Anesthesia and analgesia
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Anesthesia and analgesia · Jul 2011
Case ReportsBilateral ultrasound-guided transversus abdominis plane block combined with ilioinguinal-iliohypogastric nerve block for cesarean delivery anesthesia.
The ultrasound-guided transversus abdominis plane block and ilioinguinal-iliohypogastric nerve block have been shown to provide pain relief after abdominal surgery. A combination of the 2 blocks may provide acceptable surgical anesthesia for cesarean delivery. ⋯ Breakthrough pain during the delivery of the fetus was treated with small doses of IV ketamine and propofol. We suggest that this technique may be an alternative to local anesthesia for cesarean delivery in clinical practice.
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Anesthesia and analgesia · Jul 2011
Comparative StudyNeuropeptides contribute to peripheral nociceptive sensitization by regulating interleukin-1β production in keratinocytes.
It is increasingly evident that there is a close connection between the generation of cutaneous inflammatory cytokines and elevated neuropeptide signaling in complex regional pain syndrome (CRPS) patients. Previously, we observed in the rat tibia fracture model of CRPS that activation of caspase-1 containing NALP1 inflammasomes was required for interleukin (IL)-1β production in keratinocytes, and that administration of an IL-1 receptor antagonist (anakinra) reduced the fracture-induced hindpaw mechanical allodynia. We therefore hypothesized that neuropeptides lead to nociceptive sensitization through activation of the skin's innate immune system by enhancing inflammasome expression and caspase-1 activity. ⋯ Collectively, these results demonstrate that neuropeptides induce nociceptive sensitization by enhancing IL-1 β production in keratinocytes. Neuropeptides rely on both caspase-1 and cathepsin B for this enhanced production. Neurocutaneous signaling involving neuropeptide activation of the innate immunity may contribute to pain in CRPS patients.
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Anesthesia and analgesia · Jul 2011
Case ReportsPositioning an intraaortic balloon pump using intraoperative transesophageal echocardiogram guidance.
A 72-year-old man with an ejection fraction of 25% is scheduled to undergo elective coronary artery bypass graft using cardiopulmonary bypass. Because of the high-risk nature of the operation, the surgeon wants to insert an intraaortic balloon pump (IABP) before initiating cardiopulmonary bypass. An intraoperative transesophageal echocardiogram (TEE) is requested to ensure correct placement.