Anesthesia and analgesia
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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.
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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
Comparative StudyThe systemic toxicity of equipotent proxymetacaine, oxybuprocaine, and bupivacaine during continuous intravenous infusion in rats.
Although proxymetacaine and oxybuprocaine produce topical ocular and spinal anesthesia, they have never been tested as cutaneous anesthetics. We compared cutaneous analgesia of proxymetacaine and oxybuprocaine with bupivacaine and tested their central nervous system and cardiovascular toxicity. ⋯ Oxybuprocaine and proxymetacaine were more potent at producing cutaneous anesthesia but were less potent than bupivacaine at producing central nervous system and cardiovascular toxicity.
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Anesthesia and analgesia · Jan 2010
Plasmapheresis and heparin reexposure as a management strategy for cardiac surgical patients with heparin-induced thrombocytopenia.
Heparin-induced thrombocytopenia (HIT) complicates the management of patients presenting for cardiac surgery, because high-dose heparin anticoagulation for cardiopulmonary bypass is contraindicated in these patients. Alternative anticoagulants are available, but there are concerns about dosing, efficacy, monitoring, thrombosis, and hemorrhage. ⋯ This case series describes an alternative management strategy using intraoperative plasmapheresis for patients presenting for cardiac surgery with acute or subacute HIT. Reducing antibody load can potentially decrease the thrombotic risk associated with high anti-HPF4 titers and decrease the urgency to initiate postoperative anticoagulation in this patient group at high risk of postoperative bleeding.
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Anesthesia and analgesia · Jan 2010
The effect of preoperative heart rate and anxiety on the propofol dose required for loss of consciousness.
Conflicting results have been reported on the effect of anxiety on the propofol dose required for inducing loss of consciousness (LOC). The hemodynamic effects of anxiety, increased heart rate (HR), and cardiac output may account for these discrepancies. We therefore designed this study to address, first, the effect of perioperative HR on propofol dose required for LOC and, second, the effect of perioperative anxiety on HR. ⋯ Increased perioperative HR is associated with increased propofol dose required for LOC. Perioperative anxiety accounts for increased HR.