Anesthesiology
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This historical landmark paper demonstrated the terribly-higher maternal mortality during cesarean section performed under general anesthesia vs regional anesthesia in the United States from 1979-1990.
This resulted in the oft-quoted statistic of being '...17 times more likely to die under a GA cesarean section than epidural or spinal.'
It is very important to note that this is a historical article and that the demonstrated very high mortality was greatly contributed to by a culture tolerating inexperienced anesthesia residents performing GA CS after-hours with limited senior support.
Hawkins followed up this study with another in 2011: Anesthesia-related maternal mortality in the United States: 1979-2002. This reassuringly showed a much improved GA CS maternal mortality from 1997-2002 (although still higher than regional CS).
The important take-home from this paper is that a GA cesarean section increases the risk of serious airway events, and if this is not managed by experienced and appropriately trained anaesthetists/anesthesiologists, will result in maternal deaths.
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Randomized Controlled Trial Clinical Trial
Dexmedetomidine as an anesthetic adjunct in coronary artery bypass grafting.
Alpha 2-adrenergic agonists decrease sympathetic tone with ensuing attenuation of neuroendocrine and hemodynamic responses to anesthesia and surgery. The effects of dexmedetomidine, a highly specific alpha 2-adrenergic agonist, on these responses have not been reported in patients undergoing coronary artery bypass grafting. ⋯ Intraoperative intravenous infusion of dexmedetomidine to patients undergoing coronary artery revascularization decreased intraoperative sympathetic tone and attenuated hyperdynamic responses to anesthesia and surgery but increased the propensity toward hypotension.
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Ketamine shows, besides its general anesthetic effect, a local anesthetic-like action that is due to blocking of peripheral nerve sodium currents. In this study, the stereoselectivity of the blocking effects of the ketamine enantiomers S(+) and R(-) was investigated in sodium and potassium channels in peripheral nerve membranes. ⋯ Ketamine blockade of sodium and potassium channels in peripheral nerve membranes shows no stereoselectivity except for the flicker K+ channel, which showed a very weak stereoselectivity in favor of the R(-) form. This potential-insensitive flicker K+ channel may contribute to the resting potential. Block of this channel and subsequent depolarization of the resting membrane potential leads, besides to direct Na+ channel block, to inexcitability via Na+ channel inactivation.
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Randomized Controlled Trial Multicenter Study Clinical Trial
Perioperative sympatholysis. Beneficial effects of the alpha 2-adrenoceptor agonist mivazerol on hemodynamic stability and myocardial ischemia. McSPI--Europe Research Group.
Mivazerol hydrochloride is a new alpha 2-adrenoceptor agonist. In vitro and animal studies have demonstrated both sympatholytic and antiischemic properties. To evaluate the safety and efficacy of mivazerol in patients during perioperative stress, this multicenter phase II clinical trial studied hemodynamic stability and myocardial ischemia in patients with coronary artery disease undergoing noncardiac surgery. ⋯ Continuous, 72-h perioperative administration of mivazerol to high-risk patients appears to be relatively safe, producing no significant hypotension or adverse events but some evidence of bradycardia not associated with adverse clinical events. Mivazerol decreased the incidence of, and treatment for, tachycardia, hypertension, and myocardial ischemia, particularly during high stress periods. Therefore, these salutary effects of mivazerol indicate further study in large-scale trials that assess mivazerol's effects on adverse cardiac outcomes, including death and myocardial infarction.