Anesthesiology
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Randomized Controlled Trial Multicenter Study
Avoidance of nitrous oxide for patients undergoing major surgery: a randomized controlled trial.
Nitrous oxide is widely used in anesthesia, often administered at an inspired concentration around 70%. Although nitrous oxide interferes with vitamin B12, folate metabolism, and deoxyribonucleic acid synthesis and prevents the use of high inspired oxygen concentrations, the consequences of these effects are unclear. ⋯ Avoidance of nitrous oxide and the concomitant increase in inspired oxygen concentration decreases the incidence of complications after major surgery, but does not significantly affect the duration of hospital stay. The routine use of nitrous oxide in patients undergoing major surgery should be questioned.
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Current evidence indicates that p38 mitogen-activated protein kinase activation in spinal microglia contributes to the development of neuropathic pain. However, how nerve injury activates p38 in spinal microglia is incompletely unknown. Nerve injury-induced ectopic spontaneous activity is essential for the generation of neuropathic pain. The authors examined whether peripheral neural activity is necessary for p38 activation in spinal microglia. ⋯ After nerve injury, activity in the peripheral nerve is required for the induction but not the maintenance of p38 activation in spinal microglia.
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To eliminate the influence of hydrostatic pressure, proper transducer positions for central venous pressure and pulmonary artery wedge pressure are at the uppermost blood levels of right atrium (RA) and left atrium (LA). This study was performed to investigate accurate reference levels of central venous pressure and pulmonary artery wedge pressure in the supine position. ⋯ In the supine position, a central venous pressure transducer should be positioned approximately 4.6 cm higher than a pulmonary artery wedge pressure transducer. The external reference level for central venous pressure seems to be at approximately four fifths of the AP diameter of the thorax from the back, and that for pulmonary artery wedge pressure seems to be at approximately three fifths of the AP diameter.
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Transesophageal echocardiography has become an invaluable investigation in patients with cardioembolic events because of its high sensitivity and specificity for defining detailed structure and function of the cardiovascular system. Patients who receive anesthesia and critical care may be at risk of systemic embolism from various cardiovascular sources. ⋯ In this review article, the authors describe how transesophageal echocardiography may be used to identify various cardiovascular sources of embolism, provide risk stratification, influence medical therapy, and refine clinical decision making in patients receiving critical care and anesthesia. With these improvements, it is hoped that better patient outcomes may be achieved in the perioperative period.
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Randomized Controlled Trial Multicenter Study
Skin reactions to intradermal neuromuscular blocking agent injections: a randomized multicenter trial in healthy volunteers.
Numerous reports confirm the performance of intradermal tests for the diagnosis of anaphylaxis during anesthesia; however, there is controversy over their diagnostic value regarding the newer neuromuscular blocking agents (NMBAs). ⋯ The aminosteroidal NMBAs pancuronium, vecuronium, and rocuronium and the benzylisoquinoline cisatracurium have a similar potency to induce a nonspecific skin reactivity. If the criteria for positivity and the maximal concentrations of the commercially available compounds recommended by French practice guidelines are used, the risk of false-positive results is limited, and only minor modifications of these recommendations could be suggested. A slight reduction in the maximal concentration used for rocuronium from 1:100 to 1:200 and an increase from 1:1,000 to 1:200 for mivacurium can be proposed.