Anesthesia and analgesia
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Anesthesia and analgesia · Mar 2009
Lidocaine injection into the rat dorsal root ganglion causes neuroinflammation.
Injury of a spinal nerve or dorsal root ganglion (DRG) during selective spinal nerve blocks is a potentially serious complication that has not been adequately investigated. Our hypothesis was that local anesthetic injection into these structures may result in an inflammatory response and hyperalgesia. ⋯ Lidocaine injection into the DRG may produce hyperalgesia, possibly due to activation of resident satellite glial cells. In a clinical setting, local anesthetic injection into the DRG should be avoided during selective spinal nerve blocks.
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Anesthesia and analgesia · Mar 2009
Case ReportsTreatment of serious calcium channel blocker overdose with levosimendan, a calcium sensitizer.
Calcium channel blocker (CCB) overdose is often lethal. Conventional medical treatment includes i.v. calcium, high doses of catecholamines, insulin, and glucagon. A new inotropic drug, levosimendan, should be considered in severe CCB poisoning. ⋯ We describe two patients with serious CCB overdose. Despite intensive medical and mechanical cardiovascular support, both patients remained in shock. Hemodynamics gradually improved after administration of levosimendan.
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Anesthesia and analgesia · Mar 2009
The effects of fibrinogen levels on thromboelastometric variables in the presence of thrombocytopenia.
The binding of fibrinogen and fibrin to platelets is important in normal hemostasis. The extent of platelet-fibrin interaction can be measured as the viscoelastic strength of clot by rotational thromboelastometry (ROTEM). In this study, we investigated the effect of fibrinogen concentration and its relative contribution to overall clot strength using ROTEM. ⋯ These in vitro and clinical data indicate that the clot strength increases in a fibrinogen concentration-dependent manner independent of platelet count, when analyzed by ROTEM. The maintenance of fibrinogen concentration is critical in the presence of thrombocytopenia. EXTEM (extrinsic activation) and FIBTEM may be useful in guiding fibrinogen repletion therapy.