Anesthesiology
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Comparative Study
Preoperative prolonged steroid use is not associated with intraoperative blood transfusion in noncardiac surgical patients.
Prolonged steroid therapy is reportedly associated with changes in coagulation, suggesting increased intraoperative bleeding or hypercoagulability. The aim of this retrospective study was to assess whether long-term steroid use was associated with increased transfusion requirements, infection, or hypercoagulability in adults undergoing noncardiac surgery. ⋯ The effect of prolonged steroid use on bleeding, if any, thus seems likely to be small and is probably of limited clinical consequence. In contrast, corticosteroid use augments the risk of both systemic and wound infections.
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Randomized Controlled Trial Multicenter Study Comparative Study
Multicenter, randomized, comparative cost-effectiveness study comparing 0, 1, and 2 diagnostic medial branch (facet joint nerve) block treatment paradigms before lumbar facet radiofrequency denervation.
Among patients presenting with axial low back pain, facet arthropathy accounts for approximately 10-15% of cases. Facet interventions are the second most frequently performed procedures in pain clinics across the United States. Currently, there are no uniformly accepted criteria regarding how best to select patients for radiofrequency denervation. ⋯ Using current reimbursement scales, these findings suggest that proceeding to radiofrequency denervation without a diagnostic block is the most cost-effective treatment paradigm.
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Comparative Study
Enhancement of GABAergic tonic currents by midazolam and noradrenaline in rat substantia gelatinosa neurons in vitro.
Substantia gelatinosa of the spinal dorsal horn is crucial for transmission and modification of noxious stimuli. Previous studies have demonstrated that intrathecal midazolam, a benzodiazepine agonist, enhanced perioperative analgesia. Not only synaptic but also extrasynaptic inhibitory currents contribute to modification of noxious stimuli. Thus, the effects of midazolam on extrasynaptic gamma-aminobutyric acid (GABA) type A receptors in substantia gelatinosa neurons and interaction with noradrenaline, a transmitter of the descending inhibitory systems, were investigated. ⋯ Midazolam had much larger effects on extrasynaptic GABA type A receptors than the synaptic receptors, suggesting a role of the enhancement of GABAergic extrasynaptic currents in the midazolam-induced analgesia. Because noradrenaline is shown to increase extrasynaptic GABA concentration, simultaneous administration of noradrenaline and midazolam may enhance the increased GABA action by midazolam, thereby resulting in an increase in tonic extrasynaptic currents.