IMPLICATIONS: A survey of anesthesiologists found that pulmonary artery catheter monitoring is currently more frequently used compared with transesophageal echocardiography during cardiac and vascular surgery.
IMPLICATIONS: Complications, particularly when they involve organs other than just the heart, increase mortality and prolong the length of hospital stay after heart surgery, independent of a patient's preoperative risk factors and the duration of cardiopulmonary bypass. Strategies aimed at preventing damage to other organs during cardiac surgery need to be improved.
IMPLICATIONS: Isolated systolic hypertension is associated with a 40% increase in the likelihood of perioperative cardiovascular morbidity in coronary artery surgery patients.
IMPLICATIONS: Melatonin is a hormone that plays an important role in adjusting the biological clock in humans and that regulates secretion of various other hormones. We studied melatonin secretion in patients undergoing cardiac surgery with cardiopulmonary bypass. Melatonin secretion was disturbed during and immediately after surgery but had recovered a circadian rhythm 24 h later, raising the question of whether melatonin should be supplemented before cardiac surgery.
IMPLICATIONS: In the presence of low cardiac output, the clinician's ability to identify which patients are more likely to benefit from volume administration to improve hemodynamic status while avoiding fluid overload is important. The analysis of Doppler measurement of the mitral flow as an indirect indicator of the individual diastolic pressure/volume relationship may be useful to predict the intravascular volume responsiveness in patients undergoing coronary artery bypass graft surgery.
IMPLICATIONS: Rapacuronium is associated with a significantly larger decrease in blood pressure than succinylcholine or vecuronium, and this decrease should be considered when using rapacuronium in patients who cannot tolerate this decrease.
IMPLICATIONS: Both sevoflurane and isoflurane modified pulmonary blood flow in patients with coronary artery disease, but only sevoflurane depresses arterial oxygenation in this population.
IMPLICATIONS: IV insulin, as used in this study, had effects on blood glucose only after cardiac surgery, when it was associated with an increased neutrophil count and a greater total capacity of peripheral blood neutrophils to ingest foreign particles.
IMPLICATIONS: Acute normovolemic hemodilution enhances LV (left ventricular) diastolic function by alterations in the LV loading condition produced by hemodilution, which mainly contributes to a compensatory increase in cardiac output.
IMPLICATIONS: The use of solvent/detergent virus-inactivated plasma is of increasing importance in the prevention of human immunodeficiency virus and hepatitis C virus transmission. Since the use of this plasma during orthotopic liver transplantation has increased, the incidence of hyperfibrinolysis was observed. Clotting analysis of the patients revealed small {alpha}2-antiplasmin concentrations because of the solvent/detergent process.
IMPLICATIONS: In this canine pneumonectomy model, advanced age was associated with an increased incidence of supraventricular arrhythmias, perhaps because of increased atrial fibrosis and inflammation.
IMPLICATIONS: {alpha}-receptors on blood vessels regulate constriction and dilation and therefore modulate blood pressure. This research indicates that vasoconstriction via the {alpha}1-receptor vascular response is impaired during isoflurane and desflurane anesthesia.
IMPLICATIONS: A clinically useful way to quantify nonrespiratory disturbances of the acid-base balance is calculation of the base excess of extracellular fluid by using blood gas analyzers. In this study, we found significant variability in estimates of base excess of extracellular fluid obtained with five analyzers from different manufacturers. This variability is attributable to multiple factors, including lack of correction for deoxygenated hemoglobin (Haldane effect).
IMPLICATIONS: Radiofrequency ablation is a new investigational therapy for primary and secondary neoplasms. In this article, the authors describe the anesthetic management of the radiofrequency ablation of a pulmonary neoplasm complicated by massive hemorrhage.
IMPLICATIONS:Two previously reported causes of postoperative limb ischemia after use of a tourniquet, compartment syndrome and arterial thromboembolism, require aggressive and invasive management. We report another probable cause that can be managed nonsurgically: vasospasm.
IMPLICATIONS: This article discusses the process and specific nature of informed consent for clinical research in pediatric anesthesia. For informed consent to be meaningful, permission from the child's proxy must be obtained and the child's assent must be tailored in a manner that is sensitive to the abilities of children.
IMPLICATIONS: A lax anal sphincter in children undergoing inguinal and/or penile surgery can predict the effectiveness of analgesia after pediatric caudal blockade.
IMPLICATIONS: Although pediatric caudal anesthesia does not alter heart rate nor arterial blood pressure, significant changes occur in regional blood flow distribution. Descending aortic blood flow increases significantly after caudal anesthesia, whereas lower body vascular resistances decrease.
IMPLICATIONS: Caudally administered preservative-free S(+)-ketamine combined with 1 or 2 {micro}g/kg clonidine provides excellent perioperative analgesia in children and has minimal side effects.
