References of "Anesthesia and Analgesia"
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See detailThe volume of blood for epidural blood patch in obstetrics: a randomized, blinded clinical trial
Paech, M. J.; Doherty, D. A.; Christmas, T. et al

in Anesthesia and Analgesia (2011), 113(1), 126-33

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See detailPerioperative management of a child with von Willebrand disease undergoing surgical repair of craniosynostosis: looking at unusual targets.
Maquoi, Isabelle ULg; Bonhomme, Vincent ULg; Born, Jacques Daniel et al

in Anesthesia and Analgesia (2009), 109(3), 720-4

We report the successful management of a craniosynostosis repair in a child with severe Type I von Willebrand disease diagnosed during the preoperative assessment and treated by coagulation factor VIII ... [more ▼]

We report the successful management of a craniosynostosis repair in a child with severe Type I von Willebrand disease diagnosed during the preoperative assessment and treated by coagulation factor VIII and ristocetin cofactor. Collaboration among the anesthesiologist, the neurosurgeon, the clinical pathologist, and the pediatric hematologist is important for successful management. [less ▲]

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See detailThe Effect of Clonidine Infusion on Distribution of Regional Cerebral Blood Flow in Volunteers
Bonhomme, Vincent ULg; Maquet, Pierre ULg; Phillips, Christophe ULg et al

in Anesthesia and Analgesia (2008), 106(3), 899-909

BACKGROUND: Through their action on the locus coeruleus, alpha2-adrenoceptor agonists induce rapidly reversible sedation while partially preserving cognitive brain functions. Our goal in this ... [more ▼]

BACKGROUND: Through their action on the locus coeruleus, alpha2-adrenoceptor agonists induce rapidly reversible sedation while partially preserving cognitive brain functions. Our goal in this observational study was to map brain regions whose activity is modified by clonidine infusion so as to better understand its loci of action, especially in relation to sedation. METHODS: Six ASA I-II right-handed volunteers were recruited. Electroencephalogram (EEG) was monitored continuously. After a baseline H2(15)O activation scan, clonidine infusion was started at a rate ranging from 6 to 10 microg x kg(-1) x h(-1). A sequence of 11 similar scans was then performed at 8 min intervals. Plasma clonidine concentration was measured. Using statistical parametric mapping, we sought linear correlations between normalized regional cerebral blood flow (rCBF), an indicator of regional brain activity, and plasma clonidine concentration or spindle EEG activity. RESULTS: Clonidine induced clinical sedation and EEG patterns (spindles) comparable to early stage nonrapid eye movement sleep. A significant negative linear correlation between clonidine concentration and rCBF or spindle activity was observed in the thalamus, prefrontal, orbital and parietal association cortex, posterior cingulate cortex, and precuneus. CONCLUSIONS: The EEG patterns and decreases in rCBF of specific brain regions observed during clonidine-induced sedation are similar to those of early stage nonrapid eye movement sleep. Patterns of deactivated brain regions are also comparable to those observed during general anesthesia or vegetative state, reinforcing the hypothesis that alterations in the activity of a common network occur during these modified conscious states. [less ▲]

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See detailA comparison among portal lactate, intramucosal sigmoid pH, and Delta CO2 (Paco(2) regional Pco(2)) as indices of complications in patients undergoing abdominal aortic aneurysm surgery
Donati, A.; Cornacchini, O.; Loggi, S. et al

in Anesthesia and Analgesia (2004), 99(4), 1024-1031

Our aim in this observational, prospective, noncontrolled study was to detect, in 29 patients who underwent abdominal aortic aneurysm (AAA) surgery, correlations between the incidence of postoperative ... [more ▼]

