Anesthesia and analgesia
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Anesthesia and analgesia · Jun 2004
Anterior approach to the sciatic nerve block: adaptation to the patient's height.
To improve the incidence of block of the posterior femoral cutaneous nerve (PFCN) when using an anterior approach as described recently, we hypothesized that the distance between the inguinal line and the puncture site depends on the patient's height. A preliminary radiological study performed in 13 patients established a formula describing the relationships between the patient's height and the puncture site "S." A line was drawn between the anterior iliac spine and the superior angle of the pubic tubercle (inguinal line) and another line from the midpoint of the inguinal line to the puncture site "S." "S" was calculated from the midpoint of the inguinal line as "S" = (height in cm--100)/10. A prospective study was conducted in 53 patients. Results are presented as median (range, 0.25-0.75). Two minutes were required to locate the sciatic nerve at a depth of 12 cm (10.5-13.0 cm). Complete sciatic and PFCN blocks were observed in 92% of the patients. We conclude that consideration should be given to the patient's height when the sciatic nerve is blocked using an anterior approach. This technique seems to improve the success of block of the PFCN, essential to tolerate a thigh tourniquet. ⋯ This prospective but noncomparative work was performed to evaluate a new anterior technique of sciatic block, an adaptation of the anatomic landmarks described by Chelly and Delaunay, to patient height.
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Anesthesia and analgesia · Jun 2004
A platelet activating factor receptor antagonist inhibits cytokine production in human whole blood by bacterial toxins and live bacteria.
We previously reported that a platelet-activating factor receptor (PAFR) antagonist (TCV-309) suppressed lipopolysaccharide (LPS)-induced mortality and tumor necrosis factor (TNF) production in mice. However, the effect of TCV-309 on cytokine production induced by Staphylococcus enterotoxin B (SEB) or live bacteria has not been reported. In this study we investigated the effect of TCV-309 on cytokine production in human whole blood induced by LPS, SEB, and both Gram-positive and -negative bacteria. Human whole blood diluted 5:1 (980 microL) was placed in the wells of a 24-well plate. Ten microliters of LPS, SEB, Escherichia coli O18 K(+), or Staphylococcus aureus were added to each well. After incubation at 37 degrees C for 6 h, TNF, interleukin (IL)-6, and IL-8 in the culture medium were measured. TCV-309 did not affect the growth of either E. coli or S. aureus bacteria in the culture medium for the 6 h incubation. LPS, SEB, and both E. coli and S. aureus induced TNF, IL-6, and IL-8 in human whole blood. TCV-309 significantly inhibited the production of TNF, IL-6, and IL-8 induced by LPS, SEB, and bacteria. A PAFR antagonist suppressed cytokine production induced by LPS, SEB, and both Gram-positive and -negative bacteria in human whole blood. A PAFR plays an important role of producing proinflammatory cytokines induced by both toxins and live bacteria. ⋯ The platelet-activating factor receptor plays an important role in producing proinflammatory cytokines induced by bacterial toxins, such as lipopolysaccharide,Staphylococcus enterotoxin B, and live Gram-positive and Gram-negative bacteria.
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Anesthesia and analgesia · Jun 2004
Case ReportsA severe complication after laser-induced damage to a transtracheal catheter during endoscopic laryngeal microsurgery.
Subcutaneous emphysema and pneumothorax is a rare and severe complication of percutaneous transtracheal jet ventilation, usually caused by obstruction of the upper airway or displacement of the tracheal catheter. Nevertheless, it is our preferred technique for endoscopic laryngeal laser surgery. We report a patient with acute subcutaneous emphysema and pneumothorax during laser surgery, caused by unobserved laser damage and discuss the associated risk factors. ⋯ The percutaneous transtracheal jet ventilation for elective laryngeal laser surgery reduces the risk of airway fires and gives a free endoscopic operative field. This case report suggests that, even when using a teflon catheter, laser-induced damage with severe complications might occur.
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Anesthesia and analgesia · Jun 2004
Case ReportsThe long-term effect of repeated intravenous lidocaine on central pain and possible correlation in positron emission tomography measurements.
Functional neuroimaging suggests that similar brain regions are involved in the processing of pain in healthy subjects and in patients with chronic neuropathic central pain. We present a patient with chronic neuropathic central pain due to a unique lesion to the trigeminal and spinothalamic pathway who had persistent pain relief after repeated IV lidocaine infusions. Positron emission tomography scan results showed a relative hypoactivity of the left posterolateral thalamus before treatment which disappeared after therapy. This case may suggest a stereo-selective analgesic effect of lidocaine accompanied by regional cerebral blood flow changes in the thalamus, indicating that sodium channels could, in fact, be highly expressed or modified in the thalamus after thalamic deafferentation. ⋯ We present a case of persistent central pain after encephalitis in a patient who had long-term pain relief after a series of IV lidocaine infusions. A positron emission tomography scan study, done before and after treatment, suggested that lidocaine for the diagnosis of chronic neuropathic pain may have a specific site of action in the brain.
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Anesthesia and analgesia · Jun 2004
Case ReportsChange in bispectral index during epileptiform electrical activity under sevoflurane anesthesia in a patient with epilepsy.
We observed abnormal fluctuation in Bispectral Index (BIS) caused by repeated alternations between two electroencephalographic (EEG) waveform patterns in a patient with a recent history of epileptic seizure under sevoflurane anesthesia. The repetitive development of the abnormal EEG changes (slow delta with or without spike) and the fluctuation in BIS disappeared almost immediately after administration of anticonvulsants. BIS may give useful information not only on the sedative-hypnotic state, but also on the development of and recovery from abnormal epileptiform EEG activity. ⋯ During epileptiform electroencephalographic activity (EEG), the Bispectral Index shows an abnormal fluctuation caused by repeated abrupt alterations between normal EEG and abnormal epileptiform EEG patterns.