Anesthesiology
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Comparative Study
Influence of methylenetetrahydrofolate reductase gene polymorphisms on homocysteine concentrations after nitrous oxide anesthesia.
Mutations in the methylenetetrahydrofolate reductase (MTHFR) gene (677C>T, 1298A>C) cause elevated plasma homocysteine concentrations and have been linked to fatal outcomes after nitrous oxide anesthesia. This study tested the hypothesis that patients with common MTHFR 677C>T or 1298A>C mutations develop higher plasma homocysteine concentrations after nitrous oxide anesthesia than wild-type patients. ⋯ This study shows that patients with a homozygous MTHFR 677C>T or 1298A>C mutation are at a higher risk of developing abnormal plasma homocysteine concentrations after nitrous oxide anesthesia.
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Comparative Study
Cardiac surgery fast-track treatment in a postanesthetic care unit: six-month results of the Leipzig fast-track concept.
The authors compared the safety and efficacy of a newly developed fast-track concept at their center, including implementation of a direct admission postanesthetic care unit, to standard perioperative management. ⋯ The Leipzig fast-track protocol is a safe and effective method to manage cardiac surgery patients after a variety of operations.
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Comparative Study
Comparison of thoracic epidural pressure in the sitting and lateral decubitus positions.
The hanging drop technique identifies the epidural space using the negative pressure of this space. Although the hanging drop technique is popular at the thoracic level, there is still controversy on the negative epidural pressure at this level. The authors hypothesized that the epidural pressure is more consistently negative in the sitting position than in the lateral decubitus position at the thoracic level. ⋯ The thoracic epidural pressure is more negative in the sitting position than in the lateral decubitus position. These results suggest that the patient should be sitting when the hanging drop technique is used to identify the epidural space.
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Comparative Study
Cholinesterase inhibitor donepezil dilates cerebral parenchymal arterioles via the activation of neuronal nitric oxide synthase.
An acetylcholinesterase inhibitor donepezil currently is used to treat patients with Alzheimer disease. However, its direct effect on cerebral blood vessels has not been evaluated. The present study was designed to examine whether donepezil induces acute cerebral arteriolar dilation and whether neuronal nitric oxide synthase contributes to this vasodilator response. ⋯ Donepezil produces acute vasodilation induced by a selective activation of neuronal nitric oxide synthase in the cerebral parenchymal arterioles. This agent may be capable of enhancing this enzymatic activity directly or via acetylcholinesterase existing on the arteriolar wall.