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Anaesthesia 2002 Jun;57(6):624-5
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PMID: 12071177, UI: 22066076
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Anaesthesia 2002 Jun;57(6):624
PMID: 12071175, UI: 22066073
Anaesthesia 2002 Jun;57(6):622-3
PMID: 12071173, UI: 22066071
Anaesthesia 2002 Jun;57(6):578-81
Department of Anaesthesia, National University Hospital, Singapore.
Two patients with nasopharyngeal carcinoma, radiotherapy treatment and 'difficult' airways were anaesthetised for oral surgery. A triple lumen central venous catheter was inserted through the cricoid membrane and transtracheal jet ventilation with an AMS 1000 jet ventilator was performed via the distal lumen. The middle and proximal lumens were connected to an airway pressure monitor and a capnograph, enabling breath-by-breath monitoring of ventilation.
PMID: 12071158, UI: 22066079
Anaesthesia 2002 Jun;57(6):617; discussion 617
PMID: 12010280, UI: 22005626
Anaesthesia 2002 Jun;57(6):616-7
PMID: 12010279, UI: 22005625
Anaesthesia 2002 Jun;57(6):606; discussion 606-7
PMID: 12010274, UI: 22005620
Anaesthesia 2002 Jun;57(6):567-71
Department of Anaesthesia and Pain Management, University Hospital Lewisham, London SE13 6LH, UK.
Inadvertent cross-connection of epidural local anaesthetic delivery systems with intravenous lines can cause significant morbidity and even death. Inadvertent intrathecal injection of toxic intravenous drugs has already led to many deaths. If epidural and spinal systems had the standard Luer lock connection reversed the problem would be prevented. The practical implications of this idea are explored. Patient safety would be enhanced if this system were adopted.
PMID: 12010272, UI: 22005618
Anaesthesia 2002 Jun;57(6):535-9
Department of Anaesthesia, St. Thomas' Hospital, London, UK.
A double-blind clinical trial was conducted on 47 patients scheduled for hand surgery under general anaesthesia to determine whether ketorolac given as part of an intravenous regional anaesthesia technique could provide better postoperative analgesia than ketorolac given intravenously either before or after surgery. Patients were randomly allocated to one of three groups to receive ketorolac 20 mg: intravenously in the non-operative arm before surgery (systemic presurgery group); intravenously to the operative arm after tourniquet inflation (regional presurgery group); intravenously in the non-operative arm after surgery (systemic postsurgery group). Postoperative pain scores were similar in the systemic presurgery and regional presurgery groups. The mean visual analogue summary pain score during the 24 h after surgery was 12.2 mm higher in the systemic postsurgery group than in the systemic presurgery group (95% CI: 0.8-23.7 mm, p = 0.037). There were no clinically important differences in mean postoperative visual analogue pain scores between the three study groups. There were no statistical differences in the mean postoperative morphine requirements between the three study groups. There is no benefit, in terms of improved postoperative analgesia, in giving ketorolac as an intravenous regional anaesthetic compared with systemic administration before surgery. The administration of ketorolac after surgery, rather then before, is not supported.
PMID: 12010266, UI: 22005612
Anesth Analg 2002 Aug;95(2 Suppl):S115-40
PMID: 12148521, UI: 22143060
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Anesth Analg 2002 Aug;95(2):504
Department of Anesthesia, Osaka Kosei-Nenkin Hospital, 4-2-78 Fukushima, Fukushima-ku, Osaka 553-0003, Japan.
[Medline record in process]
PMID: 12145093, UI: 22139680
Anesth Analg 2002 Aug;95(2):494-5
Department of Anaesthesiology and Intensive Care Medicine, Marienkrankenhaus Soest, Germany.
IMPLICATIONS:Chronic hiccups may be a serious therapeutic problem. Pharmacological treatment with increasing dosages of baclofen, carbamazepine, or gabapentin is not always successful. In this paper, the use of general anesthesia with positive-pressure ventilation and muscle relaxation for the termination of chronic hiccups is described.
PMID: 12145080, UI: 22139667
Anesth Analg 2002 Aug;95(2):472-5
Department of Anesthesiology, Vanderbilt University, Nashville, Tennessee.
PMID: 12145074, UI: 22139661
Anesth Analg 2002 Aug;95(2):467-71
Department of Anesthesiology and Emergency Surgery, Vita-Salute University of Milano, IRCCS H.S. Raffaele, Milano, Italy.
We compared the effects of a laparoscopic (n = 23) versus laparotomic (n = 21) technique for major abdominal surgery on temperature control in 44 patients undergoing colorectal surgery during a combined epidural/general anesthesia. A thoracic epidural block up to T4 was induced with 6-10 mL of 0.75% ropivacaine; general anesthesia was induced with thiopental, fentanyl, and atracurium IV and maintained with isoflurane. Core temperature was measured with a bladder probe and recorded every 15 min after the induction. In both groups, core temperature decreased to 35.2 degrees C (range, 34 degrees C-36 degrees C) at the end of surgery. After surgery, normothermia returned after 75 min (60-120 min) in the Laparoscopy group and 60 min (45-180 min) in the Laparotomy group (P = 0.56). No differences in postanesthesia care unit discharge time were reported between the two groups. The degree of pain during coughing was smaller after laparoscopy than laparotomy from the 24th to the 72nd observation times (P < 0.01). Morphine consumption was 22 mg (2-65 mg) in the Laparotomy group and 5 mg (0-45 mg) in the Laparoscopy group (P = 0.02). The time to first flatus was shorter after laparoscopy (24 h [16-72 h]) than laparotomy (72 h [26-96 h]) (P = 0.0005), and the first intake of clear liquid occurred after 48 h (24-72 h) in the Laparoscopy group and after 96 h (90-96 h) in the Laparotomy group (P = 0.0005). Although laparoscopic surgery provides positive effects on the degree of postoperative pain and recovery of bowel function, the reduction in heat loss produced by minimizing bowel exposure with laparoscopic surgery does not compensate for the anesthesia-related effects on temperature control, and active patient warming must also be used with laparoscopic techniques. IMPLICATIONS: This prospective, randomized, controlled study demonstrates that laparoscopic colorectal surgery results in less postoperative pain and earlier recovery of bowel function than conventional laparotomy but does not reduce the risk for perioperative hypothermia. Accordingly, active warming must be provided to patients also during laparoscopic procedures.
PMID: 12145073, UI: 22139660
Anesth Analg 2002 Aug;95(2):457-60
Department of Anesthesiology, Baystate Medical Center and Tufts University School of Medicine, Springfield, Massachusetts.
