Anesthesia and analgesia
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Anesthesia and analgesia · May 2007
Comparative StudyUltrasound using the transverse approach to the lumbar spine provides reliable landmarks for labor epidurals.
Ultrasound imaging of the spine has recently been proposed to facilitate identification of the epidural space. In this study, we assessed the accuracy and precision of the transverse approach, using a "single-screen" method, to facilitate labor epidurals. ⋯ We found a good level of success in the ultrasound-determined insertion point, and very good agreement between UD and ND. This suggests that our proposed ultrasound single-screen method, using the transverse approach, can be a reliable guide to facilitate labor epidural insertion.
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Anesthesia and analgesia · May 2007
Case ReportsCerebral oxygen desaturation after cardiopulmonary bypass in a patient with raynaud's phenomenon detected by near-infrared cerebral oximetry.
Raynaud's phenomenon is characterized by episodes of arterial vasospasm precipitated by cold stress, usually affecting the digits of the hands. There is controversy about the occurrence of vasospasm in internal organ systems. In this report, we present a case of Raynaud's peripheral vasospasm accompanied by cerebral oxygen desaturation as detected by near infrared cerebral oximetry after separation from cardiopulmonary bypass.
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Anesthesia and analgesia · May 2007
Comparative StudyThe effects of general anesthetics on P2X7 and P2Y receptors in a rat microglial cell line.
Microglial cells play important roles in coordinating the inflammatory brain responses to hypoxia and trauma. Ionotropic P2X receptors and metabotropic P2Y receptors (P2YRs) expressed in microglia can be activated by extracellular adenosine triphosphate (ATP) derived from damaged cells or astrocytes, and participate in the signaling pathways evoked in brain insult. Although several inhaled and IV anesthetics produce neuroprotective effects through neuronal mechanisms, little is known about how general anesthetics modulate microglial responses in the pathological state. We examined the effects of various general anesthetics on purinergic responses in a rat microglial cell line. ⋯ Our results suggest that IV anesthetics, particularly thiopental and propofol, may modulate microglial functions through P2X7Rs in pathological conditions.
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Anesthesia and analgesia · May 2007
Case ReportsUltrasound-guided infraclavicular block in an anticoagulated and anesthetized patient.
The author describes the use of ultrasound to facilitate a continuous infraclavicular brachial plexus block in a patient who had been anticoagulated with 5000 U of heparin. The procedure was done 2 h after the patient was anticoagulated, and his activated clotting time was 203 s. The patient had vascular checks with a laser Doppler monitor every hour and neurological checks every 12 h.
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Anesthesia and analgesia · May 2007
Case ReportsIntrathecal local anesthetic infusion as a treatment for complex regional pain syndrome in a child.
Diagnosis and treatment of complex regional pain syndrome in children is one of the most challenging clinical pain problems encountered in the chronic pain setting. Despite the intense and debilitating nature of the pain, referral to appropriate specialists often comes too late, thereby prolonging an already arduous (and controversial) course of treatment and risking long-term disability. On the contrary, full recovery can be expected with early diagnosis and prompt treatment. The following case study describes a novel and successful use of intrathecal catheter administration of ropivacaine in a child with early, rapidly progressing, and debilitating complex regional pain syndrome.