Anesthesia and analgesia
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Anesthesia and analgesia · Sep 2011
Comparative StudyUltrasound assessment of the vertebral level of the intercristal line in pregnancy.
The intercristal line is known to most frequently cross the L4 spinous process or L4-5 interspace; however, it is speculated to be positioned higher during pregnancy because of the exaggerated lumbar lordosis. Clinical estimation of vertebral levels relying on the use of the intercristal line has been shown to often be inaccurate. We hypothesized that the vertebral level of the intercristal line determined by palpation would be higher than the level determined by ultrasound in pregnant women. ⋯ The anatomical position of the intercristal line was at L3 or higher in at least 6% of term pregnant patients using ultrasound. Clinical estimates were found to be ≥1 vertebral level higher than the anatomical position determined by ultrasound at least 40% of the time. This disparity may contribute to misidentification of lumbar interspaces and increased risk of neurologic injury during neuraxial anesthesia.
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Anesthesia and analgesia · Sep 2011
Comparative StudyThe effect of ventilator performance on airway pressure release ventilation: a model lung study.
Using a model lung connected to six different ventilators, with each ventilator in the airway pressure release ventilation mode, we measured differences in intrinsic positive end-expiratory pressure (PEEPi) during the expiratory phase and calculated the inspiratory and expiratory pressure time product (PTP) as an index of work of breathing during the inspiratory phase. ⋯ PEEPi varied significantly among ventilators. Inspiratory and expiratory work of breathing varied between ventilators when spontaneous breathing occurred during the ventilator's inspiratory phase.
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Anesthesia and analgesia · Sep 2011
Case ReportsAirway management of tetanus after the Haitian earthquake: new aspects of old observations.
Two men developed severe tetanus after the 2010 Haitian earthquake. They were admitted to the United States Naval Ship Comfort, a hospital ship sent to provide humanitarian relief. ⋯ Presynaptic impairment of inhibitory neurotransmitter release by tetanospasmin toxin is countered by enhancement of spinal cord postsynaptic inhibitory receptor activity by general anesthetics. Avoidance of tracheal intubation and mechanical ventilation during anesthesia may be desirable in the settings of limited resources in which tetanus usually presents.
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Anesthesia and analgesia · Sep 2011
Immune cell populations decrease during craniotomy under general anesthesia.
Postoperative infections are common and potentially fatal complications in neurosurgical intensive care medicine. An impairment of immune function after central nervous system surgery is associated with higher risk of infection and postoperative complications. The aim of our study was to investigate how the immune cell population changes during the anesthesia process in patients undergoing craniotomy surgery. ⋯ Our results showed that anesthesia and surgery upset the balance of the immune system during craniotomy, and a significant decrease in immune cell populations emerged after induction under general anesthesia.