Anesthesiology
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Comparative Study
Triiodothyronine increases contractility independent of beta-adrenergic receptors or stimulation of cyclic-3',5'-adenosine monophosphate.
Triiodothyronine regulates cardiac contractility; however, the mechanisms by which it produces its acute contractile effects remains unknown. We compared the acute effects of thyroid hormones (triiodothyronine [T3] and thyroxine [T4]) and of isoproterenol on the contractility of isolated rat hearts. In addition, we sought to determine whether the acute inotropic effects of thyroid hormones were mediated by beta-adrenergic receptors or by increased production of cyclic-3',5'-adenosine monophosphate (cAMP). ⋯ These results demonstrate that the acute inotropic effects of T3 are not shared by T4 and appear unrelated to beta-adrenergic receptor mechanisms or to generation of cAMP. Thus, T3 acutely stimulates cardiac contraction by mechanisms that differ from those of the more commonly used beta-adrenergic receptor agonists and phosphodiesterase inhibitors. Further studies are needed to identify the mechanisms underlying the acute contractile effects of T3 and to determine whether T3 will prove useful for increasing ventricular function in patients.
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Randomized Controlled Trial Comparative Study Clinical Trial
Does spinal anesthesia result in a more complete sympathetic block than that from epidural anesthesia?
Spinal and epidural injection of local anesthetics are used to produce sympathetic block to diagnose and treat certain chronic pain syndromes. It is not clear whether either form of regional anesthesia produces a complete sympathetic block. Spinal anesthesia using tetracaine has been reported to produce a decrease in plasma catecholamine concentrations. This has not been demonstrated for epidural anesthesia in humans with level of anesthesia below C8. One possible explanation is that spinal anesthesia results in a more complete sympathetic block than epidural anesthesia. To examine this question, a cross-over study was performed in young, healthy volunteers. ⋯ Spinal anesthesia did not result in a more complete attenuation of the sympathetic response to a CPT than did epidural anesthesia. In response to the CPT, spinal anesthesia blocked the increase in cardiac index, and epidural anesthesia resulted in a decrease in total peripheral resistance compared to the pre-anesthesia state. The differences between the techniques are not significant and are of uncertain clinical implications.
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Randomized Controlled Trial Comparative Study Clinical Trial
Cervical spine movement during laryngoscopy with the Bullard, Macintosh, and Miller laryngoscopes.
Direct laryngoscopy requires movement of the head, neck, and cervical spine. Spine movement may be limited for anatomic reasons or because of cervical spine injury. The Bullard laryngoscope, a rigid fiberoptic laryngoscope, may cause less neck flexion and head extension than conventional laryngoscopes. The purpose of this study was to compare head extension (measured externally), cervical spine extension (measured radiographically), and laryngeal view obtained with the Bullard, Macintosh, and Miller laryngoscopes. ⋯ The Bullard laryngoscope caused less head extension and cervical spine extension than conventional laryngoscopes and resulted in a better view. It may be useful in care of patients in whom cervical spine movement is limited or undesirable.
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Randomized Controlled Trial Comparative Study Clinical Trial
Influence of gas composition on recurrence of atelectasis after a reexpansion maneuver during general anesthesia.
Atelectasis, an important cause of impaired gas exchange during general anesthesia, may be eliminated by a vital capacity maneuver. However, it is not clear whether such a maneuver will have a sustained effect. The aim of this study was to determine the impact of gas composition on reappearance of atelectasis and impairment of gas exchange after a vital capacity maneuver. ⋯ The composition of inspiratory gas plays an important role in the recurrence of collapse of previously reexpanded atelectatic lung tissue during general anesthesia in patients with healthy lungs. The reason for the instability of these lung units remains to be established. The change in the amount of atelectasis and shunt appears to be independent of the change in the compliance of the respiratory system.
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Comparative Study Clinical Trial
Weekly ventilator circuit changes. A strategy to reduce costs without affecting pneumonia rates.
Mechanical ventilator circuits are commonly changed at 48-h intervals. This frequency may be unnecessary because ventilator-associated pneumonia often results from aspiration of pharyngeal secretions and not from the ventilator circuit. We compared the ventilator-associated pneumonia rates and costs associated with 48-h and 7-day circuit changes. ⋯ We found no difference in pneumonia rates with ventilator circuit changes at 48-h and 7-day intervals. Ventilator circuits can be safely changed at weekly intervals, resulting in large cost savings.