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Anesthetics
Kinds of Anesthetics Terms modified by Anesthetics Selected AbstractsLetter: Is Articaine the Hypoallergenic Anesthetic?DERMATOLOGIC SURGERY, Issue 2 2007SHARON E. JACOB MD No abstract is available for this article. [source] Hand augmentation with Radiesse® (Calcium hydroxylapatite)DERMATOLOGIC THERAPY, Issue 6 2007Mariano Busso ABSTRACT:, The hand has remained a considerable treatment challenge, as new soft tissue fillers have arrived in the esthetic marketplace. The challenge has been the result of both the multiple visits required for treatment in, for example, autologous fat grafting and the simple management of pain in the innervated areas of the hand between the bones. This paper introduces a novel, noticeably less painful approach to treatment of the hand with calcium hydroxylapatite (CaHA; Radiesse®, BioForm Medical, San Mateo, CA). Anesthetic is added to the compound prior to injection, resulting in a homogenous admixture of CaHA and anesthetic. A bolus of the mixture is injected into the skin, using tenting, and then spread throughout the hand. The result of this approach , mixing anesthetic with CaHA , is treatment that is easier to massage and disseminate, less painful to the patient than conventional hand injection, and characterized by less swelling and bruising, with minimal post-treatment downtime. [source] Safety and Acceptability of Implantation of Internal Cardioverter-Defibrillators Under Local Anesthetic and Conscious SedationPACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 8 2007DAVID J. FOX B.M.Sc., M.B.Ch.B., M.R.C.P. Background: Implantation and testing of implantable defibrillators (ICDs) using local anesthetic and conscious sedation is widely practiced; however, some centers still use general anesthesia. We assessed safety and patient acceptability for implantation of defibrillators using local anesthetic and conscious sedation. Methods: The records of 500 consecutive device implants from two UK cardiac centers implanted under local anesthetic and conscious sedation from January 1996 to December 2004 were reviewed. Procedure time, left ventricular ejection fraction (LVEF) sedative dosage (midazolam), analgesic dosage (fentanyl or diamorphine), requirement for drug reversal, and respiratory support were recorded. Patient acceptability of the procedure was also assessed. Results: Of 500 implants examined, 387 were ICDs, 88 were biventricular ICDs, and 25 were generator changes. Patients with biventricular-ICDs had significantly longer (mean ± SD) procedure times 129.7 ± 7.6 minutes versus 63.3 ± 32.3 minutes; P < 0.0001 and lower LVEF 24.4 ± 8.4% versus 35.7 ± 15.4%; P < 0.0001. There were no differences in the doses (mean ± SD) of midazolam 8.9 ± 3.5 mg versus 8.0 ± 3.1 mg; P = NS, diamorphine 4.3 ± 2.0 mg versus 3.8 ± 1.7 mg; P = NS or fentanyl 94.4 ± 53.7 mcg versus 92.2 ± 48.6 mcg; P = NS, between the two groups. There were no deaths or tracheal intubations in either group. Acceptability was available for 373 of 500 (75%) patients, 41 of 373 (11%) described "discomfort," but from these 41 patients only 14 of 373 (3.8%) declined a second procedure under the same conditions. Conclusions: Implantation of defibrillators under local anesthetic and sedation is safe and acceptable to patients. General anesthesia is no longer routinely required for implantation of defibrillators. [source] Two-Minute Skin Anesthesia Through Ultrasound Pretreatment and Iontophoretic Delivery of a Topical Anesthetic: A Feasibility StudyPAIN MEDICINE, Issue 1 2008Egilius L. H. Spierings MD ABSTRACT Background and Objectives., The pain associated with percutaneous procedures is a significant source of distress in clinical practice, especially in children. Topical anesthetics require 30,60 minutes to provide skin anesthesia; with iontophoresis, they minimally require 10 minutes, and with ultrasound pretreatment, 5 minutes. In this study, we assessed the feasibility of providing skin anesthesia to needle prick with the combination of ultrasound pretreatment and 2-minute low-voltage (1 mA) iontophoresis. We compared it with sham-ultrasound pretreatment and with standard, 10-minute high-voltage (4 mA) iontophoresis. Methods., This is a single-blind, randomized, controlled, crossover study in healthy volunteers, specifically for the purpose of the study subjected to standardized needle prick. They rated the absolute pain associated with the needle prick on a 10-cm visual analog scale, with 0 being "no pain" and 10 being "extremely painful." Results., Of the 31 subjects who consented to the study, 30 were randomized and completed the study. The mean duration of the ultrasound pretreatment was 21.4 seconds (range: 6,85). The absolute pain scores for the ultrasound plus 2-minute low-voltage iontophoresis and the standard, 10-minute high-voltage iontophoresis were not statistically significantly different (0.9 ± 0.31 vs 0.46 ± 0.20; P = 0.49). However, they were statistically significantly different from the sham-ultrasound plus 2-minute low-voltage iontophoresis pain score (2.6 ± 0.55) (P = 0.0001 and 0.0012, respectively). Conclusions., Ultrasound pretreatment plus 2-minute low-voltage iontophoresis provides better skin anesthesia than sham-ultrasound plus 2-minute low-voltage iontophoresis, and similar to standard, 10-minute high-voltage iontophoresis. [source] Temporary Neurologic Deficit After Cervical Transforaminal Injection of Local AnestheticPAIN MEDICINE, Issue 2 2004Michael Karasek MD ABSTRACT Objective To describe the effects of spinal cord block after injection of local anesthetic into a cervical radicular artery. Design Case report. Setting Neurology practice specializing in spinal pain. Interventions A patient underwent a C6,7 transforaminal injection. Contrast medium indicated correct and safe placement of the