Acta anaesthesiologica Scandinavica
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Acta Anaesthesiol Scand · Nov 2008
Randomized Controlled TrialHigh-volume infiltration analgesia in total knee arthroplasty: a randomized, double-blind, placebo-controlled trial.
High-volume infiltration analgesia may be effective with a low risk of side effects in hip and knee arthroplasty. The present placebo-controlled study was carried out to evaluate the analgesic effect of high-volume infiltration analgesia in bilateral total knee arthroplasty, along with a detailed description of the infiltration technique. ⋯ High-volume infiltration analgesia is effective in knee arthroplasty and, due to its simplicity, may be preferable compared with other analgesic techniques in knee arthroplasty.
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Acta Anaesthesiol Scand · Nov 2008
Randomized Controlled TrialItraconazole, a potent inhibitor of P-glycoprotein, moderately increases plasma concentrations of oral morphine.
Individual variation in opioid response is considerable, partly due to pharmacokinetic factors. Transporter proteins are becoming increasingly interesting also in the pharmacokinetics of opioids. The efflux transporter P-glycoprotein can affect gastrointestinal absorption and tissue distribution, particularly brain access of many opioids. The aim of this study was to evaluate whether itraconazole, which is a potent inhibitor of P-glycoprotein and CYP3A4, would change the pharmacokinetics or the pharmacodynamics of oral morphine. ⋯ Itraconazole moderately increases plasma concentrations of oral morphine, probably by enhancing its absorption by inhibiting intestinal wall P-glycoprotein. A possible improvement of morphine penetration to the brain could not be observed.
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Acta Anaesthesiol Scand · Nov 2008
Comparative StudySevoflurane improves myocardial ischaemic tolerance in a closed-chest porcine model.
Volatile anaesthetics prevent experimental myocardial ischaemia-reperfusion injury (I/R) in several species, but this finding is partially inconsistent with clinical evidence. Some experimental models may not accurately represent the complex signal transduction pathways triggered by volatile anaesthetics. We therefore investigated sevoflurane I/R prevention in vivo in a porcine model with greater likeness to human physiology than models previously used and compared it with neutral anaesthetic. ⋯ Sevoflurane markedly decreased myocardial infarct size after prolonged coronary occlusion in a porcine model. In addition to novel sevoflurane cardioprotection in the closed-chest model, which is more comparable to normal human hearts than models previously used, sevoflurane cardioprotection is substantiated in the juvenile intact organism. The perspectives underline recommending volatile anaesthetics in risk patients and in cardiac surgery.
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Acta Anaesthesiol Scand · Nov 2008
Apolipoprotein E polymorphism and gender difference in outcome after severe traumatic brain injury.
Traumatic brain injury (TBI) is one of the most common causes of death and dismal outcome among children and young adults. The morbidity and mortality differ but more aggressive monitoring and more designated neuro intensive care units have improved the results. Studies have demonstrated a connection between apolipoprotein E (APOE) genotype and outcome after TBI, but few are prospective and none is from northern Europe. APOE has three alleles: epsilon2, epsilon3 and epsilon4. ⋯ APOE epsilon4 correlated to worse outcome in TBI patients. We also found that males with APOE epsilon4 had poor outcome while females did not. Thus, the results indicate that genetic polymorphism may influence outcome after TBI.
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Acta Anaesthesiol Scand · Nov 2008
Randomized Controlled TrialEffect of magnesium sulfate on extubation time and acute pain in coronary artery bypass surgery.
Post-operative pain control is one of the greatest concerns for both physicians and patients. In this study, the effect of magnesium sulfate (MgSO(4)) solution infusion on post-operative pain scores and extubation time in patients undergoing elective coronary artery bypass graft (CABG) surgeries was assessed. ⋯ The results demonstrated a significantly shortened post-operative time for extubation and reduced acute post-operative pain scores by intravenous MgSO(4) infusion during elective CABG surgery.