Intravenous regional anesthesia (IVRA) using a forearm tourniquet may be a potentially safer technique compared with using an upper arm tourniquet. Ketorolac is a useful adjuvant to lidocaine for IVRA. In this study, we assessed the analgesic efficacy of administering IVRA lidocaine and ketorolac with either a forearm or upper arm tourniquet for outpatient hand surgery. Upper arm IVRA was established using 40 mL of a solution containing 200 mg of lidocaine and ketorolac 20 mg (0.5 mg/mL). Forearm IVRA was established using 20 mL of a solution containing 100 mg of lidocaine and ketorolac 10 mg (0.5 mg/mL). Onset and duration of sensory block as well as postoperative pain and analgesic use were recorded. The patients who received forearm IVRA had a significantly longer period during which they required no analgesics (701 +/- 133 min) compared with 624 +/- 80 min for the upper arm IVRA ketorolac patients (P = 0.032). Onset of sensory block was similar between the two groups; however, recovery of sensation was significantly longer in the Forearm IVRA (22 +/- 5 min) group compared with the Upper Arm IVRA (13 +/- 3 min) group (P < 0.05). There were no differences in postoperative analgesic use or pain scores between the two groups. We conclude that forearm IVRA with lidocaine and ketorolac provides safe and effective perioperative analgesia for patients undergoing ambulatory hand surgery. This technique results in a longer duration of sensory block and prolonged postoperative analgesia compared with upper arm IVRA while using one-half the doses of both lidocaine and ketorolac. IMPLICATIONS: Forearm tourniquet intravenous regional anesthesia (IVRA) with 50% less lidocaine and ketorolac provides for both a longer duration of sensory block and prolonged postoperative analgesia compared with upper arm IVRA.
PMID: 12145071, UI: 22139658
Anesth Analg 2002 Aug;95(2):444-9
Department of Anesthesia and Intensive Care Medicine, CHU de Liege, Domaine du Sart-Tilman, Belgium.
Ropivacaine (ROPI), which is less toxic and produces less motor block than bupivacaine (BUPI), seems attractive for epidural analgesia. Few data are available concerning dose requirements of epidural ROPI when combined with morphine. In this study, we compared the dose requirements and side effects of ROPI and BUPI combined with small-dose morphine after major abdominal surgery. Postoperatively, 60 patients were randomly allocated (double-blinded manner) to four groups: patient-controlled epidural analgesia with the same settings using 0.1% or 0.2% solution of ROPI or BUPI combined with an epidural infusion of 0.1 mg/h of morphine. Pain scores, side effects, motor block, and local anesthetic consumption were measured for 60 h. Pain scores and the incidence of side effects did not differ among the groups. Consumption of ROPI and BUPI were similar in both 0.1% groups. Doubling the concentration significantly reduced the consumption (milliliters) of BUPI (P < 0.05) but not of ROPI. Consequently, using ROPI 0.2% significantly increased the dose administered as compared with ROPI 0.1% (ROPI 0.1% = 314 +/- 151 mg and ROPI 0.2% = 573 +/- 304 mg at Hour 48; P < 0.05). Patient-controlled epidural analgesia with the 0.1% or 0.2% solution of ROPI or BUPI combined with epidural morphine resulted in comparable analgesia. As compared with ROPI 0.1%, the use of ROPI 0.2% increased consumption of local anesthetic without improving analgesia. IMPLICATIONS: Small-dose (0.1%) ropivacaine and bupivacaine have similar potency and result in comparable analgesia and incidence of side effects.
PMID: 12145069, UI: 22139656
Anesth Analg 2002 Aug;95(2):430-5
Department of Anesthesia and Perioperative Medicine, University of California, San Francisco, California.
Several anesthetic techniques have been used successfully to provide anesthesia for resection of intracranial supratentorial mass lesions. One technique used to enhance recovery involves changing anesthesia from vapor-based to propofol-based for cranial closure. However, there are no data to support a beneficial effect of this approach in the immediate postoperative period after craniotomy. We evaluated 3 anesthetic techniques in 60 patients undergoing elective surgery for supratentorial mass lesions. Patients were randomly assigned to three anesthesia study groups: propofol infusion, isoflurane inhalation, and these two techniques combined. In the combination group, once the dura was closed, isoflurane was discontinued and propofol infusion simultaneously started. We studied intra- and postoperative hemodynamics and several recovery variables for 2 h after the end of anesthesia. Baseline and average intraoperative blood pressure and heart rate values did not differ among the groups. Heart rate and blood pressure increased similarly in all groups in response to intubation and pin placement and postoperatively. None of the recovery event times (open eyes, extubation, follow commands, oriented, Aldrete score) or psychomotor test performance differed significantly. We conclude that the sequential administration of isoflurane and propofol did not provide earlier recovery and cognition than the intraoperative use of isoflurane alone. IMPLICATIONS: We evaluated three anesthetic techniques with and without propofol in patients undergoing elective surgery for supratentorial mass lesions by using a prospective, randomized clinical study design and found that the three anesthetics did not differ in intra- or postoperative hemodynamic stability or early postoperative recovery variables.
PMID: 12145066, UI: 22139653
Anesth Analg 2002 Aug;95(2):411-6
Department of Anaesthesiology, Hospital Governador Celso Ramos, Florianopolis, Brazil.
This study aimed at constructing learning curves for basic procedural skills in anesthesiology using the cumulative sum method. We recorded 1234 peripheral venous cannulations, 895 orotracheal intubations, 688 spinals, and 344 epidurals performed by residents during the first 10 mo of training. Learning curves for each procedure were constructed by using the cusum method. The number of procedures performed until attainment of acceptable failure rates was calculated. All residents mastered peripheral venous cannulation after 79 +/- 47 procedures. Four of 7 residents attained acceptable failure rates at orotracheal intubation after 43 +/- 33 proce- dures. Seven of 11 residents attained acceptable failure rates at spinal anesthesia after 36 +/- 20 procedures. At epidural anesthesia, 5 of 11 residents attained acceptable failure rates after 21 +/- 11 procedures. The cusum method is a useful tool for objectively measuring performance during the learning phase of basic procedures. The wide interindividual variability in the number of procedures required to be performed before attaining acceptable failure rates suggests that performance should be followed on an individual basis. IMPLICATIONS: Learning curves for peripheral venous cannulation, tracheal intubation, and spinal and epidural anesthesia were constructed using the cumulative sum (cusum) method. There was a wide variability in the number of procedures performed until attainment of acceptable failure rates. The cusum method may improve our means of evaluating residents' technical skills.
PMID: 12145063, UI: 22139650
Anesth Analg 2002 Aug;95(2):409-10
Department of Anaesthesiology and Critical Care, Bokaro General Hospital, Jharkhand, India.
