Anesthesia and analgesia
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Anesthesia and analgesia · Nov 2009
Isoflurane preconditioning ameliorates endotoxin-induced acute lung injury and mortality in rats.
The effects of isoflurane pretreatment on pulmonary proinflammatory cytokines and survival in severe endotoxin-induced acute lung injury (ALI) have not been studied systemically. We investigated the effect of preadministration of isoflurane on ALI induced by lipopolysaccharide (LPS) in rats. ⋯ Isoflurane preconditioning can attenuate pulmonary proinflammatory cytokine release and decrease the mortality induced by severe sepsis. Early protection seems to be mediated partly through inhibition of iNOS-NO pathway activation.
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Anesthesia and analgesia · Nov 2009
Comparative StudyIncrease in quality, but not quantity, of clinical trials in acute pain: 1992 versus 2007.
The annual number of published clinical trials in acute postoperative pain in adults has changed little in 15 yr and, as a fraction of all clinical trials published in the six highest impact journals in anesthesiology, has actually decreased from 16% (95% confidence interval: 12-20) to 11% (95% confidence interval: 9-15). However, the methodological quality of reports has improved, with explicit statements on power analysis, allocation concealment, and specification of primary end points exceeding 90% of reports in 2007. There has been a shift in hypothesis interests away from neuraxial analgesia and toward multimodal analgesia.
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Anesthesia and analgesia · Nov 2009
Comparative StudyAcute methadone treatment reduces myocardial infarct size via the delta-opioid receptor in rats during reperfusion.
Methadone is an opioid agonist often given to manage acute and chronic pain. We sought to determine whether methadone compared with morphine dose dependently reduces myocardial infarct size (IS) and whether the mechanism is delta-opioid receptor mediated. Furthermore, we examined whether myocardial IS reduction varies with the timing of methadone administration or duration of induced ischemia. ⋯ These findings demonstrate that methadone and morphine produce similar myocardial IS-sparing effects that are delta-opioid receptor mediated and that are dependent on the duration of myocardial ischemia.
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Anesthesia and analgesia · Nov 2009
Randomized Controlled TrialThe effect of perioperative intravenous lidocaine on postoperative pain and immune function.
Surgery-associated tissue injury leads to nociception and inflammatory reaction, accompanied by increased production of proinflammatory cytokines. These cytokines can induce peripheral and central sensitization, leading to pain augmentation. Recently, a frequently used local anesthetic, lidocaine, was introduced as a part of a perioperative pain management technique. In addition to its analgesic effects, lidocaine has an antiinflammatory property, decreasing the upregulation of proinflammatory cytokines. We focused on the effects of preincisional and intraoperative IV lidocaine on pain intensity and immune reactivity in the postoperative period. ⋯ The present findings indicate that preoperative and intraoperative IV lidocaine improves immediate postoperative pain management and reduces surgery-induced immune alterations.
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Anesthesia and analgesia · Nov 2009
Randomized Controlled Trial Comparative StudyIntraoperative ventilatory strategies for prevention of pulmonary atelectasis in obese patients undergoing laparoscopic bariatric surgery.
Atelectasis occurs regularly after induction of general anesthesia, persists postoperatively, and may contribute to significant postoperative morbidity and additional health care costs. Laparoscopic surgery has been reported to be associated with an increased incidence of postoperative atelectasis. It has been shown that during general anesthesia, obese patients have a greater risk of atelectasis than nonobese patients. Preventing atelectasis is important for all patients but is especially important when caring for obese patients. ⋯ Intraoperative alveolar recruitment with a VCM followed by PEEP 10 cm H(2)O is effective at preventing lung atelectasis and is associated with better oxygenation, shorter PACU stay, and fewer pulmonary complications in the postoperative period in obese patients undergoing laparoscopic bariatric surgery.