Ultimo Aggiornamento: Agosto 2001

Acta Anaesthesiol Scand 2001 Apr;45(4):520-1

Different approaches to brachial plexus block.

Edelman VF, Weinbroum AA

Publication Types:

Letter

PMID: 11300398, UI: 21193669

Acta Anaesthesiol Scand 2001 Apr;45(4):477-81

Total knee replacement: a comparison of ropivacaine and bupivacaine in combined femoral and sciatic block.

McNamee DA, Convery PN, Milligan KR

Department of Anaesthetics and Intensive Care Medicine, Queens University of Belfast, UK.

BACKGROUND: Femoral and sciatic nerve block may improve post-operative analgesia following total knee replacement. OBJECTIVES: To compare the post-operative analgesia following primary total knee replacement provided by spinal anaesthesia alone or in combination with femoral and sciatic nerve block with bupivacaine or ropivacaine. METHODS: Seventy-five patients were randomised into one of three groups: spinal anaesthesia only; spinal anaesthesia and combined femoral and sciatic nerve block with 1 mg x kg(-1) bupivacaine 7.5 mg x ml(-1) to each nerve; spinal anaesthesia and combined femoral and sciatic nerve block with 1 mg x kg(-1) ropivacaine 7.5 mg x ml(-1) to each nerve. RESULTS: The mean (SD) time to first morphine request was significantly prolonged for both groups receiving combined femoral and sciatic block, 912 (489) min for the bupivacaine group and 781 (394) min for the ropivacaine group (P<0.001) compared with 413 (208) min for the group receiving spinal anaesthesia alone. Morphine consumption was significantly reduced in both groups receiving combined femoral and sciatic block. There were no systemic or neurological sequelae in any of the groups. CONCLUSIONS: Femoral and sciatic blockade following intrathecal bupivacaine/diamorphine provided superior analgesia when compared with intrathecal bupivacaine/diamorphine alone. There were no significant clinical differences between the group receiving bupivacaine 7.5 mg x ml(-1) and the group receiving ropivacaine 7.5 mg x ml(-1).

Publication Types:

Clinical trial
Randomized controlled trial

PMID: 11300387, UI: 21193658

Acta Anaesthesiol Scand 2001 Apr;45(4):407-13

Cardiopulmonary bypass elicits a pro- and anti-inflammatory cytokine response and impaired neutrophil chemotaxis in neonatal pigs.

Brix-Christensen V, Petersen TK, Ravn HB, Hjortdal VE, Andersen NT, Tonnesen E

Department of Anesthesia and Intensive Care, Aarhus University Hospital, Denmark. vbc@iekf.au.dk

BACKGROUND: Cardiopulmonary bypass (CPB) induces a systemic inflammatory response and organ dysfunction, especially in children. Plasma concentration of inflammatory markers are increased in response to the trauma of cardiac surgery and CPB. The aim of the present study was to investigate whether the CPB procedure in itself elicits increased levels of inflammatory markers in neonatal pigs. METHODS: The inflammatory response was measured in piglets undergoing sternotomy alone (sham group, n=13) or sternotomy and CPB (n=14). Inflammatory mediators were measured at baseline and at fixed time-points during and after CPB. IL-8, IL-10 and TNF-alpha levels and C-reactive protein (CRP) concentrations were measured in plasma samples. Polymorphonuclear neutrophils (PMN) chemotaxis was measured ex vivo, and CD-18 expression using an immunofluorescence technique. RESULTS: Immediately after the CPB procedure increased IL-8 levels were found in the CPB group, but not in sham operated animals (P=0.005). Simultaneously, a marked IL-10 response was measured in the CPB group. Concurrently, PMN chemotaxis decreased in CPB animals but not in the sham group (P=0.04). CD-18 expression and CRP levels were not significantly different between groups and TNF-alpha showed no changes in either group. The chemotactic response did not correlate with plasma IL-8 or IL-10, nor with CD-18 expression. CONCLUSION: The CPB procedure elicited a systemic inflammatory response in terms of significantly elevated plasma levels of IL-8 and IL-10. Furthermore, a temporary and simultaneous decrease in PMN chemotaxis was observed immediately after CPB.

PMID: 11300377, UI: 21193648

Anaesthesia 2001 Aug;56(8):799-820

Predicting caudal epidural analgesia using nerve stimulation.

Tsui BC

University of Alberta Hospital, Edmonton, Alberta, Canada T6G 2B7.

[Medline record in process]

PMID: 11494425, UI: 21384513

Anaesthesia 2001 Aug;56(8):799-820

Combined spinal-epidural as an alternative method of anaesthesia for a sigmoid-colectomy.

Morton G, Bowler I

Llandough Hospital, Cardiff, UK.

[Medline record in process]

PMID: 11494424, UI: 21384512

Anaesthesia 2001 Aug;56(8):799-820

Damage to the conus medullaris following spinal anaesthesia: 3.

Grewal BS, Tarpey J

Warwick Hospital, Warwick CV34 SBW, UK.

[Medline record in process]

PMID: 11494421, UI: 21384509

Anaesthesia 2001 Aug;56(8):799-820

Damage to the conus medullaris following spinal anaesthesia: 2.

Bahk JH, Ko H

Seoul National University Hospital, Seoul 110-744, South Korea bahkjh@plaza.snu.ac.kr

[Medline record in process]

PMID: 11494420, UI: 21384508

Anaesthesia 2001 Aug;56(8):799-820

Damage to the conus medullaris following spinal anaesthesia: 1.

