Acta Anaesthesiol Scand 2001 Aug;45(7):923-4
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PMID: 11472301, UI: 21365035
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Acta Anaesthesiol Scand 2001 Aug;45(7):922-3
PMID: 11472299, UI: 21365033
Acta Anaesthesiol Scand 2001 Aug;45(7):911-3
Department of Anaesthesia and Intensive Care, Singapore General Hospital, Republic of Singapore.
Negative pressure pulmonary edema due to upper airway obstruction following extubation is a well-recognized problem. However, frank pulmonary hemorrhage as a manifestation of upper airway obstruction is uncommon. We report a case of significant pulmonary hemorrhage and negative pressure pulmonary edema in an intubated patient. Bronchoscopy showed a collection of blood in the right lower lobe of the lungs, suggesting a localized source of bleeding. There have been two previously reported cases of pulmonary hemorrhage after upper airway obstruction. One suggested that the bleeding was due to damage to the pulmonary capillaries, the other that it was due to disruption of the bronchial vessels. We feel that in our case there was some indication that the pulmonary bleeding was a result of bronchial vessel damage. A number of factors might have been involved in its development, including negative pulmonary pressure, recent respiratory tract infection, and positive airways pressure (due to coughing).
PMID: 11472296, UI: 21365030
Acta Anaesthesiol Scand 2001 Aug;45(7):906-10
Department of Anesthesiology, New York University Medical Center, New York, USA.
BACKGROUND: The research on conductive analgesia induced by perineural opioids generated a large body of conflicting data. In this study we reassessed the antinociceptive response to perineural administration of morphine, fentanyl or meperidine in a rat model. METHODS: Analgesia was assessed using the hind paw withdrawal latency (HPWL) response to radiant heat. The opioid dose producing 20% of maximal possible effect (20%MPE) for systemic analgesia was calculated for each drug. Then sciatic blockade was performed with the dose corresponding to 20%MPE. The injected hind paw was used to measure direct perineural effect and the contralateral hind paw was used as an indicator of systemic effect. RESULTS: The response latency produced by morphine or fentanyl was not significantly different for ipsilateral (perineural effect) or contralateral (systemic effect) paw (27+/-11 vs. 28+/-16 and 3l+/-16 vs. 23+/-16 s, respectively). However, the meperidine group showed significantly higher %MPE for the ipsilateral paw (79+/-32 s) than for the contralateral paw (27+/-22 s). CONCLUSIONS: The results indicate that perineural fentanyl or morphine do not produce analgesia. Perineural block produced by meperidine was attributed to local anesthetic-like effect, rather than to drug interaction with opioid receptor.
PMID: 11472295, UI: 21365029
Acta Anaesthesiol Scand 2001 Aug;45(7):899-905
Department of Anesthesia, Children's Hospital, Boston, Massachusetts, USA.
BACKGROUND: Millimolar-range concentrations of some adrenergic antagonists have been shown to have local anesthetic-like properties, and to stimulate GTPase activity in vitro. In this report, we investigate whether these agents can potentiate the effect of tetrodotoxin (TTX) and bupivacaine, a conventional local anesthetic, and whether GTPase activation plays a role. METHODS: Rats received sciatic nerve blockade with tetrodotoxin or bupivacaine co-injected with adrenergic antagonists and/or agonists, or pertussis toxin. Thermal nociceptive blockade was quantified with modified hotplate testing. RESULTS: Nerve block from TTX alone lasted 153 (99-223) min (median and 25th and 75th percentiles). Co-injection with 20 mM phentolamine, propranolol, and yohimbine prolonged TTX block to 856 (765-862), 486 (444-510), and 465 (413-495) min respectively (P<0.005 in all cases, compared to TTX alone). Micromolar concentrations of adrenergic antagonists (which inhibited the prolongation of TTX block by epinephrine) did not prolong TTX block. Injection of adrenergic antagonists alone did not produce specific nerve block. They did not prolong TTX block when injected at a remote subcutaneous site. Prolongation of TTX block by phentolamine was not inhibited by co-injection with pertussis toxin. Adrenergic antagonists did not prolong bupivacaine block. CONCLUSIONS: High concentrations of adrenergic antagonists markedly prolonged TTX block, but not bupivacaine block. This locally mediated action does not appear to be adrenergic-receptor-specific, or mediated by GTPase activation.
