Journal of anesthesia
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Journal of anesthesia · Apr 2015
Review Meta AnalysisAnesthetic effects of propofol in the healthy human brain: functional imaging evidence.
Functional imaging methods, including positron emission tomography (PET) and functional magnetic resonance imaging (fMRI), have become important tools for studying how anesthetic drugs act in the human brain to induce the state of general anesthesia. Recent imaging studies using fMRI and PET techniques have demonstrated the regional effects of propofol on the brain. However, the pharmacological mechanism of the action of propofol in the intact human central nervous system is unclear. ⋯ During deep sedation, propofol preserves cortical sensory reactivity, the specific thalamocortical network is moderately affected, whereas the nonspecific thalamocortical network is severely suppressed. In contrast, several recent fMRI studies are consistent on the systemic decreased effects of propofol in the frontoparietal network. Accumulating evidence suggest that propofol-induced unconsciousness is associated with a global metabolic and vascular depression in the human brain and especially with a significant reduction in the thalamocortical network and the frontoparietal network.
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Journal of anesthesia · Apr 2015
Randomized Controlled TrialMagnesium sulfate with lidocaine for preventing propofol injection pain: a randomized, double-blind, placebo-controlled trial.
Propofol injection pain, despite various strategies, remains common and troublesome. This study aimed to test the hypothesis that pretreatment with the combination of intravenous lidocaine and magnesium would have an additive effect on reducing propofol injection pain. ⋯ In this double-blind, placebo-controlled, randomized trial, the combination of intravenous magnesium sulfate and lidocaine offered no additional benefit for the relief of propofol injection pain compared to intravenous lidocaine alone. An improved, receptor-based understanding of the mechanism of propofol injection pain is still needed.
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Journal of anesthesia · Apr 2015
Randomized Controlled TrialThe efficacy of pregabalin for prevention of catheter-related bladder discomfort: a prospective, randomized, placebo-controlled double-blind study.
The present study evaluated the efficacy of preoperative pregabalin for prevention of catheter-related bladder discomfort. ⋯ Pretreatment with pregabalin 150 mg prevents CRBD and also decreases postoperative fentanyl consumption. ClinicalTrials.gov identifier: (ref: CTRI/2013/11/004170).
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Journal of anesthesia · Apr 2015
ReviewImplications of recent accumulating knowledge about endothelial glycocalyx on anesthetic management.
The endothelial glycocalyx is a labile, fine structure coating the luminal membrane of intact healthy vascular endothelium. For many decades, no physiologic importance was linked to this structure. It is crucial for vascular barrier function. ⋯ Perioperative damage of the glycocalyx has been demonstrated, and is linked with morbidity and even mortality in surgical patients. Research on the glycocalyx should change many of the current perioperative management guidelines, and focusing on its protection is plausible. The present article reviews what we already know about the glycocalyx and how this knowledge has changed anesthesiologist perspectives.
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Journal of anesthesia · Apr 2015
Randomized Controlled TrialCan we gain an advantage by combining distal median, radial and ulnar nerve blocks with supraclavicular block? A randomized controlled study.
The aim of this study was to compare the combined ultrasound-guided supraclavicular brachial plexus block (SCB) and distal median, radial, and ulnar nerve blocks, with the supraclavicular block alone. ⋯ The addition of distal median, radial, and ulnar nerve blocks to SCB shortens anesthesia-related time and anesthesia onset time when compared with a SCB alone.