Journal of anesthesia
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Emerging evidence from case reports suggests that fentanyl may precipitate potentially life-threatening serotonin syndrome in patients taking serotonergic drugs. However, the underlying mechanism of the association between serotonin syndrome and fentanyl remains under investigation. We therefore investigated the pharmacological effects of an analgesic dose of fentanyl (0.2 mg/kg) injected subcutaneously (s.c.) on serotonergic toxicity-like responses in rats. ⋯ Pretreatment with naloxone [2.0 mg/kg, intraperitoneal (i.p.) injection], an opioid receptor antagonist, failed to antagonize the fentanyl-induced exaggerated serotonin syndrome-like behaviors. In contrast, pretreatment with WAY-100653, a serotonin 5-HT1A receptor antagonist (0.5 mg/kg, i.p. injection) completely inhibited all responses. Our findings provide preclinical proof-of-concept that an analgesic dose of fentanyl enhances serotonin toxicity, likely via its serotonin-reuptake inhibitory activity, independently of interaction with the opioid receptors.
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Journal of anesthesia · Feb 2016
Randomized Controlled TrialThe effect of pregabalin and celecoxib on the analgesic requirements after laparoscopic cholecystectomy: a randomized controlled trial.
Early postoperative pain is a common complaint after elective laparoscopic cholecystectomy. The use of non-opioid medications as a part of multimodal analgesia has been increasingly advocated in the management of acute post-surgical pain. This randomized, double-blinded, placebo-controlled study evaluated the efficacy of pregabalin, celecoxib, and their combination in the management of acute postoperative pain in patients undergoing elective laparoscopic cholecystectomy. ⋯ Pregabalin, celecoxib alone, or in combination offers no analgesic superiority over standard opioid care in the treatment of postoperative pain following laparoscopic cholecystectomy.
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Journal of anesthesia · Feb 2016
ReviewDevelopment of technologies for placement of perineural catheters.
Continuous peripheral nerve block (CPNB) success is largely dependent on placement of the catheter close enough to the nerve to allow effective and sustained analgesia following painful surgeries with a minimum volume of local anesthetic. One of the most common problems associated with CPNB involves accurate placement of the catheter tip, migration, and dislodgement of the catheter. ⋯ In response to the challenges of providing safe, effective, and consistently reliable analgesia, research and development in this field is expanding rapidly. This review article presents results from recent publications addressing the subject of peripheral nerve catheter localization.
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Journal of anesthesia · Feb 2016
Case ReportsAcute intraoperative neurogenic myocardial stunning during intracranial endoscopic fenestration and shunt revision in a pediatric patient.
Neurogenic stunned myocardium (NSM) is syndrome of myocardial dysfunction following an acute neurological insult. We report a case of NSM that occurred intraoperatively in a pediatric patient undergoing endoscopic fenestration and shunt revision. Accidental outflow occlusion of irrigation fluid and ventricular distension resulted in an acute increase in heart rate and arterial blood pressure. ⋯ She was later discharged to home on the fourth postoperative day. In the current endoscopic era, this report highlights the possibility of intraoperative NSM and neurogenic pulmonary edema in the pediatric population. Early detection and treatment with a team approach help to achieve optimal control of this life-threatening condition and improve the outcome.