IMPLICATIONS:We discuss the successful management of gangrene of the upper and lower limbs after ergot-induced abortion by unlicensed medical charlatans in a developing country. Our purpose is to highlight the dangerous means adopted by unlicensed medical charlatans to induce abortion as well as to emphasize the key role played by anesthesiologists in the management of such cases.
PMID: 12145062, UI: 22139649
Anesth Analg 2002 Aug;95(2):389-92
Department of Anesthesia, Akita University School of Medicine, Akita, Japan.
We studied the dose-response relationships for atropine-induced heart rate (HR) changes in 61 patients during propofol anesthesia. The control group (n = 15) received no propofol. Group P-5 (n = 22) received IV propofol 1.25 mg/kg over 1 min followed by propofol at 5 mg. kg(-1). h(-1). After tracheal intubation, anesthesia was maintained with propofol 5 mg. kg(-1). h(-1) and 67% nitrous oxide in oxygen. Group P-10 (n = 24) received IV propofol 2.5 mg/kg over 1 min followed by propofol at 10 mg. kg(-1). h(-1). The P-10 protocol was otherwise identical. All patients received incremental doses of IV atropine 5 microg/kg over 5 s at 2-min intervals until HR increased >20 bpm from baseline values. Heart rate response to atropine 10 microg/kg was attenuated in Groups P-5 (12 +/- 7 bpm) and P-10 (9 +/- 6 bpm) compared with the control group (28 +/- 13 bpm, P<0.05). When atropine 20 microg/kg was administered, HR increased >20 bpm in all patients of the control group, but in only 43% and 13% of patients in Groups P-5 and P-10, respectively (P<0.05). These results indicate the decreased HR responsiveness to IV atropine in patients receiving propofol, which cannot be effectively overcome by a large dose of atropine, is possibly attributable to propofol-induced suppression of the sympathetic nervous system. IMPLICATIONS: Heart rate response to IV atropine is attenuated during propofol anesthesia, and the decreased responsiveness to atropine cannot be effectively overcome by a large dose of atropine.
PMID: 12145057, UI: 22139644
Anesth Analg 2002 Aug;95(2):368-72
Department of Critical and Traumatic Medicine, Queen Astrid Military Hospital, Military Medical Research Program and Development Committee, Brussels, Belgium.
Perfluorocarbon-based emulsions increase the blood solubility of isoflurane, enflurane, and halothane, with a maximal effect reported for the less soluble isoflurane. Current volatile anesthetics are less soluble and may be more affected by this phenomenon. Perflubron (Oxygent(TM)) is a perfluorocarbon-based emulsion in late-stage clinical testing in surgical patients for use as a temporary oxygen carrier. We tested the hypothesis that perflubron increases the solubility of isoflurane, sevoflurane, and desflurane, as reflected by their blood/gas partition coefficient (lambda(Bl:g)). Fresh whole-blood samples were drawn from eight volunteers and mixed with perflubron to obtain concentrations of 1.2%, 1.8%, and 3.6% by volume (equivalent to in vivo doses of 1.8 to 5.4 g/kg, which represent up to twice the intended clinical dose range). By using the double-extraction method, we demonstrated increased lambda(Bl:g) for isoflurane, sevoflurane, and desflurane. However, the solubility in blood does not really change, because volatile anesthetics are actually partitioning into perflubron. Increasing the amount of emulsion in the blood consequently increases the amount of gas carried, as reflected by the measured linear correlation between the lambda(Bl:g) values of all three volatile anesthetics and perflubron doses. Even though the increase ranges from 0.9 (desflurane) to 2.6 (sevoflurane) times the normal value, the apparent lack of clinical implications in current trials with perflubron may trigger further in vivo experiments. IMPLICATIONS:Perflubron increases the in vitro solubility of volatile anesthetics when present in the blood at clinically relevant concentrations. Volatile anesthetics actually partition into the emulsion, but the solubility in the blood does not change. Further studies are needed to assess whether perflubron will affect the pharmacokinetics of volatile anesthetics in vivo.
PMID: 12145053, UI: 22139640
Anesth Analg 2002 Aug;95(2):362-7
Department of Anesthesia and Perioperative Care, University of California, San Francisco.
Volatile anesthetics enhance the neuromuscular blockade produced by nondepolarizing muscle relaxants (NDMRs). The neuromuscular junction is a postulated site of this interaction. We tested the hypothesis that volatile anesthetic enhancement of muscle relaxation is the result of combined drug effects on the nicotinic acetylcholine receptor. The adult mouse muscle nicotinic acetylcholine receptor (alpha(2), beta, delta, epsilon) was heterologously expressed in Xenopus laevis oocytes. Concentration-effect curves for the inhibition of acetylcholine-induced currents were established for vecuronium, d-tubocurarine, isoflurane, and sevoflurane. Subsequently, inhibitory effects of NDMRs were studied in the presence of the volatile anesthetics at a concentration equivalent to half the concentration producing a 50% inhibition alone. All individually tested compounds produced rapid and readily reversible concentration-dependent inhibition. The calculated 50% inhibitory concentration values were 9.9 nM (95% confidence interval [CI], 8.4-11.4 nM), 43.4 nM (95% CI, 33.6-53.3 nM), 897 microM (95% CI, 699-1150 microM), and 818 microM (95% CI, 685-1001 microM) for vecuronium, d-tubocurarine, isoflurane, and sevoflurane, respectively. Coapplication of either isoflurane or sevoflurane significantly enhanced the inhibitory effects of vecuronium and d-tubocurarine, especially so at small concentrations of NDMRs. Volatile anesthetics increase the potency of NDMRs, possibly by enhancing antagonist affinity at the receptor site. This effect may contribute to the clinically observable enhancement of neuromuscular blockade by volatile anesthetics. IMPLICATIONS: Isoflurane and sevoflurane enhance the receptor blocking effects of nondepolarizing muscle relaxants on nicotinic acetylcholine receptors.
PMID: 12145052, UI: 22139639
Anesth Analg 2002 Aug;95(2):356-61
Department of Anesthesia, Harvard Medical School.
Isoflurane and normal alkanols reduce the apparent agonist dissociation constant (K(d)) of the nicotinic acetylcholine receptor (nAChR) at clinically relevant concentrations, whereas cyclopropane and butane do not. This suggests that electrostatic (hydrogen bonding and/or dipolar) interactions modulate anesthetic potency in this model receptor system. To further define the nature of these interactions, we quantified the potencies with which a heterologous group of general anesthetics reduces the nAChR's apparent K(d) for acetylcholine. We assessed the importance that an anesthetic's molecular volume, ability to donate a hydrogen bond (hydrogen bond acidity), ability to accept a hydrogen bond (hydrogen bond basicity), and dipole moment play in determining aqueous potency. We found that aqueous anesthetic potency increases with molecular volume and decreases with hydrogen bond basicity but is unaffected by dipole moment and hydrogen bond acidity. These results suggest that anesthetics reduce the apparent agonist K(d) of the nAChR by binding to a site that has a dipolarity and ability to accept hydrogen bonds that are similar to those of water, but a hydrogen bond-donating capacity that is less. IMPLICATIONS: Anesthetics representing a wide range of chemical classes reduce the apparent agonist dissociation constant of the Torpedo nicotinic acetylcholine receptor with aqueous potencies that are governed by their molecular volumes and hydrogen bond basicities. However, neither their hydrogen bond acidities nor dipole moments influence aqueous potency.
