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Acta Anaesthesiol Scand 2003 Mar;47(3):371-3
[Medline record in process]
PMID: 12648209, UI: 22534925
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Acta Anaesthesiol Scand 2003 Mar;47(3):369-70
Department of Anesthesiology and Reanimation, Hacettepe University School of Medicine, Ankara, Turkey.
Weill-Marchesani syndrome is characterized by short stature, brachydactylyl, myopia, microspherophakia, lens dislocation, glaucoma, joint stiffness, restricted articular movements and facial features. The anesthetic management of an 11-year-old-male patient with diagnosis of this syndrome is reported.
PMID: 12648208, UI: 22534924
Acta Anaesthesiol Scand 2003 Mar;47(3):366-8
Departments of Anesthesiology and ENT Surgery, The Brookdale University Hospital and Medical Center, New York, NY.
Anaesthetic management of patients with obstructive sleep apnea for upper airway surgery has always been a challenging task. We report our anaesthetic approach for a young, mentally retarded obese patient with documented obstructive sleep apnea undergoing uvulopalatopharyngoplasty. The therapeutic intervention before, during and after operation is discussed.
PMID: 12648207, UI: 22534923
Acta Anaesthesiol Scand 2003 Mar;47(3):361-2
Department of Ophthalmology, and Department of Anesthesiology, University Hospital, Umea, Sweden.
The right eye of a 66-year-old man was operated with vitrectomy and peeling of an epiretinal membrane. Perioperatively, the eye was filled with 20% SF6 gas to tamponade retinal breaks. Five days later the patient underwent prostatectomy under general anesthesia using nitrous oxide. Postoperatively the eye had no light perception as a result of ischemic retinopathy. The movement of nitrous oxide into gas-containing spaces in the body has been known for a long time. The use of nitrous oxide in patients with intravitreal gas will elevate the intraocular pressure with risk for closure of the central retinal artery. The present case report highlights the problems that can occur when preoperative assessment is carried out a long time before surgery.
PMID: 12648205, UI: 22534921
Acta Anaesthesiol Scand 2003 Mar;47(3):307-11
Department of Anaesthesia, Hospital for Sick Children and the University of Toronto, Toronto, Ontario, Canada.
BACKGROUND: Propofol for maintenance of anesthesia by continuous infusion is gaining popularity for use in pediatric patients. Nitrous oxide (N2O) has been shown to increase cerebral blood flow velocity (CBFV) in both children and adults. To determine the effects of N2O on middle cerebral artery blood flow velocity (Vmca) during propofol anesthesia in children, Vmca was measured with and without N2O using transcranial Doppler (TCD) sonography. METHODS: Thirty ASA I or II children aged 18 months to 6 years undergoing elective urological surgery were enrolled. Anesthesia comprised propofol aimed at producing an estimated steady-state serum concentration of 3 micro g.ml-1 and a caudal epidural block. A transcranial Doppler probe was used to measure middle cerebral artery blood flow velocity. Each patient was randomized to receive a sequence of either Air/N2O/Air or N2O/Air/N2O in 35% oxygen. Fifteen min after each change in the N2O concentration, three measurements of cerebral blood flow velocity, blood pressure and heart rate were recorded. Ventilatory parameters and EtCO2 were kept constant throughout the study period. RESULTS: CBFV increased by 12.4% when air was replaced by N2O, and returned to baseline when N2O was subsequently removed. There was a 14% decrease in CBFV when N2O was replaced with air, which increased to baseline when air was subsequently replaced with N2O. Mean heart rate and blood pressure remained constant throughout the study period. CONCLUSION: The effects of nitrous oxide on CBFV are preserved in children during propofol anesthesia.
