Anesthesia and analgesia
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Anesthesia and analgesia · Mar 2010
N-antipyrine-3, 4-dichloromaleimide, an effective cyclic imide for the treatment of chronic pain: the role of the glutamatergic system.
In recent years, cyclic imides have attracted the attention of the scientific community because of their promising therapeutic potential. Studies with the compound N-antipyrine-3,4-dichloromaleimide (NA-3,4-DCM) also demonstrated an antinociceptive effect in formalin or capsaicin models of nociception, and that it reduced acetic acid-induced abdominal writhing in mice. ⋯ These results provide strong evidence that NA-3,4-DCM produces antihypernociception in mice at peripheral, spinal, and supraspinal sites, and that interaction with the group I metabotropic glutamate receptors and NMDA receptors contributes to the mechanisms underlying its effect.
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Anesthesia and analgesia · Mar 2010
Comparative StudySevoflurane causes greater QTc interval prolongation in elderly patients than in younger patients.
Sevoflurane and droperidol prolong the QT interval, and advancing age is not only associated with a prolongation of the QT interval but is also a risk factor for drug-induced QT interval prolongation. In this study, we compared the effect of sevoflurane and droperidol on the corrected QT (QTc) interval and the dispersion of ventricular repolarization (time interval from the peak to the end of the T wave [Tp-e]) in elderly patients with those in younger patients. ⋯ Sevoflurane causes greater QTc interval prolongation in elderly patients than in younger patients. Although sevoflurane does not affect the transmural dispersion of repolarization and sevoflurane-induced QTc prolongation does not advance with time and by droperidol administration, QT interval prolongation and its associated arrhythmias should be carefully monitored during sevoflurane anesthesia in elderly patients.
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Anesthesia and analgesia · Mar 2010
Case ReportsPerioperative analgesia for forequarter amputation in a child: a dual paravertebral approach.
We describe the management of postoperative pain for a 10-year-old girl who underwent forequarter amputation for osteosarcoma of the left humerus. Because the brachial plexus itself was divided and resected during surgery, and the main body part innervated by the nerves from this plexus (the entire upper limb including the scapula and clavicle) was removed, providing analgesia via a brachial plexus block alone would probably not have provided adequate coverage. Because the tissue not resected with this surgery was innervated via the cervical and brachial plexuses and some upper thoracic nerve roots, we elected to combine a perioperative high continuous cervical paravertebral block at the C5 level with a continuous thoracic paravertebral block at the T2 level for postoperative analgesia. Our patient experienced excellent postoperative analgesia and required no narcotics during the immediate postoperative period.
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Anesthesia and analgesia · Mar 2010
Randomized Controlled Trial Multicenter StudyThe effect of bispectral index monitoring on long-term survival in the B-aware trial.
When anesthesia is titrated using bispectral index (BIS) monitoring, patients generally receive lower doses of hypnotic drugs. Intraoperative hypotension and organ toxicity might be avoided if lower doses of anesthetics are administered, but whether this translates into a reduction in serious morbidity or mortality remains controversial. The B-Aware Trial randomly allocated 2463 patients at high risk of awareness to BIS-guided anesthesia or routine care. We tested the hypothesis that the risks of death, myocardial infarction (MI), and stroke would be lower in patients allocated to BIS-guided management than in those allocated to routine care. ⋯ Monitoring with BIS and absence of BIS values <40 for >5 min were associated with improved survival and reduced morbidity in patients enrolled in the B-Aware Trial.
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Anesthesia and analgesia · Mar 2010
Randomized Controlled Trial Multicenter StudyPosttraumatic stress disorder in aware patients from the B-aware trial.
The long-term consequences of an awareness episode vary. Some patients do not have any long-term disability, whereas others develop psychological problems that may be severe and persistent. In this study, we compared the incidence of posttraumatic stress disorder (PTSD) in patients with and without confirmed awareness who were randomized in the B-Aware Trial. ⋯ PTSD was common and persistent in the confirmed awareness patients of the B-Aware Trial. Strategies to prevent awareness in patients under general anesthesia are justified.