These results show that remifentanil hydrochloride does not directly activate NMDA receptors. The NMDA current recorded after application of Ultiva is related to the presence of glycine. Induced NMDA current is potentiated by application of remifentanil hydrochloride through a pathway involving the mu-opioid receptor.

This study determined the ED50 of HP is 28.9 mg and suggests that a 40-mg dose of HP is adequate to provide successful spinal anesthesia for outpatient knee arthroscopy.

P Pu ur rp po os se e: : Sciatic nerve blocks through lateral approaches in the popliteal fossa have been proposed. We describe a new medial approach to the sciatic nerve at this level.M Me et th ho od ds s: : After an anatomical study on six cadavers, we performed sciatic nerve blocks on 20 patients. A 100-mm insulated needle and a nerve stimulator were used; 20 mL of lidocaine 1.5% with epinephrine were injected.R Re es su ul lt ts s: : Patients lied in the supine position, the thigh flexed, abducted and rotated externally (30° in all directions). The leg was flexed at 130°. In this position, above the adductor tubercle, a depression known as Jobert's fossa is palpated. Through this groove, a medial approach to the sciatic nerve at the level of the popliteal fossa is possible. The mean distance between the adductor tubercle and the puncture site is 6.18 cm (range 4-8 cm) and the mean distance between the skin and the sciatic nerve is 6.62 cm (range 4-9 cm). Mean time to perform the block was 100 sec (range 55-165 sec). Complete motor blockade was obtained after a mean time of 30 min (range 5-60 min) inside the common peroneal nerve area and 43 min (range 15-75 min) inside the tibial nerve area. Motor block was complete in 17 patients and sensory block in 18 patients. No vessel puncture was observed.

The classic procedure for aortobifemoral bypass is open surgery. Since the first totally laparoscopic aortobifemoral bypass reported in 1997 by Yves-Marie Dion, laparoscopy has been accepted by several authors as a possible minimally invasive alternative for aorto-iliac occlusive disease. The transperitoneal left retrocolic and retrorenal ways are generally used. The totally retroperitoneal laparoscopic procedure has been described as an alternative to the transperitoneal approach. We report here a totally laparoscopic retroperitoneal approach to performing aortobifemoral bypass. This approach was proposed to a 51-year-old man with aorto-iliac occlusive disease. There was no indication for endovascular revascularization. The patient suffered from 10 metres of bilateral intermittent claudication and lower limb ulcers. During the surgical procedure our patient was placed in a 30-degree right lateral decubitus position. The optical system was first placed in an intra-abdominal position to check the positioning of the trocars in the left retroperitoneal space. The dissection of the retroperitoneal space was performed by CO2 insufflation and by blunt dissection using laparoscopic forceps. The infrarenal aorta was exposed and clamped by laparoscopic clamps. A bifurcated graft was sutured on the left-hand side of the aorta by a running suture. Both prosthetic limbs were tunnelized retroperitoneally to the groin under optical control. The femoral anastomoses were performed by classic open surgery.

BACKGROUND: The presence of A 2A receptors in the dorsal horn of the spinal cord remains controversial. At this level, activation of N-methyl-d-aspartate (NMDA) receptors induces wind-up, which is clinically expressed as hyperalgesia. Inhibition of NMDA receptor currents after activation of A 2A receptors has been shown in rat neostriatal neurons. In this study, we sought to establish the presence of adenosine A 2A receptors in the lamina II of the rat lumbar dorsal horn neurons and investigated whether the activation of A 2A receptors is able to modulate NMDA receptor currents. METHODS: Experiments were conducted in the rat lumbar spinal cord. The presence of adenosine A 2A receptor transcripts inside the lumbar spinal cord is assessed with the reverse transcriptase polymerase chain reaction (RT-PCR) technique. Western blot experiments are performed at the same level. The RT-PCR technique is also performed specifically in the lamina II, and the presence of adenosine A 2A receptor transcripts is assessed in neurons from the lamina II with the single-cell RT-PCR technique. The effect of adenosine A 2A receptor activation on NMDA receptor currents is studied by the whole-cell configuration of the patch clamp technique. RESULTS: RT-PCR performed on the lumbar spinal cord revealed the presence of adenosine A 2A receptor transcripts. Western blot experiments revealed the presence of A 2A receptors in the lumbar spinal cord. RT-PCR performed on the substantia gelatinosa also revealed the presence of adenosine A 2A receptor transcripts. Finally, single cell RT-PCR revealed the presence of adenosine A 2A receptor transcripts in a sample of lamina II neurons. Patch clamp recordings showed an inhibition of NMDA currents during the application of a selective A 2A agonist. CONCLUSIONS: These results demonstrate the presence of A 2A receptor on neurons from the substantia gelatinosa of the rat lumbar dorsal horn and the inhibition of NMDA-induced currents by the application of a selective A 2A receptor agonist. Therefore, A 2A receptor ligands could modulate pain processing at the spinal cord level.