Όπως όλοι γνωρίζουμε, υπάρχουν σοβαροί περιορισμοί στη δημιουργία ανθρώπινων μοντέλων σχετικά με την επιτέλεση πειραμά-των, που αφορούν τους μηχανισμούς και τις οδούς αίσθησης του πόνου. Τα ερεθίσματα, που μπορούν να εφαρμοστούν σε εθελοντές, είναι απαραίτητα μικρής έως μέσης έντασης και συνήθως εξαρτώνται από τις χειρουργικές συν-θήκες και την υποκείμενη νόσο.
Continue readingAlthough the experience of nociceptive pain ultimately depends on interpretation by the cerebral cortex, it occurs primarily as a result of a noxious stimulus (one which when prolonged produces damage resulting in the humoral and cellular responses of inflammation) activating myelinated A-δ and unmyelinated C noci-ceptors.
Continue readingNSAIDs are widely used compounds in the management of several acute and chronic pain syndromes. NSAIDs induce their action by blocking the cyclooxygenase enzymes, cox-1 and cox-2, during the conversion of arachidonic acid to prostaglandins. Conventional NSAIDs inhibit both cox isoforms and are therefore at risk of serious complications as gastrointestinal irritation, postoperative bleeding, renal failure, water and sodium retention and hepatic failure.
Continue readingThe pericardial diseases result in cardiovascular perturbations ranging from asymptomatic electrocardiographic findings (in pericarditis of end-stage renal disease) to circulatory shock (in acute hemorrhagic pericardial tamponade). Despite of clinical features that resemble right-, or left-side failure, the clinical management of pericardial pathology may differ significantly from those of ventricular systolic or diastolic dysfunction. Therefore, prompt diagnosis and appropriate medical or surgical therapy is imperative.
Continue readingSince the advent of clinical anesthesia, there has been a continuous need for evaluating the depth of anesthesia. Depth of anesthesia was always important in avoiding either overdose (toxicity) or “underdose” (administering less than absolutely necessary). The problem of overdosing has been partly solved by assignment of dedicated and specially trained doctors to provide anesthesia services, by accumulating more than a 100 years of experience in administering anesthesia, by using safer drugs (volatile and intravenous) with extremely smaller toxicity than the older ones and by recognizing and establishing the stages of anesthesia (such as Guedel stages) and the hemodynamic parameters as indirect but useful indices of the depth of anesthesia. The current trend of minimizing expenses of anesthesia calls for tight titration of drug administration.
Continue readingOne of the few areas in clinical medicine which is more affected by advances in engineering technology is cardiac pacing. In about half a century since the first implantation of a pacing system, there has been a significant progress concerning the pacing devices and along with the growing number of new indications for pacing, this will lead to an increasing number of implanted devices over the following years.
Continue readingPain has been defined by the International Association for the Study of Pain as “an unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage”. However, the ability to describe the concept of pain is difficult largely because pain is an individualized and subjective experience. The mechanisms of nociception in animals have been found to resemble closely those present in humans.
Continue readingThis study was undertaken to examine the impact of the variations of cardiac mechanical work in heart’s respiratory quotient (RQ) and venoarterial carbon dioxide difference (ΔPCO2). In twenty-seven patients undergoing coronary artery bypass grafting under extracorporeal circulation, a coronary sinus line was instituted and it’s correct position was verified by the waveform displayed in the monitor. Immediately after cannulae placement, a haemodynamic profile was obtained and simultaneous arterial and coronary sinus (a & cs) sampling for blood gas analysis was done in an ABL 720 (Radiometer Copenhagen) analyzer.
Continue readingIn this study we compared the efficacy of three methods of analgesia following total knee arthroplasty (TKA). Fifty-seven patients (n=57), with mean age 70 + 5 and physical status ΑSA I-III, were scheduled for TKA and were randomly allocated in into three groups. Group A patients (n=19) received analgesia by continuous iliac fascia block (CIFB), group B patients (n=19) received continuous epidural analgesia (CEA) and group C patients (n= 19) received intramuscular pethidine at regular time intervals.
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