IMPLICATIONS: Intravascular volume replacement during major orthopedic surgery causes dilutional coagulopathy, primarily by interfering with fibrinogen/fibrin polymerization. This is exacerbated by the administration of hydroxyethyl starch solutions. Administration of fibrinogen concentrate can help correct the coagulopathy.
IMPLICATIONS: In this randomized, double-blind, placebo-controlled trial, the ultrashort-acting dihydropyridine calcium channel blocker, clevidipine, was shown to be effective for treating preoperative hypertension with a 92.5% success rate in decreasing systolic blood pressure at least 15% from baseline in a high-risk patient population scheduled for cardiac surgery.
IMPLICATIONS: Brief exposure to volatile anesthetics protects the heart against subsequent myocardial ischemia, a phenomenon known as "anesthetic-induced cardiac preconditioning." Here we present evidence showing that the human cardiac mitochondrial KATP channel, reconstituted in lipid bilayers, can be directly activated by isoflurane. This activation apparently does not require the translocation of cytosolic kinases, as previously proposed, in anesthetic-induced preconditioning.
IMPLICATIONS: During anticoagulation with bivalirudin, recovery of thrombin activity is observed due to the decay of bivalirudin. Similar prolongations of ACT between heparin and bivalirudin do not reflect the similar extent of thrombin inhibition.
IMPLICATIONS: After his ninth anesthetic with sevoflurane or isoflurane and opioids, an 8-mo-old infant died of fever, profound metabolic derangement, and massive rhabdomyolysis. Autopsy demonstrated previously undiagnosed Duchenne's muscular dystrophy.
IMPLICATIONS: In a volunteer study, scoring results of the one-channel NarcotrendTM monitor was compared with those from visual expert analysis of five-channel electroencephalogram, which is the basis of NarcotrendTM scoring. Classification differences of more than three substages were noted during more than half of the 24 procedures. Discordant trends for at least five consecutive 20-s epochs were observed in 9 of 24 propofol administrations.
IMPLICATIONS: Small doses of anesthetics can induce an excitatory state characterized by activation of the electroencephalogram and increased responsiveness to noxious stimuli. Here we have shown that low concentrations of pentobarbital are associated with an increased excitability of rat hippocampal neurons in vitro.
IMPLICATIONS: Opioids depress the immune response, but the involvement of opioid receptors on immune cells is controversial. In the blood of volunteers we failed to detect MOP ({micro}), DOP ({delta}), KOP ({kappa}) or Nociceptin receptor (NOP) protein, but we did find NOP mRNA. Direct immunomodulation by opioids in health is unlikely to involve classical opioid receptors, but the nociceptin system may represent a new clinical target.
IMPLICATIONS: Using rats chronically implanted with electrodes, excitatory postsynaptic potential and population spike amplitude were measured in the hippocampal CA1 field by stimulating Schaffer collaterals. Isoflurane depressed excitatory postsynaptic potential responses and enhanced synaptic efficacy, but population spike amplitude was depressed only with high concentrations. This suggests that isoflurane affects multiple sites of CA1 synapses.
IMPLICATIONS: We used the wavelet transform of laser Doppler flowmetry signals to detect changes in the microcirculation of the skin induced by anesthesia with propofol, fentanyl, and midazolam. We found that general anesthesia reduced the components of the signals related to inhibition of sympathetic and myogenic activity and endothelial function.
IMPLICATIONS: Isoflurane, halothane, and propofol depress spinal neurons in the ventral horn, but not the dorsal horn, in the 0.8 1.2 minimum alveolar anesthetic concentration range. These data suggest that immobility likely occurs as a result of anesthetic action on ventral neurons, presumably motoneurons, central pattern generators, and premotor interneurons.
IMPLICATIONS: We evaluated the effects of propofol on oxidative stress-induced endothelial cell insults and the possible protection by Akt modulation of endothelial nitric oxide synthase (eNOS). Our results show that propofol can reduce hydrogen peroxide-induced damage and apoptosis in endothelial cells, by suppressing caspase-3 activity and increasing eNOS expression via an Akt-independent mechanism.
IMPLICATIONS: Sildenafil, as a selective phosphodiesterase type 5 inhibitor, prevents pulmonary artery smooth muscle cell proliferation via upregulation of MKP-1 and degradation of phosphorylation of ERK1/2. This suggests the potential utility of the drug in patients with congenital heart disease complicated by severe pulmonary hypertension and pulmonary vascular remodeling.
