Anesthesia and analgesia
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IV lidocaine (1.5 mg/kg) administered to facilitate endotracheal intubation was associated with transient bronchospasm in a 17-month-old-female with mild intermittent asthma. Immediately after lidocaine administration, the patient developed diffuse bilateral expiratory wheezes and dramatic increases in peak inspiratory pressure. ⋯ This is consistent with recent clinical studies suggesting that IV lidocaine may cause airway narrowing in asthmatics. Practitioners should be aware of this potential complication.
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Anesthesia and analgesia · Oct 2008
The effect of injectate conductivity on the electric field with the nerve stimulator needle: a computer simulation.
Electrical neural stimulation is commonly used to localize neural structures and place local anesthetic for regional anesthesia. The sharp tip of the stimulating needle gives rise to an electric field which is highly localized. The electrostatic effect of the injected solution on the field distribution and strength has not previously been modeled. ⋯ The electric field magnitude in the vicinity of the needle tip decayed more slowly with distance than predicted by Coulomb's law. This was independent of the presence of injectate. The near instantaneous abolition of muscle twitch with injection of small volumes of local anesthetic is consistent with an electrostatic effect, rather than a pharmacological or mechanical one. The change in field strength depended upon the volume of the injectate and its conductivity relative to that of the surrounding tissue. In this simulation, even tiny volumes of injectate lead to significant changes in field and therefore threshold current, which may have clinical implications.
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Anesthesia and analgesia · Oct 2008
Noble gas binding to human serum albumin using docking simulation: nonimmobilizers and anesthetics bind to different sites.
Nonimmobilizers are structurally similar to anesthetics, but do not produce anesthesia at clinically relevant concentrations. Xenon, krypton, and argon are anesthetics, whereas neon and helium are nonimmobilizers. The structures of noble gases with anesthetics or nonimmobilizers are similar and their interactions are simple. Whether the binding site of anesthetics differs from that of nonimmobilizers has long been a question in molecular anesthesiology. ⋯ This analysis of binding energy components provides a rationale for the binding site difference of anesthetics and nonimmobilizers, reveals the differences between the binding interactions of anesthetics and nonimmobilizers, may explain pharmacological differences between anesthetics and nonimmobilizers, and provide an understanding of anesthetic action at the atomic level.
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Anesthesia and analgesia · Oct 2008
Adoption of anesthesia information management systems by academic departments in the United States.
Information technology has been promoted as a way to improve patient care and outcomes. Whereas information technology systems for ancillary hospital services (e.g., radiology, pharmacy) are deployed commonly, it has been estimated that anesthesia information management systems (AIMS) are only installed in a small fraction of United States (US) operating rooms. In this study, we assessed the adoption of AIMS at academic anesthesia departments and explored the motivations for and resistance to AIMS adoption. ⋯ At least 61 or 44% of the 140 US academic departments surveyed in this study have already implemented, are planning to acquire, or are currently searching for an AIMS. Adoption of AIMS technology appears to have reached sufficient momentum within academic anesthesiology departments to result in a fundamental change.
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Anesthesia and analgesia · Oct 2008
Case ReportsPerioperative management of patients with an intrathecal drug delivery system for chronic pain.
The use of intrathecal medications in the treatment of chronic pain is becoming more commonplace. As such, the incidence of encountering patients receiving therapy via an intrathecal drug delivery system in the perioperative period will also increase. In this case series, we discuss anesthetic management and postoperative analgesic issues in three patients with indwelling intrathecal drug delivery systems placed for treatment of chronic pain.