Our aim in this observational, prospective, noncontrolled study was to detect, in 29 patients who underwent abdominal aortic aneurysm (AAA) surgery, correlations between the incidence of postoperative organ failure and intraoperative changes in arterial and portal blood lactate; changes in intramucosal sigmoid pH (pHi); differences between sigmoid P-CO2 and arterial P-CO2 (DeltaCO(2)); and hemoglobin (Hb). Hb, arterial blood lactate concentrations, pHi, and DeltaCO(2) (air tonometry) were recorded at the start of anesthesia (T0), before aorta clamping (T1), 30 minutes after clamping (T2), and at the end of surgery (T3). Portal venous lactate concentrations were recorded at T1 and T2. Patients were stratified into two groups: group A patients had no postoperative organ failure, and group B patients had one or more organ failures. As compared with group A (n = 16), group B patients (n = 13) had a lower pHi value at T2 and T3 and a higher DeltaCO(2) at T3. A pHi value of <7.15 was a predictor of organ failure, with a sensitivity of 92.3%, a specificity of 68.8%, and positive and negative predictive values of 70.6% and 91.7%, respectively, whereas a DeltaCO(2) value of >28 mm Hg predicted later organ failure with a sensitivity of 92.3%, a specificity of 62.5%, and positive and negative predictive values of 66.6% and 90.9%, respectively. Portal venous lactate concentrations were larger in group B at T2 (P<0.001), and an increase greater than or equal to5 g/dL predicted later postoperative organ failure with a sensitivity of 92.3%, a specificity of 100%, and positive and negative predictive values of 100% and 94.1%, respectively. The comparison of the receiving operator characteristic curves to test the discrimination of each variable and the logistic regression analysis revealed that the increase in portal lactate was the best predictor for the development of postoperative organ failure. Hb concentration was significantly smaller in group B at T0 (13.8 +/- 1.0 g/dL versus 12.2 +/- 2.2 g/dL) and T2 (10.9 +/- 1.2 g/dL versus 9.1 +/- 1.9 g/dL). In conclusion, both pHi and DeltaCO(2) are reasonably sensitive prognostic indices of organ failures after AAA surgery, but they are less specific and accurate than portal venous lactate. [less ▲]

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See detailA European, multicenter, observational study to assess the value of gastric-to-end tidal Pco(2) difference in predicting postoperative complications
Lebuffe, Gilles; Vallet, Benoît; Takala, Jukka et al

in Anesthesia and Analgesia (2004), 99(1), 166-172

Automated online tonometry displays a rapid, semicontinuous measurement of gastric-to-end tidal carbon dioxide (Pr-etCO(2)) as an index of gastrointestinal perfusion during surgery. Its use to predict ... [more ▼]

Automated online tonometry displays a rapid, semicontinuous measurement of gastric-to-end tidal carbon dioxide (Pr-etCO(2)) as an index of gastrointestinal perfusion during surgery. Its use to predict postoperative outcome has not been studied in general surgery patients. We, therefore, studied ASA physical status III-IV patients operated on for elective surgery under general anesthesia and a planned duration of >2 h in a European, multicenter study. As each center was equipped with only 1 tonometric monitor, a randomization was performed if more than one patient was eligible the same day. Patients not monitored with tonometry were assessed only for follow-up. The main outcome measure was the assessment of postoperative functional recovery delay (FRD) on day 8. Among the 290 patients studied, 34% had FRD associated with a longer hospital stay. The most common FRDs were gastrointestinal (45%), infection (39%), and respiratory (35%). In those monitored with tonometry (n = 179), maximum Pr-etCO(2) proved to be the best predictor increasing the probability of FRD from 34% for all patients to 65% at a cut-off of 21 mm Hg (2.8 kPa) (sensitivity 0.27, specificity 0.92, positive predictive value 64%, negative predictive value 70%). We conclude that intraoperative Pr-etCO(2) measurement may be a useful prognostic index of postoperative morbidity. [less ▲]

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See detailEpidural levobupivacaine 0.1 % or ropivacaine 0.1 % combined with morphine provides comparable analgesia after abdominal surgery
Senard, Marc ULg; Kaba, Abdourahmane ULg; Jacquemin, Murielle et al

in Anesthesia and Analgesia (2004), 98

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See detailSpinal mechanisms contribute to analgesia produced by epidural sufentanil combined with bupivacaine for postoperative analgesia
Joris, Jean ULg; Jacob, Eric; Sessler, Daniel et al

in Anesthesia and Analgesia (2003), 97

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See detailAn intervention study to enhance postoperative pain management.
Bardiau, Françoise ULg; Taviaux, Nicole F; Albert, Adelin ULg et al

in Anesthesia and Analgesia (2003), 96(1), 179-85

This study, conducted before and after the implementation of an acute pain service (APS) in a 1000-bed hospital, describes the process of the implementation of an APS. The nursing, anesthesia, and surgery ... [more ▼]

