Anesthesia and analgesia
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Anesthesia and analgesia · Aug 2016
Anesthetic Management of 65 Cases of Ex Utero Intrapartum Therapy: A 13-Year Single-Center Experience.
The anesthetic management for open fetal surgery has been described, but many therapeutic tenets have not been supported with data. We present data on the anesthetic management and outcomes of 65 patients undergoing ex utero intrapartum therapy procedures at the Children's Hospital of Philadelphia between 1998 and 2011. ⋯ High levels of volatile anesthetic were used for uterine relaxation. Case characteristics such as fetal procedure, operative time, blood loss, transfusion requirements, vasopressor use, and fetal resuscitative measures are described.
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Anesthesia and analgesia · Aug 2016
Predicting the Best Fit: A Comparison of Response Surface Models for Midazolam and Alfentanil Sedation in Procedures with Varying Stimulation.
Selecting an effective dose of sedative drugs in combined upper and lower gastrointestinal endoscopy is complicated by varying degrees of pain stimulation. We tested the ability of 5 response surface models to predict depth of sedation after administration of midazolam and alfentanil in this complex model. The procedure was divided into 3 phases: esophagogastroduodenoscopy (EGD), colonoscopy, and the time interval between the 2 (intersession). ⋯ The reduced Greco model had the lowest objective function value and AICc and thus the best fit. This model was reliable with acceptable predictive ability based on adequate clinical correlation. We suggest that this model has practical clinical value for patients undergoing procedures with varying degrees of stimulation.
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Anesthesia and analgesia · Aug 2016
Heterogeneity in the Structure of the Left Ventricular Outflow Tract: A 3-Dimensional Transesophageal Echocardiographic Study.
The left ventricular outflow tract (LVOT) is a composite of adjoining structures; therefore, a circular or elliptical shape at one point may not represent its entire structure. The purpose of this study was to evaluate the presence of heterogeneity in the LVOT. ⋯ There was heterogeneity in the major axis diameter and cross-sectional area for the different regions of the LVOT. The distal LVOT (aortic side) was more circular, whereas the proximal LVOT (left ventricular side) was more elliptical in shape. This change in shape from circular to elliptical was accounted for by a difference in the major axis diameter from proximal to distal LVOT and a relatively similar minor axis diameter. Although the clinical significance of this finding is unknown, the assumption of a uniform structure of LVOT is incorrect. Three-dimensional imaging may be useful for assessing the LVOT shape and size at a specific region of interest.
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Anesthesia and analgesia · Aug 2016
Amitriptyline, but Not Pregabalin, Reverses the Attenuation of Noxious Stimulus-Induced Analgesia After Nerve Injury in Rats.
Noxious stimulus-induced analgesia (NSIA) is a type of conditioned pain modulation in rats that has been used to assess endogenous pain control systems. The descending noradrenergic system is involved in NSIA, and nerve injury induces plastic changes of descending noradrenergic neurons. Thus, we hypothesized that nerve injury would affect NSIA strength and that amitriptyline and pregabalin, which often are used for treating neuropathic pain, might further modulate NSIA through effects on the descending noradrenergic system. ⋯ These data suggest that endogenous analgesia in neuropathic pain states is strongly decreased from a certain time after nerve injury and that amitriptyline reverses the attenuation of endogenous analgesia through effects on the descending noradrenergic system.