Der Anaesthesist
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Molecular biological investigations led to the discovery of the ORL1 receptor ( opioid receptor like-1 receptor) and its endogenous ligand nociceptin. Although its sequence and structure are closely related to traditional opioid receptors, the ORL1 receptor shows low binding affinities for selective opioid agonists and antagonists. On the other hand, the ORL1 ligand nociceptin does not bind to the three traditional opioid receptors. ⋯ The physiological role and detailed mechanisms of these dose-dependent nociceptin effects in opposite directions are not yet known. In addition, nociceptin modulates other biological phenomena such as feeding, locomotion, gastrointestinal function,memory, cardiovascular function,immunity, renal function, anxiety,dependence and tolerance. Future research on the physiological and pathophysiological importance of the nociceptin/ORL1 receptor systems may provide a target for novel therapeutics.
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Peripartum care of parturients has contributed a great deal to the development of modern anaesthesia during the past 150 years. The introduction of general and regional anaesthesia provided new options of relieving pain during delivery and preventing suffering. ⋯ Using the MLAC model as a scientifically based pharmacodynamic measure of analgesia, empirically developed "recipes" can be compared and validated. The importance of this clinical model will be put into a pharmacological context including issues such as the up-down sequential allocation technique, dose-response curves and differential nerve blockade.
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The localisation of the nerve to be blocked is one of the special challenges in local anaesthesia. Since the first time local anaesthesia procedures were carried out approximately 100 years ago, the basic limitations of this method have always been the unsatisfactory success rate and the specific risks involved. Even by variation of the access route to the various nerves and use of different identification methods, no ideal blockade technique has been found which allows a 100% success rate and at the same time reduces the risks to a minimum. ⋯ Organising committees have established that this method will be the future direction. Perhaps even the prediction of Alon P. Winnie for ultrasound-guided local anaesthesia will become true: "Sooner or later someone will make a sufficiently close examination of the anatomy involved, so that exact techniques will be developed."
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Review Case Reports
[Current aspects of the diagnosis of malignant hyperthermia].
The aim of this work was to give a survey of experiences and results obtained over a period of 15 years of diagnosis of malignant hyperthermia in the MH centre in Leipzig. The new branch of MH diagnosis, the molecular genetics and its general diagnostic potential will be presented in more detail. ⋯ The disposition to MH may be assessed by the IVCT, DNA analysis and with limitations by the clinical phenotype. The IVCT represents a highly specific method, the DNA analysis appears to be very specific. Under defined conditions an alternative use of the methods is possible. However, these methods should not be regarded as in competition but rather their potential should be complementary or used in specific situations in order to avoid non-detection of MH events in affected families.