Anesthesia and analgesia
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Anesthesia and analgesia · Dec 2011
Comparative StudyApplication of the Rasch model to develop a simplified version of a multiattribute utility measurement on attitude toward labor epidural analgesia.
Valid and reliable measures based on health behavior theory, such as multiattribute utility decision theory, are essential to elucidate complex relationships between psychological factors and labor pain. In this study we aimed to use Rasch analysis to simplify a previously developed 20-item multidimensional questionnaire on attitude toward labor epidural analgesia using multiattribute utility theory. ⋯ We demonstrated application of the Rasch analysis to simplifying a multiattribute utility questionnaire without compromising reliability. Further study is necessary to determine whether the simplified questionnaire is valid for use in clinical practice.
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Anesthesia and analgesia · Dec 2011
Comparative StudyOperation timing and 30-day mortality after elective general surgery.
Human factors such as fatigue, circadian rhythms, scheduling, and staffing may have an impact on patient care over the course of a day across all medical specialties. Research by the transportation industry concludes that human performance is degraded by shift work, circadian rhythm disturbances, and prolonged duty. We investigated whether the timing of general surgery (specifically, increasing time of day, increasing day of week, July/August cases versus other months), and moon phase is independently related to 30-day mortality. A secondary outcome of composite in-hospital complications was also evaluated. ⋯ Elective general surgery appears to be comparably safe at any time of the workday, any day of the workweek, and in any month of the year.
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Anesthesia and analgesia · Dec 2011
Comparative StudyIntrathecal ultra-low dose naloxone enhances the antinociceptive effect of morphine by enhancing the reuptake of excitatory amino acids from the synaptic cleft in the spinal cord of partial sciatic nerve-transected rats.
In this study, we examined the effects of ultra-low dose naloxone on the antinociceptive effect of morphine and on spinal cord dorsal horn glutamate transporter expression in rats with neuropathic pain. ⋯ Ultra-low dose naloxone enhanced the antinociceptive effect of morphine in PST rats, possibly by restoration of GLAST and GLT-1 expression in astrocytes, which inhibited the accumulation of EAAs in the synapses, resulting in a neuroprotective effect.
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Anesthesia and analgesia · Dec 2011
Comparative StudyContinuous noninvasive hemoglobin monitoring during complex spine surgery.
Monitoring hemoglobin levels in the operating room currently requires repeated blood draws, several steps, and a variable time delay to receive results. Consequently, blood transfusion management decisions may be delayed or made before hemoglobin results become available. The ability to measure hemoglobin continuously and noninvasively may enable a more rapid assessment of a patient's condition and more appropriate blood management. A new technology, Pulse CO-Oximetry, provides a continuous, noninvasive estimate of hemoglobin concentration (SpHb) from a sensor placed on the finger. We evaluated the accuracy of SpHb compared with laboratory CO-Oximetry measurements of total hemoglobin (tHb) during complex spine procedures in patients at high risk for blood loss. ⋯ Continuous, noninvasive hemoglobin measurement via Pulse CO-Oximetry demonstrated clinically acceptable accuracy of hemoglobin measurement within 1.5 g/dL compared with a standard laboratory reference device when used during complex spine surgery. This technology may provide more timely information on hemoglobin status than intermittent blood sample analysis and thus has the potential to improve blood management during surgery.
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Anesthesia and analgesia · Dec 2011
Comparative StudyMutated p.4894 RyR1 function related to malignant hyperthermia and congenital neuromuscular disease with uniform type 1 fiber (CNMDU1).
Ryanodine receptor 1 (RyR1) is a Ca(2+) release channel located in the sarcoplasmic reticulum membrane of skeletal muscle. More than 200 variants in RyR1 have been identified in DNA from patients with malignant hyperthermia (MH) and congenital myopathies; only 30 have been sufficiently studied so as to be identified as MH-causative mutations. The Ala4894Thr RyR1 variant was found in a Japanese patient with susceptibility to MH, and the Ala4894Pro variant in a rare case of myopathy: congenital neuromuscular disease with uniform type 1 fiber (CNMDU1). We hypothesized that different Ala4894 variants of RyR1 cause different pathophysiological changes that are identifiable by having differing pharmacological sensitivities to RYR1 agonists. ⋯ We concluded that different Ala4894 variants of RyR1 lead to different agonist/antagonist sensitivities, which may predict differing RYR1 functionality during excitation-contraction coupling and sensitivity to MH. The hypersensitive Ala4894Thr-RyR1 is associated with MH and the poorly functional Ala4894Pro-RyR1 with CNMDU1.