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Reliable fluid biomarkers for evaluating neurotoxicity have yet to be established. However, recent studies have reported neurofilament light chain as a fluid biomarker of several neurodegenerative disorders. In this study, we investigated changes in the cerebrospinal fluid and plasma levels of neurofilament light chain in mice treated with trimethyltin as a neurotoxicant. Trimethyltin diluted with saline was administered by intraperitoneal injection to mice at dose levels of 0 (vehicle control), 1.0, and 2.6 mg/kg body weight (dosage volume: 10 mL/kg). At 3 or 7 days after administration, animals were euthanized by exsanguination under 2–3% isoflurane inhalation anesthesia. Increased neurofilament light chain levels in both the cerebrospinal fluid and plasma were observed in animals from the trimethyltin 2.6 mg/kg body weight group, which indicated the brain lesions including neuronal cell death. Animals from the trimethyltin 1.0 mg/kg body weight group exhibited changes neither in neurofilament light chain levels in the cerebrospinal fluid and plasma nor in the histopathology of the brain at any time point. These data indicate that plasma neurofilament light chain can serve as a useful peripheral biomarker for detecting brain lesions such as neuronal necrosis in mice. [ABSTRACT FROM AUTHOR]

Background: Functional Endoscopic Sinus Surgery (FESS) has been employed as a surgical intervention to treat chronic rhinosinusitis in patients with no response to drug therapy, during which the surgical vision may be greatly reduced by a small amount of bleeding. There by, the intraoperative controlled hypotension can improve the visibility. While excessive bleeding intraoperative cause serious complications in the postoperative period, including eye socket infections, visual acuity damage, meningeal infections, and other. Objective: Induced hypotension limits intra operative (IO) blood loss provides better visibility of the surgical field and diminishes the incidence of major complications during Functional Endoscopic Sinus Surgery (FESS). We aimed at comparing Nitroglycerine; Magnesium Sulfate and Dexmedetomidine for inducing controlled hypotension and evaluate narcotic used, mac of inhalational anesthesia, and Ramsay Sedation Scale (RSS) in the recovery and pre-anesthetic time in patients undergoing Functional Endoscopic Sinus Surgery (FESS). Patients and Methods: This study was conducted on 75 patients who underwent elective functional endoscopic sinus surgery (FESS) who matched the inclusion criteria and were randomly allocated into 3 groups each containing 25 patients. The first group received loading dose of dexmedetomidine 1lg/kg infused over 10 min before induction of anesthesia then 0.7 lg/ kg/h via syringe pump, second group received nitroglycerine infusion at a dose of 2lg/kg/min according to the response started after induction, intubation, positioning and sterilization of the patient and third group received a loading dose of magnesium sulfate 40 mg/kg over 10 minutes followed by an infusion 15mg/kg/h via syringe pump. Results: The result of our study showed that dexmedetomidine, magnesium sulfate, or nitroglycerine successfully induced deliberate hypotension and were effective in providing good surgical field during FESS, but dexmedetomidine showed superior hemodynamic profile. Compared with nitroglycerine, both dexmedetomidine and magnesium sulfate offered the advantage of inherent analgesic and sedative effect. Conclusion: Dexmedetomidine, magnesium sulfate, or nitroglycerine successfully induced deliberate hypotension and were effective in providing good surgical field during FESS, but dexmedetomidine showed superior hemodynamic profile. Compared with nitroglycerine, both dexmedetomidine and magnesium sulfate offered the advantage of inherent analgesic and sedative effect. Dexmedetomidine also showed shorter duration of surgery with less blood loss and favorable frommer score with more surgeon satisfaction. Dexmedetomidine showed longest time to 1st analgesic rescue in PACU comparing with magnesium sulfate and nitroglycerine. So, it’s advised to use dexmedetomidine to induce hypotension than magnesium sulfate and nitroglycerine. However, dexmedetomidine should be used with caution as it caused hypotension and bradycardia, t had sedative effect with low aldert score comparing with nitroglycerine and magnesium sulfate. [ABSTRACT FROM AUTHOR]