PMID: 12145051, UI: 22139638
Anesth Analg 2002 Aug;95(2):336-50
Department of Anesthesiology, George Washington University, Washington, DC.
PMID: 12145049, UI: 22139636
Anesth Analg 2002 Aug;95(2):331-2
Department of Anesthesiology, College of Medicine, Seoul National University, Seoul, Korea.
IMPLICATIONS:We experienced an unexpected tracheomalacia exhibiting CO(2) retention and an increased peak inspiratory pressure after beginning an operation; it was confirmed with fiberoptic bronchoscopy. If there are no problems in the circuit or tube when the patient shows CO(2) retention and increases in peak inspiratory pressure, the fiberoptic bronchoscope is helpful
PMID: 12145047, UI: 22139634
Anesthesiology 2002 Aug;97(2):518-20
Department of Anesthesia, Kyorin University School of Medicine, Shinkawa, Mitaka City, Tokyo, Japan, and University of Utah School of Medicine, VA Salt Lake City Health Care System, Salt Lake City, Utah.
PMID: 12151949, UI: 22145671
Anesthesiology 2002 Aug;97(2):513-5
Wake Forest University, Winston-Salem, North Carolina, and Division of Obstetric Anesthesia, Medical College of Virginia, Virginia Commonwealth University Health System, Richmond, Virginia.
PMID: 12151947, UI: 22145669
Anesthesiology 2002 Aug;97(2):497-502
Pain Research Center, Department of Anesthesiology, Perioperative and Pain Medicine, Brigham & Women's Hospital, Boston, Massachusetts.
PMID: 12151942, UI: 22145664
Anesthesiology 2002 Aug;97(2):478-87
Center for Anesthesiology Research, Division of Anesthesiology and Critical Care Medicine, The Cleveland Clinic Foundation, Cleveland, Ohio.
BACKGROUND: The authors previously reported that the pulmonary vasodilator response to the sympathetic beta-adrenoreceptor agonist isoproterenol is potentiated during isoflurane anesthesia compared with the conscious state. In the present in vivo study, the authors tested the hypothesis that halothane and enflurane anesthesia also enhance sympathetic beta adrenoreceptor-mediated pulmonary vasodilation. The authors also used the membrane-permeable analog of cyclic adenosine monophosphate (cAMP), dibutyryl cAMP, to help delineate the site in the signaling pathway for an anesthesia-induced effect on beta adrenoreceptor-mediated pulmonary vasodilation. METHODS: Mongrel dogs were chronically instrumented to measure the left pulmonary vascular pressure-flow (LPQ) relationship. LPQ plots were measured on separate days in the conscious, halothane-, and enflurane-anesthetized states at baseline, after preconstriction with the thromboxane analog U46619, and during the cumulative intravenous administration of isoproterenol. LPQ plots were also measured in conscious, halothane-, and isoflurane-anesthetized dogs after U46619 preconstriction and during the cumulative intravenous administration of dibutyryl cAMP. RESULTS: Compared with the conscious state, neither halothane nor enflurane had an effect on the baseline LPQ relationship. The magnitude of the pulmonary vasodilator response to isoproterenol was potentiated during halothane anesthesia but unchanged during enflurane anesthesia. The pulmonary vasodilator response to dibutyryl cAMP was not altered during either halothane or isoflurane anesthesia compared with the conscious state. CONCLUSIONS: These results indicate that inhalational anesthetic agents can exert differential effects on the pulmonary vasodilator response to sympathetic beta-adrenoreceptor activation. The potentiated vasodilator response observed during halothane and isoflurane anesthesia is the result of effects proximal to cAMP accumulation in the beta-adrenoreceptor signaling pathway.
PMID: 12151940, UI: 22145662
Anesthesiology 2002 Aug;97(2):400-4
Department of Anesthesiology, Intensive Care and Pain Therapy, Onze Lieve Vrouw Hospital, Aalst, Belgium, and the Department of Anesthesiology, Northwestern University Medical School, Chicago, Illinois.
BACKGROUND: Uptake of a second gas of a delivered gas mixture decreases the amount of carrier gas and potent inhaled anesthetic leaving the circle system through the pop-off valve. The authors hypothesized that the vaporizer settings required to maintain constant end-expired sevoflurane concentration (Etsevo) during minimal-flow anesthesia (MFA, fresh gas flow of 0.5 l/min) or low-flow anesthesia (LFA, fresh gas flow of 1 l/min) would be lower when sevoflurane is used in oxygen-nitrous oxide than in oxygen. METHODS: Fifty-six patients receiving general anesthesia were randomly assigned to one of four groups (n = 14 each), depending on the carrier gas and fresh gas flow used: group Ox.5 l (oxygen, MFA), group NOx.5 l (oxygen-nitrous oxide, MFA after 10 min high fresh gas flow), group Ox1 l (oxygen, LFA), and group NOx1 l (oxygen-nitrous oxide, LFA after 10 min high fresh gas flow). The vaporizer dial settings required to maintain Etsevo at 1.3% were compared between groups. RESULTS: Vaporizer settings were higher in group Ox.5 l than in groups NOx.5 l, Ox1 l, and NOx1 l; vaporizer settings were higher in group NOx.5 l than in group NOx1 l between 23 and 47 min, and vaporizer settings did not differ between groups Ox1 l and NOx1 l. CONCLUSIONS: When using oxygen-nitrous oxide as the carrier gas, less gas and vapor are wasted through the pop-off valve than when 100% oxygen is used. During MFA with an oxygen-nitrous oxide mixture, when almost all of the delivered oxygen and nitrous oxide is taken up by the patient, the vaporizer dial setting required to maintain a constant Etsevo is lower than when 100% oxygen is used. With higher fresh gas flows (LFA), this effect of nitrous oxide becomes insignificant, presumably because the proportion of excess gas leaving the pop-off valve relative to the amount taken up by the patient increases. However, other unexplored factors affecting gas kinetics in a circle system may contribute to our observations.
