Anesthesia and analgesia
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Anesthesia and analgesia · Aug 2011
An in vitro investigation of the coagulation effects of exogenous oxytocin using thromboelastography in healthy parturients.
We investigated the coagulation effects in vitro of exogenous oxytocin in whole blood of healthy term parturients. ⋯ The results of this in vitro investigation suggest that exogenous oxytocin is associated with modest hypercoagulable effects in the maternal blood of healthy term parturients.
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Anesthesia and analgesia · Aug 2011
Mean arterial pressures bracketing prolonged monitoring interruptions have negligible systematic differences from matched controls without such gaps.
Comparing intraoperative hemodynamic data from anesthesia information management systems (AIMS) among hospitals involves handling missing or edited values. There routinely are periods >5 minutes ("gaps") in recorded blood pressure in AIMS records. Previous studies showed the importance of monitoring the incidences of unexplained gaps, because providers interpolate when charting vital signs in gaps. We studied whether ignoring missing vital signs during gaps systematically biases monitoring results. ⋯ Our results show that when comparing hospitals using mean MAP data from hundreds of AIMS cases, statistical issues related to gaps are of minor importance. The more important issues when comparing hospitals are the incidences of gaps themselves and/or the manual editing of automatically recorded vital signs. Nevertheless, when quantifying hemodynamic variability (e.g., brief periods with rapid changes in MAP), gaps cannot be ignored. Furthermore, none of our results apply to individual patients (i.e., it is best not to have gaps in blood pressure during anesthesia).
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Anesthesia and analgesia · Aug 2011
Airway collapse with an anterior mediastinal mass despite spontaneous ventilation in an adult.
Patients with anterior mediastinal masses are at increased risk for perioperative complications. Our case demonstrates that airway collapse and inability to ventilate may occur in the asymptomatic adult despite spontaneous ventilation with inhaled anesthesia and an endotracheal tube. ⋯ Though repositioning the pediatric patient lateral or prone has been reported to reestablish airway patency, this maneuver may be of limited benefit in the adult population because of a more ossified and developed chest wall. Lastly, if a high-risk patient requires a general anesthetic, strong consideration should be given to preinduction placement of femoral cardiopulmonary bypass cannulae and the availability to immediately initiate cardiopulmonary bypass.
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Anesthesia and analgesia · Aug 2011
Delayed preconditioning by sevoflurane elicits changes in the mitochondrial proteome in ischemia-reperfused rat hearts.
Delayed myocardial preconditioning by volatile anesthetics involves changes in DNA transcription and translation. Mitochondria play a central role in myocardial ischemia/reperfusion (I/R) injury and in ischemic or pharmacologic preconditioning. In this study, we investigated whether there are alterations in myocardial mitochondrial protein expression after volatile anesthetic preconditioning (APC) to examine the underlying mechanisms of delayed cardioprotection. ⋯ Delayed sevoflurane myocardial preconditioning induces mitochondrial proteome remodeling, which mainly involves proteins that are related to ATP generation and transport. Therefore, proteomic changes related to bioenergetic balance may be the mechanistic basis of delayed anesthetic myocardial preconditioning.
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Anesthesia and analgesia · Aug 2011
The macrophage-mediated effects of the peroxisome proliferator-activated receptor-gamma agonist rosiglitazone attenuate tactile allodynia in the early phase of neuropathic pain development.
Neuroinflammation triggered by macrophage infiltration into sites of peripheral nerve injury may result in neuropathic pain. Peroxisome proliferator-activated receptor (PPAR)γ signaling regulates the properties of macrophages. However, the macrophage-mediated effects of PPARγ signaling on neuropathic pain triggered by peripheral inflammation have not been investigated. ⋯ Rosiglitazone treatment in the early phase of neuropathic pain significantly alleviated the development of tactile allodynia by regulating macrophage infiltration and production of proinflammatory molecules at the inflamed site. Our results indicate that the activation of PPARγ signaling in macrophages during the early phase may suppress neuropathic pain development.