Category Archives: Anesthesiology

Pharmacokinetic Pharmacodynamic Perspective on the Detection of Signs of Neural Inertia in Humans.

Pharmacokinetic Pharmacodynamic Perspective on the Detection of Signs of Neural Inertia in Humans.
Anesthesiology. 2018 Aug;129(2):373-375
Authors: Colin PJ, Kuizenga MH, Vereecke HEM, Struys MMRF
PMID: 30020… Continue reading

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Increased Noradrenergic Neurotransmission to a Pain Facilitatory Area of the Brain Is Implicated in Facilitation of Chronic Pain.

Increased Noradrenergic Neurotransmission to a Pain Facilitatory Area of the Brain Is Implicated in Facilitation of Chronic Pain.

Anesthesiology. 2015 Jul 3;

Authors: Martins I, Carvalho P, de Vries MG, Teixeira-Pinto A, Wilson SP, Westerink BH, Tavares I

Abstract
BACKGROUND: Noradrenaline reuptake inhibitors are known to produce analgesia through a spinal action but they also act in the brain. However, the action of noradrenaline on supraspinal pain control regions is understudied. The authors addressed the noradrenergic modulation of the dorsal reticular nucleus (DRt), a medullary pronociceptive area, in the spared nerve injury (SNI) model of neuropathic pain.
METHODS: The expression of the phosphorylated cAMP response element-binding protein (pCREB), a marker of neuronal activation, was evaluated in the locus coeruleus and A5 noradrenergic neurons (n = 6 rats/group). pCREB was studied in noradrenergic DRt-projecting neurons retrogradely labeled in SNI animals (n = 3). In vivo microdialysis was used to measure noradrenaline release in the DRt on nociceptive stimulation or after DRt infusion of clonidine (n = 5 to 6 per group). Pharmacology, immunohistochemistry, and western blot were used to study α-adrenoreceptors in the DRt (n = 4 to 6 per group).
RESULTS: pCREB expression significantly increased in the locus coeruleus and A5 of SNI animals, and most noradrenergic DRt-projecting neurons expressed pCREB. In SNI animals, noradrenaline levels significantly increased on pinprick (mean ± SD, 126 ± 14%; P = 0.025 vs. baseline) and acetone stimulation (mean ± SD, 151 ± 12%; P < 0.001 vs. baseline), and clonidine infusion showed decreased α2-mediated inhibitory function. α1-adrenoreceptor blockade decreased nociceptive behavioral responses in SNI animals. α2-adrenoreceptor expression was not altered.
CONCLUSIONS: Chronic pain induces brainstem noradrenergic activation that enhances descending facilitation from the DRt. This suggests that antidepressants inhibiting noradrenaline reuptake may enhance pain facilitation from the brain, counteracting their analgesic effects at the spinal cord.

PMID: 26146901 [PubMed – as supplied by publisher]

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Different Approaches to Ultrasound-guided Thoracic Paravertebral Block: An Illustrated Review.

Different Approaches to Ultrasound-guided Thoracic Paravertebral Block: An Illustrated Review.
Anesthesiology. 2015 Jun 17;
Authors: Krediet AC, Moayeri N, van Geffen GJ, Bruhn J, Renes S, Bigeleisen PE, Groen GJ
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Development of an Optimized Pharmacokinetic Model of Dexmedetomidine Using Target-controlled Infusion in Healthy Volunteers.

Development of an Optimized Pharmacokinetic Model of Dexmedetomidine Using Target-controlled Infusion in Healthy Volunteers.
Anesthesiology. 2015 Jun 12;
Authors: Hannivoort LN, Eleveld DJ, Proost JH, Reyntjens KM, A… Continue reading

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Postoperative Bladder Catheterization Based on Individual Bladder Capacity: A Randomized Trial.

Postoperative Bladder Catheterization Based on Individual Bladder Capacity: A Randomized Trial.

