IMPLICATIONS: Noble gases without anesthetic properties, including helium, neon, and argon, protect myocardium against infarction produced by prolonged coronary artery occlusion and reperfusion by activating prosurvival signaling kinases and inhibiting mitochondrial permeability transition in vivo.
IMPLICATIONS: The incidental diagnosis of patent foramen ovale is often encountered on echocardiographic examination during cardiac surgery. We review the embryology, physiology, and proper methods for detection along with perioperative implications and decision-making processes that may lead to immediate, delayed, or no intervention.
IMPLICATIONS: Plasma cGMP concentrations are inversely correlated to measured plasma propofol concentrations in children. Plasma cGMP could serve as a biochemical marker for monitoring the depth of propofol anesthesia.
IMPLICATIONS: We evaluated three clinically prevalent methods for endotracheal tube (ETT) positioning in children with regard to the safety from endobronchial intubation or extubation during neck movement. The results of our study suggest that ETT positioning by auscultation places the ETT more deeply than midtrachea, and therefore increases the risk of endobronchial intubation during neck flexion.
IMPLICATIONS: This case report introduces the use of preanesthetic anatomical evaluation of the upper airway using three-dimensional computed tomography images for safe airway management of a patient predicted to be difficult to intubate.
IMPLICATIONS: The authors demonstrate that a short period of sevoflurane inhalation at subanesthetic concentrations (<1%) alters the blood transcriptome in healthy volunteers. Flow cytometry analysis further demonstrated reduced L-selectin expression on granulocytes accompanied with resistance to inflammatory stimulation 24 to 48 h after sevoflurane exposure, consistent with the occurrence of a second window of protection in humans.
IMPLICATIONS: The calcium-sensitizer, levosimendan, is an effective inotropic drug in ropivacaine-induced myocardial depression. Levosimendan myocardial sensitivity and efficacy were not affected by the local anesthetic. Our results suggest that levosimendan is effective in local anesthetic-induced cardiac depression.
IMPLICATIONS: We used functional magnetic resonance imaging to measure the effects of 0.25 MAC sevoflurane on visual, auditory, and motor activation in 16 healthy volunteers. We showed that 0.25 MAC sevoflurane predominantly affects the primary visual cortex, the related association cortex, and certain other higher order association cortices.
IMPLICATIONS: We previously reported that landiolol, an ultra short-acting {beta}1-adrenoceptor antagonist, does not alter the electroencephalographic effect of isoflurane. Here, we investigated the influence on the minimum alveolar anesthetic concentration of isoflurane and concluded that landiolol does not alter the antinociceptive effect of isoflurane, suggesting that landiolol does not influence the anesthetic potency of inhaled anesthetics.
IMPLICATIONS: Sodium channels may mediate part of the capacity of isoflurane to produce immobility in the face of noxious stimulation.
IMPLICATIONS: Dexmedetomidine is a potential sedative drug after major facial reconstructive surgery, but may induce vasoconstriction in denervated flaps and thus increase the risk of tissue damage. Our data suggest that, even if used for deep sedation, dexmedetomidine does not have deleterious effects on tissue perfusion in denervated musculocutaneous flaps.
IMPLICATIONS: The ketone bodies {beta}-hydroxybutyric acid and acetone are anesthetics in animals, and show anesthetic-like modulation of glycine and {gamma}-aminobutyric acid type A receptors at pathophysiologic concentrations.
IMPLICATIONS: Measurement of anesthetic gas tension in blood using a sidestream gas analyzer is comparable in accuracy and precision to analysis by gas chromatography. This simplified approach facilitates direct studies of anesthetic vapor delivery to blood, instead of relying upon measuring exhaled gas concentrations.
IMPLICATIONS: Neuromuscular blockade blunts the bispectral index and auditory-evoked potential index response to tetanic stimulation of a peripheral nerve. The degree of neuromuscular blockade may be a factor when interpreting electroencephalogram-based monitoring of the hypnotic state.
IMPLICATIONS: The inspired oxygen concentration influences the concentration of carbon monoxide in the blood and exhaled gases during anesthesia. Inspired oxygen concentration should be considered when interpreting measurements of exhaled carbon monoxide concentration.
IMPLICATIONS: A balloon located in the abdominal aorta can be intermittently used to occlude aortic blood flow and significantly reduce blood loss and surgical time during sacrococcygeal tumor resection.
IMPLICATIONS: We report four cases of intraoperative cerebral desaturations, as measured by near-infrared cerebral oximetry, after IV administration of indigo carmine. Anesthesiologists and intensivists should be aware of this effect when using cerebral oximetry.
IMPLICATIONS: Operating room departments that cannot improve efficiency by current known scheduling practices can benefit from lowering organizational barriers and adopting mathematical algorithms to their surgical case scheduling. This study demonstrates that operating room utilization can be increased by 4.5% point.
