Anesthesiology
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Comparative Study
Recovery from sleep deprivation occurs during propofol anesthesia.
Some neurophysiologic similarities between sleep and anesthesia suggest that an anesthetized state may reverse effects of sleep deprivation. The effect of anesthesia on sleep homeostasis, however, is unknown. To test the hypothesis that recovery from sleep deprivation occurs during anesthesia, the authors followed 24 h of sleep deprivation in the rat with a 6-h period of either ad libitum sleep or propofol anesthesia, and compared subsequent sleep characteristics. ⋯ These data show that a recovery process similar to that occurring during naturally occurring sleep also takes place during anesthesia and suggest that sleep and anesthesia share common regulatory mechanisms. Such interactions between sleep and anesthesia may allow anesthesiologists to better understand a potentially important source of variability in anesthetic action and raise the possibility that anesthetics may facilitate sleep in environments where sleep deprivation is common.
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Comparative Study
Differentiating among hospitals performing physiologically complex operative procedures in the elderly.
The authors previously showed how a statewide discharge abstract database could be used to quantify for stakeholders how surgical practices differ among hospitals. The two pediatric hospitals in Iowa differ from other hospitals in Iowa based on their providing a more diverse, comprehensive, and physiologically complex selection of procedures in younger patients. Physiologically complex surgery performed in children aged 0-2 yr has been regionalized to a few high-volume facilities. ⋯ Results observed for geriatric patients provide further evidence of the validity of these methods and the usefulness of discharge abstract data for comparing surgical practices among facilities. A hospital can use discharge abstract data to assist governmental agencies, charitable organizations, philanthropists, insurers, etc., in appreciating the unique contributions of individual hospitals to surgical care.
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Comparative Study
Production of paradoxical sensory hypersensitivity by alpha 2-adrenoreceptor agonists.
Administration of opioid receptor agonists is followed by paradoxical sensory hypersensitivity. This hypersensitivity has been suggested to contribute to the antinociceptive tolerance observed with opioids. The authors hypothesized that alpha 2-adrenoreceptor agonists, which also produce antinociceptive tolerance, would produce sensory hypersensitivity. ⋯ alpha 2-Adrenoreceptor agonists produce sensory hypersensitivity that may be analogous to that produced by opioids. Sensory hypersensitivity was prevented by idazoxan, demonstrating that it is mediated by alpha 2 receptors. Clonidine infusion increased spinal dynorphin content. Sensory hypersensitivity was prevented or reversed by MK-801 and dynorphin antiserum, implicating N-methyl-D-aspartate receptors and spinal dynorphin in its production. Clinicians should be mindful of the possibility of drug-induced hyperalgesia in patients treated with alpha 2-adrenoreceptor agonists.
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Singapore reported its first case of Severe Acute Respiratory Syndrome (SARS) in early March 2003 and was placed on the World Health Organization's list of SARS-affected countries on March 15, 2003. During the outbreak, Tan Tock Seng Hospital was designated as the national SARS hospital in Singapore to manage all known SARS patients. Stringent infection control measures were introduced to protect healthcare workers and control intrahospital transmission of SARS. Work-flow processes for surgery were extensively modified. ⋯ Staff personal protection, patient risk categorization, and reorganization of operating room workflow processes formed the key elements for the containment of SARS transmission. Lessons learned during this outbreak will help in the planning and execution of infection control measures, should another outbreak occur.