PMID: 11472294, UI: 21365028
Acta Anaesthesiol Scand 2001 Aug;45(7):875-84
Department of Surgical and Perioperative Sciences, Anesthesiology and Intensive Care and Surgery, Umea University Hospital, Umea, Sweden. stefan.lehtipalo.us@vll.se
BACKGROUND: Reduced gut perfusion is associated with multiple organ failure. Positive end-expiratory pressure (PEEP) reduces cardiac output (CO) and portal blood flow, and might be detrimental in a situation of already compromised intestinal circulation. The aim of this study was to investigate regional circulatory and metabolic effects of PEEP during graded regional hypoperfusion. METHODS: In 12 barbiturate-anesthetized pigs, we measured systemic and regional blood flows (superior mesenteric arterial, QSMA and portal venous, QPORT), jejunal mucosal perfusion (LDF), tissue oxygenation (PO2TISSUE) and metabolic parameters at PEEP (0, 4, 8 and 12 cm H2O) in a randomized order. Measurements were performed at unrestricted intestinal perfusion pressures (IPP) and at IPP levels of 50 and 30 mmHg. RESULTS: During unrestricted IPP, PEEP decreased MAP, CO, QSMA and QPORT, while systemic, and preportal (RPORT) vascular resistances and jejunal mucosal perfusion were not significantly changed. Preportal tissue oxygen delivery and PO2TISSUE decreased, while preportal tissue oxygen uptake was unaltered. During restricted IPP, PEEP produced the same pattern of hemodynamic alterations as when IPP was not restricted. QPORT and QSMA were lowered by the reductions in IPP, and QPORT was further reduced during PEEP. At an IPP of 30 mmHg, this reduction in QPORT decreased preportal tissue oxygen uptake. Consequently, intestinal ischemia, as indicated by increased net lactate production, occurred. Simultaneously, jejunal mucosal perfusion and PO2TISSUE declined. CONCLUSION: At IPP levels below 50 mmHg, even moderate levels of PEEP impaired local blood flow enough to cause intestinal ischemia. Our data underscore the importance of considering regional circulatory adaptations during PEEP ventilation.
PMID: 11472291, UI: 21365025
Acta Anaesthesiol Scand 2001 Aug;45(7):868-74
Surgical and Perioperative Sciences, Section for Anaesthesiology and Intensive Care Medicine, Umea University, Umea, Sweden. michael.haney.us@vll.se
BACKGROUND: Variations or disturbances in intrathoracic and extracardiac pressures (ECP) occur in critically ill and anaesthetised patients. There are uncertainties concerning the analysis of left ventricular pressure-volume relationship (LVPVR) and the calculation of systolic function parameters when conducted without reference to transmural left ventricular pressure (LVPtm) in the setting of elevated ECP. METHODS: In 7 anaesthetised adult pigs, we measured LVPVR using conductance volumetry and tip manometry along with measurement of pericardial and other intrathoracic pressures. Experimental pericardial infusion and pleural insufflation were performed. Transient controlled preload reductions were accomplished using balloon occlusion of the inferior vena cava. Preload recruitable stroke work (PRSW) was calculated using both intracavitary left ventricular pressure (LVPic) and LVPtm, and differences were tested for using a paired t-test. RESULTS: The pericardial and pleural interventions produced significant elevations in ECP. No difference in PRSW calculated using LVPic and LVPtm was detected. CONCLUSION: These results suggest that LVPtm need not be measured and included in LVPVR analysis of systolic function when there is significant external cardiac pressure. To be able to employ LVPVR analysis of systolic function without reference to LVPtm is important for simplified application in the clinical setting, particularly when elevated extracardiac pressures are suspected, or have been therapeutically induced, as with continuous positive pressure ventilation.
PMID: 11472290, UI: 21365024
Acta Anaesthesiol Scand 2001 Aug;45(7):834-8
Department of Cardiothoracic Anaesthetics and Intensive Care, Karolinska Hospital, Stockholm, Sweden.
BACKGROUND: Being awake during anaesthesia is a serious complication. An anaesthetic depth monitor must discriminate in real time between wakefulness and unconsciousness. The present study created a period of wakefulness during propofol-induced hypnosis. Bispectral index (BIS), explicit and implicit memories of the awake period were investigated. METHODS: Ten volunteers were studied. The calculated brain concentration of a target controlled infusion of propofol was increased until loss of response (LOR) to verbal command and then propofol was stopped. When fully awake, volunteers were presented with a picture, sound and smell. Propofol infusion was restarted until LOR and then ceased. BIS and the calculated brain concentration of propofol were recorded every minute. A structured interview was conducted for explicit memories after awakening and for explicit as well as implicit memories the day after. RESULTS: Median BIS-index for the transition between awake and asleep and vice versa differed significantly. It was not possible, however, to establish any threshold value or zone for discriminating between wakefulness and LOR due to the large inter-individual variations in BIS-index. No volunteer could explicitly recall any of the stimuli presented during the period of wakefulness. CONCLUSION: The BIS-index decreases with increasing sedation but because of the large individual variations, the real-time BIS-index for the individual subject cannot reliably discriminate wakefulness from unconsciousness during propofol infusion. Propofol causes such profound amnesia that lack of postoperative recall does not assure that episodes of awareness have not occurred during propofol-induced hypnosis.
