Anesthesia and analgesia
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Anesthesia and analgesia · Aug 2009
Children with infantile neuronal ceroid lipofuscinosis have an increased risk of hypothermia and bradycardia during anesthesia.
Neuronal ceroid lipofuscinoses (NCLs) are a group of autosomal recessive neurodegenerative diseases characterized by lysosomal accumulation of autofluorescent material in neurons and other cell types. The infantile NCL (INCL) subtype is rare (1 in >100,000 births), the most devastating of childhood subtypes, and is caused by mutations in the gene CLN1, which encodes palmitoyl-protein thioesterase-1. ⋯ We report that patients with INCL have lower baseline body temperature and during general anesthesia, despite rewarming interventions, are at increased risk for hypothermia and bradycardia. This suggests a previously unknown INCL phenotype, impaired thermoregulation. Therefore, when anesthetizing these children, careful monitoring and routine use of warming interventions are warranted.
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Anesthesia and analgesia · Aug 2009
Nosocomial contamination of laryngoscope handles: challenging current guidelines.
Laryngoscope blades are often cleaned between cases according to well-defined protocols. However, despite evidence that laryngoscope handles could be a source of nosocomial infection, neither our institution nor the American Society of Anesthesiologists has any specific guidelines for handle disinfection. We hypothesized that laryngoscope handles may be sufficiently contaminated with bacteria and viruses to justify the implementation of new handle-cleaning protocols. ⋯ We found a high incidence of bacterial contamination of laryngoscope handles despite low-level disinfection. However, no vancomycin-resistant enterococci, methicillin-resistant S. aureus, Gram-negative rods, or respiratory viruses were detected. Our results support adoption of guidelines that include, at a minimum, mandatory low-level disinfection of laryngoscope handles after each patient use.
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Anesthesia and analgesia · Aug 2009
Intraneural injection with low-current stimulation during popliteal sciatic nerve block.
Prevention of an intraneural injection of a local anesthetic during peripheral nerve blockade is considered important to avoid neurologic injury. However, the needle-nerve relationship during low-current electrical nerve localization is not well understood. ⋯ The absence of motor response to nerve stimulation during popliteal sciatic nerve block does not exclude intraneural needle placement and may lead to additional unnecessary attempts at nerve localization. Additionally, low-current stimulation was associated with a high frequency of intraneural needle placement.
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Anesthesia and analgesia · Aug 2009
Airway stenosis-related increase of pulmonary pressure during high-frequency jet ventilation depends on injector's position.
High-frequency jet ventilation (HFJV) can lead to high-airway pressures under certain conditions. In this laboratory study, we evaluated the influence of the injector's position relative to a fixed airway obstruction on peak pressures in a tracheal-lung model. ⋯ This study in a lung model suggests that placing an injector more than 8 cm proximal to a laryngotracheal stenosis will prevent changes in intrapulmonary pressure related to the degree of stenosis or driving pressure during HFJV. The location of the injector chosen for clinical care should balance the need for effective ventilation with the risk of barotrauma.
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Anesthesia and analgesia · Aug 2009
Long-term pain vulnerability after surgery in rats: prevention by nefopam, an analgesic with antihyperalgesic properties.
Tissue damage associated with surgery often produces peripheral and central sensitization that may outlast the stimuli, leading to exaggerated postoperative pain. Paradoxically, the use of opioid analgesia, which is essential for surgical pain management may induce pain sensitization leading to enhanced postoperative pain and an increased risk of developing chronic pain. We studied whether a surgical incision in the rat hindpaw may favor the development of long-term pain vulnerability by estimating hyperalgesia induced by an inflammatory stimulation of the unlesioned contralateral hindpaw 3 wk later. We also evaluated the ability of nefopam, an analgesic drug commonly used in postoperative pain management, to prevent not only exaggerated postoperative pain but also long-term pain vulnerability. The efficacy of morphine was assessed 1 day after surgical incision. ⋯ Given preemptively, nefopam may be effective at improving postoperative pain management and at reducing the risk of developing postoperative chronic pain, because the drug has both analgesic and antihyperalgesic properties.