This study, conducted before and after the implementation of an acute pain service (APS) in a 1000-bed hospital, describes the process of the implementation of an APS. The nursing, anesthesia, and surgery departments were involved. In this study we sought to evaluate the results of a continuous quality improvement program by defining quality indicators and using quality tools. A quality program in accordance with current standards of acute pain treatment (multimodal) was worked out to enhance pain relief for all surgical inpatients. A survey of nurses' knowledge with regard to postoperative pain was conducted, and a visual analog scale (VAS) was introduced to assess pain intensity. Both nurses and physicians became familiar with evidence-based guidelines concerning postoperative pain. The entire process was monitored in three consecutive surveys and enrolled 2383 surgical inpatients. Pain indicators based on VAS and analgesic consumption were recorded during the first 72 postoperative hours. After a baseline survey about current practices of pain treatment, a nurse-based, anesthesiologist-supervised APS was implemented. The improvement in pain relief, expressed as VAS scores, was assessed in two further surveys. A quality manual was written and implemented. A major improvement in pain scores was observed after the APS inception (P < 0.001). IMPLICATIONS: The implementation of an acute pain service, including pain assessment by a visual analog scale, standard multimodal pain treatment, and continuous quality evaluation, improved postoperative pain relief. Establishing teams of surgeons, anesthesiologists, and nurses is the prerequisite for this improvement. [less ▲]

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See detailA comparison of the training value of two types of anesthesia simulators: Computer screen-based and mannequin-based simulators
Nyssen, Anne-Sophie ULg; Larbuisson, Robert ULg; Janssens, Marc ULg et al

in Anesthesia and Analgesia (2002), 94(6), 1560-1565

In this study, we compared two different training simulators (the computer screen-based simulator versus the full-scale simulator) with respect to training effectiveness in anesthesia residents ... [more ▼]

In this study, we compared two different training simulators (the computer screen-based simulator versus the full-scale simulator) with respect to training effectiveness in anesthesia residents. Participants were evaluated in the management of a simulated preprogrammed scenario of anaphylactic shock using two variables: treatment score and diagnosis time. Our results showed that simulators can contribute significantly to the improvement of performance but that learning in treating simulated crisis situations such as anaphylactic shock did not significantly vary between full-scale and computer screen-based simulators. Consequently, the initial decision on whether to use a full-scale or computer screen-based training simulator should be made on the basis of cost and learning objectives rather than on the basis of technical or fidelity criteria. Our results support the contention that screen-based simulators are good devices to acquire technical skills of crisis management. Mannequin-based simulators would probably provide better training for behavioral aspects of crisis management, such as communication, leadership, and interpersonal conflicts, but this was not tested in the current study. IMPLICATIONS: We compared two different training simulators (computer screen-based versus full-scale) for training anesthesia residents to better document the effectiveness of such devices as training tools. This is an important issue, given the extensive use and the high cost of mannequin-based simulators in anesthesiology. [less ▲]

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See detailHemodynamic changes and catecholamine release during laparoscopic adrenalectomy for pheochromocytoma.
Joris, Jean ULg; Hamoir, Etienne ULg; Hartstein, Gary ULg et al

in Anesthesia and Analgesia (1999), 88(1), 16-21

We investigated hemodynamics and plasma catecholamine concentrations in eight consecutive patients undergoing laparoscopic adrenalectomy for suspected pheochromocytoma. The same anesthesia protocol was ... [more ▼]

We investigated hemodynamics and plasma catecholamine concentrations in eight consecutive patients undergoing laparoscopic adrenalectomy for suspected pheochromocytoma. The same anesthesia protocol was used in all patients: a continuous infusion of sufentanil 0.5 microg x kg(-1) x h(-1) and isoflurane 0.4% (end-tidal) in 50% N2O/O2. Systolic arterial pressure was maintained between 120 and 160 mm Hg by adjusting an infusion of nicardipine, a calcium-channel blocker, while tachycardia (>100 bpm) was treated by 1-mg boluses of atenolol. Hemodynamics (thermodilution technique) and plasma catecholamine concentrations were measured before surgery, after the induction of anesthesia, after turning the patient to the lateral position, during pneumoperitoneum, during tumor manipulation, after adrenalectomy, and at the end of surgery. Two events resulted in significant catecholamine release: creation of the pneumoperitoneum and adrenal gland manipulation. As a consequence, a twofold increase in cardiac output was recorded. Adjustments of nicardipine infusion (2-6 microg x kg(-1) x min(-1)) minimized changes in mean arterial pressure. Beta-adrenergic blockade was necessary in six patients. In conclusion, laparoscopic adrenalectomy for pheochromocytoma results in marked catecholamine release during pneumoperitoneum and tumor manipulation. Titration of a nicardipine infusion allowed easy and quick control of the hemodynamic aberrancies related to these processes. IMPLICATIONS: Pneumoperitoneum during laparoscopy, now used for adrenalectomy, may complicate anesthetic management of patients with pheochromocytoma. In this study, laparoscopic adrenalectomy was associated with catecholamine release during the creation of pneumoperitoneum and tumor manipulation. Adjustments of a nicardipine infusion readily attenuated the subsequent hemodynamic aberrancies. [less ▲]