Anesthesiology. 2014 Nov 3;

Authors: Brouwer TA, Rosier PF, Moons KG, Zuithoff NP, van Roon EN, Kalkman CJ

Abstract
BACKGROUND:: Untreated postoperative urinary retention can result in permanent lower urinary tract dysfuncion and can be prevented by timely bladder catheterization. The author hypothesized that the incidence of postoperative bladder catheterization can be decreased by using the patient’s own maximum bladder capacity (MBC) instead of a fixed bladder volume of 500 ml as a threshold for catheterization.
METHODS:: Randomized parallel-arm and single-blinded comparative effectiveness trial conducted in 1,840 surgical patients, operated under general or spinal anesthesia without an indwelling urinary catheter. Patients were randomized to either use their individual MBC (index) or a fixed bladder volume of 500 ml (control) as a threshold for postoperative bladder catheterization. Preoperatively, the MBC was determined at home by voiding in a calibrated bowl. All other bladder volumes were measured by ultrasound. Postoperatively, bladder catheterization was performed when spontaneous voiding was impossible, and the ultrasound measurement exceeded the threshold for the group in which the patient was randomized (500 or MBC). The primary outcome was the incidence of bladder catheterization.
RESULTS:: The average MBC in the control group was 582 ml (±199 ml) and in the index group 611 ml (±209 ml). The incidence of catheterization decreased from 11.8% (107 of 909 patients) in the control group to 8.6% (80 of 931) in the index group (relative risk 0.73, 95% CI 0.55 to 0.96, P = 0.025). There were no adverse events in either group.
CONCLUSIONS:: In patients undergoing surgery under general or spinal anesthesia using the MBC rather than a fixed 500 ml threshold for bladder catheterization is a safe approach that significantly reduces the incidence of postoperative bladder catheterizations.

PMID: 25371036 [PubMed – as supplied by publisher]

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Simulator-based transesophageal echocardiographic training with motion analysis: a curriculum-based approach.

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Simulator-based transesophageal echocardiographic training with motion analysis: a curriculum-based approach.

Anesthesiology. 2014 Aug;121(2):389-99

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A response surface model approach for continuous measures of hypnotic and analgesic effect during sevoflurane-remifentanil interaction: quantifying the pharmacodynamic shift evoked by stimulation.

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A response surface model approach for continuous measures of hypnotic and analgesic effect during sevoflurane-remifentanil interaction: quantifying the pharmacodynamic shift evoked by stimulation.

Anesthesiology. 2014 Jun;120(6):1390-9

Authors: Heyse B, Proost JH, Hannivoort LN, Eleveld DJ, Luginbühl M, Struys MM, Vereecke HE

Abstract
BACKGROUND: The authors studied the interaction between sevoflurane and remifentanil on bispectral index (BIS), state entropy (SE), response entropy (RE), Composite Variability Index, and Surgical Pleth Index, by using a response surface methodology. The authors also studied the influence of stimulation on this interaction.
METHODS: Forty patients received combined concentrations of remifentanil (0 to 12 ng/ml) and sevoflurane (0.5 to 3.5 vol%) according to a crisscross design (160 concentration pairs). During pseudo-steady-state anesthesia, the pharmacodynamic measures were obtained before and after a series of noxious and nonnoxious stimulations. For the “prestimulation” and “poststimulation” BIS, SE, RE, Composite Variability Index, and Surgical Pleth Index, interaction models were applied to find the best fit, by using NONMEM 7.2.0. (Icon Development Solutions, Hanover, MD).
RESULTS: The authors found an additive interaction between sevoflurane and remifentanil on BIS, SE, and RE. For Composite Variability Index, a moderate synergism was found. The comparison of pre- and poststimulation data revealed a shift of C50SEVO for BIS, SE, and RE, with a consistent increase of 0.3 vol%. The Surgical Pleth Index data did not result in plausible parameter estimates, neither before nor after stimulation.
CONCLUSIONS: By combining pre- and poststimulation data, interaction models for BIS, SE, and RE demonstrate a consistent influence of “stimulation” on the pharmacodynamic relationship between sevoflurane and remifentanil. Significant population variability exists for Composite Variability Index and Surgical Pleth Index.

PMID: 24566244 [PubMed – indexed for MEDLINE]

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Age-dependent role of microvascular endothelial and polymorphonuclear cells in lipopolysaccharide-induced acute kidney injury.

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Age-dependent role of microvascular endothelial and polymorphonuclear cells in lipopolysaccharide-induced acute kidney injury.
Anesthesiology. 2012 Jul;117(1):126-36
Authors: Wulfert FM, van Meurs M, Kurniati … Continue reading

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Interaction between nitrous oxide, sevoflurane, and opioids: a response surface approach.

