Call for an alternative coupling system for regional equipment.
Cyna A, Simmons S
Publication Types:
Letter
PMID: 11892644, UI: 21889359
Anaesthesia 2002 Mar;57(3):288-9
The Pro-Seal laryngeal mask airway.
Cook TM, Nolan JP
Publication Types:
Letter
PMID: 11892642, UI: 21889354
Anaesthesia 2002 Mar;57(3):288
Overfilling of vaporisers.
Daniels D
Publication Types:
Letter
PMID: 11892641, UI: 21889353
Anaesthesia 2002 Mar;57(3):281-3
The effect of swabs soaked in bupivacaine and epinephrine
for pain relief following simple dental extractions in children.
Andrzejowski J, Lamb L
Department of Anaesthesia, Charles Clifford Dental Hospital,
Sheffield, UK.
We studied 133, ASA I or II children, aged 5-12 years undergoing
general anaesthesia for simple dental extractions. Induction
and maintenance of anaesthesia were achieved using sevoflurane
in nitrous oxide and oxygen. At the end of surgery, patients
had swabs soaked in a trial solution placed over the exposed
teeth sockets. The bupivacaine group had swabs soaked in
bupivacaine 0.25% with epinephrine 1:200 000, the saline
group had swabs soaked in saline. Pain scores were recorded
on a 4-point scale as follows: 0 = I don't hurt at all;
1 = I hurt a bit; 2 = I hurt a lot; 3 = I hurt the most.
Nurse pain assessments and the patient's own scores were
recorded at 15 and 30 min following recovery from anaesthesia.
The median pain scores (2 at 15 min and 1 at 30 min postoperatively)
were the same in both groups.
Publication Types:
Clinical trial
Randomized controlled trial
PMID: 11892639, UI: 21889348
Anaesthesia 2002 Mar;57(3):277-80
An evaluation of ultrasound imaging for identification
of lumbar intervertebral level.
Furness G, Reilly MP, Kuchi S
Altnagelvin Area Hospital, Londonderry, UK.
The accuracy of ultrasound imaging to identify lumbar intervertebral
level was assessed in 50 patients undergoing X-ray of the
lumbar spine. Using an ultraviolet marker, an anaesthetist
attempted to mark the L2/3, L3/4 and L4/5 intervertebral
spaces. A radiologist unaware of these marks attempted to
mark the same spaces with the aid of ultrasound imaging.
X-ray-visible pellets were taped to the back at the various
marks prior to lateral lumbar X-ray. Ultrasound imaging
identified the correct level in up to 71% of cases, but
palpation was successful in only 30% (p < 0.001). Up
to 27% of marks using the palpation method were more than
one spinal level above or below the assumed level using
palpation, but none were more than one level high or low
using ultrasound guidance.
Publication Types:
Evaluation studies
PMID: 11892638, UI: 21889346
Anaesthesia 2002 Mar;57(3):270-5
The management of pain following day-case surgery.
McHugh GA, Thoms GM
University Department of Anaesthesia, Manchester Royal
Infirmary, UK.
The object of this study was to assess patients' experience
of pain management following day surgery. One hundred and
two patients agreed to take part in a telephone survey,
2 and 4 days following day surgery. The majority of patients
(73%) were broadly satisfied with the quality of pain management
they received, however, there was room for improvement.
Despite modern anaesthesia and surgery, 17% of patients
surveyed reported having severe pain immediately following
day-case surgery. The majority (82%) of patients left the
day-case ward in pain and an even higher proportion (88%)
had pain at some time between 2 and 4 days postoperatively.
Severe levels of pain following discharge from hospital
were a concern for 21% of patients. It was reported that
day-case staff did not always ask patients whether they
were in pain. Communication with patients is vital in the
delivery of optimal care. More support and more information
are needed to manage patients' pain effectively, whilst
in the day-case wards and also following discharge, at home.
PMID: 11892636, UI: 21889341
Anaesthesia 2002 Mar;57(3):266-70
Patient-controlled epidural fentanyl following spinal
fentanyl at Caesarean section.
Cooper DW, Garcia E, Mowbray P, Millar MA
Department of Anaesthesia, Cheriton House, James Cook University
Hospital, Middlesbrough, Cleveland, UK. Drdavidcooper@aol.com
Spinal fentanyl can improve analgesia during Caesarean
section. However, there is evidence that, following its
relatively short-lived analgesic effect, there is a more
prolonged spinal opioid tolerance effect. The effectiveness
of postoperative epidural fentanyl analgesia may therefore
be reduced following the use of spinal fentanyl at operation.
This randomised, double-blind study was designed to assess
whether patient-controlled epidural fentanyl could produce
effective analgesia following 25 microg of spinal fentanyl
at operation. Patients undergoing elective Caesarean section
received spinal bupivacaine combined with either fentanyl
25 microg (fentanyl group; n = 18) or normal saline (saline
group; n = 18). Patient-controlled epidural fentanyl was
used for postoperative analgesia. The fentanyl group used
a mean of 23.4 (SD 14.5) microg x h(-1) of fentanyl, compared
with 27.0 (10.8) microg x h(-1) for the saline group (p
=0.41). Using a 0-100 mm visual analogue score for pain,
the maximum pain score recorded at rest for the fentanyl
group was median 24 [IQR 15-35] mm, compared with 15 [13-45]
mm for the saline group (p = 0.41). The maximum pain score
recorded on coughing for the fentanyl group was 29 [24-46]
mm, compared with 27 [19-47] mm for the saline group (p
= 0.44). Nine of the fentanyl group rated postoperative
analgesia as excellent and nine as good, compared with 10
of the saline group who rated it as excellent and eight
as good (p = 0.74). Epidural fentanyl can produce effective
analgesia following the use of 25 microg spinal fentanyl
at Caesarean section.
Publication Types:
Clinical trial
Randomized controlled trial
PMID: 11892635, UI: 21889337
Anaesthesia 2002 Mar;57(3):294-5
Airway management of a child with temporomandibular joint
ankylosis following otitis media.
Kawasaki T, Sata T, Kawasaki C, Ogata M, Shigematsu A
Publication Types:
Letter
PMID: 11879227, UI: 21868425
Anaesthesia 2002 Mar;57(3):293
A new cause of airway obstruction.