needle. Results After the injection of local anesthetic, the patient developed quadriplegia. The injection was terminated. The neurologic impairment resolved after 20 minutes observation. Conclusion Despite correct placement of the needle for a cervical transforaminal injection, injectate may nevertheless enter a cervical radicular artery. Whereas local anesthetic, so injected, appears to have only a temporary effect on spinal cord function, particulate steroids may act as an embolus and cause permanent impairment. [source] A Randomized, Double-Blind Comparison of Two Topical Anesthesic Formulations Prior to Electrodesiccation of Dermatosis Papulosa NigraDERMATOLOGIC SURGERY, Issue 1 2006ERIC L. CARTER MD BACKGROUND Liposomal lidocaine 4% (L.M.X.4 cream, Ferndale Laboratories Inc., Ferndale, MI, USA) has been proposed as a more rapidly acting topical anesthetic than the eutectic mixture of lidocaine 2.5% and prilocaine 2.5% (EMLA cream, AstraZeneca LP, Wilmington, DE, USA) for venipuncture and laser procedures. However, their anesthetic efficacy has not been previously compared for electrosurgical destruction of superficial skin lesions. OBJECTIVE To test the hypothesis that L.M.X.4 and EMLA differ in anesthetic efficacy when applied under occlusion for 30 minutes prior to electrodesiccation of papules of dermatosis papulosa nigra. METHODS Forty adults were randomly assigned to treatment with either agent for 30 minutes under Tegaderm. The study drug was administered for an additional 30 minutes if the electrodesiccation of the first few papules was too painful. RESULTS One subject treated with EMLA versus none treated with L.M.X.4 experienced complete anesthesia after a single 30-minute application. Nineteen of 20 (95%) subjects treated with EMLA versus 18 of 20 (90%) subjects treated with L.M.X.4 required only a single application (p=.49). Pain scores after the initial 30-minute application (scale: 0=none to 10=very severe) were EMLA 3.3±2.2 (mean±SD) versus L.M.X. 4 2.9±2.0 (p=.46). CONCLUSION EMLA and L.M.X.4 provide comparable levels of anesthesia after a single 30-minute application under occlusion prior to electrodesiccation of superficial skin lesions. [source] Complications of Nail Surgery: A Review of the LiteratureDERMATOLOGIC SURGERY, Issue 3 2001Meena Moossavi MD Background. The realm of nail unit surgery encompasses the dermatologist as well as the hand surgeon. Nail surgery complications may include allergy to anesthetic, infection, hematoma, nail deformity, and persistent pain and swelling. Objective. To review the pertinent literature regarding nail unit surgery complications. Methods. A Medline literature search was performed for relevant publications. Results. Nail unit surgery complications appear to be relatively infrequent. The majority of postoperative nail deformity complications result from nail matrix damage. Conclusion. Complications may be reduced to a minimum by preventive measures, such as careful patient selection, sterile technique, and gentle treatment of the nail matrix. [source] Hand augmentation with Radiesse® (Calcium hydroxylapatite)DERMATOLOGIC THERAPY, Issue 6 2007Mariano Busso ABSTRACT:, The hand has remained a considerable treatment challenge, as new soft tissue fillers have arrived in the esthetic marketplace. The challenge has been the result of both the multiple visits required for treatment in, for example, autologous fat grafting and the simple management of pain in the innervated areas of the hand between the bones. This paper introduces a novel, noticeably less painful approach to treatment of the hand with calcium hydroxylapatite (CaHA; Radiesse®, BioForm Medical, San Mateo, CA). Anesthetic is added to the compound prior to injection, resulting in a homogenous admixture of CaHA and anesthetic. A bolus of the mixture is injected into the skin, using tenting, and then spread throughout the hand. The result of this approach , mixing anesthetic with CaHA , is treatment that is easier to massage and disseminate, less painful to the patient than conventional hand injection, and characterized by less swelling and bruising, with minimal post-treatment downtime. [source] Maternal anesthesia via isoflurane or ether differentially affects pre-and postnatal behavior in rat offspringDEVELOPMENTAL PSYCHOBIOLOGY, Issue 7 2007April E. Ronca Abstract Our understanding of prenatal behavior has been significantly advanced by techniques for direct observation and manipulation of unanesthetized, behaving rodent fetuses with intact umbilical connections to the mother. These techniques involve brief administration of an inhalant anesthesic, enabling spinal transection of the rat or mouse dam, after which procedures can continue with unanesthetized dams and fetuses. Because anesthetics administered to the mother can cross the placental barrier, it is possible that fetuses are anesthetized to varying degrees. We compared in perinatal rats the effects of prenatal maternal exposure to two inhalant anesthetics: ether and isoflurane. Fewer spontaneous fetal movements and first postpartum nipple attachments were observed following maternal exposure to ether as compared to isoflurane. Neonatal breathing frequencies and oxygenation did not account for group differences in nipple attachment. Our results provide evidence that the particular inhalant anesthetic employed in prenatal manipulation studies determines frequencies of perinatal behavior. © 2007 Wiley Periodicals, Inc. Dev Psychobiol 49: 675,684, 2007. [source] Methemoglobinemia Following Transesophageal Echocardiography: A Case Report and ReviewECHOCARDIOGRAPHY, Issue 4 2006Swarnalatha BheemReddy M.D. Benzocaine (ethyl aminobenzoate) is a topical anesthetic widely used for oropharyngeal anesthesia prior to transesophageal echocardiography (TEE). Topical anesthetics have been reported to cause methemoglobinemia, but