Multimodal therapy in perioperative analgesia.

This article reviews the current evidence for multimodal analgesic options for common surgical procedures. As perioperative physicians, we have come a long way from using only opioids for postoperative pain to combinations of acetaminophen, nonsteroidal anti-inflammatory drugs (NSAIDs), selective Cyclo-oxygenase (COX-2) inhibitors, local anesthetics, N-methyl-d-aspartate (NMDA) receptor antagonists, and regional anesthetics. As discussed in this article, many of these agents have decreased narcotic requirements, improved patient satisfaction, and decreased postanesthesia care unit (PACU) times, as well as morbidity in the perioperative period.

Liposomal bupivacaine and clinical outcomes.

In the multimodal approach to the management of postoperative pain, local infiltration and regional blocks have been increasingly utilized for pain control. One of the limitations of local anesthetics in the postoperative setting is its relatively short duration of action. Multivesicular liposomes containing bupivacaine have been increasingly utilized for their increased duration of action.

Perioperative analgesia: ever-changing technology and pharmacology.

Our understanding of pain and its long-term implications have dramatically changed with the advent of advancements in molecular mechanisms involved in acute or postoperative pain and chronic pain. This better understanding has led to multiple pharmacologic advancements to better treat pain with minimal side effects. Currently, we are still struggling to find the right balance between all of the different modalities that we have at our leisure.

Opioid induced hyperalgesia altered with propofol infusion.

Propofol is a common induction agent that is utilized worldwide in the field of anesthesiology. In recent years, its potential therapeutic role in a variety of patient states has been demonstrated. Controversy exists regarding Propofol mediated analgesic and antihyperalgesic properties.

An Analysis of Responses to Defibrotide in the Pulmonary Vascular Bed of the Cat.

Defibrotide is a polydisperse mixture of single-stranded oligonucleotides with many pharmacologic properties and multiple actions on the vascular endothelium. Responses to defibrotide and other vasodepressor agents were evaluated in the pulmonary vascular bed of the cat under conditions of controlled pulmonary blood flow and constant left atrial pressure. Lobar arterial pressure was increased to a high steady level with the thromboxane A2 analog U-46619.

Kinesin-5: cross-bridging mechanism to targeted clinical therapy.

Kinesin motor proteins comprise an ATPase superfamily that works hand in hand with microtubules in every eukaryote. The mitotic kinesins, by virtue of their potential therapeutic role in cancerous cells, have been a major focus of research for the past 28 years since the discovery of the canonical Kinesin-1 heavy chain. Perhaps the simplest player in mitotic spindle assembly, Kinesin-5 (also known as Kif11, Eg5, or kinesin spindle protein, KSP) is a plus-end-directed motor localized to interpolar spindle microtubules and to the spindle poles.

Sedation, analgesia, and local anesthesia: a review for general and interventional radiologists.

Radiologists, like other physicians, need to know how to use sedatives, analgesics, and local anesthetics; however, their exposure to patients requiring discomfort control is limited, not just during residency but also in postgraduate practice. The purpose of this article is to provide a reference guide for radiologists who need pertinent and ready information on discomfort control. The authors discuss policies and standards that the Joint Commission has established for sedation providers; also discussed are the clinical pharmacology and dosage recommendations for the sedative, analgesic, anesthetic, and reversal agents that radiologists are most likely to use.

QT interval abnormalities: risk factors and perioperative management in long QT syndromes and Torsades de Pointes.

Electrophysiological abnormalities of the QT interval of the standard electrocardiogram are not uncommon. Congenital long QT syndrome is due to mutations of several possible genes (genotype) that result in prolongation of the corrected QT interval (phenotype). Abnormalities of the QT interval can be acquired and are often drug-induced.

A 52-year-old woman with headache and bradycardia.

Cardiac sarcoidosis should be suspected in young patients with cardiac symptoms, especially when there is concurrent personal or family history of sarcoidosis. While sarcoidosis is self-limiting in about 40% of cases, cardiac involvement portends a more ominous prognosis with higher mortality rates. The definitive diagnostic test for cardiac sarcoidosis is the endomyocardial biopsy, an invasive test with low sensitivity.

An unexpected silver lining to Katrina: elimination of inter-campus transfer delay in STEMI care.

