Implications: The present study indicates that rats below 3wk old lack an antinociceptive effect to nitrous oxide by usingthe tail flick test. Because a 3-wk-old rat is comparable inneurological development with the toddler stage in humans, wemay anticipate that patients below this age may not experiencethe usual analgesic effect of nitrous oxide.
Implications: We studied the efficacy of ketorolac, a prostaglandinsynthesis inhibitor, in the treatment of bladder spasm afterureteroneocystostomy (antireflux operation). Patients wererandomized in a double-blinded manner to receive either ketorolacor placebo after the surgery. We demonstrate that ketorolacreduces the frequency and severity of postoperative bladderspasm.
Implications: Children with Duchenne's muscular dystrophyshould not be exposed to succinylcholine because of the riskof hyperkalemic cardiac arrest and rhabdomyolysis. This reportdescribes the response to rapacuronium bromide in two patientswith Duchenne's muscular dystrophy. Both patients hada recovery index 2 times longer than that reported in childrenwith normal neuromuscular function.
Implications: In a randomized study of 132 consecutive patientsundergoing liver transplantation, we found that tranexamic acid,but not {epsilon}-aminocaproic acid, reduced intraoperative total packedred blood cell transfusion.
Implications: Rabbits may serve as a model of hemostasis thatclosely approximates human situations to mechanistically determinethe etiology of coagulopathy. The contribution of platelet functionto total clot strength is similar to that observed in humans.
Implications: No convenient test has been validated as an indicatorof salvaged erythrocyte cleanliness. This in vitro study suggeststhat residual potassium concentration seems to be a good indicatorof quality after washing with a contemporary intraoperativesalvage system.
Implications: The efficacy of interpleural analgesia to reducepostoperative pain intensity in patients after lateral thoracotomyis controversial. In this study, we demonstrated a lack of efficacyof interpleural analgesia.
Implications: In this double-blinded, randomized study, we evaluatedwhether morphine could induce immediate cardiovascular stimulation,as seen previously in animal studies. In healthy volunteers,during a painful stimulus, morphine caused an initial, transienthemodynamic stimulation, accompanied by increased oxygen consumption,without detectable release of histamine or catecholamines intothe plasma. Oxycodone caused only minor hemodynamic alterations.
Implications: This study investigates the effect on the heartand blood vessels of various rates of administration of bolusesof a relatively new potent opiate, remifentanil, to patientswith coronary artery disease. The results show that remifentanilshould be given only by slow infusion to such patients.
Implications: This is the first study providing evidence thatthiopental-induced vascular contraction is caused by Ca2+ releasefrom the sarcoplasmic reticulum of the smooth muscle.
Implications: Etomidate produced a similar dose-dependent negativeinotropic effect in both failing and nonfailing human myocardium.This effect was present only at concentrations exceeding thoseattained clinically and was reversible with {beta}-adrenergicstimulation.
Implications: Vasodilation of very small coronary arteriolesby isoflurane depends on preexisting tone and may in part bemediated by the K+-ATP channels.
Implications: Evaluation of intracellular Ca2+ oscillationsin neonatal rat myocytes suggests that increased extracellularK+ may be an important component of bupivacaine cardiotoxicity.
Implications: A desflurane-based general anesthetic techniqueusing the cuffed oropharyngeal airway device was found to bea highly acceptable alternative to propofol-based monitoredanesthesia care sedation for outpatient immersion lithotripsy.
Implications: This study assessed the validity of a novel functionalability questionnaire that measured functional status afterrecovery from anesthesia and satisfaction 24 h after outpatientsurgery. The content, construct, discriminant, and criterion(predictive) validities demonstrated the utility of this assessmentinstrument in the outpatient setting.
Implications: We compared the classic mixture of lidocaine 2%plus bupivacaine 0.5% to mepivacaine 2% for caruncle episcleral(sub-Tenon) anesthesia for cataract surgery. Mepivacaine provideda more efficient block with a quicker onset and a quicker recovery.However, these differences were very small and were of littleclinical interest.
Implications: The mechanism of acute tolerance to the analgesiceffect of alfentanil depends on participation of multiple systemsof adaptation that include cholecystokininB receptors and N-methyl-D-asparticacid-nitric oxide cascade. Drugs that inhibit function of thesesystems attenuate tolerance development.
Implications: Maintenance of anesthesia with remifentanil-nitrousoxide (N2O), compared with isoflurane-N2O-fentanyl, can safelyshorten postoperative recovery of cognitive function in a geriatricpopulation. Earlier recovery may facilitate postoperative neurologicalassessment. Use of remifentanil-N2O for maintenance did notshorten the overall length of stay in the postanesthesia careunit, a stay often related to multiple administrative issues,rather than cognitive recovery.
Implications: Remifentanil anesthesia, combined with small-dosepropofol, desflurane, or sevoflurane, enables predictably fastand smooth early recovery after ear, nose, and throat surgery.Despite such faster, early recovery and less need for postoperativeanalgesic and antiemetic medication, late recovery was comparableamong the remifentanil combination groups and the control group.
Implications: We demonstrated that 0.6 minimal alveolar concentrationof nitrous oxide combined with a potent anesthetic and an opioidprevents movement after orotracheal intubation without affectingthe bispectral index. This demonstrates that the bispectralindex is not a useful neurophysiologic variable to monitor thelevel of anesthesia when nitrous oxide is added to a generalanesthetic regimen using propofol and remifentanil.
Implications: We evaluated the effect of timing of dexamethasoneadministration on its efficacy as a prophylactic antiemeticon postoperative nausea and vomiting. We found that dexamethasone,when given immediately before the induction of anesthesia, wasmore effective than when given at the end of anesthesia.
