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Items 1 - 8 of 8 |
One page. |
[In vitro effects of anaesthetic agents on the blood-brain barrier.]
[Article in German]
Fischer S, Renz D, Kleinstuck J, Schaper W, Karliczek GF.
Abteilung fur Anasthesiologie und Intensivmedizin, Kerckhoff-Klinik GmbH, Bad Nauheim.
BACKGROUND. The blood-brain barrier (BBB) forms a selective barrier between blood and brain and regulates the passage of most molecules. Pathological conditions such as ischemia lead to breakdown of the BBB. Vascular endothelial growth factor (VEGF) has been shown to be responsible for hypoxia-induced hyperpermeability of the BBB in vivo as well as in vitro. To eliminate factors which alter the permeability of the BBB in vivo, an in vitro model was used to test the effects of intravenous and volatile anesthetics on the permeability and on VEGF expression during normoxia and hypoxia. METHODS. The in vitro model of the BBB consisted of primary cultures of porcine brain microvascular endothelial cells (BMEC). The permeability was measured by the paracellular passage of [3H]inulin across the BMEC monolayer and the expression of VEGF was determined by northern blot analysis. RESULTS. All intravenous and volatile anesthetics tested (etomidate, ketamine, fentanyl, propofol, midazolam, sodium-gamma-hydroxybutyrate as well as halothane, enflurane, isoflurane, sevoflurane, desflurane) did not alter the permeability of the BBB or the expression of VEGF in vitro. Hypoxia (2 vol%) increased the permeability and the VEGF expression significantly which was not altered in the presence of the anesthetics. CONCLUSION. The in vitro model represents a suitable model of the BBB to investigate direct effects of anesthetics on functions of the BBB independent of hemodynamic factors.
PMID: 15549193 [PubMed - as supplied by publisher]
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[Therapeutic hypothermia after traumatic brain injury or subarachnoid hemorrhageCurrent practices of German anaesthesia departments in intensive care.]
[Article in German]
Himmelseher S, Werner C.
Klinik fur Anaesthesiologie, Klinikum rechts der Isar, Technische Universitat Munchen, Munchen.
BACKGROUND. We aimed to explore current practices in use of therapeutic hypothermia after traumatic brain injury (TBI) or subarachnoid hemorrhage (SAH) in intensive care of adults. METHODS. Questionnaires were sent to anaesthesia department chairs in German hospitals with neurosurgical care in January 2004 with a survey focussing on cooling procedures, temperature measurement, depth and duration of hypothermia, and rewarming after therapy. RESULTS. 99 (67%) questionnaires on TBI and 95 (64%) on SAH could be analysed. Hypothermia was used in 39% after TBI and 18% after SAH. Its aims were neuroprotection in approximately 45% and control of refractory intracranial hypertension in approximately 50%. However, in most cases (69% TBI, 59% SAH) hypothermia was used in less than a quarter of patients treated. A criterion for hypothermia was severe disease in approximately 40% and refractory intracranial hypertension in approximately 50%. Temperatures were targeted to 36-34 degrees C in 77% after TBI and 88% after SAH. In more than 80%, bladder temperatures were measured. For induction of hypothermia, surface cooling was applied in approximately 90%. The duration of hypothermia was 24-48 h in 62% after TBI and 29% after SAH. Cooling was orientated at the intracranial pressure (ICP) in 31% after TBI and 47% after SAH, and was used for more than 48 h in approximately 25%. After hypothermia was stopped, a rewarming rate of 0.5 degrees C/h was applied in 38% after TBI and 53% after SAH. In approximately 35%, rewarming was orientated at the ICP, and in 33% after TBI and 24% after SAH, it was performed over 24 h. After SAH, spontaneous rewarming was used in 24%. CONCLUSION. Therapeutic hypothermia is used in 39% after TBI and 18% after SAH in the intensive care of German anaesthesia departments. There is no standard in management, and there is wide variation in practices of duration of cooling and rewarming. For patients' benefit, evidence-based recommendations on therapeutic hypothermia should be published by the appropriate medical societies in the German language.
PMID: 15549192 [PubMed - as supplied by publisher]
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Sedation in Japanese dental schools.
Morse Z, Sano K, Fujii K, Kanri T.
School of Oral Health, Fiji School of Medicine, Suva, Fiji Islands.
There is very little information about the practice of sedation in Japan. Despite the remarkable advances in dentistry, fear and anxiety continue to be significant deterrents for seeking dental services. Most dental procedures can fortunately be undertaken with the aid of sedation. A comprehensive survey of all the dental schools in Japan was carried out to determine what sedation practices were used in Japan. All 29 dental schools in Japan possessed a dedicated department of anesthesiology at the time of this survey. The survey attempted to determine the specific sedation methods (techniques, routes of administration, and agents used in sedation) as well as practices (monitoring, fasting, location, education, and fees involved in sedation). The results indicate that there was a broad range in sedation practices. The Japanese Dental Society of Anesthesiology may wish to examine the findings of this study and may wish to formulate guidelines appropriate for the practice of sedation in Japan. Others may also wish to compare their own practices with those of Japan.