PMID: 12648197, UI: 22534913
Acta Anaesthesiol Scand 2003 Mar;47(3):260-266
Department of Anaesthesia, Center of Head and Orthopaedics, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark; Department of Anaesthesia, Hope Hospital, Salford, UK; Eindhoven University of Technology, Eindhoven, the Netherlands; Department of Anaesthesia, Hillerod Hospital, Denmark; Department of Biostatistics, University of Copenhagen, Denmark; Department of Anaesthesia, Hospital Universitari Germans Trias i Pujol, Barcelona; Brain & Behaviour Institute and Department of Psychiatry & Neuropsychology, Maastricht University, Limburg, Maastricht, the Netherlands; Department of Anaesthesiology, University Hospital of Iraklion, Crete, Greece; Departments of Anesthesiology, Surgery and Geriatrics & Adult Development, Mount Sinai School of Medicine, New York, USA; Department of Anaesthesia, Hospital General Elche, Alicante, Spain; Department of Anaesthesia, Ullevaal University Hospital, Oslo, Norway; Department of Anaesthesia, Bispebjerg Hospital, Copenhagen, Denmark; University of Helsinki Department of Anaesthesia and Intensive Care, Helsinki, Finland; Department of Anaesthesia, Fundacion Hospital Alcorcon, Madrid, Spain, Department of Anaesthesia, South Cleveland Hospital, Middlesbrough, UK; and Department of Anaesthesia, Leicester General Hospital, Leicester, UK.
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BACKGROUND: Postoperative cognitive dysfunction (POCD) is a common complication after cardiac and major non-cardiac surgery with general anaesthesia in the elderly. We hypothesized that the incidence of POCD would be less with regional anaesthesia rather than general. METHODS: We included patients aged over 60 years undergoing major non-cardiac surgery. After giving written informed consent, patients were randomly allocated to general or regional anaesthesia. Cognitive function was assessed using four neuropsychological tests undertaken preoperatively and at 7 days and 3 months postoperatively. POCD was defined as a combined Z score >1.96 or a Z score >1.96 in two or more test parameters. RESULTS: At 7 days, POCD was found in 37/188 patients (19.7%, [14.3-26.1%]) after general anaesthesia and in 22/176 (12.5%, [8.0-18.3%]) after regional anaesthesia, P = 0.06. After 3 months, POCD was present in 25/175 patients (14.3%, [9.5-20.4%]) after general anaesthesia vs. 23/165 (13.9%, [9.0-20.2%]) after regional anaesthesia, P = 0.93. The incidence of POCD after 1 week was significantly greater after general anaesthesia when we excluded patients who did not receive the allocated anaesthetic: 33/156 (21.2%[15.0-28.4%]) vs. 20/158 (12.7%[7.9-18.9%]) (P = 0.04). Mortality was significantly greater after general anaesthesia (4/217 vs. 0/211 (P < 0.05)). CONCLUSION: No significant difference was found in the incidence of cognitive dysfunction 3 months after either general or regional anaesthesia in elderly patients. Thus, there seems to be no causative relationship between general anaesthesia and long-term POCD. Regional anaesthesia may decrease mortality and the incidence of POCD early after surgery.
PMID: 12648190
Acta Anaesthesiol Scand 2003 Mar;47(3):241-259
Departments of Anesthesia & Intensive Care and Clinical Pharmacology, St. Olav's University Hospital, Trondheim, Norway, Departments of Anesthesia & Medical Imaging and Laboratory Medicine, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway, Departments of Anesthesiology and Medicinal Chemistry, University of Washington, Seattle, WA.
BACKGROUND: The gender aspect in pharmacokinetics and pharmacodynamics of anesthetics has attracted little attention. Knowledge of previous work is required to decide if gender-based differences in clinical practice is justified, and to determine the need for research. METHODS: Basis for this paper was obtained by Medline searches using the key words 'human' and 'gender' or 'sex,' combined with individual drug names. The reference lists of these papers were further checked for other relevant studies. RESULTS: Females have 20-30% greater sensitivity to the muscle relaxant effects of vecuronium, pancuronium and rocuronium. When rapid onset of or short duration of action is very important, gender-modified dosing may be considered. Males are more sensitive than females to propofol. It may therefore be necessary to decrease the propofol dose by 30-40% in males compared with females in order to achieve similar recovery times. Females are more sensitive than males to opioid receptor agonists, as shown for morphine as well as for a number of kappa (OP2) receptor agonists. On this basis, males will be expected to require 30-40% higher doses of opioid analgesics than females to achieve similar pain relief. On the other hand, females may experience respiratory depression and other adverse effects more easily if they are given the same doses as males. CONCLUSION: These examples illustrate that gender should be taken into account as a factor that may be predictive for the dosage of several anesthetic drugs. Moreover, there is an obvious need for more research in this area in order to further optimize drug treatment in anesthesia.
