Anesthesia and analgesia
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Anesthesia and analgesia · Jun 2008
Case ReportsMigraine with atypical aura in the recovery room: a sometimes complicated diagnosis!
Migraine is a frequent neurological pathology. However, the diagnosis can be difficult to establish, especially when it is accompanied with an atypical aura that can be confounded with a stroke. ⋯ The patient had not mentioned migraine in her history before the surgery. This lack of information led to unnecessary therapy.
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Anesthesia and analgesia · Jun 2008
The analgesic drug, tramadol, acts as an agonist of the transient receptor potential vanilloid-1.
Tramadol is an effective analgesic substance widely used in medical practice. Its therapeutic action have been mainly attributed to the activation of mu-opioid receptors as well as to the inhibition of neurotransmitter reuptake mechanisms and various voltage- and ligand-gated ion channels of the nociceptive system. As transient receptor potential vanilloid-1 (TRPV1, "the capsaicin receptor") has been shown to function as a central integrator molecule of pain sensation, our aim in the current study was to define the involvement of TRPV1 in the complex mechanism of action of tramadol. ⋯ Collectively, these findings strongly support the intriguing and novel concept that tramadol acts as an agonist of TRPV1. Considering that activation of TRPV1 on sensory neurons is followed by a local release of vasoactive neuropeptides and a marked desensitization of the afferent fibers (hence termination of pain sensation), our findings may equally explain both the desired analgesic as well as the often-seen, yet "unexpected," local side effects (e.g., initiation of burning pain and erythema) of tramadol.
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Anesthesia and analgesia · Jun 2008
Cone beam computed tomography: an innovative tool for airway assessment.
Improvements in airway imaging technology provide the potential for an improved understanding of airway pathology and upper airway mechanics. We present here a preliminary report on the applicability of cone beam computed tomography technology in conjunction with multidimensional digital analysis for the purposes of clinical airway management. The use of this technology for airway imaging in anesthesiology has not been reported. ⋯ Three-dimensional image reconstructions as well as "virtual laryngoscopy" were achieved with resulting excellent image quality, suggesting a broad range of possibilities for upper airway examination and analysis. A modified Muller test with volumetric rendering of the airway passages under baseline and negative pressure conditions was also performed, made possible as a result of the system's short (9 s) scanning times. We believe that cone beam computed tomography technology offers an additional dimension to airway evaluation that has considerable potential.
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Anesthesia and analgesia · Jun 2008
Case ReportsDexmedetomidine sedation leading to refractory cardiogenic shock.
Dexmedetomidine is frequently used for deep sedation during electrophysiology procedures. We report a case where, presumably, the use of dexmedetomidine resulted in a patient's death. ⋯ We postulate that, in certain susceptible individuals, dexmedetomidine may lead to terminal complications. We therefore urge caution about using dexmedetomidine in the electrophysiology laboratory.
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Anesthesia and analgesia · Jun 2008
Subanesthetic doses of propofol induce neuroapoptosis in the infant mouse brain.
Drugs that block N-methyl-d-aspartate glutamate receptors or that promote gamma-aminobutyric acid type A inhibition trigger neuroapoptosis in the developing rodent brain. Propofol reportedly interacts with both gamma-aminobutyric acid type A and N-methyl-d-aspartate glutamate receptors, but has not been adequately evaluated for its ability to induce developmental neuroapoptosis. ⋯ We then administered graduated doses of propofol (25-300 mg/kg i.p.) and found that doses >or=50 mg/kg induce a significant neuroapoptosis response. We conclude that propofol induces neuroapoptosis at 1/4 the dose required for surgical anesthesia.