Anesthesia and analgesia
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Anesthesia and analgesia · Apr 2004
Randomized Controlled Trial Clinical TrialModafinil improves recovery after general anesthesia.
Recovery from general anesthesia often involves residual sedation, drowsiness, fatigue, and lack of energy that may last hours to days. Modafinil is a wakefulness-promoting drug approved for patients with excessive daytime sleepiness associated with narcolepsy. We evaluated the effect of single doses of modafinil (200 mg) and placebo in patients recovering from general anesthesia. Thirty-four subjects participated in this prospective, randomized, double-blind study approved by our IRB. Preoperatively, patients were asked to rate various symptoms they had experienced over the previous 24-h using a verbal analog scale (VAS) of 0 to 10 as well as discrete scale when indicated. Postoperatively, once the patient was able to tolerate oral intake and met our institutional discharge criteria, the study drug (modafinil 200 mg or placebo) was administered with a sip of water. Patients were contacted 24 (1) hours after dosing to evaluate postdischarge symptoms. Patients in the placebo group reported significantly more postoperative fatigue (4.8 [3.3] versus 1.4 [1.8]), exhaustion (4.3 [3.3] versus 2.4 [3.1]), or degree of feeling worn out (4.7 [3.6] versus 2.9 [2.4]). Significantly more patients reported moderate to severe fatigue in the placebo group (65% versus 12%). Two major themes of "alertness" and "energy" were expressed by 71% of the patients receiving modafinil versus 18% of those receiving placebo. Patients recovering from general anesthesia can significantly benefit from modafinil. ⋯ Modafinil significantly reduces fatigue and improves feelings of alertness and energy in postoperative patients. Patients recovering from general anesthesia can significantly benefit from modafinil administration.
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Anesthesia and analgesia · Apr 2004
Randomized Controlled Trial Clinical TrialWarm steaming enhances the topical anesthetic effect of lidocaine.
Warm steaming has been used for hydrating the skin, thereby increasing its permeability. We studied whether skin pretreatment with a steamed towel (at 45 degrees C) for 5 min could enhance the anesthetic effect of a topical lidocaine tape in 14 female volunteers. After each volunteer received the skin pretreatment on one of the forearms, lidocaine tape was applied for 30 min on both the treated and the untreated forearms. Superficial anesthesia was scored by recording the number of painful experience during 5 pinpricks delivered with a 27-gauge needle. To assess anesthesia of the deeper layer, single insertion of a 27-gauge needle to a depth of 3 mm was made and pain was scored by a visual analog scale (VAS). There were significant reductions in the scores of superficial anesthesia (median [range]: treated arm, 2 [0-5], versus untreated arm, 4 [1-5]; P < 0.01) and the VAS scores of deeper insertion (median [range]: treated arm, 4.5 [0-8], versus untreated arm, 8 [2-10]; P < 0.01). In conclusion, the application of a warm steamed towel enhanced the anesthetic effect of a topical lidocaine tape. ⋯ We showed that the skin pretreatment with a steamed towel (at 45 degrees C) enhanced the anesthetic effect of a topical lidocaine tape in female volunteers.
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Postoperative nausea and vomiting are common after general anesthesia but rarely produce life-threatening conditions. We report a case of postoperative vomiting complicated by esophageal rupture (Boerhaave's syndrome). As this complication is quite rare and can have varied and atypical presentations, anesthesiologists may fail to consider this diagnosis. ⋯ We report a case of postoperative vomiting complicated by esophageal rupture (Boerhaave's syndrome). As this complication is quite rare, anesthesiologists may fail to consider this diagnosis.
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Anesthesia and analgesia · Apr 2004
Historical ArticleCardiac anesthesiology, professionalism and ethics: a microcosm of anesthesiology and medicine.
The granting of professional status to medicine by society at large entails obligations by physicians. Those physicians in the young subspecialty of cardiac anesthesiology have fulfilled these obligations by developing a body of scientific and clinical knowledge and the technical bases to increase survival and decrease morbidity of patients with heart disease undergoing either cardiac or noncardiac surgery. Furthermore, they have contributed effectively to the broad practice of medicine. However, a strong argument can be made that these contributions, though benefiting many individual patients, do not by themselves completely fulfill our obligations. The concept of Civic Professionalism states that our moral responsibilities as physicians must be expanded beyond our immediate patients. Physicians have the obligation to use their knowledge and influence to promote the common good. The Universal Declaration of Human Rights includes access to health care as a basic tenet. The present health care system of the United States excludes many people. Thus, cardiac anesthesiologists have a moral obligation to actively advocate for universal access to health care until it is achieved. Doing so will make the specialty of cardiac anesthesiology an example to the entire profession of medicine. ⋯ Cardiac anesthesiologists have contributed to enhanced survival and decreased morbidity of patients with heart disease undergoing surgery. These achievements do not by themselves fulfill the moral obligations incurred by the concept of Civic Professionalism, however. Cardiac anesthesiologists, in common with all physicians, must share the obligation to advocate for the human right of universal access to health care.
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Anesthesia and analgesia · Apr 2004
The effects of propofol on hypothalamic paraventricular nucleus neurons in the rat.
The mechanism of hypotension induced by anesthetics is not completely understood. Because no electrophysiologic examination of the effects of propofol on the central nervous system has shown its involvement in the control of sympathetic and cardiovascular functions, we investigated the actions of propofol on rat hypothalamic paraventricular nucleus (PVN) neurons using the whole-cell mode of the patch-clamp technique in rat hypothalamic PVN slice preparations. Propofol induced Cl(-) currents at concentrations of 10(-5) and 10(-4) M, which were sensitive to picrotoxin and, to a lesser extent, to strychnine. Propofol (10(-6) M) enhanced gamma-aminobutyric acid(A) (GABA(A); 10(-6) M)-induced current synergistically. Moreover, propofol (10(-5) and 10(-4) M) significantly increased the decay time of evoked-inhibitory postsynaptic currents, which suggests a postsynaptic modulation of GABA(A) receptors. In addition, propofol (10(-5), 10(-4), and 2 x 10(-4) M) reversibly inhibited voltage-gated Ca(2+) currents. Taken together, these results suggest that propofol enhancement of GABA(A)-receptor mediated currents and inhibition of voltage-gated Ca(2+) currents at the central level, which is involved in the control of cardiovascular and sympathetic functions may be, at least in part, involved in general anesthetic-induced cardiovascular and sympathetic depression. ⋯ We investigated the actions of propofol on the rat hypothalamic paraventricular nucleus neurons, which are involved in the control of cardiovascular and sympathetic functions. The results suggest that propofol enhancement of gamma-aminobutyric acid(A)-receptor mediated currents and inhibition of voltage-gated Ca(2+) currents at the central level may be, at least in part, involved in general anesthetic-induced cardiovascular and sympathetic depression.