1,720,969 research outputs found
Attenuation of aortic banding-induced cardiac hypertrophy by propranolol is independent of beta-adrenoceptor blockade
No full textRacemic propranolol attenuates cardiac hypertrophy secondary to abdominal aortic banding-induced pressure overload by a mechanism independent of its effect on cardiac work load. This was only observed, however, using doses of propranolol that were much higher than those needed to induce beta-adrenoceptor blockade. Thus, the question remains as to whether the antihypertrophic effect of propranolol depends on its ability to antagonize cardiac beta-adrenoceptor-mediated action (positive chronotropic effect, trophic effect) or on beta-adrenoceptor-independent action
Video-assisted orotracheal intubation in mice
No full textOrotracheal intubation in mice is a complicated technique because of the peculiar oropharyngeal anatomy and the difficulty in visualizing the laryngis aditus. Here we report a new and simple method for rapid endotracheal intubation by using a small bore, straight fibre-optic arthroscope. Under endoscope-assisted visualization of the laryngis aditus, a polyethylene cannula, inserted on a guide-wire in order to facilitate the introduction of the tip across the vocal cords, was advanced in the trachea. The success rate of intubation was 100%. We were also able to re-intubate the mice 4 and 8 weeks later without any major complications. We conclude that this method can be easily and safely used for studies where controlled pulmonary ventilation is necessary
Inhibition of left ventricular remodelling preserves chamber systolic function in pressure-overloaded mice
No full textControversy exists whether the development of left-ventricular hypertrophy (LVH) is a mechanism able to prevent cardiac dysfunction under conditions of pressure overload. In the present study we re-assessed the long-term effects of attenuating LVH by using L- and D-propranolol, which are equally able to inhibit the development of LVH induced by aortic banding. The aortic arch was banded proximal to the left common carotid artery in 71 CD-1 mice that were then assigned randomly to receive L-propranolol, D-propranolol (both 80 mg/kg per day) or vehicle. Concurrently, sham-operated mice were given L-propranolol, D-propranolol or vehicle. LV dimension and performance were evaluated under isoflurane anaesthesia by cine-magnetic resonance imaging, echocardiography and cardiac catheterization up to 8 weeks after surgery. After 2 weeks of pressure overload, the vehicle-treated banded mice had enhanced LV weight, normal chamber size and increased relative wall thickness (concentric hypertrophy), whereas L-propranolol- or D-propranolol-banded mice showed a markedly blunted hypertrophic response, i.e. normal chamber size and normal relative wall thickness, as well as preserved systolic LV chamber function. After 4 weeks, the vehicle-treated banded mice showed LV enlargement with a reduced relative wall thickness (eccentric remodelling) and a clear-cut deterioration in LV systolic function. In contrast, L-propranolol- or D-propranolol-treated banded mice showed normal chamber size with a normal relative wall thickness and preserved systolic function. A distinct histological feature was that in banded mice, L-or D-propranolol attenuated the development of cardiomyocyte hypertrophy but not the attendant myocardial fibrosis. At the 8-week stage, LV dysfunction was present in propranolol-treated banded mice although it was much less severe than in vehicle-treated banded mice. It is concluded that (i) deterioration of LV systolic performance is delayed if LV hypertrophy is inhibited, (ii) banding-induced deterioration of LV systolic function is associated with LV eccentric remodelling and (iii) the antihypertrophic effect of propranolol is due to a selective action on cardiomyocytes rather than on collagen accumulatio
Regional anesthesia in a child with sotos syndrome
No full textSotos syndrome is a complex genetic disease first
described by Sotos' in 1964. The four major criteria in the
diagnosis were established in 1994 by Cole and Hughes'.
Basing their findings on the systematic assessment of 41
typical cases they characterized this syndrome by:
1. Advanced bone age.
2. Macrocephaly.
3. Characteristic facial appearance: the face is
round with an abnormal prominence of the forehead and
becomes longer in adolescence.
4. Learning difficulties. This is often associated
with delay in walking that can start after 15 months of age
and speech delay until 2,5 year of age.
Other findings include dolicocephaly, prognatism,
hypertelorism, high-arched palate, early eruption of
teeth, seizures, scoliosis and congenital heart defects 3-4.
Affected patients also show social contact problems and
anxious behavior 5. For forty years the diagnosis of Sotos
syndrome has been based on subjective evaluation of
clinical features. More recently genetic studies showed
mutations of gene NSD 1 in almost all the patients. The
intragenic mutation of NSD 1 gene causes 60-80% of
Sotos syndromes in Europe and USA, whereas 5q35
microdelections encompassing NSD 1 cause 10% of cases
6-7. In contrast, NSDI microdelections are the primary
cause ofSotos syndrome in Japan where the incidence the
incidence of congenital heart defects seems to be higher
8. The gene NSDI encodes a hystone methyltransferase
implicated in chromatin regulation 9.
