Anesthesia and analgesia
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Anesthesia and analgesia · Aug 2014
Performance of Propofol Target-Controlled Infusion Models in the Obese: Pharmacokinetic and Pharmacodynamic Analysis.
Obesity is associated with important physiologic changes that can potentially affect the pharmacokinetic (PK) and pharmacodynamic (PD) profile of anesthetic drugs. We designed this study to assess the predictive performance of 5 currently available propofol PK models in morbidly obese patients and to characterize the Bispectral Index (BIS) response in this population. ⋯ The Eleveld allometric PK model proved to be superior to all other tested models using TBW. All models, however, showed a trend to underestimate propofol concentrations. The use of adjusted body weight instead of TBW with the traditional Schnider and Marsh models markedly improved their performance achieving the lowest predictive errors of all tested models. Our results suggest no relevant effect of obesity on both the time profile of BIS response and the propofol concentration-BIS relationship.
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Anesthesia and analgesia · Aug 2014
Review Historical ArticleCoagulation, flocculation, and denaturation: a century of research into protoplasmic theories of anesthesia.
Within two decades of the discovery of anesthesia, the physicochemical concept of colloid and the biological concept of protoplasm had emerged. Fusion of these concepts into a theoretical framework, which has been largely forgotten decades ago, promised to uncover fundamental biological truths and determined research into anesthetic mechanisms for a century after "Ether Day." Observations of optical changes in unstained tissue were condensed into a theory of anesthesia by coagulation of protoplasm in the 1870s. ⋯ This large body of work, swept aside during the decades of lipid membrane hegemony, has remained in obscurity even after proteins in excitable membranes became firmly established as mediators of the immediate anesthetic effects. This article is a reminder of the prolonged interdisciplinary research effort dedicated to "protoplasmic theories" at a time when attention is increasingly directed toward examining the nature of (un)consciousness well as noncanonical consequences of anesthetic exposure that are not easily accounted for within conventional pharmacological concepts.
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Anesthesia and analgesia · Aug 2014
The Implementation of Quantitative Electromyographic Neuromuscular Monitoring in an Academic Anesthesia Department.
Although experts agree on the importance of quantitative neuromuscular blockade monitoring, particularly for managing reversal, such monitoring is not in widespread use. We describe the processes and results of our departmental experience with the introduction of such quantitative monitoring. ⋯ Implementation of universal electromyographic-based quantitative neuromuscular blockade monitoring required a sustained process of education along with repeated PACU surveys and feedback to providers. Nevertheless, this effort resulted in a significant reduction in the incidence of incompletely reversed patients in the PACU.
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Anesthesia and analgesia · Aug 2014
The Role of Hippocampal Tau Protein Phosphorylation in Isoflurane-Induced Cognitive Dysfunction in Transgenic APP695 Mice.
Previous studies have shown that exposure to inhaled anesthetics can cause cognitive dysfunction, suggesting that general anesthesia might be a risk factor for the development of Alzheimer disease. However, the underlying mechanisms remain to be elucidated. In the present study, we tested our hypothesis that enhanced tau protein phosphorylation in hippocampus contributes to isoflurane-induced cognitive dysfunction in a mouse model of Alzheimer disease. ⋯ Isoflurane may induce cognitive dysfunction by enhancing phosphorylation of hippocampal tau protein at Ser262 site, and this effect is more significant in transgenic APP695 mice.
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Anesthesia and analgesia · Aug 2014
Mechanisms of Lidocaine's Action on Subtypes of Spinal Dorsal Horn Neurons Subject to the Diverse Roles of Na+ and K+ Channels in Action Potential Generation.
Superficial dorsal horn neurons of the spinal cord receive sensory information from Aδ and C fibers. According to their response to sustained depolarization, these cells can be divided into 3 groups: tonic (TFN), adapting (AFN), and single spike firing (SSN) neurons. During spinal and systemic administration of lidocaine, these neurons are exposed to different concentrations of the local anesthetic lidocaine. In this study, we explored its effect on the excitability of sensory neurons. ⋯ Lidocaine at low concentrations suppresses tonic firing neurons by interacting with voltage-gated potassium channels. The effects on adapting firing neurons can be explained by an interaction with voltage-gated sodium channels. In contrast, the firing pattern of SSN is not affected at the administered concentrations. This different sensitivity to low concentrations of sodium and particularly of potassium channel blockers might represent a novel approach for a differentiated blockade of different spinal dorsal horn neurons.