Anesthesia and analgesia
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Anesthesia and analgesia · Oct 2004
Case ReportsThe diagnosis and treatment of a patient with puerperal infection and subdural hygromas.
We describe a patient readmitted after developing a persistent postural headache resulting from an accidental lumbar puncture during labor 10 days earlier. Magnetic resonance imaging demonstrated bifrontal subdural hygromas and diffuse pachymeningeal enhancement. The patient had signs of a puerperal infection, and an epidural patch was performed with dextran 40 instead of blood, after which gradual improvement was noted. The patient was discharged totally asymptomatic 3 days later.
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Anesthesia and analgesia · Oct 2004
Reduced sensitivity to ketamine and pentobarbital in mice lacking the N-methyl-D-aspartate receptor GluRepsilon1 subunit.
Ketamine is an IV anesthetic with N-methyl-d-aspartate receptor (NMDAR)-blocking properties. However, it is still unclear whether ketamine's general anesthetic actions are mediated primarily via blockade of NMDAR. Functional NMDARs are composed by the assembly of a GluRzeta1 (NR1) subunit with GluRepsilon (GluRepsilon1-4; NR2A-D) subunits, which confer unique properties on native NMDARs. ⋯ Mutant mice were more resistant to ketamine than control mice. Unexpectedly, mutant mice were also more resistant to pentobarbital, which is thought not to interact with NMDAR at clinically relevant concentrations. Although these data in no way eliminate the possibility of the involvement of the NMDAR GluRepsilon1 subunit in mediation of ketamine anesthesia/hypnosis, they suggest the difficulties with interpretation of altered anesthetic sensitivity in knockout animal models.
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Anesthesia and analgesia · Oct 2004
The effects of remifentanil on endotracheal suctioning-induced increases in intracranial pressure in head-injured patients.
In patients with severe traumatic brain injury, bronchotracheal toilet may be accompanied by deleterious variations in intracranial pressure (ICP). To avoid these effects, IV opioids have been proposed. Twenty mechanically-ventilated patients received 3 ascending IV doses of remifentanil: dose 1 (1 microg/kg bolus, 0.25 microg/kg/min infusion); dose 2 (2 microg/kg bolus, 0.5 microg/kg/min infusion); and dose 3: (4 microg/kg bolus, 1 microg/kg/min infusion). ⋯ Suctioning resulted in coughing in 16, 15, and 5 patients receiving dose 1, 2, and 3, respectively. An increase in ICP, without change in V(MCA), corresponded to the reduction in MAP consistent with the preservation of autoregulation. Remifentanil used as a continuous infusion in head-injured patients is not an effective drug to block responses to suctioning.
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Anesthesia and analgesia · Oct 2004
Propofol and midazolam inhibit gastric emptying and gastrointestinal transit in mice.
We studied the effect of propofol and midazolam on gastric emptying and gastrointestinal transit in mice. Ten minutes after intraperitoneal injection of propofol or midazolam, 0.2 mL of saline containing fluorescent microbeads was infused into the stomach. ⋯ Midazolam, but not propofol, delayed gastrointestinal transit (P < 0.001). At a larger dose that produced a deeper level of sedation (absence of righting reflex >10 s), both drugs significantly inhibited gastric emptying (propofol: P < 0.001; 95% CI for difference, 31.4%-61.2%; midazolam: P < 0.001; 95% CI for difference, 30.8%-61.1%) and gastrointestinal transit (P < 0.001 for both drugs).
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Anesthesia and analgesia · Oct 2004
Comment Letter Case ReportsPersistent cerebrospinal fluid leak.