IMPLICATIONS: This case reports a patient with an implanted cardiac pacemaker who underwent an uneventful percutaneous radiofrequency trigeminal rhizotomy in which the radiofrequency was a source of electromagnetic interference, potentially disruptive to the cardiac pacemaker.
IMPLICATIONS: Hemodilution-associated hypercoagulability is of clinical interest, given the morbidity and mortality associated with perioperative thrombophilia. We determined that decreased antithrombin activity is responsible for accelerated clot initiation via thrombelastography with in vitro plasma-based experiments. Celite activation of plasma resulted in a linear relationship between degree of dilution and thrombelastographic variables.
IMPLICATIONS: Hemopure(R), a polymerized bovine hemoglobin used as a blood substitute, might interfere with coagulation. At clinically relevant in vitro dilutions of whole blood, the effects of Hemopure(R) on whole-blood coagulation as measured by the thrombelastograph were not significantly different from those of the carrier substance, lactated Ringer's solution.
IMPLICATIONS: Patients without factor V Leiden (FVL) have increased sensitivity to the activated protein C after cardiac surgery, whereas FVL carriers do not. These data provide mechanistic support for previous speculations that FVL subjects are at increased postoperative thrombotic risk relative to noncarriers.
IMPLICATIONS: We evaluated renal function comparing fenoldopam versus dopamine in liver transplantation recipients. In the fenoldopam-treated group, serum creatinine and BUN improved. There were more "interventions" of furosemide to maintain urine output >1 mL {middle dot} kg-1 {middle dot} h-1 in the dopamine group.
IMPLICATIONS: Bronchoscopic lung volume reduction is a novel approach to the treatment of severe emphysema. We describe the anesthetic experience with this new procedure, highlighting the problems facing the anesthesiologist.
IMPLICATIONS: Halothane, isoflurane, and sevoflurane reduce action potential duration (APD) by virtue of inhibitory effects on membrane currents, principally the calcium current. The differential effects of anesthetics on APD in the subepicardium and subendocardium appear to be due to their inhibitory action on the transient outward K+ current.
IMPLICATIONS: Transfusion may rarely cause acute lung injury. Diagnosis is difficult because there is no single test for the condition. Diagnosis and management are described. Earlier recognition may lead to earlier diagnosis, treatment, and prevention.
IMPLICATIONS: The anterior jugular venous system provides an important collateral venous network with the subclavian and deep jugular veins, especially in unilateral occlusion of an innominate vein. In such cases, central venous catheters may be correctly placed via the anterior jugular venous system. However, central venous catheters malpositioned in the anterior jugular vein can increase the risk for complications and should be removed.
IMPLICATIONS: The incidence of postoperative vomiting might be predicted using duration of surgery >=30 min, age >=3 yr, strabismus surgery, and a positive history of postoperative vomiting/postoperative nausea and vomiting in the children or in their relatives. The predicted incidence of postoperative vomiting is 9%, 10%, 30%, 55%, and 70% for 0-4 of these risk factors present.
IMPLICATIONS: We investigated the effects of body position shifting and airway maneuvers on airway patency in anesthetized children scheduled for adenotonsillectomy. Lateral positioning not only improved airway patency but also enhanced the potential of airway maneuvers.
IMPLICATIONS: In this study, our aim was to evaluate the accuracy of a noninvasive technique of measuring cardiac output in children. Measures of cardiac output obtained via partial rebreathing were compared with measures obtained by thermodilution.
IMPLICATIONS: A practicing clinician can now predict the development of adverse postoperative phenomena, such as emergence delirium and postoperative behavioral changes, based on levels of preoperative anxiety.
IMPLICATIONS: We describe the adaptation of a cardiovascular model that reflects infant cardiovascular physiology and reacts appropriately to a set of interventions. This model can form the basis for a screen-based educational simulator. The ultimate goal is the simulation of a 6-mo-old infant in full-scale.
IMPLICATIONS: The robotic surgical system for pediatric laparoscopy severely limits the anesthesiologist's access to the patient and requires advance preparation to ensure patient safety. We present the anesthetic management of the first successful robot-assisted laparoscopic Kasai procedure in an infant.
IMPLICATIONS: Patients undergoing ambulatory knee arthroscopy recover equally fast when using either selective spinal anesthesia with hyperbaric bupivacaine or general anesthesia with desflurane. Spinal anesthesia is associated with decreased pain scores and less postoperative nausea and vomiting in the hospital.
IMPLICATIONS: Some elderly patients are preoperatively treated with benzodiazepines for anxiety, insomnia, and depression. Although preoperative use of benzodiazepines is one of the risk factors for postoperative confusion, the relationship between postoperative confusion and preoperative psychiatric symptoms or duration of benzodiazepine exposure is unclear.
IMPLICATIONS: To decrease complications related to blood transfusions, pharmacological manipulation of the clotting system may be performed. However, such strategies must be safe, reliable, and easy to administer. This study demonstrates that the blood-sparing efficacy of oral tranexamic acid is similar to that of IV tranexamic acid.