PMID: 12151930, UI: 22145652
Anesthesiology 2002 Aug;97(2):382-389
Department of Anesthesiology, University Hospital Rotterdam, the Department of Medical Psychology and Psychotherapy, Netherlands Institute of Health Sciences, Erasmus University Rotterdam, and the Department of Methods and Statistics, Utrecht University, The Netherlands.
[Record supplied by publisher]
BACKGROUND: Conscious recall and implicit memory have been shown to depend on hypnotic state as measured by electroencephalographic (EEG) bispectral index (BIS). A third expression of memory (unconscious-controlled memory) was recently observed after moderate to light sedation (BIS, 70-80). The present study investigated memory function during deep sedation (BIS, 60-70). As memory effects are small, the authors studied potential predictors of individual differences in memory performance. METHODS: Memory function and speed of information processing were assessed in 56 outpatients before surgery. During propofol anesthesia supplemented with alfentanil, patients heard a series of words while anesthesia was titrated to BIS, 60-70. In between words, response to command was assessed using the Isolated Forearm Technique. The authors tested memory with a word stem completion task and process dissociation procedure to distinguish explicit from implicit effects. RESULTS: Mean (+/- SD) BIS during word presentation was 64.0 +/- 3. Patients with conscious recall of verbal commands (n = 9) did not recall or recognize presented words. Even so, the process dissociation procedure revealed evidence of memory by a significantly higher hit rate in the inclusion condition (0.26) than in the exclusion condition (0.12). Patients without conscious recall showed no evidence of memory for presented words. Hit scores correlated significantly with scores in the preoperative memory test (r = 0.35). CONCLUSIONS: The authors found evidence of weak explicit memory function during anesthesia titrated to BIS, 60-70. The observations strongly suggest that postoperative memory relates to awareness during anesthesia, but the nature of this relation remains unclear. Memory seems more likely in patients with good preoperative memory performance.
PMID: 12151928
Anesthesiology 2002 Aug;97(2):325-8
Department of Anesthesiology, Yale University School of Medicine, New Haven, Connecticut.
BACKGROUND: Levobupivacaine, a long acting, amino-amide, local anesthetic, may offer advantages over lidocaine for intravenous regional anesthesia (IVRA). The objective of this investigation was to compare levobupivacaine to lidocaine for IVRA. METHODS: After institutional review board approval and informed consent, eight unpremedicated male American Society of Anesthesiologists (ASA) I-II volunteers received 40 ml of levobupivacaine 0.125% or lidocaine 0.5% for IVRA on separate days. Onset and regression of sensory anesthesia by pinprick, transcutaneous electrical stimulation (TES), and of motor function were tested before, during, and after release of the tourniquet. Central nervous system and cardiac side effects were evaluated after local anesthetic administration and tourniquet release. The tourniquet remained inflated for 30-45 min. RESULTS: Intravenous regional anesthesia with either agent provided surgical anesthesia. Sensory anesthesia to pinprick (lateral antebrachial cutaneous nerve) was faster with lidocaine at median 1.5 min. versus 12.5 min with levobupivacaine. Loss of sensation to TES occurred at median 22.5 and 27.5 min for lidocaine and levobupivacaine, respectively. Loss of motor function occurred earlier after lidocaine administration. After release of the tourniquet, return of sensation to TES, pinprick (ulnar nerve), and return of motor function occurred later with levobupivacaine at median 25, 15, and 21.25 versus 10, 4.5, and 10 min with lidocaine. Central nervous system side effects were absent in volunteers given levobupivacaine, but five of eight volunteers given lidocaine experienced mild side effects. No cardiac events were noted. CONCLUSIONS: Levobupivacaine 0.125% may be an alternative to lidocaine 0.5% for IVRA. Longer lasting analgesia after release of the tourniquet may be caused by a more profound and prolonged tissue binding effect of levobupivacaine.
PMID: 12151920, UI: 22145642
Anesthesiology 2002 Aug;97(2):320-4
Departments of Anaesthetics, Obstetrics, Sexual Health, Virology, Immunology, and Child Health, King's College Hospital NHS Trust, London, SE5 9RS, United Kingdom.
BACKGROUND: Elective cesarean section decreases the likelihood of vertical human immunodeficiency virus (HIV) transmission from mother to infant. This study aimed to determine whether cesarean section done with spinal anesthesia on HIV-1-infected pregnant women taking antiretroviral therapy is associated with intraoperative hemodynamic instability, postoperative complications, or changes in immune function or HIV-1 viral load. METHODS: A case-controlled study was conducted over a 3-year period in a London academic hospital. Forty-four women infected with HIV-1 and a control group of 45 HIV-negative women undergoing cesarean sections were included. The main outcome measures included intraoperative blood pressure, heart rate, blood loss, and ephedrine requirements, and postoperative infective complications, blood transfusion, changes in blood HIV-1 viral load and lymphocyte subsets, and time to hospital discharge. RESULTS: There were no differences in hemodynamic stability and postoperative complications between the HIV-infected group and the controls. There was an acute postoperative increase in the CD4T lymphocyte count (P = 0.01), but the CD4T:CD8T ratio and viral load did not change. CONCLUSIONS: Elective cesarean section under spinal anesthesia for women infected with HIV-1 taking antiretroviral therapy was not associated with intraoperative or postoperative complications.
PMID: 12151919, UI: 22145641
Anesthesiology 2002 Aug;97(2):315-9
Virginia Mason Medical Center, Seattle, Washington.
BACKGROUND: Voiding before discharge is usually required after outpatient epidural or spinal anesthesia because of concern about bladder overdistention and dysfunction. Shorter duration spinal and epidural anesthesia may allow return of bladder function before overdistention occurs in low-risk patients (those younger than age 70, not having hernia, rectal, or urologic surgery, and without a history of voiding difficulty), and predischarge voiding may not be necessary. METHODS: After institutional review board approval and informed consent, 201 low-risk ambulatory patients were prospectively studied in either a standard or accelerated pathway after undergoing spinal or epidural anesthesia with procaine, lidocaine, 2-chloroprocaine, or less than 7 mg bupivacaine; epinephrine was not used in any anesthetic. Standard pathway patients (n = 70) were required to void before discharge. Accelerated pathway (n = 131) patients were not required to void. (After randomization of an initial 163 patients to one of the two tracks, 38 additional patients were assigned to the accelerated pathway.) If accelerated pathway patients voided, they were discharged when all other discharge criteria were met. If they did not spontaneously void after block resolution, a bladder ultrasound (BUS) was performed. If the BUS indicated a urine volume of less than 400 ml, the patients were discharged and instructed to return to the emergency department if they were unable to void within 8 h of discharge. If the BUS indicated a urine volume of greater than 400 ml, the patients were reassessed in 1 h and were discharged if they could void spontaneously. If they could not void spontaneously, they were catheterized to facilitate discharge. All patients were contacted the next day to assess the return of normal bladder function. RESULTS: All standard pathway patients voided without difficulty, and were discharged in 153 +/- 49 (SD) min. 62 patients in the accelerated pathway voided spontaneously after resolution of their block and were discharged in 127 +/- 41 min. 46 patients were discharged with a BUS less than 400 ml in 120 +/- 42 min. 23 patients had a BUS greater than 400 ml: of these, 20 patients voided within an hour and were discharged in 162 +/- 45 min. Three were catheterized after 1 h, and were discharged in 186 +/- 61 min. Mean discharge time for all patients in the accelerated pathway was 22 min shorter than the standard pathway (P = 0.002). No patients had difficulty voiding or returned to the hospital for urinary problems. None reported new urologic symptoms. CONCLUSIONS: Delay of discharge after outpatient spinal or epidural anesthesia with short-duration drugs for low-risk procedures is not necessary, and may result in prolonged discharge times.