PMID: 15497299 [PubMed - indexed for MEDLINE]
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Effects of a midazolam-ketamine admixture in human volunteers.
Morse Z, Sano K, Kanri T.
School of Oral Health, Fiji School of Medicine, Suva, Fiji Islands.
As the ideal sedative does not exist for all situations, we examined the effect of a midazolam-ketamine sedoanalgesic admixture in human volunteers. Ten ASA physical status I volunteers were administered loading doses of 0.07 mg/kg of midazolam followed by 0.7 mg/kg of ketamine. The same amount of midazolam and ketamine was then infused constantly over 1 hour via a 60 drops (gtts)/mL i.v. infusion set. Blood samples were analyzed for plasma catecholamine levels. Respiration rate and oxygen saturation did not alter significantly from baseline levels. Heart rate and systolic blood pressure remained stable with an increase of 15% in heart rate and 6% in systolic blood pressure only at 10 minutes following the bolus loading. Diastolic blood pressure did not alter significantly from baseline levels (P < .05). Plasma catecholamines levels remained stable except for an increase in epinephrine (38%) and norepinephrine (19%) 10 minutes following the bolus injections. Plasma dopamine levels remained unchanged. There were no cases of unpleasant dreaming, dysphoria, or emergence-type reactions. This combined nonnarcotic sedoanalgesic technique maintains spontaneous ventilation and stable cardiorespiratory parameters and may be considered as an alternative to traditional conscious sedation or general anesthesia.
Publication Types:
PMID: 15497296 [PubMed - indexed for MEDLINE]
An RCT pilot study to test the effects of intravenous midazolam as a conscious sedation technique for anxious children requiring dental treatment - an alternative to general anaesthesia.
Averley PA, Lane I, Sykes J, Girdler NM, Steen N, Bond S.
1Principal Dentist, Principal Investigator, Queensway Anxiety Management Clinic, 170 Queensway, Billingham.
Aim To add to the evidence base for acceptable and effective paediatric conscious sedation techniques in dental primary care.Objectives To compare three conscious sedation techniques for primary care as an alternative to dental general anaesthesia (DGA) in children. To assess the feasibility and practicality of running the trial in general dental practice. To form the basis for sample size calculations and assess scales of measurement.Design Single centre, randomised control trial (RCT).Setting Queensway Anxiety Management Clinic (QAMC). A primary care based general and referral dental practice for the management of anxious patients.Subjects, materials and methods Sixty five children too anxious for management with relative analgesia, requiring invasive dental procedure for which dental general anaesthesia (DGA) will be required if an alternative cannot be found.Interventions Group 1 (n = 20) - A combination of inhaled medical air and titrated intravenous midazolam. Group 2 (n = 22) - A combination of inhaled 40% nitrous oxide in oxygen and titrated intravenous midazolam. Group 3 (n = 23) - A combination of an inhaled mixture of 0.3% sevoflurane and 40% nitrous oxide in oxygen with titrated intravenous midazolam.Main outcome measures Successful completion of the intended dental treatment with a child who is co-operative and responsive to verbal commands.Results Fifty per cent (ten children) successfully completed treatment in Group 1, 73% (16 children) in Group 2 and 83% (19 children) in Group 3. This difference was not significant at a 5% level (chi(2) = 5.53, df = 2, P = 0.07) Of the total of 20 failures, eight children in Group 1 and one child in Group 2 were successfully treated with the addition of sevoflurane and nitrous oxide in oxygen. Only two children required referral to a hospital setting for DGA and the remaining nine children were managed with an alternative conscious sedation technique.Conclusion This pilot shows that intravenous midazolam especially in combination with the addition of inhaled nitrous oxide or sevoflurane and nitrous oxide were promising safe and effective techniques, sufficient to justify progression to a definitive RCT with appropriate methods.
PMID: 15543117 [PubMed - in process]
Interstitial muscle concentrations of rocuronium under steady-state conditions in anaesthetized dogs: actual versus predicted values.
Ezzine S, Varin F.
Faculte de pharmacie, Universite de Montreal, Montreal, Quebec, Canada.
