Anesthesia and analgesia
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Anesthesia and analgesia · Oct 2004
Comparative Study Clinical TrialA comparison among portal lactate, intramucosal sigmoid Ph, and deltaCO2 (PaCO2 - regional Pco2) as indices of complications in patients undergoing abdominal aortic aneurysm surgery.
Our aim in this observational, prospective, noncontrolled study was to detect, in 29 patients who underwent abdominal aortic aneurysm (AAA) surgery, correlations between the incidence of postoperative organ failure and intraoperative changes in arterial and portal blood lactate; changes in intramucosal sigmoid pH (pHi); differences between sigmoid Pco(2) and arterial Pco(2) (DeltaCO(2)); and hemoglobin (Hb). Hb, arterial blood lactate concentrations, pHi, and DeltaCO(2) (air tonometry) were recorded at the start of anesthesia (T0), before aorta clamping (T1), 30 minutes after clamping (T2), and at the end of surgery (T3). Portal venous lactate concentrations were recorded at T1 and T2. ⋯ The comparison of the receiving operator characteristic curves to test the discrimination of each variable and the logistic regression analysis revealed that the increase in portal lactate was the best predictor for the development of postoperative organ failure. Hb concentration was significantly smaller in group B at T0 (13.8 +/- 1.0 g/dL versus 12.2 +/- 2.2 g/dL) and T2 (10.9 +/- 1.2 g/dL versus 9.1 +/- 1.9 g/dL). In conclusion, both pHi and DeltaCO(2) are reasonably sensitive prognostic indices of organ failures after AAA surgery, but they are less specific and accurate than portal venous lactate.
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Anesthesia and analgesia · Oct 2004
Case ReportsRapid development of severe interstitial pneumonia caused by epoprostenol in a patient with primary pulmonary hypertension.
A young woman with primary pulmonary hypertension developed severe interstitial pneumonia (IP) 5 days after induction of epoprostenol infusion. Although the pathogen involved was not identified, her IP was initially responsive to steroids, and discontinuation of steroid therapy caused the redevelopment of IP. ⋯ Epoprostenol infusion can cause a rapid severe IP, even soon after the induction of therapy. Clinicians should keep this syndrome in mind, especially when treating a severe case of IP.
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Anesthesia and analgesia · Oct 2004
Case ReportsIatrogenic hyperthermia during cardiac magnetic resonance imaging.
We report the occurrence of accidental hyperthermia in a young child undergoing anesthesia for cardiac magnetic resonance imaging. Although the tendency during anesthesia is to develop hypothermia, the absorbed radiofrequency energy from magnetic resonance scanning is added to metabolic energy and must be balanced by appropriate heat loss to maintain normothermia. In addition to stressing the clinical importance of temperature monitoring, this report suggests that the recommended specific absorption rates to prevent excessive patient heating may need to be revised for infants and young children.
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Anesthesia and analgesia · Oct 2004
Faculty and finances of United States anesthesiology training programs: 2002-2003.
Between February, 2000 and August, 2002 three surveys have been submitted to the program directors of the anesthesiology training programs in the United States (U. S.) to assess the departments' needs for faculty and financial support from their institutions. In this article we present the results of a fourth follow-up survey. ⋯ Open faculty positions in U. S. training programs have remained fairly constant at 8% to 10% from 2000 to 2003. Institutional support for training departments has more than doubled since 2000, reaching approximately 85,000 dollars/faculty in 2003.
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Anesthesia and analgesia · Oct 2004
Bradykinin antagonists have no analgesic effect on incisional pain.
Bradykinin, an endogenous nonapeptide and an important mediator of inflammation, is also implicated in the initiation and maintenance of pain. Both des-Arg(8), Leu(8)-bradykinin (dALBK) and HOE-140, the prototypic bradykinin B1 and B2 receptor antagonists, respectively, have been shown to reduce pain behaviors and inflammation in animal models of persistent nociception. We studied them for activity against incision-induced pain behaviors in a rat model for postoperative pain. ⋯ None of the doses of either dALBK or HOE-140 affected the responses to punctate or blunt mechanical stimulation or heat, either as a pretreatment or as a posttreatment. These data support the unique mechanisms for incision-induced pain relative to inflammation-related pain. Although inflammation may represent a component of incisional pain, the etiology of inflammation and its role seem different than in other models.