Implications: Postoperative cerebral hypoperfusion, indicated by oxyhemoglobin desaturation < 50%, occurs in many patients after coronary artery bypass graft surgery. However, this measurement of hypoperfusion does not appear to influence long-term cognition after coronary artery bypass graft surgery.
Implications: Xenon might be a suitable volatile anesthetic in an ischemia-reperfusion situation.
Implications: The use of the volatile anesthetic desflurane during cardiac ischemia is controversial because of its effect of sympathetic activation. In chronically instrumented dogs, recovery from myocardial stunning was faster when desflurane was used for anesthesia during ischemia compared with propofol.
Implications: Although cerebral oximetry was easy to apply but considerably unspecific (13% false positives), transcranial Doppler ultrasonography was more accurate in indicating the risk of cerebral hypoperfusion during carotid cross-clamping. Additionally, the improvement in cerebral blood flow velocity after inducing arterial hypertension might prevent cerebral hypoperfusion during cross-clamping.
Implications: We compared the relaxant effects of olprinone and aminophylline on serotonin-induced pulmonary hypertension and bronchoconstriction in dogs. Olprinone was a more potent pulmonary vasodilator and bronchodilator than aminophylline. In addition, olprinone may produce greater effects on phosphodiesterase-3 in pulmonary vascular than in airway smooth muscle.
Implications: We demonstrate that serum K+ concentration, serum lactate, and cardiac index during the anhepatic phase predict K+ concentration just after revascularization in orthotopic liver transplantation and that the extent of preservation injury of graft liver and duration of cold ischemia do not contribute significantly to the induction of hyperkalemia.
Implications: There is always a danger of arterial puncture during central venous access. One can usually identify an inadvertent arterial puncture when the aspirated blood is bright red. This sign is removed if one were to put saline in the aspirating syringe, as dusky venous blood turns bright red on dilution.
Implications: Using certain specialized endotracheal tubes designed to allow single-lung ventilation for certain thoracic surgical procedures may be fraught with technical difficulties owing to common anatomic anomalies. This case report describes a simple solution for an ill-fitting right double-lumen endotracheal tube using a balloon-tipped catheter.
Implications: During a right lobectomy operation, a patient with carcinoma of the lung developed postoperative headache caused by a leak of cerebrospinal fluid from an area of dura injured during the procedure. Conservative treatment was unsuccessful. Injection of 10 mL of the patient's own blood into the epidural space relieved the headache.
Implications: We evaluated intraoperative pulmonary artery flow velocity patterns with transesophageal Doppler echocardiography (TEE) in patients during a Fontan procedure. Because pulmonary artery flow is influenced by pulmonary vascular resistance and ventricular function, intraoperative evaluation of pulmonary artery flow using TEE should be further evaluated as a predictor of surgical outcome after a Fontan procedure.
Implications: We studied work of breathing (WOB) measured with four airway devices, with and without application of continuous positive airway pressure (CPAP). Laryngeal mask airway and mask with oral airway decrease WOB compared with mask alone. CPAP decreases WOB with all devices except the endotracheal tube. Increased WOB appears mostly because of soft tissue upper airway obstruction.
Implications: This report is a description of the ventilation techniques used in 94 children undergoing general anesthesia for foreign body removal of the bronchus. No particular technique was found to be associated with a greater incidence of adverse outcomes.
Implications: We report three cases of prolonged paralysis resulting from rapacuronium in the presence of sevoflurane.
Implications: Twin reversed arterial perfusion sequence and twin-twin transfusion syndrome can be managed by fetoscopic fetal surgery. It is important to consider the fetal, uteroplacental, and maternal issues when choosing an anesthetic technique. We report on three patients with differing anesthetic issues using fetoscopic surgery for umbilical cord coagulation.
Implications: We have compared two methods for predicting whether the amount of propofol given to a human subject is sufficient to cause unconsciousness, defined as failure to respond to a simple verbal command. The two methods studied are the auditory steady-state response, which measures the electrical response of the brain to sound, and the bispectral index, which is a number derived from the electroencephalogram. The results showed that both methods are very good predictors of the level of consciousness; however, bispectral was easier to use.
Implications: We evaluated four doses of IV dexamethasone in preventing postoperative nausea and vomiting in women undergoing thyroidectomy. We found that dexamethasone 5 mg was as effective as dexamethasone 10 mg, and was more effective than saline control. Dexamethasone 5 mg is suggested to be the minimum effective dose for this purpose.
Implications: Use of a multimodal clinical care algorithm eliminates predischarge vomiting and improves satisfaction in patients undergoing outpatient laparoscopy.
Implications: In patients with risk factors for ischemic heart disease, cataract surgery occurs in 30% of the cases with ischemic events of short duration. There were significantly less intraoperative episodes in the local anesthesia group, suggesting that local anesthesia may be safer than general anesthesia in patients during this type of surgery.
Implications: As an opioid adjuvant to general anesthesia for outpatient gynecologic laparoscopy and hysteroscopy, the benefits of remifentanil did not offset its added cost as compared with fentanyl.
Implications: The average number of ambulatory surgery cases performed with an anesthesia provider each day in the United States per 10,000 population did not vary systematically month to month on a medium-range (11-mo) basis. These findings suggest that the relatively simple statistical methods that are available to estimate future anesthesia workload will work for many anesthesia groups.
Implications: In case of difficult airway during cardiopulmonary resuscitation, insertion of an IV catheter through the trachea is easy, and insufflation of 10 L/min of oxygen through the needle can not only maintain the oxygenation but also prevent aspiration.
