Anesthesia and analgesia
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Anesthesia and analgesia · Mar 2009
The efficacy of skin temperature for block assessment after infraclavicular brachial plexus block.
Although it has been reported that an increase in skin temperature indicates block success with higher specificity and sensibility than skin sensitivity to pinprick and cold, the methodology previously used computer-assisted infrared thermography, a technique that is expensive and requires substantial personnel training. In this prospective observational study, we evaluated whether a simple infrared thermometer can reliably predict block effectiveness after infraclavicular brachial plexus blockade. ⋯ Skin temperature assessment with an infrared thermometer is a reliable, simple and early indicator of a successful nerve block.
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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.
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Anesthesia and analgesia · Mar 2009
Case ReportsSevere methemoglobinemia detected by pulse oximetry.
An elderly surgical patient acquired a life-threatening methemoglobinemia as a result of topical benzocaine spray to the oropharynx in preparation for awake endotracheal intubation. A new multiwavelength pulse oximeter, the Masimo Rad-57, detected this methemoglobinemia an hour before it was confirmed by laboratory CO-oximetry. ⋯ The new pulse oximeter gave continuous readings of methemoglobin level at the bedside, whereas the laboratory values were delayed by up to an hour. This case demonstrates the clinical application of a multiwavelength pulse oximeter in the diagnosis and treatment of a life-threatening dyshemoglobinemia.
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Anesthesia and analgesia · Mar 2009
Case ReportsThe utility of ketamine for the preoperative management of a patient with Parkinson's disease.
Loss of dopaminergic neurons from the substantia nigra characterizes the classical pathology of Parkinson's disease, but persistent activation of N-methyl-D-aspartate receptors is also a major component. During difficult airway management in a patient with advanced Parkinson's disease, the use of low-dose (20 mg) i.v. ketamine resulted in complete abolition of severe tremor and dysarthria. This led to the current case report in which low-dose ketamine was used for preoperative sedation and dyskinesia attenuation. Prior research and our experience would suggest that low-dose ketamine, titrated to effect, may provide optimal patient comfort and perioperative control of Parkinsonian tremor.
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Anesthesia and analgesia · Mar 2009
Ifenprodil induced antinociception and decreased the expression of NR2B subunits in the dorsal horn after chronic dorsal root ganglia compression in rats.
Spinal N-methyl D-aspartate receptors play an important role in the pathogenesis of neuropathic pain, and administration of N-methyl D-aspartate receptor antagonists can attenuate this hyperpathia. Ifenprodil is an antagonist selective for N-methyl D-aspartate receptor 2B (NR2B) subunits. Several researches have reported effective analgesia of ifenprodil in animal models of neuropathic pain. We extended this work to include chronic compression of the dorsal root ganglia (CCD). ⋯ These data suggest that ifenprodil induced antinociception in CCD rats and provided further evidence for the important role of NR2B subunits in the development of neuropathic pain.