Regional anesthesia and pain medicine
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Reg Anesth Pain Med · May 2005
ReviewTwo-pore domain potassium channels: new sites of local anesthetic action and toxicity.
Potassium (K+) channels form the largest family of ion channels with more than 70 such genes identified in the human genome. They are organized in 3 superfamilies according to their predicted membrane topology: (1) subunits with 6 membrane-spanning segments and 1-pore domain, (2) subunits with 2 membrane-spanning segments and 1-pore domain, and (3) subunits with 4 membrane-spanning segments and 2-pore domains arrayed in a tandem position. The last family has most recently been identified and comprises the so-called 2-pore domain potassium (K2P) channels, believed responsible for background or leak K+ currents. ⋯ K2P channels are widely expressed in the central nervous system and are involved in the control of the resting membrane potential and the firing pattern of excitable cells. This article will therefore review recent findings on actions of local anesthetics with respect to 2P channels. It begins with an overview of the role of background K+ channels in neuronal excitability and nerve conduction and is followed by a description of the K2P channel family including experimental evidence for the contribution of K2P channels to the mechanism of action and toxicity of local anesthetics.
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The number of regional anesthesia fellowships has grown over the past 2 decades. There currently exist no guidelines for what constitutes ideal regional anesthesia fellowship training. ⋯ The intent of these initial guidelines is to improve the quality and consistency of regional anesthesia fellowship training. The creation process also led to an affirmation of the directors' commitment to continued dialogue for the purpose of facilitating the exchange of ideas among programs.
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This case report describes the accidental placement of a lumbar labor epidural catheter into the subdural space resulting in the rapid onset of massive subdural anesthesia. ⋯ Massive subdural anesthesia is a complication of epidural catheter placement and may have a rapid onset causing a loss of consciousness, respiratory arrest, and absent pulses.
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Reg Anesth Pain Med · May 2005
Peripheral block of the hyperpolarization-activated cation current (Ih) reduces mechanical allodynia in animal models of postoperative and neuropathic pain.
Block of the hyperpolarization-activated inward current (I h) reduces excitability of peripheral axons during stimulation and decreases ectopic discharges in axotomized sensory neurons. Changes in I h expression in DRG neurons have been suggested to partially underlie sensitization after nerve injury and inflammation. We hypothesized that peripheral block of I h on axons would produce an antiallodynic effect in postoperative as well as neuropathic conditions, and we tested perineural administration of ZD 7288, a specific blocker of I h , on pain-associated behavior in animal models of neuropathic and postoperative pain. ⋯ The current study shows that peripheral block of I h produces an antiallodynic effect, which suggests that I h channels represent a novel target for nerve block treatment of postoperative and neuropathic pain.
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The education and subsequent careers of regional anesthesia fellows have not been examined but may provide insight into improving future fellowship training and/or the future of the subspecialty. ⋯ This report details how regional anesthesia fellows from 1983 to 2002 were trained and how they currently practice and examines their insights regarding the strengths and weaknesses of past and future regional anesthesia education.