Background: Timely primary percutaneous coronary intervention (PCI) is recommended for ST-elevation myocardial infarction (STEMI), with increasing focus being paid to the time required for inter-hospital transfer. An overlooked barrier to timely care is inter-campus transfer when the emergency department (ED) and cardiac catheterization lab (CCL) are in separate buildings. In August 2005, Hurricane Katrina closed one campus of the Medical Center of Louisiana at New Orleans (MCLNO), forcing the ED and CCL to move into one building.

Inapparent atrial flutter due to atrial dissociation.

Percutaneous and surgical procedures intended to potentially cure atrial fibrillation require creating lines of conduction block in specific locations throughout the atrial chambers. In patients presenting with recurrent atrial fibrillation, repeat procedures are often performed, resulting in more extensive regions of conduction block and the potential for regions of dissociated atrial rhythms. The present case describes a patient post-multiple ablation procedures who presented with a symptomatic atrial arrhythmia, the mechanism of which was hidden by the presence of extensive atrial dissociation.

Quantitative analysis of random migration of cells using time-lapse video microscopy.

Cell migration is a dynamic process, which is important for embryonic development, tissue repair, immune system function, and tumor invasion (1, 2). During directional migration, cells move rapidly in response to an extracellular chemotactic signal, or in response to intrinsic cues (3) provided by the basic motility machinery. Random migration occurs when a cell possesses low intrinsic directionality, allowing the cells to explore their local environment.

The importance of training for ultrasound guidance in central vein catheterization.

Objective: To review the complication and success rates associated with CVC placement in patients undergoing cardiovascular surgery depending on the technique utilized and the degree of ultrasound experience of the anesthesia provider.

Design: Randomized controlled trial.

Setting: Operating room and post anesthesia care unit.

Rho GTPase effector functions in tumor cell invasion and metastasis.

Rho GTPases (Ras homologous family) comprise the largest subfamily cluster of the Ras-homology superfamily. Rho GTPases exist in inactive GDP and active GTP forms. The active forms of the Rho family members bind with numerous effector proteins that are crucial for various biological processes.

Breast cancer stem cells: a new challenge for breast cancer treatment.

The biggest challenge for cancer research is relapses that occur in patients undergoing chemotherapy and radiotherapy, suggesting that some cells in tumors escape targeted treatment. Key questions are why relapses occur and why current therapies fail to remove all cancer cells. The cancer stem-cell hypothesisis based on the fact that not all cells within a tumor are similar.

Integrin-mediated function of Rab GTPases in cancer progression.

The RAS (rat sarcoma) superfamily of small GTPases is broadly subdivided into five groups: Ras, Rho, Rab, Ran, and Arf. Rab family proteins are important in regulating signal transduction and cellular processes such as differentiation, proliferation, vesicle transport, nuclear assembly, and cytoskeleton formation. However, some Rab proteins have been reported to be necessary for the adhesion and migration of cancer cells.

Ethics in the primary care office.

Thirty-one doctors completed surveys on perceived ethical issues in their office and then evaluated each office visit for a single day, yielding a total of 644 patient encounters. Overall, 33% of office visits involved an ethical issue of some type. Prescription related issues were the most common type of problem encountered.

Important role of integrins in the cancer biology.

Adhesion of breast cancer cells is supported by various integrins. Cell adhesion is critical for maintenance of both three-dimensional and normal function of these tissues. Several integrins have been shown to have higher expression levels in metastatic cancers and have been implicated in degrading basement membrane by interacting with proteolytic enzymes.

Cancer stem cells: relevance to SCT.

The cancer stem cell (CSC) hypothesis suggests that clonogenic growth potential within an individual tumor is restricted to a specific and phenotypically defined cell population. Evidence for CSC in human tumors initially arose from studies of AML, but functionally similar cell populations have been identified in an increasing number of malignancies. Despite these findings, controversy surrounds the CSC hypothesis, especially the generalization that clonogenic tumor cells are rare.

A mitotic role for GSK-3beta kinase in Drosophila.

Glycogen synthase kinase-3beta (GSK-3beta) is involved in a wide variety of cellular processes, and implicated in a growing list of human diseases. Recent drug inhibition studies have suggested a role for GSK-3beta in mitosis in animals. Here, we take an alternative approach to understanding GSK-3beta function in mitosis by genetic mutational analysis in Drosophila.