Journal of anesthesia
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Journal of anesthesia · Oct 2014
ReviewEpidural anesthesia and analgesia in the neonate: a review of current evidences.
The role of single shot spinal anesthesia has been established in ex-premature infants at risk of apnea. However, use of epidural anesthesia in neonates is on the rise. In this systematic analysis, we have reviewed the current evidence on the safety and efficacy of the use of single shot and continuous epidural anesthesia/analgesia in neonates. ⋯ Use of continuous epidural anesthesia through the caudal route or caudo-thoracic advancement of the catheter for major thoracic and abdominal surgery offers good perioperative analgesia. Other observed benefits are early extubation, attenuation of stress response, early return of bowel function and reduction of general anesthesia-related postoperative complications. However, risk of procedure-related and drug-related complications to the developing neural structure remains a serious concern.
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Journal of anesthesia · Oct 2014
Randomized Controlled Trial Comparative StudyEvaluation of chest compression effect on airway management with air-Q(®), aura-i (®), i-gel (®), and Fastrack (®) intubating supraglottic devices by novice physicians: a randomized crossover simulation study.
In the 2010 American Heart Association guidelines, supraglottic devices (SGDs) such as the laryngeal mask are proposed as alternatives to tracheal intubation for cardiopulmonary resuscitation. Some SGDs can also serve as a means for tracheal intubation after successful ventilation. The purpose of this study was to evaluate the effect of chest compression on airway management with four intubating SGDs, aura-i (aura-i), air-Q (air-Q), i-gel (i-gel), and Fastrack (Fastrack), during cardiopulmonary resuscitation using a manikin. ⋯ This simulation study revealed the utility of intubating SGDs for airway management during chest compression.
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Journal of anesthesia · Oct 2014
ReviewCellular signaling pathways and molecular mechanisms involving inhalational anesthetics-induced organoprotection.
Inhalational anesthetics-induced organoprotection has received much research interest and has been consistently demonstrated in different models of organ damage, in particular, ischemia-reperfusion injury, which features prominently in the perioperative period and in cardiovascular events. The cellular mechanisms accountable for effective organoprotection over heart, brain, kidneys, and other vital organs have been elucidated in turn in the past two decades, including receptor stimulations, second-messenger signal relay and amplification, end-effector activation, and transcriptional modification. ⋯ The salubrious effects of inhalational anesthetics on vital organs, if reproducible in human subjects in clinical settings, would be of exceptional clinical importance, but clinical studies with better design and execution are prerequisites for valid conclusions to be made. Xenon as the emerging inhalational anesthetic, and its organoprotective efficacy, mechanism, and relative advantages over other anesthetics, are also discussed.
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The nociceptin system comprises the nociceptin receptor (NOP) and the ligand nociceptin/orphanin FQ (N/OFQ) that binds to the receptor. The archetypal role of the system is in pain processing but the NOP receptor is also expressed on immune cells. ⋯ As there is a loss of regulation of inflammatory responses during sepsis, the nociceptin system could be a target for therapies aimed at modulating sepsis. This review details the known effects of NOP activation on leucocytes and the vascular endothelium and discusses the most recent human and animal data on the role of the nociceptin system in sepsis.
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Journal of anesthesia · Oct 2014
Comparative StudyEvaluation of the peripheral analgesic effect of sufentanil lipid nanoparticles.
We wished to evaluate the effect of sufentanil lipid nanoparticles on peripheral analgesia of inflammatory pain model rats. ⋯ Sufentanil lipid nanoparticles had a comparatively weak effect on the central nervous system because of their features such as large particle size and targeted and controlled release. They have shown a remarkable analgesic effect in the peripheral inflammatory pain areas.