Articles: function.
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Transthoracic examination of the heart and great vessels is an essential skill that allows the anesthesiologist to evaluate cardiac function. In this article, we describe a pragmatic technique to obtain the essential views to evaluate normal or abnormal cardiac function and to appreciate great vessel anatomy and physiology. ⋯ The integration of the echocardiographic information particularly from the heart and great vessels with the case story, physical examination, laboratory data, and other relevant clinical information should become the way of the future, and this will benefit the patients under our care.
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Anesthesia and analgesia · Apr 2018
ReviewThe Science of Local Anesthesia: Basic Research, Clinical Application, and Future Directions.
Local anesthetics have been used clinically for more than a century, but new insights into their mechanisms of action and their interaction with biological systems continue to surprise researchers and clinicians alike. Next to their classic action on voltage-gated sodium channels, local anesthetics interact with calcium, potassium, and hyperpolarization-gated ion channels, ligand-gated channels, and G protein-coupled receptors. They activate numerous downstream pathways in neurons, and affect the structure and function of many types of membranes. ⋯ Allergy to local anesthetics is rare, while the variation in individual patient's response to local anesthetics is probably larger than previously assumed. Several adjuncts are available to prolong sensory block, but these typically also prolong motor block. The 2 main research avenues being followed to improve action of local anesthetics are to prolong duration of block, by slow-release formulations and on-demand release, and to develop compounds and combinations that elicit a nociception-selective blockade.
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Semin. Arthritis Rheum. · Apr 2018
Sensorimotor performance and function in people with osteoarthritis of the hand: A case-control comparison.
To determine whether hand left/right judgements, tactile acuity, and body perception are impaired in people with hand OA. To examine the relationships between left right judgements, tactile acuity and hand pain. To explore the relationships between sensorimotor measures (left/right judgements and tactile acuity) and measures of hand function in people with hand OA. ⋯ People with hand OA had more frequent neglect-like symptoms and were slower and less accurate compared to healthy controls at hand left/right judgments, which was indicative of disrupted working body schema. Future studies may wish to examine whether interventions targeting sensorimotor dysfunction are effective at reducing pain and improving hand function and dexterity in people with hand OA.
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Minerva anestesiologica · Apr 2018
Clinical ethics: what the anaesthesiologist and the intensivist need to know.
Clinical ethics if often perceived as an intuitive understanding of what is right versus wrong. This is insufficient for healthcare workers in general, but particularly for anesthesiologists and intensivists, who often must weigh up complex and emergent life or death decisions and subsequently justify these decisions to their team and patients, as well as patient's families. ⋯ The most important concept is that interventions offered should be both clinically appropriate and ethically proportionate, desirable by both the patient and the medical team, and offering a meaningful benefit to the patient within the context of his or her own life narrative. This puts an emphasis on understanding, from the patient or his/her proxies, not just who the patient is biologically but also biographically: that is what gives meaning to his/her life subjectively, and what quality of life would be compatible with this level of functioning, as well as when he/she would wish life sustaining therapy to be withheld or withdrawn.
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The Human Pain Genetics Database (HPGDB) is a comprehensive variant-focused inventory of genetic contributors to human pain. After curation, the HPGDB currently includes 294 studies reporting associations between 434 distinct genetic variants and various pain phenotypes. Variants were then submitted to a comprehensive analysis. ⋯ In addition, we found that HPGDB variants show many pleiotropic associations, indicating that genetic pathophysiological mechanisms are also shared among painful and nonpainful conditions. Finally, we demonstrated that the HPGDB data set is significantly enriched for functional variants that modify gene expression, are deleterious, and colocalize with open chromatin regions. As such, the HPGDB provides a validated data set that represents a valuable resource for researchers in the human pain field.