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See detailIntrathecal clonidine and fentanyl with hyperbaric bupivacaine improves analgesia during cesarean section
Benhamou, Dan; Schneider, Markus; Brichant, Jean-François ULg et al

in Anesthesia and Analgesia (1998), 87

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See detailPneumothorax during laparoscopic fundoplication: diagnosis and treatment with positive end-expiratory pressure.
Joris, Jean ULg; Chiche, Jean-Daniel; Lamy, Maurice ULg

in Anesthesia and Analgesia (1995), 81(5), 993-1000

Pneumothorax can develop during laparoscopy, particularly during laparoscopic fundoplication, since the left parietal pleura is exposed and can be torn during dissection in the diaphragmatic hiatus. Such ... [more ▼]

Pneumothorax can develop during laparoscopy, particularly during laparoscopic fundoplication, since the left parietal pleura is exposed and can be torn during dissection in the diaphragmatic hiatus. Such an event will result in specific pathophysiologic changes, since CO2, under pressure in the abdominal cavity, will pass into the pleural space. The aim of this study was to document the pathophysiologic changes induced by pneumothorax, and to evaluate the benefit of positive end-expiratory pressure (PEEP) to treat pneumothorax. Forty-six ASA physical status I and II patients scheduled for laparoscopic fundoplication were monitored extensively; heart rate, mean arterial pressure, end-tidal CO2 (PETCO2), oxygen saturation of hemoglobin (Spo2), minute ventilation, tidal volume, dynamic total lung thorax compliance, and airway pressures were recorded. In 25 patients, oxygen uptake, CO2 elimination and arterial blood gases were also measured. Pneumothorax was diagnosed in seven patients. It resulted in the following pathophysiologic changes: decrease in total lung thorax compliance, increase in airway pressures, and increase in CO2 absorption. Consequently, PACO2 and PETCO2 also increased. Spo2, however, remained normal. The use of PEEP largely corrected these respiratory changes. None of these pneumothoraces required drainage. These data suggest that pneumothorax is common during laparoscopic fundoplication. Early diagnosis is possible by simultaneous monitoring of PETCO2, total lung thorax compliance, and airway pressures. Finally, treatment with PEEP provides an alternative to chest tube placement when pneumothorax is secondary to passage of peritoneal CO2 into the interpleural space. [less ▲]

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See detailPain after laparoscopic cholecystectomy: characteristics and effect of intraperitoneal bupivacaine.
Joris, Jean ULg; Thiry, E.; Paris, P. et al

in Anesthesia and Analgesia (1995), 81(2), 379-84

Although pain after laparoscopic cholecystectomy is less intense than after open cholecystectomy, some patients still experience considerable discomfort. Furthermore, the characteristics of ... [more ▼]

Although pain after laparoscopic cholecystectomy is less intense than after open cholecystectomy, some patients still experience considerable discomfort. Furthermore, the characteristics of postlaparoscopy pain differ considerably from those seen after laparotomy. Therefore, we investigated the time course of different pain components after laparoscopic cholecystectomy and the effects of intraperitoneal bupivacaine on these different components. Forty ASA physical status grade I-II patients were randomly assigned to receive either 80 mL of bupivacaine 0.125% with epinephrine 1/200,000 (n = 20) or the same volume of saline (n = 20) instilled under the right hemidiaphragm at the end of surgery. Intensity of total pain, visceral pain, parietal pain, and shoulder pain was assessed 1, 2, 4, 6, 8, 24, and 48 h after surgery. Analgesic consumption was also recorded. Patient data were similar in the two groups. In the saline group, visceral pain was significantly more intense than parietal pain at each time point; visceral and parietal pain were greater than shoulder pain during the first 8 h postoperatively. Intraperitoneal bupivacaine did not significantly affect any of the different components of postoperative pain. Analgesic consumption was similar in the two groups. This study demonstrates that visceral pain accounts for most of the pain experienced after laparoscopic cholecystectomy. Intraperitoneal bupivacaine is not effective for treating any type of pain after laparoscopic cholecystectomy. [less ▲]

