Anesthesia and analgesia
-
Anesthesia and analgesia · Apr 2004
The antiinflammatory effects of ketamine in endotoxemic rats during moderate and mild hypothermia.
Endotoxemia is a common problem among critically-ill patients. We previously found that ketamine inhibited hypotension, metabolic acidosis, and increase of plasma cytokines during endotoxemia in rats. Although endotoxic patients often develop hypothermia, it has not been determined whether ketamine retains its antiinflammatory effects during hypothermia. We investigated the effects of ketamine on endotoxemic rats subjected to moderate and mild hypothermia. Male Wistar rats (n = 100) were anesthetized intraperitoneally with pentobarbital sodium and assigned to one of two protocols: one representing moderate hypothermia (30 degrees C-32 degrees C) and the other, mild hypothermia (33 degrees C-35 degrees C). Each protocol included 5 equal groups: 1). Escherichia coli endotoxin (15 mg/kg IV) in normothermia, 2). ketamine (10 mg x kg(-1) x h(-1) IV) during and after endotoxin injection in normothermia, 3). saline in hypothermia, 4). endotoxin (15 mg/kg IV) in hypothermia, and 5) ketamine (10 mg x kg(-1) x h(-1) IV) in hypothermia after endotoxin injection. Rats were then warmed or cooled to maintain rectal temperatures as above for 6 h. We assessed hemodynamics, acid-base status, and plasma concentrations of tumor necrosis factor-alpha, and interleukin-6. Endotoxemic rats developed hypotension and metabolic acidosis as well as increased plasma cytokine concentrations. At 6 h after endotoxin injection, the mean systolic arterial blood pressure decreased by 71% in the saline/normothermia/endotoxin group, whereas it decreased by only 6%, 41%, and 29% in the ketamine/normothermia/endotoxin, saline/moderate hypothermia/endotoxin, and ketamine/moderate hypothermia/endotoxin groups, respectively. Ketamine administration to endotoxemic rats with hypothermia, whether moderate or mild, also attenuated hypotension, metabolic acidosis, and cytokine increase, but these effects were not superior to those of hypothermia alone. Our findings suggest that, during hypothermia, ketamine administration may not have additive beneficial antiinflammatory effects. ⋯ Although ketamine administration decreased the severity of hypotension and acidosis in endotoxemic rats, ketamine administration may not have additive beneficial antiinflammatory effects during hypothermia.
-
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.
-
Anesthesia and analgesia · Apr 2004
Case ReportsAn epidural hematoma in an adolescent patient after cardiac surgery.
An 18-yr-old patient had a thoracic epidural placed under general anesthesia preceding an uneventful aortic valve replacement with a bioprosthetic valve. On the second postoperative day, he was anticoagulated and also received an antithrombotic medication. While ambulating, he experienced pain in his back, and there was blood in his epidural catheter. The catheter was removed, and he developed motor and sensory loss. Rapid surgical decompression resulted in recovery of his lost neurological function. Management and strategies for preventing this problem are discussed. ⋯ Epidural hematoma is a rare complication of epidural anesthesia and has not been reported in pediatric patients undergoing cardiac surgery. The successful treatment of this complication requires swift recognition, diagnosis, and surgical intervention.
-
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.
-
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.