PMID: 11472283, UI: 21365017
Acta Anaesthesiol Scand 2001 Aug;45(7):818-22
Department of Anesthesiology, Kansai Medical University, Osaka, Japan. asait@takii.kmu.ac.jp
BACKGROUND: In patients with unstable necks, the neck should be stabilized during induction of anaesthesia, but this may make tracheal intubation difficult. Awake intubation may produce straining, which could be detrimental to the unstable neck. METHODS: We studied 20 patients with unstable necks to examine the efficacy of insertion of the intubating laryngeal mask under conscious sedation (to minimize the possibility of losing a patent airway and to facilitate fibrescope-aided intubation) followed by tracheal intubation through the laryngeal mask after induction of anaesthesia (to reduce stress response to intubation). After the patient had been sedated with midazolam (up to 5 mg) and fentanyl (up to 100 microg), the intubating laryngeal mask was inserted. General anaesthesia was then induced with sevoflurane and tracheal intubation attempted. RESULTS: In all patients, tracheal intubation through the laryngeal mask succeeded without airway obstruction. Neither insertion of the mask under conscious sedation nor tracheal intubation after induction of anaesthesia caused straining, and only two patients moved upper extremities at intubation. Insertion of the laryngeal mask did not significantly alter blood pressure or heart rate. Tracheal intubation significantly increased blood pressure and heart rate, but the increase was considered to be small. CONCLUSIONS: In the patient with an unstable neck with a low risk of pulmonary aspiration, insertion of the intubating laryngeal mask while the patient is sedated may minimize difficulty in obtaining a patent airway before tracheal intubation and may facilitate a fibrescope-aided tracheal intubation; subsequent induction of anaesthesia before tracheal intubation may minimize stress response to intubation.
PMID: 11472280, UI: 21365014
Ann Fr Anesth Reanim 2001 Aug;20(7):658-9
PMID: 11545094, UI: 21422485
Ann Fr Anesth Reanim 2001 Aug;20(7):656-7
PMID: 11530757, UI: 21422483
Ann Fr Anesth Reanim 2001 Aug;20(7):655-6
PMID: 11530756, UI: 21422482
Ann Fr Anesth Reanim 2001 Aug;20(7):651-4
Departement d'anesthesie-reanimation, centre hospitalier Lyon Sud, 165, chemin du Grand-Revoyet, 69495 Pierre-Benite, France. pierre.michael.bouche@vnumail.com
We report an observation of acute rhabdomyolysis of gluteus maximum muscles occurring in a non-obese patient installed in supine position that underwent knee arthroscopy under spinal anaesthesia. The patient had insulin-dependent diabetes melitus with documented microangiopathy. The interest of this observation resides in the occurrence of the syndrome after a short period of time (one hour) of installation in the supine position in a patient that did not have any of the generally described risk factors of rhabdomyolysis.
PMID: 11530755, UI: 21422481
Ann Fr Anesth Reanim 2001 Aug;20(7):647-50
Departement d'anesthesie-reanimation, centre hospitalier universitaire, 2, boulevard de Lattre-de-Tassigny, BP 1542, 21034 Dijon, France. t.brossier@libertysurf.fr
The typical explosive form of malignant hyperthermia caused by following isoflurane anaesthesia is a well-known phenomenon. Nevertheless, since dantrolene is used, its evolution toward a multiple organ failure has been rarely described. We report a case of typical explosive malignant hyperthermia caused by an isoflurane anaesthesia complicated by a cardiovascular failure, a disseminated intravascular coagulation, an acute liver failure and an acute renal failure. Afterwards, muscle weakness of the right calf was the only aftermath.
PMID: 11530754, UI: 21422480
Ann Fr Anesth Reanim 2001 Aug;20(7):643-6
Service d'anesthesie reanimation chirurgicale 2, centre hospitalier universitaire Pontchaillou, 35033 Rennes, France. philippe.carre@chu-rennes.fr
The authors describe the anaesthetic procedure for a strangulated hernia repair needing resection and anastomosis of the small bowel in an adult patient. This procedure was performed with an ilio-inguinal/ilio-hypogastric nerve block according to a paediatrical simplified technique with a single puncture. For this patient who had relative contraindications for central blocks, this regional technique allowed to avoid general anaesthesia with its gastric aspiration and predictible difficult intubation risks. This block associated with a very light sedation was sufficient for all the surgical procedure, and postoperative analgesia was efficient over 3 hours. This simplified nerve block, better than the conventional approach for the clinical practice, represents a recommended alternative for hernia repair in emergency for high risk patients who could have a general anaesthesia or a central block.
PMID: 11530753, UI: 21422479
Ann Fr Anesth Reanim 2001 Aug;20(7):639-42
Service d'anesthesie-reanimation, CHI Andre Gregoire, 93150 Montreuil, France. kamel.rezig@chi-andre-gregoire.fr
During pregnancy the thyroid undergoes several changes including altered function and gland enlargement. We describe the management of a 36-week pregnant woman presenting with upper-way obstruction secondary to tracheal compression by a large multinodular goitre. The patient was successfully managed with an awake fibreoptic intubation performed orally followed by a caesarean section and thyroidectomy as a combines procedure.
PMID: 11530752, UI: 21422478
Ann Fr Anesth Reanim 2001 Aug;20(7):635-8
Departement d'anesthesie-reanimation, CHU, hopital General, 21033 Dijon, France.
Mastocytosis is a disorder with potential anaesthesia complications. Reviewing the literature, anaesthetic management of mastocytosis is controversial. We report the successful use of remifentanil and sevoflurane in a woman with systemic mastocytosis. No reaction nor histamine release was observed in these cases.