PMID: 12648189
Anaesthesia 2003 Apr;58(4):406
The Children's Hospital at Westmead, Westmead 2145, Australia E-mail: davidb@chw.edu.au
PMID: 12648155, UI: 22535060
Anaesthesia 2003 Apr;58(4):405-6
James Cook University Hospital, Middlesbrough TS4 3BW, UK E-mail: tim.meek@doctors.org.uk
PMID: 12648154, UI: 22535059
Anaesthesia 2003 Apr;58(4):405
East Surrey Hospital, Redhill RH1 5RH, UK E-mail: claire_mearns@hotmail.com
PMID: 12648153, UI: 22535058
Anaesthesia 2003 Apr;58(4):404-5
University of Toronto, Toronto M5T 2S8, Canada E-mail: colin.mccartney@uhn.on.ca
PMID: 12648152, UI: 22535057
Anaesthesia 2003 Apr;58(4):404
Kettering General Hospital, Kettering NN16 8UZ, UK E-mail: gmuralikrishna@hotmail.com
PMID: 12648151, UI: 22535056
Royal Bournemouth Hospital, Bournemouth, UK E-mail: djdalgleish@doctors.org.uk
PMID: 12648150, UI: 22535055
Anaesthesia 2003 Apr;58(4):403-4
King Faisal Specialist Hospital, Riyadh 11211, Saudi Arabia E-mail: paymaster@arab.net.sa
PMID: 12648149, UI: 22535054
Anaesthesia 2003 Apr;58(4):403
St Peter's Hospital, Chertsey KT16 0PZ, UK E-mail: mike.jordan@asph.nhs.uk
PMID: 12648148, UI: 22535053
Royal Bolton Hospital, Bolton BL1 5BB, UK E-mail: wyn.price@boltonh-tr.nwest.nhs.uk
PMID: 12648147, UI: 22535052
St. Georges Hospital, London SW20 9NY, UK E-mail: putul@tinyonline.co.uk
PMID: 12648146, UI: 22535051
Anaesthesia 2003 Apr;58(4):397
St Thomas' Hospital, London SE1 7EH, UK E-mail: igasbest@hotmail.com
PMID: 12648136, UI: 22535041
Anaesthesia 2003 Apr;58(4):385
Fuchu Hospital, Izumi, Osaka, Japan E-mail: mizutanik@msic.med.osaka-cu.ac.jp
PMID: 12648122, UI: 22535027
Anaesthesia 2003 Apr;58(4):358-62
Research Fellow and Professor, Department of Anaesthetics and Intensive Care Medicine, The Queen's University of Belfast, The Whitla Medical Building, 97 Lisburn Road, Belfast BT9 7BL, UK Consultant Anaesthetist, Royal Hospitals Trust, Belfast, UK.
The use of remifentanil has been recommended because of its ability to minimise the hypertensive response to tracheal intubation and surgical stimulation in various types of surgery. We describe the use of remifentanil in the anaesthetic management of three cases of open adrenalectomy, two for removal of a phaeochromocytoma and one for removal of an adrenal cortical tumour. Although the use of remifentanil was associated with no adverse events in the patient undergoing resection of the adrenal cortical tumour, its administration was associated with significant hypotension and bradycardia in the two phaeochromocytoma patients, who had both been given alpha- and beta-adrenergic receptor blocking drugs before surgery. It did not prevent the increases in blood pressure or plasma catecholamine levels associated with tumour manipulation in these patients. Remifentanil should therefore be used with caution in patients receiving alpha- and beta-adrenergic receptor blocking drugs. The use of potent vasodilators may still be necessary during tumour manipulation even if remifentanil is being infused.
PMID: 12648118, UI: 22535023
Anaesthesia 2003 Apr;58(4):339-345
Specialist Anaesthetist, Department of Anaesthesiology and Perioperative Medicine, North Shore Hospital, Auckland, New Zealand Statistician, Department of Information Technology, North Shore Hospital, Auckland, New Zealand Clinical Psychologist, Department of Clinical Psychology, Imperial College, University of London, London, UK.
