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Anaesthesia 2001 Sep;56(9):907
Whitington Hospital, London N19 5NF, UK alan_mcglennan@ hotmail.com
[Medline record in process]
PMID: 11531694, UI: 21422892
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Anaesthesia 2001 Sep;56(9):906-24
National Hospital for Neurology and Neurosurgery, London, UK gary.mathews@ btinternet.com
PMID: 11531690, UI: 21422888
Royal Cornwall Hospital, Truro TR1 3LJ, UK.
PMID: 11531685, UI: 21422883
Singapore General Hospital, Singapore 169608.
PMID: 11531683, UI: 21422881
Anaesthesia 2001 Sep;56(9):893-7
Associate Professor and Consultant and Medical Officer, Department of Anaesthesia, Faculty of Medicine, University of Malaya, 59100 Kuala Lumpur, Malaysia.
We conducted a double-blind, randomised, placebo-controlled study evaluating the efficacy of prophylactic metaraminol for preventing propofol-induced hypotension. Thirty patients aged 55-75 years undergoing general anaesthesia were randomly allocated to receive either metaraminol 0.5 mg or saline before administration of fentanyl 1 &mgr;g.kg-1 and propofol 2 mg.kg-1. Induction of anaesthesia was associated with a decrease in mean and systolic arterial pressure in both groups (p = 0.0001). However, there was no significant difference between the two groups. These results show that prophylactic use of metaraminol 0.5 mg does not prevent the decrease in blood pressure following fentanyl and propofol induction in older patients.
PMID: 11531679, UI: 21422877
Anaesthesia 2001 Sep;56(9):879-81
Specialist Registrar and Consultant in Anaesthesia and Intensive Care, Department of Anaesthesia, Pinderfields & Pontefract Hospitals NHS Trust, Wakefield, UK.
A postal questionnaire survey was sent to Royal College of Anaesthetists' tutors in Great Britain and Northern Ireland to gain insight into current practice with regard to information and consent for anaesthesia. Details of consent practice in three specific areas were requested: anaesthesia in general, teaching medical students during anaesthesia and obstetric anaesthesia. Replies were received from 218 tutors (77%). Of these, 72% of departments had a policy on consent for anaesthesia that was in accordance with The Association of Anaesthetists of Great Britain and Ireland guidelines on 'Information and Consent for Anaesthesia'. We identified three areas of concern. Firstly, almost a third of departments (27%) had no policy on consent for anaesthesia. Second, only 18% of relevant departments obtain specific consent for the teaching of medical students on anaesthetised patients. Third, 1 year after publication of the guidelines, 17% of obstetric anaesthetic units, despite stating an intention to alter their departmental policy based on the Association's recommendations, had not yet implemented any changes.
PMID: 11531676, UI: 21422874
Anaesthesia 2001 Sep;56(9):873-8
Senior Registrar, Consultant, Department of Anaesthesia, National Women's Hospital, and Consultant, Spinal and Orthopaedic Surgeon, Auckland Public Hospital, New Zealand.
A case is described in which a parturient developed a Staphylococcus aureus paraspinal abscess following epidural analgesia in labour. We compared this case with other reported cases of paraspinal abscesses in obstetric patients. The presentation, diagnosis and management of these cases were reviewed. Anaesthetists need to be aware that non-spinal-epidural abscesses can occur in patients with an associated labour epidural.
PMID: 11531675, UI: 21422873
Anaesthesist 2001 Jul;50(7):536-57; quiz 557, 559
Abt. fur Anasthesie und Schmerztherapie, Rheumazentrum Oberammergau, Waldburg-Zeil Kliniken, Oberammergau, Hubertusstrasse 40, 82487 Oberammergau. gmeier@wz-kliniken.de
Publication Types:
PMID: 11496698, UI: 21388758
Anaesthesist 2001 Jul;50(7):534-5
Klinik fur Anaesthesiologie, Klinikum Grosshadern, Marchioninistr. 15, 81377 Munchen.
PMID: 11496697, UI: 21388757
Anaesthesist 2001 Jul;50(7):531-3
Klinik fur Anasthesiologie, Klinikum Grosshadern, Marchioninistrasse 15, 81377 Munchen.