We present a case ofSotos syndrome which underwent
regional anesthesia with spontaneous breath sedation for
neurological flat foot
Erector spinae plane block in children: a narrative review
Full text linkThe erector spinae plane block (ESPB) is a novel technique used in both adult and pediatric patients. Its use in children has mostly been described in terms of perioperative pain management for various types of surgery. After its introduction, anesthesiologists began using ESPBs in various surgical settings. As adequate analgesia along with a low complica-tion rate were reported, interest in this technique dramatically increased. Many studies in adults and children, including randomized controlled trials, have been published, resulting in the emergence of different clinical indications, with various technical and pharmacolog-ical approaches currently evident in the literature. This narrative review aims to analyze the current evidence in order to guide practitioners towards a more homogeneous approach to ESPBs in children, with a major focus on clinical applications. The ESPB is an efficient, safe, and relatively easy technique to administer. It can be applied in a wide range of surgeries, includes thoracic, abdominal, hip, and femur surgery. Its usefulness is evident in the context of enhanced recovery after surgery protocols and multimodal analgesia. Sin-gle-shot, intermittent bolus, and continuous infusion techniques have been described, and non-inferiority has been observed when compared with other locoregional techniques. Even though both the efficacy and safety of the procedure are widely accepted, current evidence is predominantly based on case reports, with very few well-designed observational studies. Consequently, the level of evidence is still poor, and more well-designed dou-ble-blind, randomized, placebo-controlled trials are needed to refine the procedure for different clinical applications in the pediatric population
Anaesthesia for total knee arthroplasty: efficacy of single-injection or continuous lumbar plexus associated with sciatic nerve blocks--a randomized controlled study
No full textTotal knee arthroplasty (TKA) often results in marked postoperative pain. We compared in a randomized controlled study tramadol consumption, postoperative pain and patient satisfaction after primary TKA in patients who received a single injection lumbar plexus and sciatic nerve blocks or a continuous lumbar plexus and sciatic nerve blocks. Forty-four patients scheduled for unilateral total knee arthroplasty were allocated to the single shot group (group A) or to the catheter group (group B). All patients (in both groups) reported being satisfied with their anaesthetic management. Although pain scores and tramadol consumption appeared lower in the active infusion group, the differences did not reach statistical significance. This study confirms that either single injection or continuous infusion of Ropivacaine in lumbar plexus provides reliable and long-acting anaesthesia and analgesia
Hypobaric versus isobaric spinal levobupivacaine for total hip arthroplasty
No full textSpinal anesthesia (SA) in the lateral decubitus position is often used to perform total hip arthroplasty (THA). Hypobaric local anesthetic ensures enhanced and prolonged sensory and motor block in the involved side. The aim of this study was to compare the intraoperative anesthetic efficacy of hypobaric with isobaric levobupivacaine solutions for THA
The effect of norepinephrine versus epinephrine in irrigation fluid on the incidence of hypotensive/bradycardic events during arthroscopic rotator cuff repair with interscalene block in the sitting position
No full textPurpose: To compare the occurrence rate of hypotensive and bradycardic events (HBEs) during arthroscopic rotator cuff
repair performed with interscalene brachial plexus block anesthesia in the sitting position in 2 groups of patients who
underwent the procedure with norepinephrine or epinephrine added to the irrigation fluid. The secondary objective was
to evaluate the efficacy of norepinephrine in comparison with epinephrine in controlling intraoperative bleeding and
maintaining adequate visualization of the arthroscopic field of view during the procedure. We hypothesized that
norepinephrine added to the irrigation fluid during shoulder arthroscopy in the sitting position would reduce the
occurrence of HBEs, allowing optimal intraoperative bleeding control. Methods: One hundred twenty patients underwent
an arthroscopic rotator cuff repair performed under peripheral anesthesia and in the beach-chair position. Patients
were randomly divided into 2 groups of 60 cases each: Norepinephrine (0.66 mg/L) and epinephrine (0.33 mg/L) were
added to irrigation bags in group N and group E, respectively. The primary outcome was the occurrence rate of HBEs
during surgery. The secondary outcomes were timing of onset of HBEs, accompanying symptoms, and intraoperative
bleeding that impaired arthroscopic visualization. The clarity of the visual field was rated postoperatively by the surgeon
using a visual analog scale. Comparison between groups for all baseline variables and outcome measurements was performed
with the c2 or Fisher exact test, as appropriate, for categorical variables and the Student t test or Mann-Whitney U
test, as appropriate, for continuous variables. Significance was set at P < .05. Results: One patient was excluded from
group E because of block failure; therefore 119 patients were finally included in the study. Comparison between groups
showed no significant differences in baseline characteristics. The occurrence rate of HBEs was significantly greater in group
E (n 1⁄4 15) than in group N (n 1⁄4 5) (P 1⁄4 .02). No differences between groups were found in the average time of onset of
HBEs, accompanying symptoms, and clarity of the visual field. Conclusions: Continuous administration of norepinephrine,
0.66 mg/L, diluted in irrigation fluid during arthroscopic rotator cuff repair with the patient in the beach-chair
position reduces the incidence of HBEs and is as effective as epinephrine in controlling intraoperative bleeding and
maintaining the visual clarity of the surgical field. Level of Evidence: Level I, randomized clinical stud
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
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