Anesthesia and analgesia
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Anesthesia and analgesia · Jan 2012
Case ReportsCase report: automated machine checkout leaves an internal gas leak undetected: the need for complete checkout procedures.
We report a complete internal fresh gas flow disconnect within a Dräger Fabius GS anesthesia machine without any alarms being triggered. This was undetected primarily because of an incomplete machine checkout in which the step of ensuring proper gas flows by using a "test lung" was omitted. Machine-specific factors, however, also contributed to prevent diagnosis: (1) the machine passed its leak test because the flowmeter bobbin (i.e., floating ball) sealed the flowmeter when back pressure was applied; (2) the mechanical ventilator entrains room air, thus functioning in the absence of fresh gas flow; and (3) the electronic flow sensors functioned "appropriately" because the leak was downstream. Despite the advent of highly automated machines, manual checkout procedures remain crucial to minimizing undiagnosed failures.
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Anesthesia and analgesia · Jan 2012
Clinical TrialCardiovascular effects of dexmedetomidine sedation in children.
Dexmedetomidine (DEX) affects heart rate (HR), mean arterial blood pressure, cardiac index (CI), stroke index (SI), and systemic vascular resistance index (SVRI) in adults. In this study we sought to determine whether similar effects occur in children undergoing DEX sedation. ⋯ DEX decreases CI in children and has a cumulative effect. For patients undergoing prolonged procedures HR and CI remained decreased at the time of discharge together with a decrease in SI and an increase in SVRI.
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Anesthesia and analgesia · Jan 2012
Salvinorin A pretreatment preserves cerebrovascular autoregulation after brain hypoxic/ischemic injury via extracellular signal-regulated kinase/mitogen-activated protein kinase in piglets.
Cerebral hypoxia/ischemia during infant congenital heart surgery is not uncommon and may induce devastating neurologic disabilities persistent over the lifespan. Hypoxia/ischemia-induced cerebrovascular dysfunction is thought to be an important contributor to neurological damage. No pharmacological agents have been found to prevent this. Mitogen activated protein kinase (MAPK), including extracellular signal regulated kinase (ERK), c-Jun-N-terminal kinase, and p38, is thought to contribute to ischemic preconditioning. We investigated whether pretreatment with salvinorin A, the only natural nonopioid κ receptor agonist, could preserve autoregulation of the pial artery via MAPK. ⋯ Salvinorin A pretreatment preserves autoregulation of the pial artery to hypotension and hypercapnia after hypoxia/ischemia via ERK in a piglet model.