect brain signaling. The present study shows that they are unlikely to alter memory processing.
IMPLICATIONS: This study examines laser-assisted drug delivery for topical anesthesia before venipuncture. Results indicate that the lower-energy laser is as effective as the higher-energy laser for this procedure.
IMPLICATIONS: Acetylcholine receptors do not mediate the capacity of isoflurane to produce immobility in the face of noxious stimulation.
IMPLICATIONS: We investigated whether preoperative heart rate variability can predict hemodynamic fluctuations during the induction of general anesthesia. We found that ultra short-term entropy can independently predict arterial blood pressure fluctuations.
IMPLICATIONS: Measurements from bispectral index sensors placed in a nonstandard location at the side of the temple may not provide reliable information, particularly during induction and emergence from anesthesia.
IMPLICATIONS: The average United States academic anesthesiology department is currently receiving $95,000/faculty of support, calculated after the dollars being provided for Certified Registered Nurse Anesthetists' salaries are removed. The primary cause of this negative financial status appears to be the large variation in reimbursement for services provided.
IMPLICATIONS: The implementation of a cell salvage program can be cost-favorable for a large, tertiary care hospital.
IMPLICATIONS: Registered nurses underwent the nitrous oxide training requirements prescribed for state licensure of dentists and dental hygienists, with special emphasis on pediatric sedation principles. A case series of 1018 nurse-administered nitrous oxide anesthetics for ASA physical status I and II children undergoing urethral catheterization for urologic imaging is presented.
IMPLICATIONS: Patients developing new supraventricular arrhythmias in intensive care have an increased risk of mortality, both in hospital and afterwards. Special attention should be paid to treating the potentially reversible causes of such arrhythmias.
IMPLICATIONS: Patients with severe emphysema have impaired filling of the left ventricle. A standardized increase in preload causes a more pronounced increase in stroke volume in these patients. These findings might have clinical implications for the perioperative hemodynamic management of these patients.
IMPLICATIONS: Measurements of plasma sodium in critically ill patients with hypoalbuminemia are influenced by the method of measurement. This should be considered in evaluating electrolyte states since these influences can be clinically relevant.
IMPLICATIONS: High concentrations of sevoflurane increase neurogenesis 28 days after transient forebrain ischemia in the rat. This study suggests that two triggers, high concentrations of sevoflurane and cerebral ischemia, are required to increase neurogenesis in the dentate gyrus.
IMPLICATIONS: We demonstrated a clinical profile for motor block potency for the pipecolylxylidines when administered spinally: low, intermediate, and high for ropivacaine, levobupivacaine, and bupivacaine, respectively. Intrathecal ropivacaine and levobupivacaine are significantly less potent than bupivacaine, which may explain the lesser motor blocking effects of intrathecal ropivacaine and levobupivacaine.
IMPLICATIONS: Steam sterilization reduces the light intensity of reusable fiberoptic laryngoscope blades. After 80 cycles of sterilization, the light intensity from a reusable blade is significantly less than that obtained with a single-use disposable plastic blade.
IMPLICATIONS: This clinical trial demonstrated improved pain relief after major surgery by the addition of ketamine to IV tramadol and morphine patient-controlled analgesia. Combining ketamine and tramadol improved analgesia, was opioid-sparing and less sedating, and reduced physician interventions to manage severe pain.
IMPLICATIONS: The Hong Kong version of the Pain Self-Efficacy Questionnaire is a reliable clinical assessment tool for Chinese patients with chronic nonmalignant pain.
IMPLICATIONS: Percutaneous vertebroplasty is a simple and generally safe treatment of vertebral compression fractures, but complications from venous leakage of polymethylmethacrylate can arise years after the procedure.
IMPLICATIONS: Local, but not systemic, administration of nonsteroidal antiinflammatory drugs (NSAIDs) produces antinociception in the tail-flick thermal assay. The endogenous opioid system contributes to the peripheral antinociceptive effects of dipyrone, but not to that of diclofenac, ketorolac, lysine asetyl salicylate, or sodium salicylate, suggesting differences in the mechanisms of action among the NSAIDs.
IMPLICATIONS: L5 spinal nerve ligation (SNL) for 4 wk reduced pain responses to formalin injection in rats. Decreased c-Fos staining indicated that decreased neuronal activity in the spinal cord in response to inflammatory pain may be important in altering the perception of acute pain. Brain-derived neurotrophic factor may be involved in this alteration.
IMPLICATIONS: This pilot rat study showed that marrow derived stem cells were effective for treating neuropathic pain arising from nerve injury.
IMPLICATIONS: We have demonstrated that the prevention of hyperalgesia does not automatically mean the prevention of all spinal changes associated with peripheral inflammation. It would seem important, therefore, to identify, in preclinical settings, those pharmacological treatments that can fully prevent the central modifications associated with persistent inflammatory pain.
IMPLICATIONS: Three Class I antiarrhythmic drugs, quinidine, mexiletine, and flecainide, are local anesthetics that cause dose-related cutaneous analgesia on injection.
IMPLICATIONS: For outpatient knee arthroscopy, spinal anesthesia with 2-chloroprocaine 1% resulted in a faster onset, more rapid recovery of sensory/motor function and unassisted ambulation, and fewer incidences of transient neurologic symptoms as compared to spinal anesthesia with lidocaine.
IMPLICATIONS: Our review suggests that the rate of neurological complications after central nerve blockade is <4:10,000, or 0.04%. The rate of neuropathy after peripheral nerve blockade is <3:100, or 3%. However, permanent neurological injury after regional anesthesia is rare in contemporary anesthetic practice.
IMPLICATIONS: Severe, secondary neurologic complications of central neuraxial blockade observed in rehabilitation centers in France are often associated with underlying spinal conditions, particularly lumbar canal stenosis and arachnoid cyst.
IMPLICATIONS: Maintaining the arm in abduction after axillary blockade results in a shorter onset time and prolongation of sensory and motor block compared to placement of the arm in adduction.
IMPLICATIONS: Clonidine prolongs anesthesia from superficial lidocaine infiltration by a peripheral mechanism.
IMPLICATIONS: During epidural anesthesia, the sevoflurane requirement is decreased; and the reduction depends on the concentration of ropivacaine used for epidural anesthesia.
IMPLICATIONS: Administration of IV dexamethasone prior to intrathecal meperidine reduces the intensity of postoperative pain, nausea, and vomiting.
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