Anesthesia and analgesia
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Anesthesia and analgesia · Jul 2008
Randomized Controlled TrialIntraarticular tramadol-bupivacaine combination prolongs the duration of postoperative analgesia after outpatient arthroscopic knee surgery.
Intraarticular (IA) local anesthetics are often used for the management and prevention of pain after arthroscopic knee surgery. Recently, IA tramadol was also used for the management of these patients. However, the IA combination of local anesthetic and tramadol has not been evaluated in arthroscopic outpatients. Our primary aim in this study was to evaluate the analgesic effect of an IA combination of bupivacaine and tramadol when compared with each drug alone using visual analog scale (VAS) pain scores in patients undergoing day-care arthroscopic knee surgery. Additionally, we assessed analgesic demand. ⋯ The IA admixture of tramadol 100 mg with bupivacaine 0.25% provides a pronounced prolongation of analgesia compared with either drug alone in patients undergoing day care arthroscopic knee surgery.
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Neuroanesthesia for the pregnant patient is required infrequently, and evidence-based recommendations for neuroanesthetic management are sparse. We present a framework for a practical approach to anesthesia of the pregnant patient with subarachnoid or intracerebral hemorrhage, intracranial tumor, traumatic brain injury, spinal tumor, or spinal injury. ⋯ The anesthesiologist may have to anesthetize the pregnant patient for neurosurgery well before delivery, for cesarean delivery at the time of the neurosurgical procedure, or for delivery after neurosurgery. These scenarios are discussed along with fetal safety and anesthetic considerations for interventional neuroradiology.
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Anesthesia and analgesia · Jul 2008
Comparative StudyVariability comparison of the composite auditory evoked potential index and the bispectral index during propofol-fentanyl anesthesia.
Monitors of hypnotic depth help anesthesiologists to guide the anesthetic. The performance of different monitors depends on several factors, index variability at a steady state of hypnotic depth being one. We compared the recently introduced AAI1.6 with the established bispectral index (BIS), regarding index variability during stable values of propofol effect-site concentration. ⋯ Variability in relation to the difference between the median index value during anesthesia and the threshold necessary to detect consciousness with high sensitivity is higher for the AAI1.6 than for the BIS. This, as well as the steeper concentration-response function found for AAI1.6, impairs the performance of the AAI1.6 in predicting imminent return of consciousness during decreasing propofol concentrations. However, it makes AAI1.6 well suited to detect consciousness when it has occurred.
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Anesthesia and analgesia · Jul 2008
The ankle-to-arm blood pressure index predicts risk of cardiac complications after noncardiac surgery.
Peripheral arterial disease, as detected by a reduced ankle-to-arm blood pressure index (AAI), has been shown to predict future cardiac events. However, the utility of measuring the AAI to predict postoperative cardiac complications in patients undergoing noncardiac surgery is unknown. ⋯ An abnormally low AAI, indicative of underlying peripheral arterial disease, is an independent risk factor for postoperative cardiac complications. The accuracy of the AAI is similar to the rCRI, and it provides additional independent predictive value for preoperative cardiac risk stratification.
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Anesthesia and analgesia · Jul 2008
A high concentration of resiniferatoxin inhibits ion channel function in clonal neuroendocrine cells.
Resiniferatoxin (RTX) is a potent agonist of the transient receptor potential vanilloid 1 channel (TRPV1) found in peripheral nociceptors. RTX causes cellular excitation first, followed by a long-lasting refractory state, which has suggested its therapeutic use for pain control. RTX's effect could result from specific actions on TRPV1 channels, but might also arise from previously reported TRPV1-independent effects. We have tested whether exposure to RTX compromises ion channels in a TRPV1-independent manner. ⋯ RTX at 10 microM directly and acutely inhibited voltage-dependent Ca(2+) channels, in a TRPV1-independent manner. Prolonged exposure (24 h) to 10 microM RTX inhibited voltage-dependent Na(+) channels in addition to the Ca(2+) channels, in at least a partially reversible manner.