Boumphrey S
Publication Types:
Letter
PMID: 11879225, UI: 21868423
Anaesthesia 2002 Mar;57(3):233-41
The effects of subanaesthetic concentrations of xenon
in volunteers.
Bedi A, McCarroll C, Murray JM, Stevenson MA, Fee JP
The Department of Anaesthetics and Intensive Care Medicine,
The Queen's University of Belfast, Northern Ireland. a.bedi@ntlworld.com
This study reports the subjective, psychomotor and physiological
properties of subanaesthetic concentrations of xenon. Ten
healthy male volunteers received either xenon or nitrous
oxide in a randomised crossover study design. The subjects
breathed either xenon (Xe) or nitrous oxide (N2O) from a
closed circuit breathing system, according to a randomised,
double-blind protocol. The concentration of xenon required
to produce sedation, ranged between 27 and 45% (median 35%).
All subjects completed the xenon protocol. Subjects were
tested using the Critical Flicker Fusion test and derived
electroencephalogram parameters, however, neither test was
found to reliably predict sedation. The respiratory rate
decreased markedly during sedation with xenon. The subjects
did not experience any airway irritability (coughing, breath-holding
or laryngospasm) during administration of either gas. One
subject required anti-emetic treatment in the N2O group
compared to none in the Xe group. Eight subjects reported
that they found sedation with xenon pleasant and preferable
to nitrous oxide. Xenon sedation was well tolerated and
was not associated with any adverse physiological effects,
however, it was reported to be subjectively dissimilar to
nitrous oxide.
Publication Types:
Clinical trial
Randomized controlled trial
PMID: 11879212, UI: 21868410
Anesth Analg 2002 Jan;94(1 Suppl):S44-6
Pulse oximetry in the management of children in the PICU.
Miyasaka K
Department of Anesthesia and ICU, National Children's Hospital,
Tokyo, Japan. kmiyasaka@nch.go.jp
The noninvasive and continuous nature of pulse oximetry
is a considerable asset inpatient monitoring in the PICU.
Its use in the PICU is constantly challenged by the combined
presence of vigorous body motion and poor peripheral circulation,
conditions which demand special consideration in developing
a better pulse oximeter. This is a point of fierce competition
among manufacturers.
PMID: 11900038, UI: 21896704
Anesthesiology 2002 Feb;96(2):517
The safety of rapid sequence induction.
Adnet F, Borron SW, Lapostolle F
Publication Types:
Letter
PMID: 11818796, UI: 21676129
Anesthesiology 2002 Feb;96(2):516; discussion
517
The intubating dose of succinylcholine.
Kopman AF
Publication Types:
Letter
PMID: 11818795, UI: 21676128
Anesthesiology 2002 Feb;96(2):515-6
Extrapolating beyond the data.
Fisher DM
Publication Types:
Letter
PMID: 11818794, UI: 21676127
Anesthesiology 2002 Feb;96(2):467-84
Perioperative shivering: physiology and pharmacology.
De Witte J, Sessler DI
Department of Anesthesia and Intensive Care, OLV Hospital,
Aalst, Belgium. jan.de.witte@olvz-aalst.be
Publication Types:
Review
Review, academic
PMID: 11818783, UI: 21676116
Anesthesiology 2002 Feb;96(2):346-51
Sympathetic neural activation evoked by mu-receptor blockade
in patients addicted to opioids is abolished by intravenous
clonidine.
Kienbaum P, Heuter T, Michel MC, Scherbaum N, Gastpar
M, Peters J
Abteilung fur Anasthesiologie und Intensivmedizin, Universitatsklinikum,
Essen, Germany. peter.kienbaum@uni-essen.de
BACKGROUND: Mu-opioid receptor blockade by naloxone administered
for acute detoxification in patients addicted to opioids
markedly increases catecholamine plasma concentrations,
muscle sympathetic activity (MSA), and is associated with
cardiovascular stimulation despite general anesthesia. The
current authors tested the hypothesis that the alpha2-adrenoceptor
agonist clonidine (1) attenuates increased MSA during mu-opioid
receptor blockade for detoxification, and (2) prevents cardiovascular
activation when given before detoxification. METHODS: Fourteen
mono-opioid addicted patients received naloxone during propofol
anesthesia. Clonidine (10 microg x kg(-1) administered over
5 min + 5 microg x kg(-1) x h(-1) intravenous) was infused
either before (n = 6) or after (n = 6) naloxone administration.
Two patients without immediate clonidine administration
occurring after naloxone administration served as time controls.
Muscle sympathetic activity (n = 8) in the peroneal nerve,
catecholamine plasma concentrations (n = 14), arterial blood
pressure, and heart rate were assessed in awake patients,
during propofol anesthesia before and after mu-opioid receptor
blockade, and after clonidine administration. RESULTS: Mu-receptor
blockade markedly increased MSA from a low activity (burst
frequency: from 2 burst/min +/- 1 to 24 +/- 8, means +/-
SD). Similarly, norepinephrine (41 pg/ml +/- 37 to 321 +/-
134) and epinephrine plasma concentration (13 pg/ml +/-
6 to 627 +/- 146) significantly increased, and were associated
with, increased arterial blood pressure and heart rate.
Clonidine immediately abolished both increased MSA (P <
0.001) and catecholamine plasma concentrations (P < 0.001).
When clonidine was given before mu-opioid receptor blockade,
catecholamine plasma concentrations and hemodynamic variables
did not change. CONCLUSIONS: Administration of the alpha2-adrenoceptor
agonist clonidine decreases both increased MSA and catecholamine
plasma concentrations observed after mu-opioid receptor
blockade for detoxification. Furthermore, clonidine pretreatment
prevents the increase in catecholamine plasma concentration
that otherwise occurs during mu-opioid receptor blockade.
Publication Types:
Clinical trial
PMID: 11818767, UI: 21676100
Anesthesiology 2002 Feb;96(2):300-5
Electroacupuncture prophylaxis of postoperative nausea
and vomiting following pediatric tonsillectomy with or without
adenoidectomy.
