Anesthesia and analgesia
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Anesthesia and analgesia · Jul 2010
Ropivacaine-induced peripheral nerve injection injury in the rodent model.
Intraneural administration of local anesthetics has been associated with nerve damage. We undertook the present study to investigate histological changes induced by ropivacaine injection into rat sciatic nerve. ⋯ This study demonstrates that, in the rat model, ropivacaine is associated with marked histological abnormality, including edema of the perineurium and axonal destruction with wallerian degeneration, when injected into or extraneurally placed onto a nerve. Extrafascicular injection and extraneural placement were associated with similar, although milder, histological damage than intrafascicular injection. Further work is needed to investigate the functional implications, if any, of the histological abnormalities observed in this study.
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Anesthesia and analgesia · Mar 2010
Controlled Clinical TrialA point-of-care assessment of the effects of desmopressin on impaired platelet function using multiple electrode whole-blood aggregometry in patients after cardiac surgery.
Blood loss after cardiac surgery can be caused by acquired platelet dysfunction after cardiopulmonary bypass. Monitoring of platelet function is clinically important for the identification of patients experiencing such platelet dysfunction. 1-Deamino-8-D-arginine vasopressin (desmopressin acetate, DDAVP) has been shown to augment platelet function and to reduce blood loss in patients with platelet dysfunction. In this study, we examined the feasibility of whole blood multiple electrode aggregometry (MEA) for the detection of cardiopulmonary bypass-induced platelet dysfunction and investigated its ability to monitor DDAVP treatment. ⋯ Impaired platelet function after cardiac surgery can be assessed at the bedside using MEA. The effect of DDAVP on impaired platelet function can also be detected as significant improvement in platelet aggregation to all activators. This device might be helpful for the identification of patients who may benefit from DDAVP therapy.
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Anesthesia and analgesia · Jul 2010
Blockade of the sinuvertebral nerve for the diagnosis of lumbar diskogenic pain: an exploratory study.
In this exploratory study we evaluated sensitivity and target specificity of sinuvertebral nerve block (SVNB) for the diagnosis of lumbar diskogenic pain. Diskography has been the diagnostic gold standard. Fifteen patients with positive diskography underwent SVNB via interlaminar approach to the posterior aspect of the disk. ⋯ The sensitivity was 73.3% (95% CI: 50.9%-95.7%). The target specificity was 40% (15.2%-64.8%). The results indicate that SVNB cannot yet replace diskography but encourage future studies to improve its target specificity.
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Anesthesia and analgesia · Jul 2010
Control chart monitoring of the numbers of cases waiting when anesthesiologists do not bring in members of call team.
An anesthesia group staffing agreement with a hospital often specifies the minimum number of operating rooms (ORs) to be covered during evening or weekend hours. Frequently, 1 anesthesiologist works in-house and others take call from home, coming in if multiple cases are waiting to be done. The anesthesiologist in-house sometimes does not bring in colleagues from home when the number of ORs he can supervise is less than the number specified in the agreement with the hospital (i.e., assignment is less than staffing). Queuing occurs even if managers have selected an appropriate number of ORs to be run during evenings and weekends (i.e., the number of cases [jobs] exceeds the number of ORs [identical machines] that are actually run). ⋯ Anesthesiologists sometimes do not notify call team members when cases are waiting and the number of ORs running is less than allocated. The number of cases waiting, rather than the amount of waiting, is more appropriate for monitoring trends over time. Simple Shewhart charts can be used for monitoring contractually specified staffing.
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Anesthesia and analgesia · Jul 2010
Inhaled carbon monoxide prevents acute kidney injury in pigs after cardiopulmonary bypass by inducing a heat shock response.
Cardiopulmonary bypass (CPB) may be associated with acute kidney injury (AKI). Inhaled carbon monoxide (CO) is cyto- and organ-protective. We hypothesized that pretreatment with inhaled CO prevents CPB-associated AKI. ⋯ CO treatment before CPB was associated with evidence of renoprotection, demonstrated by fewer histological injuries and decreased cystatin C concentrations. The findings that the antiinflammatory and antiapoptotic effects of CO were accompanied by activation of HSP-70, which in turn were reversed by quercetin, suggest that renoprotection by pretreatment with inhaled CO before CPB is mediated by activation of the renal heat shock response.