Bromage PR

PO Box 420, Vermont 05471, USA.

[Medline record in process]

PMID: 11494419, UI: 21384507

Anaesthesia 2001 Aug;56(8):799-820

An unexpected and preventable cause of failed epidural analgesia.

Prater BJ, Timberlake C

Bromley Hospital, Bromley BR2 9AJ, UK bjprater@hotmail.com

[Medline record in process]

PMID: 11494417, UI: 21384505

Anaesthesia 2001 Aug;56(8):799-820

Anaesthesia and hair fashion.

Kuczkowski KM, Benumof JL

University of California San Diego, San Diego, CA 92103-8812, USA kkuczkowski@ucsd.edu

[Medline record in process]

PMID: 11494416, UI: 21384504

Anaesthesia 2001 Aug;56(8):799-820

Anaesthesia in pyruvate dehydrogenase deficiency.

Acharya D, Dearlove OR

Royal Manchester Children's Hospital, Manchester M27 4HA, UK.

[Medline record in process]

PMID: 11493256, UI: 21384500

Anaesthesia 2001 Aug;56(8):777-98

Prevention and management of hypotension during spinal anaesthesia for elective Caesarean section: a survey of practice.

Burns SM, Cowan CM, Wilkes RG

1Specialist Registrar in Anaesthesia and 2Consultant Anaesthetist, Liverpool Women's Hospital, Crown Street, Liverpool L8 7SS, UK.

[Medline record in process]

Hypotension during obstetric spinal anaesthesia has traditionally been managed by such measures as fluid preloading, positioning of the patient and the use of vasoconstrictors. However, studies and reports have regularly appeared in the literature disputing the value of conventional management, in particular, the fluid preload. With this in mind, we surveyed UK consultant obstetric anaesthetists to determine current practice in this area. Of the 558 respondents, 486 (87.1%) stated that they routinely give a fluid preload. The fluid chosen by 405 (83.3%) of the preloaders was Hartmann's solution and the usual volume, chosen by 194 (39.9%), was 1000 ml. A simple left lateral position was preferred by 221 respondents (39.6%) overall and in the treatment of hypotension, ephedrine was the sole vasoconstrictor selected by 531 (95.2%). Heavy bupivacaine 0.5% was the local anaesthetic chosen by 545 (97.7%) and 407 (72.9%) respondents indicated the use of additional spinal drugs.

PMID: 11493248, UI: 21384492

Anaesthesia 2001 Aug;56(8):777-98

Anaesthesia for insertion of bone-anchored hearing aids in children: a 7-year audit.

Jones SE, Dickson U, Moriarty A

1Consultant Anaesthetist, and 2Specialist Registrar, Birmingham Children's Hospital, Steelhouse Lane, Birmingham B4 6NH, UK.

[Medline record in process]

Forty-three children, aged 23 months to 14 years, received 102 anaesthetics for insertion of bone-anchored hearing aids, each lasting approximately 30-60 min. Forty of the children had a recognised syndrome involving the head and neck, including Goldenhar's and Treacher Collin's syndrome. The incidence of congenital heart disease was 19%. Pre-existing conditions, anaesthetic technique, grade of intubation, complications and discharge were audited. Sixteen of the patients were classified as Grade 3 or 4 intubations. Over the 7 years, laryngeal mask airway usage increased for airway maintenance rather than tracheal intubation, as did the use of propofol for induction rather than inhalational methods. Intra-operative complications (5.9%) were related to the airway, and postoperative ones (17.6%) mainly to nausea and vomiting. Surgery was performed as a day case in 71% of the patients despite some long-distance travel.

PMID: 11493244, UI: 21384488

Anaesthesia 2001 Aug;56(8):772-6

False-positive epidural catheter aspiration tests in needle through needle combined spinal-epidural anaesthesia.

Isaac R, Coe AJ, Hornsby VP

1Department of Anaesthesia and 2Department of Radiology, Scunthorpe and Goole NHS Trust, Cliff Gardens, Scunthorpe DN15 7BH, UK.

[Medline record in process]

We describe two separate episodes of free aspiration of clear fluid through epidural catheters during needle-through-needle combined spinal-epidural anaesthesia in the lateral position. Although both catheters were assumed to have been located intrathecally, both subsequently gave negative test doses and were used as epidural catheters. In the second patient, the position of the catheter was investigated using contrast spiral computerised tomography scanning, which showed epidural contrast spread only. This is the first time such an occurrence has been recognised, and we consider its significance for catheter site confirmation testing in combined spinal-epidural anaesthesia.

PMID: 11493243, UI: 21384487

Anaesthesia 2001 Aug;56(8):764-7

Undiagnosed adult diastematomyelia associated with neurological symptoms following spinal anaesthesia.

Wenger M, Hauswirth CB, Brodhage RP

1Neurosurgical Department, Klinik Beau-Site, Schanzlihalde 11, CH-3000 Bern 25, Switzerland 2Gynaecological Department, Spitalgruppe Oberland A, Spital Zweisimmen, CH-3770 Zweisimmen, Switzerland 3Rontgeninstitut Brunnhof, CH-3007 Bern, Switzerland.

[Medline record in process]

Spinal anaesthesia is a safe, routinely performed procedure. However, in patients with lumbar cutaneous abnormities or deformities of the lower extremities, a previously undetected spinal anomaly may be present. In such patients, it may be prudent to avoid central neuraxial block to prevent neural damage. This instructive case presents such an adult patient in whom previously undiagnosed diastematomyelia, low conus and tethered cord was discovered only in the assessment of postspinal neurological symptoms.

