Continuous intrathecal clonidine and tizanidine in conscious dogs: analgesic and hemodynamic effects.

Unlabelled: Alpha-2-adrenergic agonists, such as clonidine, produce antinociception in animal pain models after intrathecal administration. However, clinical usage is limited by cardiovascular side effects. To investigate alternative alpha(2)-adrenergic agonists as analgesics, we implanted six dogs with an intrathecal catheter and infusion pump.

The mechanisms of intracranial pressure modulation by epidural blood and other injectates in a postdural puncture rat model.

Unlabelled: The epidural blood patch is considered effective in treating postdural puncture headache. We have developed a postdural puncture model in rats for quantitative evaluation of the magnitude and duration of changes in cerebrospinal fluid (CSF) pressure in the cisterna magna in response to the administration of epidural blood or other moieties. This model was used to compare the efficacy of various methods of epidural injection for restoring and maintaining CSF pressure for up to 240 min.

The antinociceptive and histologic effect of sciatic nerve blocks with 5% butamben suspension in rats.

Unlabelled: Butamben, a lipophilic local anesthetic of the ester class, produces a differential nerve block of long duration. Epidural and peripheral nerve blocks with butamben, formulated as a 5%--10% suspension, result in prolonged analgesia without significant motor blockade. We evaluated the effect of butamben sciatic nerve block on antinociception using the rat paw formalin test, as well as withdrawal latencies to thermal stimulation, and assessed histologic changes in the nerve.

Wound healing of animal and human body sport and traffic accident injuries using low-level laser therapy treatment: a randomized clinical study of seventy-four patients with control group.

Background And Objective: The main objective of current animal and clinical studies was to assess the efficacy of low level laser therapy (LLLT) on wound healing in rabbits and humans.

Study Design/materials And Methods: In the initial part of our research we conducted a randomized controlled animal study, where we evaluated the effects of laser irradiation on the healing of surgical wounds on rabbits. The manner of the application of LLLT on the human body are analogous to those of similar physiologic structure in animal tissue, therefore, this study was continued on humans.

Comparison of epidural butamben to celiac plexus neurolytic block for the treatment of the pain of pancreatic cancer.

Objective: To compare pain relief in metastatic pancreatic cancer patients between neurolytic celiac plexus block (NCPB) and epidural 5% butamben suspension (EBS), a material-based delivery system of a local anesthetic that produces a long-lasting differential nerve block.

Design: Open-label patient-selected parallel groups.

Setting: Urban tertiary care medical center.

Long-term testing of an intracranial pressure monitoring device.

Object: Long-term monitoring of intracranial pressure (ICP) is limited by the lack of an implantable sensor with low drift. The goal of this study was to demonstrate that a new capacitive transducer system will produce accurate and stable ICP records over extended periods.

Methods: Intracranial pressure sensors were implanted into the frontal white matter of four dogs.

Magnesium sulfate potentiates morphine antinociception at the spinal level.

Unlabelled: Intrathecal magnesium sulfate coinfusion with morphine increases antinociception in normal rats; however, because magnesium also delays the onset of tolerance, it is not clear whether this additional antinociception is a result of potentiated analgesia or tolerance abatement. We examined the antinociceptive interaction of intrathecal (IT) bolus magnesium sulfate and morphine in morphine naive rats and those with mechanical allodynia after a surgical incision. After intrathecal catheter implantation, rats were given preinjections of magnesium or saline, followed by injections of morphine or saline.

The use of a ketamine-propofol combination during monitored anesthesia care.

Unlabelled: Supplemental analgesics are commonly used to enhance analgesia and improve patient comfort during procedures performed under local anesthesia and sedation. Because the use of ketamine as an analgesic adjunct to propofol sedation has not been well established, we evaluated its impact on analgesia, sedation, and recovery after ambulatory surgery. One hundred female outpatients undergoing breast biopsy procedures under local anesthesia participated in this randomized, double-blinded, placebo-controlled study.

Aprotinin pretreatment diminishes postischemic myocardial contractile dysfunction in dogs.

Unlabelled: We evaluated the effect of aprotinin, administered before the onset of acute regional myocardial ischemia, on reversible contractile dysfunction induced by ischemia and reperfusion in pentobarbital-anesthetized dogs. Animals were randomized to receive either aprotinin 30,000 kallikrein inactivator units (KIU)/kg and 7000 KIU x kg(-1) x hr(-1) (n = 8) or equivalent volumes of 0.9% sodium chloride (n = 7) IV 60 min before a 15-min interruption of circumflex coronary artery blood flow and then reperfusion.

Intrathecal bupivacaine reduces pruritus and prolongs duration of fentanyl analgesia during labor: a prospective, randomized controlled trial.

Unlabelled: Pruritus is a frequent complication (40%-100%) of intrathecal (IT) fentanyl 25 microg (F) for labor analgesia. The addition of IT bupivacaine 2.5 mg (B) to F has been reported in a nonrandomized series to have a 17.

Nerve blocks with 5% butamben suspension for the treatment of chronic pain syndromes.

Background And Objectives: Butamben is a non-water-soluble local anesthetic that can be prepared as an aqueous suspension for nerve blocks. This report describes the use of 5% butamben suspension for the treatment of chronic pain of cancer and noncancer origin.

Methods: The clinical courses of 75 consecutive patients were analyzed following 5% butamben nerve blocks (35 epidural blocks only, 33 peripheral nerve blocks only, and 7 had both epidural and peripheral nerve blocks).

Antinociceptive potentiation and attenuation of tolerance by intrathecal co-infusion of magnesium sulfate and morphine in rats.

