Anesthesia and analgesia
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Anesthesia and analgesia · Jan 2009
Comparative StudyIntrathecal morphine preconditioning induces cardioprotection via activation of delta, kappa, and mu opioid receptors in rats.
Small doses of intrathecal morphine provide cardioprotection similar to that conferred by IV morphine. However, the extent of intrathecal morphine preconditioning (IT-MPC) relative to that resulting from ischemic preconditioning (IPC) is unknown. Further, it is uncertain whether IT-MPC is mediated by opioid receptor dependent pathways. In this study, we compared the extent of cardioprotection conferred by IT-MPC with IPC and investigated the role of opioid receptors in this effect. ⋯ IT-MPC produced comparable cardioprotection to myocardial IPC and IV morphine. Myocardial preconditioning from intrathecal morphine seems to involve delta, kappa, and mu opioid receptors.
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Anesthesia and analgesia · Jan 2009
Case ReportsMigration of a thoracic epidural catheter into the intercostal space via the intervertebral foramen.
We describe a documented migration of a thoracic epidural catheter into the thoracic cage in a 5-wk-old with DiGeorge's syndrome and an uncorrected acyanotic Tetralogy of Fallot who underwent laparotomy for malrotation, gastric fundoplication, and gastrostomy tube insertion under combined general and epidural anesthesia. A 20-gauge stimulating catheter was inserted caudally and advanced cephalad to the thoracic level while applying a low electrical current (1-10 mA) to confirm epidural placement at approximately T5-6. Despite good pain control through the third postoperative day, using an epidural infusion of bupivacaine 0.1% at 1-1.2 mL/h, radiography demonstrated catheter migration into the seventh intercostal space.
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Anesthesia and analgesia · Jan 2009
Failure of augmentation of labor epidural analgesia for intrapartum cesarean delivery: a retrospective review.
In this study, we aimed to identify the incidence and predictive factors associated with failed labor epidural augmentation for cesarean delivery. Data of parturients, who had received neuraxial labor analgesia and who subsequently required intrapartum cesarean delivery during an 18-mo period, were retrospectively studied. ⋯ Of the 1025 parturients, 1.7% had failed epidural extension. Predictors of failed epidural anesthesia included initiation of labor analgesia with plain epidural technique (compared to combined spinal-epidural) (P = 0.001), >or=2 episodes of breakthrough pain during labor (P < 0.001) and prolonged duration of neuraxial labor analgesia (P = 0.02).