Anesthesia and analgesia
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Anesthesia and analgesia · Aug 2009
Volatile anesthetics inhibit angiotensin II-induced vascular contraction by modulating myosin light chain phosphatase inhibiting protein, CPI-17 and regulatory subunit, MYPT1 phosphorylation.
Vascular contraction is regulated by myosin light chain (MLC) phosphorylation. Inhibition of MLC phosphatase (MLCP) increases MLC phosphorylation for a given Ca(2+) concentration, and results in promoting myofilament Ca(2+) sensitivity. MLCP activity is mainly determined by protein kinase C (PKC) and Rho kinase through the phosphorylation of both PKC-potentiated inhibitory protein (CPI-17) and myosin phosphatase target subunit (MYPT1). We have previously demonstrated that sevoflurane inhibits PKC phosphorylation and membrane translocation of Rho kinase. This study was designed to investigate the effects of sevoflurane and isoflurane on CPI-17, MYPT1, and MLC phosphorylation in response to angiotensin II (Ang II) in rat aortic smooth muscle. ⋯ Although both volatile anesthetics inhibited Ang II-induced vasoconstriction and MLC phosphorylation to similar extent, the mechanisms behind the inhibitory effects of each anesthetic on MLCP activity appear to differ.
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Anesthesia and analgesia · Aug 2009
Review Meta AnalysisThe efficacy of an intraoperative cell saver during cardiac surgery: a meta-analysis of randomized trials.
Cell salvage may be used during cardiac surgery to avoid allogeneic blood transfusion. It has also been claimed to improve patient outcomes by removing debris from shed blood, which may increase the risk of stroke or neurocognitive dysfunction. In this study, we sought to determine the overall safety and efficacy of cell salvage in cardiac surgery by performing a systematic review and meta-analysis of published randomized controlled trials. ⋯ Current evidence suggests that the use of a cell saver reduces exposure to allogeneic blood products or red blood cell transfusion for patients undergoing cardiac surgery. Subanalyses suggest that a cell saver may be beneficial only when it is used for shed blood and/or residual blood or during the entire operative period. Processing cardiotomy suction blood with a cell saver only during cardiopulmonary bypass has no significant effect on blood conservation and increases fresh frozen plasma transfusion.
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Anesthesia and analgesia · Aug 2009
Review Meta AnalysisNeuraxial techniques in obstetric and non-obstetric patients with common bleeding diatheses.
There are few data in the literature regarding the safety of neuraxial techniques in patients with the most common bleeding diatheses, including hemophilia, von Willebrand's disease (vWD), and idiopathic thrombocytopenic purpura (ITP). Neuraxial techniques are not widely used in these populations because of concerns of potential hemorrhagic and/or subsequent neurologic complications. In this article, we review the available literature describing neuraxial techniques in patients with hemophilia, vWD, or ITP with the aim to assist anesthesiologists considering neuraxial techniques in these populations. ⋯ There is a paucity of published data regarding the provision and safety of neuraxial techniques in patients with common bleeding diatheses. The minimum "safe" factor levels and platelet count for neuraxial techniques remain undefined in both the obstetric and general populations, and evidence-based recommendations in the setting of hemophilia, vWD, or ITP cannot be offered.
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Anesthesia and analgesia · Aug 2009
Randomized Controlled TrialHealth-related quality of life after hip arthroplasty with and without an extended-duration continuous posterior lumbar plexus nerve block: a prospective, 1-year follow-up of a randomized, triple-masked, placebo-controlled study.
We previously reported that extending an overnight continuous posterior lumbar plexus nerve block to 4 days after hip arthroplasty provides clear benefits during the perineural infusion in the immediate postoperative period. However, it remains unknown whether the extended infusion improves subsequent health-related quality of life. ⋯ This investigation found no evidence that extending an overnight continuous posterior lumbar plexus nerve block to 4 days improves (or worsens) subsequent health-related quality of life between 7 days and 12 mo after hip arthroplasty.