Anesthesiology
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Biography Historical Article
Zeljko J. Bosnjak, Ph.D., recipient of the 2008 Excellence in Research Award.
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Application of radiofrequency currents to the dorsal root ganglia, in the treatment of various pain syndromes, has been clinically practiced for more than 30 yr. The clinical efficacy and the safety of this technique, however, remain poorly understood. The authors reviewed the literature on this modality of pain relief to determine its clinical efficacy, safety, and mechanisms of action. ⋯ Five randomized controlled trials evaluated their clinical use; these trials were relatively short-termed and small in size, and their results were variable. The mechanism of action of these techniques was unclear. Larger controlled clinical trials evaluating the long-term effects of these techniques and basic science research to determine their precise mode of action are needed.
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Randomized Controlled Trial Clinical Trial
Motor and somatosensory evoked potentials are well maintained in patients given dexmedetomidine during spine surgery.
Many commonly used anesthetic agents produce a dose-dependent amplitude reduction and latency prolongation of evoked responses, which may impair diagnosis of intraoperative spinal cord injury. Dexmedetomidine is increasingly used as an adjunct for general anesthesia. Therefore, the authors tested the hypothesis that dexmedetomidine does not have a clinically important effect on somatosensory and transcranial motor evoked responses. ⋯ Use of dexmedetomidine as an anesthetic adjunct at target plasma concentrations up to 0.6 ng/ml does not change somatosensory or motor evoked potential responses during complex spine surgery by any clinically significant amount.
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Malignant hyperthermia (MH) is a hypermetabolic condition caused by a genetic disposition leading to increased Ca release from the sarcoplasmic reticulum after exposure to triggering agents. In the authors' ongoing evaluation of patients undergoing MH testing in Austria, they detected a family with a new variant of the ryanodine receptor 1. Guidelines suggest that genetic tests are possible only for individuals from families in which the mutations are known. The aim of this study was to provide functional data that establish a potential link between this new variant and susceptibility to MH, and thus enable application in genetic tests. ⋯ These data document a role of the new W3985R variant in MH susceptibility.