PMID: 11493240, UI: 21384484

Anaesthesia 2001 Aug;56(8):756-9

A comparison of two techniques for manual ventilation of the lungs by non-anaesthetists: the bag-valve-facemask and the cuffed oropharyngeal airway (COPA) apparatus.

Clayton TJ, Pittman JA, Gabbott DA

1 Specialist Registrars in Anaesthesia, Frenchay Hospital, Frenchay Park Road, Bristol BS16 1LE, UK2 Consultant Anaesthetist, Gloucestershire Royal NHS Trust, Gloucester, UK.

[Medline record in process]

In order to evaluate the possible role of the cuffed oropharyngeal airway during cardiopulmonary resuscitation, we compared its use by non-anaesthetists with the bag-valve-facemask technique of providing ventilation. A group of anaesthetic nurses and operating department practitioners were asked to manually ventilate the lungs of 40 patients undergoing elective surgery following the induction of general anaesthesia with neuromuscular blockade. Ventilation was first attempted using the bag-valve-facemask technique and then using the appropriate size cuffed oropharyngeal airway and self-inflating bag. Ventilation was clinically adequate in 32/40 (80%) patients using the bag-valve-facemask and in 38/40 (95%) patients using the cuffed oropharyngeal airway. Measured expired tidal volumes were greater using the cuffed oropharyngeal airway than with bag-valve-facemask ventilation in two-thirds of patients, despite a higher incidence of audible air leak. Successful ventilation was achieved using the cuffed oropharyngeal airway in seven of the eight patients in whom bag-valve-facemask ventilation was inadequate. The cuffed oropharyngeal airway may offer an effective method of providing ventilation during cardiopulmonary resuscitation by non-anaesthetic hospital staff, particularly when attempted ventilation using a bag-valve-facemask technique is proving ineffective.

PMID: 11493238, UI: 21384482

Anaesthesia 2001 Aug;56(8):745-55

Risk perception and communication: recent developments and implications for anaesthesia.

Adams AM, Smith AF

1 Specialist Registrar and 2 Consultant Anaesthetist, Department of Anaesthesia, Royal Lancaster Infirmary, Ashton Road, Lancaster LA1 4RP, UK.

[Medline record in process]

This review begins by outlining the history of probability theory, exposing cultural differences between scientists and lay people in the way risks are viewed. The basic principles of the science of risk perception are described, and the various methods of communicating risk in health care, both verbal and numerical, are then discussed critically. These concepts are then applied to the practice of anaesthesia. Risk perception may affect anaesthetists' choice of career and may be involved in the genesis and evolution of critical incidents; we also discuss possibilities for training in risk perception issues. The place of risk communication in informed consent and its ethical implications are discussed.

PMID: 11493237, UI: 21384481

Anaesthesia 2001 Jul;56(7):712-3

Which side?

Roberts WO

Publication Types:

Letter

PMID: 11463046, UI: 21355319

Anaesthesia 2001 Jul;56(7):711-2

Pre-filled drugs for the obstetric theatre.

Rayen AT, Rasanayagan R

Publication Types:

Letter

PMID: 11463044, UI: 21355317

Anaesthesia 2001 Jul;56(7):708-9

What's the point?

Lewis S, Donald F, Ford P

Publication Types:

Letter

PMID: 11463041, UI: 21355314

Anaesthesia 2001 Jul;56(7):699-700

Another faulty catheter mount: now you see it now you don't.

Newnam PT

Publication Types:

Letter

PMID: 11437794, UI: 21331147

Anaesthesia 2001 Jul;56(7):697-9

Challenges in paediatric mask holding; the 'claw hand' technique.

Podder S, Dutta A, Yaddanapudi S, Chari P

Publication Types:

Letter

PMID: 11437792, UI: 21331145

Anaesthesia 2001 Jul;56(7):705

Preventing latex sensitisation and foreign body micro-emboli.

Nyabadza M

Publication Types:

Letter

PMID: 11437781, UI: 21331134

Anaesthesia 2001 Jul;56(7):704-5

How invasive should one go?

Chikungwa MT

Publication Types:

Letter

PMID: 11437780, UI: 21331133

Anaesthesia 2001 Jul;56(7):680-4

Effectiveness of continuous positive airway pressure to enhance pre-oxygenation in morbidly obese women.

Cressey DM, Berthoud MC, Reilly CS

Anaesthesia, Surgical and Anaesthetic Sciences, University of Sheffield, Royal Hallamshire Hospital, Sheffield S10 2JF, UK.

Morbid obesity is associated with a reduction in time to desaturate during apnoea following standard pre-oxygenation and induction of anaesthesia. We have compared the effects of using 7.5 cmH2O of continuous positive airway pressure (CPAP) for pre-oxygenation with a standard technique using a Mapleson A breathing system, in 20 morbidly obese women. In a prospective, open, randomised trial, we measured the time taken to desaturate to 90% from time of giving a succinylcholine bolus as part of a rapid induction of anaesthesia. All patients received 3 min pre-oxygenation prior to induction. Tracheal intubation was confirmed and all patients kept apnoeic until oxygen saturation decreased to 90%. No statistically significant difference in mean time to desaturate to 90% could be demonstrated in the CPAP group compared to the Mapleson A group (240 s and 203 s, respectively). A brief period of lower mean heart rate in the CPAP group was the only statistically significant difference in cardiovascular parameters. There was no significant difference in the volume of gastric gas after induction between groups.

