Implications: The current dosing schedule for aprotinin results in a large variation in aprotinin plasma concentrations among patients and a large variation within each patient over time. We combined the information provided by our study with that of a previous pharmacokinetic study to develop a potentially improved, weight-based, dosing regime for aprotinin.
Implications: Modified ultrafiltration may enhance the eliminationof recombinant-hirudin, although plasmapheresis systems providethe most rapid and complete elimination of recombinant-hirudinduring simulated cardiopulmonary bypass. The decision to usea specific system will ultimately depend on the prevailing clinicalsituation and overall health of the patient.
Implications: We examined the association between myocardialfunction and proinflammatory cytokines after esophagectomy.Interleukin-6 may be the cytokine that most sensitively reflectsthe postoperative myocardial dysfunction.
Implications: By using intact, isolated rat heart ventriclecells, we investigated the mechanisms and concentration dependenceof the depressant effect of propofol on contractility of theheart. We conclude that direct effects of propofol on the heartare unlikely to be of significance at the clinical dosage usuallygiven.
Implications: As part of a cardiac fast-tracking program involvingdesflurane anesthesia, the use of intrathecal morphine in combinationwith a remifentanil infusion provided improved postoperativepain control, compared with IV sufentanil alone.
Implications: The authors describe the occurrence of severepostoperative pain and long thoracic nerve injury after Port-Accessminimally invasive mitral valve surgery. The potential for theseevents and the impact on postoperative hospitalization and rehabilitationare emphasized.
Implications: Inhaled prostacyclin (PGI2) can be used as aneffective pulmonary vasodilator intraoperatively to treat pulmonaryhypertension and impending right ventricular failure.
Implications: The authors describe two cases of massive intraoperativepulmonary thromboembolism resulting in cardiovascular collapseduring liver transplantation. The potential role of antifibrinolyticdrugs is discussed, along with the use of treatment modalitiesnot previously applied in this setting.
Implications: Tracheal bronchus is a congenital anomaly in whichthe right upper lobe bronchus originates from the lateral trachealwall. This anatomic variant is reported in approximately 1 of250 patients at bronchoscopy. Although it is usually of littleclinical significance, this atypical origin of the right upperlobe bronchus may complicate one-lung ventilation during thoracicsurgery.
Implications: This study examines the management of patientsdiagnosed with pheochromocytoma at a major academic teachinghospital. The findings indicate that most patients can be safelymanaged as outpatients preoperatively, resulting in significantlyshorter hospitalizations and no adverse sequelae.
Implications: The awakening concentration of sevoflurane inunpremedicated children was 0.78%. Oral clonidine premedicationat a dose of 2 {micro}g/kg reduced the awakening concentrationto 0.36%. However, an additional decrease in this value wasnot observed after the administration of the larger dose ofclonidine premedication (4 {micro}g/kg).
Implications: Propionic acidemia is a rare genetic disease associatedwith significant medical problems. When patients with this diseasepresent for surgery, their anesthetic must be tailored to meettheir special needs. This case report provides information regardingpropionic acidemia and its anesthetic management.
Implications: The results of this study show that the frequencyof muscle pains after surgery in outpatients is approximately20%, regardless of whether succinylcholine (after precurarization)or mivacurium is used to assist in insertion of the breathingtube.
Implications: Using a small volume of distilled water as thediluent for endobronchial epinephrine administration significantlyincreased epinephrine absorption and arterial pressure in comparisonwith normal saline, without having a serious detrimental effecton PaO2, in an anesthetized, noncardiopulmonary, resuscitationdog model.
Implications: The mechanisms by which chronic glucocorticoidtherapy alters neuromuscular physiology and pharmacology areunclear. We suggest that the observed effects are dose-dependentand derive primarily from muscle atrophy and derive less fromchanges in acetylcholine receptor expression.
Implications: A total of 14 brain-injured patients with theclinical criteria of imminent brain death were enrolled forelectrocardiogram recording and heart rate variability analysis(a noninvasive method to investigate autonomic nervous systemactivity). For 6 h before brain death, we observed a progressiveextinction of autonomic nervous system activity which was notpresent as soon as brain death was clinically evoked.
Implications: In a hospital with a sophisticated material managementinformation system, operating room managers will probably achievegreater cost reductions from focusing on negotiating less expensivepurchase prices for items than on trying to link the operatingroom information system with the hospital's material managementinformation system to achieve just-in-time inventory control.
