Articles: anesthetics.
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We outline the indications and contraindications of carotid endarterectomy (CEA) and appraise four key areas still debated to this day; shunting versus non-shunting, patch angioplasty (PA) versus primary closure (PC) and local anaesthesia (LA) versus general anaesthesia (GA). Importantly, we compare CEA with Best Medical Therapy (BMT), which is an area that is still largely debated, principally because many of the studies conducted to date do not reflect the era of modern BMT practices, and these outcomes are eagerly awaited. Literature searches were conducted using Pubmed with the keywords 'carotid', and 'endarterectomy', which provided a wide variety of journals and articles. ⋯ In carotid stenosis >50% BMT offers limited benefits without accompanying surgical intervention and BMT alone tends to be advantageous primarily for patients with <50% carotid stenosis. Where CEA is appraised in terms of superiority of the procedural components; the literature does not support wildly contrasting outcomes to change majority practice. However, the area of considerable interest is superiority of BMT to surgical intervention in terms of both carotid artery stenting (CAS) and CEA and more studies need to be conducted in this area.
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Randomized Controlled Trial
Dose-response of epidural ropivacaine with 0.4 μg mL-1 of dexmedetomidine for labor analgesia: A prospective double-blinded study.
Studies have shown that the ideal dose of epidural dexmedetomidine is 0.4 μg mL-1 for epidural labor analgesia. However, the appropriate dose of ropivacaine when combined with 0.4 μg mL-1 of dexmedetomidine for epidural labor analgesia is still unknown. Therefore, we aimed to determine the dose-response of ropivacaine when using 0.4 μg mL-1 of dexmedetomidine as epidural adjuvant for labor analgesia. ⋯ Under the condition of the study, a bolus of 12 mL ropivacaine 0.086% and dexmedetomidine 0.4 μg mL-1 could afford 95% of nulliparous singleton pregnant patients without suffering labor pain after a test dose of lidocaine 45 mg.
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Chronic alcohol users often exhibit an increased minimum alveolar concentration (MAC) of sevoflurane, yet the specific mechanism remains unclear. It has been reported that ethanol exposure can upregulate the protein expression and enzyme activity of cytochrome P450 2E1 (CYP2E1). CYP2E1 is a key enzyme that converts 2-5% of sevoflurane into equimolar amounts of hexafluoroisopropanol (HFIP) and F-. This study aims to explore whether ethanol exposure could alter sevoflurane metabolism through CYP2E1 modulation, potentially explaining the increased MAC observed in alcohol users. ⋯ Ethanol exposure increased both the expression and enzymatic activity of CYP2E1, consequently enhancing the metabolism of sevoflurane.
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Randomized Controlled Trial
Effect of adductor canal block combined with infiltration between the popliteal artery and posterior capsular of the knee on chronic pain after total knee arthroplasty: a prospective, randomized, double-blind, placebo-controlled trial.
Total knee arthroplasty (TKA) is accompanied by severe postoperative pain, which is reported to be an important cause of chronic pain. Ultrasound-guided adductor canal block (ACB) combined with infiltration between the popliteal artery and posterior capsular of the knee (IPACK) has been proven to have a better effect on relieving acute pain after TKA. However, whether it has a significant effect on the incidence of chronic pain after TKA has not been reported. This trial was designed to investigate the effect of ultrasound-guided ACB combined with IPACK on the incidence and intensity of chronic pain after TKA. ⋯ In the context of multimodal analgesia protocols, ACB combined with IPACK before surgery decreases the incidence and intensity of chronic pain 3 months after TKA compared with placebo injection. In addition, it reduces the NRS scores, whether at rest or during mobilization, and improves knee function within 24 hours after TKA.