this adverse event is extremely rare and has not been listed as one of the possible complications of TEE. However, recently the number of published case reports of TEE-associated methemoglobinemia has increased. Since its first description in 1950, 65 cases of methemoglobinemia have been reported including a recent report of five cases from a single center. Physicians who are not familiar with the association of TEE with benzocaine-induced methemoglobinemia may not recognize the idiosyncratic and often nonspecific characteristic of this condition. Recognition is critical, however, since left untreated methemoglobinemia can lead to cardiopulmonary compromise, neurological sequelae, and even death. The current report documents an additional case of TEE-associated methemoglobinemia from a high-volume (8000 cases /year including 400,450 TEE/year) echo lab. A review of the literature suggests that this complication may be more prevalent, than generally appreciated. This case report emphasizes the importance of appropriate dose, recognition, and the treatment of this entity to cardiologists performing TEE. [source] Liposomes for entrapping local anesthetics: A liposome electrokinetic chromatographic studyELECTROPHORESIS, Issue 9 2010Jana Lokajová Abstract Bupivacaine is a lipophilic, long-acting, amide class local anesthetic commonly used in clinical practice to provide local anesthesia during surgical procedures. Several cases of accidental overdose with cardiac arrest and death have been reported since bupivacaine was introduced to human use. Recent case reports have suggested that Intralipid (Fresenius Kabi) is an effective therapy for cardiac toxicity from high systemic concentrations of, e.g. bupivacaine, even though the mechanism behind the interaction is not fully clear yet. Our long-term aim is to develop a sensitive, efficient, and non-harmful lipid-based formulation to specifically trap harmful substances in vivo. In this study, the in vitro interaction of local anesthetics (bupivacaine, prilocaine, and lidocaine) with Intralipid or lipid vesicles containing phosphatidylglycerol, phosphatidylcholine, cardiolipin, cholesterol, and N -palmitoyl- D - erythro -sphingosine (ceramide) was determined by liposome electrokinetic chromatography. The interactions were evaluated by calculating the retention factors and distribution constants. Atomic force microscopy measurements were carried out to confirm that the interaction mechanism was solely due to interactions between the analytes and the moving pseudostationary phase and not by interactions with a stationary lipid phase adsorbed to the fused-silica wall. The heterogeneity of the liposomes was also studied by atomic force microscopy. The liposome electrokinetic chromatography results demonstrate that there is higher interaction between the drugs and negatively charged liposome dispersion than with the commercial Intralipid dispersion. [source] The role of peripheral Na+ channels in triggering the central excitatory effects of intravenous cocaineEUROPEAN JOURNAL OF NEUROSCIENCE, Issue 4 2006P. Leon Brown Abstract While alterations in dopamine (DA) uptake appear to be a critical mechanism underlying locomotor and reinforcing effects of cocaine (COC), many centrally mediated physiological and affective effects of this drug are resistant to DA receptor blockade and are expressed more quickly following an intravenous (i.v.) injection than expected based on the dynamics of drug concentration in the brain. Because COC is also a potent local anesthetic, its rapid action on Na+ channels may be responsible for triggering these effects. We monitored temperatures in the nucleus accumbens, temporal muscle and skin together with conventional locomotion during a single i.v. injection of COC (1 mg/kg), procaine (PRO, 5 mg/kg; equipotential anesthetic dose), a short-acting local anesthetic drug that, like COC, interacts with Na+ channels, and cocaine methiodide (COC-MET, 1.31 mg/kg, equimolar dose), a quaternary COC derivative that is unable to cross the blood,brain barrier. In this way, we explored not only the importance of Na+ channels in general, but also the importance of central vs. peripheral Na+ channels specifically. COC induced locomotor activation, temperature increase in the brain and muscle, and a biphasic temperature fluctuation in skin. Though PRO did not induce locomotor activation, it mimicked, to a greater degree, the temperature effects of COC. Therefore, Na+ channels appear to be a key substrate for COC-induced temperature fluctuations in the brain and periphery. Similar to PRO, COC-MET had minimal effects on locomotion, but mimicked COC in its ability to increase brain and muscle temperature, and induce transient skin hypothermia. It appears therefore that COC's interaction with peripherally located Na+ channels triggers its central excitatory effects manifested by brain temperature increase, thereby playing a major role in drug sensing and possibly contributing to COC reinforcement. [source] Binding of the volatile general anesthetics halothane and isoflurane to a mammalian ,-barrel proteinFEBS JOURNAL, Issue 2 2005Jonas S. Johansson A molecular understanding of volatile anesthetic mechanisms of action will require structural descriptions of anesthetic,protein complexes. Porcine odorant binding protein is a 157 residue member of the lipocalin family that features a large ,-barrel internal cavity (515 ± 30 Å3) lined predominantly by aromatic and aliphatic residues. Halothane binding to the ,-barrel cavity was determined using fluorescence quenching of Trp16, and a competitive binding assay with 1-aminoanthracene. In addition, the binding of halothane and isoflurane were characterized thermodynamically using isothermal titration calorimetry. Hydrogen exchange was used to evaluate the effects of bound halothane and isoflurane on global protein