Implications: This report demonstrates the extremely high yieldof autopsies performed in the case of postoperative death withsuspicion of malpractice. They frequently identified undetectedcomplications. They could also suggest faulty or negligent practicethat would otherwise go unrecognized. This report supports thewidespread use of autopsies to investigate perioperative death.
Implications: This study is a preliminary report evaluatingthe changes in cerebral oxygenation during the tracheal extubation.Cerebral oxygenated hemoglobin increased significantly, presumablycaused by the increase in cerebral blood flow during extubation.In addition, these changes were enhanced by calcium channelblockers.
Implications: Cytosolic calcium concentration and metabolismwere measured in cultured astrocytes, the predominant glialcells. The results suggest that dexmedetomidine may owe itsanesthetic effects to a Ca2+-dependent increase in astrocyticenergy metabolism, allowing these cells to more effectivelyremove extracellular glutamate and potassium ions, and thus,decreasing neuronal excitability.
Implications: Nausea and vomiting after brain surgery are particularlytroubling, because effective treatment may cause sedation, makingpostoperative neurological assessment difficult. Our study showsthat both ondansetron and droperidol are effective in reducingnausea, and that droperidol is particularly effective in reducingvomiting. Neither drug caused more sedation than placebo.
Implications: Hypocapnia increases the toxic dose of lidocainegiven IV without altering lidocaine concentrations in blood,brain, or cerebrospinal fluid. Whole-brain monoethylglycinexylidide concentration is greater during hypocapnia than duringnormocapnia, and the addition of epinephrine to lidocaine increasesthe concentration of monoethylglycine xylidide in plasma.
Implications: Obtaining informed consent for obstetric anesthesiastudies presents a challenge to the anesthesiologist. Resultsfrom this study suggest that the environment in which consentfor obstetric studies is sought is not coercive. However, itis important that the anesthesiologist ensures that the patientfully understands the study and develops a rapport with thepatient to allay any anxiety associated with her participationas a potential research subject.
Implications: In early laboring patients, epidural fentanyl100 {micro}g, after a lidocaine and epinephrine test dose, providesanalgesia comparable to that of sufentanil 20 {micro}g.
Implications: The addition of verapamil to brachial plexus blockwith lidocaine and morphine prolongs the duration of sensoryanesthesia, but has no effect on analgesic duration or 24 hanalgesic use.
Implications: It is still unclear whether the addition of aperipheral opioid is useful for nerve blockade in humans. Peripheralapplication of fentanyl to lidocaine for axillary brachial plexusblockade in this study provided an improved success rate ofsensory blockade and prolonged duration.
Implications: This prospective, randomized, double-blinded studydemonstrated that, when providing combined sciatic-femoral nerveblock for hallux valgus repair, the addition of 1 {micro}g/kgclonidine to 0.75% ropivacaine prolongs the duration of postoperativeanalgesia by 3 h, with only a slight and short-lived increasein the degree of sedation and no hemodynamic adverse effects.
Implications: In patients undergoing total hip replacement,the addition of the {alpha}2-adrenergic agonist clonidine to epiduralinfusions of levobupivacaine significantly improved postoperativeanalgesia.
Implications: Current perception thresholds at the 70{degrees} tilt-upposture were significantly lower than those at the horizontalposture. When the compensatory mechanism for preserving bloodpressure was emphasized, the current perception thresholds wouldhave a relational connection to mean systolic blood pressure,similar to the concept of hypertension-induced hypoalgesia.
Implications: Local anesthetic instillation (ropivacaine ratherthan bupivacaine) at the end of laparoscopy prevents postoperativepain and dramatically decreases the need for morphine. Thistechnique, compared with placebo, is safe, improves patientcomfort, shortens the stay in the postoperative care unit anddecreases nursing care in the ward.
Implications: Trigger-point injection with a mixture of commerciallyavailable 1% lidocaine in sterile distilled water at a ratioof 1:3 compared with 1% lidocaine alone resulted in better efficacyand less injection pain. This simple procedure may be suitablefor treatments of a wide range of myofascial pain syndromes.
Implications: Here we show that the more potent optical R-isomerof bupivacaine (Bup) can be used at a smaller dose (80%) thanthe S-isomer of Bup to give equal pain relief of a skin prick.Although the analgesia from R-Bup is briefer than that fromequipotent S-Bup solutions, the durations become equal whena very dilute solution of the vasoconstrictor epinephrine ismixed with the R-isomer. The resulting vasoconstriction thusreduces vascular drug uptake and peak blood levels of systemicdrug, reducing potential toxicity.