PMID: 11496695, UI: 21388755
Anaesthesist 2001 Jul;50(7):529
PMID: 11496693, UI: 21388753
Anaesthesist 2001 Jul;50(7):525-8
Abteilung fur Anasthesie, Universitatsfrauenklinik Basel, Schanzenstrasse 46, 4031 Basel, Schweiz. Markus.Schneider@unibas.ch
In 1900, Oskar Kreis (1872-1958), a gynecologist and obstetrician who received his training at the Basle University Women's Hospital, pioneered the use of spinal anaesthesia in six parturients for labour pain relief. Cocaine was used as a local anaesthetic, which had previously been shown to be effective for spinal anaesthesia by August Bier in 1898. This important advance in anaesthetic care was not widely acknowledged for a long period of time and it has only been during the past few decades that spinal anaesthesia was rediscovered as an important technique available for obstetric anaesthesia.
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Anaesthesist 2001 Jul;50(7):517-21
Frauenklinik, Heinrich-Heine-Universitat Dusseldorf.
PMID: 11496690, UI: 21388750
Anaesthesist 2001 Jul;50(7):484-93
Klinik fur Anaesthesiologie der Technischen Universitat Munchen, Klinikum rechts der Isar.
Myasthenia gravis is a chronic autoimmune disease characterised by progressive weakness and easy fatigability of voluntary skeletal muscles. These symptoms are related to a decrease in the number of functional acetylcholine receptors, impaired neuromuscular transmission, and a broadened neuromuscular cleft. Symptomatic treatment is based on anticholinesterases in order to increase the synaptic dwell of acetylcholine. Immune therapy includes immune suppressive drugs, plasma exchange, immunoglobulins, and thymectomy. Anticholinesterase therapy should be continued in the current mode until anaesthesia. Regional anaesthesia should be preferred. Although sensitivity to non-depolarising neuromuscular blocking agents is increased, muscle relaxants can be administered during general anaesthesia as long as neuromuscular monitoring assesses their individual effect. Due to the individual variability in the response to muscle relaxants, accurate titration in combination with pre- and intraoperative neuromuscular monitoring is essential for myasthenic patients. Postoperatively, intensive care observation is mandatory including neuromuscular monitoring.
PMID: 11496685, UI: 21388745
Anaesthesist 2001 Jul;50(7):481-3
PMID: 11496684, UI: 21388744
Ann Fr Anesth Reanim 2001 Jun;20(6):f110-2
Service d'anesthesie et de reanimations, Hotel-Dieu, 44093 Nantes, France.
PMID: 11471514, UI: 21364966
Ann Fr Anesth Reanim 2001 Jun;20(6):f102-4
Departement d'anesthesie-reanimation chirurgicale, CHU Bichat-Claude Bernard, 75877 Paris, France.
PMID: 11471512, UI: 21364964
Ann Fr Anesth Reanim 2001 Jun;20(6):556-8
Departement d'anesthesie-reanimation chirurgicale, hopital Necker-Enfants Malades, 149, rue de Sevres, 75743 Paris, France.
We report a case of pulmonary embolism associated with percutaneous sclerotherapy (absolute ethanol: 0.5 mL.kg-1) of a venous angioma, performed under general anaesthesia in a 13 year-old child. The diagnosis of pulmonary embolism, suspected on the clinical setting and symptoms, was supported by the pulmonary scintigraphy obtained 4 hours later, showing 3 minimal pulmonary defects. The outcome was rapidly favourable without sequelae under heparin administration and the pulmonary scintigraphy, performed on day 7, was normal. The role of absolute ethanol, for explaining the apparent contrast between the severity of the symptoms and the minimal obstruction noted on pulmonary scintigraphy is discussed. Also discussed are the prophylactic and curative therapeutic issues of this severe complication.
PMID: 11471504, UI: 21364956
Ann Fr Anesth Reanim 2001 Jun;20(6):537-48
Service d'anesthesie-reanimation chirurgicale, Hopitaux Universitaires de Strasbourg, hopital de Hautepierre, 67098 Strasbourg, France.