Rusy LM, Hoffman GM, Weisman SJ
Department of Pediatric Anesthesiology, Medical College
of Wisconsin-Children's Hospital of Wisconsin, Milwaukee,
Wisconsin 53226, USA. lrusy@mcw.edu
BACKGROUND: Electrical stimulation of acupuncture point
P6 reduces the incidence of postoperative nausea or vomiting
(PONV) in adult patients. However, acupressure, laser stimulation
of P6, and acupuncture during anesthesia have not been effective
for reducing PONV in the pediatric population. The authors
studied the effect of electrical P6 acupuncture in awake
pediatric patients who had undergone surgery associated
with a high incidence of PONV. METHODS: Patients aged 4-18
yr undergoing tonsillectomy with or without adenoidectomy
were randomly assigned to acupuncture, sham acupuncture,
or control groups. Acupuncture needles at P6 and a neutral
point were placed while patients were anesthetized, and
low-frequency electrical stimulation was applied to these
points for 20 min in the recovery room while the patients
were awake (P6 Acu group). This treatment was compared with
sham needles along the arm at acupuncture points not associated
with antiemesis (sham group) and a no-needle control group.
The arms were wrapped to prevent identification of treatment
group, and anesthetic, analgesic, and surgical technique
were standardized. Assessed outcomes were occurrence of
nausea, occurrence and number of episodes of vomiting, time
to vomiting, and use of antiemetic rescue medication. RESULTS:
One hundred twenty patients were enrolled in the study,
40 per group. There were no differences in age, weight,
sex, or opioid administration between groups. The PONV incidence
was significantly lower with P6 acupuncture (25 of 40 or
63%; odds ratio, 0.135; number needed to treat, 3.3; P <
0.001) compared with controls (37 of 40 or 93%). Sham puncture
had no effect on PONV (35 of 40 or 88%; P = not significant).
Occurrence of nausea was significantly less in P6 Acu (24
of 40 or 60%; odds ratio, 0.121; P < 0.01), but not in
the sham group (34 of 40 or 85%) compared with the control
group (37 of 40 or 93%). Vomiting occurred in 25 of 40 or
63% in P6 Acu; 35 of 40 or 88% in the sham group, and 31
in 40 or 78% in the control group (P = not significant).
Patients receiving sham puncture vomited significantly earlier
(P < 0.02) and needed more rescue treatment (33 of 40
or 83%; odds ratio, 3.48; P < 0.02) compared with P6
Acu (23 of 40 or 58%) and the control group (24 of 40 or
60%). CONCLUSIONS: Perioperative P6 electroacupuncture in
awake patients significantly reduced the occurrence of nausea
compared with the sham and control groups, but it did not
significantly reduce the incidence or number of episodes
of emesis or the use of rescue antiemetics. Sham acupuncture
may exacerbate the severity but not the incidence of emesis.
The efficacy of P6 acupuncture for PONV prevention is similar
to commonly used pharmacotherapies. Its appropriate role
in prevention and treatment of PONV requires further study.
Publication Types:
Clinical trial
Randomized controlled trial
PMID: 11818760, UI: 21676093
Anesthesiology 2002 Feb;96(2):276-82
Absence of beneficial effect of acute normovolemic hemodilution
combined with aprotinin on allogeneic blood transfusion
requirements in cardiac surgery.
Hohn L, Schweizer A, Licker M, Morel DR
Department of Anesthesiology, Pharmacology and Surgical
Intensive Care, University Hospital of Geneva, Geneva, Switzerland.
BACKGROUND: The efficacy of acute normovolemic hemodilution
(ANH) in decreasing allogeneic blood requirements remains
controversial during cardiac surgery. METHODS: In a prospective,
randomized study, 80 adult cardiac surgical patients with
normal cardiac function and no high risk of ischemic complications
were subjected either to ANH, from a mean hematocrit of
43% to 28%, or to a control group. Aprotinin and intraoperative
blood cell salvage were used in both groups. Blood (autologous
or allogeneic) was transfused when the hematocrit was less
than 17% during cardiopulmonary bypass, less than 25% after
cardiopulmonary bypass, or whenever clinically indicated.
RESULTS: The amount of whole blood collected during ANH
ranged from 10 to 40% of the patients' estimated blood volume.
Intraoperative and postoperative blood losses were not different
between control and ANH patients (total blood loss, control:
1,411 +/- 570 ml, n = 41; ANH: 1,326 +/- 509 ml, n = 36).
Allogeneic blood was given in 29% of control patients (median,
2; range, 1-3 units of packed erythrocytes) and in 33% of
ANH patients (median, 2; range, 1-5 units of packed erythrocytes;
P = 0.219). Preoperative and postoperative platelet count,
prothrombin time, and partial thromboplastin time were similar
between groups. Perioperative morbidity and mortality were
not different in both groups, and similar hematocrit values
were observed at hospital discharge (33.7 +/- 3.9% in the
control group and 32.6 +/- 3.7% in the ANH group; nonsignificant)
CONCLUSIONS: Hemodilution is not an effective means to lower
the risk of allogeneic blood transfusion in elective cardiac
surgical patients with normal cardiac function and in the
absence of high risk for coronary ischemia, provided standard
intraoperative cell saving and high-dose aprotinin are used.
Publication Types:
Clinical trial
Randomized controlled trial
PMID: 11818756, UI: 21676089
Anesthesiology 2002 Feb;96(2):271-5
Involvement of renin-angiotensin system in pressure-flow
relationship: role of angiotensin-converting enzyme gene
polymorphism.
Lasocki S, Iglarz M, Seince PF, Vuillaumier-Barrot S,
Vicaut E, Henrion D, Levy B, Desmonts JM, Philip I, Benessiano
J
Departement d' Anesthesie-Reanimation, Hopital Bichat,
Paris, France.
BACKGROUND: The renin-angiotensin system is involved in
blood pressure regulation. The insertion/deletion (I/D)
polymorphism of the angiotensin-converting enzyme (ACE)
gene is known to be associated with variation of plasma
and cellular ACE concentrations. Furthermore, changes in
arterial function have been suggested to be associated to
the DD genotype. The aim of the study was to investigate
the arterial vascular response to a physiologic stimulus
(i.e., flow) according to the I/D ACE gene polymorphism.
