Implications: The study demonstrates the techniques and feasibility of the use of regional anesthesia in pediatric patients undergoing a variety of cardiothoracic operations. Regional anesthesia is compatible with immediate extubation after cardiopulmonary bypass in pediatric patients. The thoracic (T6-12) catheter epidural approach may be preferable to other regional approaches. There were no cases of symptomatic periduaral hematoma in 220 patients.
Implications: Techniques for combining regional and general anesthesia in children undergoing open heart surgery are described. Patients having spinal anesthesia may require more sedative/analgesic interventions postoperatively compared with those having epidural anesthesia. A prospective study with a larger sample size is required to determine other differences, including the incidence of postoperative vomiting.
Implications: Chest tube removal is one of the most painful parts of the cardiothoracic surgical experience. This study compared EMLA(R) (Astra Pharmaceuticals, Wayne, PA) cream to morphine in providing pain relief for chest tube removal. EMLA(R) can be used as a useful means of controlling the pain of chest tube removal.
Implications: This study demonstrates that adding fentanyl to bupivacaine for caudal epidural blocks has no beneficial effect on the stress response in pediatric patients undergoing inguinal herniorrhaphy, as evaluated by plasma epinephrine and norepinephrine values, compared with bupivacaine alone.
Implications: By using the whole-cell patch technique, ropivacaine is a voltage- and use-dependent inhibitor of the sodium current in dorsal horn neurons; it preferentially acts on steady-state inactivation by the sodium channel. The inhibition of ropivacaine on the sodium channel may contribute to the mechanism of action of local anesthetics during epidural and spinal anesthesia.
Implications: Both gene expression and production of proinflammatory cytokines were greater in alveolar than plasma leukocytes after cardiopulmonary bypass. These results suggest that cardiopulmonary bypass provokes more serious pulmonary than systemic inflammatory responses.
Implications: The increases in neutrophil number, interleukin-8, and elastase concentrations in bronchoalveolar lavage correlated significantly with decreases in arterial oxygenation. Our results suggest immunologic responses in the distal airway are closely related to pulmonary gas change.
Implications: Health care economics has challenged clinicians to reduce costs and improve resource use in cardiac surgery and anesthesia in a patient population increasing in age and in severity of disease. Optimizing cardiovascular function to maintain adequate oxygen delivery during the immediate postoperative period after cardiac surgery can decrease morbidity and reduce length of hospital stay.
Implications: The {alpha}2 agonist, medetomidine, decreased and redistributed organ blood flow in sheep. Although the highly selective {alpha}2 antagonist, atipamezole, reversed medetomidine-induced hemodynamic changes, blood flow to the heart and kidney rmeoaned significantly depressed, whereas skeletal muscle blood flow increased to twice baseline values.
Implications: Mean frequency and amplitude of ventricular fibrillation predicted successful defibrillation in pigs. Vasopressin was superior to epinephrine in maintaining these variables above a success defibrillation threshold.
Implications: In vitro addition of antithrombin III (0.2 U/mL) to heparinized blood samples (4.1-6.8 units of heparin/mL) from patients on previous heparin therapy increases sensitivity to supplemental heparin as reflected by significantly prolonged activated clotting time.
Implications: Exposure of the left ventricular myocyte to endothelin during cardioplegic arrest directly contributed to contractile dysfunction after reperfusion. Moreover, alterations in intracellular calcium may play a role in potentiating the myocyte contractile dysfunction associated with endothelin exposure during cardioplegic arrest.
Implications: In view of the possible significance for volatile anesthetics in cardiac surgery, the effects of sevoflurane and halothane were compared on postcardioplegic recovery of rat hearts. Both anesthetics were equally effective in improving functional recovery after normothermic cardioplegic arrest. Sevoflurane's beneficial effects were abolished by glibenclamide, suggesting a role for the adenosine triphosphate regulated potassium channel.
Implications: The intraarticular administration of both clonidine and morphine along with bupivacaine improves postoperative analgesia compared with either drug alone. There was an increased time to first analgesic request, decreased need for postoperative analgesics, and lower pain scores after arthroscopic knee surgery.
