Anesthesia and analgesia
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Anesthesia and analgesia · Nov 2009
Ultrasound-guided paravertebral block using an intercostal approach.
We describe an ultrasound-guided technique of continuous bilateral paravertebral block using an intercostal approach in 12 patients undergoing elective abdominal surgery. Postoperatively, each of the patient's paravertebral catheters was bolused with 10 mL lidocaine (15 mg/mL), and each of the patient's catheters was infused with 0.2% ropivacaine at 10 mL/h. ⋯ The median verbal pain score on postoperative day 1 was 5.5 (interquartile range, 3.5-6), and median dose of IV hydromorphone consumed during the first 24 h after surgery was 1.9 mg (interquartile range, 0.7-5.05). All catheters were removed within 72 h after surgery.
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Anesthesia and analgesia · Nov 2009
Maximizing prediction probability PK as an alternative semiparametric approach to estimate the plasma effect-site equilibration rate constant ke0.
The k(e)(0) value is the first order rate constant determining the equilibration of drugs between plasma or end-tidal concentration and effect-site (e.g., brain) concentration. Parametric and semiparametric approaches have been used for estimating individual k(e)(0) values and describing the drug-response curve. In this study, we introduce a new semiparametric approach calculating k(e)(0) values for isoflurane, sevoflurane, and desflurane by maximizing the prediction probability P(K). ⋯ Maximizing the prediction probability P(K) for estimating k(e)(0) seems to be a promising method that researchers could use on an exploratory basis.
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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
Propofol inhibits aquaporin 4 expression through a protein kinase C-dependent pathway in an astrocyte model of cerebral ischemia/reoxygenation.
Aquaporin 4 (AQP4) plays a key role in maintaining water balance in the central nervous system, and its dysfunction may lead to brain edema. Previous studies have suggested that propofol may be involved in neuroprotection by preventing brain edema. In this study, we examined the effects of propofol on edema and assessed its neuroprotective actions in an oxygen and glucose deprivation (OGD) model of cultured rat astrocytes. We assessed the effects of propofol on AQP4 expression and the possible role of the protein kinase C (PKC) pathway on this effect. ⋯ Propofol, administered during OGD, provided neuroprotective effects and down-regulated AQP4 expression in the OGD/reoxygenation model of cultured rat astrocytes. Activation of the PKC pathway may block the effects of propofol.