Anesthesia and analgesia
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Anesthesia and analgesia · Dec 2005
Case ReportsThe Cohen flexitip endobronchial blocker: an alternative to a double lumen tube.
One-lung ventilation (OLV) is usually achieved by the use of a double-lumen tubes (DLTs). With increasing need for use of OLV for video-assisted thoracoscopic procedures, the limitations of traditional DLT's, including difficult insertion and positioning, have become evident. This has led to renewed interest in devising alternative methods of achieving lung separation, such as the Univent tube or Arndt endobronchial blocker. This report describes the technical features and clinical use of a new tip-deflecting endobronchial blocker.
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Anesthesia and analgesia · Dec 2005
Spinal L-type calcium channel blockade abolishes opioid-induced sensory hypersensitivity and antinociceptive tolerance.
Recent studies have suggested that prolonged exposure to morphine results in the development of paradoxical, abnormal enhanced pain. It has also been suggested that this enhanced pain state may be interpreted as antinociceptive tolerance. Although the precise mechanisms that drive opioid-induced abnormal pain are not well known, considerable evidence suggests that this state may be supported by enhanced, stimulus-evoked excitatory transmission. ⋯ These hypersensitivities were prevented by the coadministration of the putative selective L-type calcium channel blocker amlodipine. Moreover, mice receiving morphine for 8 days demonstrated a significant rightward shift of the morphine antinociceptive dose-response curve, indicative of antinociceptive tolerance, whereas those that also received amlodipine along with morphine did not demonstrate tolerance. These results suggest that blockade of the L-type calcium channels with amlodipine prevented opioid-induced hyperalgesia and the expression of antinociceptive tolerance to spinal morphine, presumably by reducing stimulus-induced excitatory neurotransmitter release.