Implications: This study shows that spinal ibuprofen blocksopioid withdrawal hyperalgesia in the rat in a stereospecificfashion, implicating the likely release of spinal prostaglandinsduring withdrawal and their possible role as neuromodulatorsin the enhancement of nociception that accompanies this phenomenon.
Implications: Two isomers of liposome (L-dipalmitoylphosphatidylcholine and D-dipalmitoylphosphatidyl choline) encapsulationof morphine prolonged the analgesic effect on acute thermal-inducedpain when administered intrathecally and could decrease sideeffects, compared with morphine alone.
Implications: Intrathecal baclofen is a useful therapy in patientswith spasticity. We describe a patient who underwent an intrathecalpump implant, complicated by epidural lipomatosis that ultimatelyrequired a single level laminectomy and fat debulking beforesuccessful implantation.
Implications: We describe a case of neurological symptoms afterthe intrathecal use of an opioid. These symptoms were not reversibleby the use of an opioid-antagonist.
Implications: Sevoflurane degradation to Compound A is decreasedby lowering the concentration of monovalent bases in the carbondioxide absorbent (Dragersorb 800 Plus(R) [Drager,Luebeck, Germany] and Medisorb(R) [Datex-Ohmeda, Bromma, Sweden])and is virtually eliminated in the absence of these bases (Amsorb(R)[Armstrong Medical, Coleraine, Northern Ireland]).
Implications: Inhaled anesthetics increase intracellular ionizedcalcium in the skeletal muscle cell and the ionized calciumincrease is partly released from the intracellular store byinositol 1,4,5-triphosphate (IP3) formation. IP3 plays an importantrole in excitation-contraction coupling and malignant hyperthermia.We studied whether sevoflurane affects IP3 formation and themechanisms that modulate IP3.
Implications: We determined, in vitro, that carbon monoxide(CO) formation from isoflurane by dry soda lime is reduced bycarbon dioxide (CO2). We believe that the potential for injuryfrom CO is less in the clinical milieu than suggested by datafrom experiments without CO2 because of an interdependence betweenCO formation and CO2 absorption.
Implications: The diagnostic outcomes of tests for malignanthyperthermia susceptibility were compared between two laboratoriesby using muscle tissue from the same patients. Identical outcomeswere found for 56% of the patients. Almost all diverging outcomeswere seen in cases with a few small contractures near the cutofflimit. Different diagnostic criteria for clinical and scientificpurposes are suggested.
Implications: In this study, contrary to all preceding studiesusing predefined doses of propofol and opioids, we determinedthe minimal required propofol dose in combination with fentanylfor conventional or fiberoptic nasotracheal intubation withoutmuscle relaxants.
Implications: The inhaled anesthetics isoflurane, halothane,nitrous oxide, and diethyl ether produce antianalgesia at subanestheticconcentrations, with a maximal effect at approximately one-tenththe concentration required for anesthesia. This effect may enhanceperception of pain when such small concentrations are reachedduring recovery from anesthesia.
Implications: Glycopyrrolate induces long-lasting hyposalivationand decreases the secretion of salivary immunologic and nonimmunologicdefense factors in healthy volunteers.
Implications: Premedication with 0.05 mg/kg melatonin was associatedwith preoperative anxiolysis and sedation without impairmentof cognitive and psychomotor skills or affecting the qualityof recovery.
Implications: By measuring single-fiber chemoreceptor activityin anesthetized rabbits, we showed that isoflurane at 1.0% end-tidalconcentration does not depress the hypoxic chemosensitivityof peripheral chemoreceptors during either hypo-, normo-, orhypercapnia in this species.
Implications: We evaluated vecuronium-induced neuromuscularblock in both arms of a patient with cerebral palsy and hemiplegia.A remarkable resistance to vecuronium was observed in the hemiplegiaside compared with cerebral palsy side. Complete recovery fromneuromuscular block should be assessed in the cerebral palsyside that shows a delayed recovery.
To see an article, click its [Full Text] or [PDF] link. To review many abstracts, check the boxes to the left of the titles you want, and click the 'Get All Checked Abstract(s)' button. To see one abstract at a time, click its [Abstract] link.