Anesthesia and analgesia
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Anesthesia and analgesia · Feb 2010
Randomized Controlled TrialHemofiltration during cardiopulmonary bypass does not decrease the incidence of atrial fibrillation after cardiac surgery.
Atrial fibrillation (AF) occurs in 20%-50% of patients after cardiac surgery and is associated with increased morbidity and mortality. Corticosteroids are reported to decrease the incidence of postoperative AF, presumably by attenuating inflammation caused by surgery and cardiopulmonary bypass (CPB). We hypothesized that hemofiltration during CPB, which may attenuate inflammation, might decrease the incidence of AF after cardiac surgery. ⋯ Perioperative corticosteroids or the use of hemofiltration during CPB did not decrease the incidence of AF after cardiac surgery. Further studies evaluating the efficacy and safety of perioperative corticosteroids for prevention of postoperative AF are warranted before their routine use can be recommended.
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Anesthesia and analgesia · Feb 2010
ReviewIntraosseous infusions: a review for the anesthesiologist with a focus on pediatric use.
Intraosseous (IO) access is used most frequently for emergency care of critically ill infants and children when IV access cannot be rapidly achieved. Despite its efficacy in such situations, applications outside of the emergency room or resuscitation scenario have been limited. ⋯ Anyone providing anesthesia care for infants and children may want to become facile with the use of IO infusions for selected indications. We present the history of IO infusions, review the anatomy of the bone marrow space, discuss the potential role of IO infusions in the perioperative period, and analyze its adverse effect profile.
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Anesthesia and analgesia · Feb 2010
Inhibition of human alpha4beta2 neuronal nicotinic acetylcholine receptors by volatile aromatic anesthetics depends on drug hydrophobicity.
Volatile aromatic compounds such as benzene are general anesthetics that cause amnesia, hypnosis, and immobility in response to noxious stimuli when inhaled. Although these compounds are not used clinically, they are frequently found in commercial items such as solvents and household cleaning products and are abused as inhalant drugs. Volatile aromatic anesthetics are useful pharmacological tools for probing the relationship between chemical structure and drug activity at putative general anesthetic targets. Neuronal nicotinic acetylcholine (nACh) receptors are ligand-gated ion channels widely expressed in the brain, which are thought to play important roles in learning and memory. In this study, we tested the hypothesis that aromatic anesthetics reversibly inhibit alpha(4)beta(2) neuronal nACh receptor function and sought to determine the structural correlates of receptor inhibition. ⋯ Volatile aromatic anesthetics potently and reversibly inhibit human alpha(4)beta(2) neuronal nACh receptors. This inhibition may play a role in producing amnesia. In contrast to N-methyl-d-aspartate receptors, the inhibitory potencies of aromatic anesthetics for alpha(4)beta(2) neuronal nACh receptors seem to be dependent on drug hydrophobicity rather than electrostatic properties. This implies that the volatile aromatic anesthetic binding site in the alpha(4)beta(2) neuronal nACh receptor is hydrophobic in character and differs from the nature of the binding site in N-methyl-D-aspartate receptors.
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Anesthesia and analgesia · Feb 2010
Pulse pressure and long-term survival after coronary artery bypass graft surgery.
Data from longitudinal studies reveal that widened pulse pressure (PP) is a major predictor of coronary heart disease and mortality, but it is unknown whether PP similarly decreases survival after coronary artery bypass graft (CABG) surgery for coronary heart disease. We therefore assessed long-term survival in patients with increased PP at the time of presentation for CABG surgery. ⋯ An increase in perioperative PP is associated with poor long-term survival after CABG surgery. Together with our previous report linking PP to in-hospital fatal and nonfatal vascular complications, the established models for surgical risk assessment, patient counseling, and treatment should be revised to include PP.
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Anesthesia and analgesia · Feb 2010
Case ReportsAcute intraoperative neurogenic pulmonary edema during endoscopic ventriculoperitoneal shunt revision.
We present an incident of fulminant intraoperative neurogenic pulmonary edema in a 21-yr-old man undergoing an endoscopic ventriculoperitoneal shunt revision. His intraoperative course was complicated by intracranial bleeding requiring vigorous saline irrigation, which was accompanied by an acute increase in heart rate and arterial blood pressure. Shortly thereafter, the patient developed pulmonary edema and was promptly treated with resolution of pulmonary symptoms within 24 h. This report addresses the importance of recognition of neurogenic pulmonary edema as a possible intraoperative complication resulting from an increase in intracranial pressure due to hemorrhage and intraventricular irrigation during endoscopic ventriculoperitoneal shunt revision.