Anesthesiology
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Measurement of motor evoked responses to transcranial stimulation (tc-MER) is a technique for intraoperative monitoring of motor pathways in the brain and spinal cord. However, clinical application of tc-MER monitoring is hampered because most anesthetic techniques severely depress the amplitude of motor evoked responses. Because paired electrical stimuli increase tc-MER responses in awake subjects, we examined their effects in anesthetized patients undergoing surgery. METHODS. Eleven patients whose neurologic condition was normal and who were undergoing spinal or aortic surgery were anesthetized with sufentanil-N20-ketamine. Partial neuromuscular blockade (single-twitch height 25% of baseline) was maintained with vecuronium. Single and paired electrical stimuli were delivered to the scalp, and compound action potentials were recorded from the tibialis anterior muscle. The amplitude and latency of the tc-MERs were measured as the interval between paired stimuli was varied between 0 (single stimulus) and 10 ms. All recordings were completed before spinal manipulation or aortic clamping. ⋯ Application of paired transcranial electrical stimuli increases amplitudes and reproducibility of tc-MERs during anesthetic-induced depression of the motor system. The effect may represent temporal summation of stimulation at cortical or spinal sites. The results of this study warrant further clinical evaluation of paired transcranial stimulation.
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Randomized Controlled Trial Clinical Trial
Placental transfer and neonatal effects of epidural sufentanil and fentanyl administered with bupivacaine during labor.
This randomized double-blind investigation was designed to study the placental transfer and neonatal effects of epidural sufentanil and fentanyl infused with bupivacaine for labor analgesia. ⋯ Although the degree of placental transfer of sufentanil appeared greater than that of fentanyl, lower MV sufentanil concentrations resulted in less fetal exposure to sufentanil. The lower NACS at 24 h in group B-F may reflect the continued presence of fentanyl in the neonate.
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Systemic vascular resistance (the ratio of mean aortic pressure [AP] and mean aortic blood flow [AQ]) does not completely describe left ventricular (LV) afterload because of the phasic nature of pressure and blood flow. Aortic input impedance (Zin) is an established experimental description of LV afterload that incorporates the frequency-dependent characteristics and viscoelastic properties of the arterial system. Zin is most often interpreted through an analytical model known as the three-element Windkessel. This investigation examined the effects of isoflurane, halothane, and sodium nitroprusside (SNP) on Zin. Changes in Zin were quantified using three variables derived from the Windkessel: characteristic aortic impedance (Zc), total arterial compliance (C), and total arterial resistance (R). ⋯ The major difference between the effects of isoflurane and halothane on LV afterload derived from the Windkessel model of Zin was related to R, a property of arteriolar resistance vessels, and not to Zc or C, the mechanical characteristics of the aorta. No changes in arterial wave reflection patterns determined from Zin spectra occurred with isoflurane and halothane. These results indicate that isoflurane and halothane have no effect on frequency-dependent arterial properties.
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Visceral sensations are an important component of many clinical pain states. It is apparent that intrathecal pain relief may be more effective if appropriate combinations of drugs rather than a single agent can be used. The purpose of this study was to examine the relative contribution of opioid receptor subtypes to visceral antinociception using colorectal distension as a visceral pain model. ⋯ The results suggest that spinal mu- and delta- but not kappa-opioid receptors have a significant role in the modulation of visceral nociception induced by colorectal distension. In addition, the results indicate that activation of nonspinal kappa receptors may mediate visceral antinociception.