IMPLICATIONS: In a retrospective cohort study, significant risk factors for the development of bronchospasm with the administration of rapacuronium on induction of anesthesia included rapid sequence induction and prior history of reactive airways disease. In a case-control study, children with bronchospasm during induction of anesthesia were several times more likely to have received rapacuronium compared with other muscle relaxants.
IMPLICATIONS: Chin lift and jaw thrust maneuvers combined with continuous positive airway pressure improve the view of the glottic opening as viewed by flexible nasal laryngoscopy and decrease stridor in anesthetized, spontaneously breathing children.
IMPLICATIONS: Peritoneal CO2 absorption during laparoscopic surgery causes hypercapnia and CO2-mediated cerebral hemodynamic effects. Hyperventilation and the head-up position before CO2 insufflation is not sufficient to counteract these effects of low-pressure pneumoperitoneum (5-8 mm Hg) in children.
IMPLICATIONS: We demonstrate the usefulness of the bispectral index monitor for assessing sedation in pediatric intensive care unit patients. The bispectral index monitor correlated with clinically assessed sedation levels and was useful for differentiating adequate from inadequate sedation, which would be of value when the clinical examination is unavailable.
IMPLICATIONS:A newborn undergoing flexible fiberoptic bronchoscopy before repair of a tracheoesophageal fistula developed a life-threatening tension pneumothorax. The mechanisms of this complication are discussed and recommendations are made for preventing this complication.
IMPLICATIONS: We developed a method for measurement of protamine in human blood. In volunteers, protamine concentrations decreased rapidly after administration. The rapid disappearance of protamine from the circulation, as defined by a median half-life of 7.4 min, could contribute to cases of "heparin rebound" after initial adequate reversal of heparin.
IMPLICATIONS: A prospective, randomized, double-blinded, placebo-controlled study of postthoracotomy pain relief showed that IV tramadol in the form of a bolus followed by continuous infusion was as effective as epidural morphine. The use of tramadol avoids the necessity of placing a thoracic epidural catheter.
IMPLICATIONS: We evaluated the influence of leukocyte reduction by filtration of packed red blood cells (RBC) on postoperative infections and adverse outcomes in patients undergoing elective major aortic surgery by comparing two epochs with and without filtration. Data from this study suggest that the effect of using filtered RBC on postoperative infections is not of obvious importance.
IMPLICATIONS: Hextend(R) is a new plasma volume expander containing 6% hydroxyethyl starch in a physiologically balanced medium. This open-label volunteer study demonstrated that it has pharmacokinetic and pharmacodynamic profiles similar to those of established HES.
IMPLICATIONS: Regional administration of xenon direct to the left anterior descending-perfused myocardium resulted in a small but consistent negative inotropic effect of the noble gas in the dog heart in vivo.
IMPLICATIONS: Ketamine inhibits norepinephrine-induced inositol 1,4,5-triphosphate formation in a dose-dependent manner via pathways that involve protein kinase C and a decrease in intracellular Ca2+ concentrations.
IMPLICATIONS: Dynamic left ventricular outflow tract obstruction is not an uncommon phenomenon, but it is often unrecognized. Its rapid recognition and effective treatment was only possible with transesophageal echocardiography (TEE). This contributes to the support for TEE being routinely available for assessment of hemodynamic instability.
IMPLICATIONS: Geriatric outpatients undergoing brief urologic procedures more rapidly achieve fast-tracking discharge criteria after desflurane (versus isoflurane and propofol) anesthesia. Use of isoflurane was also associated with an increased need for nursing interventions in the early recovery period compared with desflurane and propofol.
IMPLICATIONS: Small-dose spinal anesthesia is an effective alternative to a desflurane general anesthetic in terms of cost and recovery profiles in ambulatory gynecological laparoscopy.
IMPLICATIONS: This double-blinded, randomized study investigated the impact of physostigmine of BIS values during 0.6% sevoflurane anesthesia as well as in the postoperative recovery, when sevoflurane is administered as a sole anesthetic. Physostigmine has no effect on BIS values or on the tests assessing recovery.