PMID: 12151918, UI: 22145640
Anesthesiology 2002 Aug;97(2):298-305
nesthesiology and Diagnostic Radiology Services and Section of Cardiothoracic Surgery at the Edward Hines Jr. Veterans Affairs Hospital, Hines, Illinois.
BACKGROUND: Diaphragmatic excursion during spontaneous ventilation (SV) in normal supine volunteers is greatest in the dependent regions (bottom). During positive pressure ventilation (PPV) after anesthesia and neuromuscular blockade and depending on tidal volume, the nondependent region (top) undergoes the greatest excursion, or the diaphragm moves uniformly. The purpose of this study was to compare diaphragmatic excursion (during SV and PPV) in patients with chronic obstructive pulmonary disease (COPD) with patients having normal pulmonary function. METHODS: Twelve COPD patients and 12 normal control subjects were compared. Cross-table diaphragmatic fluoroscopy was performed while patients breathed spontaneously. After anesthetic induction and pharmacologic paralysis and during PPV, diaphragmatic fluoroscopy was repeated. For analytic purposes, the diaphragm was divided into three segments: top, middle, and bottom. Percentage of excursion of each segment during SV and PPV in normal subjects was compared with the percentage of excursion of each segment in patients with COPD. RESULTS: There was no significant difference in the pattern of regional diaphragmatic excursion (as a percentage of total excursion)-top, middle, bottom-when comparing COPD patients with control subjects during SV and PPV. In the control subjects, regional diaphragmatic excursion was 16 +/- (5), 33 +/- (5), 51 +/- (4) during SV and 49 +/- (13), 32 +/- (6), 19 +/- (9) during PPV. In COPD patients, regional diaphragmatic excursion was 18 +/- (7), 34 +/- (5), 49 +/- (7) during SV and 47 +/- (10), 32 +/- (6), 21 +/- (9) during PPV. CONCLUSION: Regional diaphragmatic excursion in patients with COPD during SV and PPV is similar to that in persons with normal pulmonary function.
PMID: 12151916, UI: 22145638
Anesthesiology 2002 Aug;97(2):295-7
PMID: 12151915, UI: 22145637
Anesthesiology 2002 Aug;97(2):5A-6A
PMID: 12151914, UI: 22145636
Anesthesiology 2002 Jul;97(1):285-6; discussion 286
PMID: 12131143, UI: 22122155
Anesthesiology 2002 Jul;97(1):281-2; discussion 282
PMID: 12131139, UI: 22122151
Anesthesiology 2002 Jul;97(1):280-1; discussion 281
PMID: 12131138, UI: 22122150
Anesthesiology 2002 Jul;97(1):279-80; discussion 280
PMID: 12131137, UI: 22122149
Anesthesiology 2002 Jul;97(1):278; discussion 278
PMID: 12131135, UI: 22122147
Anesthesiology 2002 Jul;97(1):261-4
Department of Anesthesia, London Health Sciences Centre-University Campus, London, Ontario, Canada. michael.sharpe@lhsc.on.ca
PMID: 12131129, UI: 22122141
Anesthesiology 2002 Jul;97(1):257-8
Department of Anesthesiology and Critical Care Medicine, Hebrew University Hadassah Medical School, Hadassah University Hospital, Jerusalem, Israel. avidan3@netvision.net.il
PMID: 12131127, UI: 22122139
Anesthesiology 2002 Jul;97(1):139-47
University of California, San Diego, USA.
BACKGROUND: A reengineering approach to intravenous drug and fluid administration processes could improve anesthesia care. In this initial study, current intravenous administration tasks were examined to identify opportunities for improved design. METHODS: After institutional review board approval was obtained, an observer sat in the operating room and categorized, in real time, anesthesia providers' activities during 35 cases ( approximately 90 h) into 66 task categories focused on drug/fluid tasks. Both initial room set-up at the beginning of a typical workday and cardiac and noncardiac general anesthesia cases were studied. User errors and inefficiencies were noted. The time required to prepare de novo a syringe containing a mock emergency drug was measured using a standard protocol. RESULTS: Drug/fluid tasks consumed almost 50 and 75%, respectively, of the set-up time for noncardiac and cardiac cases. In 8 cardiac anesthetics, drug/fluid tasks comprised 27 +/- 6% (mean +/- SD) of all prebypass clinical activities. During 20 noncardiac cases, drug/fluid tasks comprised 20 +/- 8% of induction and 15 +/- 7% of maintenance. Drug preparation far outweighed drug administration tasks. Inefficient or error prone tasks were observed during drug/fluid preparation (e.g., supply acquisition, waste disposal, syringe labeling), administration (infusion device failure, leaking stopcock), and organization (workspace organization and navigation, untangling of intravenous lines). Anesthesia providers (n = 21) required 35 +/- 5 s to prepare a mock emergency drug. CONCLUSIONS: Intravenous drug and fluid administration tasks account for a significant proportion of anesthesia care, especially in complex cases. Current processes are inefficient and may predispose to medical error. There appears to be substantial opportunity to improve quality and cost of care through the reengineering of anesthesia intravenous drug and fluid administration processes. General design requirements are proposed.
PMID: 12131115, UI: 22122127
Ann Fr Anesth Reanim 2001 Nov;20(9):f170-1
Departement d'anesthesie-reanimaion, hopital Tenon,4 rue de la Chine, 75970 Paris, France
PMID: 11759329, UI: 21595928
Ann Fr Anesth Reanim 2001 Nov;20(9):f166-8
PMID: 11759328, UI: 21595927
Ann Fr Anesth Reanim 2001 Nov;20(9):763-85
Service d'anesthesie, institut Gustave-Roussy, 39, rue Camille Desmoulins, 94805 Villejuif, France. billard@igr.fr
Spontaneous EEG has been proposed for monitoring depth of anaesthesia and adjusting anesthetic drugs doses. This review describes the main features of spontaneous EEG, the principles of EEG signal analysis used in anaesthesia, and the EEG effects of the different anesthetic drugs in adults and children. Then, the correlations between EEG parameters changes and clinical signs of anesthesia (loss of consciousness and memory, lack of movement and haemodynamic stability despite noxious stimulations) are analyzed. The best signal analysis technique available today for routine use seems to be bispectral analysis, which returns, in the available monitors, a single number called bispectral index or BIS. Based upon the recent literature, clinical uses, performances and limits of use of BIS are described and discussed.
