Anesthesia and analgesia
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Anesthesia and analgesia · Mar 2009
An absorbable local anesthetic matrix provides several days of functional sciatic nerve blockade.
Functional blockade of peripheral nerves is the primary objective of local anesthesia, and it is often desirable to have a persistent blockade, sustained throughout and beyond a surgical procedure. Current local anesthetics give effective analgesia for <8-12 h after a single bolus injection. We report on an implantable, controlled-release drug delivery system intended for use in bone and consisting of a Food and Drug Administration-approved matrix containing lidocaine that is capable of local delivery for several days. ⋯ Xybrex is an absorbable, controlled-release drug delivery system that provides several days of analgesia for rat peripheral nerves without apparent significant local neurotoxicity or systemic toxicity.
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Anesthesia and analgesia · Mar 2009
Xenon preconditioning: the role of prosurvival signaling, mitochondrial permeability transition and bioenergetics in rats.
Similar to volatile anesthetics, the anesthetic noble gas xenon protects the heart from ischemia/reperfusion injury, but the mechanisms responsible for this phenomenon are not fully understood. We tested the hypothesis that xenon-induced cardioprotection is mediated by prosurvival signaling kinases that target mitochondria. ⋯ These results indicate that xenon preconditioning reduces myocardial infarct size, phosphorylates Akt, and GSK-3beta, preserves mitochondrial function, and inhibits Ca(2+)-induced mitochondrial permeability transition pore opening. These data suggest that xenon-induced cardioprotection occurs because of activation of prosurvival signaling that targets mitochondria and renders them less vulnerable to ischemia-reperfusion injury.
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Anesthesia and analgesia · Mar 2009
Comparative StudyImplications of event entry latency on anesthesia information management decision support systems.
Decision support systems (DSSs) are being developed to use events entered in anesthesia information management systems (AIMS) for quality of care, compliance, billing, documentation, and management purposes. DSS performance is impacted by latency from the actual time an event occurs to when it is written to the database, as well as how often the database is queried. Such latencies may result in poor DSS recommendations. ⋯ DSS performance is influenced by the timeliness of documentation, the incidence of missing documentation and the query interval. Facilities using a DSS, including electronic whiteboards showing patient status, should assess the latencies of the measured events and critique the influence of the latencies on clinical and managerial decisions.
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Anesthesia and analgesia · Mar 2009
Proprioceptive function is more sensitive than motor function to desflurane anesthesia.
Evaluating the effects of sub-immobilizing anesthetic doses on movement will identify target neural circuits for investigation as sites of action for anesthetic-induced immobility. ⋯ Proprioceptive function is more sensitive to anesthetic-induced depression than motor function in frogs. This suggests that the most anesthetic-sensitive component of the spinal neural circuitry underlying movement generation in response to noxious stimulus is prior to the level of the motoneuron.
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Anesthesia and analgesia · Mar 2009
Case ReportsAn exaggerated hypertensive response to glycopyrrolate therapy for bradycardia associated with high-dose dexmedetomidine.
At our institution, high-dose i.v. dexmedetomidine is used to provide sedation for pediatric patients undergoing nonpainful radiological imaging studies. Some of these patients exhibit marked bradycardia (more than 20% deviation from the lowest age-adjusted normal values) while maintaining an arterial blood pressure within an acceptable normal range. We report on three cases wherein treatment of dexmedetomidine-induced bradycardia with i.v. glycopyrrolate (5.0 microg/kg) not only resulting in resolution of bradycardia but also resulting in an exaggerated increase of arterial blood pressure.