Publication Types:

Clinical trial
Randomized controlled trial

PMID: 11437771, UI: 21331124

Anaesthesia 2001 Jul;56(7):660-4

An evaluation of the Airway Management Device.

Cook TM, Gupta K, Gabbott DA, Nolan JP

Royal United Hospital NHS Trust, Bath, Combe Park, Bath BA1 3NG, UK.

We have evaluated the Airway Management Device (AMD) in 105 anaesthetised patients. We were successful in establishing a clear airway on the first attempt on 69 occasions and unable to establish a patent airway at all in 10 patients. Airway obstruction requiring removal of the device occurred during maintenance of anaesthesia in a further two cases and during emergence in three. Loss of the airway during anaesthesia occurred in eight of 95 patients and could be reversed by manipulation of the airway in six cases. Overall, a mean of 0.56 manipulations per patient were required to establish an airway and a further 0.42 per patient were required during maintenance of anaesthesia. In the 95 patients in whom an airway was established, assisted ventilation was satisfactory in 93, with a leak pressure above 20 cmH2O in 65. Intracuff pressure was measured in 12 cases and was above 100 cmH2O in eight. Minor complications occurred in 12 patients. Blood was visible on removal of the device in six cases.

Publication Types:

Evaluation studies

PMID: 11437766, UI: 21331119

Anaesthesia 2001 Jul;56(7):648-59

Status epilepticus.

Chapman MG, Smith M, Hirsch NP

Department of Neuroanaesthesia and Intensive Care, The National Hospital for Neurology and Neurosurgery, University College London Hospitals, Queen Square, London WC1N 3BG, UK.

Status epilepticus is a medical emergency that requires rapid and vigorous treatment to prevent neuronal damage and systemic complications. Failure to diagnose and treat status epilepticus accurately and effectively results in significant morbidity and mortality. Cerebral metabolic decompensation occurs after approximately 30 min of uncontrolled convulsive activity, and the window for treatment is therefore limited. Therapy should proceed simultaneously on four fronts: termination of seizures; prevention of seizure recurrence once status is controlled; management of precipitating causes of status epilepticus; management of the complications. This article reviews current opinions about the classification, aetiology and pathophysiology of adult generalised convulsive status epilepticus and details practical management strategies for treatment of this life-threatening condition.

Publication Types:

Review
Review, tutorial

PMID: 11437765, UI: 21331118

Anaesthesia 2001 Jul;56(7):630-7

Peri-operative silent myocardial ischaemia and long-term adverse outcomes in non-cardiac surgical patients.

Higham H, Sear JW, Neill F, Sear YM, Foex P

Nuffield Department of Anaesthetics, University of Oxford, John Radcliffe Hospital, Headington, Oxford OX3 9DU, UK. helen.higham@nda.ox.ac.uk

Two hundred and seventy-five non-cardiac surgical patients were recruited to determine risk factors associated with the development of postoperative cardiovascular complications during the first year after surgery. Patients underwent ambulatory electrocardiography pre- and postoperatively. There were 34 adverse events over the whole study period. Twenty-four occurred within 6 months and the remaining 10 occurred between 6 and 12 months postoperatively. Silent myocardial ischaemia was associated with adverse outcome over both the first 6 months [OR 4.44 (95% CI 1.77-11.13)] and the whole study period [OR 2.81 (1.26-6.07)]. Other risk factors were: vascular surgery [OR 17.09 (2.67-351.44)], history of angina [OR 6.29 (2.21-17.62)], concurrent treatment with calcium entry blockers [OR 2.68 (1.03-6.93)] and smoking [OR 4.93 (2.00-12.02)]. None of these was a useful predictor of long-term outcome (between 6 and 12 months postsurgery). These results are at variance with other published data, but we conclude that monitoring for peri-operative silent myocardial ischaemia does not aid the prediction of long-term cardiovascular complications.

PMID: 11437762, UI: 21331115

Anaesthesist 2001 Jun;50(6):465-78; quiz 479

[Anesthesia for diagnostic procedures in a non-operating room area].
[Article in German]

Krayer S

Institut fur Anasthesiologie, Universitatsspital Zurich, Ramistrasse 100, 8091 Zurich. sebastian.krayer@ifa.usz.ch

Publication Types:

Review
Review, tutorial

PMID: 11458732, UI: 21352371

Anaesthesist 2001 Jun;50(6):461-2

[Parallel anesthesia].
[Article in German]

Weissauer W

Bundesberufsverband Deutscher Anasthesisten und Berufsverband Deutscher Chirurgen, Roritzerstrasse 27, 90419 Nurnberg.

PMID: 11458730, UI: 21352369

Anaesthesist 2001 Jun;50(6):460

[Changeover of artificial respiration devices in anesthesia].
[Article in German]

Conzen PF

Universitat Munchen, Klinikum Grosshadern, Marchioninistrasse 15, 81377 Munchen.

