Anesthesia and analgesia
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Anesthesia and analgesia · Jan 2011
Case ReportsCase report: computed tomography scan-guided Gasserian ganglion injection of dexamethasone and lidocaine for the treatment of recalcitrant pain associated with herpes simplex type 1 infection of the ophthalmic division of the trigeminal nerve.
We describe the case of a 17-year-old boy with dermatologic herpes simplex virus-1 outbreaks with incapacitating facial pain requiring multiple hospitalizations. He failed to respond to aggressive treatments including antiviral drugs, opioid analgesics, stellate ganglion, and supraorbital and supratrochlear nerve blocks. ⋯ The patient remained pain free during 6-month follow-up visits. This is the first reported use of Gasserian ganglion block for treatment of herpes simplex virus-1 infection of the trigeminal nerve.
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Anesthesia and analgesia · Nov 2011
Comparative StudySpontaneous breathing improves shunt fraction and oxygenation in comparison with controlled ventilation at a similar amount of lung collapse.
Spontaneous breathing (SB), when allowed during mechanical ventilation (MV), improves oxygenation in different models of acute lung injury. However, it is not known whether oxygenation is improved during mechanically unsupported SB. Therefore, we compared SB without any support with controlled MV at identical tidal volume (VT) and respiratory rate (RR) without positive end-expiratory pressure in a porcine lung collapse model. ⋯ SB without any support improves oxygenation and reduces shunt in comparison with MV at identical settings. This seems to be achieved without any major signs of recruitment of collapsed lung regions.
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Anesthesia and analgesia · Nov 2011
Validation and insights of anesthetic action in an early vertebrate network: the isolated lamprey spinal cord.
The lamprey spinal cord is a well-characterized vertebrate network that could facilitate our understanding of anesthetic action. We tested several hypotheses concerning the lamprey's clinical application to anesthesia, and the sites/mechanisms of anesthetic action. ⋯ The lamprey spinal cord is a relevant and tractable vertebrate network model for anesthetic action. Isoflurane disrupts interneuronal locomotor networks. γ-Aminobutyric acid A and glycine receptors have marginal roles in isoflurane-induced immobility in lampreys. Propofol's selective γ-aminobutyric acid A receptor-mediated immobilizing mechanism is conserved in lampreys. The differential immobilizing mechanisms of isoflurane versus propofol reflect those in mammals, and further suggest different network modes of immobilizing action.
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Anesthesia and analgesia · Nov 2011
Editorial CommentAnesthetic neurotoxicity: a difficult dragon to slay.
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Anesthesia and analgesia · Nov 2011
Hemodynamic perturbations during robot-assisted laparoscopic radical prostatectomy in 45° Trendelenburg position.
Robot-assisted laparoscopic radical prostatectomy has gained widespread use. However, circulatory effects in patients subjected to an extreme Trendelenburg position (45°) are not well characterized. ⋯ Pneumoperitoneum and 45° Trendelenburg position caused 2- to 3-fold increases in filling pressures, without effects on cardiac performance. Filling pressures were normalized immediately after surgery. Lung compliance was halved. Gas exchange was unaffected. No perioperative cardiovascular complications occurred.