METHODS: Sixty patients scheduled for coronary artery bypass
grafting (n = 24) or valve surgery (n = 36) under normothermic
cardiopulmonary bypass were genotyped in a blind manner
by polymerase chain reaction. Mean arterial pressure was
measured at pump flows ranging from 1 to 3 l x min(-1) x
m (-2) by 0.25 l x min(-1) x m(-2) step each 15 s, to obtain
a pressure-flow relation. Independent factors associated
with the variation of the slope of the pressure-flow relation
curve were assessed by multivariate analysis. RESULTS: We
found a D allelic frequency of 0.54. Patients were separated
in two groups (DD, n = 16; ID/II, n = 44). There were no
significant difference with regard to preoperative and intraoperative
data between the two groups. DD patients had their pressure-flow
relation curves shifted upward (with higher pressures as
flow increased), indicating a lesser decrease in vascular
resistance. Furthermore, DD genotype was the only independent
predictor of the slope of the curves (21.5 +/- 4.2 vs. 18.1
+/- 5 mmHg/[l x min(-1) x m(-2)] for DD and ID/II, respectively;
P = 0.02; values are mean +/-SD). CONCLUSION: These results
show that vasomotor properties are influenced by the I/D
polymorphism of the ACE gene.
PMID: 11818755, UI: 21676088
Anesthesiology 2002 Feb;96(2):264-70
Perioperative myocardial ischemia and infarction: identification
by continuous 12-lead electrocardiogram with online ST-segment
monitoring.
Landesberg G, Mosseri M, Wolf Y, Vesselov Y, Weissman
C
Department of Anesthesiology and Critical Care Medicine,
Hadassah University Hospital, Ein-Kerem, Jerusalem, Israel.
gio@cc.huji.ac.il
BACKGROUND: Perioperative myocardial ischemia is conventionally
monitored using five electrocardiographic leads, with only
one precordial lead placed at V5. This is based on studies
from more than a decade ago. The authors reassessed this
convention by analyzing data obtained from continuous on-line
12-lead electrocardiographic monitoring. METHODS: One hundred
eighty-five consecutive patients undergoing vascular surgery
were monitored by continuous 12-lead ST-trend analysis during
and for 48-72 h after surgery. Cardiac troponin I was measured
in the first 3 postoperative days, and cardiac outcome was
prospectively recorded. Ischemia was defined as ST deviation,
relative to the reference preanesthesia electrocardiogram,
of 0.2 mV or more in one lead or 0.1 mV or more in two contiguous
leads, lasting more than 10 min. RESULTS: During 11,132
patient-hours of monitoring, 38 patients (20.5%) had 66
transient ischemic events, with all but one denoted by ST-segment
depression. Twelve patients (6.5%) sustained postoperative
infarction (cardiac troponin I > 3.1 ng/ml). Among the
38 patients with ischemia, lead V3 most frequently (86.8%)
demonstrated ischemia, followed by V4 (78.9%) and V5 (65.8%).
Among the 12 patients with infarction, V4 was most sensitive
to ischemia (83.3%), followed by V3 and V5 (75% each). Combining
two precordial leads increased the sensitivity for detecting
ischemia (97.4% for V3 + V5 and 92.1% for either V4 + V5
or V3 + V4) and infarction (100% for V4 + V5 or V3 + V5
and 83.3% for V3 + V4). On average, baseline preanesthesia
ST was above isoelectric in V1 through V3 and below isoelectric
in V5 through V6. Lead V4 was closest to the isoelectric
level on the baseline electrocardiogram, rendering it most
suitable for ischemia monitoring. CONCLUSIONS: As a single
lead, V4 is more sensitive and appropriate than V5 for detecting
prolonged postoperative ischemia and infarction. Two precordial
leads or more are necessary so as to approach a sensitivity
of greater than 95% for detection of perioperative ischemia
and infarction.
Publication Types:
Clinical trial
Evaluation studies
PMID: 11818754, UI: 21676087
Anesthesiology 2002 Feb;96(2):259-61
Multilead precordial ST-segment monitoring: "the
next generation?".
London MJ
Publication Types:
Comment
Editorial
PMID: 11818752, UI: 21676085
Links:
BMJ 2002 Apr 6;324(7341):806A
Indian group seeks ban on use of electroconvulsive therapy
without anaesthesia.
Mudur G
New Delhi.
[Medline record in process]
PMID: 11934766, UI: 21932118
Br J Anaesth 2002 Jan;88(1):94-100
Concurrent ketamine and alfentanil administration: pharmacokinetic
considerations.
Edwards SR, Minto CF, Mather LE
Centre for Anaesthesia and Pain Management Research, University
of Sydney at Royal North Shore Hospital, St Leonards, NSW,
Australia.
BACKGROUND: A ketamine-alfentanil combination has been
suggested for total i.v. anaesthesia. We determined the
pharmacokinetics of ketamine and alfentanil, alone and together,
in three groups of adult male rats, to assess any pharmacokinetic
interaction. METHODS: Group 1 animals were infused with
i.v. ketamine for 5 min; in group 2, constant low plasma
concentrations of alfentanil were maintained by computer-controlled
infusion; in group 3, the treatments were combined. Serial
plasma and terminal tissue concentrations were measured
by high performance liquid chromatography or gas chromatography-mass
spectrometry. RESULTS: In the presence of alfentanil, the
mean plasma ketamine concentration-time area under the curve
(AUC) value was significantly lower (by 13%, P<0.05),
while clearance (CIT) and volume of distribution (Vss) were
significantly higher (by 16 and 28%, respectively, both
P<0.05). Tissue:plasma distribution coefficients for
ketamine in the presence of alfentanil were significantly
higher in forebrain (by 128%, P<0.005), hindbrain (by
207%, P<0.01), gut (by 254%, P<0.005), and fat (by
344%, P<0.0001). Mean AUC values for alfentanil did not
differ significantly in the presence of ketamine, but alfentanil
tissue concentrations were significantly lower in forebrain
(by 77%, P<0.0001), hindbrain (by 28%, P<0.01), heart
(by 33%, P<0.01), lung (30%, P<0.05), and gut (by
21%, P<0.05). Corresponding tissue:plasma distribution
coefficients were significantly lower for forebrain (by
69%, P<0.0001) alone. CONCLUSIONS: The finding that the
distribution of ketamine into the brain was increased by
low plasma concentrations of alfentanil could have important
clinical applications for pain management.