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See detailEpidural anesthesia and intrathoracic blood volume.
Warner, David O; Brichant, Jean-François ULg; Ritman, Erik L et al

in Anesthesia and Analgesia (1993), 77(1), 135-40

To investigate how epidural anesthesia changes intrathoracic gas volume, high epidural anesthesia was administered to five pentobarbital-anesthetized dogs lying supine, and the total intrathoracic volume ... [more ▼]

To investigate how epidural anesthesia changes intrathoracic gas volume, high epidural anesthesia was administered to five pentobarbital-anesthetized dogs lying supine, and the total intrathoracic volume at end-expiration was measured with a high-speed three-dimensional x-ray scanner. The amount of gas in the lungs at end-expiration [the functional residual capacity (FRC)] was measured with a nitrogen washout technique, and the intrathoracic tissue volume, including the intrathoracic blood volume, was calculated as the difference between intrathoracic volume at end-expiration and FRC. High epidural anesthesia with the local anesthetic etidocaine to a T-1 myotomal level significantly (P < 0.05) increased intrathoracic volume at end-expiration [76 +/- 35 mL (M +/- SD)] by significantly increasing both intrathoracic tissue volume (33 +/- 15 mL) and FRC (43 +/- 26 mL). Increases in intrathoracic tissue volume were probably caused by increases in intrathoracic blood volume. We conclude that increases in FRC caused by epidural anesthesia in anesthetized dogs lying supine may be minimized by a concurrent increase in intrathoracic blood volume. These results suggest that measurements of thoracic gas volume alone may be insufficient to describe chest wall responses to epidural anesthesia. [less ▲]

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See detailHemodynamic changes during laparoscopic cholecystectomy.
Joris, Jean ULg; Noirot, Didier P; Legrand, Marc ULg et al

in Anesthesia and Analgesia (1993), 76(5), 1067-71

Hemodynamics during laparoscopic cholecystectomy under general anesthesia (isoflurane in N2O/O2 (50%)) were investigated in 15 nonobese ASA Class I patients by using invasive hemodynamic monitoring ... [more ▼]

Hemodynamics during laparoscopic cholecystectomy under general anesthesia (isoflurane in N2O/O2 (50%)) were investigated in 15 nonobese ASA Class I patients by using invasive hemodynamic monitoring including a flow-directed pulmonary artery catheter. During surgery, intraabdominal pressure was maintained automatically at 14 mm Hg by a CO2 insufflator, and minute ventilation was controlled and adjusted to avoid hypercapnia. Hemodynamics were measured before anesthesia, after the induction of anesthesia, after tilting into 10 degrees head-up position, 5 min, 15 min, and 30 min after peritoneal insufflation, and 30 min after exsufflation. Induction of anesthesia decreased significantly mean arterial pressure and cardiac index (CI). Tilting the patient to the head-up position reduced cardiac preload and caused further reduction of CI. Peritoneal insufflation resulted in a significant increase (+/- 35%) of mean arterial pressure, a significant reduction (+/- 20%) of CI, and a significant increase of systemic (+/- 65%) and pulmonary (+/- 90%) vascular resistances. The combined effect of anesthesia, head-up tilt, and peritoneal insufflation produced a 50% decrease in CI. Administration of increasing concentrations of isoflurane, via its vasodilatory activity, may have partially blunted these hemodynamic changes. These results demonstrate that laparoscopy for cholecystectomy in head-up position results in significant hemodynamic changes in healthy patients, particularly at the induction of pneumoperitoneum. [less ▲]

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See detailVentilatory effects of continuous epidural infusion of fentanyl.
Renaud, B.; Brichant, Jean-François ULg; Clergue, F. et al

in Anesthesia and Analgesia (1988), 67(10), 971-5

The effects of a continuous epidural administration of fentanyl on pain and on ventilation were studied in eight patients scheduled for orthopedic surgery of the knee. In each subject, epidural fentanyl ... [more ▼]