This article reviews the development of Standards, Recommendations and Guidelines for practice in anaesthesiology in France and other countries. The French society for anaesthesia and intensive care (Sfar) has published, since 1989, 11 basic Standards: 1) Recommendations for the monitoring of patients during anaesthesia (June 1989, amended on January 1994) [APSF Newsletter, Summer 1990, page 22]; 2) Recommendations for postanaesthesia monitoring and care (September 1990); 3) Recommendations for preanaesthesia care (September 1991); 4) Recommendations for anaesthetic apparatus and checking before use (January 1994); 5) Recommendations for the equipment of anaesthesia working places (January 1995); 6) Recommendations for the tasks of the nurse anaesthetist (January 1995); 7) Recommendations for hygiene standards in anaesthesia practice (December 1997); 8) Recommendations for outpatient anaesthesia (September 1990); 9) Recommendations for the practice of obstetrical analgesia (September 1992); 10) Recommendations for interhospital physician-accompanied transfers (December 1992); 11) Recommendations for intrahospital physician-accompanied transfers (February 1994). Additionally the Sfar produced or coproduced 9 Experts' conferences, 15 Consensus conferences and 5 Guidelines for clinical practice.
PMID: 11471501, UI: 21364953
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Can J Anaesth 2001 Sep;48(8):828
Kitakyushu, Fukuoka, Japan.
PMID: 11546734, UI: 21430750
Can J Anaesth 2001 Sep;48(8):827
Lucknow, India.
PMID: 11546732, UI: 21430748
Can J Anaesth 2001 Sep;48(8):760-767
Departments of Anesthesie-Reanimation Adulte, Groupe Hospitalier de La Timone, Marseilles. Anesthesie-Reanimation, Hopital Percy, Paris. Anesthesie-Reanimation, Hopital Sainte Anne, Toulon Armees. Anesthesie-Reanimation, Hopital d'Instruction des Armees Laveran, Marseilles, France.
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PURPOSE: In vitro, halogenated agents reduce the pulmonary vasoconstrictor response to alveolar hypoxia in isolated perfused lungs. However, studies in intact animals have been less convincing. The aim of the present study was to assess the effect of sub-MAC concentrations of desflurane on hypoxic pulmonary vasoconstriction (HPV) in anesthetized piglets using the pressure/cardiac output relationship (P/Q). METHODS: Eleven large white piglets were anesthetized and ventilated mechanically, alternatively in hyperoxia (FIO(2)=0.4) and in hypoxia (FIO(2)=0.12). Multipoint plots of pulmonary arterial pressure (PAP), or differences between PAP and left atrial pressure (LAP) against Q were generated by gradual inflation of a balloon advanced into the inferior vena cava. P/Q relationships were established in hyperoxia and in hypoxia at baseline, and then with gradual concentrations of desflurane. RESULTS: In hypoxia, pressure gradients (PAP-LAP) increased significantly at every level of Q, demonstrating active pulmonary vasoconstriction. Desflurane did not affect these P/Q relationships either in hyperoxia, or in hypoxia, when compared with baseline. CONCLUSION: Desflurane at a clinically relevant dose has no significant effect on HPV in anesthetized piglets.
PMID: 11546716
Can J Anaesth 2001 Sep;48(8):748-54
Departements d'anesthesie. et De Microbiologie Centre hospitalier affilie universitaire de Quebec (Hopital Enfant-Jesus) et service de microbiologic Centre hospitalier universitaire de Quebec Universite Laval Quebec Quebec Canada.
PURPOSE: In order to reuse the same anesthesia breathing circuit for more than one patient, it has been proposed to add a breathing filter between the Y-piece and the artificial airway. The purpose of this study was to evaluate the in vivo bacterial filtration efficacy of an anesthesia filter in a usual clinical anesthesia setting. METHODS: A sterile DAR Barrierbac S(R) breathing filter was inserted at the Y-piece of a sterile single-use anesthesia breathing circuit before induction of general anesthesia. At the end of anesthesia, the breathing circuit connector of the filter and of the endotracheal tube connector were cultured separately on growth media (chocolate and blood agar). These were incubated for 48 hr and bacterial identification was conducted using standard methods. RESULTS: Bacterial cultures were negative on both sides of the filter membrane of 1842 of the 2001 filters studied. Cultures were positive on the patient side of 104 filters. In two of those, the same bacteria were found on both the circuit side and the patient side of the filter. Therefore these data indicate a clinical effectiveness of 99.9% (confidence interval, CI 95%, 99.6-99.998%), and an in vivo filtration efficacy of 98.08% (CI 95%, 92.54-99.67%). CONCLUSION: Using the upper limit of the CI, it can be assumed that the practice of using a sterile DAR Barrierbac S(R) breathing filter for every patient while reusing the anesthesia breathing circuit would result in a cross contamination rate of the breathing circuit lower than once every 250 cases.
