Current Issue : July - September Volume : 2012 Issue Number : 3 Articles : 7 Articles
Background: Articles cited counts are catalogued and help identify landmark papers. This study provides a citation\r\nclassics of anesthesiology literature using the framework of subspecialties to provide a review of well-developed\r\nareas of research in anesthesiology.\r\nMethods: A comprehensive list of the most-cited articles in anesthesia was compiled using a bibliometric database\r\nand general search terms such as ââ?¬Å?anesthesiaââ?¬Â as well as subspecialty-specific search terms. Queries were reviewed\r\nfor relevance to anesthesiology practice, categorized by subspecialty, and ranked according to their citation counts.\r\nResults: The database resulted in 2519 articles published between 1945 and 2008. The specialty areas most\r\nrepresented were chronic pain medicine (11%), pharmacology (9%), and pain sciences (9%).\r\nConclusions: This citations classic allows for advances in anesthesiology and its subspecialties to be highlighted as\r\nwell to provide useful manuscripts to guide patient care, direct future research, and serve as sources for future\r\nacademic pursuit....
Background: The effect of local infiltration after breast surgery is controversial. This prospective double blind\r\nrandomized study sought to document the analgesic effect of local anaesthetic infiltration after breast cancer\r\nsurgery.\r\nMethods: Patients scheduled for mastectomy or tumorectomy and axillary nodes dissection had immediate\r\npostoperative infiltration of the surgical wound with 20 ml of ropivacaine 7.5 mg.ml-1 or isotonic saline. Pain was\r\nassessed on a visual analogue scale at H2, H4, H6, H12, H24, H72, and at 2 month, at rest and on mobilization of\r\nthe arm. Patientââ?¬â?¢comfort was evaluated with numerical 0-3 scales for fatigue, quality of sleep, state of mood, social\r\nfunction and activity.\r\nResults: Twenty-two and 24 patients were included in the ropivacaine and saline groups respectively.\r\nPostoperative pain was lower at rest and on mobilization at 2, 4 and 6 hour after surgery in the ropivacaine group.\r\nNo other difference in pain intensity and patient ââ?¬Ë?comfort scoring was documented during the first 3 postoperative\r\ndays. Patients did not differ at 2 month for pain and comfort scores.\r\nConclusion: Single shot infiltration with ropivacaine transiently improves postoperative pain control after breast\r\ncancer surgery....
Local anesthetics are widely used as an intraosseous injection particularly in the field of dentistry. Occasionally,\r\nlarge doses of anesthetics are injected to elicit the desired effect during many surgical procedures. In this study\r\nwe examined the effect of a local anesthetic, lidocaine, on osteoblasts as there are only a few reports on the effect\r\nof local anesthetics directly on bone cells. Our results showed that physiological as well as supra physiological\r\nconcentrations of lidocaine cause cell death. At low concentrations, lidocaine was found to enhance both proliferation\r\nof osteoblasts and bone matrix production. In addition, low concentration of lidocaine increased the expression of\r\nosteocalcin, a key regulator in the signaling pathway of bone matrix production. Our results show that lidocaine\r\nhas a biphasic effect on osteoblasts and low concentrations of this anesthetic may assist in bone matrix production.\r\nThis preliminary study can lead to the therapeutic usage of intraosseous lidocaine as a bone strengthening agent....
The authors review the opioid literature for evidence of increased analgesia and reduced adverse side effects by combining muopioid-\r\nreceptor (MOR) agonists, kappa-opioid-receptor (KOR) agonists , and nonselective low-dose-opioid antagonists (LD-Ant).\r\nWe tested fentanyl (MOR agonist) and spiradoline (KOR agonist), singly and combined, against somatic and visceral pain models.\r\nCombined agonists induced additive analgesia in somatic pain and synergistic analgesia in visceral pain. Other investigators report\r\nsimilar effects and reduced tolerance and dependence with combined MOR agonist and KOR agonist. LD-Ant added to either a\r\nMOR agonist or KOR agonist markedly enhanced analgesia of either agonist. In accordance with other place-conditioning (PC)\r\nstudies, our PC investigations showed fentanyl-induced place preference (CPP) and spiradoline-induced place aversion (CPA).\r\nWe reduced fentanyl CPP with a low dose of spiradoline and reduced spiradoline CPA with a low dose of fentanyl. We propose\r\ncombined MOR agonist, KOR agonist, and LD-Ant to produce superior analgesia with reduced adverse side effects, particularly\r\nfor visceral pain....
