Ultimo Aggiornamento: 31 Dicembre 2002

38 citations found

Acta Anaesthesiol Scand 2002 Feb;46(2):224-6

Central anticholinergic syndrome in a child undergoing circumcision.

Schultz U, Idelberger R, Rossaint R, Buhre W

Klinik fur Anasthesiologie, Universitatsklinikum der RWTH, Aachen, Germany. uta.schultz@post.rwth-aachen.de

We describe one of the few pediatric cases of central anticholinergic syndrome (CAS) in an 8-year-old boy undergoing elective surgery. Deep sedation, inadequate response to stimuli and reduced muscular tone of the upper airway resulting in airway obstruction were the clinical manifestations of CAS. The symptoms resolved immediately after administration of physostigmine. This case illustrates the importance of considering central anticholinergic syndrome as a differential diagnosis in children if prolonged sedation after general anesthesia occurs.

PMID: 11942877, UI: 21940011

Acta Anaesthesiol Scand 2002 Feb;46(2):217-20

Postoperative epidural hematoma or cerebrovascular accident? A dilemma in differential diagnosis.

Pay LL, Chiu JW, Thomas E

Department of Anesthesia, KK Women's and Children's Hospital, Singapore.

An elderly lady developed an epidural hematoma following combined spinal-epidural anesthesia with a local anesthetic-opioid mixture for a vaginal hysterectomy. This occurred in association with the use of prophylactic subcutaneously administered unfractionated heparin. She had diabetes, hypertension and had previously undergone coronary artery bypass surgery and right carotid endarterectomy. Warfarin and aspirin were discontinued 2 weeks before the surgery. Postoperatively, an atypical presentation of backache, bilateral sensory loss and left lower limb monoplegia ensued. The initial clinical impression was of a cerebrovascular accident. Magnetic resonance imaging, however, revealed an extensive epidural hematoma that necessitated decompression laminectomy. Progression to paraparesis occurred but the patient gradually regained much of her functionality over the next 2 years.

PMID: 11942875, UI: 21940009

Acta Anaesthesiol Scand 2002 Feb;46(2):194-8

Pharmacokinetics of a 24-hour intravenous ketoprofen infusion in children.

Kokki H, Karvinen M, Jekunen A

Department of Anesthesiology and Intensive Care, Kuopio University Hospital, Finland. hannu.kokki@nam.fi

BACKGROUND: No pharmacokinetic data are available with respect to the plasma concentration of ketoprofen during intravenous infusion in children. METHODS: We present here the pharmacokinetics of ketoprofen after a 10-min intravenous infusion of 1 mg/kg followed by a 24-h infusion of 4 mg/kg in 18 children aged 7 months to 16 years. Venous blood samples were collected at 5 min, 1, 2, 4, 24 h following the loading dose, and then 1, 2 and 4 h after the end of the infusion. A validated HPLC method was used to measure plasma levels of ketoprofen. RESULTS: The steady state plasma concentration of ketoprofen was 2.0 microg/mL (range 1.3-2.7 microg/mL). The clearance of ketoprofen was 0.09 L x h(-1) x kg(-1) (range 0.06-0.13 L x h(-1) x kg(-1)). The distribution volume was 0.16 L/kg (range 0.12-0.21 L/kg). The terminal half-life was 1.3 h (range 0.8-1.7 h). CONCLUSION: The pharmacokinetics of ketopofen in children is similar to that reported in adults. Our results indicate that ketoprofen is a feasible drug for continuous intravenous infusion in acute pain treatment in children.

PMID: 11942870, UI: 21940004

Anaesthesia 2002 May;57(5):501-521

Anaesthetic management of a patient with Stiff-person syndrome.

[Record supplied by publisher]

PMID: 11966568

Anaesthesia 2002 May;57(5):501-521

Monitoring of the anaesthetic volatile agent may be impaired in hydrocarbons abusers.

[Record supplied by publisher]

PMID: 11966567

Anaesthesia 2002 May;57(5):501-521

Anaesthesia and the elderly.