IMPLICATIONS: Opioids increase the incidence of postoperative vomiting (POV). Remifentanil is characterized by the shortest half-life of all opioids used in anesthetic practice. Therefore, we studied the effect of remifentanil on POV compared with the longer-acting opioid fentanyl in children undergoing strabismus surgery.
IMPLICATIONS: The concurrent use of fentanyl in a dose of 2.5 {micro}g/kg in children receiving desflurane or sevoflurane results in a low incidence of emergence agitation. Desflurane allows for a more rapid emergence and recovery than sevoflurane.
IMPLICATIONS: The lowest pressure possible should be used when inflating the abdomen with CO2 to perform a laparoscopy in babies. A low pressure allows better ventilation and may prevent mortality if CO2 is accidentally injected into a vein.
IMPLICATIONS: Oral premedication with a combination of acetaminophen (2000 mg) and celecoxib (200 mg) was effective in decreasing pain and improving patient satisfaction after otolaryngologic surgery. However, acetaminophen (2000 mg) or celecoxib (200 mg) alone was not significantly more effective than placebo in reducing postoperative pain.
IMPLICATIONS: With experience and appropriate patient selection, it is possible to induce and maintain anesthesia using a laryngeal mask airway in patients in the prone position for ambulatory surgery.
IMPLICATIONS: Ondansetron orally disintegrating tablet reduces postdischarge nausea and vomiting and improves patient satisfaction with postoperative nausea and vomiting management.
IMPLICATIONS: Central {alpha}2 adrenoceptor is thought to be involved in several IV anesthetics-induced sleep. In this study, activation of the receptor increased the propofol-induced sleep time, whereas its inhibition decreased the sleep time. The results provide further evidence that the {alpha}2 receptor is a good tool to elucidate the mechanism of anesthetics-induced sleep.
IMPLICATIONS: The effect of anesthetics on vasopressor-mediated cardiovascular effects is poorly understood. We evaluated the pressor response to ephedrine during propofol or sevoflurane anesthesia. Our study suggests that anesthesia-induced hypotension may be easier to reverse with ephedrine during propofol anesthesia than during sevoflurane anesthesia.
IMPLICATIONS: This study compares the clinical profile of propofol anesthesia for direct laryngoscopy with spontaneous ventilation when the drug is administered either as a manually controlled infusion or by targeting the effect-site concentration through a target-controlled infusion (TCI) device. TCI improves the time course of propofol effects.
IMPLICATIONS: We compared an inhalation bolus of sevoflurane with remifentanil for managing hemodynamic responses to major abdominal or thoracic surgery. This prospective, randomized trial demonstrated better results with sevoflurane.
IMPLICATIONS: The opioid remifentanil was applied to 20 volunteers at a constant concentration for 3 h while pain thresholds to temperature and current were repeatedly assessed. Our aim was to study whether thresholds decrease over time because of the rapid development of opioid tolerance. No development of rapid opioid tolerance was observed.
IMPLICATIONS: This study demonstrates dose-related remifentanil neurotoxicity in physiologically controlled rats with congruent brain metabolic effects in four humans undergoing positron emission tomography evaluation during brief large-dose remifentanil anesthesia. These data suggest that some adverse effects reported in rats may be clinically relevant.
IMPLICATIONS: Neuroexcitatory movements associated with propofol anesthesia are well recognized. Here we report on the successful use of benztropine (2 mg) to abolish abnormal dystonic movements after propofol anesthesia. Forty-five case reports are reviewed, and a treatment strategy for abnormal movements during propofol anesthesia is provided.
IMPLICATIONS: The pharmacokinetic characteristics of midazolam and remifentanil administered by bolus injection may make them advantageous for providing brief, intense analgesia without prolonged respiratory depression. This application is particularly useful for awake, direct laryngoscopy.
IMPLICATIONS: In this study, we have shown that the occupational exposure to waste anesthetic gases is comparable when using the cuffed oropharyngeal airway (COPA) and the laryngeal mask airway and is increased when using the face mask. Therefore, the COPA may be a valuable alternative to the conventional face mask during short surgical procedures.
IMPLICATIONS: Pre-ictal bispectral index had a positive correlation with seizure duration and could be useful to prevent an unacceptably short seizure in electroconvulsive therapy under propofol anesthesia.
IMPLICATIONS: We report that an ultrapotent vanilloid agonist resiniferatoxin can provide a selective and long-lasting neural blockade. Applied to the sciatic and saphenous nerves, it completely prevented pain hypersensitivity caused by prolonged inflammatory process (injection of carrageenan into the paw).
IMPLICATIONS: An average onset time of approximately 7 min for topical 4% liposomal lidocaine was determined using neuroselective neurostimulation. This suggests that procedural pain such as venipuncture may be attenuated in this time frame. This technique requires correlation with conventional sensory measurements.
