Anesthesia and analgesia
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Anesthesia and analgesia · Nov 2009
Comparative StudyAcute methadone treatment reduces myocardial infarct size via the delta-opioid receptor in rats during reperfusion.
Methadone is an opioid agonist often given to manage acute and chronic pain. We sought to determine whether methadone compared with morphine dose dependently reduces myocardial infarct size (IS) and whether the mechanism is delta-opioid receptor mediated. Furthermore, we examined whether myocardial IS reduction varies with the timing of methadone administration or duration of induced ischemia. ⋯ These findings demonstrate that methadone and morphine produce similar myocardial IS-sparing effects that are delta-opioid receptor mediated and that are dependent on the duration of myocardial ischemia.
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Anesthesia and analgesia · Nov 2009
A cost-effective screening method for preoperative hyperglycemia.
The preoperative encounter may offer a cost-effective opportunity for diabetes screening. ⋯ This preoperative blood glucose screening test was implemented at a cost of approximately one-tenth of current methods.
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Anesthesia and analgesia · Nov 2009
The interrelationship between preoperative anemia and N-terminal pro-B-type natriuretic peptide: the effect on predicting postoperative cardiac outcome in vascular surgery patients.
N-terminal pro-B-type natriuretic peptide (NT-proBNP) predicts adverse cardiac outcome in patients undergoing vascular surgery. However, several conditions might influence this prognostic value, including anemia. In this study, we evaluated whether anemia confounds the prognostic value of NT-proBNP for predicting cardiac events in patients undergoing vascular surgery. ⋯ Both anemia and NT-proBNP are independently associated with an increased risk for postoperative cardiac events in patients undergoing vascular surgery. NT-proBNP has less predictive value in anemic patients.
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Anesthesia and analgesia · Nov 2009
Comparative StudyThe effects of sevoflurane and propofol on glucose metabolism under aerobic conditions in fed rats.
Recent studies reported that intraoperative hyperglycemia is an independent risk factor for mortality and morbidity related to surgery. Volatile anesthetics, such as sevoflurane, impair glucose use, suggesting their possible contributions to intraoperative hyperglycemia. However, the effects of IV anesthetics, such as propofol, on glucose metabolism are poorly understood. Thus, we compared the effects of sevoflurane and propofol on glucose metabolism under aerobic conditions in fed rats. ⋯ During surgery, hyperglycemia was observed under sevoflurane and sevoflurane/buprenorphine anesthesia, but blood glucose levels were relatively stable under propofol and propofol/buprenorphine anesthesia. Whereas sevoflurane exaggerates glucose intolerance, propofol has no significant effects on glucose tolerance. We speculate that this feature of propofol contributes, at least in part, to the stable glucose metabolism during surgery observed in this study. The results of this study confirm the marked difference in the effects of sevoflurane and propofol on glucose metabolism.
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Anesthesia and analgesia · Nov 2009
Case ReportsMisalignment of disposable pulse oximeter probes results in false saturation readings that influence anesthetic management.
We report a small case series in which misaligned disposable pulse oximeter sensors gave falsely low saturation readings. In each instance, the sensor performed well during preinduction oxygen administration and the early part of the case, most notably by producing a plethysmographic trace rated as high quality by the oximeter software. The reported pulse oximeter oxygen saturation eventually decreased to concerning levels in each instance, but the anesthesiologists, relying on the reported high-quality signal, initially sought other causes for apparent hypoxia. ⋯ When the malpositioned sensors were discovered and repositioned, the apparent hypoxia was quickly relieved in each case. We then undertook a survey of disposable oximeter sensors as patients entered the recovery room, and discovered malposition of more than 1 cm in approximately 20% of all sensors, without apparent consequence. We conclude that the technology is quite robust, but that the diagnosis of apparent hypoxia should include a quick check of oximeter position early on.