[Record supplied by publisher]

PMID: 11966560

Anaesthesia 2002 May;57(5):429-33

Study of a combined percutaneous local anaesthetic and nitric oxide-generating system for venepuncture.

Tucker AT, Makings E, Benjamin N

The Ernest D. Cooke Clinical Microvascular Unit and Department of Anaesthetics, St. Bartholomew's Hospital, West Smithfield, London EC1A 7BE, UK Clinical Pharmacology, St. Bartholomew's and the Royal London School of Medicine and Dentistry, London, UK.

[Medline record in process]

Nitric oxide (NO) may be generated and delivered into the skin via a novel system of sodium nitrite and ascorbic acid. This placebo-controlled, double-blind trial compared the analgesic properties of this system alone and when supplemented with lidocaine. The pain of dorsal hand vein cannulation was assessed in 100 volunteers. The NO-generating system was prepared by mixing two gels, the first KY jellytrade mark and sodium nitrite (10% w/v), the second KY jellytrade mark and ascorbic acid (10% w/v). NO-generating gel was the placebo treatment, and when combined with lidocaine (final concentration 5%), formed the active treatment. The gels were applied to the dorsum of the hands bilaterally and simultaneously for 10 min. Following cannulation, pain perception was measured with a verbal rating score (VRS) and a visual analogue score (VAS). The active formulation significantly decreased the VRS (p < 0.0001) and also reduced the mean VAS by > 40% compared with placebo (p < 0.001). This investigation suggests a 10-min topical application of anaesthetic combined with the NO-generation system may provide effective analgesia for venous cannulation in adults.

PMID: 11966551, UI: 21963372

Anaesthesia 2002 May;57(5):421-423

Anaesthesia in the Magnetic Resonance Unit: a hazardous environment.

[Record supplied by publisher]

PMID: 11966549

Anesth Analg 2002 May;94(5):1374

Failure of the chain-link mechanism of the ohmeda excel 210 anesthesia machine.

Paine GF, Kochan JJ 3rd

Department of Anesthesiology, Naval Medical Center, Portsmouth, VA. Department of Anaesthesia & Surgical Intensive Care, Singapore General Hospital, Singapore.

[Medline record in process]

PMID: 11973234, UI: 21969051

Anesth Analg 2002 May;94(5):1365

Thoracic epidural anesthesia & analgesia in patients undergoing coronary artery bypass surgery.

Riedel BJ, Shaw AD

Division of Anesthesiology and Critical Care Medicine, The University of Texas M. D. Anderson Cancer Center, Houston, TX.

[Medline record in process]

PMID: 11973221, UI: 21969038

Anesth Analg 2002 May;94(5):1351-64

Anesthesia for electroconvulsive therapy.

Ding Z, White PF

Departments of Anesthesiology and Pain Management, First Affiliated Hospital of Nanjing Medical University, China.

[Medline record in process]

PMID: 11973219, UI: 21969036

Anesth Analg 2002 May;94(5):1340-4

Should we reevaluate the variables for predicting the difficult airway in anesthesiology?

Turkan S, Ates Y, Cuhruk H, Tekdemir I

Departments of Anesthesiology & Reanimation and Anatomy, Ankara University Medical Faculty, Turkey.

[Medline record in process]

Anesthesiologists have often been confronted with the difficult question of determining which patient will present an increased difficulty for endotracheal intubation. The limits of the previously reported morphometric airway measurements for predicting difficult intubation have inadequately addressed the normal patient population variables. We designed this prospective study to investigate the age and sex-related changes in the morphometric measurements of the airway in a large group of patients without anatomic abnormality and a group of cadavers. Hyomental, thyromental, sternomental distances, neck extension, and Mallampati scores were evaluated in 12 cadavers and in 334 patients. Patients were allocated to three groups based on age: Group 1 (20-30 yr), Group 2 (31-49 yr), and Group 3 (50-70 yr). Male and female sex differences were also evaluated. Hyomental distance was the only variable not affected by age. In addition, the mean population values were less than the threshold values suggested as criteria for difficult endotracheal intubation. All the other criteria were age-dependent and inversely affected by the increase in age. Male sex was also a distinction for increased measurements of all the morphometric distances. The mean degree of neck extension was similar in both sex groups. This study provides a more comprehensible approach to the morphometric measurements of the human airway. Adequate data of normal values may help the clinician to identify patients that are outside the range and therefore may be challenging. IMPLICATIONS: This study was performed to establish data on the average values of airway morphology in the adult population of different age groups and sex. Hyomental, thyromental, sternomental distances and neck extension values were measured on 12 cadavers and 334 patients.