PMID: 11881891, UI: 21873324
Br J Anaesth 2002 Jan;88(1):65-71
Randomized controlled trial to investigate influence of
the fluid challenge on duration of hospital stay and perioperative
morbidity in patients with hip fractures.
Venn R, Steele A, Richardson P, Poloniecki J, Grounds
M, Newman P
Department of Anaesthesia and Intensive Care, Worthing
Hospital, W. Sussex UK.
BACKGROUND: A prospective, randomized controlled trial
comparing conventional intraoperative fluid management with
two differing methods of invasive haemodynamic monitoring
to optimize intraoperative fluid therapy, in patients undergoing
proximal femoral fracture repair under general anaesthesia.
METHODS: Ninety patients randomized to three groups; conventional
intraoperative fluid management (Gp CON, n=29), and two
groups receiving additional repeated colloid fluid challenges
guided by central venous pressure (Gp CVP, n=31) or oesophageal
Doppler ultrasonography (Gp DOP, n=30). Primary outcome
measures were time to medical fitness to discharge, hospital
stay and postoperative morbidity. RESULTS: The fluid challenge
resulted in significantly greater perioperative changes
in central venous pressure between Gp CVP and Gp CON (mean
5 (95% confidence interval 3-7) mm Hg) (P<0.0001). Important
perioperative changes were also shown in Gp DOP with increases
of 49.4 ms (19.7-79.1 ms) in the corrected flow time, 13.5
ml (7.4-19.6 ml) in stroke volume, and 0.9 (0.49-1.39) litre
min(-1) in cardiac output. As a result, fewer patients in
Gp CVP and Gp DOP experienced severe intraoperative hypotension
(Gp CON 28% (8/29), Gp CVP 9% (3/31), Gp DOP 7% (2/30),
P=0.048 (chi-squared, 2 degrees of freedom (df). No differences
were seen between the three groups when major morbidity
and mortality were combined, P=0.24 (chi-squared, 2 df).
Postoperative recovery for survivors, as defined by time
to be deemed medically fit for discharge, was significantly
faster, in comparison with Gp CON, in both the Gp CVP (10
vs 14 (95% confidence interval 8-12 vs 12-17) days, P=0.008
(t-test)), and Gp DOP (8 vs 14 (95% confidence interval
6-12 vs 12-17) days, P=0.023 (t-test). There were no significant
differences between groups, for survivors, with respect
to acute orthopaedic hospital and total hospital stay. CONCLUSIONS:
Invasive intraoperative haemodynamic monitoring with fluid
challenges during repair of femoral fracture under general
anaesthetic shortens time to being medically fit for discharge.
Publication Types:
Clinical trial
Randomized controlled trial
PMID: 11881887, UI: 21873320
Br J Anaesth 2002 Jan;88(1):4-5
Oxygen and elective caesarean section.
Backe SK, Lyons G
Publication Types:
Comment
Editorial
PMID: 11881882, UI: 21873310
Br J Anaesth 2002 Jan;88(1):129-32
Deep topical fornix nerve block versus peribulbar block
in one-step adjustable-suture horizontal strabismus surgery.
Aziz ES, Rageh M
Department of Anaesthesia, Faculty of Medicine, Cairo University,
Zamalek, Egypt.
BACKGROUND: We compared the efficacy of deep topical fornix
nerve block anaesthesia (DTFNBA), which does not paralyse
the extraocular muscles, with peribulbar block in patients
undergoing one-step adjustable-suture horizontal strabismus
surgery. Patients with a vertical, oblique squint were excluded
from the study. METHODS: We studied 100 patients, allocated
randomly to two groups. Group 1 (n=50) received peribulbar
block with 5 ml of 1:1 mixture of 0.5% plain bupivacaine
and 2% lignocaine supplemented with hyaluronidase 300 i.u.
ml(-1). Group 2 (n=50) received DTFNBA with placement of
a sponge soaked in 0.5% bupivacaine deep into the conjunctival
fornices for 15 min. No sedation was given to either group.
Analgesia was assessed by direct questioning of patients
during the procedure. A three-point scoring system was used
(no pain = 0, discomfort = 1, pain =2). If the pain score
was 1, the patient was asked to look in the opposite direction
to decrease the tension on the periosteal attachment of
the muscle to relieve discomfort. If the pain score was
2 at any stage of the operation, general anaesthesia was
given. RESULTS: In Group 2, significantly more patients
(15) experienced discomfort than in Group 1 (no patients)
(P<0.05), but general anaesthesia was not needed. CONCLUSIONS:
DTFNBA is a useful technique for intraoperative adjustable-suture
strabismus surgery. It does not alter muscle tone, thus
allowing the surgeon to adjust the muscle sutures intraoperatively,
and reducing the incidence of under- or over-correction
of the squint in the immediate postoperative period.
Publication Types:
Clinical trial
Randomized controlled trial
PMID: 11881868, UI: 21873328
Links:
Br J Pharmacol 2001 Dec;134(8):1724-30
Antianginal effects of hydroxyfasudil, a Rho-kinase inhibitor,
in a canine model of effort angina.
Utsunomiya T, Satoh S, Ikegaki I, Toshima Y, Asano T,
Shimokawa H
Institute of Life Science Research, Asahi Kasei Corporation,
632-1, Mifuku, Ohito-Cho, Tagata-Gun, 410-2321, Japan.
1. The effects of Rho-kinase inhibitor, fasudil, and of
a more specific Rho-kinase inhibitor, hydroxyfasudil, on
pacing-induced myocardial ischaemia were determined in anaesthetized
open-chest dogs. 2. The dogs were subjected to left anterior
descending coronary artery (LAD) stenosis producing a sufficient
ischaemia as measured by ST-segment depression on electrocardiograms
only when the hearts were paced 60 beats min(-1) above the
baseline. After a recovery (nonpacing) period, drugs or
saline were infused intravenously over 30 min. The animals
were again subjected to 5 min of pacing 25 min after the
initiation of the treatment. 3. Hydroxyfasudil (0.1 and
0.3 mg kg(-1)) and fasudil (0.3 mg kg(-1)) suppressed the
ST-segment depression. Hydroxyfasudil and fasudil also increased
the regional blood flow of the LAD perfused endomyocardium
region in the canine model of effort angina. 4. To determine
the flow profile for hydroxyfasudil in dogs, blood flow
in three vascular beds was measured. Hydroxyfasudil (0.3
mg kg(-1) for 30 min) significantly increased coronary blood
flow and vertebral blood flow, without significantly changing
the femoral blood flow. 5. Hydroxyfasudil had no inotropic
or chronotropic effect on the isolated hearts of guinea-pigs.