IMPLICATIONS: Temporal artery thermometry is not sufficiently precise to be an adequate substitute for temperature measurement by a bladder thermometer.
IMPLICATIONS: Mixed exhaled CO2 (PECO2) is difficult to measure using standard anesthesia equipment. In this study, we demonstrated that mixed exhaled CO2 can be measured by sampling gas from within the bellows of an anesthesia ventilator and used to calculate CO2 production.
IMPLICATIONS: We combined data from an anesthesia or operating room information management system and a pharmacy dispensing system to identify two anesthesia care providers known to have diverted drugs. The methodology, if in use at the time, would have identified their addiction earlier than was actually recognized. This approach may be a useful method to detect drug diversion in the operating room.
IMPLICATIONS: Linking anesthesia information management systems to medication dispensing systems may facilitate automated reconciliation of controlled substances. In practice, there were too many data entry errors in both the automated dispensing and anesthesia information systems for useful automation.
IMPLICATIONS: The academic anesthesiology training programs in the United States reported 25 cases of propofol abuse during the past decade, including 7 deaths, 6 among residents. Programs with lack of control of propofol (e.g. pharmacy accounting) had a significantly higher incidence of abuse (P = 0.048).
IMPLICATIONS: The pressure volume curve may be better than the pressure time curve in evaluating lung recruitment in experimental lung injury.
IMPLICATIONS: Venovenous renal replacement therapy with relatively low flow rates has no clinically relevant effect on the measurement of cardiac index, intrathoracic blood volume, and extravascular lung water by the transpulmonary thermodilution technique in hemodynamically stable patients with sepsis. Furthermore, the position of the dialysis catheter tip (superior vena cava versus inferior vena cava) does not have a significantly different influence under these conditions.
IMPLICATIONS: Continuous subglottic aspiration of secretions often fails, and may injure the airway mucosa.
IMPLICATIONS: Repetitive doses of intrathecal morphine can induce neurologic injury after noninjurious spinal cord ischemia which is ameliorated by IV sedative doses of dexmedetomidine in rats.
IMPLICATIONS: The Nottingham cerebral simulator is a computational model of cerebral blood flow and oxygenation that can be used to simulate, teach, or generate hypotheses related to cerebrovascular physiology.
IMPLICATIONS: The Nottingham Cerebral Simulator (NCS) was used to examine the effects of physiological and pathophysiological changes on cerebral blood flow and oxygenation. The results are consistent with experimental findings, and so the NCS may be used for teaching and hypothesis generation.
IMPLICATIONS: Administration of supplemental oxygen during the interval between delivery of the infant and the end of the cesarean delivery does not appear to reduce the incidence or severity of intraoperative or postoperative nausea or vomiting.
IMPLICATIONS: The authors present and validate a two-dimensional model of the airway. The model helps explain how anatomic relationships affect laryngoscopy.
IMPLICATIONS: We described asystolic episodes from painful acute herpetic ophthalmicus, eventually managed with oxycontin, amitriptyline, gabapentin, and intranasal fentanyl spray.
IMPLICATIONS: An extravasated IV catheter may have serious clinical consequences. The technique described here using indigo carmine dye is a quick, safe, and inexpensive way to confirm IV placement.
IMPLICATIONS: Gabapentin and dexamethasone administered together an hour before varicocele operation results in less laryngeal and tracheal intubation response, better postoperative analgesia, and prevents postoperative nausea and vomiting better than individual administration of each drug.
IMPLICATIONS: Sedation associated with high pain scores occurred during morphine titration in the postanesthesia care unit. Sedated patients in pain frequently reported the memory of moderate-to-severe pain in the postanesthesia care unit and at 24 h after surgery. Concern over side effects associated to morphine sedation is likely to have caused under-treatment of postoperative pain.
IMPLICATIONS: IV regional block with the tumor necrosis factor-{alpha} antibody, infliximib, may be a useful treatment for complex regional pain syndrome 1.
IMPLICATIONS: Epidural tezampanel may be useful for epidural analgesia after surgery.
IMPLICATIONS: Superficial cervical plexus block with 0.35 mL/kg of 0.5% levobupivacaine provided similar anesthetic efficacy as combined superficial and deep cervical plexus block for patients undergoing minimally invasive parathyroidectomy.
IMPLICATIONS: The EpisureTM syringe is a new loss-of-resistance syringe for locating the epidural space. The pressure on the plunger of the syringe is supplied by a spring. The syringe reliably detected needle entry into the epidural space in a laboratory and an animal model and, clinically, in women receiving labor epidural analgesia.
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