Unlabelled: N-methyl-D-aspartate (NMDA) antagonists, such as MK801, delay the development of morphine tolerance. Magnesium, a noncompetitive NMDA antagonist, reduces postoperative morphine requirements. The present study was designed to evaluate the effects of intrathecal co-administration of magnesium sulfate with morphine on antinociceptive potentiation, tolerance, and naloxone-induced withdrawal signs.

Aspirin does not increase allogeneic blood transfusion in reoperative coronary artery surgery.

While preoperative aspirin (ASA) therapy does not increase allogeneic transfusion in elective primary coronary artery bypass grafting (CABG) operations, the impact of ASA consumption on transfusion in cardiac operations with greater risk of bleeding has not been investigated. We examined the influence of ASA consumption on mediastinal drainage and allogenic transfusion in 317 patients undergoing reoperative CABG surgery. Patients receiving ASA or ASA containing medications within 7 days preoperatively (n = 215) had similar perioperative characteristics but were older and had smaller red cell volumes than control patients not receiving ASA (n = 102).

Psychological differences between reflex sympathetic dystrophy and non-RSD chronic pain patients.

This study examined possible psychological differences between Reflex Sympathetic Dystrophy (RSD) and non-RSD chronic pain patients. Unlike the few previous studies in this area, this study controlled statistically for age and pain duration differences across diagnostic groups, and included a non-RSD limb pain control group. Subjects were a consecutive series of 34 RSD, 50 non-RSD limb pain (Limb), and 165 low back pain (LBP) patients presenting for treatment at the Rush Pain Center.

Preoperative airway assessment: predictive value of a multivariate risk index.

Using readily available and objective airway risk criteria, a multivariate model for stratifying risk of difficult endotracheal intubation was developed and its accuracy compared to currently applied clinical methods. We studied 10,507 consecutive patients who were prospectively assessed prior to general anesthesia with respect to mouth opening, thyromental distance, oropharyngeal (Mallampati) classification, neck movement, ability to prognath, body weight, and history of difficult tracheal intubation. After induction of anesthesia, the laryngeal view during rigid laryngoscopy was graded and the ability of experienced anesthesia personnel to ventilate via a mask was determined.

Intrathecal clonidine and tizanidine in conscious dogs: comparison of analgesic and hemodynamic effects.

Intrathecal delivery of alpha(2)-adrenergic agonists produces an analgesic effect. However, hemodynamic side effects limit their clinical usage. To more fully characterize the effects on heart rate and arterial blood pressure of alpha(2)-adrenergic agonists, clonidine and tizanidine were injected intrathecally in conscious dogs.

Angiotensin-converting enzyme inhibitors increase vasoconstrictor requirements after cardiopulmonary bypass.

Preoperative use of angiotensin-converting enzyme (ACE) inhibitors is common and has been associated with hypotension at separation from cardiopulmonary bypass (CPB). This study prospectively examined the influence of chronic preoperative ACE inhibitor use and other perioperative factors on the incidence of vasoconstrictor therapy required to maintain systolic blood pressure at more than 85 mm Hg despite a normal cardiac output after CPB in 4301 adults undergoing elective coronary artery and/or valve surgery. Hypothermic, nonpulsatile CPB and either opioid or ketamine-benzodiazepine anesthesia were common features of the operations.

Effects of phenylephrine or volume loading on right ventricular function in patients undergoing myocardial revascularization.

The acute effects of phenylephrine (PHE) administration or intravascular volume loading on right ventricular (RV) function were examined in 34 patients undergoing elective coronary artery surgery. After anesthetic induction with sufentanil and midazolam, 20 patients received PHE to treat hypotension and increase systemic arterial pressure 20% above baseline values. PHE effectively restored arterial pressure without changing stroke index (SI), although RV ejection fraction (RVEF) declined (41.

Postthoracotomy pain management using continuous epidural analgesia in 1,324 patients.

Continuous epidural analgesia consisting of an opioid with or without a local anesthetic agent is a commonly employed technique for pain relief after thoracotomy. In this study, we prospectively evaluated the use of continuous epidural analgesia in 1,324 patients undergoing elective thoracotomy between 1987 and 1993. Epidural pain management was continued for 1 to 3 postoperative days.

Does the design of the Sprotte spinal needle reduce the force needed to deform the tip?

Study Objective: To determine whether the window design of pencil-point spinal needles leads to deformation under lateral or axial loading conditions.

Design: Independent-measure, multigroup study of the force required to deform needles.

Setting: Independent testing laboratory.

Comparison of patient-assisted epidural analgesia with continuous-infusion epidural analgesia for postoperative patients.

Background And Objectives: Patient-assisted epidural analgesia, a mode of epidural analgesic delivery in which self-administered epidural boluses supplement a baseline continuous epidural infusion, was compared to continuous epidural infusion in 62 postsurgical patients.

Methods: Patients were randomly assigned to receive continuous epidural infusion (n = 31) or patient-assisted epidural analgesia (n = 31) consisting of fentanyl 10 mcg/mL and bupivacaine 1 mg/mL for the first 2 days after the operation. Variables examined included the adequacy of analgesia, amount of epidural infusion solution used, use of supplemental opioids, as well as incidence of side effects including nausea, pruritus, sedation, urinary retention, and respiratory depression.

Evaluation of coagulation during cardiopulmonary bypass with a heparinase-modified thromboelastographic assay.

Thromboelastography (TEG) is a useful method of assessing perioperative coagulation function in patients undergoing cardiac surgery. The presence of significant amounts of heparin in blood samples, however, prevents determination of changes in coagulation function by TEG or introduces artifactual error if samples contain heparin that is not present in vivo. For these reasons, whole blood coagulation function monitoring with TEG has not been feasible during cardiopulmonary bypass (CPB) with heparin anticoagulation.