Anesthesiology
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Depression of myocardial contractility associated with the volatile anesthetics is well established clinically and experimentally. The molecular mechanisms underlying this effect, however, have not been completely characterized. Whereas the Ca2+ release channel of cardiac sarcoplasmic reticulum (SR) has been implicated as a potential target contributing to anesthetic-induced myocardial depression, the effect of the volatile anesthetics on this protein have not been characterized at the isolated, single-channel level. The authors sought to identify changes in channel gating and conductance resulting from exposure to halothane, enflurane, and isoflurane that would contribute to the associated negative inotropy, as well as to explain the observation that isoflurane causes less contractile depression than either halothane or enflurane. ⋯ Halothane and enflurane gate the Ca2+ release channel into the open state without altering the channel conductance. An increase in the duration of open events results from halothane and enflurane, but does not occur in the presence of isoflurane. Activation of the SR Ca2+ release channel would lead to loss of SR stores of Ca2+ into the cytoplasm, which is rapidly mobilized to the extracellular space. A net depletion of Ca2+ available for excitation-contraction coupling would result. The observation that isoflurane does not alter gating of this channel contributes to the understanding of the molecular mechanisms by which isoflurane depresses myocardial contractility less than halothane and enflurane.
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Randomized Controlled Trial Clinical Trial
Propofol causes a dose-dependent decrease in the thermoregulatory threshold for vasoconstriction but has little effect on sweating.
Volatile anesthetics increase the core temperature required to trigger sweating and decrease the core temperature required to trigger vasoconstriction. However, little is known about the effects of intravenous anesthetics on thermoregulation. We therefore tested the hypothesis that propofol increases the sweating threshold and decreases the vasoconstriction threshold, thereby increasing the inter-threshold range (core temperatures not triggering autonomic thermoregulatory responses). The study was conducted using a new model in which thermal manipulations were restricted to insensate skin, and sensate skin temperature was controlled. ⋯ Like volatile anesthetics, propofol reduces the vasoconstriction threshold and increases the inter-threshold range. However, propofol differs in leaving the sweating threshold unchanged.
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Randomized Controlled Trial Clinical Trial
Neuromuscular effects of rocuronium bromide and mivacurium chloride administered alone and in combination.
Rocuronium is a new nondepolarizing neuromuscular blocking agent with a rapid onset but with intermediate duration of action. Mivacurium, on the other hand, is a new short-acting nondepolarizing neuromuscular relaxant, but of slower onset of action. The current study was undertaken to characterize the interaction between rocuronium and mivacurium. ⋯ The interaction between rocuronium and mivacurium was found to be synergistic.
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Comparative Study
Echocardiographic and hemodynamic indexes of left ventricular preload in patients with normal and abnormal ventricular function.
Transesophageal echocardiography (TEE) is used to diagnose hypovolemia despite the lack of validation studies. The objective was to determine the effects of acute graded hypovolemia on TEE and conventional hemodynamic determinants of left ventricular (LV) preload in anesthetized patients with normal and abnormal LV function. ⋯ TEE and hemodynamic determinants of LV preload detected changes in LV function caused by acute blood loss. Acute blood loss caused directional changes in LV end-diastolic area, pulmonary artery occlusion pressure, and LV end-diastolic wall stress even in patients with LV wall motion abnormalities. Changes in LV end-diastolic wall stress, derived from both TEE and hemodynamic measurements corresponded to changes in cardiac output, stroke volume, and mixed venous oxygen saturation that occurred during acute blood loss.