PMID: 11458729, UI: 21352368

Anaesthesist 2001 Jun;50(6):456-9

[Werner Hugin--pioneer of anesthesiology in Switzerland].
[Article in German]

Schneider MC, Niederer W, Skarvan K

Departement Anasthesie der Universitatsfrauenklinik, Schanzenstrasse 46, CH-4031 Basel. Markus.Schneider@unibas.ch

Publication Types:

Biography
Historical article

Personal Name as Subject:

Hugin W
PMID: 11458728, UI: 21352367

Anaesthesist 2001 Jun;50(6):427-8

[Anesthesia for 100 years].
[Article in German]

Ganssen O

Publication Types:

Historical article

PMID: 11458724, UI: 21352361

Anaesthesist 2001 Jun;50(6):406-10

[Urapidil for treatment of postanesthetic shivering following general anesthesia. A placebo controlled pilot study].
[Article in German]

Fritz H, Schwarzkopf K, Hoff H, Kurzweg V, Hartmann M, Klein U

Klinik fur Anasthesiologie und Intensivtherapie des Klinikums der Friedrick-Schiller-Universitat Jena.Harald.Fritz@med.uni-jena.de

OBJECTIVE: Postanaesthetic shivering is common during recovery from general anaesthesia. Therefore we studied whether urapidil suppresses postanaesthetic shivering. METHODS: With written informed consent and approval of the local ethics committee, patients (ASA I-II) recovering from general anaesthesia were monitored for 1 h. Patients with continuous shivering for a period of 5 min were randomly treated either with 5 ml placebo (isotonic saline) or 25 mg urapidil in a double-blind trial. This treatment procedure was repeated if shivering did not stop. A complete suppression of shivering was appraised as a sufficient treatment. RESULTS: Shivering occurred in 20 of the patients studied and urapidil stopped shivering in 7 out of the 10 treated patients, whereas the placebo stopped shivering in only 2 out of 10 patients (P < 0.05). CONCLUSION: In a placebo controlled trial, it was demonstrated that postanaesthetic shivering can be successfully treated by urapidil in 70% of the patients.

Publication Types:

Clinical trial
Randomized controlled trial

PMID: 11458721, UI: 21352358

Anaesthesist 2001 Jun;50(6):395-400

[The use of cuffed endotracheal tubes in infants and small children].
[Article in German]

Erb T, Frei FJ

Abteilung Anasthesie, Universitats-Kinderspital beider Basel (UKBB), Postfach, CH-4005 Basel.

The use of endotracheal tubes with a cuff is controversial in infants and small children. Often anaesthetists advocate extreme opinions and whereas some propagate the use of cuffed tubes in all cases without restriction, others condemn their use in infants and small children under all circumstances. In this article, the discussion concerning the use of cuffed endotracheal tubes in infants and small children is based on current data and arguments. Relevant facts about the anatomy of the upper airway are reviewed and tube products that are currently available, their correct use in infants as well as the inherent potential advantages and disadvantages related to their use are discussed. The overall incidence of iatrogenic damage after short lasting endotracheal intubation is low. However, acquired subglottic stenosis might represent a severe long-lasting complication. Regardless as to whether tubes with or without cuffs are used, a disproportion between the outer diameter of the tube and the inner diameter of the nonexpandable cricoid ring is the main reason for the genesis of this lesion. A continuous monitoring of the cuff pressure is recommended when using cuffed endotracheal tubes in this age group.

Publication Types:

Review
Review, tutorial

PMID: 11458719, UI: 21352356

Anaesthesist 2001 Jun;50(6):393-4

[To "cuff" or "not to cuff"--that is the question].
[Article in German]

Kretz FJ

Publication Types:

Editorial

PMID: 11458718, UI: 21352355

Anaesthesist 2001 May;50(5):375-6

[5-HT3 receptor antagonists for obstetric anesthesia].
[Article in German]

Krick C, Hennes HJ

Klinik fur Anasthesiologie, Klinikum der Johannes-Gutenberg-Universitat, Langenbeckstrasse 1, 55131 Mainz.

PMID: 11417277, UI: 21310950

Anaesthesist 2001 May;50(5):371-4

[Anesthesia for kidney transplantation].
[Article in German]

Conzen PF, Roth U

Institut fur Anasthesiologie der Ludwigs-Maximilian-Universitat, Klinikum Grosshadem, Marchioninistrasse 15, 81377 Munchen.

PMID: 11417276, UI: 21310949

Anaesthesist 2001 May;50(5):367-9

[Pneumocephalus following spinal anesthesia].
[Article in German]

Litz RJ

Universitatsklinikum Dresden, Klinik fur Anasthesiologie, Fetscherstrasse 74, 01307 Dresden.

PMID: 11417274, UI: 21310947

Anaesthesist 2001 May;50(5):365-6

[TIVA in unknown pregnancy].
[Article in German]

Schuttler J

Klinik fur Anasthesiologie der Universitat Erlangen-Nurnberg, Krankenhausstrasse 12, 91054 Erlangen.

PMID: 11417273, UI: 21310946

Anaesthesist 2001 May;50(5):363-4

[Is the use of tumescence anesthesia in general anesthesia contraindicated]?
[Article in German]

Hempel V

Klinikum Konstanz, Anasthesie I, 78461 Konstanz.

PMID: 11417272, UI: 21310945

Anaesthesist 2001 May;50(5):333-41

[Interscalene plexus block. Anatomic requirements--anesthesiologic and operative aspects].
[Article in German]

Meier G, Bauereis C, Maurer H, Meier T

Abteilung fur Anasthesie und Schmerztherapie, Rheumazentrum Oberammergau, Waldburg-Zeil-Kliniken, Hubertusstrasse 40, 82487 Oberammergau. gmeier@wz-kliniken.de

The interscalene brachial plexus block with and without a catheter has become an indispensable method for anaesthesia and analgesia in shoulder surgery. Not only thorough knowledge of anatomy, but also accurate indication assessment and discussion with the surgeon regarding the location of access, is essential for the successful practice of this technique. Important and practical tips for implementation should especially help the less experienced, with special emphasis on correct positioning of the patient for surgery to avoid iatrogenic neural damage. Preoperative counselling of inevitable side-effects of the technique enhances the patient's acceptance and satisfaction.