PMID: 11530751, UI: 21422477
Ann Fr Anesth Reanim 2001 Aug;20(7):600-3
Service d'anesthesie-reanimation, assistance publique-hopitaux de Paris, hopital Saint-Vincent-de-Paul, 74-82 avenue Denfert-Rochereau, 75014 Paris, France.
OBJECTIVES: To assess the antibacterial efficiency of filters used in obstetrics when epidural top-ups are performed. STUDY DESIGN: Observational prospective study. PATIENTS AND METHODS: We aseptically collected 201 antibacterial filters that had been used for top-ups with ropivacaine +/- sufentanil for epidural analgesia during labour. We flushed them first with 2 mL of saline and then with 2 mL of a solution containing 1.5 x 10(6) Staphylococcus epidermidis/mL. The filtrates were incubated at 37 degrees C for 72 h. Number of top-ups and duration of epidural analgesia are expressed as median (extremes). RESULTS: 3 (1-10) top-ups were performed for labour analgesia over a period of 6.5 h (1.8-18). After filtering, all the solutions were found to be sterile. Especially, when using Staphylococcus epidermidis solutions, bacteria were not found beyond any filter. These results suggest the integrity of the filter membrane after several boluses. No infection related to epidural analgesia was reported. CONCLUSION: Antibacterial filters provide a good protection against a potentially contaminated procedure during epidural top-ups.
PMID: 11530747, UI: 21422473
Ann Fr Anesth Reanim 2001 Aug;20(7):592-9
Departement d'anesthesie-reanimation chirurgicale et de medecine d'urgence, centre hospitalier universitaire Cote-de-Nacre, 14033 Caen, France.
OBJECTIVES: Measuring the incidence of intraoperative recall in our hospital. STUDY DESIGN: Prospective study. PATIENTS AND METHODS: Three hundred and twenty-six patients who underwent a general anaesthesia for elective surgery on selected sites (general, urology, ORL, gynaecology and obstetrical, vascular and cardiac, thoracic) were interviewed on the first or the second postoperative day using a standard questionnaire. When recall was suspected, the anaesthetist was consulted and the anaesthetic record was looked at in order to evaluate the authenticity of any recollections. RESULTS: Four patients mentioned an anomaly evoking intra-operative recall. The reduction in the anaesthetic level would explain authentic recollection for one patient. The recollection of another patient could not be truly verified. The site was the same for these two cases and the anaesthetic protocol for digestive surgery comprised curare and droperidol. The recollections for the two other patients did not correspond to the intraoperative period. The incidence of this phenomenon on the totality of sites was 0.6 per cent. CONCLUSION: This result conforms to other studies. This phenomenon is a quality indicator, but probably under estimated. Although retrospective, this evaluation is quick and easy. This research in post-operative period should be systematic in order to find the reason and to propose an early course of action for these patients. An analysis of the anaesthetic protocol is necessary when the frequency of intraoperative recall is too high.
PMID: 11530746, UI: 21422472
Br J Anaesth 2001 Feb;86(2):291-2
PMID: 11573683, UI: 21457586
Br J Anaesth 2001 Feb;86(2):272-4
Department of Anaesthesia, University of Toronto, Toronto Western Hospital, Ontario, Canada.
Due to the growing importance of quality assurance and cost containment in healthcare, eliciting patients' preferences for post-operative outcomes may be a more economical and reliable method of assessing quality. Three hundred and fifty-five day surgery patients completed a pre-operative written questionnaire to identify patients' preferences for avoiding 10 particular post-operative symptoms: pain, nausea, vomiting, disorientation, shivering, sore throat, drowsiness, gagging on the tracheal tube, thirst and a normal outcome. The two scoring methods used to evaluate preferences were priority ranking and relative value scores. The effects of age, gender, previous health status, type of surgery and previous experience of anaesthesia on patients' preferences were also examined. Avoiding post-operative pain, gagging on the tracheal tube and nausea and vomiting are major priorities for day-case patients. Anaesthetists should take patients' preferences into consideration when developing guidelines and planning anaesthetic care.
PMID: 11573673, UI: 21457576
Br J Anaesth 2001 Feb;86(2):223-9
Department of Anesthesia, Children's Hospital and Harvard Medical School, Boston, MA 02115, USA.
The pharmacokinetics and time course of action of vecuronium in normal children and children receiving anticonvulsant drugs for prolonged periods were characterized. A bolus dose of vecuronium 0.15 mg kg(-1) was administered i.v. to 10 non-epileptic children and to 10 children on phenytoin and 10 children on carbamazepine, who were matched for age and weight. Plasma concentrations of vecuronium, 3-OH desacetylvecuronium (the primary metabolite of vecuronium) and alpha1-acid glycoprotein (AAG) were determined. Pharmacokinetic variables were derived from plasma samples collected before and after administration of vecuronium. Neuromuscular transmission was monitored by evoked compound electromyography. Recovery of the first twitch of the train-of-four (T1/T0) and the recovery index (RI), the time for 25-75% recovery of T1/T0, were determined. The elimination half-life of vecuronium was significantly reduced in both anticonvulsant groups compared with control [control 48.2 (SD 40.3), phenytoin 23.5 (13.1), carbamazepine 18.4 (16.6) min, P<0.05]. Vecuronium clearance was increased in both anticonvulsant groups [control 9.0 (3.6), phenytoin 15.1 (8.9), carbamazepine 18.8 (13.1) ml kg(-1) min(-1), 0.05<P<0.1]. Children on chronic anticonvulsant therapy had a significantly shorter RI than control [control 21.8 (11), phenytoin 12.5 (8.3), carbamazepine 10.6 (5.9) min, P<0.05]. Concentrations of vecuronium at different degrees of recovery of T1, volumes of distribution and AAG concentrations were not different between groups. Our data confirm anticonvulsant-induced resistance to vecuronium in children and support a pharmacokinetic component contributing to the resistance.
