Anesthesia and analgesia
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Anesthesia and analgesia · Aug 2007
Comparative StudyThe anesthetic management of children with neonatal-onset multi-system inflammatory disease.
Neonatal-onset multi-system inflammatory disease (NOMID), a rare autosomal dominantly inherited disease, belongs to a growing spectrum of autoinflammatory diseases, is characterized by urticarial rash, arthropathy, and chronic aseptic meningitis, and is associated with mutations in the cold-induced autoinflammatory gene, CIAS1, the gene that encodes the protein, cryopyrin. As little is known about the anesthetic considerations of the disease, we sought to identify the main features and respective anesthetic and perioperative implications of NOMID. ⋯ This study is the first to investigate the anesthetic implications of NOMID, an autoinflammatory disease associated with arthropathy, recurrent fevers, urticarial rash, and chronic aseptic meningitis. While for the pediatric anesthesiologist, the presence of fever and aseptic meningitis might make the conduct of anesthetics for elective procedures less desirable, our findings suggest that without evidence of active infection, even in the presence of fever and chronic aseptic meningitis, general and regional anesthesia may be conducted in patients with NOMID without untoward complications.
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Anesthesia and analgesia · Aug 2007
Comparative StudyVentilation-induced plethysmographic variations predict fluid responsiveness in ventilated postoperative cardiac surgery patients.
It has been shown that ventilation-induced pulse pressure variation (PPV) is a better variable than central venous pressure (CVP) or pulmonary artery occlusion pressure (PAOP) for predicting cardiac output changes after fluid administration. The plethysmographic wave form measured with a fingertip pulse is very similar to the arterial blood pressure curve. ⋯ This study shows that VPV, like PPV, is a more reliable predictor of fluid responsiveness than CVP and PAOP.
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Anesthesia and analgesia · Aug 2007
Comparative StudyA modified mid-femoral approach to the sciatic nerve block: a correlation between evoked motor response and sensory block.
The lateral sciatic mid-femoral block (LSMF), proved to be reliable, safe, and effective on both branches of the sciatic nerve with a single injection. However, we do not know which component of the sciatic nerve (the tibial [T] or the common peroneal [CP]) produces a better success rate when performing a LSMF with a single injection technique. In this prospective study we compared the success rate of the T motor response with the CP motor response. ⋯ We conclude that the evoked motor response of the T branch is associated with a higher success rate than a CP response using the modified LSMF block.
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Anesthesia and analgesia · Aug 2007
Comparative StudyTrendelenburg position, simulated Valsalva maneuver, and liver compression do not alter the size of the right internal jugular vein in patients with a bidirectional Glenn shunt.
Ultrasound is increasingly used to facilitate right internal jugular vein (RIJV) cannulation in children. In children without cardiac disease, position changes and enhancement maneuvers increase RIJV cross-sectional area (CSA) and further facilitate cannulation. We investigated the effect of these maneuvers on RIJV CSA in children with a bidirectional Glenn (BDG) shunt presenting for a Fontan procedure. ⋯ Position changes and enhancement maneuvers are unlikely to facilitate RIJV cannulation in BDG shunt patients presenting for Fontan procedure because these interventions do not increase RIJV CSA.
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Anesthesia and analgesia · Aug 2007
Comparative StudyAnesthetic-like modulation of a gamma-aminobutyric acid type A, strychnine-sensitive glycine, and N-methyl-d-aspartate receptors by coreleased neurotransmitters.
A mechanism of anesthesia has recently been proposed which predicts that coreleased neurotransmitters may modulate neurotransmitter receptors for which they are not the native agonist in a manner similar to anesthetics. ⋯ These results show that neurotransmitters that are coreleased onto anesthetic-sensitive receptors may modulate the function of receptors for which they are not the native agonist via an anesthetic-like mechanism. These findings lend support to a recent theory of anesthetic action.