Objective Adequate postoperative analgesia may enhance recovery. The efficacy of continuous wound infusion vs intermittent epidural ropivacaine for postoperative analgesia was investigated. Design Prospective randomized, observer blind trial. Setting Aretaieio University Hospital. Subjects Patients scheduled for open abdominal hysterectomy or myomectomy. Methods Patients received 10 mL of 0.75% ropivacaine along the skin incision before skin closure, followed by wound infusion 2 mL/hour of 0.375% ropivacaine or epidurally 10 mL of 0.75% ropivacaine in the beginning of surgery followed by 10 mL of 0.2% ropivacaine 6 hourly. The epidural injections or the wound infusion of ropivacaine lasted 48 hours. Rescue analgesia consisted of patient-controlled analgesia morphine up to 48 hours and acetaminophen/codeine tablets the next 24 hours. Analgesic consumption and visual analog scale pain at rest and during cough were assessed 2, 4, 8, 24, 48, and 72 hours postoperatively. One and three months later, patients were interviewed by phone for analgesic consumption at home and presence of pain. Results The subcutaneous group consumed more morphine during the first 2, 4, and 8 hours postoperatively ( P < 0.001, P < 0.001, and P < 0.001, respectively). Subsequent morphine and acetaminophen/codeine requirements did not differ between the two groups. Pain intensity during cough was higher only 2 hours after surgery in the subcutaneous group ( P = 0.002). Three months postoperatively, the two groups did not differ in the analgesic requirements and presence of persisting and/or burning pain. Conclusion Based on our results, there is no clinical significant difference between the epidural ropivacaine and the subcutaneous ropivacaine group or a clear superiority to one management strategy. [ABSTRACT FROM AUTHOR]

Objective Continuous lumbar plexus blocks provide excellent analgesia for total hip arthroplasty ( THA), but their utility has been questioned as they may increase motor weakness. The aim of this study was to compare the efficacy of two different concentrations of ropivacaine on both postoperative analgesia and motor function. Methods Thirty patients were examined in this prospective, single center, double-blinded, parallel group, comparative, randomized controlled trial in patients undergoing primary THA. Lumbar plexus catheters were inserted preoperatively. After surgery, patients were randomly assigned to receive an infusion of ropivacaine at a concentration of either 0.1% (group 0.1%) or 0.2% (group 0.2%) at a standardized volume of 7 mL per hour for 24 hours. Patients were also given free access to patient-controlled analgesia hydromorphone for 24 hours, supplemental intravenous ( IV) opiates, and boluses of their assigned local anesthetic concentration via the lumbar plexus catheter. The primary endpoint was total hydromorphone consumption in 24 hours. Secondary endpoints included pain scores, sensory and motor function, and patient satisfaction. Results There was no significant difference in hydromorphone consumption in the first 24 hours postoperatively (mean [95% confidence interval]) between group 0.1% (8.02 mg [6.02-10.02]) and group 0.2% (8.21 mg [5.75-10.69], P = 0.90). The volume of local anesthetic received, pain scores, sensory and motor function, and patient satisfaction did not vary between groups. Conclusions Following primary THA, lumbar plexus perineural infusion of 0.1% ropivacaine provided similar benefits for postoperative analgesia and functional recovery as 0.2% ropivacaine. [ABSTRACT FROM AUTHOR]

Background Dexamethasone, when added to local anesthetics, has been shown to prolong the duration of peripheral nerve blocks; however, there are limited studies utilizing large numbers of patients. The purpose of this study was to examine the effect of adding dexamethasone to ropivacaine on duration of nerve blocks of the upper and lower extremity. Methods We reviewed 1,040 patient records collected in an orthopedic outpatient surgery center that had received an upper or lower extremity peripheral nerve block with ropivacaine 0.5% with or without dexamethasone and/or epinephrine. The primary outcome was duration of analgesia in upper or lower extremity blocks containing dexamethasone as an adjunct. Secondary outcomes included postoperative patient pain scores, satisfaction, and the incidence of block related complications. Linear and ordinal logistic regression models were used to examine the independent effect of dexamethasone on outcomes. Results Dexamethasone was observed to increase median block duration by 37% (95% confidence interval: 31-43%). The increased block duration persisted within body regions (upper and lower) and across a range of block types. Dexamethasone was also observed to reduce pain scores on the day of surgery ( P = 0.001) and postoperative day 1 ( P < 0.001). There was no significant difference in duration of nerve blocks when epinephrine (1:400,000) was added to 0.5% ropivacaine with or without dexamethasone. Conclusion The addition of dexamethasone to 0.5% ropivacaine prolongs the duration of peripheral nerve blocks of both the upper and lower extremity. [ABSTRACT FROM AUTHOR]