PMID: 11759318, UI: 21595917
Ann Fr Anesth Reanim 2001 Nov;20(9):743-4
PMID: 11759314, UI: 21595913
BMJ 2002 Jul 27;325(7357):182
PMID: 12143852, UI: 22138527
Br Dent J 2002 Apr 27;192(8):457-62
Department of Sedation, Newcastle Dental School and Hospital, Newcastle upon Tyne. katherine.wilson@ncl.ac.uk
OBJECTIVES: To assess the safety, effectiveness and acceptability of o:ral midazolam sedation for orthodontic extraction of permanent teeth in children. DESIGN: A prospective, randomised, controlled, crossover trial. METHODS: A total of 26 children aged 10-16 (ASA I), referred for orthodontic extraction of premolar or canine teeth under sedation, were included in the study. Each child required two treatment sessions for the extraction of equivalent teeth on opposite sides of the mouth. Each subject was sedated with either ora midazolam (0.5 mg/kg) or nitrous oxide and oxygen (30%/70%) at the first visit and the alternative form at the second visit. At each visit two teeth were extracted, one upper and one lower. Heart rate, arterial oxygen saturation, respiration rate, sedation and behavioural scores were recorded every five minutes. Overall behaviour, patient acceptance and patient satisfaction were recorded at the end of treatment. RESULTS: Of the 26 children included in the study there were 12 males and 14 females. The mean age was 12.5 years. The mean heart rate and respiratory rate for both groups were similar and within acceptable clinical limits. The lowest mean arterial oxygen saturation levels for nitrous oxide and midazolam sedation were 97.7% and 95.0% respectively. Although midazolam caused greater oxygen desaturation, the range (91%-100%) was within safe limits for conscious sedation. The mean level of sedation was greater in the midazolam group compared with the nitrous oxide group and all but one case completed treatment. A total of 23 patients (88%) said they would be prepared to have ora midazolam sedation again and 17 (65%) actually preferred oral midazolam to nitrous oxide sedation. CONCLUSION: Oral midazolam (0.5mg/kg) appears to be a safe and acceptable form of sedation for 10-16 year old paediatric dental patients.
PMID: 12014695, UI: 22008851
Br Dent J 2002 Apr 27;192(8):425
PMID: 12014689, UI: 22008845
Br Dent J 2002 Apr 27;192(8):424; discussion 424-5
PMID: 12014687, UI: 22008843
Eur J Pharmacol 2002 Apr 19;441(1-2):67-74
INSERM U161, 2 rue d'Alesia, 75014 Paris, France. buritova@broca.inserm.fr
We have evaluated the effects of nefopam on the spinal c-Fos protein expression in the model of acute (noxious heat) and persistent (intraplantar injection of formalin) nociception in the rat. One and two hours after i.pl. formalin injection, c-Fos immunoreactive (c-Fos-IR) nuclei were preferentially located in the superficial (I-II) and deep (V-VI) laminae of the spinal dorsal horn of segments L4-L5, i.e. spinal areas containing numerous neurons responding exclusively, or not, to peripheral nociceptive stimuli. The doses of 15 and 30 mg/kg (s.c.) of nefopam had significant reducing effects on the formalin-evoked spinal c-Fos protein expression (36+/-14% and 47+/-9% reduction of the total number of c-Fos-IR nuclei per section, respectively, P<0.05 for both). These reducing effects of nefopam were not detectable 2 h after formalin. These results provide evidence that the significant effects of nefopam are time-limited in the formalin model of persistent nociception. One hour after noxious heat stimulation (52 degrees C for 15 s), c-Fos-IR nuclei were principally located in the superficial laminae I-II of the spinal dorsal horn (about 90% of the total number of c-Fos-IR nuclei per section). Nefopam (15 mg/kg s.c.) significantly reduced the noxious heat-evoked spinal c-Fos protein expression (33+/-3% reduction of the total number of c-Fos-IR nuclei, P<0.0001). The present results provide first evidence for the reducing effects of nefopam on the noxiously evoked spinal c-Fos protein expression, principally in acute nociceptive processes. These results suggest that nefopam may produce antinociceptive effects mainly in acute pain states.
PMID: 12007921, UI: 22003598
J Cardiothorac Vasc Anesth 2002 Aug;16(4):468-70
Department of Anesthesiology, Inonu University Hospital, Malatya, Turkey.
PMID: 12154428, UI: 22148862
J Cardiothorac Vasc Anesth 2002 Aug;16(4):426-30
Departments of Anaesthesia and Intensive Care Medicine, Helsinki University Central Hospital, Helsinki, Finland.
OBJECTIVE: To estimate the current incidence of conscious recollections from the time of anesthesia, the contribution of anesthetic drugs to this incidence, and the patients' experience of cardiac anesthesia and surgery. DESIGN: Prospective, horizontal survey of cardiac surgery patients using structured interview method. SETTING: Tertiary care university hospital. PARTICIPANTS: All cardiac surgery patients during 1 year (n = 1,218). INTERVENTIONS: None. Measurements and Main Results: Of 1,218 patients operated on, 929 were interviewed. The patients' memories were classified to estimate the number of patients with possible or definite intraoperative awareness and later conscious recall. The use of anesthetics was estimated from anesthetic charts for patients with awareness and recall and control patients. These charts were compared using Poisson regression. The incidence of definite awareness with recall was 0.5% (5 patients), and the incidence of possible recall was 2.3% (21 patients). A lower dose of midazolam was used for the patients with awareness and recall. Only 1 patient rated the experience of awareness as the worst perioperative memory. Benzodiazepine premedication caused amnesia for the preoperative period but not for the time of anesthesia. CONCLUSION: The incidence of awareness and recall is similar to the incidence reported during general surgery. Cardiac surgery does not carry increased risk of awareness. Benzodiazepines given during anesthesia are effective in decreasing the incidence of recalled awareness, and the experience of awareness is not often particularly traumatizing. Premedication with benzodiazepine is not effective in preventing recollection of anesthesia, however. Copyright 2002, Elsevier Science (USA). All rights reserved.
