Journal of anesthesia
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Cerebral injury following cardiac surgery continues to be a significant source of morbidity and mortality after cardiac surgery. A spectrum of injuries ranging from subtle neurocognitive dysfunction to fatal strokes are caused by a complex series of multifactorial mechanisms. Protecting the brain from these injuries has focused on intervening on each of the various etiologic factors. Although numerous studies have focused on a pharmacologic solution, more success has been found with nonpharmacologic strategies, including optimal temperature management and reducing emboli generation.
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Pharmacological preconditioning with volatile anesthetics, or anesthetic-induced preconditioning (APC), is a phenomenon whereby a brief exposure to volatile anesthetic agents protects the heart from the potentially fatal consequences of a subsequent prolonged period of myocardial ischemia and reperfusion. Although not completely elucidated, the cellular and molecular mechanisms of APC appear to mimic those of ischemic preconditioning, the most powerful endogenous cardioprotective mechanism. This article reviews recently accumulated evidence underscoring the importance of mitochondria, reactive oxygen species, and K(ATP) channels in cardioprotective signaling by volatile anesthetics. Moreover, the article addresses current concepts and controversies regarding the specific roles of the mitochondrial and the sarcolemmal K(ATP) channels in APC.
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Journal of anesthesia · Jan 2007
Randomized Controlled TrialEpidural ropivacaine infusion for the treatment of pain following axillary muscle-sparing thoracotomy: a dose-evaluation study.
We aimed to investigate the optimal dose of continuous epidural ropivacaine for effective analgesia with minimal side effects after axillary muscle-sparing thoracotomy. ⋯ Our results showed that epidural analgesia using ropivacaine, at 12 mg x h(-1), provided the best analgesia with few side effects.
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Journal of anesthesia · Jan 2007
Randomized Controlled Trial Comparative StudyThe analgesic efficacy of two different approaches to the lumbar plexus for patient-controlled analgesia after total knee replacement.
This study assessed the efficacy of a patient-controlled regional analgesia technique for either psoas compartment block or femoral nerve block after total knee replacement in 68 patients who were randomly divided into these two groups. All patients received 40 ml of 0.25% bupivacaine via femoral or psoas catheters before general anesthesia, and then, as patient-controlled regional analgesia, 10-ml boluses of 0.125% bupivacaine, with a lockout time of 60 min over 48 h. ⋯ All measured parameters were comparable in the two groups. Both techniques achieved a good quality of analgesia and satisfaction without any major side effect.