Background. There is currently no reliable treatment for phantom limb pain ( PLP). Chronic PLP and associated cortical abnormalities may be maintained from abnormal peripheral input, raising the possibility that a continuous peripheral nerve block ( CPNB) of extended duration may permanently reorganize cortical pain mapping, thus providing lasting relief. Methods. Three men with below-the-knee (2) or -elbow (1) amputations and intractable PLP received femoral/sciatic or infraclavicular perineural catheter(s), respectively. Subjects were randomized in a double-masked fashion to receive perineural ropivacaine (0.5%) or normal saline for over 6 days as outpatients using portable electronic infusion pumps. Four months later, subjects returned for repeated perineural catheter insertion and received an ambulatory infusion with the alternate solution ('crossover'). Subjects were followed for up to 1 year. Results. By chance, all three subjects received saline during their initial infusion and reported little change in their PLP. One subject did not receive crossover treatment, but the remaining two subjects reported complete resolution of their PLP during and immediately following treatment with ropivacaine. One subject experienced no PLP recurrence through the 52-week follow-up period and the other reported mild PLP occurring once each week of just a small fraction of his original pain (pretreatment: continuous PLP rated 10/10; posttreatment: no PLP at baseline with average of one PLP episode each week rated 2/10) for 12 weeks (lost to follow-up thereafter). Conclusions. A prolonged ambulatory CPNB may be a reliable treatment for intractable PLP. The results of this pilot study suggest that a large, randomized clinical trial is warranted. [ABSTRACT FROM AUTHOR]

Objective. Transversus abdominis plane blocks have been recently utilized for analgesia after cesarean delivery. However, little data concerning continuous transversus abdominis plane blocks has been reported in the existing literature. Avail-able studies mainly examine the efficacy of single-injection blocks, and only one small case series has been published regarding continuous blocks for analgesia after cesarean delivery. First-hand experiences and observations of three acute pain medicine specialists who received a continuous transversus abdominis plane block for analgesia after cesarean delivery are presented. Settings and Patients. Three physicians specialized in acute and perioperative pain medicine personally underwent continuous transversus abdominis plane block placements for analgesia after cesarean deliv-ery via a disposable infusion pump at the same teaching hospital. Results. In a very motivated, well-supported, and informed patient after uncomplicated cesarean delivery, the use of continuous transversus abdomi-nis plane blocks for analgesia offers the significant advantages of early functional recovery and excel-lent prolonged analgesia. Conclusion. The patients experienced postopera-tive continuous transversus abdominis plane blocks that seem to be of value in limiting opiate use and improving analgesia with daily activities in the acute postoperative phase after cesarean delivery. [ABSTRACT FROM AUTHOR]

Introduction. The mechanism of complex regional pain syndrome (CRPS) was reported as being related to both the central and peripheral nervous systems. Recurrence of CRPS was, reportedly, induced by hand surgery in a patient with upper limb CRPS. However, there is no documentation of mechanical allodynia and burning abdominal pain induced by Cesarean section under spinal anesthe-sia in patients with upper limb CRPS. Case. We report the case of a patient who suffered from burning abdominal pain during Cesarean section under spinal anesthesia 13 years after the occurrence of venipuncture-induced CRPS of the upper arm. The patient's pain characteristics were similar to the pain characteristics of her right arm during her previous CRPS episode 13 years earlier. In addition, mechanical allodynia around the inci-sion area was confirmed after surgery. We provided ultrasound-guided rectus sheath block using 20 mL of 0.4% ropivacaine under ultrasound guidance twice, which resulted in the disappearance of the spontaneous pain and allodynia. Discussion. The pain relief was probably related to blockade of the peripheral input by this block which in turn would have improved her central sensitization. Conclusion. Our report shows that attention should be paid to the appearance of neuropathic pain of the abdomen during Cesarean section under spinal anesthesia in patients with a history of CRPS. [ABSTRACT FROM AUTHOR]