PMID: 11973217, UI: 21969034

Anesth Analg 2002 May;94(5):1338-9

Spinal anesthesia as a complication of brachial plexus block using the posterior approach.

Aramideh M, Van Den Oever HL, Walstra GJ, Dzoljic M

Departments of Anesthesiology and Neurology, Academic Medical Center, University of Amsterdam, The Netherlands.

[Medline record in process]

IMPLICATIONS: In this case report we describe a technique used to provide local analgesia for surgical procedures. Although this technique has a reduced risk of complications, we present a patient who experienced a life-threatening paralysis without loss of consciousness during an attempted brachial plexus block with a posterior approach.

PMID: 11973216, UI: 21969033

Anesth Analg 2002 May;94(5):1331-1337

Isoflurane Requirements During Combined General/Epidural Anesthesia for Major Abdominal Surgery.

Casati L, Fernandez-Galinski S, Barrera E, Pol O, Puig MM

Department of Anesthesiology, Hospital Universitario del Mar, Universidad Autonoma de Barcelona, Barcelona, Spain.

[Record supplied by publisher]

We evaluated the effects of bupivacaine on the requirements for thiopental and isoflurane during combined general/epidural anesthesia. Sixty patients scheduled for colon resection were randomly distributed into six groups that received, before the induction of anesthesia, an epidural (T9-10) bolus (8 mL) followed by an infusion (8 mL/h) of saline (Groups 1 and 4), bupivacaine 0.0625% plus fentanyl 2 &mgr;g/mL (Groups 2 and 5), or bupivacaine 0.125% plus fentanyl 2 &mgr;g/mL (Groups 3 and 6). We evaluated the amount of thiopental needed to abolish the eyelid reflex and the percentage of isoflurane required to maintain the bispectral index (BIS) between 50 and 60 (Groups 1-3) or the mean arterial blood pressure (MAP) within 20% of basal values (Groups 4-6). All groups required similar doses of thiopental (5 mg/kg); the time of evaluation, but not epidural treatment, had a significant effect (P < 0.0001) on BIS and MAP. After tracheal intubation, MAP and BIS increased by 18% and 49%, respectively (P < 0.05). In the bupivacaine groups, isoflurane requirements similarly decreased by 35% (P < 0.03). For BIS and MAP, the epidural treatment (P < 0.02) and type of evaluation (P < 0.03) had a significant effect; MAP was lower (P < 0.05) with 0.125% bupivacaine. We conclude that epidural bupivacaine does not alter the thiopental dose, but it decreases isoflurane requirements by 35%. This study demonstrates that both doses of bupivacaine and fentanyl induce similar isoflurane-sparing effects. However, patients receiving 0.125% bupivacaine showed lower values of MAP when compared with controls, and thus bupivacaine 0.0625% should be favored during combined anesthesia. IMPLICATIONS: In patients undergoing colon resection under combined anesthesia, isoflurane requirements were assessed by changes in blood pressure or bispectral index. Epidural bupivacaine at concentrations of 0.125% or 0.0625% (each with 2 mg/mL of fentanyl) induced the same sparing of isoflurane (35%). The smaller dose produced less hypotension and should be favored.

PMID: 11973215

Anesth Analg 2002 May;94(5):1325-1330

The Effects of Age on Neural Blockade and Hemodynamic Changes After Epidural Anesthesia with Ropivacaine.

Simon MJ, Veering BT, Stienstra R, Van Kleef JW, Burm AG

Department of Anesthesiology, Leiden University Medical Center, Leiden, The Netherlands.

