Implications: Prophylactic {beta} adrenergic blockade administeredafter elective total knee arthroplasty was associated with areduced prevalence and duration of postoperative myocardialischemia detected with Holter monitoring.
Implications: We performed epiaortic echocardiography duringcoronary artery bypass grafting and found that the presenceof atheroma and deformities at the cross-clamping site weresignificantly more prevalent in nonisoechoic walls than isoechoicwalls.
Implications: Recovery of patients undergoing Minimally InvasiveDirect Coronary Artery Bypass Surgery is significantly shorterand more predictable after total IV anesthesia with remifentanil-propofolthan with alfentanil-propofol, which may be important if thegoal is that patients will be awakened and tracheally extubatedin the operating room.
Implications: The reductions in splanchnic organ blood flowsduring CGRP-induced hypotension with propranolol are due toa reflex augmentation in sympathetic vasoconstrictor tone causedby an increase in plasma catecholamine concentrations. Thesefindings suggest that propranolol may impair splanchnic organblood flow during CGRP-induced hypotension.
Implications: Values from two activated coagulation time-basedtest systems used to identify significant heparin resistanceor platelet dysfunction after cardiopulmonary bypass were notsignificantly affected by epsilon-aminocaproic acid administeredIV.
Implications: This is the first study of the effects of propofolon intracellular Ca2+ concentration and myofilament Ca2+ sensitivityunder physiologic conditions in intact isolated beating guineapig hearts.
Implications: Ketamine, thiopental, and midazolam, but not etomodateor fentanyl, reduce postischemic adhesion of neutrophils inthe coronary system of isolated perfused guinea pig hearts,suggesting a role in mitigating myocardial reperfusion injury.
Implications: In the population studied, small-dose ornipressinwas effective to restore arterial blood pressure without causingmajor ischemic side effects.
Implications: Animal experiments have shown levobupivacaineand ropivacaine to be less cardiotoxic than racemic bupivacaine.This in vivo study, using a validated swine model, comparedthe relative direct cardiotoxicities of these three local anesthetics.The lethal dose did not differ between levobupivacaine and ropivacaine,but was lowest for racemic bupivacaine.
Implications: Thromboelastography is useful in assessing thecoagulopathies that follow cardiopulmonary bypass in children.Modifying blood samples with celite or tissue factor and heparinaseallows thromboelastography begun before the termination of cardiopulmonarybypass to become a rapid point-of-care monitor to provide objectivedata for guiding blood component therapy to manage these coagulopathies.
Implications: In equipotent, clinically relevant concentrations,halothane, but not isoflurane, markedly decreased aortic bloodflow and cardiac performance measured with ultrasound techniquesin chick embryos. Chick and human embryos are similar duringearly stages of development; therefore, chick embryo may bea useful model to study the cardiovascular effects of anesthetics.
Implications: Pulse oximetry that incorporates Masimo SignalExtraction TechnologyTM (Masimo Corporation, Irvine, CA) mayoffer an advantage over conventional pulse oximetry by reducingthe incidence of false alarms while identifying a higher numberof true alarms in children in the postanesthesia care unit.
Implications: Automated, noninvasive blood pressure devicesfacilitate repeated blood pressure measurements in anesthetizedpatients. The authors report the recording of multiple factitiousmeasurements of blood pressure in a small infant by using oneof these devices.
Implications: Approximately one third of all ambulatory caseswere a procedure or combination of procedures possibly performedas infrequently as once per year per facility. This could impairthe effectiveness of predicting the durations of ambulatorycases by using historical case-duration data.
Implications: Findings of this national survey conducted amongactive members of the Society for Ambulatory Anesthesia mayencourage anesthesiologists throughout the world to take a moreliberal attitude toward allowing clear liquids 2-3 h anda light breakfast 6 h before an elective surgery in healthypatients.
Implications: When administered at the end of surgery, 12.5mg of dolasetron IV is as effective as 25 mg of dolasetron IV,4 mg of ondansetron IV, and 8 mg of ondansetron IV in preventingemetic symptoms after otolaryngologic surgery and was associatedwith similar patient satisfaction at a reduced cost. There wereno differences in the antiemetic efficacy of the 4 and 8 mgdoses of ondansetron.
Implications: Compared with sufentanil, 14-methoxymetopone doesnot induce hypoxia and hypercarbia, induces less hypotensionand bradycardia, and induces less sedative effects (electroencephalogram).Antinociception is similar to sufentanil (skin-twitch method,amplitude depression in the evoked potential). All effects arereversed by naltrexone. Interaction of {kappa}-receptor is suggested.
Implications: The addition of fentanyl, a potent opioid, reducedthe intraoperative requirement of propofol, an IV anesthetic,in the order of the plasma fentanyl concentrations. The ceilingeffects of fentanyl were demonstrated in the reduction of propofolrequirements and recovery of consciousness but not in the fentanylrequirements for postoperative analgesia.
