Anesthesia and analgesia
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Anesthesia and analgesia · Feb 2008
Comparative StudyActivation of mitochondrial large-conductance calcium-activated K+ channels via protein kinase A mediates desflurane-induced preconditioning.
ATP-regulated K+ channels are involved in anesthetic-induced preconditioning (APC). The role of other K+ channels in APC is unclear. We tested the hypothesis that APC is mediated by large-conductance calcium-activated K+ channels (K(Ca)). ⋯ These data suggest that desflurane-induced APC is mediated in part by activation of mitochondrial large-conductance K(Ca) channels, and that activation of these channels by desflurane is mediated by PKA.
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Anesthesia and analgesia · Feb 2008
Comparative StudyPharmacological characterization of noroxymorphone as a new opioid for spinal analgesia.
Noroxymorphone is one of the major metabolites of oxycodone. Although oxycodone is commonly used in the treatment of acute and chronic pain, little is known about the antinociceptive effects of noroxymorphone. We present an in vivo pharmacological characterization of noroxymorphone in rats. ⋯ The results of this study indicate that noroxymorphone is a potent mu-opioid receptor agonist when administered intrathecally. The lack of systemic efficacy may indicate reduced ability of noroxymorphone to penetrate the blood-brain barrier due to its low calculated logD value (log octanol/water partition coefficient). Thus, noroxymorphone should have a negligible role in analgesia after systemic administration of oxycodone. Because of its spinal efficacy and long duration of effect, noroxymorphone is an interesting opioid for spinal analgesia with a low potential for abuse. Its safety for spinal administration should be assessed before clinical use.
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Anesthesia and analgesia · Feb 2008
Calculating institutional support that benefits both the anesthesia group and hospital.
Institutional support to anesthesia groups for clinical care is very common, particularly when compensation for certified registered nurse anesthetists and anesthesiology residents is considered. Poor contracts can reduce incentives for good operating room (OR) management. We show that two types of agreements for institutional support are rational, and that alternatives to those models increase profit for either the hospital or anesthesia group at the expense of the other. ⋯ For groups with uncommonly low net collections, group profit is higher if the hospital provides support expected to assure a reasonable (fair) income for the group to recruit and retain members. For what is likely the majority of groups, with average net collections per anesthesia hour exceeding the hospital's compensation per scheduled hour, expected profit is higher if institutional support is payment at a reasonable rate (fair market value) for the expected incremental hours of underutilized OR time (i.e., nonbillable idle time) caused by the specialty-specific staffing (i.e., OR allocations). Such an agreement creates incentives whereby the hospital and anesthesia group both profit from increased OR workload and from more accurate specialty-specific staffing.