[Record supplied by publisher]

We studied the influence of age on the neural blockade and hemodynamic changes after the epidural administration of ropivacaine 1.0% in patients undergoing orthopedic, urological, gynecological, or lower abdominal surgery. Fifty-four patients were enrolled in one of three age groups (Group 1: 18-40 yr; Group 2: 41-60 yr; Group 3: >/=61 yr). After a test dose of 3 mL of prilocaine 1.0% with epinephrine 5 &mgr;g/mL, 15 mL of ropivacaine 1.0% was administered epidurally. The level of analgesia and degree of motor blockade were assessed, and hemodynamic variables were recorded at standardized intervals. The upper level of analgesia differed among all groups (medians: Group 1: T8; Group 2: T6; Group 3: T4). Motor blockade was more intense in the oldest compared with the youngest age group. The incidence of bradycardia and hypotension and the maximal decrease in mean arterial blood pressure during the first hour after the epidural injection (median of Group 1: 11 mm Hg; Group 2: 16 mm Hg; Group 3: 29 mm Hg) were more frequent in the oldest age group. We conclude that age influences the clinical profile of ropivacaine 1.0%. The hemodynamic effects in older patients may be caused by the high thoracic spread of analgesia, although a diminished hemodynamic homeostasis may contribute. IMPLICATIONS: Analgesia levels after the epidural administration of 15 mL of ropivacaine 1.0% increase with increasing age. This is associated with an increased incidence of hypotension in the elderly, although an effect of age on the hemodynamic homeostasis may have contributed. It appears that epidural doses should be adjusted for elderly patients.

PMID: 11973214

Anesth Analg 2002 May;94(5):1318-20

Does hearing loss after spinal anesthesia differ between young and elderly patients?

Gultekin S, Ozcan S

Department of Anesthesiology, Ministry of Health, Menemen State Hospital, Izmir, Turkey.

[Medline record in process]

Fifty male patients scheduled for inguinal hernia repair with spinal anesthesia were included in this study. The patients were divided into two groups: 25 patients aged 30 yr or younger (Group Y) and 25 patients aged 60 yr or older (Group E). We performed subarachnoidal injection at the L3-4 interspace by using a 25-gauge Quincke needle with the patient in the sitting position, and 3 mL of 0.5% isobaric bupivacaine was administered. Patients were evaluated by pure tone audiometry (LdB [low frequencies], 125-500 Hz; SdB [speech frequencies], 500-2000 Hz; HdB [high frequencies], 2000-6000 Hz) on the day before and 2 days after spinal anesthesia. Low-frequency hearing loss observed in Group Y was significantly more common than in Group E (P < 0.01). There was no difference between the groups in speech and high frequencies. Mild hearing loss, defined as a hearing loss of 10-20 dB at two or more frequencies, was observed three times more frequently in Group Y than Group E (52% vs 16%; P = 0.014). We conclude that transient hearing loss was more common in young patients after spinal anesthesia, perhaps because the cerebrospinal fluid leakage after dural puncture is less in the elderly than in the young, a finding also associated with the infrequent incidence of postdural puncture headache in the elderly. IMPLICATIONS: Spinal anesthesia is one of the most frequently used regional anesthesia techniques in surgical interventions; however, rarely it may cause some transient or permanent neurological problems. One of these problems is headache, which is more frequent and severe in the young, and hearing loss, especially at low frequencies. Both the pain and the hearing loss are caused by leak of cerebrospinal fluid caused by the puncture in the membrane of the spinal cord during the procedure. We hypothesized that hearing loss might also be more frequent and severe in the young, and to test this hypothesis, we compared the hearing loss developing after spinal anesthesia between the young and the elderly. The implications of this study are as follows: First, spinal anesthesia must be performed carefully, especially in the young. Second, measures must be taken to avoid the leak of cerebrospinal fluid. This study reveals possible problems caused by spinal anesthesia in the young which can be easily overlooked.

PMID: 11973212, UI: 21969029

Anesth Analg 2002 May;94(5):1298-1303

Mild Core Hypothermia and Anesthetic Requirement for Loss of Responsiveness During Propofol Anesthesia for Craniotomy.

