Journal of anesthesia
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Journal of anesthesia · Jan 2008
Adhesiolysis and targeted steroid/local anesthetic injection during epiduroscopy alleviates pain and reduces sensory nerve dysfunction in patients with chronic sciatica.
The aim of this study was to evaluate the effect of adhesiolysis followed by the injection of steroid and local anesthetic during epiduroscopy on sensory nerve function, pain, and functional disability in patients with chronic sciatica. ⋯ Epidural adhesiolysis followed by the injection of steroid and local anesthetic during epiduroscopy alleviated pain, and functional disability, and reduced dysfunction of Abeta and Adelta fibers in patients with chronic sciatica.
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Journal of anesthesia · Jan 2008
Maternal satisfaction with single-dose spinal analgesia for labor pain in Indonesia: a landmark study.
The purpose of this study was to assess maternal satisfaction with single-dose spinal analgesia for the management of obstetric pain in Indonesian women. The investigation included 62 laboring women with single pregnancy at term, with 45 primigravidas and 17 multigravidas. The participants' ages ranged from 15 to 29 years. ⋯ Our study was the first one in Indonesia to assess maternal satisfaction with single-dose spinal analgesia for labor pain. We concluded that single-dose spinal analgesia with a combination of bupivacaine, morphine, and clonidine provided effective labor pain control for Indonesian women, and maternal satisfaction with this technique was very high. This technique is very cost-effective and should be recommended for routine obstetric pain control in Indonesia and other developing countries.
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Journal of anesthesia · Jan 2008
Recovery of neuromuscular blockade caused by vecuronium is delayed in patients with hypertriglyceridemia.
We investigated the effects of hypertriglyceridemia on the onset and recovery of neuromuscular blockade, induced by vecuronium, over the adductor pollicis muscle, electromyographically. Eighteen adult patients with hypertriglyceridemia (hypertriglyceridemia group) and 18 healthy patients with normal serum triglyceride (control group) were studied. The supramaximal stimulating current for train-of-four (TOF) in the hypertriglyceridemia group was significantly higher than that in the control group (45.7 +/- 16.7 vs 31.5 +/- 9.8 mA; mean +/- SD; P = 0.004). ⋯ During recovery from neuromuscular blockade, T1/control did not differ between the two groups. However, the TOF ratios (T4/T1) in the hypertriglyceridemia group were significantly lower than those in the control group 80-120 min after vecuronium (P < 0.05). We conclude that, in patients with hypertriglycemidemia, a higher current is needed to elicit supramaximal response of the adductor pollicis muscle, and recovery from vecuronium-induced neuromuscular blockade is delayed.
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Journal of anesthesia · Jan 2008
Peroxynitrite affects lidocaine by acting on membrane-constituting lipids.
Inflammation frequently decreases local anesthetic effects, especially in dental anesthesia in patients with pulpitis and periodontitis. The pharmacokinetics and the mode of action of local anesthetics are closely associated with the hydrophobic interactions between these drugs and lipid bilayers that change the membrane physicochemical property, fluidity. A lipid oxidant, peroxynitrite, is produced by inflammatory cells, and it may act on nerve cell membranes and affect anesthetic efficacy. ⋯ Peroxynitrite (0.1-50 microM) rigidified nerve-cell model membranes consisting of unsaturated phospholipids, as well as liposomal membranes consisting of 1,2-dioleoylphosphatidylcholine and 1-stearoyl-2-arachidonylphosphatidylcholine, but peroxynitrite did not rigidify 1, 2-dipalmitoylphosphatidylcholine liposomal membranes. The pretreatment of nerve-cell model membranes with peroxynitrite (0.1-50 microM) decreased the membrane-fluidizing effects of lidocaine (5.0 mg x ml(-1)) to 63%-86% of the control (not treated with peroxynitrite) depending on the peroxynitrite concentration. As one of the mechanisms of the local anesthetic failure associated with inflammation, inflammatory peroxynitrite may affect local anesthesia by acting on membrane-constituting unsaturated phospholipids.