Implications: Accurate measurement of pulmonary arterial pressure has generally required cardiac catheterization; noninvasive intraoperative estimation of pulmonary arterial pressure has been an important clinical challenge for anesthesiologists. We demonstrated that pulsed Doppler transesophageal echocardiography can be used to estimate intraoperative pulmonary arterial pressure.
Implications: Jugular bulb venous oxygen desaturation has been suggested as a predictor of cognitive decline after cardiac surgery. However, the clinical value of jugular bulb venous oxygen saturation (SjVO2) may be limited during hypothermic cardiopulmonary bypass (CPB) when oxygen affinity to hemoglobin is increased. This study shows that high SjVO2 before and during hypothermic CPB is a predictor of subsequent cognitive decline.
Implications: The administration of a single dose of milrinone before aortic cross-clamping resulted in significantly larger intramyocardial cyclic adenosine monophosphate concentration in myocardial biopsy specimens compared with controls.
Implications: The pharmacokinetics of {epsilon}-aminocaproic acid do not differ significantly between males and females; therefore (after correction for weight), a gender-specific dosing scheme is unnecessary. A 70 mg/kg initial dose (given over 20 min) and a maintenance infusion of 30 mg{middle dot}kg-1{middle dot}h-1should ensure that fewer than 5% of patients will have {epsilon}-aminocaproic acid concentrations <130 mg/L during infusion.
Implications: When 200 U/kg or more of heparin is administered into the central venous circulation in hemodynamically stable anesthetized patients, peak arterial activated clotting time (ACT) prolongation occurs within 30 s and peak venous ACT prolongation within 60 s. This information may assist physicians in making decisions about vascular interventions such as aortic cannulation or cross-clamping and strongly suggests that blood sampling to determine the adequacy of heparin-induced anticoagulation can occur as soon as 30-60 s after heparin administration. The drug heparin is given to patients during blood vessel surgery to temporarily inhibit blood clotting when blood vessels are clamped. The activated clotting test was used to determine just how fast heparin works after it is administered.
Implications: A von Willebrand-like syndrome occurred immediately after 6% HES 200/0.6 infusion in patients undergoing abdominal surgery. These hemostasis alterations were more pronounced in patients of the O blood group and may suggest a restricted intraoperative use of HES in this patients population undergoing surgical procedures with a high risk for bleeding.
Implications: Comparison of hydroxyethyl starch solutions in healthy adults indicates that increased molecular weight and degree of substitution are associated with inhibition of platelet function by reduction of the availability of platelet surface fibrinogen receptors.
Implications: Endotracheal adrenaline (0.05 mg/kg diluted with normal saline to 10 mL total volume) with or without nonselective ß-blocker (propranolol) pretreatment was studied to clarify the mechanism of blood pressure decrease after this anesthetic protocol in dogs. An optimal dose of endotracheal adrenaline should achieve a high {alpha}-adrenergic vasoconstrictive threshold.
Implications: The authors report on the accuracy of noninvasive, transcutaneous CO2 monitoring during mechanical ventilation in children 4 yr or older. Application of this technique should be useful by decreasing the need for repeated, costly, and sometimes painful arterial blood gas analysis, and the continuity of assessment should facilitate proactive, rather than reactive, ventilator manipulations.
Implications: Children and adolescents with pain may safely have a spinal catheter placed for a period of time without undo risk of infection or other complications. Spinal catheters provide excellent pain relief, often eliminating the need for riskier medications for painful events such as wound cleansing and dressing changes.
Implications: Simultaneous use of small-dose ketamine during propofol sedation improves ventilation and produces positive mood states in the recovery room. The combination of drugs may also provide earlier return of cognitive function.
Implications: We evaluated the utility of propacetamol as an adjunct to the administration of patient-controlled analgesia morphine in the treatment of postoperative pain after spine stabilization surgery. This combination was associated with an appropriate analgesic effect and with a smaller morphine consumption.
Implications: Molecular flexibility is not a necessary structural requirement for anesthetic action, at least for compounds having six carbon atoms or fewer. Unsaturation, particularly a triple bond, increases anesthetic potency defined either by minimum alveolar anesthetic concentration or the Meyer-Overton constant.
Implications: We performed a cold pressor test while baseline pulse oximeter monitoring was performed on the finger and ear. The ear was immune to the vasoconstrictive effect of the cold pressor test, suggesting that it may be a more suitable monitor of systemic circulation.
Implications: Statistical methods can identify, for some surgical suites, anesthesia staffing solutions whereby all the cases are covered but for which labor costs are significantly less than those obtained using the staffing plans developed by the managers based on data and their experience.
