Journal of anesthesia
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Journal of anesthesia · Oct 2011
Randomized Controlled Trial Clinical TrialA randomized, double blind, placebo controlled clinical trial of the preoperative use of ketamine for reducing inflammation and pain after thoracic surgery.
We hypothesized that patients who received ketamine during thoracic surgery would benefit from suppression of the inflammatory cascade, represented by lower interleukin (IL)-6 and C-reactive protein (CRP) plasma levels. ⋯ These findings suggest that the routine use of a single dose of ketamine prior to chest wall incision is not effective at reducing pain or inflammation in thoracic surgery patients at 24 h postoperatively.
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Journal of anesthesia · Oct 2011
Review Historical ArticleThe role of Certified Registered Nurse Anesthetists in the United States.
Certified Registered Nurse Anesthetists (CRNAs) have been providing anesthesia care in the United States (US) for nearly 150 years. Historically, anesthesia care for surgical patients was mainly provided by trained nurses under the supervision of surgeons until the establishment of anesthesiology as a medical specialty in the US. Currently, all 50 US states utilize CRNAs to perform various kinds of anesthesia care, either under the medical supervision of anesthesiologists in most states, or independently without medical supervision in 16 states; the latter has become an on-going source of conflict between anesthesiologists and CRNAs. Understanding the history and current conditions of anesthesia practice in the US is crucial for countries in which the shortage of anesthesia care providers has become a national issue.
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Journal of anesthesia · Oct 2011
Case ReportsSuccessful treatment of acute respiratory distress syndrome after hysterectomy for life-threatening atonic bleeding by inhaled nitric oxide.
We report a case of a 33-year-old female who developed severe acute respiratory distress syndrome (ARDS) after emergency hysterectomy for life-threatening atonic bleeding. A marked decline in pulmonary oxygenation was observed during the surgery, which led to a diagnosis of ARDS. ⋯ Inhaled nitric oxide (NO 10 ppm) was administered to the patient as a rescue treatment, resulting in a gradual but dramatic improvement in pulmonary oxygenation. Although several randomized trials have failed to confirm the beneficial effects of NO on morbidity in patients with ARDS, NO administration is worth consideration as treatment prior to invasive treatments, such as extracorporeal membrane oxygenation, for patients with acute lung injury/ARDS.
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Journal of anesthesia · Oct 2011
Influence of bupivacaine injection dose rate on cardiovascular depression, subsequent hemodynamic course, and related bupivacaine plasma levels in piglets.
Systemic local anesthetic (LA) toxicity resulting from inadvertent intravascular injection of LA is a rare but potentially fatal event. Early recognition of intravascular injection and approaches to improve therapeutic safety are required. This study investigated the influence of intravascular injection dose rate of bupivacaine on bupivacaine plasma levels and timing of LA-induced cardiovascular compromise. ⋯ Higher dose rates of bupivacaine showed much higher plasma bupivacaine levels related to absolute infused dose at MAP 50% and were associated with an increased mortality. Slow administration of LA is recommended to allow timely detection and stopping of inadvertent intravascular administration.
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Journal of anesthesia · Oct 2011
Randomized Controlled TrialFlurbiprofen axetil enhances analgesic effect of fentanyl associated with increase in β-endorphin levels.
To examine the analgesic effect of preoperative administration of flurbiprofen axetil and that of postoperative administration of a combination of flurbiprofen axetil and fentanyl, as well as perioperative plasma β-endorphin (β-EP) levels in patients undergoing esophagectomy. ⋯ These results show that flurbiprofen axetil enhances the analgesic effect of fentanyl associated with increase in β-EP levels.