Carbon nanotubes (CNTs) have specific physico-chemical properties that are useful for the electronics, automotive, and construction industries. Yet, despite their many advantages, there is a current lack of available information on the human health and environmental hazards of CNTs. For this reason, the current study investigated the inhalation toxicity potential of multiwall CNTs (MWCNTs). Eight-week-old rats were divided into four groups (10 rats in each group), the fresh-air control (0 mg/m³), low-concentration group (0.16 mg/m³), middle-concentration group (0.34 mg/m³), and high-concentration group (0.94 mg/m³), and the whole body was exposed to MWCNTs for 5 days (6 h/day). Lung cells were then isolated from five rats in each group on day 0 and 1 month after the 5-day exposure, respectively. The MWCNTs were generated by a newly designed generation system, and the MWCNT concentrations in the exposure chambers monitored in accordance with National Institute for Occupational Safety and Health (NIOSH) 0500 using a membrane filter. The MWCNTs were also sampled for an elemental carbon concentration analysis using a glass filter. The animals exhibited no significant body weight changes, abnormal clinical signs, or mortality during the experiment. A single-cell gel electrophoresis assay (Comet assay) was conducted to determine the DNA damage in lung cells obtained from the right lung. As a result, the Olive tail moments were 23.00 ± 1.76, 30.39 ± 1.96, 22.96 ± 1.26, and 33.98 ± 2.21 for the control, low-, middle-, and high-concentration groups, respectively, on day 0 postexposure. Meanwhile, 1 month postexposure, the Olive tail moments were 25.00 ± 2.71, 28.39 ± 3.55, 22.56 ± 1.36, and 31.97 ± 3.16 for the control, low-, middle-, and high-concentration groups, respectively. Thus, the MWCNTs caused a statistically significant increase in lung DNA damage at high concentration (0.94 mg/m³) when compared with the negative control group on day 0 and 1 month postexposure. [ABSTRACT FROM AUTHOR]

OBJECTIVES Thoracotomy is one of the most painful surgical incisions. Little is known, however, about the effect of type of anaesthesia on chronic post-thoracotomy pain syndrome (CPTS). We therefore compared the incidence of CPTS after total intravenous anaesthesia (TIVA) and inhalation anaesthesia. METHODS Patients (n = 366) were prospectively randomized into two groups: Group I (n = 173) received TIVA (propofol + remifentanil) and Group II (n = 170) received inhalation anaesthesia with sevoflurane. We assessed acute pain on postoperative days 1, 3 and 5, and the prevalence of CPTS at 3 and 6 months using a numerical rating scale (NRS). RESULTS The prevalence of CPTS was significantly lower in patients receiving TIVA than in those receiving inhalation anaesthesia at 3 months (38.2% versus 56.5%, P = 0.001) and at 6 months (33.5% versus 50.6%, P = 0.002), respectively. Moreover, allodynia-like pain was significantly less common in the TIVA group at 3 (P = 0.021) and 6 months (P = 0.032). NRS score of acute pain, however, did not differ significantly between the two groups. CONCLUSIONS TIVA with propofol and remifentanil may reduce the incidence of CPTS at 3 and 6 months. [ABSTRACT FROM AUTHOR]

We report a case of acute lower extremity compartment syndrome that was diagnosed despite continuous regional analgesia with 0.2% ropivacaine via femoral and sciatic nerve catheters. Academic tertiary care center. Report of a clinical case. A 15-year-old boy with adolescent Blount's disease underwent elective distal femur and proximal tibia osteotomy with external fixation and stabilization of his right leg. The patient's anesthetic and analgesic management included general anesthesia with adjunctive regional anesthesia via continuous femoral and sciatic nerve blocks with 0.2% ropivacaine-each block initially infused at 10 mL per hour. On the first postoperative day, the patient reported no pain (0/10 on the visual analog scale, where 0 is no pain and 10 is the worst pain imaginable). However, on the second postoperative day, the patient reported severe pain despite effective blocks and oral opioid analgesic modalities. Compartment syndrome was diagnosed and treated with decompressive fasciotomy; tissue loss resulted. Despite concerns of masking pain that may be secondary to compartment syndrome, this case demonstrates that compartment syndrome can be diagnosed in the presence of effective regional anesthesia. Careful clinical evaluation coupled with a high index of suspicion is essential in the timely diagnosis and effective treatment of compartment syndrome. [ABSTRACT FROM AUTHOR]

