Anesthesia and analgesia
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Anesthesia and analgesia · Nov 2001
Clinical TrialThoracic epidural analgesia via the caudal approach in pediatric patients undergoing fundoplication using nerve stimulation guidance.
Epidural catheter placement using electrical stimulation guidance is an alternative approach for positioning the catheter into the thoracic region via the caudal space. This easily performed clinical assessment provides optimization of catheter tip positioning for achieving effective pain control.
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Anesthesia and analgesia · Nov 2001
Local anesthetic actions on thromboxane-induced platelet aggregation.
Some local anesthetics (LA), in concentrations present in blood during IV or epidural infusion, inhibit thrombus formation in the postoperative period. Studies on thromboxane A2 (TXA2) signaling in a recombinant model suggest that interference with TXA2-induced platelet aggregation may explain, in part, the antithrombotic actions of epidural analgesia and IV LA infusion. In this study we investigated the effects of clinically used LAs (lidocaine, ropivacaine, and bupivacaine) on TXA2-induced early platelet aggregation (1-5 s) by using quenched-flow and optical aggregometry. Our findings demonstrate that the LAs tested seem to have only a limited ability to inhibit TXA2-induced platelet aggregation assessed at early times (1-5 s). Therefore, the clinical effects of LAs on thrombi formation are unlikely to be explained by this manner alone. At large LA concentrations, moderate effects were obtained. Prolonged incubation with LA did not significantly increase effectiveness, and the lack of an effect could not be explained by generation of secondary mediators. The results were independent of the anesthetic studied. Local anesthetic effects on TXA2-induced early platelet aggregation (1-5 s) are unlikely to play a major role in the clinically observed antithrombotic effects of local anesthetics. ⋯ Local anesthetic effects on thromboxane A2-induced early platelet aggregation (1-5 s) are unlikely to play a major role in the clinically observed antithrombotic effects of local anesthetics. Thus, other potential targets need to be explored.
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Anesthesia and analgesia · Nov 2001
The impact of business cards on physician recognition after general anesthesia.
Despite their contribution to overall perioperative treatment of patients, anesthesiologists often remain in anonymity. We evaluated the impact of business cards on physician recognition after general anesthesia. Using a questionnaire, 441 patients were interviewed for recall of the anesthesiologist's name, the surgeon's name, and their overall satisfaction with anesthetic care 6 wk after undergoing surgery during general anesthesia. Of these patients, 155 had and 137 had not randomly received a business card during the preoperative visit, with another 149 patients serving as a control group. Business card recipients responded significantly more frequently than did nonrecipients or patients from the control group (65.8% vs 54.7% vs 53%), with recall of the anesthesiologist's name being significantly more frequent in the Business Card Recipient group (51.5% vs 14.3% vs 11.4%). Patient satisfaction with anesthetic care and recall of the surgeon's name were similar in all groups. The use of a simple tool such as a business card can indeed produce a measurable positive change in physician recognition on the part of the patient. ⋯ Anesthesiologists often remain anonymous in everyday clinical practice. Handing a business card to the patient during the preoperative visit increased the postoperative recall of the anesthesiologist's name from 11% to 51%.
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Anesthesia and analgesia · Nov 2001
The interaction between intrathecal neostigmine and GABA receptor agonists in rats with nerve ligation Injury.
Nerve ligation injury may produce a pain syndrome that includes tactile allodynia. Reversal effects on tactile allodynia have been demonstrated after the intrathecal administration of gamma-aminobutyric acid (GABA) receptor agonists or cholinesterase inhibitors in rats. We examined the drug interactions between neostigmine and muscimol or baclofen in a rat model of nerve ligation injury. Rats were prepared with tight ligation of the left L5-6 spinal nerves and chronic intrathecal catheter implantation. Tactile allodynia was measured by applying von Frey filaments ipsilateral to the lesioned hindpaw. Thresholds for paw withdrawal were assessed. Neostigmine (0.3-10 microg), muscimol (0.1-10 microg), and baclofen (0.1-3.0 microg) were administered to obtain the dose-response curve and the 50% effective dose (ED(50)). Fractions of ED(50) values were administered intrathecally to establish the ED(50)s of drug combinations (neostigmine-muscimol and neostigmine-baclofen). The drug interactions were performed. Intrathecal neostigmine, muscimol, baclofen, and their combinations produced a dose-dependent increase in withdrawal threshold of the lesioned hindpaw. Both analyses revealed a synergistic interaction for the neostigmine-muscimol combination, whereas the effect of the neostigmine-baclofen combination was additive. These results suggest that the activation of both muscarinic and GABA(A) receptors is required for synergistic interaction. ⋯ This study indicates that drug interaction is synergistic for the neostigmine-muscimol combination, whereas the effect of the neostigmine-baclofen combination is additive. In a rat model of nerve ligation injury, neostigmine, muscimol, baclofen, and their combinations provide an antagonism on touch-evoked allodynia at the spinal level.