Anesthesia and analgesia
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Anesthesia and analgesia · Mar 2015
Retracted PublicationThe impact of anesthesiologists on coronary artery bypass graft surgery outcomes.
One of every 150 hospitalized patients experiences a lethal adverse event; nearly half of these events involves surgical patients. Although variations in surgeon performance and quality have been reported in the literature, less is known about the influence of anesthesiologists on outcomes after major surgery. Our goal of this study was to determine whether there is significant variation in outcomes between anesthesiologists after controlling for patient case mix and hospital quality. ⋯ The rate of death or major complications among patients undergoing coronary artery bypass graft surgery varies markedly across anesthesiologists. These findings suggest that there may be opportunities to improve perioperative management to improve outcomes among high-risk surgical patients.
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Anesthesia and analgesia · Mar 2015
Comparative StudyLidocaine Preferentially Inhibits the Function of Purinergic P2X7 Receptors Expressed in Xenopus Oocytes.
Lidocaine has been widely used to relieve acute pain and chronic refractory pain effectively by both systemic and local administration. Numerous studies reported that lidocaine affects several pain signaling pathways as well as voltage-gated sodium channels, suggesting the existence of multiple mechanisms underlying pain relief by lidocaine. Some extracellular adenosine triphosphate (ATP) receptor subunits are thought to play a role in chronic pain mechanisms, but there have been few studies on the effects of lidocaine on ATP receptors. We studied the effects of lidocaine on purinergic P2X3, P2X4, and P2X7 receptors to explore the mechanisms underlying pain-relieving effects of lidocaine. ⋯ Lidocaine selectively inhibited the function of the P2X7 receptor expressed in Xenopus oocytes. This effect may be caused by acting on sites in the ion channel pore both extracellularly and intracellularly. These results help to understand the mechanisms underlying the analgesic effects of lidocaine when it is administered locally at least.
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Anesthesia and analgesia · Mar 2015
Multicenter Study Clinical TrialThe Reliability of the Current Perception Threshold in Volunteers and Its Applicability in a Clinical Setting.
Even though current perception threshold (CPT) has been used for evaluating the effectiveness of sensory block in patients before surgery, its reliability under controlled conditions has not been investigated. Two independent investigations were performed. The primary objective of the first study was to determine the test-retest reliability of CPT measures after repeated stimulations in a group of healthy volunteers. The primary objective of the second study was to evaluate the clinical applicability of this technique to assess the sensory onset of a femoral nerve block in patients undergoing knee surgery. ⋯ CPT proved to be a reliable assessment tool for within-day sensory perception in healthy volunteers. Our study also suggests that CPT can be applied to characterize, in a quantitative manner, the sensory onset of a peripheral nerve block in a clinical setting, thereby supporting its use in future studies comparing different regional anesthetic modalities or approaches.
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Anesthesia and analgesia · Mar 2015
Intrathecal RGS4 Inhibitor, CCG50014, Reduces Nociceptive Responses and Enhances Opioid-Mediated Analgesic Effects in the Mouse Formalin Test.
The regulator of G-protein signaling protein type 4 (RGS4) accelerates the guanosine triphosphatase activity of G(αi) and G(αo), resulting in the inactivation of G-protein-coupled receptor signaling. An opioid receptor (OR), a G(αi)-coupled receptor, plays an important role in pain modulation in the central nervous system. In this study, we examined whether (1) spinal RGS4 affected nociceptive responses in the formalin pain test, (2) this RGS4-mediated effect was involved in OR activation, and (3) the µ-OR agonist-induced antinociceptive effect was modified by RGS4 modulation. ⋯ These findings demonstrated that spinal RGS4 inhibited the endogenous or exogenous OR-mediated antinociceptive effect in the formalin pain test. Thus, the inhibition of RGS4 activity can enhance OR agonist-induced analgesia. The enhancement of OR agonist-induced analgesia by coadministration of the RGS4 inhibitor suggests a new therapeutic strategy for the management of inflammatory pain.