Background. Goal-directed fluid therapy reduces morbidity and mortality in various clinical settings. Respiratory variations in\r\nphotoplethysmography are proposed as a noninvasive alternative to predict fluid responsiveness during mechanical ventilation.\r\nThis paper aims to critically evaluate current data on the ability of photoplethysmography to predict fluid responsiveness.\r\nMethod. Primary searches were performed in PubMed, Medline, and Embase on November 10, 2011. Results. 14 papers\r\nevaluating photoplethysmography and fluid responsiveness were found. Nine studies calculated areas under the receiver operating\r\ncharacteristic curves for ?POP (>0.85 in four, 0.75ââ?¬â??0.85 in one, and <0.75 in four studies) and seven for PVI (values ranging\r\nfrom 0.54 to 0.98). Correlations between ?POP/PVI and ?PP/other dynamic variables vary substantially. Conclusion. Although\r\nphotoplethysmography is a promising technique, predictive values and correlations with other hemodynamic variables indicating\r\nfluid responsiveness vary substantially. Presently, it is not documented that photoplethysmography is adequately valid and reliable\r\nto be included in clinical practice for evaluation of fluid responsiveness....
Background\r\nLethal injection for execution was conceived as a comparatively humane alternative to\r\nelectrocution or cyanide gas. The current protocols are based on one improvised by a medical\r\nexaminer and an anesthesiologist in Oklahoma and are practiced on an ad hoc basis at the\r\ndiscretion of prison personnel. Each drug used, the ultrashort-acting barbiturate thiopental, the\r\nneuromuscular blocker pancuronium bromide, and the electrolyte potassium chloride, was\r\nexpected to be lethal alone, while the combination was intended to produce anesthesia then\r\ndeath due to respiratory and cardiac arrest. We sought to determine whether the current drug\r\nregimen results in death in the manner intended.\r\nMethods and Findings\r\nWe analyzed data from two US states that release information on executions, North Carolina\r\nand California, as well as the published clinical, laboratory, and veterinary animal experience.\r\nExecution outcomes from North Carolina and California together with interspecies dosage\r\nscaling of thiopental effects suggest that in the current practice of lethal injection, thiopental\r\nmight not be fatal and might be insufficient to induce surgical anesthesia for the duration of\r\nthe execution. Furthermore, evidence from North Carolina, California, and Virginia indicates\r\nthat potassium chloride in lethal injection does not reliably induce cardiac arrest.\r\nConclusions\r\nWe were able to analyze only a limited number of executions. However, our findings suggest\r\nthat current lethal injection protocols may not reliably effect death through the mechanisms\r\nintended, indicating a failure of design and implementation. If thiopental and potassium\r\nchloride fail to cause anesthesia and cardiac arrest, potentially aware inmates could die through\r\npancuronium-induced asphyxiation. Thus the conventional view of lethal injection leading to\r\nan invariably peaceful and painless death is questionable....
Many neurosurgery patients may have unrecognized diabetes or may develop stress-related hyperglycemia in the perioperative\r\nperiod. Diabetes patients have a higher perioperative risk of complications and have longer hospital stays than individuals without\r\ndiabetes. Maintenance of euglycemia using intensive insulin therapy (IIT) continues to be investigated as a therapeutic tool to\r\ndecrease morbidity and mortality associated with derangements in glucose metabolism due to surgery. Suboptimal perioperative\r\nglucose control may contribute to increased morbidity, mortality, and aggravate concomitant illnesses. The challenge is to\r\nminimize the effects of metabolic derangements on surgical outcomes, reduce blood glucose excursions, and prevent hypoglycemia.\r\nDifferences in cerebral versus systemic glucose metabolism, time course of cerebral response to injury, and heterogeneity of\r\npathophysiology in the neurosurgical patient populations are important to consider in evaluating the risks and benefits of IIT.\r\nWhile extremes of glucose levels are to be avoided, there are little data to support an optimal blood glucose level or recommend\r\na specific use of IIT for euglycemia maintenance in the perioperative management of neurosurgical patients. Individualized\r\ntreatment should be based on the local level of blood glucose control, outpatient treatment regimen, presence of complications,\r\nnature of the surgical procedure, and type of anesthesia administered....
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