Anesthesia and analgesia
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Anesthesia and analgesia · Jul 2007
Comparative StudyThe reliability of pulse contour-derived cardiac output during hemorrhage and after vasopressor administration.
Reliable measurement of cardiac output (CO) is important in the critically ill. Pulse contour-derived CO (PCCO) has been evaluated during stable hemodynamics, but is sensitive to changes in vascular tone and has not been validated under conditions of changing hemodynamics. Furthermore, PCCO requires calibration for the individual vascular impedance by transpulmonary thermodilution CO (TPCO), and the required frequency of recalibration to maintain accurate measurements, especially during changing conditions, has not been confirmed. We compared PCCO measurements of CO with TPCO and continuous and bolus pulmonary artery CO (CCO and BCO, respectively) during conditions of uncontrolled hemorrhage and resuscitation with norepinephrine. ⋯ PCCO needs frequent recalibration during hemorrhage and after vasopressor administration.
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Anesthesia and analgesia · Jul 2007
Comparative StudyAn observational study of surgeons' sequencing of cases and its impact on postanesthesia care unit and holding area staffing requirements at hospitals.
Staffing requirements in the operating room (OR) holding area and in the Phase I postanesthesia care unit (PACU) are influenced by the sequencing of each surgeon's list of cases in the same OR on the same day. ⋯ The uncoordinated decision-making of multiple surgeons working in different ORs can result in a sufficiently uniform rate of admission of patients into the PACU and holding that the independent sequencing of each surgeon's list of cases would not reduce the incidence of delays in admission or staffing requirements.
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Anesthesia and analgesia · Jul 2007
Comparative StudyThe mechanism behind the inhibitory effect of isoflurane on angiotensin II-induced vascular contraction is different from that of sevoflurane.
Angiotensin II (Ang II)-induced vascular contraction is mediated both by a Ca(2+)-mediated signaling pathway and a Ca(2+) sensitization mechanism. We recently demonstrated that sevoflurane inhibits the contractile response to Ang II, mainly by inhibiting protein kinase C (PKC) phosphorylation that regulates myofilament Ca(2+) sensitivity, without significant alteration of intracellular Ca(2+) concentration ([Ca(2+)](i)) in rat aortic smooth muscle. The current study was designed to determine the mechanisms by which isoflurane inhibits Ang II-induced contraction of rat aortic smooth muscle. ⋯ These results suggest that, unlike sevoflurane, the inhibitory effect of isoflurane on Ang II-induced contraction is mainly mediated by attenuation of the Ca(2+)-mediated signaling pathway.
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Anesthesia and analgesia · Jul 2007
Case ReportsPneumothorax after coracoid infraclavicular brachial plexus block.
Several variations on the technique for infraclavicular brachial plexus block have been described. The coracoid infraclavicular technique has become popular because of easily identified landmarks, reliable distribution of blockade, and low risk of respiratory complications such as pneumothorax. We report a case of pneumothorax in a patient after a coracoid infraclavicular brachial plexus block. Subtleties in landmark identification and measurement may affect the risk of pneumothorax.
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Anesthesia and analgesia · Jul 2007
Randomized Controlled Trial Comparative Study Retracted PublicationThe effect of initiating a preventive multimodal analgesic regimen on long-term patient outcomes for outpatient anterior cruciate ligament reconstruction surgery.
Unrelieved postoperative pain may impair rehabilitation, delay recovery, and result in poor outcomes. Preventive multimodal analgesic techniques may improve long-term outcome after surgery. ⋯ The administration of celecoxib as a component of a preventive multimodal analgesic technique for anterior cruciate ligament reconstruction reduces long-term patellofemoral complications and increases the likelihood of returning to a preinjury level of activity.