Hydroxyfasudil (2 mg kg(-1) for 20 min) did not affect the
PR or QTc interval in anaesthetized dogs. 6. Inhibition
of Rho-kinase appears to protect myocardium subjected to
pacing-induced ischaemia through the increase in the regional
myocardial blood flow. Hydroxyfasudil may be categorized
as a novel type of anti-anginal drug, without any inotropic
or chronotropic effects.
PMID: 11739249, UI: 21600022
Links:
Br J Pharmacol 2001 Dec;134(8):1705-10
Activation of central melanocortin receptors by MT-II
increases cavernosal pressure in rabbits by the neuronal
release of NO.
Vemulapalli R, Kurowski S, Salisbury B, Parker E, Davis
H
CNS/CV Biological Research, Schering-Plough Research Institute,
2015 Galloping Hill Road, Kenilworth, New Jersey, NJ 07033,
USA. subbarao.Vemulapalli@spcorp.com
1. Melanotan-II had been reported to cause penile erections
in men with erectile dysfunction. In the present study,
we investigated the mechanisms by which systemic administration
of MT-II increases intracavernosal pressure in anaesthetized
rabbits. 2. MT-II (10 microM) had no effect on electrical
field stimulation-evoked relaxations of rabbit corpus cavernosal
strips in vitro. 3. Intravenous injection of MT-II (66 and
133 microg kg(-1) elicited dose-related increases in cavernosal
pressure. SHU 9119 (3 microg kg(-1), i.v.), a non-selective
antagonist of MC(3) and MC(4) receptors did not significantly
affect either cavernosal pressure or systemic blood pressure
but abolished the MT-II-induced increases in cavernosal
pressure. SHU 9119 also inhibited the depressor response
produced by MT-II. 4. Intracavernosal injection 100 microl
of the cocktail containing phentolamine mesylate (1 mg ml(-1)),
papaverine (20 mg ml(-1)) and PGE1 (20 microg ml(-1)) increased
the cavernosal pressure by about 4 fold. 5. The role of
NO-cyclic GMP dependent pathway to MT-II-induced increases
in cavernosal pressure was investigated by bilateral transection
of the pudendal nerves and by inhibition of NO synthase
with L-NAME (20 mg kg(-1), i.v. over 30 min). Ablation of
the pudendal nerves or pretreatment with L-NAME abolished
the MT-II-induced increases in intracavernosal pressure
in anaesthetized rabbits. 6. The data suggest that activation
of central melanocortin receptors by MT-II increases cavernosal
pressure by the neuronal release of NO.
PMID: 11739247, UI: 21600020
Links:
Can J Anaesth 2002 Apr;49(4):438-9
Problem with Ohmeda Excel 210 SE anesthetic machine.
Sharma ML
Liverpool, Uk.
[Medline record in process]
PMID: 11927488, UI: 21924584
Links:
Can J Anaesth 2002 Apr;49(4):417-9
Best evidence in anesthetic practice: Prevention: dopamine
does not prevent death, acute renal failure, or need for
dialysis.
Bracco D, Parlow JL
Lausanne, Switzerland Kingston, Ontario.
[Medline record in process]
PMID: 11927484, UI: 21924580
Links:
Can J Anaesth 2002 Apr;49(4):361-368
Midlatency auditory evoked potentials do not allow the
prediction of recovery from general anesthesia with isoflurane:
[Les potentiels evoques auditifs de milatence ne permettent
pas de predire la recuperation apres une anesthesie generale
a l'isoflurane].
Rundshagen I, Schnabel K, Schulte Am Esch J
Department of Anesthesiology, University Hospital Charite,
Humboldt University of Berlin, Campus Charite Mitte, Berlin,
Germany. the Department of Psychology, University of Michigan,
Ann Arbor, USA. the Department of Anesthesiology, University-Hospital
Eppendorf, Hamburg, Germany.
[Record supplied by publisher]
PURPOSE: To investigate midlatency auditory evoked potentials
(MLAEP) waveforms during recovery from anesthesia. The hypothesis
was that MLAEP are sensitive variables to discriminate between
states of consciousness and unconsciousness during emergence
from anesthesia. METHODS: MLAEP were recorded in the awake
state and during the wake-up phase from isoflurane anesthesia
in 22 female patients undergoing ophthalmologic surgery.
During emergence from anesthesia the changes in latency
and amplitude of MLAEP components Na, Pa and Nb were compared
with the awake level. The next day the patients were asked
for explicit memory for the recovery period. RESULTS: In
72% of the patients the MLAEP waveforms were completely
suppressed during isoflurane anesthesia. When the patients
responded and opened their eyes spontaneously 38 +/- 12
min after anesthesia, the latencies of Na (18.3 +/- 1.2
vs 17.6 +/- 1.3; P = 0.013) and Nb (47.4 vs 7.1 vs 44.7
+/- 7.8; P = 0.048) remained prolonged compared with awake
values. In contrast, the amplitudes NaPa and PaNb had regained
baseline level. Nine patients had explicit memory for the
immediate recovery period. However, there was no difference
for any MLAEP component between patients with and without
memory at any time. CONCLUSIONS: The persistent changes
of MLAEP latency components Na and Nb indicated impaired
auditory signal processing 38 min after isoflurane anesthesia.
There was a marked intra- and inter-individual variability
during reversal of the anesthetic induced MLAEP changes.
This limits the prediction of recovery of consciousness
in the individual patient during emergence from anesthesia.
PMID: 11927474
Links:
Can J Anaesth 2002 Apr;49(4):353-360
Rocuronium pharmacokinetic-pharmacodynamic relationship
under stable propofol or isoflurane anesthesia : [La relation
pharmacocinetique-pharmacodynamique du rocuronium pendant
une anesthesie avec propofol ou isoflurane].
