Issues

The ARISCAT risk assessment tool was replicated and externally validated in over 5,000 patients across Europe.

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Cyclosporine administration at the time of reperfusion protects against reperfusion injury in patients undergoing aortic valve surgery as demonstrated by a significant reduction in cardiac troponin I compared with the control group.

In a controlled study of approximately 450 patients, electrical stimulation through the needle or needle and catheter was noninferior to ultrasound guidance alone in terms of pain score and IV opioid requirement. Additionally, the use of ultrasound alone was both faster and less expensive.

In a randomized, prospective, parallel, controlled trial of patients who were undergoing lung resection procedures with one-lung ventilation, one group of the randomized patients received limb ischemia in three cycles of 5 min of ischemia with 5 min of reperfusion. The patients receiving limb ischemia had a significant decrease in acute lung injury.

This randomized cross-over study simultaneously measured laryngoscope force and cervical spine motion during tracheal intubations with Macintosh and Airtraq laryngoscopes in anesthetized and paralyzed adult persons. The relationship between the force and motion was nonlinear and differed between the intubation devices. Notably, “low force” does not necessarily imply less cervical motion.

A retrospective review of blood histamine and tryptase concentrations from 75 patients having life-threatening allergic reactions under anesthesia and 25 patients resuscitated from cardiac or other types of shock showed significantly higher concentrations of histamine and tryptase in the patients with allergic reactions and no effect of resuscitation procedures.

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In rats, local heat and emulsified isoflurane enhanced peripheral nerve block from locally applied QX-314, and the combination of moderate warmth plus isoflurane was as great as noxious heat.

The R-enantiomer of etomidate is a more potent suppressor of adrenocortical steroid biosynthesis than the S-enantiomer. Two achiral etomidate analogues had lower hypnotic and adrenocortical suppression potencies than the R-enantiomer of etomidate. Modification of the chiral center of etomidate may be part of a strategy to produce analogues that cause less adrenocortical suppression.

Using a combination of electrophysiological, behavioral, and biochemical tasks in young adult rats, the authors confirmed and extended that isoflurane induced long-lasting deficits in hippocampal learning and modulated synaptic plasticity. Synaptic increment of GluA1 and the reduction of its ubiquitination may contribute to this impairment.

Electrical stimulation of the ventral tegmental area, but not of the substantia nigra, restored righting and activated the electroencephalogram during isoflurane or propofol anesthesia. Selective activation of the ventral tegmental area pathway resembled pharmacological activation of dopamine receptors in evoking arousal from anesthesia.

A multicenter, prospective observational investigation of 73 critically ill patients admitted to four Italian University hospitals had patients examined with transthoracic ultrasound 10 min before invasive (pulmonary artery catheters or PiCCO systems) hemodynamic measurements were made. This study confirmed that there was not always an association between the elevation of the pulmonary artery occlusion pressure and finding of B-pattern in the lungs, but there was a better specificity between the detection of B-pattern by ultrasound and detecting elevated extravascular lung water by PiCCO.

Using sophisticated quantitative electroencephalography analysis, postcardiac surgery patients show loss of α band connectivity, but increased δ band connectivity directed to frontal regions. Similar to what occurs in other conditions where cognitive function is adversely affected (such as schizophrenia and Alzheimer disease), delirium may be thought of as a syndrome of disconnection of brain regions.

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Mice with transient receptor potential melastatin 2 (TRPM2) enetically eliminated who were exposed to polymicrobial sepsis had increased mortality with increased bacterial burden, organ injury, and systemic inflammation. Similarly, patients who had lower monocytic TRPM2 levels had worse outcomes compared with patients with normal monocytic TRPM2 levels.

In 60 patients undergoing open abdominal hysterectomy, morphine consumption was lower in women receiving lidocaine intraperitoneally than intravenously, indicating a peripheral action.

Using a rat spinal nerve ligation model, the authors observed that neuropathic rats were less sensitive to morphine than were normal animals. The enhanced spinal release of serotonin acting through 5-hydroxytryptamine 3 receptors may be responsible for the reduced effects of morphine.

Phosphodiesterase 2A expression was increased in the dorsal horn of mice after paw inflammation. Inhibition of phosphodiesterase 2A exacerbated nociceptive behavior with inflammatory but not with neuropathic pain. Inhibitors of phosphodiesterases, which are being developed for treatment of neuropsychiatric diseases, may increase pain perception.

A simulation-based transesophageal echocardiography curriculum can teach knowledge and technical skills to echo-naive learners. Kinematic measures can objectively evaluate the progression of manual transesophageal echocardiography skills.

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Postoperative pulmonary complications are a major cause of postoperative morbidity and mortality. The perioperative positive pressure ventilation bundle could help at further reducing postoperative pulmonary complications.

This review highlights recent findings regarding the changes in noncoding RNAs in pain-related regions after persistent inflammation and nerve injury, and discusses how noncoding RNAs participate in the development and maintenance of chronic pain.