A postal survey was sent to specialist anaesthetists in Australia looking at aspects of job satisfaction, dissatisfaction and stress. Burnout was measured using the Maslach Burnout Inventory. The response rate was 60% (422/700) with the majority of respondents being male (83%). Stressful aspects of anaesthesia included time constraints and interference with home life. Experienced assistants and improved work organisation helped to reduce stress. The high standard of practice and practical aspects of the job were deemed satisfying, whereas poor recognition and long hours were the major dissatisfying aspects of the job. With respect to burnout, high emotional exhaustion, high levels of depersonalisation and low levels of personal achievement were seen in 20, 20 and 36% of respondents, respectively. Female anaesthetists reported higher stress levels than males (p = 0.006), but tended to prioritise home/work commitments better than males (p = 0.05). Private practitioners rated time issues of high importance compared with public hospital doctors, whereas public hospital doctors rated communication problems as being more significant than with private specialists. Although burnout levels are high in anaesthetists, they compare favourably with other medical groups. There are, however, aspects of the anaesthetist's job that warrant further attention to improve job satisfaction and stress.
PMID: 12648115
Anaesthesia 2003 Apr;58(4):311
www.asahq.org/wlm/.
PMID: 12648110, UI: 22535015
Anaesthesia 2003 Apr;58(4):309-11
North Staffordshire Hospital, Stoke-on-Trent, UK E-mail: ra_anaes_aat@yahoo.co.uk
PMID: 12648109, UI: 22535014
Br J Anaesth 2003 Apr;90(4):525-6
California, USA Bern, Switzerland.
PMID: 12644434, UI: 22530837
Br J Anaesth 2003 Apr;90(4):524-5
London, UK.
PMID: 12644433, UI: 22530836
Br J Anaesth 2003 Apr;90(4):514-516
Department of Anesthesiology and General Intensive Care, University of Vienna, Austria and Department of Anesthesiology, Washington University School of Medicine, St Louis, MO, USAAddress for correspondence: Department of Anesthesiology and General Intensive Care, University of Vienna, Wahringer Gurtel 18-20, A-1090 Vienna, Austria. E-mail: peter.nagele@univie.ac.at
BACKGROUND: In biomedical research papers, authors often use descriptive statistics to describe the study sample. The standard deviation (SD) describes the variability between individuals in a sample; the standard error of the mean (SEM) describes the uncertainty of how the sample mean represents the population mean. Authors often, inappropriately, report the SEM when describing the sample. As the SEM is always less than the SD, it misleads the reader into underestimating the variability between individuals within the study sample. METHODS: The aim of this study was to evaluate the frequency of inappropriate use of the SEM in four leading anaesthesia journals in 2001. The journals were searched manually for descriptive statistics reporting either the mean (SD) or the mean (SEM), and inappropriate use of the SEM was noted. RESULTS: In 2001, all four anaesthesia journals published articles that used the SEM incorrectly: Anesthesia & Analgesia 27.7%, British Journal of Anaesthesia 22.6%, Anesthesiology 18.7% and European Journal of Anaesthesiology 11.5%. Laboratory reports and clinical studies were equally affected, except for Anesthesiology where 90% were basic science reports. CONCLUSIONS: One in four articles (n=198/860, 23%) published in four anaesthesia journals in 2001 inappropriately used the SEM in descriptive statistics to describe the variability of the study sample. Anaesthesia journals are encouraged to provide clearer statistical guidelines on how to report data variability in descriptive statistics. Br J Anaesth 2003; 90: 514-16
PMID: 12644429
Br J Anaesth 2003 Apr;90(4):512-4
Department of Anaesthesia and Intensive Care Medicine, St George's Hospital Medical School, Cranmer Terrace, London SW17 0RE, UK.