PMID: 11573664, UI: 21457567
Br J Anaesth 2001 Mar;86(3):445-50
Morriston Hospital, Swansea, UK.
This review was undertaken to discover what assessment instruments have been used as measures of performance during anaesthesia simulation and whether their validity and reliability has been established. The literature describing the assessment of performance during simulated anaesthesia amounted to 13 reports published between 1980 and 2000. Only four of these were designed to investigate the validity or reliability of the assessment systems. We conclude that the efficacy of methodologies for assessment of performance during simulation is largely undetermined. The introduction of simulator-based tests for certification or re-certification of anaesthetists would be premature.
PMID: 11573541, UI: 21457444
Br J Anaesth 2001 Mar;86(3):442-4
Department of Anaesthesia, Princess of Wales Hospital, Bridgend, UK.
We describe an obstetric patient who presented for removal of a retained placenta. After insertion of the spinal anaesthetic, she developed a severe headache, and a subarachnoid haemorrhage was diagnosed. We discuss the differential diagnosis of the headache, the occurrence of intracranial haemorrhages after dural puncture and the future management of this patient.
PMID: 11573540, UI: 21457443
Br J Pharmacol 2001 Oct;134(3):655-63
Department of Neuroscience, University of Edinburgh Medical School, 1 George Square, Edinburgh EH8 9JZ.
[Medline record in process]
We tested the hypothesis that sensory nerves innervating blood vessels play a role in the local and systemic regulation of the cardiovascular and respiratory (CVR) systems. We measured CVR reflexes evoked by administration of anandamide (86 - 863 nmoles) and capsaicin (0.3 - 10 nmoles) into the hindlimb vasculature of anaesthetized rats. Anandamide and capsaicin each caused a rapid dose-dependent reflex fall in blood pressure and an increase in ventilation when injected intra-arterially into the hindlimb. Action of both agonists at the vanilloid receptor (VR1) on perivascular sensory nerves was investigated using capsazepine (1 mg kg(-1) i.a.) a competitive VR1 antagonist, ruthenium red (1 mg kg(-1) i.a.), a non-competitive antagonist at VR1, or a desensitizing dose of capsaicin (200 nmoles i.a.). The cannabinoid receptor antagonist SR141716 (1 mg kg(-1) i.a.) was used to determine agonist activity at the CB(1) receptor. Capsazepine, ruthenium red, or acute VR1 desensitization by capsaicin-pretreatment, markedly attenuated the reflex CVR responses evoked by anandamide and capsaicin (P<0.05; paired Student's t-test). Blockade of CB(1) had no significant effect on the responses to anandamide. Local sectioning of the femoral and sciatic nerves attenuated CVR responses to anandamide and capsaicin (P<0.05). Vagotomy or carotid sinus sectioning had no significant effect on anandamide- or capsaicin-induced responses. These data demonstrate that both the endogenous cannabinoid, anandamide, and the vanilloid, capsaicin, evoke CVR reflexes when injected intra-arterially into the rat hindlimb. These responses appear to be mediated reflexly via VR1 located on sensory nerve endings within the hindlimb vasculature.
PMID: 11588121, UI: 21472012
Br J Pharmacol 2001 Aug;133(7):1154-62
Centre Hospitalier Universitaire de Quebec, Centre de recherche du Pavillon l'Hotel-Dieu de Quebec, Quebec (Quebec), Canada, G1R 2J6.