dynamics. Halothane bound to the cavity in the ,-barrel of porcine odorant binding protein with dissociation constants of 0.46 ± 0.10 mm and 0.43 ± 0.12 mm determined using fluorescence quenching and competitive binding with 1-aminoanthracene, respectively. Isothermal titration calorimetry revealed that halothane and isoflurane bound with Kd values of 80 ± 10 µm and 100 ± 10 µm, respectively. Halothane and isoflurane binding resulted in an overall stabilization of the folded conformation of the protein by ,0.9 ± 0.1 kcal·mol,1. In addition to indicating specific binding to the native protein conformation, such stabilization may represent a fundamental mechanism whereby anesthetics reversibly alter protein function. Because porcine odorant binding protein has been successfully analyzed by X-ray diffraction to 2.25 Å resolution [1], this represents an attractive system for atomic-level structural studies in the presence of bound anesthetic. Such studies will provide much needed insight into how volatile anesthetics interact with biological macromolecules. [source] Different behavioral effects of neurotoxic dorsal hippocampal lesions placed under either isoflurane or propofol anesthesiaHIPPOCAMPUS, Issue 3 2008Mark G. Baxter Abstract Anesthetic protocols for behavioral neuroscience experiments are evolving as new anesthetics are developed and surgical procedures are refined to improve animal welfare. We tested whether neurotoxic dorsal hippocampal lesions produced under two different anesthetic protocols would have different behavioral and/or histo-pathological effects. Rats were anesthetized with either propofol, an intravenous anesthetic, or isoflurane, a gaseous anesthetic, and multiple injections of an excitotoxin (N -methyl- D -aspartate) were stereotaxically placed in the dorsal hippocampus bilaterally. Intraoperative physiological parameters were similar in the two surgical groups, as were the volumes of the lesions, although the profile of postoperative impairment in a spatial learning task differed between the lesion groups depending on the anesthetic regimen used. These results show that the choice of anesthetic protocol is a critical variable in designing behavioral neuroscience experiments using neurosurgical procedures. This factor should be considered carefully in experimental design and in cross-study comparisons of lesion effects on behavior. © 2007 Wiley-Liss, Inc. [source] Effects of sevoflurane on collagen production and growth factor expression in rats with an excision woundACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 7 2010H.-J. LEE Background: Sevoflurane is a widely used inhalation anesthetic, but there are no studies on its effect on the wound-healing process. This study was undertaken to evaluate the effect of exposure time to sevoflurane on wound healing. Method: Male Sprague,Dawley rats were used. Two circular full-thickness skin defects 8 mm in diameter were made on the dorsum of the rats. The animals were divided into six groups according to exposed gas type and time: S1 (sevoflurane, 1 h), S4 (sevoflurane, 4 h), S8 (sevoflurane, 8 h), O1 (oxygen, 1 h), O4 (oxygen, 4 h), and O8 (oxygen, 8 h). The surface area of the wounds was measured 0, 1, 3, and 7 days after surgery. Separately, the mean blood pressures (MBP) and arterial oxygen pressures (PaO2) were monitored during the sevoflurane exposure. Collagen type I production and transforming growth factor-,1 (TGF-,1) and basic fibroblast growth factor (bFGF) expression on the wound surface were analyzed. Routine histological analysis was also performed. Result: Exposure duration to sevoflurane had no influence on MBP and PaO2. The reduction in wound size and collagen type I production was delayed in S8. The expression of TGF-,1 and bFGF on the wound surface in S8 was significantly attenuated in S8. The histology of the S8 demonstrated a delayed healing status. Conclusions: Prolonged exposure to sevoflurane might alter the inflammatory phase of the wound-healing process by attenuation of growth factor expression such as TGF-,1 and bFGF and subsequently by reduced collagen production. [source] Deficient Knowledge Nursing Diagnosis: Identifying the Learning Needs of Patients With Cardiac DiseaseINTERNATIONAL JOURNAL OF NURSING TERMINOLOGIES AND CLASSIFICATION, Issue 3 2010Luzia Elaine Galdeano PhD Assistência ao paciente; avaliação de processos; conhecimento; doença das coronárias; enfermagem OBJECTIVES., To identify the learning needs of patients with cardiac disease and the aspects of the disease and anesthetic and surgical procedures about which Brazilian patients have the greatest gaps in knowledge. METHODS., Eighty preoperative patients answered a General Evaluation Questionnaire, a Questionnaire to Evaluate Patient Knowledge, and the Mini-Mental State Exam. FINDINGS., Fifty-nine patients had learning needs. More than 50% of the patients were mistaken or unable to answer questions about the disease, and the goals of and type of surgery to be performed and anesthesia to be used. CONCLUSIONS., Most patients had poor performance on the questionnaire that assessed their knowledge about coronary artery disease and its treatment. PRACTICE IMPLICATIONS., This study can contribute to health professionals' assessment of patients' knowledge. OBJETIVOS., Identificar as necessidades de aprendizagem de pacientes com doença cardíaca e os aspectos da doença arterial coronariana e da revascularização do miocárdio do nos quais os pacientes brasileiros apresentam conhecimento deficiente. MÉTODO., Oitenta pacientes responderam o Questionário para avaliação geral, o Questionário para avaliar o conhecimento e o Mini-Exame do Estado Mental. RESULTADOS., Cinqüenta e nove pacientes apresentaram necessidade de aprendizagem. Mais de 50% dos pacientes erraram ou não souberam responder as questões referentes ao nome da doença, aos