Current Issue : April - June Volume : 2014 Issue Number : 2 Articles : 6 Articles
Mucopolysaccharidoses (MPSs) are a group of uncommon genetic diseases of connective tissue metabolism. It is well established\r\nthat the elective treatment of subjects affected by MPS is multidisciplinary and must be carried out by experienced personnel in\r\nhighly specialist centers. However, there is the possibility to perform an anesthesia in a peripheral center, where anesthesiologists\r\nmight not have a large experience of MPS. Various attempts to produce guidelines have been made for MPS. There has been an\r\nincreasing interest in the topic as it is demonstrated by the number of scientific studies published in the last few years (peak in 2011).\r\nWe want to provide a summary of anesthetic management, reviewing the current literature on the topic in a procedural algorithm\r\nfor these high-risk patients, who require surgical procedures and diagnostic examinations under sedation with a higher frequency\r\nthan the general population....
Background.The stress response to laryngoscopy and intubation causes an undesirable increase in heart rate, blood pressure, and\r\nintraocular pressure. This study was designed to compare the effect of two doses of gabapentin on the stress response to laryngoscopy\r\nand intubation. Patients andMethods. (ASA I and II) 60 patients, aged from18 to 60 years undergoing elective eye surgery requiring\r\nendotracheal intubation, were randomly allocated into 3 groups, 20 patients each. 2 hours before the surgery, group I received oral\r\nplacebo, and groups II and III received oral gabapentin 800mg and 1200mg, respectively. Heart rate (HR), mean arterial pressure\r\n(MAP), and intraocular pressure (IOP) were measured before and after induction of anesthesia, immediately after, 5 minutes, and\r\n10 minutes after intubation. Results. Gabapentin 1200mg prevented the increase in HR, MAP, and IOP, secondary to laryngoscopy\r\nand intubation, and kept them below the baseline till 10 minutes after intubation (?? < 0.001), while with gabapentin 800mg, the\r\nincrease in HR, MAP, and IOP was nonsignificant (?? > 0.05) and returned to levels below the baseline at 5 and 10 minutes after\r\nintubation. Conclusion. Preoperative gabapentin 1200mg effectively prevented the stress response to laryngoscopy and intubation;\r\nmeanwhile, gabapentin 800mg only prevented significant stress response....
Despite a long history in medical and dental application, the molecular mechanism and precise site of action are still arguable\r\nfor local anesthetics. Their effects are considered to be induced by acting on functional proteins, on membrane lipids, or on both.\r\nLocal anesthetics primarily interact with sodium channels embedded in cell membranes to reduce the excitability of nerve cells\r\nand cardiomyocytes or produce a malfunction of the cardiovascular system. However, the membrane protein-interacting theory\r\ncannot explain all of the pharmacological and toxicological features of local anesthetics. The administered drug molecules must\r\ndiffuse through the lipid barriers of nerve sheaths and penetrate into or across the lipid bilayers of cellmembranes to reach the acting\r\nsite on transmembrane proteins.Amphiphilic local anesthetics interact hydrophobically and electrostatically with lipid bilayers and\r\nmodify their physicochemical property, with the direct inhibition of membrane functions, and with the resultant alteration of the\r\nmembrane lipid environments surrounding transmembrane proteins and the subsequent protein conformational change, leading to\r\nthe inhibition of channel functions.We review recent studies on the interaction of local anesthetics with biomembranes consisting\r\nof phospholipids and cholesterol. Understanding the membrane interactivity of local anesthetics would provide novel insights into\r\ntheir anesthetic and cardiotoxic effects....