Dragne A, Varin F, Plaud B, Donati F
De la Faculte de pharmacie, Universite de Montreal, et
du Departement d'anesthesiologie, Universite de Montreal
et Centre Hospitalier de l'Universite de Montreal (Hotel-Dieu),
Montreal, Quebec, Canada.
[Record supplied by publisher]
PURPOSE: To compare the pharmacokinetics, pharmacodynamics
and the concentration-effect relationship of rocuronium
in patients under stable propofol or isoflurane anesthesia.
METHODS: Ten patients were randomized to receive fentanyl,
propofol and nitrous oxide (60%) or fentanyl, thiopental,
isoflurane (1.2% end-tidal concentration) and nitrous oxide
(60%). To obtain good intubation conditions and maintain
adequate muscle relaxation during surgery, patients received
two bolus doses of rocuronium: 0.5 mg*kg(-1) (1.7 x ED(95))
at induction followed one hour later by 0.3 mg*kg(-1) (1
x ED(95)). Arterial blood samples were obtained over six
hours after the second bolus dose. Plasma concentrations
of rocuronium were measured using high pressure liquid chromatography.
Muscle twitch tension was monitored by mechanomyography
for the two doses. Pharmacokinetic and pharmacodynamic parameters
were determined. RESULTS: No differences in rocuronium pharmacokinetic
parameters were observed between both groups. After the
second bolus, clinical duration was 20 +/- 6 min in the
propofol group vs 39 +/- 8 min in the isoflurane group (P
<0.05). The effect compartment concentration corresponding
to 50% block, EC(50,) was higher under propofol anesthesia:
1008 vs 592 &mgr;g*L(-1) (P <0.05). CONCLUSION: Rocuronium
body disposition is similar under stable propofol or isoflurane
anesthesia. In contrast to isoflurane, propofol does not
prolong the neuromuscular block. Therefore, the potentiating
effect of isoflurane is of pharmacodynamic origin only,
as explained by an increased sensitivity at the neuromuscular
junction. In contrast with isoflurane anesthesia where the
dose of rocuronium has to be decreased under stable conditions,
no dose adjustment is required under propofol anesthesia.
PMID: 11927473
Links:
Can J Anaesth 2002 Apr;49(4):335-8
Is there a future for xenon anesthesia?/Le xenon a-t-il
un avenir en anesthesie ?
Goto T
Department of Anesthesia, Teikyo University Ichihara Hospital,
Ichihara-shi, Japan.
[Medline record in process]
PMID: 11927470, UI: 21924566
Links:
Can J Anaesth 2002 Apr;49(4):329-34
Observational studies and "real world" anesthesia
pharmacoeconomics/Les etudes par observation et la realite
pharmacoeconomique de l'anesthesie.
Miller DR, Tierney M
Departments of Anesthesia and Pharmacy, The Ottawa Hospital,
and the University of Ottawa, Ottawa, Ontario, Canada.
[Medline record in process]
PMID: 11927469, UI: 21924565
Neurosci Lett 2002 Feb 15;319(2):95-8
Sympathetic blockade significantly improves cardiovascular
alterations immediately after spinal cord injury in rats.
Bravo G, Hong E, Rojas G, Guizar-Sahagun G
Departamento Farmacobiologia, CINVESTAV, IPN, Calzada de
los Tenorios 235, Col. Granjas Coapa, 14330 Mexico D.F.,
Mexico. gbravof@prodigy.net.mx
Immediately after an experimental spinal cord injury (SCI)
in rats, there is a large fall in mean arterial pressure
(MAP) and heart rate (HR), followed by an abrupt increase
in MAP. To better understand the mechanism involved in these
early cardiovascular alterations, we tested the effect of
treatment with ganglionic and sympathetic blockers in anesthetized
rats subjected to T-5 SCI. Fall in MAP was partially diminished
by propranolol and pentolinium, while increase in MAP was
abolished by propranolol and pentolinium. Adrenalectomy
did not diminish the fall in MAP and HR, however, the increase
in MAP was significantly reduced. Likewise, propranolol
and pentolinium completely abolished the effects in HR.
These data suggest that the early cardiovascular alterations
secondary to SCI results from an increased parasympathetic
activity and a sympathetic withdrawal.
PMID: 11825679, UI: 21683941
Paediatr Anaesth 2002 Feb;12(2):187-91
Perioperative management of a child with very-long-chain
acyl-coenzyme A dehydrogenase deficiency.
Steiner LA, Studer W, Baumgartner ER, Frei FJ
Department of Anaesthesia, Universitatskinderspital beider
Basel (UKBB), Basel, Switzerland. las30@cam.ac.uk
Very-long-chain acyl-coenzyme A dehydrogenase deficiency
is an inborn error of fatty acid metabolism. The clinical
presentation of this disease in children is either a severe
form with onset of symptoms in the first months of life,
cardiomyopathy, metabolic acidosis, myopathy and a high
mortality, or a less severe form manifesting mainly with
hypoglycaemia. Perioperative fasting and (even emotional)
stress can trigger metabolic decompensation through the
altered metabolism of endogenous fatty acids resulting in
hypoglycaemia, acute cardiac and hepatic dysfunction and
rhabdomyolysis. We report the perioperative management of
a 9-year-old boy suffering from the severe form of this
disease who underwent circumcision. Metabolism was kept
stable in this child by using a glucose--electrolyte infusion
throughout the perioperative period to avoid the biochemical
consequences of fasting and a benzodiazepine--opioid technique
combined with regional anaesthesia to minimize the stress
response. Considering reports about a possible interference
of propofol with fatty acid oxidation and to avoid the unnecessary
administration of fatty acids, propofol should not be used
in these patients.
PMID: 11882234, UI: 21877529
Paediatr Anaesth 2002 Feb;12(2):140-5
Comparison of rocuronium and suxamethonium for rapid tracheal
intubation in children.
Cheng CA, Aun CS, Gin T
Department of Anaesthesia and Intensive Care, The Chinese
University of Hong Kong, The Prince of Wales Hospital, Shatin,
New Territories, Hong Kong.
