An observational study examining the effects of a surgically induced inflammatory response on the distribution of morphine and its metabolites into cerebrospinal fluid

AbstractPurpose Morphine is administered intravenously for pain management in the perioperative period. The effect of the inflammatory response to surgery on morphine distribution across the blood-brain barrier (BBB) in humans was investigated. We hypothesized that a graded surgically induced, systemic inflammatory response alters cerebrospinal fluid (CSF) levels of morphine, morphine-3-glucuronide (M3G), and morphine-6-glucuronide (M6G) through a temporary reduction in BBB drug efflux transporter function.MethodsWe conducted a prospective pharmacokinetic study of the plasma and CSF distribution of the P-glycoprotein (PGP) substrate morphine in 33 patients undergoing open thoracic (n = 18) or endovascular (n = 15) aortic aneurysm repair. Morphine was administered with induction of anesthesia and in the intensive care unit. Plasma and CSF concentrations of interleukin (IL)-6, morphine, M3G, M6G, and albumin were measured prior to surgery (baseline), during surgery, and postoperatively every six hours until removal of the CSF drain. The area under the curve (AUC) was determined for plasma and CSF IL-6, morphine, M3G, and M6G concentrationsvs time. The primary endpoint measures were the correlations between the morphine, M6G, and M3G AUC CSF/plasma ratios and systemic inflammation as quantified by the time-normalized IL-6 exposure, which was calculated for each individual by dividing the total exposure (AUC) by time (t). A Bonferroni correctedP 
Source: Canadian Journal of Anesthesia - Category: Anesthesiology Source Type: research

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CONCLUSIONS: EVAR is aimed for instant aneurysm exclusion. Stepwise flow-reduction of ACF was probably ideal yielding successive reduction of right-heart stress. PMID: 29969426 [PubMed - as supplied by publisher]
Source: EuroIntervention - Category: Cardiovascular & Thoracic Surgery Tags: EuroIntervention Source Type: research
AbstractImmunoglobulin (IgG) 4-related diseases (IgG4-RDs) are fibro-inflammatory conditions characterized by tumorous swelling and serum IgG4 levels. Intrapelvic IgG4-RD has been subclassified according to the localization site and aortic shape as IgG4-related aortic aneurysms (IgG4-AAs), periaortitis (IgG4-PA), and retroperitoneal fibrosis (IgG4-RF). The IgG4-AA pathogenesis would involve interleukin (IL)-6 upregulation, and Th2-predominant and Treg-activated immune conditions. We characterized the features of intrapelvic IgG4-RD lesions, including presence of vascular lesions. The clinical, serological, and pathological...
Source: Heart and Vessels - Category: Cardiology Source Type: research
SAN JUAN, Puerto Rico (AP) — Eight days after Hurricane Maria devastated Puerto Rico, Efrain Perez felt a pain in his chest. Doctors near his small town sent him to Puerto Rico's main hospital for emergency surgery for an aortic aneurysm. But when the ambulance pulled into the parking lot in the capital, San Juan, after a more than two-hour drive, a doctor ran out to stop it. "He said, 'Don't bring him in here, I can't care for him. I don't have power. I don't have water. I don't have an anesthesiologist,'" Perez's daughter, Nerybelle, recalled. The 95-year-old Perez died as the ambulance drove him back to ...
Source: JEMS: Journal of Emergency Medical Services News - Category: Emergency Medicine Authors: Tags: Major Incidents News Category Source Type: news
CONCLUSION: While eptifibatide was effective in maintaining stent patency, our patient experienced several bleeding episodes during ECMO. Thus, the risks and benefits of concurrent antiplatelet and anticoagulant therapy must be appropriately weighed in this patient population. Additionally, as the need for dual antiplatelet therapy due to coronary stent implantation is increasing, further studies are needed to validate optimal dosing of eptifibatide in patients at a high risk of bleeding during ECMO. PMID: 29874954 [PubMed - as supplied by publisher]
Source: Perfusion - Category: Cardiovascular & Thoracic Surgery Authors: Tags: Perfusion Source Type: research
Abstract Despite technological advances, the long-term outcomes of endovascular aortic aneurysm repair (EVAR) are still debatable. Although most endograft failures after EVAR can be corrected with endovascular techniques, open conversion may still be required. A 70-year-old male patient presented at the emergency unit with abdominal pain. Twice, in the third and fourth years after the first repair, a stent graft had been placed over a non-adhesive portion of the stent graft due to type Ia endoleaks. In the most recent admission, a CT scan showed type III endoleak and ruptured aneurysm sac. On this occasion the patient unde...