IMPLICATIONS: Although antithrombin levels are often low in sepsis, such levels are not related to outcome.
IMPLICATIONS: Both the molecular weight and the degree of substitution of hydroxyethyl starches modify their retention within the circulation. The properties of individual hydroxyethyl starch solutions need to be further characterized.
IMPLICATIONS: Selective lung recruitment maneuvers may facilitate safe reinflation of collapsed lung areas, even in the case of hemodynamic instability.
IMPLICATIONS: The carina in a chest radiograph can be used as a guide for positioning the intraaortic balloon pump.
IMPLICATIONS: Mild hypoxia (O2 saturation 70%) produces a transient impairment of short-term memory in adult mice. Physostigmine administered after hypoxic insult reverses cognitive dysfunction.
IMPLICATIONS: In this porcine model of increased intracranial pressure and decreased cerebral perfusion pressure, threshold values for metabolic evidence of ischemia were 30 and 40 mm Hg, respectively. Therefore, lower ICP and CPP values than expected are tolerable until ischemic changes occur.
IMPLICATIONS: Findings from this crossover study demonstrate that gastric emptying in obese, term nonlaboring pregnant volunteers did not differ after the ingestion of 50 mL compared with that after 300 mL water. These findings suggest that allowing obese pregnant women to ingest clear liquids may not increase their risk of aspiration.
IMPLICATIONS: The findings of this prospective randomized study suggest that epidural bupivacaine, ropivacaine, and levobupivacaine all confer adequate labor epidural analgesia, with no significant influence on the mode of delivery, duration of labor, or neonatal outcome.
IMPLICATIONS: We compared the postoperative antiemetic efficacy of scopolamine, ondansetron, and placebo in patients receiving intrathecal morphine undergoing cesarean delivery. The rates of all emesis were reduced by one-third by transdermal scopolamine (TDS) or ondansetron. Scopolamine is an effective medication for prophylactic use in these parturients. Its use, however, was associated with a higher incidence of side effects such as dry mouth and blurry vision.
IMPLICATIONS: This report describes the successful management of a postpartum woman with cerebral vasospasm-induced posterior reversible encephalopathy syndrome. This syndrome is associated with irreversible brain damage if not recognized or treated incorrectly.
IMPLICATIONS: Supplemental oxygen rapidly increases tissue oxygen tension in healthy, perianastomotic, and anastomotic colon tissue. Supplemental crystalloid fluid does not improve oxygenation of these tissues.
IMPLICATIONS: The authors retrospectively analyzed 1124 adult liver transplants and identified several recipient, donor, laboratory, and intraoperative predictors of hyperkalemia in the prereperfusion, early postreperfusion, and late postreperfusion periods.
IMPLICATIONS: The upper lip bite test correctly predicted an easy intubation in a patient with a Mallampati Class 4 airway.
IMPLICATIONS: Data suggest that improved postoperative analgesia leads to better patient outcomes, but there is insufficient evidence to support subsequent improvements in patient-centered outcomes such as quality of life and quality of recovery. Further studies are needed to develop validated patient-reported instruments and to assess the effect of analgesic techniques on patient-reported outcomes in the perioperative period.
IMPLICATIONS: Cerebral spinal fluid leaks may be an etiology for whiplash-associated disorder and can be treated with epidural blood patch.
IMPLICATIONS: Peripheral sensitization plays an important role in pain associated with knee arthroplasty in both the preoperative and postoperative periods.
IMPLICATIONS: Perioperative parecoxib enhanced the postoperative analgesia of intrathecal morphine/bupivacaine and improved satisfaction in patients undergoing total abdominal hysterectomy.
IMPLICATIONS: A single injection of resiniferatoxin can block the rat sciatic for up to 3-wk duration without any significant damage to the unmyelinated nerve fibers.
IMPLICATIONS: IV midazolam produces dose-related effects on somatosympathetic A{delta} and C reflex discharges in cats. The effect is enhanced in decerebrate cats.
IMPLICATIONS: During ultrasound-guided interscalene block using nerve stimulation, the observed motor response below or above 0.5 mA had no impact on success or duration of upper trunk block.
IMPLICATIONS: Single-injection femoral nerve block improves multimodal analgesia after total knee arthroplasty. However, this effect does not persist beyond the day of surgery. Obturator block alone provides no benefit.
IMPLICATIONS: Using an animal model, we showed that the drug dispositions in the intrathecal and epidural compartments are different, and that the intrathecal bioavailability of ropivacaine after epidural administration is low, and highly variable.
IMPLICATIONS: We have demonstrated that airway pressure is a factor in determining the distribution of sensory blockade in cervicothoracic epidural anesthesia.
IMPLICATIONS: A new posterolateral approach to the proximal brachial plexus, the transscalene block, is associated with an 85% success rate and only minor (transient) side effects. Additional studies are needed to compare the efficacy and safety of the transscalene block with other approaches.
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