Introduction. The objective of this study was to compare rocuronium effect (Ce) and peripheral (C2) compartment concentrations predicted by pharmacokinetic-pharmacodynamic (PK-PD) modelling with those measured in plasma (Cp) and in the interstitial fluid of muscle tissue (CISF,u) by microdialysis in anaesthetized dogs. METHODS: After approval by the Animal Care Committee, eight adult male dogs with a body weight ranging from 7 to 18 kg were anaesthetized with pentobarbital. Each dog received a 2-min rocuronium infusion of 0.15 mg kg(-1) min(-1) followed by a 118-min infusion of 60 microg kg(-1) min(-1) via the right jugular vein. Arteriovenous gradient across the hindlimb was measured at 40, 60, 100 and 120 min. Three microdialysis samples were collected at 40-min intervals. Once the infusion stopped, arterial samples were collected every 2 min for the first 10 min and every 20 min for the next 120 min. Neuromuscular function was monitored using train-of-four stimulation until full recovery. Dogs were then killed and a biopsy of muscle tissue was performed (Cm). RESULTS: At steady state, the mean CISF,u value was 1353 ng ml(-1). After correction for the unbound fraction in plasma, the mean Ce,corr and C2,corr were 1681 and 1481 ng ml(-1), respectively. At the terminal sampling point, Cm was 10-fold higher than Cp. CONCLUSION: Unbound concentration of rocuronium measured in the muscle interstitial fluid under steady-state conditions confirms that parametric PK-PD modelling gives reliable estimates of effect site concentrations. Rocuronium accumulates in muscle tissue, probably by non-specific protein binding in the interstitial space.
PMID: 15542539 [PubMed - as supplied by publisher]
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Effect of timing on the response to postal questionnaires concerning satisfaction with anaesthesia care{dagger}{ddagger}
Saal D, Nuebling M, Husemann Y, Heidegger T.
Department of Anaesthesiology, St Gallen Cantonal Hospital, CH-9007 St Gallen, Switzerland.
BACKGROUND: There is little information on the effect of time on the assessment by the patient of quality of anaesthesia care. This study compared the patient's assessment of anaesthesia care after three different periods of time following discharge from hospital. Materials. Three groups of patients were assigned to receive a standardized, validated psychometric questionnaire either 1, 5, or 9 weeks after discharge from hospital. We measured response rate and the total mean problem score of six dimensions. RESULTS: Groups 1, 2, and 3 received 748, 743, and 723 questionnaires, respectively. The response rates including one reminder were 67.3 (95% confidence interval [CI] 63.9-70.6%), 64.5% (CI 61.1-67.9%), and 58.9% (CI 55.5-62.4%), respectively (Group 1 vs Group 3, P<0.001, and Group 2 vs Group 3, P<0.05). The total mean problem scores were not significantly different with 17 (CI 1.4%), 17 (CI 1.4%), and 15% (CI 1.3%), respectively. In two out of six dimensions ('Continuity of personal care by anaesthetist' and 'Nursing care in recovery room') significantly less problems were reported after 9 weeks. The other dimensions of the questionnaire showed no consistent differences between groups. CONCLUSIONS: The response rate is significantly lower at 9 weeks compared with 1 and 5 weeks after discharge. The total mean problem score remains unchanged but certain fields show fewer problems after 9 weeks compared with 1 and 5 weeks. Questionnaires on patient satisfaction with anaesthesia care should be sent within 5 weeks of discharge.
PMID: 15542538 [PubMed - as supplied by publisher]
Increased release of immunoreactive dynorphin A(1-17) from the spinal cord after intrathecal treatment with endomorphin-2 in anesthetized rats.
Leitermann RJ, Terashvili M, Mizoguchi H, Wu HE, Chen F, Clithero A, Tseng LF.
Department of Anesthesiology, Medical College of Wisconsin, Milwaukee, WI 53226, USA.
We previously demonstrated pretreatment with antiserum against dynorphin A(1-17) attenuates endomorphin-2-induced analgesia and antianalgesia, suggesting that these endomorphin-2 effects are mediated by the release of dynorphin A(1-17). Lumbar-cisternal spinal perfusion was used to measure the release of immunoreactive dynorphin A(1-17) into spinal perfusates from urethane-anesthetized rats following endomorphin-2 or endomorphin-1 treatment within the perfusion solution. Treatment with endomorphin-2 (5-50 nmol) for 3 min caused a dose-dependent increase of immunoreactive dynorphin A(1-17) in spinal perfusates, with a maximal increase detected between 24 and 48 min after endomorphin-2 treatment, while levels returned to baseline within 60 min. Endomorphin-2-induced release of immunoreactive dynorphin A(1-17) was attenuated by pretreatment with mu-opioid receptor antagonist naloxone or 3-methoxynaltrexone. Endomorphin-1 induced a slight increase in immunoreactive dynorphin(1-17) as well, but only at the highest dose used (50 nmol). Our results suggest that endomorphin-2 stimulated a specific subtype of mu-opioid receptor to induce the release of immunoreactive dynorphin A(1-17) in spinal cords of rats.
PMID: 15541419 [PubMed - in process]
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