IMPLICATIONS: This study demonstrated that pretreatment of succinylcholine with rocuronium failed to decrease the incidence or the severity of postoperative myalgia. However, in most patients, pretreatment was associated with muscle weakness before loss of consciousness. Thus, there is no convincing evidence supporting routine pretreatment with succinylcholine.
IMPLICATIONS: Near-infrared spectroscopy (NIRS) has been proposed as a noninvasive clinical method for assessing cerebral oxygenation. The acceptable reliability and validity of NIRS values have not been established despite their widespread use. The INVOS 4100 and the NIRO 300 can display cerebral oxygen saturation as regional cerebral oxygen saturation and tissue oxygenation index, but they produce differing results.
IMPLICATIONS:Compared with the Relaxometer mechanomyograph, the neuromuscular transmission module could equally indicate time to tracheal intubation and full recovery from 0.6 mg/kg rocuronium neuromuscular block. Its small quick-fit sensor has the advantage, in an often crowded and busy operating room, of being incorporated in the AS/3TM anesthesia workstation.
IMPLICATIONS: Potencies of nondepolarizing muscle relaxants, studied at muscle nicotinic acetylcholine receptors expressed in a recombinant expression system, correlate highly with the clinical doses needed in adults to produce 50% twitch depression at the adductor pollicis muscle.
IMPLICATIONS: Neuromuscular block level did not alter Bispectral Index (BIS) during propofol anesthesia, either by reducing electromyographic artifact or by decreasing afferent neuronal input. The BIS will thus comparably estimate sedation in deeply unconscious patients who are paralyzed, partially paralyzed, or unparalyzed.
IMPLICATIONS: Preanesthetic medication with 5 {micro}g/kg oral clonidine, but not 2.5 {micro}g/kg clonidine, is associated with prolonged recovery from propofol/fentanyl anesthesia.
IMPLICATIONS: Tourniquet inflation is associated with a continuous increase in arterial blood pressure and sympathetic outflow. This study shows that IV clonidine effectively blunts increases of both arterial blood pressure and plasma norepinephrine concentrations.
IMPLICATIONS: A bolus and continuous injection of tramadol does not alter renal blood flow (RBF) in normal rats. A bolus injection of tramadol has little effect on RBF in rats with experimentally induced renal insufficiency. These results suggest that tramadol would be a safe analgesic for maintaining RBF during the postoperative period.
IMPLICATIONS: In this study we show that the antihypertensive drug urapidil stops cold-induced shivering and decreases normal thermoregulatory responses, i.e., the thresholds for vasoconstriction and shivering, in awake volunteers.
IMPLICATIONS: The nonimmobilizer 1,2-dichlorohexafluorocyclobutane has a greater depressant effect on long-term memory than short-term memory, suggesting that it impairs the processes responsible for the retention of memory more than for the formation of memory itself.
IMPLICATIONS: With 30 workdays of operating room or anesthesia group data, the optimization method can propose staffing solutions that significantly decrease costs and increase productivity compared with existing staffing solutions. We recommend that, when the statistical method is applied routinely for adjusting staffing (e.g., on a quarterly basis), 9 to 12 mo of data be used.
IMPLICATIONS: An observational study was conducted to compare various outcomes before and after the introduction of outpatient preoperative evaluation (OPE). Although smaller than anticipated, OPE for potential inpatients leads to a significant reduction of canceled cases and of length of admission.
IMPLICATIONS: Cerebral hyperemia occurs during emergence from general anesthesia. It might be one mechanism of cerebral complications in the early postoperative period.
IMPLICATIONS: We demonstrated that thiopental, but not propofol, attenuates ischemic neuronal swelling induced by oxygen/glucose deprivation in an in vitro ischemic model.
IMPLICATIONS: In rabbits with brain tumors, brain blood flow and volume were significantly larger in all regions (tumor, peri-tumor, and contralateral normal tissue) with isoflurane than with propofol during normocapnia, and remained responsive to a reduction in PaCO2. Consequently, during hypocapnia, brain blood flow and volume values with isoflurane were similar to values with propofol.
IMPLICATIONS: The TrachlightTM may be more advantageous for orotracheal intubation in patients with cervical spine disorders than the FastrachTM with respect to reliability, rapidity and safety.
