Anesthesia and analgesia
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Anesthesia and analgesia · Mar 2009
Fast-track anesthesia and cardiac surgery: a retrospective cohort study of 7989 patients.
Fast-track cardiac anesthesia (FTCA) has been widely implemented but its safety has not been evaluated in sufficiently powered studies. ⋯ These data from 7989 cardiac surgical patients showed no evidence of an increased risk of adverse outcomes in patients undergoing FTCA.
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Anesthesia and analgesia · Mar 2009
Case Reports Clinical TrialTwo unusual cases of urinary incontinence during continuous sciatic nerve block with stimulating catheters.
One of the advantages of lower extremity peripheral nerve blocks compared with neuroaxial Neuraxial techniques is the lack of effect on urinary function. We report two cases of urinary incontinence during continuous sciatic nerve block with stimulating catheters placed using the posterior gluteal Labat approach. The two patients were able to control micturition 6 h after the catheter was removed.
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In addition to inhibiting the excitation conduction process in peripheral nerves, local anesthetics (LAs) cause toxic effects on the central nervous system, cardiovascular system, neuromuscular junction, and cell metabolism. Different postoperative neurological complications are ascribed to the cytotoxicity of LAs, but the underlying mechanisms remain unclear. Because the clinical concentrations of LAs far exceed their EC(50) for inhibiting ion channel activity, ion channel block alone might not be sufficient to explain LA-induced cell death. However, it may contribute to cell death in combination with other actions. In this study, we compared the cytotoxicity of six frequently used LAs and will discuss the possible mechanism(s) underlying their toxicity. ⋯ LAs can cause rapid cell death, which is primarily due to necrosis. Lidocaine and bupivacaine can trigger apoptosis with either increased time of exposure or increased concentration. These effects might be related to postoperative neurologic injury. Lidocaine, linked to the highest incidence of transient neurological symptoms, was not the most toxic LA, whereas bupivacaine, a drug causing a very low incidence of transient neurological symptoms, was the most toxic LA in our cell model. This suggests that cytotoxicity-induced nerve injury might have different mechanisms for different LAs and different target(s) other than neurons.
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Anesthesia and analgesia · Mar 2009
Changes in functional residual capacity during weaning from mechanical ventilation: a pilot study.
Reduction of high positive end-expiratory pressure levels and pressure support ventilation (PSV) are frequently used before tracheal extubation in critically ill patients, but the impact of PSV on functional residual capacity (FRC) is unknown. In this study, we sought to detect the changes of FRC and pulmonary function during a weaning protocol in patients ventilated after cardiac surgery. ⋯ Decreasing FRC during the weaning process after cardiac surgery may, at least in part, be explained by alveolar derecruitment. Whether this variable could help guide a weaning protocol has to be studied further.
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Anesthesia and analgesia · Mar 2009
Xenon preconditioning: the role of prosurvival signaling, mitochondrial permeability transition and bioenergetics in rats.
Similar to volatile anesthetics, the anesthetic noble gas xenon protects the heart from ischemia/reperfusion injury, but the mechanisms responsible for this phenomenon are not fully understood. We tested the hypothesis that xenon-induced cardioprotection is mediated by prosurvival signaling kinases that target mitochondria. ⋯ These results indicate that xenon preconditioning reduces myocardial infarct size, phosphorylates Akt, and GSK-3beta, preserves mitochondrial function, and inhibits Ca(2+)-induced mitochondrial permeability transition pore opening. These data suggest that xenon-induced cardioprotection occurs because of activation of prosurvival signaling that targets mitochondria and renders them less vulnerable to ischemia-reperfusion injury.