Background. Elderly patients have unique age-related comorbidities that may lead to an increase in postoperative complications\r\ninvolving neurological, pulmonary, cardiac, and endocrine systems. There has been an increase in the number of elderly patients\r\nundergoing surgery as this portion of the population is increasing in numbers. Despite advances in perioperative anesthesia\r\nand analgesia along with improved delivery systems, monotherapy with opioids continues to be the mainstay for treatment of\r\npostop pain. Reliance on only opioids can oftentimes lead to inadequate pain control or increase in the incidence of adverse\r\nevents. Multimodal analgesia incorporating regional anesthesia is a promising alternative that may reduce needs for high doses\r\nand dependence on opioids along with any potential associated adverse effects. Methods. The following databases were searched\r\nfor relevant published trials: Cochrane Central Register of Controlled Trials and PubMed. Textbooks and meeting supplements\r\nwere also utilized.The authors assessed trial quality and extracted data. Conclusions. Multimodal drug therapy and perioperative\r\nregional techniques can be very effective to perioperative pain management in the elderly. Regional anesthesia as part ofmultimodal\r\nperioperative treatment can often reduce postoperative neurological, pulmonary, cardiac, and endocrine complications. Regional\r\nanesthesia/analgesia has not been proven to improve long-termmorbidity but does benefit immediate postoperative pain control. In\r\naddition, multimodal drug therapy utilizes a variety of nonopioid analgesic medications in order to minimize dosages and adverse\r\neffects from opioids while maximizing analgesic effect and benefit....
There is a relatively long history of the use of the ??-adrenergic antagonist, phenoxybenzamine, for the treatment of complex\r\nregional pain syndrome (CRPS). One form of this syndrome, CRPS I, was originally termed reflex sympathetic dystrophy (RSD)\r\nbecause of an apparent dysregulation of the sympathetic nervous system in the region of an extremity that had been subjected\r\nto an injury or surgical procedure. The syndrome develops in the absence of any apparent continuation of the inciting trauma.\r\nHallmarks of the condition are allodynia (pain perceived froma nonpainful stimulus) and hyperalgesia (exaggerated pain response\r\nto a painful stimulus). In addition to severe, unremitting burning pain, the affected limb is typically warm and edematous in the\r\nearly weeks after trauma but then progresses to a primarily cold, dry limb in later weeks andmonths. The later stages are frequently\r\ncharacterized by changes to skin texture and nail deformities, hypertrichosis, muscle atrophy, and bone demineralization. Earlier\r\ntreatments of CRPS syndromes were primarily focused on blocking sympathetic outflow to an affected extremity. The use of an ??-\r\nadrenergic antagonist such as phenoxybenzamine followed from this perspective. However, the current consensus on the etiology\r\nof CRPS favors an interpretation of the symptomatology as an evidence of decreased sympathetic activity to the injured limb and\r\na resulting upregulation of adrenergic sensitivity. The clinical use of phenoxybenzamine for the treatment of CRPS is reviewed,\r\nand mechanisms of action that include potential immunomodulatory/anti-inflammatory effects are presented. Also, a recent study\r\nidentified phenoxybenzamine as a potential intervention for painmediation fromits effects on gene expression in human cell lines;\r\non this basis, it was tested and found to be capable of reducing pain behavior in a classical animal model of chronic pain....
Supraventricular arrhythmias are common rhythmdisturbances following pulmonary surgery.The overall incidence varies between\r\n3.2% and 30% in the literature, while atrial fibrillation is the most common form. These arrhythmias usually have an uneventful\r\nclinical course and revert to normal sinus rhythm, usually before patent�s discharge from hospital. Their importance lies in\r\nthe immediate hemodynamic consequences, the potential for systemic embolization and the consequent long-term need for\r\nprophylactic drug administration, and the increased cost of hospitalization. Their incidence is probably related to the magnitude\r\nof the performed operative procedure, occurring more frequently after pneumonectomy than after lobectomy. Investigators\r\nbelieve that surgical factors (irritation of the atria per se or on the ground of chronic inflammation of aged atria), direct injury\r\nto the anatomic structure of the autonomic nervous system in the thoracic cavity, and postthoracotomy pain may contribute\r\nindependently or in association with each other to the development of these arrhythmias. This review discusses currently available\r\ninformation about the potential mechanisms and risk factors for these rhythmdisturbances. The discussion is in particular focused\r\non the role of postoperative pain and its relation to the autonomic imbalance, in an attempt to avoid or minimize discomfort with\r\nproper analgesia utilization....
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