Anesthesia and analgesia
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Anesthesia and analgesia · Aug 2011
Biography Historical ArticleRoss C. Terrell, PhD, an anesthetic pioneer.
On December 30, 2010, Ross C. Terrell, PhD, died. With his passing at age 85, we lost one of the pioneers of modern anesthesia. Terrell synthesized most of the inhalation anesthetics used today, including desflurane, enflurane, isoflurane, and sevoflurane.
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Anesthesia and analgesia · Aug 2011
Performance of the On-Q pain infusion device during hyperbaric therapy.
There are reports in the literature regarding the effects of hyperbaric conditions on various medical devices. In the current study we evaluated the performance of an elastomeric infusion device during exposure to a hyperbaric environment. ⋯ This preliminary investigation demonstrates no clinically significant change in the function of the On-Q pain device during exposure to a hyperbaric environment.
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Anesthesia and analgesia · Aug 2011
Randomized Controlled TrialPrior epidural lidocaine alters the pharmacokinetics and drug effects of extended-release epidural morphine (DepoDur®) after cesarean delivery.
A potential physicochemical interaction between epidural local anesthetics and extended-release epidural morphine (EREM) could negate the sustained release. In this study, we sought to determine the pharmacokinetic and drug effects of prior epidural lidocaine administration on EREM. ⋯ A large dose of epidural lidocaine 1 hour before EREM administration alters the pharmacokinetics and drug effects of EREM. Clinicians must apply caution when EREM is administered even 1 hour after an epidural lidocaine "top-up" for cesarean delivery.
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Anesthesia and analgesia · Aug 2011
ReviewThe physiologic implications of isolated alpha(1) adrenergic stimulation.
Phenylephrine and methoxamine are direct-acting, predominantly α(1) adrenergic receptor (AR) agonists. To better understand their physiologic effects, we screened 463 articles on the basis of PubMed searches of "methoxamine" and "phenylephrine" (limited to human, randomized studies published in English), as well as citations found therein. Relevant articles, as well as those discovered in the peer-review process, were incorporated into this review. ⋯ Furthermore, the cost of increased blood pressure after pure α(1)-agonism is almost invariably decreased cardiac output, likely due to increases in venous resistance. The venous system contains α(1) ARs, and though stimulation of α(1) ARs decreases capacitance and may transiently increase venous return, this gain may be offset by changes in afterload, venous compliance, and venous resistance. Data on the effects of α(1) stimulation in the central nervous system show conflicting changes, while experimental animal data suggest that renal blood flow is reduced by α(1)-agonists, and both animal and human data suggest that gastrointestinal perfusion may be reduced by α(1) tone.
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Anesthesia and analgesia · Aug 2011
Clinical TrialFactors affecting the decision to defer endotracheal extubation after surgery for congenital heart disease: a prospective observational study.
Fast-tracking and early endotracheal extubation have been described in patients undergoing surgery for congenital heart disease (CHD); however, criteria for patient selection have not been validated in a prospective manner. Our goal in this study was to prospectively identify factors associated with the decision to defer endotracheal extubation in the operating room (OR). ⋯ Preoperatively known factors alone can predict the relative chances of deferring extubation after surgery for CHD. The early extubation strategies applied in the 2 centers were successful in the majority of cases.