BACKGROUND: L-Bupivacaine has a safer side-effect profile than bupivacaine. We compared the efficacy of a mixture of L-bupivacaine 0.75% and lidocaine 2% with bupivacaine 0.75% and lidocaine 2% for peribulbar anaesthesia in cataract surgery. METHODS: Ninety patients were allocated randomly to receive 8 ml of a mixture of equal parts of bupivacaine 0.75% and lidocaine 2% or an equal volume of L-bupivacaine and lidocaine 2%. Hyaluronidase 15 IU ml(-1) was added to both solutions. RESULTS: There were significant differences between the groups in clinical end-points. The median time at which the block was adequate to start surgery was 4 min (interquartile range 4-8 min) in the bupivacaine group and 8 min (5-12 min) in the L-bupivacaine group (P=0.002). Median ocular and eyelid movement scores were similarly significantly decreased in the bupivacaine group compared with the L-bupivacaine group at all times (P</=0.03). There was no difference between groups in the incidence of minor complications. CONCLUSIONS: A mixture of bupivacaine 0.75% and lidocaine 2% provides faster onset time than a mixture of L-bupivacaine 0.75% and lidocaine 2%. Br J Anaesth 2003; 90: 512-14
PMID: 12644428, UI: 22530831
Br J Anaesth 2003 Apr;90(4):509-511
Department of Anaesthetics, Glasgow Royal Infirmary, Glasgow G4 0SF, UK. Department of Radiology, Western Infirmary, Glasgow, Glasgow G11 6NT, UK. Department of Anaesthetics, Monklands Hospital, Airdrie ML6 0JS, UK Present address: Department of Anaesthetics, Shelly Court, Gartnavel General Hospital,Glasgow G12 0WN, UK Present address: Department of Radiology, Royal Alexandra Hospital, Paisley PA2 9PN, UK.
BACKGROUND: Insertion of a needle into the lumbar subarachnoid space may cause damage to the spinal cord. Current techniques to identify a safe interspace have limitations. Ultrasound was investigated as a means to improve anatomical accuracy. METHODS: Seventeen patients attending for elective magnetic resonance imaging (MRI) of the spine were studied. Ultrasonic identification of the L3-4 interspace was attempted by an anaesthetist and a marker was placed. A radiologist identified the anatomical location of the marker on the MRI scan. RESULTS: Thirteen out of 17 markers were at the L3-4 interspace; four were at the L2-3 interspace. CONCLUSIONS: These results suggest that ultrasonography may be a useful adjunct to safe subarachnoid anaesthesia. Br J Anaesth 2003; 90: 509-11
PMID: 12644427
Br J Anaesth 2003 Apr;90(4):474-9
Royal Victoria Infirmary, Queen Victoria Road, Newcastle upon Tyne, UK. Department of Surgery, Cumberland Infirmary, Newtown Road, Carlisle, Cumbria CA2 7HY, UK. Department of Anaesthetics, Cumberland Infirmary, Carlisle, UK.
BACKGROUND: The perioperative management of two-stage oesophagectomy has not been standardized and the prevailing practice regarding the timing of extubation after the procedure varies. This audit has evaluated the outcome, in particular the respiratory morbidity and mortality, after immediate extubation in patients who have had thoracic epidural analgesia. METHODS: All the patients who underwent two-stage oesophagectomy by a single specialist upper gastrointestinal surgeon were recorded both retrospectively (1993-1999) and prospectively (1999-2001). Physical characteristics, comorbid factors, anaesthetic management and postoperative events were recorded on a computer database. Analysis was undertaken to evaluate the morbidity and mortality, in particular the need for reventilation and transfer to the ITU. RESULTS: Seventy-six patients underwent two-stage oesophagectomy between 1993 and 2001. Seventy-three (96%) patients were extubated in theatre and transferred to a high-dependency bed. Three were ventilated electively and extubated within 36 h and made an uncomplicated recovery. Seven (10%) of the immediately extubated patients subsequently needed admission to the ICU and reventilation. Sixty-seven patients had effective epidural analgesia and nine needed i.v. morphine by patient-controlled analgesia. The 30-day or in-hospital mortality was 2.6% (2 of 76). A further two patients died within 90 days, but after discharge. Respiratory complications were responsible for half of the overall morbidity (44.7%). Respiratory failure occurred in 6.5% (5 of 76) and acute respiratory distress syndrome in 2.6% (2 of 76). Both the in-hospital deaths occurred in patients requiring reventilation and resulted from respiratory complications. The following factors were found to be significant in the reventilated patients: duration of one-lung ventilation; forced expiratory volume in the first second; and ratio of forced expiratory volume in the first second/forced vital capacity. CONCLUSIONS: Immediate extubation after two-stage oesophagectomy in patients with thoracic epidural analgesia is safe and associated with low morbidity and mortality. Patients can be managed in a high-dependency unit, thus avoiding the need for intensive care. This has cost-saving and logistical implications. Br J Anaesth 2003; 90: 474-9
PMID: 12644420, UI: 22530823
Br J Anaesth 2003 Apr;90(4):428-9
Department of Anaesthesia and Intensive Care Medicine, St George's Hospital Medical School, London SW17 0RE, UK.