The effects of a continuous epidural administration of fentanyl on pain and on ventilation were studied in eight patients scheduled for orthopedic surgery of the knee. In each subject, epidural fentanyl was given by a bolus dose of 1 microgram.kg-1, followed by a continuous infusion of 1 microgram.kg-1.h-1 over 18 hours. Ventilatory measurements were performed during quiet breathing and during CO2 stimulation tests before surgery. After surgery measurements were made before epidural administration of fentanyl; 1, 2, 5, 18 hours after the start of epidural fentanyl infusion; and 6 hours after its discontinuation. Adequate pain relief was achieved in all patients during fentanyl administration. No significant change in ventilation was noted during quiet breathing. The slope of the ventilatory response to CO2 (VE/PaCO2) decreased significantly from 1.46 +/- 0.2 to 0.75 +/- 0.1 L.min-1.mm Hg-1 (mean +/- SEM; P less than 0.05) one hour after the onset of fentanyl administration, and remained stable throughout the infusion. Eighteen hours after the onset of epidural fentanyl infusion, VE/PaCO2 was still 0.76 +/- 0.14 L.min-1.mm Hg-1. At the end of fentanyl administration, plasma fentanyl levels measured in six patients had progressively increased from 0.42 +/- 0.02 ng.ml one hour after the onset of the infusion to 1.54 +/- 0.19 ng.ml at the end of the infusion. These results suggest that a continuous epidural administration of fentanyl is a technique of analgesia that can provide adequate pain relief but which is associated with ventilatory depression. However, with the doses used in this study, the ventilatory depression remained moderate and of no demonstrable clinical consequence. [less ▲]

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See detailOpioid analgesia at peripheral sites: a target for opioids released during stress and inflammation?
Joris, Jean ULg; Dubner, R.; Hargreaves, K. M.

in Anesthesia and Analgesia (1987), 66(12), 1277-81

The peripheral analgesic effects of opiates were evaluated in a rat model of inflammation. The experimental design excluded a potential central nervous system site of action for the observed analgesia ... [more ▼]

The peripheral analgesic effects of opiates were evaluated in a rat model of inflammation. The experimental design excluded a potential central nervous system site of action for the observed analgesia. After the injection of carrageenan (CARRA) in the plantar surface of both hind paws, an opiate was injected into one paw and saline was injected into the other paw. The inflamed paws injected with the mu-agonist, fentanyl (0.3 micrograms) or the kappa-agonist, ethylketocyclazocine (10 micrograms) were significantly less hyperalgesic (P less than 0.001 and P less than 0.01, respectively) than were the contralateral inflamed paws injected with saline. At these doses, fentanyl and ethylketocyclazocine were devoid of systemic effects. Another mu-agonist, levorphanol (20, 40, 80, or 160 micrograms) and dextrorphan (160 micrograms), its dextrorotatory isomer, were used next to evaluate opioid specificity. Levorphanol produced a dose-related blockade of CARRA-induced hyperalgesia (P less than 0.005). In contrast, 160 micrograms of dextrorphan was inactive. These results demonstrate that local administration of opiates into an inflamed paw produces a dose-related, stereospecific analgesia restricted to the injected area. [less ▲]

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See detailIntermittent positive pressure ventilation with either positive end-expiratory pressure or high frequency jet ventilation (HFJV), or HFJV alone in human acute respiratory failure.
Brichant, Jean-François ULg; Rouby, J. J.; Viars, P.

in Anesthesia and Analgesia (1986), 65(11), 1135-42

Continuous Positive Pressure Ventilation (CPPV), High-Frequency Jet Ventilation (HFJV), and a combination of HFJV with Intermittent Positive Pressure Ventilation (CV) were randomly compared in 13 ... [more ▼]

Continuous Positive Pressure Ventilation (CPPV), High-Frequency Jet Ventilation (HFJV), and a combination of HFJV with Intermittent Positive Pressure Ventilation (CV) were randomly compared in 13 critically ill patients with severe acute respiratory failure. Ventilatory settings were chosen in order to apply the same mean airway pressure (Paw) during the three modes. Respiratory frequencies were adjusted during CPPV (16 +/- 2 breaths/min) and HFJV (235 +/- 32 breaths/min) to achieve the same level of PaCO2 and were then combined during CV. All patients were heavily sedated during the study and had had peripheral and balloon-tipped pulmonary arterial catheters previously inserted. After a steady state at FIO2 1 in each mode of ventilation, hemodynamic and respiratory parameters were measured. A Paw of 13.8 +/- 2.9 mm Hg was applied to each patient by using a PEEP of 7.4 mm Hg during CPPV; a driving pressure of 2.9 +/- 0.2 bars and an I/E ratio of 0.43 during HFJV; and by combining HFJV, using a driving pressure of 1.2 +/- 0.3 bars with intermittent positive pressure ventilation during CV. There were no significant differences in any of the hemodynamic or respiratory parameters measured, except for a significant decrease in PaCO2 during CV when compared to CPPV or HFJV. We concluded that 1) arterial oxygenation and cardiac output depend mainly on Paw independent of the method used to increase Paw and 2) CV can improve CO2 elimination without increasing Paw.(ABSTRACT TRUNCATED AT 250 WORDS) [less ▲]

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