Journal of cardiothoracic and vascular anesthesia
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Even if the first quasi-randomized study in history was published in 1747, there is still a need for evidence-based medicine. In the specific field of cardiac anesthesia, there are few magic bullets (ie, drugs/techniques/strategies that might reduce perioperative mortality), and a recent international consensus conference attempted to list them all. In the absence of evidence-based medicine, medical decisions are made by eminence, experience, or physiopathologic reasoning. ⋯ Patients should be fully aware of the reduced complication rates and the improved outcomes that occur in patients involved in randomized "researcher-driven" clinical trials, the so-called "Hawthorne effect." In conclusion, physicians have to do their best although they sometimes have little information. Their ability must counteract the lack of scientific evidences. Caring for critical patients involves making decisions based on realistic tradeoffs of clinical benefit and side effects, but too often these choices are made on the basis of extrapolations and educated guesses.
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J. Cardiothorac. Vasc. Anesth. · Jun 2012
Morphine reduces the threshold of remote ischemic preconditioning against myocardial ischemia and reperfusion injury in rats: the role of opioid receptors.
Opioid receptors mediate the cardioprotection of remote ischemic preconditioning (RIPC). The authors tested the hypothesis that morphine reduces the threshold of cardioprotection produced by RIPC. ⋯ MOR reduces the threshold of RIPC, and opioid receptors mediate this augmentative effect.