Abstract:
BACKGROUND:Intercostal nerve blocks with liposomal bupivacaine are commonly used for thoracic surgery pain management. However, dose scheduling is difficult because the pharmacokinetics of a single-dose intercostal injection of liposomal bupivacaine has never been investigated. The primary aim of this study was to assess the median time to peak plasma concentration (Tmax) following a surgeon-administered, single-dose infiltration of 266 mg of liposomal bupivacaine as a posterior multilevel intercostal nerve block in patients undergoing posterolateral thoracotomy. METHODS:We chose a sample size of 15 adults for this prospective observational study. Intercostal injection of liposomal bupivacaine was considered time 0. Serum samples were taken at the following times: 5, 15, and 30 minutes, and 1, 2, 4, 8, 12, 24, 48, 72, and 96 hours. The presence of sensory blockade, rescue pain medication, and pain level were recorded after the patient was able to answer questions. RESULTS:Forty patients were screened, and 15 patients were enrolled in the study. Median (interquartile range [IQR]) Tmax was 24 (12) hours (confidence interval [CI], 19.5-28.5 hours) with a range of 15 minutes to 48 hours. The median (IQR) peak plasma concentration (Cmax) was 0.6 (0.3) μg/mL (CI, 00.45-0.74 μg/mL) in a range of 0.3-1.2. The serum bupivacaine concentration was undetectable (<0.2 μg/mL) at 96 hours in all patients. There was significant variability in reported pain scores and rescue opioid medication across the 15 patients. More than 50% of patients had return of normal chest wall sensation at 48 hours. All patients had resolution of nerve blockade at 96 hours. No patients developed local anesthetic toxicity. CONCLUSIONS:This study of the pharmacokinetics of liposomal bupivacaine following multilevel intercostal nerve blockade demonstrates significant variability and delay in systemic absorption of the drug. Peak serum concentration occurred at 48 hours or sooner in all patients. The serum bupivacaine concentration always remained well below the described toxicity threshold (2 μg/mL) during the 96-hour study period.
journal_name
Anesth Analgjournal_title
Anesthesia and analgesiaauthors
Manson WC,Blank RS,Martin LW,Alpert SB,Dobrzanski TP,Schneider EB,Ratcliffe SJ,Durieux MEdoi
10.1213/ANE.0000000000005115subject
Has Abstractpub_date
2020-12-01 00:00:00pages
1843-1849issue
6eissn
0003-2999issn
1526-7598pii
00000539-202012000-00022journal_volume
131pub_type
杂志文章abstract:BACKGROUND:Previous modeling of the kinetics of uptake and elimination of anesthetic drugs from the site of action has used measures derived from the electroencephalogram. Such measures lag the current brain activity because of the time needed to acquire a signal sample and derive the measure. With a direct measure of ...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1213/ANE.0b013e3182549490
更新日期:2012-09-01 00:00:00
abstract::Ketanserin, a serotonin antagonist, was used to control blood pressure during cardiopulmonary bypass in 12 patients having cardiac surgery. The drug was administered as a 10 mg bolus followed by a continuous infusion of either 40, 80, or 120 mg/hr to maintain mean arterial blood pressure below 70 mm Hg. There were 16 ...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:
更新日期:1987-11-01 00:00:00
abstract:UNLABELLED:Intraoperative recording of myogenic motor responses evoked by transcranial electrical stimulation (tcMEPs) is a method of assessing the integrity of the motor pathways during aortic surgery. To identify conditions for optimal spinal cord monitoring, we investigated the effects of manipulating the level of n...
