British journal of anaesthesia
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Randomized Controlled Trial
Autonomic nervous system state: the effect of general anaesthesia and bilateral tonsillectomy after unilateral infiltration of lidocaine.
Autonomic nervous system (ANS) sensitively responds to intraoperative stress. Several indices characterizing the state and responses of autonomic signs to nociceptive stimuli have been introduced. This study evaluated the behaviour of ANS descriptors after induction, before and during tracheal intubation, and during bilateral tonsillectomies after random and blinded unilateral infiltration of lidocaine 1% until emergence from anaesthesia. ⋯ HR, PPI, PPGA, ANSS, ANSSI, SPI, and RE-SE detect autonomic responses to nociceptive stimuli and differentiate between tonsillectomies on locally anaesthetized tonsils from controls.
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Local anaesthetic blocks of the greater occipital nerve (GON) are frequently performed in different types of headache, but no selective approaches exist. Our cadaver study compares the sonographic visibility of the nerve and the accuracy and specificity of ultrasound-guided injections at two different sites. ⋯ Our findings confirm that the GON can be visualized using ultrasound both at the level of the superior nuchal line and C2. This newly described approach superficial to the obliquus capitis inferior muscle has a higher success rate and should allow a more precise blockade of the nerve.
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Previous studies have indicated that protein kinase C (PKC) may enhance endothelial nitric oxide synthase (eNOS) activation, although the detailed mechanism(s) remains unclear. In this study, we investigated the roles of PKC isoforms in regulating propofol-induced eNOS activation in human umbilical vein endothelial cells (HUVECs). ⋯ Propofol induces the Ser(1177) phosphorylation-dependent eNOS activation through the drug-stimulated translocation of PKC isoforms to distinct intracellular sites in HUVECs, which is independent of PI3K/Akt-independent pathway.
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Hyperbaric prilocaine 2% is a medium long-acting spinal anaesthetic. There are few data on time to recovery and rate of urinary retention after spinal administration of hyperbaric prilocaine 2%. This prospective study was carried out to evaluate the time to spontaneous micturition, quantify the rate of necessary bladder catheterizations, and identify the risk factors for urinary retention after intrathecal prilocaine administration. ⋯ After spinal anaesthesia with hyperbaric prilocaine 2% (60 mg) for ambulatory lower limb surgery, 23% of patients required postoperative urinary catheterization. Postoperative bladder ultrasound and early catheterization are essential to avoid bladder distension and facilitate discharge in patients after intrathecal prilocaine 2% administration in ambulatory surgery.
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Context-sensitive times to 50%, 80%, and 90% elimination from the brain have been calculated for volatile anaesthetics. This does not represent complete recovery because there are important residual effects even at 90% elimination, and the effect of anaesthetic metabolism on the rate of elimination has not been considered. ⋯ Large amounts of anaesthetics are absorbed during anaesthesia and significant amounts remain in the body for days after apparent recovery.