Anesthesia and analgesia
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Anesthesia and analgesia · Jun 2004
Case ReportsPressure sore as a complication of labor epidural analgesia.
Lumbar epidural analgesia has become a common mode of pain control for laboring patients. Side effects, such as hypotension, motor blockade, respiratory depression, dural puncture, and urinary retention, are well described. Although pressure sores have been thought of as a complication limited to elderly, emaciated, unconscious, or bedridden patients, we describe the occurrence of pressure sores in a young and healthy parturient after lumbar epidural analgesia. ⋯ We report a pressure sore that resulted from lumbar epidural analgesia for labor.
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Anesthesia and analgesia · Jun 2004
Multiple casualty terror events: the anesthesiologist's perspective.
In a 28-mo period 14 multiple-casualty terror events occurred in Jerusalem, challenging the Department of Anesthesiology and Critical Care Medicine of the city's sole Level 1 trauma center. We performed a retrospective review of the response of the department to evaluate staff activities, resource use (emergency department, operating rooms, and intensive care unit [ICU]), and patient flow. A total of 1062 people were injured in the 14 multi-casualty terror incidents. The emergency department treated 355 victims; 108 of them were hospitalized, and 58 underwent surgery during the first 8 h. Only two surgeries were performed during the first hour, and the average time to the first surgery was 124 min. Fifty-one patients were admitted to the ICU an average of 5.5 h after the terror event. After a terrorist act, multiple, simultaneous efforts were required of the anesthesiology department, including taking part in the initial resuscitation in the emergency department, anesthetizing victims for surgery and angiographies, and caring for them in the recovery room and ICU. Therefore, anesthesiology departments are greatly impacted by such events and must plan for them to maximize the use of available personnel and to have the appropriate equipment and supplies available. ⋯ Anesthesiologists provide essential care to patients injured in terror events, from the initial resuscitation through therapeutic/diagnostic procedures and surgeries. Operational issues faced by a department of anesthesiology during the initial 8 h after terrorist actions were examined. Multiple, and often parallel, efforts were required of the department.
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Anesthesia and analgesia · Jun 2004
The effect of propofol on cytotoxicity and apoptosis of lipopolysaccharide-treated mononuclear cells and lymphocytes.
IV anesthetics may inhibit proper immune responses and further compromise an already depressed defense system. To assess the possible role of propofol on human immune function in sepsis, we studied cytotoxicity, and apoptosis of mononuclear cells (MNCs). Peripheral blood MNCs were preincubated in 1 microg/mL of lipopolysaccharide (LPS) and then reincubated in different concentrations of propofol (1 microg/mL, 5 microg/mL, 10 microg/mL, or 50 microg/mL). To determine cytotoxicity, lactate dehydrogenase release was assayed by mixing MNCs (4 x 10(5)/100 microL) with K-562 tumor cells as target cells (1 x 10(4)/100 microL)(E: T ratio of 40:1). Apoptosis was determined by measuring the annexin positive cells using flow cytometry. Cytotoxicity and apoptosis of LPS-treated MNCs were unchanged by clinically acceptable concentrations of propofol (1 microg/mL, 5 microg/mL, and 10 microg/mL). However, significant differences were observed in cytotoxicity (P = 0.004) and apoptosis (P = 0.002) with propofol 50 microg/mL. By gating MNCs, we found that lymphocyte apoptosis was significantly increased at 50 microg/mL of propofol, but monocytes were unaffected (P = 0.02). In terms of cytotoxicity and apoptosis, propofol allowed MNCs to retain their cytotoxicity in septic conditions by protecting immune cells from apoptosis. ⋯ Propofol at acceptable therapeutic concentrations, and under experimentally contrived septic conditions, did not affect the cytotoxic activity of mononuclear cells or the apoptosis level of mononuclear cells, lymphocytes, and monocytes from peripheral blood.