Anesthesia and analgesia
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Anesthesia and analgesia · Oct 2002
Case ReportsThe breaking of an intrathecally-placed epidural catheter during extraction.
Misplacement of an epidural catheter into the subarachnoid space is a recognized complication. However, breakage of an intrathecal epidural catheter during removal presents a dilemma. Appropriate imaging, a neurosurgical consultation, and aggressive surgical exploration and extraction of the retained piece are warranted, even in the asymptomatic patient.
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Anesthesia and analgesia · Oct 2002
A retrospective analysis of the costs and benefits related to alterations in cardiac surgery from routine intraoperative transesophageal echocardiography.
We sought to determine how frequently intraoperative transesophageal echocardiography (TEE) altered the planned surgical procedure and to assess the potential cost implications associated with these changes. A retrospective chart review was conducted at one university hospital. Cardiac surgical operative notes from July 1999 through June 2000 were reviewed. We interrogated all adult cardiac surgical records for patients scheduled for repair of coronary artery disease or valvular disease requiring the use of cardiopulmonary bypass. Cancellations based on TEE findings were included in the analysis. Of the 430 patient records reviewed, 24 procedures were ether canceled or changed on the basis of the intraoperative TEE examination (5.6%; 95% confidence interval, 3.6%-8.2%). Six of these cases involved valvular heart disease, and the remaining 18 involved the intraoperative diagnosis and repair of a patent foramen ovale. A cost-benefit analysis based on the 6 valvular diagnoses revealed a saving of $230 per patient. Assuming that unnecessary present or future operations may be avoided by altering the surgical plan on the basis of TEE findings, these preliminary data suggest that routine intraoperative TEE in cardiac surgery is beneficial and cost-effective. ⋯ A review of 430 adult cardiac surgical records indicates that routine transesophageal echocardiography during cardiac surgery, including coronary artery surgery, is beneficial and cost-effective.
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Anesthesia and analgesia · Oct 2002
Comparative StudyThe effect of local anesthetics and amitriptyline on peroxidation in vivo in an inflammatory rat model: preliminary reports.
We studied the inhibition of peroxidation by local anesthetics in an inflammatory animal model. Inflammatory lipid peroxidation was assessed by the thiobarbituric assay in plasma from rats injected or not injected with carrageenan (Carra) and killed 1, 2, 4, 6, 12, and 24 h thereafter. Thiobarbituric acid reactive substances (TBARS) values in inflammatory animals were maximal 6 h after Carra administration. ⋯ We investigated the antioxidant effects of local anesthetics and amitriptyline in an inflammatory rat model. Amitriptyline exhibits antioxidant properties per se, whereas lidocaine and bupivacaine (plain or encapsulated) seem to inhibit the peroxidation process. This may have future application in limiting toxic oxygen metabolite production during the inflammatory process.
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Anesthesia and analgesia · Oct 2002
High thoracic epidural anesthesia for coronary artery bypass grafting using two different surgical approaches in conscious patients.
Recent developments in coronary artery bypass graft surgery (CABG) without cardiopulmonary bypass made the sole use of high thoracic epidural anesthesia (TEA) in conscious patients feasible. Previously, TEA has been reported only for single-vessel CABG via lateral thoracotomy. We investigated the feasibility and complications of sole TEA in 20 patients undergoing beating-heart arterial revascularization via partial lower sternotomy for single-vessel disease (minimally invasive direct coronary artery bypass grafting [MIDCAB] technique; n = 10) or complete median sternotomy for multivessel disease (off-pump coronary artery bypass grafting [OPCAB] technique; n = 10). ⋯ All patients rated TEA as "good" or "excellent." In conclusion, we demonstrated that the sole use of TEA for MIDCAB and OPCAB procedures was feasible and provided a high degree of patient satisfaction in our small and highly selected cohorts. IMPLICATIONS. The sole use of high thoracic epidural anesthesia was studied in 20 patients who underwent beating-heart coronary artery bypass grafting using either median or partial lower sternotomy while awake.
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Anesthesia and analgesia · Oct 2002
Comparative StudyThe actions of propofol on gamma-aminobutyric acid-A and glycine receptors in acutely dissociated spinal dorsal horn neurons of the rat.
The spinal cord plays an important role in modulating anesthetic-induced suppression of nociceptive transmission. To gain some insight into the anesthetic mechanisms of propofol at the spinal level, we investigated the direct action of propofol and its modulation on the gamma-aminobutyric acid-A receptor (GABA(A)R) and the glycine receptor (GlyR) in acutely dissociated rat spinal dorsal horn neurons by using whole-cell patch-clamp electrophysiology. Propofol induced Cl(-) currents (I(Cl)), which were sensitive to bicuculline and, to a lesser extent, to strychnine. The activation, desensitization, and deactivation of propofol-induced I(Cl) were slower than those of GABA- and glycine-induced I(Cl). In addition, this study revealed similar modulatory actions of propofol on GABA(A)R and GlyR. Propofol potentiated both GABA- and glycine-induced I(Cl) at small con-centrations and inhibited both GABA- and glycine-induced I(Cl) at large concentrations. The potentiation of propofol on I(Cl) was caused by slowing current desensitization and deactivation, whereas the inhibition actions might be involved in the cross-desensitization between GABA- and propofol-induced I(Cl) and the cross-inhibition between the GABA(A)R and GlyR. The results suggest that propofol facilitation of GABA(A)R and GlyR at the spinal level could contribute significantly to general anesthetic-induced analgesia and anesthesia. ⋯ The actions of propofol on the gamma-aminobutyric acid-A receptor (GABA(A)R) and the glycine receptor (GlyR) were investigated in acutely dissociated rat spinal dorsal horn neurons by using whole-cell patch-clamp electrophysiology. Propofol was found to potentiate the functions of GABA(A)R and GlyR at the spinal level, which might contribute to propofol-induced analgesia and anesthesia.