sinais e sintomas de complicação da doença, aos objetivos e tipo de cirurgia e anestesia. CONCLUSÃO., Muitos pacientes não apresentaram bom desempenho no questionário para medir conhecimento em relação à Doença Arterial Coronária e seu tratamento. IMPLICAÇÕES PRÁTICAS., Este estudo poderá contribuir para a avaliação do conhecimento dos pacientes por profissionais da saúde. [source] Theoretical studies on water,tetracaine interactionINTERNATIONAL JOURNAL OF QUANTUM CHEMISTRY, Issue 5 2006R. C. Bernardi Abstract The action of local anesthetics (LA) is controversial. There is experimental evidence that the unprotonated form of LA penetrates the axon, while the charged form acts in the intracellular phase. To obtain some insight on the structure of the local anesthetics tetracaine and its pharmacological action, we made calculations using the density functional theory (DFT) method. After those calculations, we performed molecular dynamics (MD) simulations in a p, N, T ensemble, in an aqueous environment, on both unprotonated and protonated forms of the molecule. The radial distribution function was used to study water solvent effects, through the characterization of the affinity of tetracaine to water. The results indicate that the molecule has regions with different degree of hydrophobicity, and the N-terminal of the anesthetic was primarily affected by changes in the protonation state of the anesthetic. The pH-dependent activity of TTC should then be analyzed in view of local changes in different regions of the molecule, rather than in terms of general effects on the hydrophobicity of the molecule as a whole. © 2005 Wiley Periodicals, Inc. Int J Quantum Chem, 2006 [source] Is nerve stimulation needed during an ultrasound-guided lateral sagittal infraclavicular block?ACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 4 2010Y. GÜRKAN Background: The objective of the study was to evaluate the influence of ultrasound (US) guidance alone vs. neurostimulation (NS) and US (NSUS) guidance techniques on block performance time and block success rate for the lateral sagittal infraclavicular block (LSIB). Methods: In a randomized and prospective manner, 110 adult patients scheduled for distal upper limb surgery were allocated to the US or the NSUS groups. In the US group, a local anesthetic (LA) was administered only with US guidance to produce a ,U'-shaped distribution around the axillary artery. In the NSUS group, LA was administered under US guidance only after electrolocation of one of the median, ulnar or radial nerve-type responses. A total of 30 ml of LA (10 ml of levobupivacaine 5 mg/ml and 20 ml of lidocaine 20 mg/ml) was administered in both groups. Sensory block was tested at 10 min intervals for 30 min. Successful block was defined as analgesia or anesthesia of all five nerves distal to the elbow. Results: Block success rate was 94.5% in both groups. Block performance time was significantly shorter in the US than the NSUS group (157 ± 50 vs. 230 ± 104 s) (P=0.000). Block onset time was similar in both groups (12.5 ± 4.8 in the US vs. 12.8 ± 5.4 min in the NSUS groups). There were two arterial punctures in the NSUS group. Conclusions: During LSIB performance US guidance alone produces block success rate identical to both US and NS guidance yet with a shorter block performance time. [source] Confounding Factors in Infant Pain Assessment During Recovery From AnesthesiaJOURNAL FOR SPECIALISTS IN PEDIATRIC NURSING, Issue 2 2003Madalynn Neu ISSUES AND PURPOSE. To investigate in what ways infant pain assessments differed between outpatient surgical recovery areas (OPSRA) and other clinical settings that included inpatient postsurgical recovery areas. METHODS. Using a qualitative descriptive design, 8 nurse participants working in OPSRA and 7 nurse participants working in other clinical settings were interviewed. RESULTS. The assessments of participants in the OPSRA differed from those of other participants and were confounded by effects of a short-acting anesthetic, lower expectations of pain, and several extraneous factors. PRACTICE IMPLICATIONS. Recognizing infant pain in OPSRA is complex. Nurses working in OPSRA may need to assume leadership to address issues relating to accurate identification of infant pain and alleviating extraneous factors that may influence adequate treatment of pain. [source] Single stimulation of the posterior cord is superior to dual nerve stimulation in a coracoid blockACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 2 2010J. RODRÍGUEZ Background: Both multiple injection and single posterior cord injection techniques are associated with extensive anesthesia of the upper limb after an infraclavicular coracoid block (ICB). The main objective of this study was to directly compare the efficacy of both techniques in terms of the rates of completely anesthetizing cutaneous nerves below the elbow. Methods: Seventy patients undergoing surgery at or below the elbow were randomly assigned to receive an ICB after the elicitation of either a single radial nerve-type response (Radial group) or of two different main nerve-type responses of the upper limb, except for the radial nerve (Dual group). Forty milliliters of 1.5% mepivacaine was given in a single or a dual dose, according to group assignment. The sensory block was assessed in each of the cutaneous nerves at 10, 20 and 30 min. Block performance times and the rates of complete anesthesia below the elbow were also noted. Results: Higher rates of sensory block of the radial nerve were found in the Radial group at 10, 20 and 30 min (P<0.05). The rates of sensory block of the ulnar nerve at 30 min were 97% and 75% in the Radial and in the Dual groups, respectively (P<0.05). The rate of complete anesthesia below the elbow was also higher in the Radial group at 30 min (P<0.05). Conclusions: Injection of a local anesthetic