Anesthesia and analgesia
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Anesthesia and analgesia · Apr 2008
Dermatome variation of lumbosacral nerve roots in patients with transitional lumbosacral vertebrae.
The presence of a transitional vertebra can create difficulty in identifying the lumbar level corresponding to an exiting nerve root at the time of a spinal nerve block. We investigated the possibility that the muscle innervation pattern and sensory dermatomes of the lumbar nerve roots are altered when a lumbosacral transitional vertebra is present using electrical stimulation. ⋯ Our findings suggest that the function of the lumbosacral nerve roots is altered in patients with a sacralized L5, and that the L4 nerve root serves the usual function of the L5 nerve root.
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Anesthesia and analgesia · Apr 2008
Does the Pleth variability index indicate the respiratory-induced variation in the plethysmogram and arterial pressure waveforms?
Respiratory variations in the pulse oximeter plethysmographic waveform amplitude (deltaPOP) are sensitive to changes in preload and can predict fluid responsiveness in mechanically ventilated patients. However, they cannot be easily calculated from a bedside monitor. Pleth variability index (PVI, Masimo Corp., Irvine, CA) is a new algorithm that automatically calculates deltaPOP. The aim of our study was to test the ability of this new device to automatically and continuously monitor deltaPOP. ⋯ This study is the first to demonstrate the ability of PVI, an index automatically derived from the pulse oximeter waveform analysis, to automatically and continuously monitor deltaPOP. This new index has potential clinical applications for noninvasive fluid responsiveness monitoring.
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Anesthesia and analgesia · Apr 2008
Antiallodynic and antihyperalgesic effect of milnacipran in mice with spinal nerve ligation.
The antidepressant, milnacipran, has been reported to have antinociceptive, antiallodynic, and antihyperalgesic effects. In this study, we examined the mechanisms of the antiallodynic and antihyperalgesic effects of milnacipran in a model of neuropathic pain induced by spinal nerve ligation in mice. ⋯ We concluded that the antiallodynic and antihyperalgesic effects of milnacipran on neuropathic pain induced by spinal nerve ligation are principally mediated through action at supraspinal and spinal sites via activation of the spinal noradrenergic system.
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Anesthesia and analgesia · Apr 2008
Randomized Controlled TrialA novel vibrotactile display to improve the performance of anesthesiologists in a simulated critical incident.
Current methods of information transfer in the operating room between monitor and anesthesiologist rely on visual and auditory modalities. These modalities can easily become overloaded in a high cognitive workload situation, such as in a critical incident. The use of vibrotactile communication has been shown to improve information transfer in other high cognitive workload environments such as aviation. We designed a novel waist-mounted vibrotactile display to be worn by the anesthesiologist to test if a vibrotactile display could improve the clinical response time to begin treating a simulated case of anaphylaxis when compared with a group using traditional information displays. In addition, we evaluated differences in situational awareness (SA) between the two groups. ⋯ Our study provides evidence that vibrotactile communication can reduce response time to critical incidents.
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Anesthesia and analgesia · Apr 2008
Randomized Controlled TrialChronic phantom limb pain: the effects of calcitonin, ketamine, and their combination on pain and sensory thresholds.
Calcitonin was effective in a study of acute phantom limb pain, but it was not studied in the chronic phase. The overall literature on N-methyl-D-aspartate antagonists is equivocal. We tested the hypothesis that calcitonin, ketamine, and their combination are effective in treating chronic phantom limb pain. Our secondary aim was to improve our understanding of the mechanisms of action of the investigated drugs using quantitative sensory testing. ⋯ Our results question the usefulness of calcitonin in chronic phantom limb pain and stress the potential interest of N-methyl-D-aspartate antagonists. Sensory assessments indicated that peripheral mechanisms are unlikely important determinants of phantom limb pain. Ketamine, but not calcitonin, affects central sensitization processes that are probably involved in the pathophysiology of phantom limb pain.