journal_title:Anesthesia and analgesia
pub_type: 临床试验,杂志文章
doi:10.1097/00000539-199901000-00005
更新日期:1999-01-01 00:00:00
abstract:BACKGROUND:There is a pronounced learning curve for the technique of ultrasound-guided regional anesthesia. Practicing with a simulator model has been shown to speed the acquisition of these skills for various ultrasound-guided procedures. However, commercial models for ultrasound-guided regional anesthesia may be too ...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1213/ANE.0b013e3181cc558b
更新日期:2010-04-01 00:00:00
abstract::Dexmedetomidine is frequently used for deep sedation during electrophysiology procedures. We report a case where, presumably, the use of dexmedetomidine resulted in a patient's death. The patient developed unexplained and refractory cardiogenic shock and could not be resuscitated. Autopsy failed to demonstrate any abn...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1213/ane.0b013e318172fafc
更新日期:2008-06-01 00:00:00
abstract::Perioperative thermal manipulations are usually directed at the skin surface because methods of directly warming the core are invasive or ineffective. However, inadequate heat flow between peripheral and core compartments will decrease the rate at which core temperature changes. We therefore determined whether core hy...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1097/00000539-199605000-00006
更新日期:1996-05-01 00:00:00
abstract::This study investigated the use of propofol in swine genetically susceptible to malignant hyperthermia (MH). Thirteen animals were exposed to 2% halothane in inspired air, a propofol infusion of 12 mg.kg-1.hr-1 for up to 45 min, or a combination of both. When MH was triggered the animals were treated with dantrolene. ...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:
更新日期:1989-06-01 00:00:00
abstract:BACKGROUND:Sedation protocols, including the use of sedation scales and regular sedation stops, help to reduce the length of mechanical ventilation and intensive care unit stay. Because clinical assessment of depth of sedation is labor-intensive, performed only intermittently, and interferes with sedation and sleep, pr...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1213/ane.0b013e3181acc85d
更新日期:2009-09-01 00:00:00
abstract::It remains questionable whether local anesthetics can interact with membrane lipids at clinically relevant concentrations to show the difference between enantiomers. We compared the effects of bupivacaine stereoisomers on biomimetic membranes containing cardiolipin and cholesterol. Bupivacaine interacted with the memb...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1213/ANE.0b013e31823ed410
更新日期:2012-02-01 00:00:00
abstract:BACKGROUND:Insufficient fixation of an epidural catheter may result in migration of the catheter and eventual catheter failure. However, the best fixation method remains to be established. Aron Alpha A (2-ethyl cyanoacrylate) adhesive is approved for clinical use and can be used for surgical adhesion to both skin and b...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章,随机对照试验
doi:10.1213/ANE.0000000000003326
更新日期:2019-07-01 00:00:00
abstract:BACKGROUND:In children, postoperative respiratory rate (RR) monitoring by transthoracic impedance (TI), capnography, and manual counting has limitations. The rainbow acoustic monitor (RAM) measures continuous RR noninvasively by a different methodology. Our primary aim was to compare the degree of agreement and accurac...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章,多中心研究
doi:10.1213/ANE.0000000000002062
更新日期:2017-06-01 00:00:00
abstract::There is precedent in medicine for recognizing and accepting intact decisional capacity and the subsequent ability to provide valid consent in one treatment domain, while simultaneously recognizing that the patient lacks decisional capacity in other domains. As such, obtaining consent for anesthesia for a surgical pro...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1213/ANE.0b013e3181c7eb12
更新日期:2010-02-01 00:00:00
abstract::The effect of laparoscopy on cardiac function is controversial. We hypothesized that cardiac dysfunction related to increased afterload could be predominant in patients undergoing elective abdominal aortic repair. To test this hypothesis, we conducted a transesophageal echocardiographic study in 15 patients during lap...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1213/01.ane.0000202473.17453.79
更新日期:2006-05-01 00:00:00
abstract::In certifying competence of anesthesiologists who have finished residency training, knowledge and judgment are evaluated objectively using written and oral examinations. Clinical motor skills, however, are not routinely assessed by objective techniques. This implicitly assumes that knowledge and judgment correlate wit...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:
更新日期:1984-06-01 00:00:00
abstract:OBJECTIVE:In this study we sought to identify differences in risk factors and outcome of critically ill patients with Candida albicans and non-albicans candidemia. METHODS:Nonimmunosuppressed, nonneutropenic patients with candidemia diagnosed after intensive care unit (ICU) admission were included in a prospective obs...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1213/ane.0b013e3181607262
更新日期:2008-02-01 00:00:00
abstract:BACKGROUND:Anesthesiologists and certified registered nurse anesthetists (CRNAs) must acquire the skills to recognize and manage a variety of acute intraoperative emergencies. A simulation-based assessment provides a useful and efficient means to evaluate these skills. In this study, we evaluated and compared the perfo...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章,随机对照试验
doi:10.1213/ane.0b013e31818e3d58
更新日期:2009-01-01 00:00:00
abstract:BACKGROUND:In this study we sought to determine whether the topographical measurement along the course of the central veins can estimate the approximate insertion depths of central venous catheters (CVC). METHODS:Two hundred central venous catheterizations were performed via the right and left internal jugular vein (I...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1213/ANE.0b013e31820902bf
更新日期:2011-06-01 00:00:00
abstract:UNLABELLED:Concern about the side effects of allogeneic red blood cell transfusion has increased interest in methods of minimizing perioperative transfusion. We performed meta-analyses of randomized trials evaluating the efficacy and safety of aprotinin, desmopressin, tranexamic acid, and epsilon-aminocaproic acid in c...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章,meta分析
doi:10.1097/00000539-199712000-00014
更新日期:1997-12-01 00:00:00
abstract::We studied three groups of patients without previous renal impairment, undergoing elective coronary artery bypass surgery. Group H (n = 7) underwent open heart surgery using moderate hypothermia (28 degrees C); Groups N and M (n = 8, each) were managed at normothermia. The extracorporeal circuit was primed with Hartma...