Source: Jornal Vascular Brasileiro - Category: Surgery Source Type: research
LITFL • Life in the Fast Lane Medical Blog LITFL • Life in the Fast Lane Medical Blog - Emergency medicine and critical care medical education blog Overview We review the original descriptions of 5 eponymous signs (n=6) associated with non-traumatic abdominal ecchymosis. These commonly cited eponyms involving the abdominal wall and flanks (Grey Turner, Cullen and Stabler); scrotum (Bryant) and upper thigh (Fox) may be useful clues directing the examiner to consider potentially serious causes of abdominal pathology. Cullen sign Thomas Stephen Cullen (1869–1953) was a Canadian gynecologist Non-traumat...
Source: Life in the Fast Lane - Category: Emergency Medicine Authors: Tags: Eponymythology Abdominal Ecchymosis Bryant sign Cullen sign fox sign Francis Edward Stabler George Grey Turner Grey Turner sign John Adrian Fox John Henry Bryant Stabler sign Thomas Stephen Cullen Source Type: blogs
SPINAL drain is indicated as a standard of care in open and endovascular thoracic aortic aneurysm repair to protect the spinal cord from ischemic injury and paralysis. Unfortunately, subdural hematoma is a complication of spinal drain that can happen during needle insertion, cerebrospinal fluid drainage, and catheter removal. Symptoms of subdural hematoma can manifest as low back pain, muscle weakness, paralysis, bowel or bladder incontinence, orcauda equina syndrome. These sagittal (panel A) and axial (panel B) T1-weighted magnetic resonance images of the lumbar spine demonstrate a subdural hematoma at the L5 to S2 verteb...
Source: Anesthesiology - Category: Anesthesiology Source Type: research
We report a rare case of delayed removal of an epidural hematoma that resulted in good patient outcomes. Patient concerns: A 69-year-old woman weighing 58 kg presented with back pain that had persisted for 12 years. Her medical history was notable for hypertension. Cervical computed tomography angiography indicated a giant abdominal aortic aneurysm measuring 11.58 × 17.34 × 13.00 cm in her abdominal cavity. Stent graft implantation was scheduled by the interventional therapy group to treat her abdominal aortic aneurysm under single-dose spinal anesthesia. Postoperatively, the patient complained of ...
Source: Medicine - Category: Internal Medicine Tags: Research Article: Clinical Case Report Source Type: research
Abstract Acute aortic syndromes include aortic dissections, intramural hematomas, penetrating ulcers, ruptured or contained ruptured aortic aneurysms. In presence of acute thoracic or dorsal pain, elevated D-Dimers and if acute coronary artery syndrome has been ruled out, additional imaging should be performed to detect acute aortic pathologies. Acute type A dissections involve the ascending aorta. Emergent open repair is the preferred treatment. Acute type B dissections involve the thoracic descending aorta. Endovascular treatment using thoracic stent grafts is indicated in complicated cases (malperfusion, ruptur...
Source: Presse Medicale - Category: General Medicine Authors: Tags: Presse Med Source Type: research
ConclusionsContinuous advances in imaging and treatment technologies are improving short- and long-term outcomes in patients with acute aortic syndrome. Knowledge and interest in intensive care medicine in this area are contributing to improved outcomes, and further research into this life-threatening disease will lead to improvements in diagnosis and management.
Source: Journal of Intensive Care - Category: Intensive Care Source Type: research
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