IMPLICATIONS: Extravasation or IV injury attributable to phenytoin can cause severe soft tissue damage. Anesthesiologists are likely to encounter this problem and should recognize it and the potential complications. With increased awareness, the occurrence may be minimized.
IMPLICATIONS: Fentanyl administered epidurally to parturients after cesarean delivery has a primarily spinal mechanism of action and this effect is enhanced by very small dose epidural bupivacaine and epinephrine.
IMPLICATIONS: We compared hyperbaric and plain ropivacaine for combined spinal/epidural analgesia in the lateral position in patients undergoing elective cesarean delivery. Hyperbaric ropivacaine produced more rapid block with faster recovery and less requirement for epidural supplementation compared with plain ropivacaine.
IMPLICATIONS: Neuromuscular block is prolonged in the postpartum period after standard doses of rocuronium. Drug administration according to lean body mass will produce a more consistent duration of block.
IMPLICATIONS: Herbal medicine use may be less prevalent in the parturient population, however, some health care providers may be promoting their use during pregnancy.
IMPLICATIONS: In many patients with postherpetic neuralgia and acute herpes zoster pain is not satisfactorily alleviated with pharmacological approaches. We report on 23 of 28 patients with postherpetic neuralgia and 4 of 4 with acute herpes zoster whose chronic pain was improved by electrical spinal cord stimulation.
IMPLICATIONS: This study showed a novel finding that the hypersensitivity state seems to be dependent on increased release of spinal excitatory amino acids (EAAs), and the significant modulatory effect of the {alpha}2-adrenergic agonist apraclonidine on the release of spinal EAAs accounts for its analgesic properties in adjuvant-induced inflammation.
IMPLICATIONS: We developed an ultrasound-guided approach to the psoas compartment at the levels L2-3, L3-4, and L4-5. Feasibility and accuracy were tested on embalmed cadavers and verified by means of computed tomography. Ultrasound guidance proved to be feasible and accurate for the performance of psoas compartment blocks.
IMPLICATIONS: Butamben 5% nerve blocks produced a prolonged antinociceptive effect to formalin-induced nociception and heat hyperalgesia, without significant motor effect or evidence of substantial histologic changes.
IMPLICATIONS: Accidental migration of an epidural catheter into a blood vessel is often detected by hemodynamic changes after injecting an epidural test dose containing epinephrine. Our results suggest that 5 {micro}g of epinephrine is not adequate to reliably produce hemodynamic and T-wave alterations in adult patients during propofol anesthesia.
IMPLICATIONS: We evaluated the interrater reliability of the Wilson scale for measuring sedation during regional anesthesia. Paired anesthesia care providers' ratings of patient sedation indicated very good interrater reliability in both the original scale and a modified version. The modified Wilson scale provides a quick noninvasive means of monitoring sedation during regional anesthesia.
IMPLICATIONS: Drugs affecting bacterial growth may influence the occurrence of postoperative infections. Ropivacaine 10 mg/mL killed Staphylococcus aureus and Escherichia coli; ropivacaine 2 mg/mL supported the growth of E. coli.
IMPLICATIONS: In 100 morbidly obese patients, neither obesity nor body mass index predicted problems with tracheal intubation. However, a high Mallampati score (>=3) and large neck circumference may increase the potential for difficult laryngoscopy and intubation.
IMPLICATIONS: The laryngeal mask airway ProSealTM is an effective temporary ventilatory device in grossly and morbidly obese patients before laryngoscope-guided tracheal intubation.
IMPLICATIONS: We compared the prophylactic IV administration of tropisetron 5 mg to prevent postoperative nausea and vomiting (PONV) associated with epidural morphine with dexamethasone 5 mg and saline in women undergoing hysterectomy. We found that tropisetron 5 mg did not significantly reduce the occurrence of PONV associated with epidural morphine. Dexamethasone 5 mg was effective for this purpose.
IMPLICATIONS: We present five patients with latex allergy who underwent desensitization by a new cutaneous exposure protocol. This study provides evidence that a safe therapeutic approach to latex allergy is possible.
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