Anesthesia and analgesia
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Anesthesia and analgesia · Nov 2007
Comparative StudyRadiologic assessment of potential sites for needle decompression of a tension pneumothorax.
The recommended treatment of suspected tension pneumothorax is immediate needle decompression. Recommended sites and needle sizes for this procedure vary, and there are published reports of failed decompression as well as iatrogenic hemothorax. We investigated the optimal needle length and relative safety of three potential needle decompression sites. ⋯ Needle decompression of suspected tension pneumothorax should be attempted in the MHL at the level of the sternal angle using a needle at least 7 cm long inserted perpendicular to the horizontal plane. This approach should yield the highest success rate and margin of safety compared with other sites.
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Anesthesia and analgesia · Nov 2007
Comparative StudyMyocardial protection by isoflurane preconditioning preserves Ca2+ cycling proteins independent of sarcolemmal and mitochondrial KATP channels.
Anesthetic preconditioning (APC) with volatile anesthetics improves recovery of contractile function and reduces calcium overload after ischemia/reperfusion (I/R). Mitochondrial and sarcolemmal K(ATP) channel openings have been implicated in APC-induced cardioprotection. In this study, we investigated the effect of APC on major calcium cycling proteins and its relation to K(ATP) channels. ⋯ I/R-induced depression in cardiac performance is associated with a down-regulation of the major sarcoplasmic reticulum Ca2+-cycling proteins. Anesthesia preconditioning with isoflurane prevents I/R-related degradation of the RyR2 and SERCA2a in the sarcoplasmic reticulum. However, this effect was independent of its activation of K(ATP) channels.
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Anesthesia and analgesia · Nov 2007
Comparative StudyGlobal end-diastolic volume during different loading conditions in a pediatric animal model.
Estimating volume status in infants and neonates is challenging. Global end-diastolic volume (GEDV) and dynamic variables of preload, such as pulse pressure variation (PPV), may be alternative variables for estimating cardiac preload and fluid responsiveness. Therefore, we designed the present study to evaluate whether GEDV and PPV are suitable variables of preload and fluid responsiveness during rapidly changing loading conditions in a pediatric animal model. ⋯ In this pediatric animal model, GEDV derived from transpulmonary thermodilution was a reliable indicator of cardiac preload. Moreover, GEDV but not PPV, central venous pressure and pulmonary capillary wedge pressure accurately reflected fluid responsiveness.
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Anesthesia and analgesia · Nov 2007
Case ReportsAccidental intraneural injection into the musculocutaneous nerve visualized with ultrasound.
Ultrasound has become a widely used tool within the practice of regional anesthesia, offering real-time visualization of the nerves, needle, and local anesthetic during performance of a block. A successful ultrasound-guided axillary block was performed on a healthy adult male undergoing wrist surgery. ⋯ The patient had an effective block and suffered no adverse neurological effects. Recording and reviewing ultrasound images of a regional block can be important for documentation and educational purposes.