British journal of anaesthesia
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Comparative Study
Enhanced antinociceptive efficacy of epidural compared with i.v. methadone in a rat model of thermal nociception.
The properties of methadone suggest a potential advantage for epidural over i.v. administration for pain relief, but little supportive evidence exists. ⋯ Epidural administration of methadone in rats resulted in systemic exposure similar to that after i.v. administration, but improved thermal antinociceptive efficacy, and reduced supraspinal undesired effects. The findings suggest the presence of local effect at the spinal cord level, in addition to the systemic effect produced by epidural methadone.
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Superimposed high-frequency jet ventilation (SHFJV) has proved to be safe and effective in clinical practice. However, it is unclear which frequency range optimizes ventilation and gas exchange. The aim of this study was to systematically compare high-frequency jet ventilation (HFJV) with HFJV by assessing chest wall volume variations (ΔEEV(CW)) and gas exchange in relation to variable high frequency. ⋯ In a porcine model, SHFJV was more effective in increasing end-expiratory volume than single-frequency HFJV, but both modes may provide adequate ventilation in the absence of airway obstruction and respiratory disease, except for HFJV at frequencies ≥300 min(-1).
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Resistance to non-depolarizing neuromuscular blocking agents induced by sepsis is associated with the qualitative change in the nicotinic acetylcholine receptor (nAChR). This study aims to investigate the effects of sepsis on the neuromuscular block properties of vecuronium in relation to the expression of fetal and neuronal α7 type nAChR. ⋯ Pharmacodynamic changes with vecuronium seem to be associated with the expression of γ- and α7-nAChR in the skeletal muscle. Ulinastatin can improve this effect by inhibiting the expression of these receptors.
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The association between preoperative blood glucose (BG) concentration and outcomes after non-cardiac surgery and the impact of the diabetes diagnosis status remain unclear. We tested two hypotheses: that preoperative BG is related to surgical outcomes; and that this relationship depends on the diabetes diagnosis status of the patient. ⋯ For elective non-cardiac surgery, preoperative hyperglycaemia should be given greater consideration in patients without diabetes than in those with diagnosed diabetes.
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We determined the minimal alveolar concentration (MAC) of sevoflurane inducing an isoelectric EEG in 50% of adult subjects (MACie). ⋯ MACie for sevoflurane was ∼2.1 times MAC for immobilization in phenobarbital premedicated middle-aged adults. Sevoflurane-induced isoelectric EEG state is associated with significant cardiovascular depression but reduced haemodynamic responses to skin incision.