A quiz concerning clinical and cost related issues of using inhalation anesthesia is presented.

In this article the author discusses aspects of using inhalation anesthesia and various factors affecting the decision making for it by anesthesiologists. The author presents information on various stages, factors affecting dosage of inhalation anesthesia and various inhalation anesthetics available. He also presents his views on special clinical considerations that anesthesiologists should make before giving inhaled anesthesia in pediatric patients, bariatric surgery and cardiac surgery.

The article focuses on the economic factors related to use of inhalation anesthesia. Costs related to inhalation anesthesia can be high, but cost saving can be done by understanding the factors affecting the costs. The major factors which can be controlled are fresh gas flow rates and vaporizer settings. Minimum alveolar concentration (MAC) hour can be used to compare costs of inhaled anesthetics at various gas flow rates.

The article discusses the difficulties faced by healthsystem pharmacists in managing the use and costs of inhaled anesthetics in operation rooms (OR). It presents information on the nature of the inhaled anesthetics, the principles for using them, and the role of inhaled anesthesia in post-surgical recovery. The problems faced by pharmacists in cost management include difficulty in quantifying anesthetic use, lack of education and training in giving inhaled anesthesia.

The interpretation of bioassay data to assess intakes and doses depends not only on the biokinetic model used but also on the choice of parameter values made by the assessor. Therefore, it is understandable that different assessors will draw different conclusions from the same datasets even if the same models are used. A systematic step-by-step procedure is proposed for the assessment of cases with comprehensive data in which the time of intake is known. The aims are to promote harmonisation of dose assessments and to assist in obtaining the best available assessment of intake and dose from the monitoring data. The procedure is illustrated by means of an example reported recently in the literature. The case which involves a 6 y follow-up of a subject who inhaled 241Am, is somewhat unusual in that there are comprehensive in vivo measurements, but few excretion data. The rate at which activity is absorbed from lungs to blood can be one of the largest sources of uncertainty in any inhalation assessment, and significantly improved fits to the measurement data were obtained by choosing appropriate values for the relevant parameters. 'The best estimate' of the resulting effective dose in this case was higher by a factor of '2 or 3, respectively, than those obtained assuming ICRP default values for Type M or Type S. [ABSTRACT FROM AUTHOR]

Purpose. Product- and patient-specific factors that may influence the selection of an inhaled anesthetic agent are discussed in four case studies. Summary. The cardiovascular, respiratory, hepatic, and renal effects of various inhaled anesthetic agents vary and may be important in selecting an agent for patients with impairment of these systems. The extent to which anesthetics are metabolized and the risk of hepatotoxicity also vary. Halothane is associated with a relatively high risk for arrhythmias and hepatotoxicity. It also has a high solubility in tissues and is associated with a slow onset and termination of effect and recovery. Pharmacokinetic and pharmacodynamic differences among anesthetics may be important considerations, depending on the surgical setting, anticipated duration of surgery, whether endotracheal intubation is used, and other patient-specific factors such as body weight and age. The duration of surgery is an important consideration for most patients because differences between inhaled anesthetics in offset of effect vary with the duration of the procedure. Desflu- rane or sevoflurane may be preferred for obese patients because of a faster recovery and greater respiratory safety compared with isoflurane. Sevoflurane is preferred for pediatric patients undergoing induction by inhalation because of its low propensity to cause respiratory irritation. Conclusion. There are many product- and patient-specific factors that pharmacists must take into account when selecting an inhaled anesthetic agent It is important to consider all of these factors when developing the pre- and post-anesthesia plan. [ABSTRACT FROM AUTHOR]