BACKGROUND: The purpose of our study was to determine whether
a smaller dose of rocuronium than previously reported could
provide similar intubating conditions to suxamethonium during
rapid-sequence induction of anaesthesia in children. METHODS:
One hundred and twenty ASA I, unpremedicated children, aged
1-10 years, who were undergoing elective surgery, were randomized
into three groups to receive rocuronium 0.6 mg.kg-1, rocuronium
0.9 mg.kg-1 or suxamethonium 1.5 mg.kg-1. The study was
double-blinded, anaesthesia and timing of injection was
standardized to alfentanil 10 microg.kg-1, thiopentone 5
mg.kg-1 and the study drug. Intubation was attempted at
30 s after injection of neuromuscular relaxant and intubating
conditions graded as excellent, good, poor or impossible.
RESULTS: All 120 children were successfully intubated within
60 s without need for a second attempt after administration
of neuromuscular relaxant. Differences between suxamethonium
and rocuronium 0.6 mg.kg-1 and between the two doses of
rocuronium were statistically significant (P=0.016 and 0.007,
respectively). CONCLUSIONS: Rocuronium 0.9 mg.kg-1 provides
similar intubating conditions to suxamethonium 1.5 mg.kg-1
during modified rapid-sequence induction using alfentanil
and thiopentone in children (P=0.671). Rocuronium 0.6 mg.kg-1
was inadequate.
Publication Types:
Clinical trial
Randomized controlled trial
PMID: 11882225, UI: 21877520
Paediatr Anaesth 2002 Feb;12(2):131-9
The effects of an educational programme on the anxiety
and satisfaction level of parents having parent present
induction and visitation in a postanaesthesia care unit.
Chan CS, Molassiotis A
Department of Nursing, Faculty of Medicine, The Chinese
University of Hong Kong, School of Nursing, University of
Nottingham, Nottingham, UK. connychan@cuhk.edu.hk
BACKGROUND: In Hong Kong, some hospitals have established
the practice of Parental Presence Induction (PPI) and visitation
in Postanaesthesia Care Units (PACU) for children receiving
surgery. The literature indicates that parents reported
extreme anxiety and discomfort after being present at induction
of anaesthesia and suggests that it would seem appropriate
to devise a programme of education to reduce anxiety for
parents. METHODS: A quasi-experimental pretest and post-test
design was employed. Parents in the experimental group received
an educational programme about the role and expectations
of parents having PPI and visitation in PACU together with
an information pamphlet. The comparison group received routine
(verbal) instructions. The Chinese version of the State
and Trait Anxiety Inventory and the Parental Satisfaction
with Care Questionnaire were used to assess parents' anxiety
and satisfaction with care. RESULTS: A total of 50 parents
(mostly mothers) were recruited. Twenty-five were allocated
in the intervention group and 25 in the comparison group.
The children were aged 1--9 years with a mean age of 2.9
years. There were 46 male and four female children. The
results demonstrate that parents who received an education
programme reported a decrease in anxiety (P < 0.001)
and an increase in their satisfaction with the care provided
(P < 0.001). A significant negative relationship (r=
-0.61, P < 0.001) between parental anxiety postoperatively
and the satisfaction with care score was also obtained,
suggesting that lower levels of parental anxiety are associated
with higher levels of satisfaction. CONCLUSIONS: The study
suggests that an educational programme preparing parents
for their child's induction of anaesthesia and visitation
to the PACU should be offered, as it can reduce their anxiety
with the practice of PPI and visitation in the PACU and
increase parents' satisfaction with care.
PMID: 11882224, UI: 21877519
Paediatr Anaesth 2002 Feb;12(2):118-23
Is haemostasis biological screening always useful before
performing a neuraxial blockade in children?
Roux CL, Lejus C, Surbleb M, Renaudin M, Guillaud C, Windt
A, Lasnier B, Pinaud M
Department of Anaesthesiology, Hotel Dieu, CHU Nantes,
France.
BACKGROUND: Because of the lack of controlled studies,
there is no consensus of opinion about the practice of routine
haemostasis tests before neuraxial blockade in children.
The purpose of this study was to compare the influence of
two different strategies of coagulation evaluation on the
incidence of diagnosed coagulopathies leading to a modification
of the preoperative or anaesthetic management in children
who were scheduled for caudal, epidural or intrathecal block.
METHODS: For a 24-month period (period 1, retrospective
study, n=751), haemostasis screening was undertaken only
after family and personal history and physical examination
in all patients. For the following 24 months (period 2,
prospective study, n=958), a standardized questionnaire
was used. In addition, routine tests (prothrombin, partial
thromboplastin time, platelet count) were performed in children
who where not yet walking. In older children, coagulation
tests were undertaken as in period 1. RESULTS: Overall,
26 significant abnormalities were diagnosed. Coagulation
tests were performed in 16.2% (period 1) and 78.2% (period
2) of the children, who were not yet walking. Routine tests
did not improve the diagnosis of haemostasis abnormalities
justifying a modification of the preoperative and anaesthetic
management (2.2% from 406 children in period 1 vs 4.1% from
266 children in period 2). The predictive positive value
of routine tests (period 2) was 19%, vs 45% for specific
tests (period 1) (P < 0.001). In older children, the
use of a standardized form increased the number of haemostasis
screenings without improvement of diagnosis leading to modified
preoperative management (0.3% from 315 children in period
1 vs 0.5% from 628 children in period 2). CONCLUSIONS: When
routine testing is performed in nonwalking children, the
screening number increases without leading to a higher number
of anaesthetic management changes, suggesting that routine
testing does not seem to provide much extra information
in the absence of a positive history.
PMID: 11882222, UI: 21877517
Paediatr Anaesth 2002 Feb;12(2):110-7
Cardiac trauma in children.
Baum VC
Department of Anesthesiology, University of Virginia, Charlottesville,
VA, USA.
Publication Types:
Review
Review, tutorial
PMID: 11882221, UI: 21877516
Paediatr Anaesth 2002 Feb;12(2):107-9
Preparing parents for their child's surgery: preoperative
parental information and education.
TUTTO
IL MATERIALE CONTENUTO IN QUESTO SITO E' STATO REPERITO IN RETE. GLI AUTORI
NON SI ASSUMONO RESPONSABILITA' PER
DANNI A TERZI DERIVATI DA USO IMPROPRIO O ILLEGALE DELLE INFORMAZIONI
RIPORTATE O DA ERRORI RELATIVI AL LORO CONTENUTO.
