Anesthesiology
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Randomized Controlled Trial
Anesthetic-induced improvement of the inflammatory response to one-lung ventilation.
Although one-lung ventilation (OLV) has become an established procedure during thoracic surgery, sparse data exist about inflammatory alterations in the deflated, reventilated lung. The aim of this study was to prospectively investigate the effect of OLV on the pulmonary inflammatory response and to assess possible immunomodulatory effects of the anesthetics propofol and sevoflurane. ⋯ This prospective, randomized clinical study suggests an immunomodulatory role for the volatile anesthetic sevoflurane in patients undergoing OLV for thoracic surgery with significant reduction of inflammatory mediators and a significantly better clinical outcome (defined by postoperative adverse events) during sevoflurane anesthesia.
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Randomized Controlled Trial
Rifampin greatly reduces the plasma concentrations of intravenous and oral oxycodone.
Oxycodone is a mu-opioid receptor agonist that is metabolized mainly in the liver by cytochrome P450 3A and 2D6 enzymes. Rifampin is a strong inducer of several drug-metabolizing enzymes. The authors studied the interaction of rifampin with oxycodone. Their hypothesis was that rifampin enhances the CYP3A-mediated metabolism of oxycodone and attenuates its pharmacologic effect. ⋯ Induction of cytochrome P450 3A by rifampin reduced the area under the oxycodone concentration-time curve of intravenous and oral oxycodone. The pharmacologic effects of oxycodone were modestly attenuated. To maintain adequate analgesia, dose adjustment of oxycodone may be necessary, when used concomitantly with rifampin.
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Comment Review Historical Article
Massive blood transfusions: the impact of Vietnam military data on modern civilian transfusion medicine.
To determine the coagulation defects associated with massive blood transfusions, coagulation studies were performed on 21 battle casualties admitted to the US Naval Support Activity Hospital, Da Nang, Vietnam. All but one patient who received less than 20 units of Acid-Citrate-Dextrose blood (7 patients) did not develop a coagulopathy. All patients who received more than 20 units (14 patients) developed a clinically significant coagulation defect. ⋯ The authors conclude that clinically important coagulopathies predictably occur after administration of 20-25 units of stored Acid-Citrate-Dextrose blood in acutely wounded, previously healthy soldiers. Fresh frozen plasma should not be a major therapeutic choice for coagulopathies in massive blood transfusions. Treatment of dilutional thrombocytopenia (50,000/mm(3)) is a primary component of treating coagulopathies associated with massive blood transfusions.
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Randomized Controlled Trial Comparative Study
Approach combining the airway scope and the bougie for minimizing movement of the cervical spine during endotracheal intubation.
The Airway Scope (AWS, AWS-S100; Hoya-Pentax, Tokyo, Japan), a recently introduced video laryngoscope, has been reported to reduce movement of the cervical spine during intubation attempts in comparison with conventional laryngoscopes. Use of the bougie as an aid for the AWS may cause further reduction. The authors compared cervical spine movement during intubation with the AWS with and without a bougie. ⋯ Use of the bougie resulted in significantly reduced extension of the cervical spine during intubation attempt with the AWS in patients with a normal cervical spine.
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A stimulation current of no more than 0.5 mA is regarded as safe in avoiding nerve injury and delivering adequate stimulus to provoke a motor response. However, there is no consistent level of stimulating threshold that reliably indicates intraneural placement of the needle. The authors determined the minimally required stimulation threshold to elicit a motor response outside and inside the most superficial part of the brachial plexus during high-resolution, ultrasound-guided, supraclavicular block. ⋯ Within the limitations of this study and the use of ultrasound, a stimulation current of 0.2 mA or less is reliable to detect intraneural placement of the needle. Furthermore, stimulation currents of more than 0.2 and no more than 0.5 mA could not rule out intraneural position.