after a single stimulation of the radial nerve fibers produced more extensive anesthesia than using a dual stimulation technique under the conditions of our study. [source] Single vs. double stimulation during a lateral sagittal infraclavicular blockACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 10 2009E. AKY Background: The objective of this study was to evaluate the influence of single vs. dual control during an ultrasound-guided lateral sagittal infraclavicular block on the efficacy of sensory block and the time of block onset. Methods: In a prospective manner, 60 adult patients scheduled for distal upper limb surgery were randomly allocated to single (Group S) or double stimulation (Group D) groups. A local anesthetic (LA) mixture of 20 ml of levobupivacaine 5 mg/ml and 20 ml of lidocaine 20 mg/ml with 5 ,g/ml epinephrine (total 40 ml) was administered in both groups. In the Group S following a median, an ulnar or a radial nerve response, the entire LA was administered at a single site. In Group D 10 ml of LA was administered following the electrolocation of the musculocutaneous nerve and 30 ml LA was injected following median, ulnar or radial nerves. A successful block was defined as analgesia or anesthesia of all five nerves distal to the elbow. Sensory and motor blocks were tested at 5-min intervals for 30 min. Results: The block was successful in 27 patients in Group S and 28 patients in Group D. The time from starting the block until satisfactory anesthesia was significantly shorter in Group D than in Group S (19.3 vs. 23.2 min) (P<0.05). Total sensory scores were significantly higher in the double stimulation group at 20 and 30 min after the block performance (P<0.05). Conclusions: Although the block performance time was longer in the double stimulation group, block onset time and extent of anesthesia were more favorable in the double stimulation group. [source] Systems biology approaches for toxicology,JOURNAL OF APPLIED TOXICOLOGY, Issue 3 2007William Slikker Jr Abstract Systems biology/toxicology involves the iterative and integrative study of perturbations by chemicals and other stressors of gene and protein expression that are linked firmly to toxicological outcome. In this review, the value of systems biology to enhance the understanding of complex biological processes such as neurodegeneration in the developing brain is explored. Exposure of the developing mammal to NMDA (N -methyl- d -aspartate) receptor antagonists perturbs the endogenous NMDA receptor system and results in enhanced neuronal cell death. It is proposed that continuous blockade of NMDA receptors in the developing brain by NMDA antagonists such as ketamine (a dissociative anesthetic) causes a compensatory up-regulation of NMDA receptors, which makes the neurons bearing these receptors subsequently more vulnerable (e.g. after ketamine washout), to the excitotoxic effects of endogenous glutamate: the up-regulation of NMDA receptors allows for the accumulation of toxic levels of intracellular Ca2+ under normal physiological conditions. Systems biology, as applied to toxicology, provides a framework in which information can be arranged in the form of a biological model. In our ketamine model, for example, blockade of NMDA receptor up-regulation by the co-administration of antisense oligonucleotides that specifically target NMDA receptor NR1 subunit mRNA, dramatically diminishes ketamine-induced cell death. Preliminary gene expression data support the role of apoptosis as a mode of action of ketamine-induced neurotoxicity. In addition, ketamine-induced cell death is also prevented by the inhibition of NF- ,B translocation into the nucleus. This process is known to respond to changes in the redox state of the cytoplasm and has been shown to respond to NMDA-induced cellular stress. Although comprehensive gene expression/proteomic studies and mathematical modeling remain to be carried out, biological models have been established in an iterative manner to allow for the confirmation of biological pathways underlying NMDA antagonist-induced cell death in the developing nonhuman primate and rodent. Published in 2007 John Wiley & Sons, Ltd. [source] Infiltration anesthetic lidocaine inhibits cancer cell invasion by modulating ectodomain shedding of heparin-binding epidermal growth factor-like growth factor (HB-EGF)JOURNAL OF CELLULAR PHYSIOLOGY, Issue 3 2002Tadanori Mammoto Although the mechanism is unknown, infiltration anesthetics are believed to have membrane-stabilizing action. We report here that such a most commonly used anesthetic, lidocaine, effectively inhibited the invasive ability of human cancer (HT1080, HOS, and RPMI-7951) cells at concentrations used in surgical operations (5,20 mM). Ectodomain shedding of heparin-binding epidermal growth factor-like growth factor (HB-EGF) from the cell surface plays an important role in invasion by HT1080 cells. Lidocaine reduced the invasion ability of these cells by partly inhibiting the shedding of HB-EGF from the cell surface and modulation of intracellular Ca2+ concentration contributed to this action. The anesthetic action of lidocaine (sodium channel blocking ability) did not contribute to this anti-invasive action. In addition, lidocaine (5,30 mM), infiltrated around the inoculation site, inhibited pulmonary metastases of murine osteosarcoma (LM 8) cells in vivo. These data point to previously unrecognized beneficial actions of lidocaine and suggest that lidocaine might be an ideal infiltration anesthetic for surgical cancer operations. © 2002 Wiley-Liss, Inc. [source] The anesthetic onset and duration of a new lidocaine/prilocaine gel intra-pocket anesthetic (Oraqix®) for periodontal scaling/root planingJOURNAL OF CLINICAL PERIODONTOLOGY, Issue 5 2001Johan Friskopp Abstract Background: A new non-injection anesthetic, lidocaine/prilocaine gel (Oraqix®, AstraZeneca) in a reversible thermosetting system, has been developed to provide local anesthesia for scaling/root planing (SRP). The aim of this study was to determine the anesthetic onset and duration of the gel for SRP in patients with periodontitis. Methods: 30 patients were randomized to either 30 s, 2 min, or 5 min of treatment with the gel prior to SRP of a tooth. The gel was applied to periodontal pockets with a blunt applicator. On completion of the SRP of each tooth (2,3 teeth treated/patient), the patients rated their pain on a 100-mm visual analogue scale (VAS). Results: The median VAS pain score was 7.5 mm in the 30-s group, 28.5 mm in the 2-min group, and 15.5 mm in the 5-min group, with a significant difference between the 30-s and 2-min groups (p=0.03). In 2 patients in the 5-min group, but none in the other groups, the SRP was interrupted due to pain. The mean duration of anesthesia measured as pain on probing were 18.1, 17.3, and 19.9 min in the 30-s, 2-min, and 5-min groups, respectively. There were no reports of numbness of the tongue, lip, or cheek, neither were there any adverse local reactions in the oral mucosa. The gel was easy to apply and did not interfere with the SRP procedure. Conclusion: Oraqix® provides anesthesia after an application time of 30 s, with a mean duration of action of about 17 to 20 min. Zusammenfassung Hintergrund: Eine neues nicht zu injizierendes Anästhetikum, Lidocain/Prilocain Gel (Oraqix®, Astra Zeneca) in einem reversiblen thermischen System, wurde entwickelt, um die lokale Anästhesie für die Wurzelreinigung und -glättung (SRP) zu verbessern. Das Ziel dieser Studie war die Bestimmung des Anästhesieeintrittes und der -dauer durch dieses Gel bei SRP bei Parodontitis-Patienten. Methoden: 30 Patienten wurden zufällig zur 30 Sekunden, 2 Minuten oder 5 Minuten Behandlung mit dem Gel vor der SRP eines Zahnes eingeteilt. Das Gel wurde mit einem stumpfen Applikator in die parodontalen Taschen appliziert. Nach der Vollendung der SRP eines jeden Zahnes (2,3 behandelte Zähne/Patient) beurteilten die Patienten ihre Schmerzen auf einer 100 mm visuellen Analogskala (VAS). Ergebnisse: Der mittlere VAS Score war 7.5 mm in der 30 Sekundengruppen, 28.5 mm in der 2 Minutengruppe und 15.5 mm in der 5 Minutengruppe mit einer signifikanten Differenz zwischen der 30 Sekunden und der 2 Minutengruppe (p=0.03). Bei 2 Patienten in der 5 Minutengruppe, aber keinem in einer anderen Gruppe, wurde das SRP wegen Schmerzen unterbrochen. Die mittlere Dauer der Anästhesie, gemessen als Schmerz auf Sondierung, war 18.1, 17.3 und 19.9 Minuten in der 30 Sekunden, 2 Minuten und 5 Minutengruppe. Es gab keine Berichte über eine Taubheit der Zunge, der Lippen oder der Wangen. Irgendwelche negativen lokalen Reaktionen an der Mukosa wurden nicht beobachtet. Das Gel war leicht zu applizieren und beeinflußte die SRP Prozedur nicht. Zusammenfassung: Oraqix® fördert die Anästhesie nach Applikation von 30 Sekunden mit einer mittleren Dauer von ungefähr 17 bis 20 Minuten. Résumé Un nouvel anesthésique non-injectable, un gel de lidocaine/prilocaine (Oraquix®, AstraZeneca) dans un système thermique réversible a été mis au point afin de créer une anesthésie locale lors du détartrage et du surfaçage radiculaire (SRP). Le but de cette étude a été de déterminer la prise et la durée anesthésique de ce gel pour le SRP chez des patients avec parodontite. 30 patients ont été traités avec ce gel pendant 30 s, 2 min ou 5 min avant le SRP d'une dent. Le gel a été placé dans les poches parodontales avec un applicateur arrondi. A la fin du SRP de chaque dent (2 à 3 dents traitées par patient) les patients ont quantifié leur douleur sur une échelle analogue visuelle de 100 mm (VAS). Le score de douleur VAS moyen était de 7.5 mm dans le groupe de 30 s, 28.5 mm dans le groupe 2 min et de 15.5 min dans celui de 5 min avec une différence significative entre les groupes 30 s et 2 min (p=0.03). Chez 2 patients du groupe 5 min mais chez aucun des 2 autres groupes le SRP a été interrompu à cause de la douleur. La durée moyenne d'anesthésie mesurée en tant que douleur au sondage était respectivement de 18.1, 17.3 et 19.9 min pour les groupes 30 s, 2 min et 5 min. Il n'y a eu aucune plainte d'anesthésie de la langue, des lèvres ou des joues ni aucune réaction locale négative de la muqueuse buccale. Le gel a été facilement appliqué et n'a absolument pas gêné le SRP. L'Oraquix® apporte une anesthésie après un temps d'application de 30 s avec une durée d'action de 17 à 20 min. [source] Ultrasound-guided technique allowed early detection of intravascular injection during an infraclavicular brachial plexus blockACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 7 2009Á. MARTÍNEZ NAVAS The reported incidence of complications after peripheral nerve blocks is generally low and varies from 0% to 5%. The injuries related to brachial plexus block are perhaps more commonly reported, than after peripheral blocks of the lower extremity nerves. Recent reports suggest that expert ultrasound guidance may reduce but not completely eliminate complications as intraneural or intravascular injection. We report a case of accidental intravascular injection of local anesthetic during infraclavicular brachial plexus block, in spite of the use of ultrasound guidance technique, and negative aspiration for blood. [source] Back to Basics: The evidence for reducing the pain of administration of local anesthesia and cosmetic injectablesJOURNAL OF COSMETIC DERMATOLOGY, Issue 3 2010Kajal Babamiri MD Summary Administration of injections, whether local anesthetic or cosmetic injectable, can result in significant distress and discomfort to patients. This review explores factors that can alleviate anxiety and pain associated with injections including cosmetic injectables. We highlight that many techniques used to reduce pain have only been reported