Anesthesia and analgesia
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Anesthesia and analgesia · Oct 2009
Obstructive sleep apnea is not a risk factor for difficult intubation in morbidly obese patients.
Morbid obesity (MO), obstructive sleep apnea (OSA), and neck circumference (NC) are widely believed to be independent risk factors for difficult tracheal intubation. In this study, we sought to determine whether these factors were associated with increased risk of difficult intubation in patients undergoing bariatric surgery. The predictive factors tested were OSA and its severity, as determined by apnea-hypopnea index (AHI), gender, NC, and body mass index (BMI). ⋯ In MO patients undergoing bariatric surgery in the "ramped position," there was no relationship between the presence and severity of OSA, BMI, or NC and difficulty of intubation or laryngoscopy grade. Only a Mallampati score of 3 or 4 or male gender predicted difficult intubation.
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Anesthesia and analgesia · Oct 2009
Isoflurane inhibits cyclic adenosine monophosphate response element-binding protein phosphorylation and calmodulin translocation to the nucleus of SH-SY5Y cells.
Calmodulin (CaM) activation by Ca(2+), its translocation to the nucleus, and stimulation of phosphorylation of cyclic adenosine monophosphate response element-binding protein (CREB) (P-CREB) are necessary for new gene expression and have been linked to long-term potentiation, a process important in memory formation. Because isoflurane affects memory, we tested whether isoflurane interfered with the translocation of CaM to the neuronal cell nucleus and attenuated the formation P-CREB. ⋯ Our data demonstrate that isoflurane inhibits CaM translocation and P-CREB formation. This most likely occurs through isoflurane inhibition of Ca(2+)entry through L-type Ca(2+) channels.
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Anesthesia and analgesia · Oct 2009
The effect of obesity on neuraxial technique difficulty in pregnant patients: a prospective, observational study.
Practitioners often presuppose that obesity will increase neuraxial technique difficulty in pregnant patients, but few investigators have systematically examined this population for risk factors associated with difficult epidural or spinal needle placement. We designed this study to prospectively identify factors that predict neuraxial technique difficulty in pregnant patients. ⋯ Despite concerns that obesity may cause difficulty with neuraxial technique, some obese patients have surprisingly easy neuraxial block placements. When approaching any neuraxial anesthetic in a pregnant patient, and especially in the obese parturient, back flexion and landmark palpation predict neuraxial technique difficulty.
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Anesthesia and analgesia · Oct 2009
Clinical TrialFractal cardiovascular dynamics and baroreflex sensitivity after stellate ganglion block.
It has been shown that stellate ganglion block can attenuate baroreflex sensitivity. Our primary purpose in this study was to determine whether fractal dynamics (dynamic change of self-similar fluctuation patterns) of not only heart rate but also systolic blood pressure variability are involved in attenuation of baroreflex sensitivity after stellate ganglion block. ⋯ Loss of complexity (status of being complex behavior) of both heart rate and systolic blood pressure variability, indicated by increased fractal slopes, is one mechanism in attenuating baroreflex sensitivity after stellate ganglion block.