Anesthesia and analgesia
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Anesthesia and analgesia · Feb 2011
Randomized Controlled TrialNitrous oxide and long-term morbidity and mortality in the ENIGMA trial.
There is a plausible pathophysiologic rationale for increased long-term cardiovascular morbidity and mortality in patients receiving significant exposure to nitrous oxide. However, this relationship has not been established clinically. The ENIGMA trial randomized 2050 patients having noncardiac surgery lasting more than 2 hours to nitrous oxide-based or nitrous oxide-free anesthesia. We conducted a follow-up study of the ENIGMA patients to evaluate the risk of cardiovascular events in the longer term. ⋯ The administration of nitrous oxide was associated with increased long-term risk of myocardial infarction, but not of death or stroke in patients enrolled in the ENIGMA trial. The exact relationship between nitrous oxide administration and serious long-term adverse outcomes will require confirmation by an appropriately designed large randomized controlled trial.
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Anesthesia and analgesia · Feb 2011
Randomized Controlled Trial Comparative StudyLow-dose, low-concentration levobupivacaine plus fentanyl selective spinal anesthesia for knee arthroscopy: a dose finding study.
Selective sensory spinal anesthesia preserves lower limb motor function and thus facilitates postanesthesia care unit (PACU) bypass and reduces ambulation recovery time. ⋯ Four milligrams levobupivacaine plus 10 μg fentanyl produced adequate surgical anesthesia with the shortest time to ambulation and the highest PACU bypass rate.
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Anesthesia and analgesia · Feb 2011
Randomized Controlled Trial Comparative StudyThe effect of mixing 1.5% mepivacaine and 0.5% bupivacaine on duration of analgesia and latency of block onset in ultrasound-guided interscalene block.
Short- and long-acting local anesthetics are commonly mixed to achieve nerve blocks with short onset and long duration. However, there is a paucity of data on advantages of such mixtures. We hypothesized that a mixture of mepivacaine and bupivacaine results in a faster onset than does bupivacaine and in a longer duration of blockade than does mepivacaine. ⋯ For ultrasound-guided interscalene block, a combination of mepivacaine 1.5% and bupivacaine 0.5% results in a block onset similar to either local anesthetic alone. The mean duration of blockade with a mepivacaine-bupivacaine mixture was significantly longer than block with mepivacaine 1.5% alone but significantly shorter than the block with bupivacaine 0.5% alone.
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Anesthesia and analgesia · Feb 2011
ReviewAntiplatelet drugs: a review of their pharmacology and management in the perioperative period.
In the normal course of the delivery of care, anesthesiologists encounter many patients who are receiving drugs that affect platelet function as a fundamental part of primary and secondary management of atherosclerotic thrombotic disease. There are several antiplatelet drugs available for use in clinical practice and several under investigation. Aspirin and clopidogrel (alone and in combination) have been the most studied and have the most favorable risk-benefit profiles of drugs currently available. ⋯ Furthermore, the risk and benefit assessment of discontinuing or continuing these drugs should be made bearing in mind the proposed surgery and its inherent risk for bleeding complications as well as decisions relating to appropriate use of general or some form of regional anesthesia. In general, the safest approach to prevent thrombosis seems to be continuation of these drugs throughout the perioperative period except where concerns about perioperative bleeding outweigh those associated with the development of thrombotic occlusion. Knowledge of the pharmacodynamics and pharmacokinetics of antiplatelet drugs may allow practitioners to anticipate difficulties associated with drug withdrawal and administration in the perioperative period including the potential for drug interactions.
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Anesthesia and analgesia · Feb 2011
Combined catechol-O-methyltransferase and mu-opioid receptor gene polymorphisms affect morphine postoperative analgesia and central side effects.
Previous studies have generated controversial results regarding the influence of the genetic variations of μ-opioid receptors on morphine analgesia and opioid-related side effects in the postoperative period. Few studies have been conducted attempting to assess the combined effects of variation within ≥2 genes in relation to morphine response. In this study, we investigated whether combined catechol-O-methyltransferase and μ-opioid receptor polymorphisms contribute to the morphine response in postoperative analgesia. ⋯ This study has demonstrated the importance of the gene-gene approach in understanding the morphine response in patients after lower abdominal surgery. More studies are needed to characterize the combined effects of multiple genes and demographic as well as clinical variables in predicting the correct morphine dosage and corresponding opioid-related side effects.