Isoflurane inhibited the release of the major central nervous system neurotransmitters with selectivity for glutamate release, consistent with both widespread inhibition and nerve terminal-specific presynaptic effects. Glutamate release was most sensitive to inhibition compared with GABA, acetylcholine, dopamine, and norepinephrine release due to presynaptic specializations in ion channel expression, regulation, and/or coupling to exocytosis. Reductions in neurotransmitter release by volatile anaesthetics could contribute to altered synaptic transmission, leading to therapeutic and toxic effects involving all major neurotransmitter systems.
The prospective study of 32 knees in 26 patients with rheumatoid arthritis was carried out with an average followup of 3 years. Relief of pain and control of inflammation locally were obtained in 22 of 32 knees (69%). Articular cartilage was preserved in 20 of 28 knees (71%) and the synovitis recurred in 9 knees (28%), 7 of which showed progressive loss of cartilage. Therefore, it appears that synovectomy, if performed at a stage in which articular cartilage is still normal and after medical therapy has failed, is a very effective method for preserving articular cartilage and controlling inflammation locally. However, with a longer followup the disease with loss of articular cartilage will recur in a large number of cases. In patients whose disease progresses rapidly, no form of therapy effectively controls joint destruction.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.