Anesthesia and analgesia
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Anesthesia and analgesia · Oct 2007
Comparative StudyTemporal artery versus bladder thermometry during perioperative and intensive care unit monitoring.
Core temperature measurements are an important component of perioperative patient monitoring. It is fairly easy to obtain core temperature measurements invasively in anesthetized patients. However, such measurements are more difficult to obtain noninvasively in awake patients. Recently, a new version of a temporal artery thermometer for noninvasive core temperature measurements (TemporalScanner TAT-5000) was introduced with accuracy and precision advertised as being comparable to invasive core temperature measurements. In this study, we sought to determine if this new thermometer is an acceptable substitute for invasive bladder temperature measurement. ⋯ The results of this study do not support the use of temporal artery thermometry for perioperative core temperature monitoring; the temporal artery thermometer does not provide information that is an adequate substitute for core temperature measurement by a bladder thermometer.
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Anesthesia and analgesia · Oct 2007
Case ReportsSuccessful intravenous regional block with low-dose tumor necrosis factor-alpha antibody infliximab for treatment of complex regional pain syndrome 1.
Cytokines, particularly tumor necrosis factor-alpha, may play an important role in the mediation of mechanical hyperalgesia and autonomic signs in complex regional pain syndrome 1. We performed an IV regional block with low-dose administration of the tumor necrosis factor-alpha antibody, infliximab, in a patient with typical clinical signs of complex regional pain syndrome 1 (moderate pain, edema, hyperhidrosis, elevated skin temperature compared with the contralateral side). ⋯ Almost complete remission was reached within 8 wk, but sensory signs improved only after 6 mo. No adverse events were observed.
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Anesthesia and analgesia · Oct 2007
Isoflurane bidirectionally modulates the paired-pulse responses in the rat hippocampal CA1 field in vivo.
We studied the effects of isoflurane on hippocampal synaptic transmission and paired-pulse plasticity, under in vivo intact interneuron circuitry. ⋯ Isoflurane appeared to affect multiple sites of CA1 synapses: 1) the depression of presynaptic glutamatergic transmission as shown by depressed EPSP and increased PPF; 2) the depression of pyramidal neurons as shown by prolonged PPF and depressed PSA under high concentration; and 3) the depression of interneurons as shown by the greater synaptic efficacy. The degree of each of these inhibitory effects seemed to vary at different concentrations, and the overall direction of the synaptic properties may depend on the balances between these inhibitory effects in vivo.
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Anesthesia and analgesia · Oct 2007
Parameters derived from the pulmonary pressure volume curve, but not the pressure time curve, indicate recruitment in experimental lung injury.
In acute lung injury, ventilation avoiding tidal hyperinflation and tidal recruitment has been proposed to prevent ventilator-associated lung injury. Information about dynamic recruitment may be obtained from the characteristics of pressure-volume (PV) curves or the profile of pressure-time (Paw-t) curves. ⋯ Parameters derived from the PV curve may help in characterizing the lung aeration of the lung and in indicating recruitment. In the presence of lung-protective ventilator settings, the stress index derived from the Paw-t curve was not able to indicate recruitment.
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Anesthesia and analgesia · Oct 2007
Investigating the failure to aspirate subglottic secretions with the Evac endotracheal tube.
Aspiration of subglottic secretions is a widely used intervention for prevention of ventilator-associated pneumonia. However, using the Hi-Lo Evac endotracheal tube (Hi-Lo Evac; Mallinckrodt; Athlone, Ireland) (Evac ETT), dysfunction of the suction lumen and subsequent failure to aspirate the subglottic secretions are common. Our objective in this study was to determine the causes of suction lumen dysfunction experienced with the Evac ETT. ⋯ Evacuation of subglottic secretions using the Evac ETT is often ineffective due to prolapse of tracheal mucosa into the subglottic suction port.