Anesthesia and analgesia
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Anesthesia and analgesia · Jan 2010
Pressures available for transtracheal jet ventilation from anesthesia machines and wall-mounted oxygen flowmeters.
Oxygen supplies capable of supporting transtracheal jet ventilators can be lifesaving. There is not much information about which oxygen sources (readily available inside and outside operating rooms) have sufficient driving pressure for transtracheal jet ventilation. ⋯ Oxygen sources other than dedicated jet ventilator connectors to high-pressure pipeline oxygen may supply adequate working pressure, but each type of oxygen source needs testing to ensure that it supplies adequate working pressure.
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Anesthesia and analgesia · Jan 2010
The first scintigraphic detection of tumor necrosis factor-alpha in patients with complex regional pain syndrome type 1.
Tumor necrosis factor (TNF)-alpha has been identified as a pathogenic factor in many immunologically based diseases and complex regional pain syndrome (CRPS). In this case series, we used radiolabeled technetium anti-TNF-alpha antibody to scintigraphically image TNF-alpha in 3 patients with type 1 CRPS. ⋯ No uptake was seen in clinically unaffected hands and late-stage CRPS. Our findings support the growing evidence for neuroimmune disturbance in patients with CRPS and may have important further implications for specific anticytokine treatment in patients with CRPS.
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Anesthesia and analgesia · Jan 2010
Transient changes in brain tissue oxygen in response to modifications of cerebral perfusion pressure: an observational study.
The relative merits of the mechanisms for the maintenance of brain tissue oxygenation (PbtO(2)) have been much debated. There is a wealth of studies regarding various factors that may determine the absolute value and changes in PbtO(2). However, only a few of them analyzed fast (few minutes) and transient behavior of PbtO(2) in response to variations (waves) of intracranial pressure (ICP) and cerebral perfusion pressure (CPP). ⋯ PbtO(2) is more than a number; it is rather a waveform following rapid changes in ICP and ABP. We show that PbtO(2) generally tracks the direction of CPP irrespective of the state of cerebral autoregulation.
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Anesthesia and analgesia · Jan 2010
Closed-circuit xenon delivery using a standard anesthesia workstation.
Xenon (Xe) is an anesthetic with minimal side effects, now also showing promise as a neuroprotectant both in vitro and in vivo. Although scarce and expensive, Xe is insoluble and patient uptake is low, making closed circuits the optimum delivery method. Although the future of Xe anesthesia is uncertain, effective neuroprotection is highly desirable even if moderately expensive. A factor limiting Xe research in all these fields may be the perceived need to purchase special Xe anesthesia workstations that are expensive and difficult to service. We investigated the practicality of 1) true closed-circuit Xe delivery using an unmodified anesthesia workstation with gas monitoring/delivery attachments restricted to breathing hoses only, 2) a Xe delivery protocol designed to eliminate wastage, and 3) recovering Xe from exhaled gas. ⋯ We report that closed-circuit Xe delivery can be achieved with a modified standard anesthesia workstation with breathing hose alterations only and that the protocol was very gas efficient, especially during the normally wasteful Xe wash-in. A Xe mixture of > or = 50% was delivered for up to 341 min (5 h 41 min) and Xe consumption was 4.95 (0.82) L/h, maintenance being achieved with 2-3 L/h. With this degree of efficiency, Xe recovery/recycling at the end of anesthesia may be of little additional benefit.
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Anesthesia and analgesia · Jan 2010
Thoracic paravertebral block using real-time ultrasound guidance.
We developed a technique for ultrasound-guided paravertebral block, which was subsequently applied in the clinical setting. ⋯ Determined by anatomical dissection, we have described the ultrasound features of the thoracic paravertebral space and performed clinically successful ultrasound-guided paravertebral block.