Anesthesia and analgesia
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Anesthesia and analgesia · Jan 2006
Comparative StudyThe effects of sevoflurane and propofol on QT interval and heterologously expressed human ether-a-go-go related gene currents in Xenopus oocytes.
Sevoflurane can induce prolongation of the cardiac QT interval by inhibiting the repolarization phase of the action potential. This may occur as a result of inhibition of the human ether-a-go-go related gene (HERG) channel. To clarify the mechanisms of anesthetics on HERG channels, we monitored the electrocardiogram and measured QT intervals in the guinea pig in the presence of sevoflurane and propofol. ⋯ The time constant of the converging current was decreased in the presence of sevoflurane, but the inactivation and activation curves were not shifted. Propofol did not affect these currents within the clinically relevant concentration. In conclusion, compared with steady-state currents, sevoflurane was more potent in inhibiting the outward tail currents, suggesting that sevoflurane may modulate the HERG channel kinetics in its inactivated state.
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Anesthesia and analgesia · Jan 2006
Case ReportsPartial sensory and motor deficit of ipsilateral lower limb after continuous interscalene brachial plexus block.
We describe a partial sensory and motor block of the ipsilateral lower limb after interscalene infusion. After and injection of 20 mL of ropivacaine through the needle, the catheter was advanced 5 cm, and an infusion of ropivacaine 0.2% 5 mL/h commenced. ⋯ We conclude that the neurological symptoms were caused by an injection of local anesthetic via an interscalene catheter placed in proximity to the epidural space. To avoid this complication, we recommend advancing the catheter no more than 2-3 cm and performing frequent neurological evaluation of patients.
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Anesthesia and analgesia · Jan 2006
Comparative StudyAccreditation Council for Graduate Medical Education competencies and the American Board of Anesthesiology Clinical Competence Committee: a comparison.
We compared the Accreditation Council for Graduate Medical Education (ACGME) Outcome Project to the long-standing requirement of the American Board of Anesthesiology for a Clinical Competence Committee Report. There are many similarities between these two systems of resident evaluation. ⋯ In addition, the Clinical Competence Committee Report is primarily a summative evaluation for the purpose of assigning credit for training. The ACGME Outcome Project may be used as a component of a summative evaluation, but the primary emphasis is on formative assessment.
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Anesthesia and analgesia · Jan 2006
Case ReportsFires in the operating room and intensive care unit: awareness is the key to prevention.
Recent recommendations from the Centers for Disease Control (CDC) to use alcohol-based substances for hand hygiene and skin antisepsis could introduce new fire hazards in the operating room (OR). This potential for an increase in the number of fires in the hospital setting with wide spread use of alcohol-based agents warrants heightened awareness of the risks and implementation of safety measures when using these agents. Here, we report a patient who, during a tracheostomy, sustained severe burns resulting from a fire in the OR. In this case, the use of an alcohol-based antiseptic was the major contributing factor to the surgical fire.
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Anesthesia and analgesia · Jan 2006
Randomized Controlled Trial Comparative StudyThe analgesic effect of tramadol after intravenous injection in healthy volunteers in relation to CYP2D6.
Tramadol analgesia results from a monoaminergic effect by tramadol itself and an opioid effect of its metabolite (+)-M1 formed by O-demethylation of tramadol by CYP2D6. In this study we sought to determine the impact of (+)-M1 on the analgesic effect of tramadol evaluated by experimental pain models. The effect of an IV injection of 100 mg tramadol on experimental pain was studied 15-90 min after dosing in volunteers, 10 extensive metabolizers with CYP2D6 and 10 poor metabolizers without CYP2D6 in 2 placebo-controlled trials. ⋯ In extensive metabolizers, tramadol reduced discomfort experienced during the cold pressor test (P = 0.002). In poor metabolizers, the pain tolerance thresholds to sural nerve stimulation were increased (P = 0.04). (+)-M1 could be detected in the serum samples from all extensive metabolizers except one, but (+)-M1 was below the limit of determination in all poor metabolizers. The opioid effect of (+)-M1 appears to contribute to the analgesic effect of tramadol, but the monoaminergic effect of tramadol itself seems to create an analgesic effect.