Anesthesia and analgesia
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Anesthesia and analgesia · Jul 2008
The efficacy of dexmedetomidine in patients with noninvasive ventilation: a preliminary study.
Agitation is associated with failure of noninvasive ventilation (NIV). We investigated the effect of dexmedetomidine in patients with NIV. ⋯ This study shows that dexmedetomidine is an effective sedative drug for patients with NIV.
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Anesthesia and analgesia · Jul 2008
ReviewSex-specific responses to opiates: animal and human studies.
It is widely reported that analgesic drugs acting at mu, kappa, and delta opioid-receptors display quantitative and qualitative differences in effect in males and females. These sex-related differences are not restricted to the analgesic/antinociceptive properties of opioids, but are also present in opioid-induced side effects, such as changes in respiration, locomotor activity, learning/memory, addiction, and changes in the cardiovascular system. ⋯ In the current review, we systematically present these animal and human studies and discuss the data in relation to the depending variables. Although the observed sex differences in opioid effect may be clinically relevant, lack of knowledge on other factors involved in the large variability in patient opioid analgesic sensitivity should compel practitioners to customize their dosing regimens based on individual requirements.
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Anesthesia and analgesia · Jul 2008
The application of tetanic stimulation of the unilateral tibial nerve before transcranial stimulation can augment the amplitudes of myogenic motor-evoked potentials from the muscles in the bilateral upper and lower limbs.
Recently, we reported a new technique to augment motor-evoked potentials (MEPs) under general anesthesia, posttetanic MEP (p-MEP), in which tetanic stimulation of the peripheral nerve before transcranial stimulation enlarged amplitudes of MEPs from the muscle innervated by the nerve subjected to tetanic stimulation. In the present study, we tested whether tetanic stimulation of the left tibial nerve can also augment amplitudes of MEPs from the muscles which are not innervated by the nerve subjected to tetanic stimulation. ⋯ In patients under propofol and fentanyl anesthesia with partial neuromuscular blockade, the application of tetanic stimulation to the left tibial nerve augmented the amplitudes of MEPs from the muscles without tetanic nerve stimulation and those with stimulation.
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Anesthesia and analgesia · Jul 2008
Intercostally placed paravertebral catheterization: an alternative approach to continuous paravertebral blockade.
Continuous paravertebral nerve blocks can provide effective postoperative analgesia after abdominal and thoracic surgery. While offering a number of advantages compared with thoracic epidural analgesia, access to the paravertebral space using a classic approach is not always easily accomplished and/or possible. In this regard, continuous paravertebral blockade via a percutaneous intercostal approach may theoretically serve as an alternative approach to the paravertebral space. ⋯ The intercostally placed paravertebral catheter provides postoperative analgesia after major surgery of the chest, abdomen, or retroperitoneum.
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Anesthesia and analgesia · Jul 2008
Cerebral microemboli during hip fracture fixation: a prospective study.
Recent studies have shown that cerebral fat microembolism takes place during surgery for hip or knee replacement. In this study, we examined the occurrence of cerebral microembolism, solid or gas, during a standard procedure of hip fracture fixation. ⋯ The incidence of cerebral microemboli during urgent surgery for hip fracture fixation is considerable. This phenomenon is not confined to hip or knee replacement surgery. The clinical implications of this finding require further investigation.