The induction of B(1) receptors (B(1)Rs) and desensitization or down-regulation of B(2) receptors (B(2)Rs) as a consequence of the production of endogenous kinins has been termed the autoregulation hypothesis. The latter was investigated using two models based on the rabbit: kinin stimulation of cultured vascular smooth muscle cells (SMCs) and in vivo contact system activation (dextran sulphate intravenous injection, 2 mg kg(-1), 5 h). Rabbit aortic SMCs express a baseline population of B(1)Rs that was up-regulated upon interleukin-1beta treatment ([(3)H]-Lys-des-Arg(9)-BK binding or mRNA concentration evaluated by RT - PCR; 4 or 3 h, respectively). Treatment with B(1)R or B(2)R agonists failed to alter B(1)R expression under the same conditions. Despite consuming endogenous kininogen (assessed using the kinetics of immunoreactive kinin formation in the plasma exposed to glass beads ex vivo) and producing hypotension mediated by B(2)Rs in anaesthetized rabbits, dextran sulphate treatment failed to induce B(1)Rs in conscious animals (RT - PCR in several organs, aortic contractility). By contrast, lipopolysaccharide (LPS, 50 microg kg(-1), 5 h) was an effective B(1)R inducer (kidney, duodenum, aorta) but did not reduce kininogen reserve. We tested the alternate hypothesis that endogenous kinin participate in LPS induction of B(1)Rs. Kinin receptor antagonists (icatibant combined to B-9858, 50 microg kg(-1) of each) failed to prevent or reduce the effect of LPS on B(1)R expression. Dextran sulphate or LPS treatments did not persistently down-regulate vascular B(2)Rs (jugular vein contractility assessed ex vivo). The kinin receptor autoregulation hypothesis is not applicable to primary cell cultures derived from a tissue known to express B(1)Rs in a regulated manner (aorta). The activation of the endogenous kallikrein-kinin system is ineffective to induce B(1)Rs in vivo in an experimental time frame sufficient for B(1)R induction by LPS.
PMID: 11487527, UI: 21379877
Can J Anaesth 2001 Jul-Aug;48(7):720
PMID: 11495893, UI: 21387174
Can J Anaesth 2001 Jul-Aug;48(7):718
PMID: 11495891, UI: 21387172
Can J Anaesth 2001 Jul-Aug;48(7):715
PMID: 11495886, UI: 21387167
Can J Anaesth 2001 Jul-Aug;48(7):701-4
Department of Anesthesiology, American University of Beirut, Beirut, Lebanon. abaraka@aub.edu.lb
PURPOSE: Evaluate oxygen jet ventilation in a patient with tracheal stenosis undergoing stent insertion. CLINICAL FEATURES: Manual intermittent low frequency oxygen jet ventilation was used during general anesthesia for fibreoptic bronchoscopy and stent insertion in a patient with tracheal stenosis. Oxygen jets were delivered via a Sander's injector adapted to the proximal end of the endotracheal tube on one side, and open to room air on the other side. Adequate oxygenation and carbon dioxide removal were ensured throughout the procedure. CONCLUSION: Low frequency jet ventilation in a patient with tracheal stenosis provided adequate ventilation as well as a non- obstructed field during fibreoptic bronchoscopy and stent insertion.
PMID: 11495881, UI: 21387162
Can J Anaesth 2001 Jul-Aug;48(7):677-80
Harvard Medical School, Department of Anesthesia Critical Care, Beth Israel Deaconess Medical Center, Boston, Massachusetts 02215, USA. aksoni@mediaone.net
PURPOSE: Although ropivacaine has been used to provide spinal anesthesia in the surgical population, its intrathecal administration for labour analgesia has only recently been described. We evaluated the effects of low dose intrathecal ropivacaine with or without sufentanil for labour analgesia. METHODS: Thirty-six term parturients in active labour were randomly assigned to receive 3 mg of intrathecal ropivacaine (group R) or 3 mg ropivacaine with 10 microg of sufentanil (group RS). Patients were evaluated by a blinded observer for hypotension, linear analogue score (VAS 0-100) for labour pain, motor power in the lower limbs, onset of analgesia, sensation to cold and pin prick, duration of analgesia, and neonatal Apgar scores. The following day patients were assessed for satisfaction, headache and neurologic deficit. RESULTS: The mean duration of analgesia in the R group was 41.4 +/- 4.9 min and 95.0 +/- 6.1 min in the RS group (mean +/- SEM, P=0.0001). All subjects had satisfactory analgesia at five minutes, although analgesia from the ropivacaine- sufentanil combination was superior to that provided by ropivacaine alone. Total duration of labour was no different between the groups (R- 306 +/- 34, RS- 384 +/- 44 min, P=0.17). No patient showed evidence of motor block. All patients were satisfied with the labour analgesia. No neurological complications were observed. CONCLUSIONS: Low dose ropivacaine provides effective analgesia during labour via the intrathecal route. It can be mixed with sufentanil in the above-mentioned concentrations to improve both the quality and duration of analgesia. Fetal outcome remains favourable. It may provide minimal or no motor block, to facilitate ambulation.
PMID: 11495875, UI: 21387156
Can J Anaesth 2001 Jul-Aug;48(7):630-6
Department of Anesthesiology, Capital Health Region, Victoria, Canada. pgd@home.com
PURPOSE: To evaluate the effectiveness of short-acting anesthetic drugs and techniques to achieve recovery room bypass criteria after minor surgery in a community hospital environment. METHODS: After agreement by a multidisciplinary committee, a pilot project was undertaken to assess the usefulness of ultra- short acting anesthetic drugs and pre-emptive analgesia to facilitate rapid recovery from general anesthesia. A cohort of 100 ASA I-II patients aged 18-65 yr undergoing simple knee arthroscopy or minor peripheral orthopedic procedures was compared to a similar cohort treated in the three months prior to the study period. Outcomes of interest included patient morbidity, success in achieving post-anesthesia care unit (PACU) bypass criteria, impact upon nursing resources, duration of operating room (OR) and hospital stay, and pharmaceutical costs before and after implementation. RESULTS: No patient morbidity was demonstrated prior to discharge home, and successful PACU bypass occurred in 83% of cases. Achievement of PACU discharge criteria while in the OR did not prolong the OR time, and discharge from hospital occurred earlier in the patients who did not require PACU care (P=0.0006 all "fast-track cases" vs all "controls"). Nursing complaints were more numerous when the day surgery personnel did not normally participate in PACU care. The cost of anesthetic care was significantly more using ultra-short acting drugs (CDN $14.17 vs CDN $20.57), but closer adherence to protocol could reduce this differential (CDN $18.84). CONCLUSION: Not all patients who receive a general anesthetic require admission to a phase I recovery facility. However, the justification for use of more expensive pharmaceuticals to achieve PACU bypass requires extensive changes in operating systems and voluntary professional behaviours.