Publication Types:

Review
Review, tutorial

PMID: 11417269, UI: 21310942

Anaesthesist 2001 May;50(5):312-22

[Peripheral nerve block. An overview of new developments in an old technique].
[Article in German]

Graf BM, Martin E

Klinik fur Anaesthesiologie, Ruprecht-Karls-Universitat Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg. bernhard_graf@med.uni-heidelberg.de

General anaesthesia and peripheral neuronal blockade are techniques which were introduced into clinical practice at the same time. Although general anaesthesia was accepted significantly faster due to effective new drugs and apparent ease of handling, neuronal blockade has recently gained great importance. The reasons are in particular newer aids such as industrially produced catheter sets, nerve stimulators and ultrasound guidance which have facilitated that these economical techniques can be used not only for intraoperative anaesthesia but also for perioperative analgesia without any major risks for the patients. In parallel to epidural anaesthesia a change of paradigms has recently taken place using catheter instead of single-shot techniques. This allows the loading dose of the local anaesthetics to be installed in a safe way, to reload the dose when intraoperatively required and to extend the analgesia perioperatively by this technique using lower concentrations of the same drugs or drug combinations. A great number of short, middle or long acting local anaesthetics are available to choose the right drug for any particular case. Short and middle acting drugs are characterised by a faster onset compared to long acting drugs, but toxic plasma levels are seen during long time application causing seizures or drowsiness or by using prilocaine methemoglobin. Therefore long acting local anaesthetics such as bupivacaine, ropivacaine or levobupivacaine are the first choice drugs for long time application via peripheral nerve catheters for perioperative anaesthesia and analgesia. By using low concentrations of these potent drugs even for a longer period of time, no toxic plasma levels are seen with the exception of artificial intravasal injections. Additives such as opioids and alpha 2-sympathomimetics are also used. While the use of opioids is controversial, alpha 2-sympathomimetics are able to accelerate the onset and to extend the duration of regional anaesthesia and analgesia.

Publication Types:

Review
Review, academic

PMID: 11417266, UI: 21310939

Anaesthesist 2001 May;50(5):311

[Peripheral nerve block: more questions than answers]?
[Article in German]

Waurick R, Van Aken H

Publication Types:

Editorial

PMID: 11417265, UI: 21310938

Br J Anaesth 2001 Aug;87(2):312-6

Ipsilateral thoraco-lumbar anaesthesia and paravertebral spread after low thoracic paravertebral injection.

Karmakar MK, Gin T, Ho AM

Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, NT, Hong Kong, People's Republic of ChinaCorresponding author.

[Medline record in process]

We report ipsilateral thoraco-lumbar anaesthesia and paravertebral spread of contrast after injection through a thoracic paravertebral catheter that was placed at the right T8-9 spinal level for pain management in a patient with multiple fractured ribs. We review the literature and describe the subendothoracic fascial communication between the thoracic paravertebral space and the retroperitoneal lumbar paravertebral region, which we propose, is the anatomical basis for ipsilateral thoraco-lumbar anaesthesia and paravertebral spread of contrast in our patient. Br J Anaesth 2001; 87: 312-16

PMID: 11493512, UI: 21384824

Br J Anaesth 2001 Aug;87(2):291-4

Touch contamination levels during anaesthetic procedures and their relationship to hand hygiene procedures: a clinical audit.

Merry AF, Miller TE, Findon G, Webster CS, Neff SP

Department of Anaesthesia, Green Lane Hospital, Auckland, New Zealand. Section of Anaesthesia, Department of Pharmacology and Department of Medicine, University of Auckland, New ZealandCorresponding author.

[Medline record in process]

After different methods of hand preparation, volunteers rolled segments of sterile central venous catheter between their fingertips, and bacterial transfer was evaluated by standardized quantitative culture. The number of bacteria transferred differed between methods (P<0.001). Comparisons were made with the control group (no preparation at all; median, third quartile and maximum count=6.5, 24, 55). Bacterial transfer was greatly increased with wet hands (1227, 1932, 3254; P<0.001). It was reduced with a new rapid method, based on thorough drying with a combination of 10 s using a cloth towel followed by either 10 or 20 s with a hot-air towel (0, 3, 7 and 0, 4, 30, respectively; P=0.007 and 0.004, respectively). When asked to follow their personal routines, 10 consultant anaesthetists used a range of methods. Collectively, these were not significantly better than control (7.5, 15, 55; P=0.73), and neither was an air towel alone (2.5, 15, 80; P=0.176) nor the hospital's standard procedure (0, 1, 500; P=0.035). If hand preparation is needed, an adequate and validated method should be used, together with thorough hand drying. Br J Anaesth 2001; 87: 291-4

PMID: 11493506, UI: 21384818

Br J Anaesth 2001 Aug;87(2):286-8

Influence of nitrous oxide on induction of anaesthesia with sevoflurane.

O'Shea H, Moultrie S, Drummond GB

Department of Anaesthetics, Critical Care, and Pain Medicine, Royal Infirmary, Edinburgh EH3 9YW, UKCorresponding author.