PMID: 12644411, UI: 22530814
Br J Pharmacol 2003 Mar;138(5):876-82
Department of Anaesthesiology, Osaka University Medical School, Suita, Osaka, 565-0871, Japan.
1 Although the principal pharmacological targets of local anaesthetics (LAs) are voltage-gated Na(+) channels, other targets have also been suggested. Here we examined the effects of LAs on the N-methyl-D-aspartate (NMDA) receptor, a receptor involved in the process of nociception. 2 LAs (bupivacaine, lidocaine, procaine, and tetracaine) reversibly and concentration-dependently inhibited recombinant epsilon1/zeta1 and epsilon2/zeta1 NMDA receptors expressed in Xenopus oocytes (IC(50)s for bupivacaine, lidocaine, procaine, and tetracaine were 1032.0, 1174.1, 642.1 and 653.8 micro M at the epsilon1/zeta1 receptor; and 1090.8, 1821.3, 683.0 and 662.5 micro M respectively (at the epsilon2/zeta1 receptor). Bupivacaine and procaine were non-competitive antagonists; bupivacaine possesses non-competitive and competitive actions when interacting with glycine, whereas procaine has only non-competitive action. 3 Mutation of asparagine residue at position 598 (Asp(598)) in the zeta1 subunit, a residue associated with the blockade site for Mg(2+) and ketamine, to glutamine or arginine reduced the sensitivity to procaine but not to bupivacaine. Thus, procaine may interact with sites of action that are closely related to those of Mg(2+) and ketamine blockade. 4 These results suggest that LAs inhibit the NMDA receptor by various mechanisms. British Journal of Pharmacology (2003) 138, 876-882. doi:10.1038/sj.bjp.0705107
PMID: 12642389, UI: 22528643
Neurosci Lett 2003 Apr 3;340(1):49-52
CURE: Digestive Diseases Research Center, VA Great Los Angeles Healthcare System, Department of Medicine, Division of Digestive Diseases and Brain Research Institute, West Los Angeles Campus, Building 115, Room 203, 11301, Wilshire Boulevard, UCLA, 90073, Los Angeles, CA, USA
Gastroparesis is a common complication of diabetes attributed to autonomic neuropathy. This study investigated whether acute hyperglycemia influences central thyrotropin-releasing hormone (TRH), a well-established brain medullary vagal stimulus, induced gastric acid secretion in overnight fasted, urethane-anesthetized rats. Intravenous infusion of D-glucose (20%, 30% and 40%) dose dependently reduced intracisternal TRH-induced gastric acid secretion (71+/-28 &mgr;mol/90 min) by 39%, 90% and 100% respectively. Pretreatment with cholecystokinin(A) (CCK(A)) receptor antagonist devazepide (1 mg/kg) did not influence the inhibitory effect of intravenous glucose (30%). These results indicate that hyperglycemia may have a central effect to antagonize medullary TRH stimulation of vagal outflow to the stomach.
PMID: 12648756
Neurosci Lett 2003 Apr 3;340(1):1-4
Department of Pharmacology and Toxicology, Indiana University School of Medicine, 46202, Indianapolis, IN, USA
Prostaglandin E2 (PGE2) acts in the preoptic area (POA) of the mammalian hypothalamus to increase body temperature and heart rate. Chemical stimulation of the dorsomedial hypothalamus (DMH), a region richly innervated by neurons in the POA, evokes sympathetically-mediated increases in heart rate and body temperature. We tested the hypothesis that neurons in the DMH mediate hyperthermia and tachycardia resulting from the action of PGE2 in the POA. Microinjection of PGE2 150 pmol/15 nl into the POA in urethane-anesthetized rats caused increases in body temperature and heart rate that were sharply reversed after injection of muscimol 80 pmol/100 nl into the DMH but not after similar injection of saline vehicle. Therefore, thermogenic and tachycardic actions of PGE2 in the POA are at least in part a consequence of neuronal activity in the region of the DMH.
PMID: 12648744, UI: 22536333