Anesthesia and analgesia
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Anesthesia and analgesia · Jan 2009
The effects of neonatal isoflurane exposure in mice on brain cell viability, adult behavior, learning, and memory.
Volatile anesthetics, such as isoflurane, are widely used in infants and neonates. Neurodegeneration and neurocognitive impairment after exposure to isoflurane, midazolam, and nitrous oxide in neonatal rats have raised concerns regarding the safety of pediatric anesthesia. In neonatal mice, prolonged isoflurane exposure triggers hypoglycemia, which could be responsible for the neurocognitive impairment. We examined the effects of neonatal isoflurane exposure and blood glucose on brain cell viability, spontaneous locomotor activity, as well as spatial learning and memory in mice. ⋯ Prolonged isoflurane exposure in neonatal mice led to increased immediate brain cell degeneration, however, no significant reductions in adult neuronal density or deficits in spontaneous locomotion, spatial learning, or memory function were observed.
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Anesthesia and analgesia · Jan 2009
Comparative StudySubspecialty impact factors: the contribution of pediatric anesthesia and pain articles.
The Science Citation Index "Journal Impact Factor" (JIF) is widely used to assess journal quality and prestige. The JIFs for the specialty anesthesia are reported annually, however, the impact factors (IFs) for subspecialties in those journals have not been reported. Therefore, we compared the IFs of pediatric anesthesia (Ped IFs) and pain (Pain IFs) articles from four anesthesia journals for two epochs. ⋯ Ped IFs were consistently less than the JIFs in which they were published and the Pain IFs, except for the British Journal of Anaesthesia 2005 in the latter case. The numbers of citations of pediatric anesthesia articles were greater in journals with greater IFs. The implications of subspecialty IFs warrant further consideration.
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Anesthesia and analgesia · Jan 2009
Six-year follow-up on work force and finances of the United States anesthesiology training programs: 2000 to 2006.
In the mid 1990s, interest in the field of anesthesiology decreased significantly among medical students, resulting in a decreasing resident class size and, subsequently, fewer anesthesiologists entering the United States workforce. This apparent practitioner shortage was associated with increased salary demands, which placed anesthesiology training departments in financial jeopardy. Starting in 1999, a survey was sent to the department chairs of the United States anesthesiology training programs to assess the status of faculty and finances of their departments. Follow-up surveys have been conducted each year thereafter. We present the results of the 2006 survey and 7 yr trend data. ⋯ This current survey reveals a continuing need for institutional support to keep anesthesiology training departments financially solvent. The amount of support is associated with the reimbursement for anesthesia work. There is also a continuing, but decreasing, number of open faculty anesthesiologist positions nationwide.
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Anesthesia and analgesia · Jan 2009
Competitive substrates for P-glycoprotein and organic anion protein transporters differentially reduce blood organ transport of fentanyl and loperamide: pharmacokinetics and pharmacodynamics in Sprague-Dawley rats.
Drug transport proteins may be instrumental in controlling the concentration of fentanyl at mu receptors in the brain and may provide potential therapeutic targets for controlling an individual response to opioid administration. P-glycoprotein (P-gp) efflux transporter and organic anion transport protein inward transporters (OATP, human; Oatp, rat) have been implicated in fentanyl and verapamil (only P-gp) transport across the blood-brain barrier. We hypothesized that transport proteins P-gp and Oatp mediate opioid uptake in a drug and organ-specific manner, making them excellent potential targets for therapeutic intervention. ⋯ Protein transporters appear to be organ and drug-specific in vivo, affecting first-pass pulmonary uptake and CNS response to opioid administration. Further, data suggest that transport protein inhibition may prove useful for normalizing an individual response to opioids.
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Anesthesia and analgesia · Jan 2009
Acute interstitial pneumonia-Hamman-Rich syndrome: clinical characteristics and diagnostic and therapeutic considerations.
Acute interstitial pneumonia is a rapidly progressive disease frequently leading to respiratory failure and mechanical ventilation. The prognosis is usually poor despite aggressive diagnostic and treatment efforts. ⋯ Acute interstitial pneumonia (Hamman-Rich syndrome) is an idiopathic, rapidly progressive and, at times, fatal form of interstitial lung disease. A transbronchial biopsy is a logical first diagnostic step, to be followed by an open lung biopsy, if necessary. Response to corticosteroids in our series was minimal. In patients who fail to respond to conventional therapy and are otherwise appropriate candidates, lung transplantation may be considered as an additional alternative.