Leslie K, Bjorksten AR, Ugoni A, Mitchell P

Outcomes Research Group, Department of Anaesthesia and Pain Management, and the Department of Radiology, Royal Melbourne Hospital, Melbourne, Australia.

[Record supplied by publisher]

Mild hypothermia may be induced during neurosurgery for brain protection. However, its effect on propofol requirement has not been defined. Accordingly, we tested the hypothesis that 3 degrees C of core hypothermia decreases the propofol blood concentration at which patients respond to command (CP50-awake) in neurosurgical patients. Forty patients were anesthetized with alfentanil 50 &mgr;g/kg IV, nitrous oxide, propofol target-controlled infusion, and rocuronium. The bispectral index (version 3.12) was monitored continuously. Patients were randomized to a core temperature of 34 degrees C or 37 degrees C. At the end of surgery, neuromuscular blockade was reversed, nitrous oxide was ceased, and propofol was infused to achieve a blood target determined by the previous patient's response. Responsiveness to command was assessed 15 min later. Results were analyzed with logistic regression models; P < 0.05 was considered statistically significant. The CP50-awake of propofol was 3.05 &mgr;g/mL (95% confidence interval, 2.34-3.66). Propofol concentration, but not core temperature, predicted loss of response to command (odds ratio, 11.76; 95% confidence interval, 2.40-57.63; P < 0.01). Core temperature did not alter the relationship between bispectral index and response to command. Propofol infusion regimens may not require adjustment during mild hypothermia. IMPLICATIONS: Neurosurgical patients may be allowed to become mildly hypothermic during anesthesia in an effort to provide brain protection. Propofol maintenance infusion doses may not require adjustment in these patients.

PMID: 11973207

Anesth Analg 2002 May;94(5):1288-97

Continuous renal replacement therapy: anesthetic implications.

Petroni KC, Cohen NH

Department of Anesthesiology, Naval Medical Center San Diego, California.

[Medline record in process]

PMID: 11973206, UI: 21969023

Anesth Analg 2002 May;94(5):1207-1211

Propofol Anesthesia Enhances the Pressor Response to Intravenous Ephedrine.

Kanaya N, Satoh H, Seki S, Nakayama M, Namiki A

Department of Anesthesiology, Sapporo Medical University School of Medicine, Sapporo, Japan.

[Record supplied by publisher]

The induction of anesthesia with propofol is often associated with a decrease in arterial blood pressure (BP). Although vasopressors are sometimes required to reverse the propofol-induced hypotension, little is known about the effect of propofol on these drugs. We studied the effects of propofol and sevoflurane on pressor response to IV ephedrine. Thirty adult patients were randomly assigned to one of two groups. In the Propofol group (n = 15), patients received pro-pofol 2.5 mg/kg IV for induction followed by 100 &mgr;g. kg(-1). min(-1) IV for maintenance. In the Sevoflurane group (n = 15), anesthesia was induced with sevoflurane 3%-4% in oxygen and maintained with sevoflurane 2% in oxygen. All patients in both groups received ephedrine 0.1 mg/kg IV before and after the anesthetic induction. Ephedrine increased the heart rate significantly (P < 0.05) in awake patients in both study groups. In contrast, there was no increase in heart rate after the ephedrine administration under propofol or sevoflurane anesthesia. In awake patients, transient increases in mean BP were observed after IV ephedrine in both groups. In the Propofol group, 2 min after the administration of ephedrine, mean BP increased 16% +/- 10% under anesthesia but increased only 4% +/- 6% when the same patients were awake. The magnitudes of the pressor responses to ephedrine during propofol anesthesia were significantly greater (P < 0.05) than during the awake state. However, ephedrine 0.1 mg/kg IV showed no significant increases in BP during sevoflurane anesthesia. We conclude that propofol, not sevoflurane, anesthesia augments the pressor responses to IV ephedrine. IMPLICATIONS: The effect of anesthetics on vasopressor-mediated cardiovascular effects is poorly understood. We evaluated the pressor response to ephedrine during propofol or sevoflurane anesthesia. Our study suggests that anesthesia-induced hypotension may be easier to reverse with ephedrine during propofol anesthesia than during sevoflurane anesthesia.