IMPLICATIONS: Epidural local anesthetics reduce the requirement of hypnotics, analgesics, and muscle relaxants. However, no study has evaluated the effect of local anesthetics on all three components of balanced anesthesia, i.e., hypnosis, analgesia, and muscle relaxation, in the clinical setting. We observed that epidural bupivacaine significantly reduces the requirement of all three during general anesthesia.
IMPLICATIONS: In isolated human myocardium, racemic ketamine induced a moderate positive inotropic effect but a profound direct negative inotropic effect in the presence of ß-adrenoceptor blockade. Furthermore, ketamine hastened relaxation through stimulation of ß-adrenoceptor. This should be interpreted with the known various physiopathologic states and treatments interfering with {alpha}- and ß-adrenoceptors.
IMPLICATIONS: Fentanyl administration elicits cough. IV lidocaine 1.5 mg/kg suppresses fentanyl-induced coughing.
IMPLICATIONS: Propofol-long- and medium-chain triglycerides resulted in a more frequent incidence of pain upon injection than propofol with 40 mg IV of lidocaine pretreatment as a Bier's block (47% versus 24%, respectively).
IMPLICATIONS: In an animal study, the effect of ephedrine on onset time, cardiac index, and muscle blood flow was determined after administration of thiopental. A correlation between onset time of muscle relaxants and hemodynamic variables is discussed. Our results demonstrated that ephedrine did not shorten onset time of rocuronium in healthy pigs.
IMPLICATIONS: Isoflurane inhibition of N-methyl-D-aspartate-induced necrotic cell death, evaluated in mixed neuronal/glial cell cultures, did not result in caspase-3-mediated apoptotic cell death. Our in vitro results failed to support the hypothesis that cells protected by isoflurane neuroprotection later deteriorate into an apoptotic state.
IMPLICATIONS: Enhancement of background K channel currents by volatile anesthetics may contribute to neuronal depression during anesthesia. Currents passed by a newly discovered human background K channel, TWIK-related spinal cord K channel, are strongly enhanced by volatile anesthetics in the clinical range, suggesting a role for it in volatile anesthetic mechanisms.
IMPLICATIONS: At equal multiples of the minimum alveolar concentration, sevoflurane produced lower bispectral index (BIS) values than did halothane. Such results indicate that BIS is drug specific.
IMPLICATIONS: Acoustic stimuli induce distinct changes in the electroencephalogram (EEG). We found that one component of these EEG modifications can be used to monitor the targeted light levels of sedation in critically ill patients nearly continuously, independent of adding remifentanil to a propofol-based sedation regime.
IMPLICATIONS: A human patient simulator may reduce the risk of learning-curve error in anesthesiologists using new, complex equipment without subjecting patients to risk. It can be used to highlight potential design errors in new equipment through usability testing or certify practitioners before they use new equipment.
IMPLICATIONS: Conductive warming with a gel-coated circulating water mattress was studied as a new method to prevent perioperative hypothermia. The physical properties of heat exchange were determined, and possibilities and limitations of the method are described.
IMPLICATIONS: Patients who underwent right lobe donor hepatectomy (RLDH) experienced more postoperative pain as compared with patients after major hepatic resection for tumor. This may be partially explained by the longer surgical duration observed in the RLDH group. Better perioperative teaching for patient-controlled epidural analgesia use may improve early postoperative pain control in RLDH patients.
IMPLICATIONS: In this study, an IV infusion of ketamine, a parenteral N-methyl-D-aspartate receptor antagonist, was found to predict the analgesic response to an oral treatment regimen of dextromethorphan, an oral N-methyl-D-aspartate antagonist, in 84% of patients with neuropathic pain. A fine-tuned IV ketamine test may enhance patient care by saving time and conserving valuable resources.
IMPLICATIONS: Epidural blood patch may be a safe therapeutic option for patients with postdural puncture headache in the context of acute varicella (chickenpox). In these circumstances, patients should first receive adequate antiviral coverage.
IMPLICATIONS: A case is presented of new intractable flank pain after intrathecal infusion system placement in a man with a T12 spinal cord injury. Pain after intrathecal infusion system placement was evaluated by magnetic resonance imaging and the catheter was found to be intraparenchymal. Increased vigilance is warranted when caring for paraplegic patients.
IMPLICATIONS: Although most surgeons and anesthesiologists believe that it is important for their patients to stop smoking at the time of surgery, most do not have the knowledge or experience to help them achieve this goal.
IMPLICATIONS: We collected data to correlate anatomical indexes and the difficult airway. The Mallampati score correlates with the laryngoscopic view (Cormack-Lehane score), but it is not useful in the prediction of difficult intubation as a single risk factor.
IMPLICATIONS: We simultaneously monitored dynamic preload variablessuch as systolic blood pressure variation, its down component, pulse pressure variation, stroke volume variation, and esophageal Doppler-derived corrected flow timeduring induced hypovolemia and hypervolemia. The results demonstrated that these variables, with the exception of corrected flow time, are useful indicators of hypovolemia, but not of hypervolemia.
