Anesthesiology
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Ketamine is a commonly used anesthetic, but the mechanistic basis for its clinically relevant actions remains to be determined. The authors previously showed that HCN1 channels are inhibited by ketamine and demonstrated that global HCN1 knockout mice are twofold less sensitive to hypnotic actions of ketamine. Although that work identified HCN1 channels as a viable molecular target for ketamine, it did not determine the relevant neural substrate. ⋯ These data indicate that forebrain principal cells represent a relevant neural substrate for HCN1-mediated hypnotic actions of ketamine. The authors suggest that ketamine inhibition of HCN1 shifts cortical neuron electroresponsive properties to contribute to ketamine-induced hypnosis.
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Many children experience significant distress before and after surgery. Previous studies indicate that healthcare providers' and parents' behaviors may influence children's outcomes. This study examines the influence of adults' behaviors on children's distress and coping in the postanesthesia care unit. ⋯ Adults can influence children's distress and coping in the postanesthesia care unit. Empathy, distraction, and assurance talk may be helpful in keeping a child from becoming distressed, and nonprocedural talk and distraction may cue children to cope. Reassurance should be avoided when a child is already distressed.
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Comparative Study
Comparison of equivolume, equiosmolar solutions of mannitol and hypertonic saline with or without furosemide on brain water content in normal rats.
Mannitol and hypertonic saline (HS) are used by clinicians to reduce brain water and intracranial pressure and have been evaluated in a variety of experimental and clinical protocols. Administering equivolume, equiosmolar solutions in healthy animals could help produce fundamental data on water translocation in uninjured tissue. Furthermore, the role of furosemide as an adjunct to osmotherapy remains unclear. ⋯ When compared to equivolume, equiosmolar administration of HS, mannitol reduced brain water content to a greater extent over the entire course of the 5-h experiment. When furosemide was added to HS, the brain-dehydrating effect could not be distinguished from that of mannitol.
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Editorial Comment
Postoperative respiratory muscle dysfunction: only the strong survive.