[Medline record in process]

Nitrous oxide is often used during inhalation induction of anaesthesia with sevoflurane. Although the value of using nitrous oxide during inhalation induction with other volatile anaesthetics has been studied, the popularity of sevoflurane induction and the different characteristics of this agent make a study of the combination of nitrous oxide with this agent of interest. We compared induction times, oxygenation, and excitatory events during inhalation induction of anaesthesia using sevoflurane, with and without nitrous oxide. We studied 64 female patients, randomly allocated to receive inhalation induction of anaesthesia using sevoflurane with or without 50% nitrous oxide in the fresh gas, using a co-axial breathing system (Mapleson D) and a fresh gas flow rate of 3-6 litre min(-1). Mean time to induction of anaesthesia (fall of an outstretched arm) was 102 s in both groups, but excitation (limb or head movement) was more frequent in those receiving nitrous oxide (10 patients) than in those receiving oxygen only (five patients) (P<0.05). Oxygenation was similar in both groups. We conclude that nitrous oxide confers no advantage when anaesthesia is induced with sevoflurane in this way. Br J Anaesth 2001; 87: 286-8

PMID: 11493504, UI: 21384816

Br J Anaesth 2001 Aug;87(2):283-6

Loss of volition and pain response during induction of anaesthesia with propofol or sevoflurane.

Thompson S, Drummond GB

Department of Anaesthetics, Royal Infirmary, Edinburgh EH3 9YW, UKCorresponding author.

[Medline record in process]

We compared the time to reach two anaesthetic end-points during induction of anaesthesia with a potent inhalation agent (sevoflurane) and an i.v. agent (propofol). We used a method to ensure steady breathing during inhalation induction, and measured loss of tone in the outstretched arm and loss of response to a painful stimulus. Thirty-eight female patients (age 39 (9) yr, weight 65 (11) kg, and height 165 (8) cm) (mean (SD)) were randomly allocated to receive either propofol or sevoflurane. The predicted induction dose of propofol, estimated from age and weight for each patient, was given at a rate of 1% of the induction dose per second, to a possible maximum of 2.5 times the predicted induction dose. Sevoflurane was given with an inhaled concentration of 8%, which was anticipated to cause loss of arm tone within 90-120 s. After loss of consciousness, we applied a painful electrical stimulus to a finger at 15-s intervals and measured the time to loss of motor response. The median times and interquartile values for loss of arm tone were 105 (88-121) s for sevoflurane and 65 (58-80) s for propofol. This was equivalent to 0.65 of the ED(50) of propofol. The time to loss of response to pain was 226 (169-300) s for sevoflurane. The variances of these three measurements were not significantly different, indicating that these dose-response relationships were similar. In contrast, only 11 of the patients given propofol lost the response to pain after 2.5xED(50) had been given. These results support previous evidence of substantial differences between anaesthetic end-points, and show that this evidence can be obtained using a simple and rapid method. Br J Anaesth 2001; 87: 283-6

PMID: 11493503, UI: 21384815

Br J Anaesth 2001 Aug;87(2):204-6

Pulmonary scintigraphy for diagnosis of aspiration during intravenous propofol anaesthesia for colonoscopy.

Rezaiguia-Delclaux S, Streich B, Bouleau D, Delchier JC, Dhonneur G, Meignan M, Duvaldestin P

Department of Anaesthesiology, Department of Gastroenterology and Department of Nuclear Medicine, Hopital Henri Mondor, AP-HP, Universite Paris XII, 51 avenue du Marechal de Lattre de Tassigny, F-94010 Creteil, FranceCorresponding author.

[Medline record in process]

A specific technique for detection of pulmonary aspiration during the perioperative period is lacking. In this study, we developed a scintigraphic method for its diagnosis. Technetium 99m sulphur colloid was given orally 2 h before an i.v. infusion of propofol in patients undergoing elective colonoscopy. During the procedure, patients were spontaneously breathing 100% oxygen via a face mask. After recovery from anaesthesia, patients had a chest scinti-scan. As a control group, 10 healthy men were studied. The lung scan was considered positive if any tracer activity greater than background level was detected in the lung field. Among 96 patients studied, three patients had a positive chest scinti-scan. One of the three patients developed pneumonia while the other two remained asymptomatic. In none of the control asymptomatic group was tracer detected in the chest. We suggest that this technique is specific and can be used as a tool to assess the risk of pulmonary aspiration during different anaesthetic procedures. Br J Anaesth 2001; 87: 204-6

PMID: 11493490, UI: 21384802

Br J Anaesth 2001 Jul;87(1):73-87

Analgesia for day-case surgery.

Rawal N

Department of Anaesthesiology and Intensive Care, Orebro Medical Centre Hospital, S-701 85 Orebro, Sweden.

Publication Types:

Review
Review, academic

PMID: 11460815, UI: 21353862

Br J Pharmacol 2001 Aug;133(7):1029-34

The anti-migraine 5-HT(1B/1D) agonist rizatriptan inhibits neurogenic dural vasodilation in anaesthetized guinea-pigs.

Williamson DJ, Hill RG, Shepheard SL, Hargreaves RJ

Department of Pharmacology, Merck Sharp and Dohme Research Laboratories, Neuroscience Research Centre, Terlings Park, Harlow, Essex, CM20 2QR.