IMPLICATIONS: Fentanyl-induced analgesia is followed by early hyperalgesia (hours), acute tolerance to the analgesic effects of morphine, and long-lasting hyperalgesia (days). All these phenomena are totally prevented by repeated administrations of the NMDA-receptor antagonist, ketamine, simultaneously with fentanyl and morphine administration.
IMPLICATIONS: The development of projected complex sensations mimicking phantom pain after interscalene block is reported. The recognition of this entity is important because it may be confused with some other cardiac, esophageal, or visceral pathologies.
IMPLICATIONS: We investigated the complex relationships among the number of surgical services, number of staffed operating rooms (ORs), length of the regularly scheduled OR workday, efficiency of use of OR time, OR staffing cost, and changes in each services' allocated OR time.
IMPLICATIONS: The effect of the combined administration of different colloids and/or crystalloids on coagulation is not known. We show that hemostasis is less impaired using a combination of gelatin and median-weight starches than using median-weight starches alone. Furthermore, the combination of lactated Ringer's solution and gelatin decreases the coagulation system to the same extent as the combination of lactated Ringer's solution and 6% hydroxyethyl starch 130/0.4.
IMPLICATIONS: Neurosurgical patients may be allowed to become mildly hypothermic during anesthesia in an effort to provide brain protection. Propofol maintenance infusion doses may not require adjustment in these patients.
IMPLICATIONS: Both {alpha}- and ß-adrenergic responses are important mechanisms for the regulation of uteroplacental perfusion. By use of an in vitromicrovascular technique, we have shown pregnancy-associated alteration in adrenergic responses in the uterine microcirculation of the rat.
IMPLICATIONS: We evaluated a continuous epidural infusion containing bupivacaine 0.05% plus the opioid hydromorphone in 1830 women requesting pain relief during labor and delivery. The infusion provided effective analgesia with minimal adverse events for patients differing in parity and at varying stages of labor. Pain relief was maintained in most patients without the need for epidural reinforcement with more concentrated doses of local anesthetic.
IMPLICATIONS: These results indicate that fetal exposure to propofol can vary considerably depending on maternal plasma albumin concentration. A fractional change in the maternal protein binding of propofol can result in a relatively large difference in fetal exposure.
IMPLICATIONS: This case report discusses the anesthetic management of two parturients with severe osteogenesis imperfecta who presented for cesarean delivery. Although the anesthetic management for milder forms of the disease has been previously reported, anesthetic options for cases of this severity have not.
IMPLICATIONS: Spinal anesthesia is one of the most frequently used regional anesthesia techniques in surgical interventions; however, rarely it may cause some transient or permanent neurological problems. One of these problems is headache, which is more frequent and severe in the young, and hearing loss, especially at low frequencies. Both the pain and the hearing loss are caused by leak of cerebrospinal fluid caused by the puncture in the membrane of the spinal cord during the procedure. We hypothesized that hearing loss might also be more frequent and severe in the young, and to test this hypothesis, we compared the hearing loss developing after spinal anesthesia between the young and the elderly. The implications of this study are as follows: First, spinal anesthesia must be performed carefully, especially in the young. Second, measures must be taken to avoid the leak of cerebrospinal fluid. This study reveals possible problems caused by spinal anesthesia in the young which can be easily overlooked.
IMPLICATIONS: A simulation of popliteal block using magnetic resonance imaging in volunteers suggests that using tendons of the hamstring muscles as the anatomical landmarks yields a more consistent localization of the sciatic nerve.
IMPLICATIONS: Analgesia levels after the epidural administration of 15 mL of ropivacaine 1.0% increase with increasing age. This is associated with an increased incidence of hypotension in the elderly, although an effect of age on the hemodynamic homeostasis may have contributed. It appears that epidural doses should be adjusted for elderly patients.
IMPLICATIONS: In patients undergoing colon resection under combined anesthesia, isoflurane requirements were assessed by changes in blood pressure or bispectral index. Epidural bupivacaine at concentrations of 0.125% or 0.0625% (each with 2 mg/mL of fentanyl) induced the same sparing of isoflurane (35%). The smaller dose produced less hypotension and should be favored.
IMPLICATIONS: In this case report we describe a technique used to provide local analgesia for surgical procedures. Although this technique has a reduced risk of complications, we present a patient who experienced a life-threatening paralysis without loss of consciousness during an attempted brachial plexus block with a posterior approach.
IMPLICATIONS: This study was performed to establish data on the average values of airway morphology in the adult population of different age groups and sex. Hyomental, thyromental, sternomental distances and neck extension values were measured on 12 cadavers and 334 patients.
IMPLICATIONS: Morbid obesity significantly decreases respiratory system compliance and increases inspiratory resistance. Increased body weight, and not altered mechanics of breathing, was associated with worse PaO2 during laparoscopy.
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