IMPLICATIONS: Median fibrillation frequency (MF) has been suggested as an online monitoring tool during resuscitation. In a pig model, during prolonged resuscitation, we compared the individual curves of MF, mean fibrillation amplitude, and coronary perfusion pressure and found that MF was not useful for monitoring resuscitation efforts.
IMPLICATIONS: We examined a novel batroxobin-based activator for detecting platelet inhibition induced by eptifibatide on thrombelastography (TEG(R)). We concluded that batroxobin-modified TEG(R) was more sensitive than kaolin TEG(R) for detecting eptifibatide-induced platelet inhibition at clinical concentrations.
IMPLICATIONS: We report the development of significant carboxyhemoglobinemia in a critically ill, mechanically ventilated patient who required massive transfusion because of retroperitoneal hemorrhage secondary to pheochromocytoma.
IMPLICATIONS: Hydrothorax is a pleural space fluid accumulation. Most pleural effusions are rarely observed. Although unusual, these effusions associated with hepatic cirrhosis and ascites have been well described. However, the case we present here showed no clinical signs of ascites before surgery. Therefore, the patient developed a right-sided hydrothorax as a result of residual motor blockade during anesthesia recovery.
IMPLICATIONS: Intrathecal administration of magnesium sulfate has a risk of neurotoxicity and shows no evidence of protective effects against ischemic spinal cord injury. Although the intrathecal use of magnesium sulfate has been reported in humans, further evaluations of its safety are warranted.
IMPLICATIONS: We describe a patient who developed adrenal insufficiency (AI) after glucocorticoid therapy for spinal cord injury. Their temporal association and the exclusion of other possible etiologies led us to postulate that AI was a complication of the glucocorticoids. Clinicians should, therefore, consider AI in patients with SCI receiving glucocorticoids.
IMPLICATIONS: Iatrogenic vascular injuries after lumbar disk surgery are rare but potentially life threatening. Such injuries may perioperatively present in a diverse array of manifestations, and often the diagnosis is delayed or overlooked, which may increase morbidity and mortality. Early diagnosis and surgical repair of these vascular injuries can be life saving.
IMPLICATIONS: The heart rate variability statistic peak point correlation dimension (PD2) successfully predicted hypotension within 20 min of spinal anesthesia in all 22 pregnant women undergoing cesarean delivery. If further research supports this finding, real-time electrocardiograph analysis of peak PD2 might prevent adverse circulatory events in these women.
IMPLICATIONS: We determined the minimum alveolar anesthetic concentration (MAC) of halothane in rats by using the bracketing technique. The size of the incremental change in halothane affected the estimation of MAC. Increment size should be considered when MAC estimates are compared between studies or when the accuracy of MAC is assessed.
IMPLICATIONS: Positioning for lumbar epidural block involves flexing the spine, which can be difficult and painful in patients with lower limb injury. With the paramedian approach, it was possible to perform the block in most sitting patients without flexing the spine. The median approach required spinal flexion in most patients.
IMPLICATIONS: We evaluated the efficacy and acceptability of cervical epidural anesthesia using ropivacaine for total parathyroidectomy with subsequent partial implantation of the gland into the forearm muscles (combined neck and upper extremity procedure). There were no complications or vital sign deterioration in 15 cases. Epidural anesthesia allowed the monitoring of vocal cord function.
IMPLICATIONS: Preoperative single-injection paravertebral block proved a suitable adjunct to a multimodal analgesic regimen: it improved postoperative analgesia and prevented postoperative nausea and vomiting after breast resection or mastectomy with and without associated axillary dissection.
IMPLICATIONS: Material characteristics of continuous spinal anesthesia small-bore catheters are very different. Although extrapolation from experimental studies to clinical routine should be made with care, our data suggest that catheters with higher strength characteristics may reduce the risk of catheter breakage in patients.
IMPLICATIONS: Morbidly obese adult patients who underwent major abdominal surgery in a prospective, randomized study awoke significantly faster after desflurane than after sevoflurane anesthesia, and the patients anesthetized with desflurane had higher oxygen saturations on entry to the postanesthesia care unit.
IMPLICATIONS: A weak diuretic effect that slightly enhanced the hemodilution occurred on infusing acetated Ringer's solution during laparoscopic cholecystectomy. A nomogram facilitates the choice of infusion rate.
IMPLICATIONS: Hydrogen peroxide is used intraoperatively and perioperatively for the identification of fistula tracts. A venous oxygen embolism occurred in a 66-yr-old man after the intraoperative injection of 60 mL 3% hydrogen peroxide into an enterocutaneous fistula. The relevant aspects of the diagnosis and treatment of oxygen embolism are discussed.
IMPLICATIONS: The incorrect assembly of a bladder irrigation system caused air to be pumped from an open drain through the resectoscope into the bladder, which led to a near fatal cardiac arrest caused by venous air embolism. Anesthesiologists and urologists should be aware of this potential complication.
IMPLICATIONS: Anesthesiologists are often asked to provide care for patients undergoing radiofrequency ablation of neoplastic lesions. It is important that they be aware of and be prepared to treat complications such as severe hypertension, tachycardia, and arrhythmias, which can occur during these procedures.
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