Anesthesia and analgesia
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Anesthesia and analgesia · Dec 2009
Superficial cervical plexus neuropathy after single-injection interscalene brachial plexus block.
Interscalene brachial plexus block (ISB) using the modified lateral approach provides a well-established method of anesthesia and analgesia for patients undergoing shoulder surgery. Considering the neural anatomy at the site of injection, the superficial cervical plexus may be at risk of injury. We evaluated the incidence and characteristics of superficial cervical plexus neuropathy. ⋯ Superficial cervical plexus neuropathy is not uncommon after ISB using the modified lateral approach and the possibility should be discussed with patients preprocedurally.
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Anesthesia and analgesia · Dec 2009
A comparison of micropore membrane inlet mass spectrometry-derived pulmonary shunt measurement with Riley shunt in a porcine model.
The multiple inert gas elimination technique was developed to measure shunt and the ratio of alveolar ventilation to simultaneous alveolar capillary blood flow in any part of the lung (V(A)'/Q') distributions. Micropore membrane inlet mass spectrometry (MMIMS), instead of gas chromatography, has been introduced for inert gas measurement and shunt determination in a rabbit lung model. However, agreement with a frequently used and accepted method for quantifying deficits in arterial oxygenation has not been established. We compared MMIMS-derived shunt (M-S) as a fraction of total cardiac output (CO) with Riley shunt (R-S) derived from the R-S formula in a porcine lung injury model. ⋯ Shunt derived from MMIMS inert gas retention data correlated well with R-S during breathing of oxygen. Shunt as derived by MMIMS was generally less than R-S.
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Anesthesia and analgesia · Dec 2009
Editorial CommentDifficult mask ventilation: what needs improvement?
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Anesthesia and analgesia · Dec 2009
Historical ArticleCardiac anesthesia: thirty years later--the second annual Arthur E. Weyman lecture.
Cardiac anesthesiology has evolved spectacularly over the past 30 yr, changing from a practice focused on the anesthetic management of patients with cardiovascular diseases to a practice of cardiovascular medicine that contributes to the medical and surgical management of cardiovascular patients. The second Weyman lecture reviews this history, the critical role of the Society of Cardiovascular Anesthesiologists in the evolution of the specialty, and the prospects for continued development for the specialty, the society, and the patients they care for.
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Anesthesia and analgesia · Dec 2009
Gamma-aminobutyric acid type A receptor alpha 4 subunit knockout mice are resistant to the amnestic effect of isoflurane.
General anesthesia produces multiple end points including immobility, hypnosis, sedation, and amnesia. Tonic inhibition via gamma-aminobutyric acid type A receptors (GABA(A)-Rs) may play a role in mediating behavioral end points that are suppressed by low concentrations of anesthetics (e.g., hypnosis and amnesia). GABA(A)-Rs containing the alpha4 subunit are highly concentrated in the hippocampus and thalamus, and when combined with delta subunits they mediate tonic inhibition, which is sensitive to low concentrations of isoflurane. ⋯ These results lend support to the hypothesis that different sites of action mediate different anesthetic end points and suggest that alpha4-containing GABA(A)-Rs are important mediators of the amnestic effect of isoflurane on hippocampal-dependent declarative memory.