Anesthesia and analgesia
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Anesthesia and analgesia · Feb 2008
Comparative StudyThree-dimensional computed tomography for difficult thoracic epidural needle placement.
Thoracic epidural anesthesia is often used as a postoperative analgesic technique in thoracic surgery. However, the structure of the overlapping spinous processes, resulting in interlaminar space occlusion, often makes thoracic epidural needle placement difficult. With the development of multi-detector row spiral computed tomography (CT), three-dimensional (3D) thoracic images can be readily obtained, providing potentially useful clinical information. Therefore, we conducted this study to evaluate the correlation between difficult thoracic epidural needle placement and anatomical findings obtained by 3DCT image processing techniques. ⋯ Preoperative 3DCT imaging may be useful in predicting difficult thoracic epidural needle placement.
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Anesthesia and analgesia · Feb 2008
Comparative StudyA presenilin-1 mutation renders neurons vulnerable to isoflurane toxicity.
Isoflurane, a commonly used inhaled anesthetic, induces apoptosis in rat pheochromocytoma neurosecretory cells (PC12) in a concentration- and time-dependent manner via an as yet unknown mechanism. We hypothesize that isoflurane induces apoptosis by causing abnormal calcium release from the endoplasmic reticulum (ER) via activation of inositol 1,4,5-trisphosphate (IP3) receptors. A presenilin-1 (PS1) mutation associated with familial Alzheimer's disease was shown to increase the activity of IP3 receptors, and therefore may render cells vulnerable to isoflurane-induced cytotoxicity. Sevoflurane and desflurane have less ability to disrupt intracellular calcium homeostasis; and thus we predict they will cause less cytotoxicity. ⋯ Our results show that the L286V PS1 mutation augments the isoflurane-induced [Ca2+]c increase via calcium release from intracellular stores which, in turn, renders the cells vulnerable to isoflurane neurotoxicity. ROS production was not involved in isoflurane-induced neurotoxicity. Sevoflurane and desflurane, at equivalent exposure to isoflurane, did not induce a similar increase of [Ca2+]c or neurotoxicity in L286V PC12 cells.
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Anesthesia and analgesia · Feb 2008
Comparative StudyThe comparative abilities of propofol and sevoflurane to modulate inflammation and oxidative stress in the kidney after aortic cross-clamping.
Propofol has been reported to provide protection against ischemia-reperfusion injury. Nuclear transcription factor kappa B (NFkappaB) plays a key role in oxidative stress and the inflammatory response during ischemia-reperfusion. We compared the effect of propofol with sevoflurane on kidney NFkappaB expression and systemic inflammatory responses induced by aortic clamping. ⋯ Compared with sevoflurane, propofol administration during suprarenal aortic clamping and unclamping led to modulation of markers of inflammation and decreased NFkappaB expression.
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Anesthesia and analgesia · Feb 2008
Comparative StudyDoes sciatic parasacral injection spread to the obturator nerve? An anatomic study.
The ability of parasacral sciatic nerve block to provide consistent obturator nerve and perineal blockade remains undetermined. In this anatomic work, we assessed the spread of a colored latex mimicking a parasacral injection, and observed the spread to the obturator nerve and sacral nerve roots. ⋯ We conclude from this anatomical study that successful parasacral injection consistently spreads to the pelvic portion of the obturator nerve and to the sacral roots. Therefore, parasacral block should theoretically provide obturator and perineal blockade, and eliminate the need for systematic separate obturator nerve block. These results must be confirmed by further clinical studies.
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Anesthesia and analgesia · Feb 2008
Comparative StudyA pilot study to compare the Episure Autodetect syringe with the glass syringe for identification of the epidural space in parturients.
The Episure AutoDetect syringe, a spring-loaded syringe, is a new loss-of-resistance syringe with an internal compression spring that applies constant pressure on the plunger. In this pilot study, we compared the spring-loaded syringe with the standard glass syringe for identification of the epidural space during initiation of epidural analgesia in parturients. ⋯ Eight residents performed 291 procedures (90%) and two attendings performed 34 procedures (10%). Epidural analgesia failed in five subjects in the glass syringe group and in no subject in the spring-loaded syringe group (P = 0.025).