Anesthesia and analgesia
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Anesthesia and analgesia · Jan 2012
The relationship between preoperative and primary care blood pressure among veterans presenting from home for surgery: is there evidence for anesthesiologist-initiated blood pressure referral?
American College of Cardiology/American Heart Association guidelines describe the perioperative evaluation as "a unique opportunity to identify patients with hypertension"; however, factors such as anticipatory stress or medication noncompliance may induce a bias toward higher blood pressure, leaving clinicians unsure about how to interpret preoperative hypertension. Information describing the relationship between preoperative intake blood pressure and primary care measurements could help anesthesiologists make primary care referrals for improved blood pressure control in an evidence-based fashion. We hypothesized that the preoperative examination provides a useful basis for initiating primary care blood pressure referral. ⋯ A small bias toward higher DOS blood pressures relative to subsequent primary care measurements was observed. DOS factors predicted only a small proportion of the observed variation. Accounting for the observed bias, a 2-stage SBP threshold and a single-reading DBP threshold were highly specific though insensitive for identifying subsequent primary care blood pressure elevation.
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Anesthesia and analgesia · Jan 2012
Brief reports: ultrasound-guided obturator nerve block: a proximal interfascial technique.
In this report, I describe and evaluate a proximal ultrasound (US)-guided obturator nerve block technique using an interfascial local anesthetic (LA) injection deep to the pectineus muscle. ⋯ The US-guided obturator nerve block using interfascial LA injection inferior to the superior pubic ramus, between the pectineus and obturator externus muscles, was shown to be a simple and successful technique.
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Anesthesia and analgesia · Jan 2012
ED50 and recovery times after propofol in rats with graded cirrhosis.
Patients with end-stage liver disease have increased sensitivity to general anesthetics. In this study, we sought to quantify sensitivity to propofol as a function of the degree of liver disease, in a rat model of cirrhosis. ⋯ Propofol sensitivity is not significantly affected in the setting of mild liver disease, similar to clinical observations, but end-stage liver disease (fibrosis) is associated with significantly prolonged time to recovery after propofol infusion. The progressive liver disease model used in these studies is useful for rigorously studying anesthetic sensitivity as a function of degree of hepatocellular-fibrotic liver disease.
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Human serum albumin (HSA) is an important carrier for opioids. However, the locations of the binding sites remain unclear. In the present study, we have characterized opioid-HSA interactions using multiple biochemical and biophysical techniques to reveal: (a) the location of the binding site(s); (b) whether naloxone shares the binding site with morphine; and (c) whether opioid agonists share their binding site(s) with general anesthetics. ⋯ The interaction of opioids with HSA is weak in comparison with propofol. Naloxone has a distinct binding site in HSA not shared with opioid agonists. Opioids share binding sites with general anesthetics in HSA.