Implications: Ropivacaine wound instillation via an elastometric pump is a simple technique that provides safe and effective analgesia after cesarean delivery.
Implications: A case of reactivation of hepatitis B and development of fulminant hepatic failure in a pregnant hepatitis B virus carrier is reported. Although the occurrence or reactivation of hepatitis B in pregnancy are rare and usually not considered to be medical indications for termination of pregnancy, decisions regarding delivery and liver transplantation must be made if severe hepatic failure develops.
Implications: Narcotics in large doses can cause brain damage in rats. This brain damage is attenuated by a narcotic antagonist, a sedative, and an antiepileptic drug.
Implications: We report a case of autonomic dysfunction secondary to intracranial hemorrhage. The patient had periodical episodes of hypertension, tachycardia, tachypnea, and diaphoresis that responded dramatically to Thorazine, but not to conventional measures.
Implications: Bupivacaine 5 mg with 25 {micro}g of fentanyl for spinal anesthesia resulted in short-acting motor block. On the contrary, the addition of 25 {micro}g of fentanyl to 10 mg of bupivacaine resulted in an increase in the motor block intensity and duration.
Implications: Inadequate intrathecal anesthesia was observed in 16% of patients with 15 mg of ropivacaine, whereas intensity and duration of motor blockade was not different in comparison to 10 mg of bupivacaine. Ropivacaine appears to be less potent than bupivacaine at doses used in spinal anesthesia.
Implications: Initial fluid administration with isotonic fluids is often used for the prevention of hypotension before spinal anesthesia. We infused 1.6 mL/kg of hypertonic saline 7.5% or 13 mL/kg of normal saline for the initial fluid administration and found that, by using hypertonic saline solution, effective initial fluid administration can be achieved without excess free water administration.
Implications: The results of this study imply that hearing loss occurs after spinal as well as after general anesthesia. The positive correlation of low-frequency hearing loss and intraoperative fluid administration replacement suggests that cerebrospinal fluid leakage via the spinal puncture hole is not the only factor involved.
Implications: This study demonstrates that it is possible to achieve successful interscalene brachial plexus continuous catheter insertion and a high degree of persistent analgesia by using a catheter insertion system and a disposable infusion pump administering 0.2% ropivacaine.
Implications: Transdermal delivery of ketamine was an useful adjuvant to postoperative analgesia after epidural lidocaine blockade in the population studied.
Implications: Ketamine attenuated the development of acute tolerance to analgesia during alfentanil infusion and suppressed rebound hyperalgesia observed the day after the infusion.
Implications: Our results clearly demonstrate that ropivacaine, even used at an equipotent dose, has a wider therapeutic index than bupivacaine.
Implications: Neuropathic pain after spinal cord injury is very difficult to control adequately by using currently available techniques. We have performed a placebo-controlled, double-blinded study demonstrating that administration of a combination of morphine and clonidine into the spinal fluid can provide substantial pain relief in some people with this type of pain.
Implications: Tetrodotoxin-resistant Na+ channels are important in peripheral nociception. During local anesthesia, these channels are blocked by mepivacaine, ropivacaine, and bupivacaine in a concentration and use-dependent manner, but not stereoselectively.
Implications: The combination of high and low respiratory frequencies (600 and 15 breaths/min) improves pulmonary gas exchange during subglottic jet ventilation via an endotracheal catheter. However, subglottic combined-frequency jet ventilation is less effective than supraglottic combined-frequency jet ventilation via a jet ventilation laryngoscope.
Implications: The results of this study show that balloon-assisted laryngoscopy facilitates the airway management of elective surgery patients by providing greater laryngeal exposure than conventional laryngoscopy. Thus, the routine use of a curved blade carrying the inflatable balloon of a 6F Fogarty catheter on its distal end is recommended.
Implications: The aim of the study was to assess whether the reverse Trendelenburg position could improve pulmonary gas exchange in obese patients undergoing abdominal surgical procedures. Our work may have a clinical value because few studies deal with this issue.
Implications: The potency of rocuronium does not differ between adults and children of Caucasian and Chinese origins. If tracheal intubating doses of 0.6 mg/kg IV are given, similar levels of neuromuscular blockade are expected but recovery will be longer by 29%-30% in Chinese compared with Caucasian children and adults.
Implications: Cerebral blood flow velocity change, measured by transcranial Doppler sonography during electroconvulsive therapy, was minor using propofol anesthesia compared with barbiturate anesthesia. Propofol anesthesia may be suitable for patients who cannot tolerate abrupt cerebral hemodynamic change.
Implications: Adenosine neuromodulation contributes to mechanisms of pentobarbital-induced excitatory postsynaptic potentials depression.
Implications: The anesthetic gases nitrous oxide (laughing gas) and xenon increase the activity of a mammalian GABAA receptor. This receptor is held responsible for the inhibition of important actions of the human brain, e.g., maintenance of consciousness and awareness.
Implications: We report a case of accidental epidural injection of vecuronium in a female patient who underwent hemorrhoidectomy using epidural anesthesia. Because epidural injection of muscle relaxants may have serious side effects, immediate establishment of airway protection, monitoring of muscle relaxation, and follow-up for clinical signs of neurotoxicity are recommended.
Implications: Commonly used muscle relaxants may have serious side effects when used in critically ill patients. This case report relates some of these side effects and reviews the mechanisms by which they are thought to occur.
Implications: The SiBITM connector is a new medical device used for vital capacity inhaled induction with sevoflurane. It allows efficient preoxygenation of patients and reduces waste anesthetic gases in the operation room during induction.
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