Anesthesia and analgesia
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Anesthesia and analgesia · Jun 2009
Lack of sensitivity of staffing for 8-hour sessions to standard deviation in daily actual hours of operating room time used for surgeons with long queues.
At multiple facilities including some in the United Kingdom's National Health Service, the following are features of many surgical-anesthetic teams: i) there is sufficient workload for each operating room (OR) list to almost always be fully scheduled; ii) the workdays are organized such that a single surgeon is assigned to each block of time (usually 8 h); iii) one team is assigned per block; and iv) hardly ever would a team "split" to do cases in more than one OR simultaneously. ⋯ For surgical teams with 8 h sessions, use the following decision rule for anesthesiology and OR nurse staffing. If actual hours of OR time used averages < or = 8 h 25 min, plan 8 h staffing. If average > or = 8 h 50 min, plan 10 h staffing. For averages in between, perform the full analysis of McIntosh et al. (Anesth Analg 2006;103:1499-516).
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Anesthesia and analgesia · Jun 2009
Hemeoxygenase-1 upregulation is critical for sirtinol-mediated attenuation of lung injury after trauma-hemorrhage in a rodent model.
Hemeoxygenase-1 induction in response to adverse circulatory conditions is protective. Our recent study has shown that administration of sirtinol attenuates hepatic injury in male Sprague-Dawley rats after trauma-hemorrhage; however, the mechanism by which sirtinol produces the salutary effects remains unknown. We hypothesized that sirtinol administration in male Sprague-Dawley rats after trauma-hemorrhage decreases cytokine production and protects against lung injury through a hemeoxygenase-1 related pathway. ⋯ The salutary effects of sirtinol administration on attenuation of lung inflammation after trauma-hemorrhage are mediated via upregulation of hemeoxygenase-1 expression.
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Anesthesia and analgesia · Jun 2009
Case ReportsHypokalaemia with severe rebound hyperkalaemia after therapeutic barbiturate coma.
Severe disturbance of potassium balance is a rare but life-threatening complication of therapeutic barbiturate coma. A 14-yr-old patient was treated with a thiopental infusion for management of increased intracranial pressure after severe head injury. The patient had persistent hypokalaemia during the thiopental infusion. ⋯ We conclude that aggressive treatment of hypokalaemia during barbiturate coma should be avoided, and advocate a tapering dose of thiopental and not abrupt cessation of an infusion. Severe disturbance of plasma potassium balance is a rare but life-threatening complication of therapeutic barbiturate coma. Awareness of this complication should be raised and management altered to less aggressive treatment of hypokalaemia occurring during thiopental infusion, with a tapering dose used on discontinuation to limit a rebound phenomenon.
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Anesthesia and analgesia · Jun 2009
The individual and combined effects of U50,488, and flurbiprofen axetil on visceral pain in conscious rats.
We examined the effects of U50,488, a kappa-opioid receptor agonist, and flurbiprofen axetil, a nonsteroidal antiinflammatory drug, in a visceral pain model using conscious rats. U50,488 produced visceral antinociception, but exaggerated the adverse effects on the central nervous system (CNS) at 0.9 mg/kg or more. ⋯ Flurbiprofen axetil produced visceral antinociception, but exaggerated the adverse effects on the CNS at 80 mg/kg. Coadministration of U50,488 (0.27 mg/kg) and flurbiprofen axetil (50 mg/kg) produced intense visceral antinociception without adverse effects on the CNS, implying therapeutic efficacies of coadministration of kappa-opioid receptor-agonists and nonsteroidal antiinflammatory drugs on visceral pain.
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Anesthesia and analgesia · Jun 2009
Case ReportsPreoperative hypoglycemia in a patient receiving insulin detemir.
The insulin regimen of a Type 2 diabetic presenting for surgery had been changed recently from a 70/30 mixture of insulin aspart protamine and aspart to insulin detemir and insulin glulisine. Preoperative instructions were to take the usual dose of basal, but none of the short-acting insulin. ⋯ A review of the basal insulin dose revealed that it had been inappropriately increased to control elevated postprandial glucose. Doses of basal insulin in excess of basal requirements will cause hypoglycemia in the fasting state.