Anesthesia and analgesia
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Anesthesia and analgesia · Mar 2012
Comparative StudyForecasting preanesthesia clinic appointment duration from the electronic medical record medication list.
When scheduling clinic appointments, scheduling patients expected to have different visit durations for different minutes of time reduces patient waiting time and staff idle time. Maintaining an active medication list is an important (and, in the United States, required) component to the meaningful use of electronic medical records. We hypothesized that the count of medications from the medication list would be a better predictor of the time taken by a nurse practitioner to evaluate the patient preoperatively than the American Society of Anesthesiologists' (ASA) physical status and other demographic variables. ⋯ Schedulers can use the number of medications that each patient is taking when choosing the time for preoperative evaluation. This approach can take schedulers only approximately 10 seconds extra per patient when scheduling the appointment.
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Our goal in this study was to develop a robotic intubation system and to conduct a feasibility pilot study on the use of a robotic intubation system for endotracheal intubations. The Kepler Intubation System was developed, consisting of a remote control center (joystick and intubation cockpit) linked to a standard videolaryngoscope via a robotic arm. Ninety intubations were performed by the Kepler Intubation System on an airway trainer mannequin by a single operator. ⋯ Both the direct and indirect view groups had a negative slope, denoting that each successive trial required less time. The semiautomated group had a slope of 0 and a low SD of 1 second, illustrating the high reproducibility of automated intubations. We concluded that a robotic intubation system has been developed that can allow remote intubations within 40 to 60 seconds.
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Anesthesia and analgesia · Mar 2012
Comparative StudyThe analgesic activity of intrathecal tianeptine, an atypical antidepressant, in a rat model of inflammatory pain.
Tianeptine is an atypical antidepressant that exhibits structural similarities to the tricyclic antidepressants but has distinct neurochemical properties. We evaluated the antinociceptive activity of tianeptine and its mechanism of action regarding serotonergic and adrenergic transmission at the spinal level. ⋯ Intrathecally administered tianeptine effectively relieved inflammatory pain in rats. The serotonergic system is related to the activity of tianeptine for facilitated pain at the spinal level. Adrenergic transmission is also involved in tianeptine-induced analgesia for both facilitated and acute pain. The combination of tianeptine and cyclooxygenase-2 inhibitor may provide additional benefits for the management of inflammatory pain.
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Anesthesia and analgesia · Mar 2012
Comparative StudyAngiotensin converting enzyme inhibitors are not associated with respiratory complications or mortality after noncardiac surgery.
General use of angiotensin-converting enzyme inhibitors (ACEIs) is associated with upper-airway complications such as cough, angioedema, and bronchospasm; furthermore, preoperative use is associated with increased morbidity or mortality. Our primary goal in this study was thus to evaluate the association of ACEI therapy with perioperative respiratory morbidity in adult noncardiac surgical patients. Our secondary goals were to evaluate the association between preoperative use of ACEI and 30-day mortality, as well as to a composite outcome of in-hospital morbidity and mortality in adult noncardiac surgical patients having general anesthesia. ⋯ We did not find any association between use of ACEIs and intraoperative or postoperative upper-airway complications. Furthermore, ACEI use was not associated with in-hospital complications or increased 30-day mortality.
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Anesthesia and analgesia · Mar 2012
Comparative StudyDorsal root ganglion application of muscimol prevents hyperalgesia and stimulates myelin protein expression after sciatic nerve injury in rats.
Peripheral nerve injuries may result in debilitating pain that is poorly responsive to conventional treatment. Neuropathic pain induced by peripheral nerve injury is caused, in part, by ectopic discharges from the injury site or the dorsal root ganglia (DRG) resulting in enhanced central input and central hyperexcitability. A heterogeneous family of γ-aminobutyric acid (GABA)(A) channels is important in quieting neuronal excitability. We have recently reported that in vivo modulation of GABAergic neurons in DRG can alter the course of neuropathic pain development after peripheral nerve injury. It seems that direct application of a potent GABA(A) agonist, muscimol, to the ipsilateral DRG prevents the development of hyperalgesia in rats subjected to a sciatic nerve crush injury. In addition to potentially curtailing hyperexcitability, GABAergic stimulation upregulated expression of peripheral myelin protein 22 (PMP22), a key component of the basal lamina. PMP22 expression correlates with peripheral myelin formation and nerve regeneration. ⋯ The DRG could be a promising therapeutic target in nerve regeneration and pain alleviation after crush injury of a myelinated peripheral nerve.