Anesthesiology
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Randomized Controlled Trial
Differences between midazolam and propofol sedation on upper airway collapsibility using dynamic negative airway pressure.
Upper airway obstruction (UAO) during sedation can often cause clinically significant adverse events. Direct comparison of different drugs' propensities for UAO may improve selection of appropriate sedating agents. The authors used the application of negative airway pressure to determine the pressure that causes UAO in healthy subjects sedated with midazolam or propofol infusions. ⋯ At the mild to moderate level of sedation studied, midazolam and propofol sedation resulted in the same propensity for UAO. In this homogeneous group of healthy subjects, there was a considerable range of negative pressures required to cause UAO. The specific factors responsible for the maintenance of the upper airway during sedation remain to be elucidated.
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Randomized Controlled Trial
Short thyromental distance: a predictor of difficult intubation or an indicator for small blade selection?
Short thyromental distance (TMD; < 5 cm) has been correlated with difficult direct laryngoscopic intubation in adult patients. The authors hypothesized that a smaller Macintosh curved blade (No. 2 MCB) would improve the predicted difficult laryngoscopy in short-TMD patients over that with a standard Macintosh curved blade (No. 3 MCB). ⋯ The predicted difficult laryngoscopy and intubation with the use of the adult No. 3 MCB in standard adult patients with a TMD < or = 5 cm is significantly easier with use of the smaller No. 2 MCB.
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Neuropathic pain and radicular low back pain both have a major impact on human health worldwide. Microarray gene analysis on central nervous system tissues holds great promise for discovering novel targets for persistent pain modulation. ⋯ These two models of persistent pain produce similar allodynic outcomes but produce differential gene expression. These results suggest that diverging mechanisms lead to a common behavioral outcome in these pain models. Furthermore, these distinct pathophysiologic mechanisms in neuropathic versus radicular pain may implicate unique drug therapies for these types of chronic pain syndromes.
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Mutations in the ryanodine type 1 receptor (RyR1) are causative for malignant hyperthermia. Studies in human B lymphocytes have shown that measurement of RyR1-mediated intracellular Ca(2+) (Ca(2+)(i)) release can differentiate between normal and malignant hyperthermia-susceptible individuals. The authors have further developed the B-cell assay by pharmacologically characterizing RyR1-mediated Ca release in two normal human B-cell lines and demonstrating increased sensitivity of lymphocytes to the RyR1 agonist 4-chloro-m-cresol (4-CmC) in the porcine model of MH. ⋯ RyR1-mediated Ca(2+) signals can be pharmacologically distinguished from other intracellular sources in human B cells, and alterations of RyR1 function can be successfully detected using Ca(2+) release from intracellular stores as an end point.
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This study was designed to evaluate the effects of blood warming during hemofiltration on global and regional hemodynamics, plasma lactate, and 24-h survival during septic shock. ⋯ Differences in temperature during hemofiltration resulted in striking differences in hemodynamics, metabolic acidosis, and survival rate in this clinically relevant experimental model of septic shock.