Anesthesia and analgesia
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Anesthesia and analgesia · Sep 2009
Sciatic nerve catheter placement: success with using the Raj approach.
Continuous regional analgesia has increased in popularity and is becoming standard of care for many painful surgical procedures. Various approaches of sciatic catheter insertion have been proposed, each with attributes and disadvantages. We investigated whether the Raj approach that uses a simple midpoint landmark between the ischial tuberosity and greater trochanter will facilitate sciatic catheter placement. ⋯ Use of a simple landmark between easily identifiable bony structures enhances the simplicity and placement of a sciatic nerve catheter and is recommended for use in clinical practice.
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Anesthesia and analgesia · Sep 2009
Increasing the duration of isoflurane anesthesia decreases the minimum alveolar anesthetic concentration in 7-day-old but not in 60-day-old rats.
While studying neurotoxicity in rats, we observed that the anesthetic minimum alveolar anesthetic concentration (MAC) of isoflurane decreases with increasing duration of anesthesia in 7-day-old but not in 60-day-old rats. After 15 min of anesthesia in 7-day-old rats, MAC was 3.5% compared with 1.3% at 4 h. We investigated whether kinetic or dynamic factors mediated this decrease. ⋯ MAC of isoflurane decreases over 1-4 h of anesthesia in 7-day-old but not in 60-day-old rats. Both pharmacodynamic and a pharmacokinetic components contribute to the decrease in MAC in 7-day-old rats. Neither endorphins nor sensory desensitization mediate the pharmacodynamic component.
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Anesthesia and analgesia · Sep 2009
Randomized Controlled TrialNasogastric tube insertion using different techniques in anesthetized patients: a prospective, randomized study.
It is often difficult to correctly place nasogastric (NG) tubes under anesthesia. We hypothesized that simple modifications in technique of NG tube insertion will improve the success rate. ⋯ The success rate of NG tube insertion can be increased by using a ureteral guidewire as stylet, a slit endotracheal tube as an introducer, or head flexion with lateral neck pressure. Head flexion with lateral neck pressure is the easiest technique that has a high success rate and fewest complications.
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Anesthesia and analgesia · Sep 2009
Ketamine inhibits maturation of bone marrow-derived dendritic cells and priming of the Th1-type immune response.
Dendritic cells (DCs) play a key role as antigen-presenting cells and growing evidence suggests that DCs influence T-cell activation and regulate the polarity of the immune response. Ketamine has been reported to have immunomodulatory properties that affect immune cells, including macrophages and natural killer cells. However, the effect of ketamine on DCs has not been characterized. We examined the immunomodulation of DCs by ketamine. ⋯ Our findings suggest that ketamine inhibits the functional maturation of DCs and interferes with DC induction of Th1 immunity in the whole animal. These novel findings provide new insight into the immunopharmacological role of ketamine.