Anesthesia and analgesia
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Anesthesia and analgesia · Jan 2010
The first scintigraphic detection of tumor necrosis factor-alpha in patients with complex regional pain syndrome type 1.
Tumor necrosis factor (TNF)-alpha has been identified as a pathogenic factor in many immunologically based diseases and complex regional pain syndrome (CRPS). In this case series, we used radiolabeled technetium anti-TNF-alpha antibody to scintigraphically image TNF-alpha in 3 patients with type 1 CRPS. ⋯ No uptake was seen in clinically unaffected hands and late-stage CRPS. Our findings support the growing evidence for neuroimmune disturbance in patients with CRPS and may have important further implications for specific anticytokine treatment in patients with CRPS.
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Anesthesia and analgesia · Jan 2010
Transient changes in brain tissue oxygen in response to modifications of cerebral perfusion pressure: an observational study.
The relative merits of the mechanisms for the maintenance of brain tissue oxygenation (PbtO(2)) have been much debated. There is a wealth of studies regarding various factors that may determine the absolute value and changes in PbtO(2). However, only a few of them analyzed fast (few minutes) and transient behavior of PbtO(2) in response to variations (waves) of intracranial pressure (ICP) and cerebral perfusion pressure (CPP). ⋯ PbtO(2) is more than a number; it is rather a waveform following rapid changes in ICP and ABP. We show that PbtO(2) generally tracks the direction of CPP irrespective of the state of cerebral autoregulation.
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Anesthesia and analgesia · Jan 2010
Pressures available for transtracheal jet ventilation from anesthesia machines and wall-mounted oxygen flowmeters.
Oxygen supplies capable of supporting transtracheal jet ventilators can be lifesaving. There is not much information about which oxygen sources (readily available inside and outside operating rooms) have sufficient driving pressure for transtracheal jet ventilation. ⋯ Oxygen sources other than dedicated jet ventilator connectors to high-pressure pipeline oxygen may supply adequate working pressure, but each type of oxygen source needs testing to ensure that it supplies adequate working pressure.
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Anesthesia and analgesia · Jan 2010
Thoracic paravertebral block using real-time ultrasound guidance.
We developed a technique for ultrasound-guided paravertebral block, which was subsequently applied in the clinical setting. ⋯ Determined by anatomical dissection, we have described the ultrasound features of the thoracic paravertebral space and performed clinically successful ultrasound-guided paravertebral block.
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Anesthesia and analgesia · Jan 2010
Gestation-related reduction in lumbar cerebrospinal fluid volume and dural sac surface area.
Facilitation of the spread of neuraxial anesthesia in pregnant women may be attributable in part to compression of the dural sac by the engorged epidural venous plexus. In this study, we used magnetic resonance imaging to examine pregnancy-induced changes in the lumbosacral cerebrospinal fluid (CSF) volume and dural sac surface area. ⋯ These findings indicate an association between gestational week (Weeks 31-39) and a reduction in both CSF volume and dural sac surface area. These reductions may, at least in part, explain the facilitation of the spread of intrathecal anesthesia in pregnant women.