Anesthesia and analgesia
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Anesthesia and analgesia · Feb 2004
Case ReportsA suspected case of delayed onset malignant hyperthermia with desflurane anesthesia.
Desflurane has been identified as a weak triggering anesthetic of malignant hyperthermia that, in the absence of succinylcholine, may produce a delayed onset of symptoms. The prolonged interval after exposure may occur more than 6 h after the induction of anesthesia. The unintended underdosing of this patient with dantrolene and the prompt reversal of symptoms may be an attribute of the genetic expression of a weak triggering volatile anesthetic such as desflurane. ⋯ There are multiple genetic variations for malignant hyperthermia (MH) at the ryanodine receptor. Desflurane, as a sole trigger of MH, is weak, and on two occasions in the literature (including this case), less than optimal doses of dantrolene were given with a good result. There may be possible to engineer the risk of MH out of an anesthetic once the genetics of the ryanodine receptor are better understood.
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Anesthesia and analgesia · Feb 2004
Case ReportsThe presence of working memory without explicit recall in a critically ill patient.
We describe an intubated patient sedated with propofol who interacted with caregivers, demonstrating intact "working memory." When neuromuscular blockade and bispectral index (BIS) monitoring were instituted, a greatly reduced amount of sedative achieved BIS values less than 60. Neither the sedation that allowed working memory nor the lighter sedation that produced BIS values less than 60 resulted in recall. This experience suggests that working memory demonstrated when BIS values are less than 60 is unlikely to lead to recall. ⋯ The presence of intact working memory during sedation is a poor predictor of explicit recall when bispectral index values are maintained less than 60.
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The number of citations an article receives after its publication reflects its recognition in the scientific community. In the present study, therefore, we identified and examined the characteristics of the top 100 most frequently cited articles published in anesthetic journals. These articles were identified using the database of the Science Citation Index Expanded (SCI-EXPANDED, 1945 to present) and the Web of SCIENCE(R). The most-cited article received 707 citations and the least cited article received 197 citations, with a mean of 283 citations per article. These citation classics were published between 1954 and 1997 in 5 high-impact anesthetic journals, led by Anesthesiology (73 articles) followed by Anesthesia & Analgesia (10), British Journal of Anesthesia (10), Anesthesia (6), and Acta Anaesthesiologica Scandinavica (2). Seventy-eight articles were original publications, 22 were review articles, and one was an editorial. They originated from nine countries, with the United States contributing 70 articles. Within the United States, California leads the list of citation classics with 25 articles. Twenty-nine persons authored two or more of the top-cited articles. The main topics covered by the top-cited articles are pharmacology, volatile anesthetics, circulation, regional anesthesia, and lung physiology. This analysis of citation rates allows for the recognition of seminal advances in anesthesia and gives a historic perspective on the scientific progress of this specialty. ⋯ We performed a citation analysis to identify important contributions and contributors to the anesthetic literature. These classic articles have influenced many people and have brought to our attention the many important advances in anesthesia made during the last 50 yr.
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Anesthesia and analgesia · Feb 2004
Meloxicam, a specific COX-2 inhibitor, does not enhance the isoflurane minimum alveolar concentration reduction produced by morphine in the rat.
A synergistic effect of nonselective cyclooxygenase (COX) inhibitors on morphine-induced decrease of isoflurane minimum alveolar concentration (MAC(ISO)) has been observed in the rat. We studied the influence of specific COX-2 inhibitors on this decrease of MAC. Sixty-four female rats were anesthetized with isoflurane in oxygen. The animals were grouped into saline solution, aspirin (30 mg/kg), morphine (1 mg/kg), morphine (1 mg/kg) + aspirin (30 mg/kg), meloxicam (1 and 3 mg/kg), and morphine (1 mg/kg) + meloxicam (1 and 3 mg/kg). Then the MAC(ISO) was determined from alveolar gas samples at the time of tail clamp. The groups treated with saline solution, aspirin, and 1 and 3 mg/kg meloxicam did not express any statistically relevant changes among them. The administration of morphine + meloxicam 1 or 3 mg/kg significantly reduced the MAC(ISO) just as in the group where only morphine was administered (morphine 1.35% +/- 0.07%, morphine + 1 mg/kg meloxicam 1.36% +/- 0.04%, and morphine + 3 mg/kg meloxicam 1.37% +/- 0.08%). The greatest reduction of MAC(ISO) was after administration of morphine + aspirin (1.19% +/- 0.05%). The administration of meloxicam does not potentiate the morphine-induced decrease of MAC(ISO) in the rat. ⋯ A synergistic effect between morphine and aspirin on isoflurane minimum alveolar concentration has been observed in the rat--an effect that does not occur between morphine and meloxicam.