PMID: 12154419, UI: 22148853
J Cardiothorac Vasc Anesth 2002 Aug;16(4):397-400
Department of Anesthesiology and Critical Care and Department of Cardiovascular Surgery and Organ Transplantation, Broussais Hospital.
OBJECTIVE: To assess the feasibility of endoscopic telemanipulated cardiac surgery and describe the anesthetic, postoperative, and surgical implications of minimally invasive robotic-assisted cardiac surgery. DESIGN: Prospective study. SETTING: Cardiovascular and transplant center, university hospital. PARTICIPANTS: Twenty patients (13 men, 7 women) scheduled for either coronary artery bypass graft surgery or valve surgery. Mean age was 53 +/- 5 years (range, 31 to 75 years) and mean New York Heart Association class was 2.4. Three patients (6 %) were having redo procedures, and 1 patient had bacterial endocarditis. INTERVENTIONS: Surgery was done with the aid of the daVinci surgical robot (Intuitive Surgical, Mountain View, CA). Induction and maintenance of anesthesia consisted of a target-controlled infusion of remifentanil and propofol. In 11 cases (55%), cardiopulmonary bypass was performed with Port-Access technology (Heartport, Redwood City, CA), and in the remaining 9 cases (45%), conventional femorofemoral bypass was used. Measurements and Main Results: Fifteen patients (75 %) were extubated within 6 hours and discharged from the cardiac surgery intensive care unit on postoperative day 1. Two patients (10%) were reexplored in the immediate postoperative period. Two conversions to thoracotomy were reported. One reoperation at 6 months and 1 late death occurred. At 1-year follow-up, excellent functional results were observed in 18 cases. CONCLUSION: Caution should be used when assessing innovative medical-surgical techniques. Despite technical difficulties and lengthy procedures, results were satisfactory. The feasibility of robotic-assisted surgery for coronary artery bypass graft and valve procedures is intuitively appealing. Copyright 2002, Elsevier Science (USA). All rights reserved.
PMID: 12154414, UI: 22148848
Pediatr Dent 2002 Mar-Apr;24(2):153-6
Department of Oral and Maxillofacial Surgery, Hebrew University Hadassah Medical Center, Jerusalem, Israel. rzeltser@cc.huji.ac.il
The implication of a broken anesthetic injection needle in the posterior part of the oral cavity is described. Needle breakage is preventable if proper preventive measures are used during local anesthesia administration. A broken needle should be removed immediately after a thorough localization and not left in the tissue, as previously believed. Computerized tomography (CT) scan is the proper diagnostic device to locate a broken needle. A careful surgical approach under general anesthesia is recommended to retrieve the needle. Clinical preventive guidelines are described and presented to the pediatric dentist.
PMID: 11991319, UI: 21986734
Pediatr Dent 2002 Mar-Apr;24(2):129-38
Department of Surgery, Northwestern University Medical School, USA. drjnathan@aol.com
PURPOSE: The purpose of this retrospective study was to examine different dosages of midazolam used alone or in combination with different dosages of meperidine for managing difficult young pediatric dental patients. METHODS: Patient records and sedation logs of 120 moderately to severely apprehensive/ uncooperative subjects, ages 24-48 mos, sedated in private practice setting, were reviewed. Subjects, divided into six groups of 20, received midazolam in doses of 0.7 or 1.0 mg/kg with and without meperidine in doses of 1.0 or 1.5 mg/kg. Ratings of the effectiveness of sedation, duration of action, need for restraint to accomplish treatment, and recovery times were made. Nitrous oxide was not used. RESULTS: When used alone, use of 0.7 mg/kg midazolam produced the most agitation, required restraint most frequently, and produced the shortest working time (P<0.001). Subjects receiving 1.0 mg/kg midazolam and meperidine were the most effective, completing 20/20 visits with no need for restraint, no loss of consciousness throughout appointments, and no adverse reactions (P<0.001). Use of lower dose midazolam and higher dose meperidine was reliable, permitting treatment to be completed without restraint in 18/20 patients. Combined higher doses of both agents demonstrated somnolence and oversedation. The addition of meperidine increased working time (P<0.05). CONCLUSIONS: The addition of meperidine appears to enhance the effectiveness and duration of action of midazolam for managing difficult young pediatric patients.
PMID: 11991315, UI: 21986730
Pediatr Dent 2002 Mar-Apr;24(2):114-8
Columbus Children's Hospital and The Ohio State University, USA.
PURPOSE: The purpose of this study was to determine if audio distraction could decrease patient anxiety, pain and disruptive behavior during pediatric dental procedures. METHODS: Forty-five children between the ages of 4 to 6 years had two visits each involving restorative dentistry with local anesthesia in a mandibular quadrant. Visit #1 was a baseline session for all patients. During visit #2, the children were assigned to either an upbeat music group, a relaxing music group or a no music group. Variables measured were: (1) parent-reported anxiety via the Modified Corah Anxiety Scale, (2) self-reported anxiety via the Venham picture scale, (3) heart rate, (4) behavior via the North Carolina Behavior Rating Scale and (5) pain via a visual analogue scale. RESULTS: No significant differences were found among the three groups during experimental visit #2 across any variables. A majority of patients (90%) stated that they enjoyed the music and would like to listen to it during their next visit. CONCLUSIONS: Audio distraction was not an effective means of reducing anxiety, pain or uncooperative behavior during pediatric restorative dental procedures. However, patients did enjoy listening to the music during their visits.
PMID: 11991313, UI: 21986728
Pediatr Dent 2002 Mar-Apr;24(2):109-13
Department of Pediatric Dentistry, University of Florida, Gainesville, USA.
PURPOSE: The purposes of this study were to determine if young children with rampant dental caries that received complete dental rehabilitation under general anesthesia: 1.) weighed less preoperatively compared to national norms; and 2.) demonstrated significant improvement postoperatively in percentile weight gain and/or quality of life indicators. METHODS: The preoperative and postoperative percentile weights based on national norms were calculated for children, aged 2-7 years old, with non-significant medical histories (absence of systemic illness) that underwent rehabilitation for rampant dental caries under general anesthesia. Changes in the quality of the children's life following dental rehabilitation under general anesthesia were determined from parental report. RESULTS: The results showed that there was a slight, non-significant increase in the mean percentile weight following dental rehabilitation under general anesthesia. There was no significant effect on the mean net percentile weight change based on the chronological age or weighing interval. There was, however, a significant improvement in the children's quality of life as reported by their parents. CONCLUSIONS: Contrary to previous reports, the mean percentile weight of children with rampant dental caries was not below the 50th percentile and the slight gain in percentile weight following dental rehabilitation under general anesthesia was not indicative of a "catch-up growth" phenomenon. There was, however, a significant improvement in the children's quality of life as based upon parental report and confirmed in a previous investigations.
PMID: 11991312, UI: 21986727
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