PMID: 11495868, UI: 21387149
Eur J Anaesthesiol 2001 Nov;18(11):766-9
Central Sheffield Universities Hospitals NHS Trust, UKDepartment of Anaesthesiology, Chesterfield and North Derbyshire Royal Hospitals NHS Trust, UK.
The use of a newly developed aid to jet ventilation of the lungs, a modified Ben-Jet tube (The Hunsaker Monjet tube), is described in a patient with partial upper airway obstruction. This report highlights an unusual use of this device. The Monjet is a fluoroplastic, monitored, self-centring, fine bore tube that can be inserted from the mouth through to the subglottic region. It was originally developed to anaesthetize healthy patients without airway obstruction who were undergoing suspension microlaryngoscopy.
PMID: 11580785, UI: 21464619
Eur J Anaesthesiol 2001 Nov;18(11):759-62
University Department of Anaesthesia, Northern General Hospital, Herries Road, Sheffield S5 7AU, UK.
We present the anaesthetic management of a patient for stenting of a thoracic aortic aneurysm at the site of an aortic coarctation. The specific challenges to the anaesthetist for this case are outlined. These include the specific problems of placing the graft, the obvious risk of aortic rupture and the unfamiliar environment of the separate radiological theatre. The advantages and disadvantages to the anaesthetist of the treatment of thoracic aortic aneurysms with stents are briefly discussed.
PMID: 11580783, UI: 21464617
Eur J Anaesthesiol 2001 Nov;18(11):755-8
NHS Department of Anaesthesia, C Floor, East Block, Nottingham NG7 2UH, UKDepartment of Obstetrics and Gynaecology, Queen's Medical Centre, Nottingham NG7 2UH, UK.
Background and objective The use of tension-free tape in the vagina is a relatively new surgical procedure for the treatment of urinary incontinence. Traditionally, the procedure is carried out using local anaesthesia and sedation. We aimed to assess the quality of anaesthesia obtained during insertion of tension-free vaginal tape using local anaesthetic infiltration and intravenous conscious sedation. Methods Twenty-four patients were studied using intravenous midazolam, fentanyl and infiltration with 0.5% prilocaine and epinephrine. Visual analogue scores before operation were used to assess anxiety. The digit symbol substitution test was used before and after surgery to assess psychomotor recovery, and amnesia for the procedure was assessed by means of picture recall. A nurse, anaesthetist and surgeon independently assessed quality of anaesthesia based on vocalization, facial expression, movement and co-operation with incontinence testing. Results The nurse, anaesthetist and surgeon reported good or excellent conditions in 18, 14 and 22 cases, respectively. There was no significant psychomotor impairment using the digit symbol substitution test, with mean (standard deviation) preoperative and postoperative scores of 22 (8) and 21 (7) correctly matched symbol digit pairs. There was a significant correlation between preoperative anxiety and intraoperative fentanyl requirement (r=0.48, P < 0.05). Conclusion Satisfactory anaesthetic conditions can be achieved for the insertion of tension-free vaginal tape using local anaesthesia with sedation.
PMID: 11580782, UI: 21464616
Eur J Anaesthesiol 2001 Nov;18(11):745-54
Department of Anaesthesia, Our Lady's Hospital for Sick Children, Dublin, Ireland.
Background and objective Epidermolysis bullosa is a rare, genetically determined disorder characterized by excessive susceptibility of the skin and mucosa to separate from the underlying tissues after mechanical trauma. Patients suffering from this disease may have multiple medical problems, but the risk of anaesthesia is attributed mainly to oropharyngeal involvement; airway management may be hazardous and preservation of mucosa and skin integrity problematical. There is a paucity of data in the literature concerning the perioperative management of children with epidermolysis bullosa. We present our experience of managing 54 general anaesthetics (and two local anaesthetics) over the past 20 years. Methods The case notes of 16 children with epidermolysis bullosa were reviewed. The children underwent surgical procedures under local or general anaesthesia over a 20-year period. Results Fifty-four general and two local anaesthetics were administered for 58 procedures in 10 children (mean age 12.6 years). Surgical procedures included oesophageal dilatation (24), insertion/revision of gastrostomy (16), dental procedures (10), hand surgery (2), skin biopsy (2) and others (4). Anaesthesia was induced by inhalation in 73.4% of patients and the airway was maintained with an endotracheal tube in 64.8%. Monitoring of anaesthesia was performed with pulse oximetry (89%), whereas electrocardiography and non-invasive blood pressure monitoring were used in 16.6% of cases each. The mean duration of anaesthesia was 64 min. Tracheal intubation was difficult in two of the five children who were intubated. Mucocutaneous blistering occurred in three children, otherwise there was no attributable morbidity. Conclusion With maximal skin and mucous membrane protection, anaesthesia in children with epidermolysis bullosa may be undertaken with few sequelae.