[Medline record in process]

These studies investigated the pharmacology of neurogenic dural vasodilation in anaesthetized guinea-pigs. Following introduction of a closed cranial window the meningeal (dural) blood vessels were visualized using intravital microscopy and the diameter constantly measured using a video dimension analyser. Dural blood vessels were constricted with endothelin-1 (3 &mgr;g kg(-1), i.v.) prior to dilation of the dural blood vessels with calcitonin gene-related peptide (CGRP; 1 &mgr;g kg(-1), i.v.) or local electrical stimulation (up to 300 &mgr;A) of the dura mater. In guinea-pigs pre-treated with the CGRP receptor antagonist CGRP((8-37)) (0.3 mg kg(-1), i.v.) the dilator response to electrical stimulation was inhibited by 85% indicating an important role of CGRP in neurogenic dural vasodilation in this species. Neurogenic dural vasodilation was also blocked by the 5-HT(1B/1D) agonist rizatriptan (100 &mgr;g kg(-1)) with estimated plasma levels commensurate with concentrations required for anti-migraine efficacy in patients. Rizatriptan did not reverse the dural dilation evoked by CGRP indicating an action on presynaptic receptors located on trigeminal sensory fibres innervating dural blood vessels. In addition, neurogenic dural vasodilation was also blocked by the selective 5-HT(1D) agonist PNU-142633 (100 &mgr;g kg(-1)) but not by the 5-HT(1F) agonist LY334370 (3 mg kg(-1)) suggesting that rizatriptan blocks neurogenic vasodilation via an action on 5-HT(1D) receptors located on perivascular trigeminal nerves to inhibit CGRP release. This mechanism may underlie one of the anti-migraine actions of the triptan class exemplified by rizatriptan and suggests that the guinea-pig is an appropriate species in which to investigate the pharmacology of neurogenic dural vasodilation.

PMID: 11487512, UI: 21379862

J Cardiovasc Pharmacol 2001 Aug;38(2):211-8

Effects of volatile anesthetics on ryanodine-treated ferret cardiac muscle.

Housmans PR, Bartunek AE

Department of Anesthesiology, Mayo Foundation, Rochester, Minnesota 55905, USA. housmans.philippe@mayo.edu

[Medline record in process]

The volatile anesthetics halothane, isoflurane, and sevoflurane depress myocardial contractility by decreasing transsarcolemmal Ca2+ influx, Ca2+ release from the sarcoplasmic reticulum, Ca2+ sensitivity of the contractile proteins, and cross-bridge performance. The aim of this study is to assess and compare the effects of halothane, isoflurane, and sevoflurane on contractility in conditions in which sarcoplasmic reticulum Ca2+ release is abolished by pretreatment with ryanodine. Ferret right ventricular papillary muscles were exposed to ryanodine at 10(-6) M and then to incremental concentrations of halothane, isoflurane, or sevoflurane. In the presence of ryanodine, each anesthetic decreased isometric and isotonic contractility in a reversible, concentration-dependent manner with no differences between anesthetics and with little or no effect on time variables. It is likely that differences between anesthetic effects on contraction amplitude in isometric and isotonic twitches reside in their effects on the sarcoplasmic reticulum.

PMID: 11483870, UI: 21383308

Neurosci Lett 2001 Aug 10;308(3):197-200

Stimulatory effect of harmane and other beta-carbolines on locus coeruleus neurons in anaesthetized rats.

Ruiz-Durantez E, Ruiz-Ortega JA, Pineda J, Ugedo L

Department of Pharmacology, Faculty of Medicine, University of the Basque Country, E-48940 Leioa, Vizcaya, Spain

[Medline record in process]

Harmane, harmaline and norharmane are beta-carboline related compounds which have been proposed to be endogenous ligands for imidazoline receptors. The effect of these compounds on the activity of locus coeruleus (LC) neurons was studied by extracellular recordings techniques. Intracerebroventricular administration of harmane and harmaline increased the firing rate of LC neurons. Systemic administration of efaroxan, a mixed alpha(2)-adrenoceptor/I(1)-imidazoline antagonist or vagotomy failed to modify the harmane effect. Furthermore, local applications of harmane and harmaline increased the firing rate of LC neurons in a dose-related manner. Finally, intravenous administration of norharmane also increased the activity of LC neurons. Our results demonstrate that beta-carbolines stimulate LC neuron activity and indicate that this stimulation occurs directly in the LC by a mechanism independent of I(1)- and I(2)-imidazoline receptors.

PMID: 11479022, UI: 21372519

Reg Anesth Pain Med 2001 May-Jun;26(3):271-3

Lumbar sympathetic block for pain relief in two patients with interstitial cystitis.

Doi K, Saito Y, Nikai T, Morimoto N, Nakatani T, Sakura S

Department of Anesthesiology, Shimane Medical University, 89-1 Enya-cho, Izumo 693-8501, Japan. kdoi@shimane-med.ac.jp

BACKGROUND AND OBJECTIVES: Interstitial cystitis (IC) is characterized clinically by lower abdominal pain, pain during urination, and increased frequency of urination. Treatment of the symptoms in IC remains challenging. We report effective treatment using lumbar sympathetic block for 2 patients with IC. CASE REPORT: A 63-year-old and 78-year-old woman were diagnosed with IC. Medical therapy with nonsteroidal anti-inflammatory drugs (NSAID), anticholinergics, and hydrodistention of the bladder failed to improve their symptoms. Subsequently, a continuous lumbar epidural block using 1% mepivacaine was used in these patients. A transient reduction of the symptoms in both patients was achieved. A lumbar sympathetic block with a neurolytic agent produced almost complete, and long-lasting relief of their symptoms. CONCLUSION: Lumbar sympathetic block using a neurolytic agent produced long-lasting pain relief in 2 patients with IC. Reg Anesth Pain Med 2001;26:271-273.

PMID: 11359229, UI: 21258263