journal_title:Anesthesia and analgesia
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1213/00000539-199405000-00004
更新日期:1994-05-01 00:00:00
abstract::Many inhaled anesthetics and intravenous analgesics have been alleged to produce both proconvulsant and anticonvulsant activity in humans. The reasons for these contrasting actions on the CNS are poorly understood at the present time. However, biologic variability plays an important role in determining individual pati...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章,评审
doi:10.1213/00000539-199003000-00013
更新日期:1990-03-01 00:00:00
abstract:BACKGROUND:In the present study, we examined the effects and mechanisms of the Chinese herb resveratrol on attenuation of morphine tolerance in rats. METHODS:Male Wistar rats were implanted with 2 intrathecal catheters; one catheter was connected to a mini-osmotic pump, used for either morphine (15 μg/h) or saline (1 ...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1213/ANE.0b013e31825da0fb
更新日期:2012-10-01 00:00:00
abstract::Qualitative arterial waveform analysis has been in existence for millennia; quantitative arterial waveform analysis techniques, which can be traced back to Euler's work in the 18th century, have not been widely used by anesthesiologists and other clinicians. This is likely attributable, in part, to the widespread use ...
journal_title:Anesthesia and analgesia
pub_type: 历史文章,杂志文章,评审
doi:10.1213/ANE.0b013e31822773ec
更新日期:2011-10-01 00:00:00
abstract:BACKGROUND:Predicting blood product transfusion requirements during orthotopic liver transplantation (OLT) remains difficult. Our primary aim in this study was to determine which patient variables best predict recipient risk for large blood transfusion requirements during OLT. The secondary aim was to determine whether...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1213/ANE.0b013e3182a76f19
更新日期:2014-02-01 00:00:00
abstract:UNLABELLED:A synergistic effect of nonselective cyclooxygenase (COX) inhibitors on morphine-induced decrease of isoflurane minimum alveolar concentration (MAC(ISO)) has been observed in the rat. We studied the influence of specific COX-2 inhibitors on this decrease of MAC. Sixty-four female rats were anesthetized with ...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1213/01.ane.0000097849.18820.c4
更新日期:2004-02-01 00:00:00
abstract::Tissue Doppler Imaging (TDI) provides information on systolic function through its systolic mitral annulus velocity wave (Sm), reflecting the peak velocity of shortening of the myocardial fibers oriented in the longitudinal direction. In this study, we evaluated the effect of load changes on Sm. Forty-two cardiac surg...
journal_title:Anesthesia and analgesia
pub_type: 临床试验,杂志文章
doi:10.1213/01.ANE.0000131972.99804.28
更新日期:2004-08-01 00:00:00
abstract:IMPLICATIONS:Esophageal insufflation can occur simultaneously with venting from the drain tube during positive pressure ventilation with the ProSeal laryngeal mask airway. ...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1097/00000539-200204000-00050
更新日期:2002-04-01 00:00:00
abstract:UNLABELLED:Prepared endotracheal tubes (PETTs) are frequently used for unanticipated difficult intubation, but their storage time is highly variable and institution-dependent. We sought to determine first, if open, unused PETTs are a potential source of pathogenic microorganisms, and second, if PETTs can provide a medi...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1213/01.ane.0000082241.56353.97
更新日期:2003-10-01 00:00:00
abstract:BACKGROUND:Sugammadex is the first selective relaxant binding agent that has been studied for reversal of neuromuscular blockade induced by rocuronium and other steroidal non-depolarizing neuromuscular blocking agents (NMBAs). OBJECTIVES:To assess the efficacy and safety of sugammadex in reversing neuromuscular blocka...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章,meta分析
doi:10.1213/ANE.0b013e3181ce8d5e
更新日期:2010-04-01 00:00:00
abstract::We compared the effect of the lithotomy position on the systolic blood pressure (SBP) with the horizontal position after spinal block. The lithotomy position was performed 5 min after spinal block. The change in SBP was expressed as percent of depression from the baseline value. The SBP increased by the lithotomy posi...
journal_title:Anesthesia and analgesia
pub_type: 杂志文章
doi:10.1097/00000539-199507000-00019
更新日期:1995-07-01 00:00:00
abstract:UNLABELLED:We compare hemodynamic responses in normotensive and hypertensive anesthetized paralyzed patients among three intubation devices: the Macintosh laryngoscope (LS), the Trachlight lightwand (LW), and the intubating laryngeal mask airway Fastrach (ILM). Seventy-five normotensive and 75 hypertensive patients wer...
journal_title:Anesthesia and analgesia
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1213/01.ane.0000048706.15720.c9
更新日期:2003-03-01 00:00:00