Anesthesia and analgesia
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Anesthesia and analgesia · Oct 2009
Obstructive sleep apnea is not a risk factor for difficult intubation in morbidly obese patients.
Morbid obesity (MO), obstructive sleep apnea (OSA), and neck circumference (NC) are widely believed to be independent risk factors for difficult tracheal intubation. In this study, we sought to determine whether these factors were associated with increased risk of difficult intubation in patients undergoing bariatric surgery. The predictive factors tested were OSA and its severity, as determined by apnea-hypopnea index (AHI), gender, NC, and body mass index (BMI). ⋯ In MO patients undergoing bariatric surgery in the "ramped position," there was no relationship between the presence and severity of OSA, BMI, or NC and difficulty of intubation or laryngoscopy grade. Only a Mallampati score of 3 or 4 or male gender predicted difficult intubation.
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Anesthesia and analgesia · Oct 2009
Isoflurane inhibits cyclic adenosine monophosphate response element-binding protein phosphorylation and calmodulin translocation to the nucleus of SH-SY5Y cells.
Calmodulin (CaM) activation by Ca(2+), its translocation to the nucleus, and stimulation of phosphorylation of cyclic adenosine monophosphate response element-binding protein (CREB) (P-CREB) are necessary for new gene expression and have been linked to long-term potentiation, a process important in memory formation. Because isoflurane affects memory, we tested whether isoflurane interfered with the translocation of CaM to the neuronal cell nucleus and attenuated the formation P-CREB. ⋯ Our data demonstrate that isoflurane inhibits CaM translocation and P-CREB formation. This most likely occurs through isoflurane inhibition of Ca(2+)entry through L-type Ca(2+) channels.
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Anesthesia and analgesia · Oct 2009
Comparative StudyProlonged propofol anesthesia is not associated with an increase in blood lactate.
Lactic acidosis is considered an early sign of propofol infusion syndrome. In this study, we investigated the changes in lactate and pH with propofol versus volatile anesthesia (VA) of long duration. ⋯ During prolonged spine surgery >8 h, VA was associated with higher serum lactate, when compared with propofol infusion. Prospective studies are needed to elucidate the exact mechanisms and clinical implications of this finding.
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Anesthesia and analgesia · Oct 2009
Case ReportsDelayed quadriparesis after an interscalene brachial plexus block and general anesthesia: a differential diagnosis.
Interscalene brachial plexus block has been widely used for upper limb surgery. Different neurological complications related to this technique have been published. ⋯ Central progression of an interscalene block can produce acute or subacute quadriparesis depending on technical factors of the placement of the local anesthetic and its subsequent spread. The symptomatology and the imaging enabled us to refine the differential diagnoses and to exclude other causes of neurologic compromise.
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Anesthesia and analgesia · Oct 2009
The risk factors for hypoxemia in children younger than 5 years old undergoing rigid bronchoscopy for foreign body removal.
Removal of an airway foreign body (FB) is usually performed by rigid bronchoscopy under general anesthesia, but the choice of anesthesia and ventilation techniques varies greatly among anesthesiologists and institutions. Hypoxemia is the most commonly observed adverse event during rigid bronchoscopy. It is influenced by a variety of factors including the patient's medical condition, the type of surgical procedure, and the anesthetic technique. In the current study, we investigated risk factors that statistically correlate with intraoperative or postoperative hypoxemia in young patients undergoing rigid bronchoscopy. ⋯ We identified risk factors associated with intraoperative or with postoperative hypoxemia in rigid bronchoscopy which included patient age, type of FB, duration of surgical procedure, pneumonia before the procedure, ventilation mode, and duration of emergence from anesthesia. These results provide evidence that will help clinicians to reduce the incidence of hypoxemia in high-risk children.