Canadian journal of anaesthesia = Journal canadien d'anesthésie
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Morphine is an effective analgesic, but adverse effects limit its clinical use in higher doses. The non-opioid antitussive, dextromethorphan (DM), can potentiate the analgesic effect of morphine and decrease the dose of morphine in acute postoperative pain, but the underlying mechanism remains unclear. We previously observed that DM increases the serum concentration of morphine in rats. Therefore, we investigated the effects of drugs administered at the spinal level to exclude possible pharmacokinetic interactions. As DM has widespread binding sites in the central nervous system [such as N-methyl-D-aspartate (NMDA) receptors, sigma receptors and alpha(3)ss(4) nicotinic receptors], we investigated whether the potentiation of morphine antinociception by DM at the spinal level is related to NMDA receptors. ⋯ Our results suggest that spinal NMDA receptors play an important role in the effect of DM to potentiate morphine antinociception.
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To report a preliminary analysis of prospectively recorded data in 27 children in whom patient-controlled regional analgesia (PCRA) was used for postoperative pain control following lower limb surgery. ⋯ Our preliminary observations indicate that PCRA in children provides satisfactory postoperative pain relief following lower limb surgery.
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Case Reports
Anesthetic management of Cesarean delivery in a patient with hypoplastic anemia and severe pre-eclampsia.
To describe the anesthetic management of Cesarean delivery in a patient with hypoplastic anemia and severe pre-eclampsia. ⋯ Hypoplastic anemia is rare in pregnancy but it poses an increased risk for both mother and fetus. The mother is at risk of life-threatening episodes of bleeding and infection and a multidisciplinary team approach (obstetrician, anesthesiologist, hematologist and pediatrician) is essential. An accurate assessment of the hematological condition should be made and abnormalities corrected before surgery. Regional anesthesia may not be possible in this circumstance.
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To describe cardiovascular collapse during a cemented hip hemiarthroplasty in a patient who, despite a successful cardiopulmonary resuscitation, remained in a persistent vegetative state due to cerebral fat embolism diagnosed by magnetic resonance imaging (MRI). ⋯ When fat embolism is suspected, serial MRI scans of the brain should be performed to diagnose the etiology of cerebral embolism as well as to evaluate the severity of brain damage.
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Comparative Study
Posterior tibial nerve and median nerve somatosensory evoked potential monitoring during carotid endarterectomy.
Somatosensory evoked potential (SSEP) monitoring using the median nerve (MN) modality during carotid endarterectomy is well established. This study assessed the usefulness of monitoring the posterior tibial nerve (PTN) SSEP as an adjunct to MNSSEP for detection of cerebral ischemia and as an indicator for the insertion of a shunt in patients undergoing a carotid endarterectomy. ⋯ Monitoring of PTNSSEP is feasible and may be considered for an adjunct to MNSSEP or as an alternative modality if there are difficulties with MNSSEP. However, there may be a greater incidence of poor quality baseline tracings for PTNSSEP.