Implications: In a prospective trial of 168 patients, the use of sedation significantly reduced pain during a multiple-nerve stimulation block. The combination of sufentanil and midazolam produced either minimal or no sedation and allowed the performance of the block in awake and cooperative patients. Light sedation may improve patient acceptance of this technique
Implications: This systematic review indicates that there is little evidence for the analgesic benefit of adding opioids to brachial plexus block. Clonidine appears to be beneficial in doses up to 150 {micro}g. There are currently insufficient data with regard to neostigmine and tramadol to allow for further recommendations.
Implications: Susceptibility to the proconvulsant action of lidocaine is significantly lower in kindled epileptic rats compared with nonepileptic rats.
Implications: The value of the minimum effective anesthetic concentration for hyperbaric spinal bupivacaine is dose-dependent. Complete anesthesia can be achieved with smaller concentrations when the dose of spinal anesthetic is increased. The current commercially available 0.75% concentration of hyperbaric bupivacaine seems to be clinically optimal when 10 mg is used if complete bilateral lower extremity blockade is desired.
Implications: This study demonstrates a spinal action of the nonsteroidal antiinflammatory drug, diclofenac, in response to a peripheral insult. Whether the action is caused by reduced peripheral neural activity cannot be ascertained. The action was consistent with a ceiling effect of diclofenac as often found clinically with this class of analgesic drug.
Implications: Epidural administration of adenosine triphosphate-sensitive potassium channel openers potentiated the analgesic actions of morphine and an {alpha}2-adrenergic agonist, presumably via activation of adenosine triphosphate-sensitive potassium channels at the spinal cord level.
Implications: Clonidine and ketorolac are two important drugs used to give pain relief to patients. We observed that ketorolac inhibits clonidine-induced analgesia in the rat. We recommend that this drug interaction should be taken into account when both clonidine and ketorolac are used together to alleviate pain in patients.
Implications: Induction of anesthesia by using a target-controlled infusion system is influenced by both age and premedication. We define the effect site propofol concentration required for hypnosis with an alternative system to that of plasma-effect site equilibration. These findings may have an impact on the induction with pumps targeting an effect site concentration.
Implications: Intrathecal fentanyl as part of a spinal anesthetic for cesarean delivery is superior to IV ondansetron for the prevention of intraoperative nausea. In addition, intrathecal fentanyl offers better perioperative pain control and is less expensive than ondansetron.
Implications: Alfentanil 10 {micro}g/kg given at the induction of general anesthesia for cesarean delivery attenuates the subsequent maternal stress response. However, all neonates should be monitored for possible immediate but transient respiratory depression.
Implications: In this study, there were quantitative and qualitative interanesthetic and interorgan differences in the expression of immediate-early genes, showing that general anesthetics can stimulate, rather than suppress, some intracellular events. Our results suggest that the appropriate anesthetics to be used to anesthetize animals differ in accord with the target organs in which the expressions of immediate-early genes in response to stimuli were studied.
Implications: Isoflurane (ISO) interacts with the inhibitory {gamma}-aminobutyric acid (GABA) receptor. This patch clamp study demonstrates that it may block or potentiate the type A of GABA receptor studied, depending on the concentrations of ISO and of GABA used. At clinically relevant concentrations, ISO considerably potentiates this receptor. This may partly explain its clinical effect.
Implications: Averaging of single-dose estimates of neuromuscular potency provides a useful adjunct and reasonable alternative to conventional regression analysis.
Implications: We observed the effect of pneumoperitoneum on the middle hepatic venous blood flow by transesophageal echocardiography and liver function in elderly patients undergoing laparoscopic cholecystectomy. Laparoscopic cholecystectomy may impair hepatic function in elderly patients because high pressure is maintained in the peritoneal cavity for an extended period.
Implications: A lightwand technique was accompanied by less hemodynamic changes after tracheal intubation than the laryngoscopic technique in normotensive patients. In hypertensive patients, however, no difference was found between the two techniques.
Implications: The IV administration of chloroprocaine effectively blunted cardiovascular response produced by laryngoscopy and endotracheal intubation, and this effect was more pronounced when compared with IV lidocaine.
Implications: This prospective, randomized, double-blinded study shows that the inhalation of nitrous oxide can reduce the dose of propofol required to induce anesthesia. The technique leads to good induction conditions with reduced usage of propofol.
Implications: We concluded that a dose of 0.5 mg {middle dot} kg-1 of esmolol significantly prolongs the onset time of rocuronium with minimal hemodynamic changes.
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