PMID: 11580781, UI: 21464615
Eur J Anaesthesiol 2001 Nov;18(11):730-8
Department of Anesthesiologie, Academisch Ziekenhuis Maastricht, The NetherlandsDepartment of Anesthesiologie, Academisch Ziekenhuis Groningen, The Netherlands.
Backgound and objective A postal survey was conducted in order to investigate current practice in airway management amongst Dutch anaesthetists and to investigate the role of recent training and the role of an 'Access to the Airway' airway management course. Methods A questionnaire containing 27 questions was sent to all practising anaesthetists in The Netherlands. Questionnaires were returned anonymously and were analysed using the Pearson chi2-test (P < 0.05) with the SPSS(R) version 8.0 statistical software program. Results The response rate was 42%. Of the respondents, 78% claim often or always to assess the expected degree of difficulty in tracheal intubation as part of routine preoperative assessment. The American Society of Anesthesiologist's Difficult Airway Algorithm was used by 19% of respondents. A wide variety of airway management techniques is being used. In 36% of all general anaesthetics a laryngeal mask airway is used. In 1.1% of all general anaesthetics tracheal intubation is performed with the flexible fibrescope. Conclusions Dutch anaesthetists, who commenced anaesthetic training after 1988, and those who attended the airway management course 'Access to the Airway' are significantly more likely to follow the American Society of Anesthesiologist's Difficult Airway Algorithm and to use adjunctive techniques for airway management.
PMID: 11580779, UI: 21464613
Eur J Anaesthesiol 2001 Nov;18(11):723-9
Klinik fur Anasthesiologie am Universitatsklinikum der RWTH Aachen, Pauwelsstr. 30, 52074 Aachen, Germany.
Background and objective To test the hypothesis that magnesium sulphate reduces the amount of remifentanil needed for general anaesthesia in combination with propofol and mivacurium, we studied 50 patients undergoing elective pars plana vitrectomy in a double-blind, randomized prospective fashion. Methods Magnesium sulphate (50 mg kg-1 body weight) or placebo (equal volume of NaCl) was given slowly intravenously after induction of anaesthesia with propofol 1-2 mg kg-1. Anaesthesia was maintained with propofol (using electroencephalographic control), mivacurium (according to train-of-four monitoring of neuromuscular blockade) and remifentanil (according to heart rate and arterial pressure). Results We observed a significant reduction in remifentanil consumption from 0.14 to 0.09 &mgr;g kg-1> min-1 (P> < 0.01). Mivacurium consumption was also markedly reduced from 0.01 to 0.008 mg kg -1min-1 (P < 0.01), whereas propofol consumption remained unchanged. There was a trend towards lower postoperative pain scores, less pain medication requirements in 24 h after surgery and less postoperative nausea and vomiting in the magnesium group but not statistically significant. No side-effects were observed. Conclusion We can recommend the use of magnesium sulphate as a safe and cost-effective supplement to a general anaesthetic regimen with propofol, remifentanil and mivacurium, although we cannot clearly distinguish between a mechanism as a (co)analgesic agent at the NMDA-receptor site or its properties as a sympatholytic. The effect of a single bolus dose of 50 mg kg-1 on induction lasts for about 2 h. For longer cases, either a continuous infusion or repeated bolus doses might be necessary.
PMID: 11580778, UI: 21464612
Eur J Anaesthesiol 2001 Nov;18(11):713-22
Department of Anaesthesia, University of Basel/Kantonsspital, Basel, Switzerland.
Background and objective Transoesophageal echocardiography is increasingly used for evaluation and monitoring of left ventricular function in anaesthetized patients. However, the only available reference values for transoesophageal echocardiography were derived from studies in awake subjects. Methods We determined left ventricular dimensions and systolic function in 45 patients without clinical evidence of heart disease who voluntarily underwent transesophageal echocardiography under conditions of balanced general anaesthesia, controlled fluid administration, supine position, muscle relaxation and controlled ventilation. Results The left ventricular dimensions obtained during these conditions were lower than the published normal values in awake subjects. The indices of global left ventricular function, however, were similar to the normal values obtained by either awake transesophageal echocardiography or transthoracic echocardiography. Conclusion We propose using the values obtained in our study as reference values for evaluation of left ventricular function in patients under general anaesthesia and controlled ventilation.
PMID: 11580777, UI: 21464611
Eur J Anaesthesiol 2001 Nov;18(11):703-5
Consultant Anaesthetist Southmead Hospital Bristol BS10 5NB UK E-mail: Nev.W.Goodman@bris.ac.uk
PMID: 11580775, UI: 21464609
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