Anesthesia and analgesia
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Anesthesia and analgesia · Nov 2013
Cesarean Delivery in the Hybrid Operating Suite: A Promising New Location for High-Risk Obstetric Procedures.
The increasing cesarean delivery rate and attendant placental implantation abnormalities, coupled with increasing general medical complexity in the obstetric population, has driven innovation to optimize the care of high-risk parturients during delivery. Novel and multidisciplinary approaches and locations may enhance the options available for care. ⋯ The hybrid operating suite may be an alternative location for obstetric delivery, and our experience suggests that this environment may prove advantageous for patients with a variety of comorbid conditions.
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Anesthesia and analgesia · Nov 2013
Randomized Controlled TrialLiposomal Bupivacaine as a Single-Injection Peripheral Nerve Block: A Dose-Response Study.
Currently available local anesthetics approved for single-injection peripheral nerve blocks have a maximum duration of <24 hours. A liposomal bupivacaine formulation (EXPAREL, Pacira Pharmaceuticals, Inc., San Diego, CA), releasing bupivacaine over 96 hours, recently gained Food and Drug Administration approval exclusively for wound infiltration but not peripheral nerve blocks. ⋯ The results of this investigation suggest that deposition of a liposomal bupivacaine formulation adjacent to the femoral nerve results in a partial sensory and motor block of >24 hours for the highest doses examined. However, the high variability of block magnitude among subjects and inverse relationship of dose and response magnitude attests to the need for a phase 3 study with a far larger sample size, and that these results should be viewed as suggestive, requiring confirmation in a future trial.
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Anesthesia and analgesia · Nov 2013
The Effect of Endoplasmic Reticulum Stress on Neurotoxicity Caused by Inhaled Anesthetics.
The mechanisms by which inhaled anesthetics cause neurotoxicity are not well clarified. Exposure to inhaled anesthetics induces a release of Ca from the endoplasmic reticulum (ER) into the cytosol. Aberrant Ca mobilization may alter the protein-folding environment in the ER, causing ER stress. Binding immunoglobulin protein (BiP) is an ER chaperone that is critical to ER functions. Because ER stress leads to cellular dysfunction and apoptotic cell death, leading to diverse human disorders such as neurodegenerative diseases, we hypothesized ER stress may play a role in neurotoxicity caused by inhaled anesthetics. ⋯ Sevoflurane exposure may cause ER stress, which is tolerated to some extent in wild-type cells. When this tolerance is limited, like in cells with mutant BiP, the exposure leads to cell death in the brain, suggesting that ER stress may partially mediate neurotoxicity caused by inhaled anesthetics. This study suggests that patients with certain conditions sensitive to ER stress such as ischemia, hypoxia, developing brain, or neurodegenerative diseases may be vulnerable to inhaled anesthetics.
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Anesthesia and analgesia · Nov 2013
Is Dilutional Coagulopathy Induced by Different Colloids Reversible by Replacement of Fibrinogen and Factor XIII Concentrates?
In this in vitro trial, we assessed the effect on blood coagulation of 60% dilution with different colloids and investigated reversibility by replacement of factor XIII (F XIII), fibrinogen, and the combination of fibrinogen and F XIII. ⋯ Coagulation and platelet function are impaired by all 3 colloids. However, in vitro gelatin-induced coagulopathy was significantly more reversible than HES-induced coagulopathy.