Journal of anesthesia
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Journal of anesthesia · Jan 2004
Randomized Controlled Trial Clinical Trial Controlled Clinical TrialRopivacaine produces sensory blockade in the lumbar sacral region more frequently than mepivacaine in lower thoracic epidural anesthesia.
The first sacral nerve has the largest diameter among the spinal nerves and is resistant to local anesthetics. Ropivacaine is a newly developed local anesthetic. There is a possibility that a difference in chemical properties between ropivacaine and other local anesthetics produces a difference in the blockade of the S1 dermatome by lower thoracic epidural anesthesia. Mepivacaine, 2%, is frequently used for epidural anesthesia and produces a level of blockade similar to that of bupivacaine, 0.5%. The purpose of this study was to examine the sensory blockade in the sacral region induced by ropivacaine with that induced by mepivacaine administered in the lower thoracic epidural space. ⋯ Ropivacaine, 1%, administered in the lower thoracic epidural space, induces sensory blockade to cold and pinprick in the S1 dermatome more frequently than 2% mepivacaine.
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Journal of anesthesia · Jan 2004
Randomized Controlled Trial Clinical TrialIsoflurane increases, but sevoflurane decreases blood concentrations of melatonin in women.
The blood concentrations of melatonin are elevated by stress-induced sympathetic nerve excitation and are affected by some anesthetics. Isoflurane has an effect to increase sympathetic nerve activity when compared with sevoflurane. This study was performed to investigate the effects of these two anesthetics on the blood concentrations of melatonin. ⋯ We obtained blood samples before and 5 min after 5% isoflurane (ISO group) or 7% sevoflurane (SEV group) anesthesia. The blood melatonin concentrations during anesthesia in the ISO group increased significantly, from 65 +/- 60 to 170 +/- 90 pg x ml(-l); mean +/- SD ( P < 0.05), whereas those in the SEV group decreased, from 60 +/- 50 to 30 +/- 30 pg x ml(-l) ( P < 0.05). In conclusion, isoflurane increases, but sevoflurane decreases blood melatonin concentrations.
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Journal of anesthesia · Jan 2004
Randomized Controlled Trial Clinical TrialAddition of epinephrine to intrathecal tetracaine augments depression of the bispectral index during intraoperative propofol sedation.
Epinephrine added to local anesthetic agents for spinal anesthesia is frequently used to prolong the duration of anesthesia. Epinephrine stimulates the alpha-adrenoceptor, and it is known that the alpha2-adrenoceptor agonists have a central inhibitory effect. We investigated the effect of intrathecal epinephrine during propofol sedation with spinal anesthesia, using a bispectral index (BIS) monitor. ⋯ Intrathecal epinephrine augments the sedative effect of propofol during spinal anesthesia.
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Journal of anesthesia · Jan 2004
Clinical TrialSystemic ATP infusion improves spontaneous pain and tactile allodynia, but not tactile hypesthesia, in patients with postherpetic neuralgia.
Activation of purinoceptors may improve neuropathic pain. Accordingly, the effects of systemic ATP infusion were assessed in patients with postherpetic neuralgia (PHN). ⋯ This study demonstrated that repetitive intravenous ATP infusion could improve spontaneous continuous pain and paroxysmal pain, as well as improving tactile allodynia, but did not influence tactile hypesthesia.
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Journal of anesthesia · Jan 2004
The volatile anesthetics halothane and isoflurane differentially modulate proinflammatory cytokine-induced p38 mitogen-activated protein kinase activation.
Volatile anesthetics affect the cardiovascular and immune systems. Toward a better understanding of the molecular mechanisms behind the modulation exerted by these agents, we focused on the effects of halothane and isoflurane on the activation of p38 mitogen-activated protein kinase (MAPK), which plays a critical role in the cellular responses to extracellular stimuli such as lipopolysaccharide (LPS) and proinflammatory cytokines, including tumor necrosis factor (TNF) and interleukin 1 (IL-1). ⋯ Our in vitro results indicate that the volatile anesthetics used in the clinical field and in animal experiments modify the p38 MAPK signaling cascade and suggest that the target molecules of the anesthetics are not unique and the anesthetics regulate them differentially at clinically relevant doses.