Implications: The study was designed to assess the role of endogenous versus exogenous vasopressin in a porcine cardiopulmonary resuscitation (CPR) model. Only pigs with effective endogenous vasopressin, or pigs with effective endogenous vasopressin and administration of exogenous vasopressin had good left ventricular myocardial blood flow during experimental CPR, had return of spontaneous circulation after defibrillation and survived the 1-h postresuscitation phase.
Implications: Drug absorption after lidocaine administration into the laryngeal mask airway is not sufficient to achieve therapeutic lidocaine plasma concentrations. IV drug administration should be used whenever the laryngeal mask is used in the cardiac arrest setting.
Implications: Both fentanyl- and remifentanil-based anesthesia are well suited for intraoperative somatosensory evoked potentials monitoring. Remifentanil anesthesia offers the advantage of earlier recovery, which may improve the ability to do a wake-up test if it is needed during surgery.
Implications: In neurosurgical patients undergoing craniotomy, infiltration of the scalp with a solution containing epinephrine alone causes significant hypertension. The addition of lidocaine attenuates the hypertensive response but entails a biphasic decrease in blood pressure.
Implications: We studied the effect of 17ß-estradiol on ischemia-induced increases in extracellular amino acids in the hippocampal CA1 region with a gerbil model of transient forebrain ischemia. We observed that 17ß-estradiol inhibited ischemia-induced accumulation of excitatory amino acids.
Implications: More intense pain during labor, as evidenced by increased self-administered analgesia, is a marker of obstructed labor and the need for cesarean delivery.
Implications: Postthyroidectomy pain has a large "superficial" component. Bilateral superficial cervical plexus blocks improve the quality of pain relief in thyroid surgery.
Implications: We demonstrated an equivalent efficacy and safety of IV tramadol and morphine in the management of pain in the prehospital trauma setting. Because tramadol is not a narcotic drug, its use would allow emergency medical systems to avoid the inconvenience of transporting controlled substances.
Implications: This study demonstrates that direct application of tramadol on the sciatic nerve inhibits somatosensory evoked potential in a dose-dependent and reversible manner that is not affected by naloxone. We conclude that tramadol exerts a local anesthetic-type effect on peripheral nerves.
Implications: Ropivacaine 0.2%, a new, long-acting local anesthetic used for continuous thoracic epidural anesthesia, is a safe and reliable alternative to general anesthesia for patients undergoing breast surgery because of cancer. It facilitates recovery from anesthesia, significantly reduces postoperative pain, nausea, and vomiting, and positively contributes to the patient's overall outcome.
Implications: Thermal hyperalgesia in the chronic constriction injury model of mononeuropathy is mediated by {alpha} receptors. Although {alpha}1 and mixed {alpha}1- and {alpha}2-receptor antagonists have been used in humans to treat reflex sympathetic dystrophy, drugs that are highly specific postjunctional {alpha}2 antagonists may also be useful in the treatment of sympathetically mediated pain.
Implications: Spinal cord serotonin (5-HT) levels seem to be critical in the development of morphine tolerance. Reduction of 5-HT levels in the spinal cord prolonged the development of tolerance to morphine. Manipulation of 5-HT levels could be a valuable method for altering the efficacy of opioid analgesia, particularly during patient-controlled analgesia.
Implications: Propacetamol (2 g IV), an acetaminophen prodrug, was similar to ketorolac (15 mg and 30 mg IV) with respect to analgesic properties during a 6-h assessment period. However, the onset of analgesic action of propacetamol seems to be faster than ketorolac (15 mg IV) and its duration of action shorter than ketorolac (30 mg IV).
Implications: Isoflurane actions in the thalamus suppressed the transmission of tactile input to the cortex. This effect was reversed by removal of thalamic inhibition. Suppression of sensory perception under general anesthesia, therefore, may result in part from isoflurane's interaction with thalamic {gamma}-aminobutyric acid-A receptors.
Implications: In rats, cerebral {gamma}-aminobutyric acid type A (GABAA) receptors, in addition to spinal GABAA receptors, influence the immobilizing action of isoflurane but are probably not responsible for that action.
Implications: Midazolam is used as a sedative and anesthetic. It reduces, in a dose-dependent manner, the diaphragmatic contractility in dogs.
Implications: In patients undergoing radical cystectomy, a multimodal approach combining continuous epidural analgesia, enforced mobilization, and oral nutrition should be used to speed recovery after major urologic surgery.
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