Anesthesia and analgesia
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Anesthesia and analgesia · Jun 2005
Clinical TrialThe effect of high thoracic epidural anesthesia on systolic and diastolic left ventricular function in patients with coronary artery disease.
In patients with coronary artery disease, vasoconstriction is induced through activation of the sympathetic nervous system. Both alpha1- and alpha2-adrenergic epicardial and microvascular constriction are potent initiators of myocardial ischemia. Attenuation of ischemia has been observed when sympathetic nervous system activity is inhibited by high thoracic epidural anesthesia (HTEA). ⋯ HTEA induced a significant improvement in diastolic LV function (e.g., Vp changed from 45.1 +/- 16.1 to 53.8 +/- 18.8 cm/s; P < 0.001), whereas indices of systolic function did not change. The change in the diastolic characteristics caused the MPI to improve from 0.51 +/- 0.13 to 0.35 +/- 0.13 (P < 0.001). We conclude that an improvement in cardiac function was due to improved diastolic characteristics.
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Anesthesia and analgesia · Jun 2005
Can the Iowa Satisfaction with Anesthesia Scale be used to measure patient satisfaction with cataract care under topical local anesthesia and monitored sedation at a community hospital?
Patient satisfaction ratings provide a means to evaluate and monitor quality of health care. We tested the ability of the Iowa Satisfaction with Anesthesia Scale (ISAS) to measure satisfaction with cataract care under topical local anesthesia and monitored sedation given by an anesthesiologist at a community hospital. Three hundred six patients were administered the ISAS along with alternate ratings of quality of care and patient satisfaction. ⋯ The ISAS demonstrated reasonable reliability (Cronbach's alpha = 0.68; test-retest = 0.48-0.67). The ISAS had excellent construct validity; ISAS scores were lower in patients who gave lower ratings of quality (4.98 versus 5.64), who had lower satisfaction visual analog scale scores (5.12 versus 5.65), who wanted changes in their care (4.76 versus 5.67), who had suggestions to improve care (5.08 versus 5.63), or who preferred more sedation (4.85 versus 5.66) (P < 0.0001). Our results indicate that the ISAS questionnaire is a feasible, reliable, and valid tool to measure patient satisfaction in patients undergoing cataract surgery under topical anesthesia and monitored sedation.
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Anesthesia and analgesia · Jun 2005
Comparative StudyThe electrical properties of epidural catheters: what are the requirements for nerve stimulation guidance?
We designed the present study to investigate the electrical resistance of commercially available epidural catheters and to search for products and procedures suitable for nerve stimulation-guided insertion. Four types of epidural catheters were evaluated: 2 nonwire-reinforced catheters (19-gauge and 20-gauge nylon) and 2 wire-reinforced catheters (19-gauge without stylet and 20-gauge with stylet). The resistance of a catheter was calculated from the voltage level proportional to the fixed resistance in series circuit. ⋯ When catheters were primed with 10% hypertonic saline, the resistance of both nonreinforced catheters decreased by one third compared with physiologic saline. The electrical resistance of the saline-filled epidural catheters significantly differed among products tested. We conclude that epidural catheterization that is guided by electrical stimulation should be performed only with catheters equipped with spiral stainless steel wire reinforcement or with a stainless steel stylet.
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Anesthesia and analgesia · Jun 2005
Case ReportsImprovement of motor-evoked potentials by ketamine and spatial facilitation during spinal surgery in a young child.
Monitoring motor evoked potentials is desirable during spine surgery but may be difficult to obtain in small children. In addition, the recording of reliable signals is often hampered by the presence of various anesthetics. We report the case of a young child whose motor evoked potentials were successfully monitored using a ketamine-based anesthesia and a newly introduced stimulation technique consisting of combined spatial and temporal facilitation.
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Anesthesia and analgesia · Jun 2005
Ketamine stereoselectively inhibits spontaneous Ca2+-oscillations in cultured hippocampal neurons.
Spontaneous Ca2+-oscillations are a result of periodic increases and decreases of cytosolic Ca2+. In neurons, they are thought to possess integrative properties because amplitude and frequency influence axon outgrowth, neuronal growth cone migration, and long distant wiring within the developing cortex. Ketamine stereoisomers differ in their affinities for the N-methyl-D-aspartic acid receptor and analgesic and anesthetic effects. ⋯ The ketamine stereoisomers dose-dependently and reversibly suppressed the amplitude and frequency of the spontaneous Ca2+-oscillations. This effect was highly stereoselective with the S+ isomer being nearly four times more potent than the R(-) enantiomer. These results correlate well with the clinical anesthetic and analgesic potency of the stereoisomers and therefore our experimental approach might represent a model system to study mechanisms of anesthetic action on Ca2+-dependent integration of neuronal information.