PMID: 11546714, UI: 21430730
Can J Anaesth 2001 Sep;48(8):727-31
Departments of Anaesthesia, Anatomy and Cell Biology, and Physiology, The University of Western Ontario, London, Ontario, Canada.
PMID: 11546710, UI: 21430726
Can J Anaesth 2001 Apr;48(4):379-82
Department of Anesthesiology, Kitasato University School of Medicine, Kanagawa, Japan. fasato@med.kitasato-u.ac.jp
PURPOSE: We often encounter patients who do not complain of pain on undergoing invasive urogenital or rectal procedures, despite incomplete epidural blockade of sacral cutaneous sensation. To clarify whether or not urethral pain is blocked faster than sacral cutaneous sensation during lumbar epidural anesthesia, we investigated the correlation between occurrence of urethral pain and loss of cold sensation in the S1-3 dermatomes. METHODS: In 46 gynecological patients, Group A (n=22) received 15 ml of 2% mepivacaine via an epidural catheter inserted cephaladly. Group B (n=24) received 5 ml of 2% mepivacaine directly in the epidural needle directed caudally and 10 ml of 2% mepivacaine via the epidural catheter inserted cephaladly. A Foley catheter was inserted into the urethra 30 min after the injection. RESULTS: Urethral pain, which was defined as a pained facial expression and/or complaint of pain, was observed in seven patients in Group A, and none in Group B. The caudad level of epidural blockade was significantly lower in patients without urethral pain (S3, median) than with urethral pain (L4) (P <0.05). In 39 patients without urethral pain, 19 (49%) experienced loss of cold sensation in the S1 dermatome, 27 (69%) in the S2 and 38 (97%) in the S3 25 min after the injection. CONCLUSION: Blockade of urethral visceral pain often occurs before complete sacral somatosensory blockade, and S3 somatosensory blockade is the important sacral level as an indicator of successful urethral sensory blockade.
PMID: 11339781, UI: 21236370
Can J Anaesth 2001 Apr;48(4):375-8
Department of Anesthesiology, Duke University Medical Center, Durham, NC 27710, USA. klein006@mc.duke.edu
PURPOSE: Major reconstructive surgery of the knee traditionally requires an extended hospital stay for pain management. Continuous peripheral nerve blockade is an alternative method of pain control but is seldom used in the ambulatory setting. This case illustrates the use of lumbar plexus and sciatic nerve peripheral catheters for major knee surgery using intermittent bolus dosing for outpatient analgesia. CLINICAL FEATURES: A 20-yr-old male presented for multi-ligamentous knee reconstruction (posterior collateral ligament and revision anterior collateral ligament and lateral collateral ligament). Anesthesia was managed with a lumbar plexus and a sciatic nerve peripheral catheter and a light general anesthetic. Post-operative analgesia was provided with a 12-hr infusion of 0.2% ropivacaine in an over night recovery care centre. Subsequent catheter dosing was performed as an outpatient, twice a day using 0.2% ropivacaine, 10 ml in each catheter (four injections total). This provided 96 hr of analgesia and low supplemental opioid use. CONCLUSION: The use of a lumbar plexus and sciatic nerve peripheral catheter offered an alternative to conventional pain control that worked well in the ambulatory setting. By providing prolonged unilateral lower limb analgesia, extensive knee surgery was performed that would normally require a hospital stay for pain control. Using a bolus dosing method the risk of local anesthetic complications occurring outside of the hospital with a continuous infusion was minimized.
PMID: 11339780, UI: 21236369
Lancet 2001 Aug 25;358(9282):673-4
PMID: 11545091, UI: 21427813
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