Implications: Fechtner's syndrome is a rare form of macrothrombocytopenia(potentially associated with other hemostatic deficiencies,e.g., von Willebrand's disease and protein Z deficiency),which can exacerbate the risk of uncontrollable bleeding duringsurgery. We describe the management of a patient with Fechtner'ssyndrome involving desmopressin, prednisone, and platelets,which produced safe and effective results during cochlear implantsurgery.
Implications: During propofol anesthesia in rabbits with normalbrains, a reduction in the arterial carbon dioxide level maynot always be accompanied by a reduction in brain blood flowand blood volume.
Implications: As compared with a similar dilute concentrationof bupivacaine, 20 mL of dilute (0.08%) ropivacaine combinedwith fentanyl (2 {micro}g/mL) effectively initiates epiduralanalgesia in nulliparous women in early, established labor whilepreserving their ability to micturate and ambulate. Of importance,it appears that a true ambulatory epidural analgesic for womenin labor is now possible.
Implications: We investigated different doses of IV ephedrineas prophylaxis for hypotension during spinal anesthesia forcesarean delivery and found that the smallest effective dosewas 30 mg. However, this dose did not completely eliminate hypotension,caused reactive hypertension in some patients, and did not improveneonatal outcome.
Implications: Cutaneous toe temperatures approaching core temperatureprovide a useful monitor of lumbar sympathetic block and maypredict relief of sympathetically maintained pain. Iohexol willnot compromise temperature changes or pain relief.
Implications: Paravertebral nerve block has the potential tooffer long-lasting pain relief and few postoperative side effectswhen used for breast surgery. We demonstrated that paravertebralnerve block, when compared with general anesthesia, is an alternativetechnique for breast surgery that may offer pain relief superiorto general anesthesia alone.
Implications: Our results show that the loss of sensation totranscutaneous electrical stimulation at 10 mA, but not cold,pinprick, or touch, is a good predictor of the dermatomal levelof block to transcutaneous electrical stimulation at 60 mA,which is considered equivalent to the dermatomal level of surgicalanesthesia after the administration of spinal anesthesia.
Implications: Recent studies suggest that opioids can have anadverse impact on the immune system. Because surgical stressalso induces immune dysfunction, the search for analgesic drugsdevoid of immunosuppressive effects is of import. This studycompared the effects on immune responses of morphine and ofthe atypical opioid analgesic, tramadol, given for postoperativepain to gynecological cancer patients. Tramadol and morphineshowed comparable analgesic activity; however, tramadol, incontrast to morphine, induced an improvement of postoperativeimmunosuppression and, therefore, may be preferred to morphinefor the treatment of postoperative pain.
Implications: Raynaud's disease is an episodic and debilitatingdisease of the circulation to the fingers and toes. This casereport describes an acute exacerbation of Raynaud's diseasein a patient undergoing surgery with epidural anesthesia. Thispotentially hazardous complication has not been previously reported.
Implications: Even though ketamine 0.4 mg/kg IV has short-lastingacute analgesic effects, it failed to produce a preemptive effectwhen given before abdominal hysterectomy procedures.
Implications: In a randomized, double-blinded, placebo-controlled,clinical study, ondansetron 8 mg IV, given just before the induction,reduced the incidence of postanesthetic shivering compared withsaline. The anticipated core-to-peripheral redistribution ofbody temperature during general anesthesia was not affected.This implies that ondansetron probably acts by a central inhibitorymechanism, and that 5-hydroxytryptaminergic pathways have arole in regulating postanesthetic shivering.
Implications: Production of the toxic substances, carbon monoxideand Compound A, from anesthetic degradation by carbon dioxideabsorbents, might be minimized by the use of one of two specificabsorbents, Amsorb(R) (Armstrong Medica, Ltd., Coleraine,Northern Ireland) (calcium hydroxide which also includes 0.7%polyvinylpyrrolidine, calcium chloride, and calcium sulfate)or lithium hydroxide.
Implications: Safe ventilation is desired when performing tracheobronchialstent implantation and balloon dilation with the fiberscope.High frequency jet ventilation, applied with a 14F insufflationcatheter through the nasotracheal route, offers safe ventilatorysupport with minimal complications. This was evaluated in 161procedures treating benign and malignant airway stenoses.
Implications: We assessed the effect of the {alpha}2-adrenoreceptoragonist clonidine on the immunoendocrine activity during theperioperative period. Clonidine 0.15 mg given as oral premedicationresulted in the reduced Interleukin-6 production in responseto total abdominal hysterectomy.
Implications: Unlike the rat, the ability of the rabbit to clearfluid from the alveolar space through amiloride-sensitive pathwaysis not decreased by halothane anesthesia.
Implications: Remifentanil and propofol mixtures may be preparedextemporaneously. This study demonstrated that such mixturesare stable for 0 to 36 h, depending on relative concentrationsof the drugs and the storage container used. The most stablemixtures were stored in syringes and used large concentrationsof the two drugs.
Implications: We measured plasma propofol levels by head space-gaschromatography analysis using solid-phase microextraction. Thismethod saves time, and does not require elimination of interferingsubstances in the plasma. The coefficient variation was {+/-}5%to {+/-}30%. The detection limit was 10 ng/mL.
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