Purpose. Types of economic analyses used for inhaled anesthetic agents, factors to consider in calculating the cost of inhaled anesthetics, limitations of pharmacoeconomic studies of these agents, and strategies for controlling inhaled anesthetic costs are discussed. Summary. Inhaled anesthetic agents comprise a substantial component of drug budgets. Calculation of the cost of administering an inhaled anesthetic should take into consideration the cost per mL, potency, waste, concentration and duration of gas delivery, fresh gas flow rate, molecular weight, and density. The use of newer inhaled anesthetic agents with low solubility in blood and tissue provides a more rapid recovery from anesthesia than older, more soluble agents, and also provides the same level of control of depth of anesthesia at a lower fresh gas flow rate and possibly a lower cost than older agents at a higher fresh gas flow rate. A more rapid recovery may facilitate fast-track recovery and yield cost savings if it allows the completion of additional surgical cases or allows a reduc- tion in personnel overtime expenses. Inter- pretation of pharmacoeconomic studies of inhaled anesthetics requires an appreciation of the limitations in methodology and ability to extrapolate results from one setting to another. Pharmacists' efforts to reduce anesthetic waste and collaborate with anesthesiologists to improve the use of these agents can help contain costs, but improving scheduling and efficiency in the operating room has a greater potential to reduce operating room costs. Conclusion. Much can be done to control costs of anesthetic agents without compromising availability of these agents and pa- tient care. [ABSTRACT FROM AUTHOR]

Purpose. The characteristics of ideal intravenous (i.v.) and inhaled anesthetic agents; the rationale for inducing anesthesia with i.v. anesthetics (particularly propofol); the rationale for inducing and maintaining anesthesia with inhaled anesthetics; and the advantages and disadvantages of specific inhaled anesthetics, namely, nitrous oxide, desflurane, halothane, isoflurane, and sevoflurane, are discussed. Summary. Propofol has many characteristics of the ideal i.v. anesthetic, including a rapid, smooth induction of anesthesia and rapid clearance from the body. The use of a n i.v. anesthetic such as propofol avoids the claustrophobia associated with the inhaled route. Inhaled anesthetics are preferred for maintenance of anesthesia because they allow a more precise control of the anesthetic state and do so at low cost. The ideal inhaled anesthetic agent has ample potency and a low solubility in blood and tissues (rapid recovery from anesthesia), resists physical and metabolic degradation, and protects and does not injure vital tissues. It also does not ca use seizures, respiratory irritation, or circulatory stimulation or deplete the ozone layer. It has a low acquisition cost. Nitrous oxide potency is too small to produce anesthesia by itself. Halothane is too soluble and poses a risk d severe hepatotoxicity. Desflurane, isoflurane, and sevoflurane are preferred because they have an adequate potency, appropriate solubility, and minimal to no risk for hepatotoxicity. Conclusion. The utilization choice among desflurane, isoflurane, and sevoflurane is mad e by weighing specific advantages and disadvantages of each agent. The primary determining factors for use are anesthetic potency and control, rate of anesthesia induction, clearance from the body, and adverse effects. [ABSTRACT FROM AUTHOR]

This review paper examines (using systematic methodology) the evidence for the use of inhalation sedation (IHS) instead of dental general anaesthesia (DGA) for dental treatment. It finds that this is an area of healthcare lacking high-quality clinical evidence (i.e. derived from randomized controlled trials). However, evidence from seven case series studies (level of evidence 3) of variable quality and design is examined. Those studies suggest that IHS is effective for a large proportion (83–97 per cent) of selected subgroups of children who would have otherwise required DGA. This may represent 45–64 per cent of all children who are referred for DGA. There is a remarkable degree of consistency between all studies in the reported treatment effectiveness of IHS, despite differences in design and populations treated. IHS is particularly suitable for orthodontic treatment, for older children, and for children requiring no more than four extractions. Morbidity associated with IHS is minor and infrequent, and user satisfaction is high, or higher compared with DGA. Comparing with DGA, IHS requires significantly longer time per episode and more treatment sessions per patient. In teaching dental hospitals, staffing costs for IHS are estimated to be cheaper by about a third compared with outpatient DGA. Indications for further areas of research are made. [ABSTRACT FROM PUBLISHER]