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Interaction between nitrous oxide, sevoflurane, and opioids: a response surface approach.

Anesthesiology. 2013 Apr;118(4):894-902

Authors: Vereecke HE, Proost JH, Heyse B, Eleveld DJ, Katoh T, Luginbühl M, Struys MM

Abstract
BACKGROUND: The interaction of sevoflurane and opioids can be described by response surface modeling using the hierarchical model. We expanded this for combined administration of sevoflurane, opioids, and 66 vol.% nitrous oxide (N2O), using historical data on the motor and hemodynamic responsiveness to incision, the minimal alveolar concentration, and minimal alveolar concentration to block autonomic reflexes to nociceptive stimuli, respectively.
METHODS: Four potential actions of 66 vol.% N2O were postulated: (1) N2O is equivalent to A ng/ml of fentanyl (additive); (2) N2O reduces C50 of fentanyl by factor B; (3) N2O is equivalent to X vol.% of sevoflurane (additive); (4) N2O reduces C50 of sevoflurane by factor Y. These four actions, and all combinations, were fitted on the data using NONMEM (version VI, Icon Development Solutions, Ellicott City, MD), assuming identical interaction parameters (A, B, X, Y) for movement and sympathetic responses.
RESULTS: Sixty-six volume percentage nitrous oxide evokes an additive effect corresponding to 0.27 ng/ml fentanyl (A) with an additive effect corresponding to 0.54 vol.% sevoflurane (X). Parameters B and Y did not improve the fit.
CONCLUSION: The effect of nitrous oxide can be incorporated into the hierarchical interaction model with a simple extension. The model can be used to predict the probability of movement and sympathetic responses during sevoflurane anesthesia taking into account interactions with opioids and 66 vol.% N2O.

PMID: 23360899 [PubMed – indexed for MEDLINE]

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In Vivo Fluorescence-mediated Tomography Imaging Demonstrates Atorvastatin-mediated Reduction of Lesion Macrophages in ApoE-/- Mice.

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In Vivo Fluorescence-mediated Tomography Imaging Demonstrates Atorvastatin-mediated Reduction of Lesion Macrophages in ApoE-/- Mice.

Anesthesiology. 2013 Apr 2;

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Ventilation before Paralysis.

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Ventilation before Paralysis.
Anesthesiology. 2013 Apr;118(4):992-3
Authors: Priebe HJ
PMID: 23511534 [PubMed – in process]

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A 28-year-old man with air in the mediastinal space after a car accident.

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A 28-year-old man with air in the mediastinal space after a car accident.

Anesthesiology. 2012 Oct;117(4):878

Authors: Brakman M, Buddingh KT, Smit M,…

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Sevoflurane Remifentanil Interaction: Comparison of Different Response Surface Models.

Sevoflurane Remifentanil Interaction: Comparison of Different Response Surface Models.

Anesthesiology. 2012 Jan 4;

Authors: Heyse B, Proost JH, Schumacher PM, Bouillon TW, Vereecke…

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Hemorrhagic shock-induced endothelial cell activation in a spontaneous breathing and a mechanical ventilation hemorrhagic shock model is induced by a proinflammatory response and not by hypoxia.

Hemorrhagic shock-induced endothelial cell activation in a spontaneous breathing and a mechanical ventilation hemorrhagic shock model is induced by a proinflammatory response and not by hypoxia.

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Adjunct nitrous oxide normalizes vascular reactivity changes after hemorrhagic shock in mice under isoflurane anesthesia.

Adjunct nitrous oxide normalizes vascular reactivity changes after hemorrhagic shock in mice under isoflurane anesthesia.
Anesthesiology. 2009 Sep;111(3):600-8
Authors: Samarska IV, van Meurs M, Buikema H, Houwertjes MC, Wulfe… Continue reading

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An evaluation of using population pharmacokinetic models to estimate pharmacodynamic parameters for propofol and bispectral index in children.

An evaluation of using population pharmacokinetic models to estimate pharmacodynamic parameters for propofol and bispectral index in children.
Anesthesiology. 2011 Jul;115(1):83-93
Authors: Coppens MJ, Eleveld DJ, Proost JH, M… Continue reading

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