based on anecdotal evidence and small series. The techniques that have been reported to reduce pain, by randomized controlled trials, include pretreatment with topical local anesthetic agents and combined cosmetic injectables with local anesthetics. [source] Nitrous oxide as an adjunct in tumescent liposuctionJOURNAL OF COSMETIC DERMATOLOGY, Issue 4 2005Garrett Bird Summary Background, Nitrous oxide (N2O) has been used as an anesthetic for over 300 years. It is safe, easy to use, and effective. In this article we will document N2O use as an adjunct to tumescent liposuction. The history, mechanism of action, use, and safety in ambulatory surgery of N2O are reviewed. Objective, The authors intend to review the history of both tumescent liposuction and N2O in surgery, discuss the possible adverse reactions, and present guidelines for the use of N2O during tumescent liposuction. Methods, A Medline review of articles, 1966,2004, related to N2O was performed, using the search terms nitrous, oxide, safety, toxicity, mechanism, anesthetic, surgery, risks, and delivery. Articles that were cited by the authors of this subset of original articles were also used when appropriate. Articles were rated and included based on date of publication, level of evidence, and applicability to tumescent liposuction. Results and conclusions, Nitrous oxide is safe, easily administered, inexpensive, and is an effective adjunct to tumescent liposuction. It provides a high level of pain control, and is patient controlled, while not putting the patient at risk of full anesthesia. When used correctly, with proper equipment, it poses little risk to either patients or healthcare workers. [source] EMLA® cream-induced irritant contact dermatitisJOURNAL OF CUTANEOUS PATHOLOGY, Issue 3 2002Huiting Dong Background:, The Eutectic Mixture of Local Anesthetics (EMLA® cream) is a topical anesthetic used for providing pain relief in patients undergoing superficial surgical procedures. Cutaneous side-effects have been reported rarely. Case Report:, We present a case of irritant contact dermatitis induced by EMLA® cream in a 6-year-old boy with Wiskott-Aldrich syndrome. Our patient showed clinically a well circumscribed patch corresponding to the site of application of the topical anesthetic. Histopathology showed confluent necrosis of keratinocytes in the upper epidermis, a mixed inflammatory infiltrate with priminent neutrophils in the upper dermis, and focal signs of interface changes including basal cell vacuolization and subepidermal cleft formation. Conclusions:, Graft-vs.-host-disease (GVHD), necrolytic migratory erythema, dermatitis enteropathica and pellagra should be considered in the histopathologic differential diagnosis of acute contact dermatitis caused by EMLA®. [source] Effect of anesthetic structure on inhalation anesthesia: Implications for the mechanismJOURNAL OF PHARMACEUTICAL SCIENCES, Issue 6 2008Michael H. Abraham Abstract Many previous attempts (e.g., the Meyer,Overton hypothesis) to provide a single set of physical or chemical characteristics that accurately predict anesthetic potency have failed. A finding of a general predictive correlation would support the notion of a unitary theory of narcosis. Using the Abraham solvation parameter model, the minimum alveolar concentration, MAC, of 148 varied anesthetic agents can be fitted to a linear equation in log (1/MAC) with R2,=,0.985 and a standard deviation, SD,=,0.192 log units. Division of the 148 compounds into a training set and a test set shows that log (1/MAC) values can be predicted with no bias and with SD,=,0.20 log units. The two main factors that determine MAC values are compound size and compound hydrogen bond acidity, both of which increase anesthetic activity. Shape has little or no effect on anesthetic activity. Our observations support a unitary theory of narcosis by inhalation anesthetics. A two-stage mechanism for inhalation anesthesia accounts for the observed structural effects of anesthetics. In this mechanism, the first main step is transfer of the anesthetic to the site of action, and the second step is interaction of the anesthetic with a receptor(s). © 2007 Wiley-Liss, Inc. and the American Pharmacists Association J Pharm Sci 97:2373,2384, 2008 [source] Glycine Receptors Contribute to Hypnosis Induced by EthanolALCOHOLISM, Issue 6 2009Jiang H. Ye Background:, Glycine is a major inhibitory neurotransmitter in the adult central nervous system (CNS), and its receptors (GlyRs) are well known for their effects in the spinal cord and the lower brainstem. Accumulating evidence indicates that GlyRs are more widely distributed in the CNS, including many supraspinal regions. Previous in vitro studies have demonstrated that ethanol potentiates the function of these brain GlyRs, yet the behavioral role of the brain GlyRs has not been well explored. Methods:, Experiments were conducted in rats. The loss of righting reflex (LORR) was used as a marker of the hypnotic state. We compared the LORR induced by systematic administration of ethanol and of ketamine in the absence and presence of the selective glycine receptor antagonist strychnine. Ketamine is a general anesthetic that does not affect GlyRs. Results:, Systemically administered (by intraperitoneal injection) ethanol and ketamine dose-dependently induced LORR in rats. Furthermore, systemically administered (by subcutaneous injection) strychnine dose-dependently reduced the percentage of rats exhibiting LORR induced by ethanol, increased the onset time, and decreased the duration of LORR. Strychnine had no effect, however, on the LORR induced by ketamine. Conclusions:, Given that hypnosis is caused by neuronal depression in upper brain areas, we therefore conclude that brain GlyRs contribute at least in part to the hypnosis induced by ethanol. [source] | ||||||||||||||||||||||||||||||||||||||||