Implications: Deliberate mild hypothermia has been proposedas a means of providing cerebral protection during neurosurgicalprocedures. Our results suggest that cerebral blood flow autoregulationin response to hemorrhagic hypotension may be impaired duringhypothermic conditions, indicating the importance of maintainingperfusion pressure during hypothermic therapy to prevent cerebralischemia.
Implications: Differential anesthetic effects on ischemic outcomeare independent of effects on adrenergic/noradrenergic responsesto ischemia. The absence of a consistent differential effectof anesthetics on either corticosterone or cytokine responsesto ischemia serves to further refute the hypothesis that isofluraneneuroprotection can be attributed to dampening of adverse stressresponses to ischemic insults.
Implications: The introduction of desflurane after the inductionof anesthesia leads to significant disturbances in cerebraland systemic hemodynamics suggesting loss of cerebral autoregulationand cerebral hyperemia. This may have implications for patientsundergoing anesthesia for intracranial surgery.
Implications: Patients given remifentanil-based anesthesia forcraniotomy had faster recovery times from anesthesia than didthose given fentanyl-based anesthesia.
Implications: We found that the use of a zero-pressure trachealfoam cuff was the ideal way to drain the intestines througha colostomy, reducing skin irritations and mucosal damage.
Implications: Ondansetron prophylaxis significantly decreasesthe incidence of pruritus, a common side effect of intrathecalmorphine used to treat postcesarean delivery pain.
Implications: We demonstrated that, after total knee arthroplasty,an extended "3-in-1" block consisting of patient-controlledanalgesia boluses (10 mL/60 min) of 0.125% bupivacaine with1 {micro}g/mL clonidine provides efficient postoperative analgesiaand significantly minimizes local anesthetic consumption.
Implications: This prospective, randomized, blinded study wasconducted to evaluate the effect of searching for multiple musculartwitches when performing femoral nerve block with small volumesof 0.75% ropivacaine. Our results demonstrated that multipleinjections markedly shortened the onset time and improved thequality of nerve blockade. This technique-related effect mustbe carefully considered when different clinical studies evaluatingthe use of new local anesthetic solutions for peripheral nerveblocks are compared.
Implications: In a randomized, placebo-controlled, double-blindedtrial with 12 healthy volunteers, we studied the interactionof morphine and gabapentin using the cold pressor test. Theanticonvulsant gabapentin enhanced the acute analgesic effectof morphine. Furthermore, the plasma concentration of gabapentinwas increased when morphine was administered concomitantly.Therefore, the well tolerated combination of gabapentin andmorphine may improve pain therapy, especially in pain states,like chronic and neuropathic pain, which respond poorly to opioids.
Implications: An infusion balloon is a well established deviceused to continuously supply drugs for pain management. In thisstudy, we determined the concentration of lidocaine that flowedout of a balloon because the balloon is made from plastics thatadsorb local anesthetics.
Implications: The intubating laryngeal mask produces segmentalmovement of the cervical spine, despite manual in-line stabilizationin patients with cervical spine pathology undergoing cervicalspine surgery. This motion is in the opposite direction to directlaryngoscopy, suggesting that different approaches to airwaymanagement may be more appropriate depending on the nature ofthe cervical instability.
Implications: Tracheal intubation with an endotracheal tubeis often necessary during anesthesia. After intubation, inflatinga cuff around the endotracheal tube maintains a seal. This canresult in coughing during emergence from anesthesia. Our studyshows that inflating the cuff of an endotracheal tube with lidocainerather than air can reduce the incidence of postextubation coughing.
Implications: We measured the lidocaine metabolite monoethylglycinexylidide,the cytosolic liver enzyme, {alpha} glutathione S-transferase, andgastric mucosal tonometry-derived variables to evaluate theeffects of desflurane and sevoflurane on hepatic function inelderly patients. Liver function was well preserved, whereasincreased {alpha} glutathione S-transferase levels and changes in tonometry-derivedvariables indicated a reduction in splanchnic blood flow anda temporary impairment of hepatocyte oxygenation for both anesthetics.
Implications: Sevoflurane and propofol had similar efficacyfor anesthetic induction. However, for routine outpatient surgery,propofol may still be the preferred induction anesthetic becauseof its favorable induction of anesthesia characteristics, highpatient satisfaction, and less frequent incidence of postoperativenausea and vomiting.
Implications: Carbon dioxide absorbents containing potassiumhydroxide/sodium hydroxide produce much larger concentrationsof Compound A from sevoflurane in clinical practice. An absorbentcontaining neither potassium hydroxide nor sodium hydroxideproduces the smallest concentrations of Compound A.
Implications: The potency order and ratio of ketamine isomersfor inhibition of N-methyl-D-aspartate receptor channels maynot be so different between the brain region and the developmentalstage.
Implications: We examined the potentiation by ketamine of the{gamma}-aminobutyric acidA receptor function using convulsive and anestheticbehavioral models in mice. Subanesthetic doses of ketamine-inhibitedtonic convulsions induced by the {gamma}-aminobutyric acidA receptorantagonist bicuculline. The {gamma}-aminobutyric acidA receptor agonist,muscimol, potentiated ketamine-induced anesthesia. Bicucullineantagonized ketamine anesthesia, but the benzodiazepine receptorantagonist, flumazenil, and the {gamma}-aminobutyric acid synthesisinhibitor, L-allyglycine, did not. The effects of ketamine onthe {gamma}-aminobutyric acidA receptors appear to correlate with itsanesthetic actions.
Implications: Intraoperative hypoxia occurred in two patientsduring the maintenance of the medical gas system. Engineerswere purging oxygen pipelines with nitrogen to remove particulatedebris but were unaware of a connection to operating room pipelines.This case illustrates the importance of communication betweenanesthesia providers and engineers servicing the gas system.
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