Acta anaesthesiologica Scandinavica
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Acta Anaesthesiol Scand · Jan 2005
Randomized Controlled Trial Comparative Study Clinical TrialSevoflurane induces less cerebral vasodilation than isoflurane at the same A-line autoregressive index level.
The use of sevoflurane in neuroanesthesia is still under debate. Comparison of dose-dependent vasodilatory properties between sevoflurane and isoflurane, the more traditional neuroanesthetic agent, requires comparable dosing of the agents. A-line autoregressive index (AAI) provides reproducible individual measurement of anesthetic depth. ⋯ Sevoflurane induced less cerebral vasodilation than isoflurane at the same depth of anesthesia, measured by AAI, and hence seems more favorable for clinical neuroanesthesia. In our opinion the difference between sevoflurane and isoflurane in the MAC fraction required to attain the same AAI level demonstrates the limitations of MAC in defining the level of anesthesia.
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Acta Anaesthesiol Scand · Jan 2005
Randomized Controlled Trial Clinical TrialThermogenic effect of amino acids not demonstrated in heart surgery with cardiopulmonary bypass.
In abdominal surgery and in healthy volunteers, amino acids increased thermogenesis. In this double-blind study we investigated if a similar effect would ensue in heart surgery and accelerate the rewarming process postoperatively. ⋯ The lack of a thermal effect of the amino acids in the heart surgery was most probably due to the temperature gradients between the different body compartments, and also may have been due to the use of beta-blockers.
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Acta Anaesthesiol Scand · Jan 2005
Randomized Controlled Trial Clinical TrialContinuous physostigmine combined with morphine-based patient-controlled analgesia in the postoperative period.
Recently, new drugs and techniques for the treatment of postoperative pain were introduced, with the goal of enhancing opiates' analgesia while minimizing their side-effects. Cholinergic agents play an antinociceptive role, but their clinical use is quite limited, due to side-effects. Physostigmine is a cholinesterase inhibitor, which crosses the blood-brain barrier and elevates brain acetylcholine level. Physostigmine can produce analgesia by itself, and enhance opiate analgesia; but these effects are of short duration following bolus administration. ⋯ Physostigmine combined with morphine in the postoperative period reduced morphine consumption, enhanced analgesia, and attenuated production of the proinflammatory cytokine, IL-1beta. This latter finding may account for the decreased pain observed in this group; this cytokine is known to mediate basal pain sensitivity and induce hyperalgesia in inflammatory conditions. Taking into account the other potential beneficial effects of physostigmine, we suggest that a continuous infusion of physostigmine should be considered as a useful component in multimodal postoperative analgesia.
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Acta Anaesthesiol Scand · Jan 2005
Randomized Controlled Trial Clinical TrialPentoxifylline attenuates the increase in whole blood viscosity after transfusion.
Pentoxifylline improves tissue oxygenation and intestinal blood flow in models of haemorrhagic shock, and it has been used for the treatment of intermittent claudication due to its beneficial effects on haemorheology. We investigated the effects of pentoxifylline on whole blood viscosity during packed red-blood cell transfusion in critically ill adult patients. ⋯ These results suggest that pentoxifylline is effective in attenuating the increase in whole blood viscosity after a transfusion of packed red-blood cells. Plasma viscosity is not influenced by pentoxifylline.
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Acta Anaesthesiol Scand · Jan 2005
Motor nerve blockade potency and toxicity of non-racemic bupivacaine in rats.
Racemic [RS(+/-)] bupivacaine can be associated with severe cardiotoxicity. The S(-) isomer is known to be less neuro- and cardiotoxic, but demonstrates a lower potency to block motor activity than RS(+/-) bupivacaine. Thus, the potency and toxicity of a non-racemic bupivacaine mixture were studied. ⋯ The potency of S(-) bupivacaine to block the motor activity in the sciatic nerve was enhanced when 25% of the S(-) isomer was replaced by the antipode R(+) bupivacaine. This effect was not associated with increased toxicity.