Anesthesia and analgesia
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Anesthesia and analgesia · Apr 2005
Randomized Controlled Trial Clinical TrialNon-zero basal oxygen flow a hazard to anesthesia breathing circuit leak test.
The non-zero basal flow (BF) of oxygen in anesthesia machines has been set to supply the basal metabolic requirement of oxygen. However, there is no scientific evidence of its necessity. In this study we sought to clarify whether non-zero BF affects leak detection during preanesthetic inspections. ⋯ The leak detection rate of leak test with BF was less than without BF (P < 0.01). We demonstrated that non-zero BF of oxygen decreases the leak detection rate and is an obstacle for leak detection, especially for small leaks. Therefore, we recommend that breathing circuit leak tests should be performed in the absence of BF of oxygen.
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Anesthesia and analgesia · Apr 2005
RGS proteins: new players in the field of opioid signaling and tolerance mechanisms.
In this article we review recent advances in our understanding of the crucial role of the Regulator of G protein Signaling (RGS) proteins in opioid signaling mechanisms and opioid tolerance development. Opioids exert their physiologic effects via complex G protein-coupled receptor-signaling mechanisms, and RGS proteins are now known to tightly regulate the G protein signaling cycle. ⋯ There have been more than 20 RGS proteins reported in the literature, and multiple RGS proteins have been shown to negatively regulate G protein-mediated opioid signaling, facilitate opioid receptor desensitization and internalization, and affect the rate at which opioid tolerance develops. Using RGS proteins as targets for future drug therapy aimed at modulating opioid effectiveness in both acute and chronic pain settings may be an important advance in the treatment of pain.
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Anesthesia and analgesia · Apr 2005
Case Reports Comparative StudyA comparison of bispectral index and entropy, or how to misinterpret both.
Consciousness monitoring has become increasingly popular in general anesthesia cases, and a new technology has recently been introduced with potential advantages over the other available products. In this case report, we discuss a patient who was monitored simultaneously with Bispectral Index and Entropy and evaluate the differences between the two. More importantly, we emphasize the importance of vigilance when using new technologies and discuss the potential impact of lack of vigilance on patient outcome.
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Anesthesia and analgesia · Apr 2005
The effect of mild hypothermia on plasma fentanyl concentration and biotransformation in juvenile pigs.
Therapeutic hypothermia may alter the required dosage of analgesics and sedatives, but no data are available on the effects of mild hypothermia on plasma fentanyl concentration during continuous, long-term administration. We therefore assessed in a porcine model the effect of prolonged hypothermia on plasma fentanyl concentration during 33 h of continuous fentanyl administration. Seven female piglets (weight: 11.8 +/- 1.1 kg) were anesthetized by IV fentanyl (15 microg . kg(-1) . h(-1)) and midazolam (1.0 mg . kg(-1) . h(-1)). ⋯ A strong temperature dependency of CYP3A4 was found (P < 0.01). Mild hypothermia induced a distribution and/or elimination-dependent increase in plasma fentanyl concentration which remained increased for several hours after rewarming. Consequently, a prolonged increase of the plasma fentanyl concentration should be anticipated for appropriate control of the analgesia/sedatives during and early after therapeutic hypothermia.
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Anesthesia and analgesia · Apr 2005
Guillain-Barré syndrome in a patient with pancreatic cancer after an epidural-general anesthetic.
Guillain-Barre syndrome is a rare occurrence in medicine and is probably rarer still as a postoperative complication. We report an uneventful operative course, during epidural-general anesthesia, in a patient undergoing pancreatectomy who presented with acute paralysis mimicking an acute cervical spinal cord syndrome or brachial plexus neuropathy. The signs and symptoms of right upper extremity paralysis occurred within 2 h postoperatively. Immediate work-up, which included magnetic resonance imaging, electromyography, and nerve conduction velocity studies, provided the diagnosis.