Anaesthetics have gained a lot of attention for their potential mutagenic/carcinogenic effects. In the present study we have investigated the genotoxicity of the inhalation anaesthetic sevoflurane on DNA of lymphocytes isolated from 20 patients undergoing orthopaedic surgery. The genotoxicity of the anaesthetic was studied by assaying DNA damage, apoptosis, DNA repair enzyme activity and GSH content in peripheral lymphocytes before, 15 min after anaesthesia and 24 h after surgery. Lymphocytes isolated 15 min after anaesthesia showed an increase in oxidized purine and pyrimidine bases without DNA strand break formation. DNA strand breaks occurred on the first post-operative day, associated with an enhancement of DNA repair activity and a decrease in GSH. Formation of strand breaks could be the consequence of DNA repair activity. In fact, at 24 h after surgery most of the oxidized DNA bases were repaired. When DNA damage was not repaired, activation of the cell cycle checkpoint protein p53 could lead to apoptosis. An altered redox status may contribute to lymphocytopenia due to an apoptotic event as a consequence of surgical trauma. The presence of apoptotic cells at 1 day after surgery could support the hypothesis that highly damaged peripheral lymphocytes are committed to undergo programmed cell death if the damage is not repaired. In conclusion, the actual risk from anaesthesia is presumably extremely small. However, these findings contribute to our understanding of the regulation of DNA damage/repair and cell death. [ABSTRACT FROM AUTHOR]

This study investigated whether the aging process in dogs is associated with an increased sensitivity to inhalation anesthesia and whether age-related changes in glutamate receptors are related to the increased sensitivity. The mean minimum alveolar concentration (MAC) of isoflurane was 1.82 +/- .08% for 2-3 year olds and 1.45 +/- .06% for 11 years olds, indicating that there was an increased potency of isoflurane in the older dogs as compared to the young. These older animals also showed a significant decrease in binding of [3H]glutamate and [3H]dizocilpine ([3H]MK801) to N-methyl-D-aspartate (NMDA) receptors in multiple cortical and hippocampal regions. The density of binding to NMDA receptors in the cortex, using a single concentration of ligand, correlated significantly with individual MAC values. These results demonstrate that dogs experience an increase in anesthetic potency with increased age, similar to humans, and that age-related changes in the NMDA receptor may represent one mechanism underlying this increased sensitivity to anesthesia. [ABSTRACT FROM AUTHOR]

The requirements for analgesia for burns dressings are discussed. Methoxyflurane has proved satisfactory in a clinical trial, and can be administered by one of two types of vaporizer. The possibility of nephrotoxicity due to methoxyflurane has not been eliminated. [ABSTRACT FROM PUBLISHER]

An introduction to the journal is presented in which the editor discusses various issues including a solution of ropivacaine, morphine, and epinephrine (adrenaline) injected intra-articularly and infiltrated peri-articularly for analgesia after hip arthroplasty, local and intraarticular infiltration analgesia (LIA), and periarticular infiltration (PAI).

The article discusses various reports published within the present issue, including one on the problems faced by hospital pharmacists in managing the usage and costs of inhaled anesthetics in the operating room, another on the cost analysis to save costs of inhalation anesthesia, and a report on anesthesiology of using inhalation anesthesia under various surgical conditions.

Discusses the role of the pharmacist in the surgical environment and pharmacoeconomic considerations in the use of inhaled anesthetics in the U.S. Changes of the agents used to provide anesthesia; Increase in the emphasis on patient safety and outcomes; Advantages and disadvantages of various inhaled anesthetic agents.

A response from the author of the article "Incidence of post-thoracotomy pain: a comparison between total intravenous anaesthesia and inhalation anaesthesia," in the previous issue is presented.

A letter to the editor is presented in response to the article "Incidenceof post-thoracotomy pain: a comparison between total intravenousanaesthesia and inhalation anaesthesia," by J.G. Song, J.W. Shin, E.H. Lee et al. in the previous issue.