Anesthesiology
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Complementary to a previous publication related to pediatric extremity and trunk blockade, the authors present a comprehensive narrative review of the literature pertaining to techniques described and outcomes evaluated for ultrasound imaging in pediatric neuraxial anesthesia. The sonoanatomy related to each block is also described and illustrated to serve as a foundation for better understanding the block techniques described. ⋯ Particularly, in young infants, direct visualization of the needle and catheter tip may be possible, whereas in older children surrogate markers including the displacement of dura mater by the injection of fluid may be necessary for confirming needle and catheter placement. More outcome-based, prospective, randomized, controlled trials are required to prove the benefits of ultrasound when compared with conventional methods.
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Review
Role of transient receptor potential and acid-sensing ion channels in peripheral inflammatory pain.
Pain originating in inflammation is the most common pathologic pain condition encountered by the anesthesiologist whether in the context of surgery, its aftermath, or in the practice of pain medicine. Inflammatory agents, released as components of the body's response to peripheral tissue damage or disease, are now known to be collectively capable of activating transient receptor potential vanilloid type 1, transient receptor potential vanilloid type 4, transient receptor potential ankyrin type 1, and acid-sensing ion channels, whereas individual agents may activate only certain of these ion channels. These ionotropic receptors serve many physiologic functions-as, indeed, do many of the inflammagens released in the inflammatory process. Here, we introduce the reader to the role of these ionotropic receptors in mediating peripheral pain in response to inflammation.
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Randomized Controlled Trial
Use of manometry for laryngeal mask airway reduces postoperative pharyngolaryngeal adverse events: a prospective, randomized trial.
Adverse events such as pharyngolaryngeal complications are indicators of quality patient care. Use of manometry to limit the laryngeal mask airway (LMA) intracuff pressure is not currently a routine practice. This double-blind randomized trial compared pharyngolaryngeal complications in patients managed with manometers to limit the LMA intracuff pressure (<44 mmHg) with patients under routine care. ⋯ Reduction of LMA intracuff pressure to less than 44 mmHg lowers the incidence of postoperative pharyngolaryngeal complications. The LMA cuff pressures should be measured routinely using manometry, and deflating the intracuff pressure to less than 44 mmHg should be recommended as anesthetic best practice.
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There is limited information on the regional inflammatory effects of mechanical ventilation and endotoxemia on the production of acute lung injury. Measurement of F-fluorodeoxyglucose (F-FDG) uptake with positron emission tomography allows for the regional, in vivo and noninvasive, assessment of neutrophilic inflammation. The authors tested whether mild endotoxemia combined with large tidal volume mechanical ventilation bounded by pressures within clinically acceptable limits could yield measurable and anatomically localized neutrophilic inflammation. ⋯ Mild short-term endotoxemia in the presence of heterogeneous lung aeration and mechanical ventilation with pressures within clinically acceptable limits produces marked spatially heterogeneous increases in pulmonary neutrophilic inflammation. The dependence of inflammation on aeration and perfusion suggests a multifactorial basis for that finding. F-FDG uptake may be a sensitive marker of pulmonary neutrophilic inflammation in the studied conditions.