PMID: 11973191

Anesth Analg 2002 May;94(5):1194-8

Induction of anesthesia and insertion of a laryngeal mask airway in the prone position for minor surgery.

Ng A, Raitt DG, Smith G

University Department of Anaesthesia, Critical Care & Pain Management, University Hospitals of Leicester, NHS Trust, Leicester Royal Infirmary, Leicester, England.

[Medline record in process]

The use of the prone position for surgery presents potential obstacles to rapid tracking of patients during ambulatory anesthesia. We describe a prospective audit of 73 patients who placed themselves in the prone position; anesthesia was induced in this position and a laryngeal mask airway (LMA) was used to maintain the airway. Additional increments of propofol were given to one patient who had laryngospasm and to nine who required deepening of anesthesia before the LMA could be inserted. Of four cases with LMA malpositioning, the LMA was adjusted easily in three, but in one patient who was edentulous, it was necessary to hold the LMA for the duration of the procedure. Manual ventilation of the lungs via the LMA was required because of arterial oxygen desaturation and hypoventilation in four patients. Blood was noted outside the nostrils in two patients, presumably caused by soft tissue trauma after insertion of the LMA, and bradycardia occurred in five patients. In the postoperative period, hoarseness and sore throat were observed in one and six patients, respectively. With experience and appropriate patient selection, it is possible to induce and maintain anesthesia using a LMA in patients in the prone position for ambulatory surgery. IMPLICATIONS: With experience and appropriate patient selection, it is possible to induce and maintain anesthesia using a laryngeal mask airway in patients in the prone position for ambulatory surgery.

PMID: 11973188, UI: 21969005

Anesth Analg 2002 May;94(5):1178-1181

The Effect of Fentanyl on the Emergence Characteristics After Desflurane or Sevoflurane Anesthesia in Children.

Cohen IT, Finkel JC, Hannallah RS, Hummer KA, Patel KM

Departments of Anesthesiology and Pediatrics, Children's National Medical Center and George Washington University Medical Center, Washington, DC.

[Record supplied by publisher]

Desflurane and sevoflurane anesthesia are associated with emergence agitation in children. In this study, we examined the effect of a single intraoperative dose of fentanyl on emergence characteristics in children undergoing adenoidectomy. One hundred children, 2-7 yr old, were randomly assigned to receive desflurane or sevoflurane for maintenance of general anesthesia after an inhaled induction with sevoflurane and a 2.5 &mgr;g/kg dose of fentanyl. An observer blind-ed to the anesthetic technique assessed the times to achieve emergence, extubation and recovery criteria, as well as emergence behaviors. The results showed a similar incidence of severe emergence agitation after general anesthesia with desflurane (24%) and sevoflurane (18%). Times to achieve extubation and postanesthesia care unit discharge criteria were shorter with desflurane than with sevoflurane. With this technique, desflurane allows for a more rapid emergence and recovery than sevoflurane. In children receiving desflurane or sevoflurane, the concurrent use of fentanyl in a dose of 2.5 &mgr;g/kg results in a small incidence of emergence agitation. IMPLICATIONS: The concurrent use of fentanyl in a dose of 2.5 &mgr;g/kg in children receiving desflurane or sevoflurane results in a low incidence of emergence agitation. Desflurane allows for a more rapid emergence and recovery than sevoflurane.

PMID: 11973185

Anesth Analg 2002 May;94(5):1165-8

The hemodynamic effects of pediatric caudal anesthesia assessed by esophageal Doppler.

Larousse E, Asehnoune K, Dartayet B, Albaladejo P, Dubousset AM, Gauthier F, Benhamou D

Department of Anesthesiology and Critical Care Medicine and Department of Pediatric Surgery, Centre hospitalo-universitaire du Kremlin Bicetre, France.

[Medline record in process]

Pediatric caudal anesthesia is an effective method with an infrequent complication rate. However, little is known about its cardiovascular consequences. Transesophageal Doppler, a noninvasive method, provides the opportunity for a reappraisal of the hemodynamic effects of this technique. After parental informed consent, we studied 10 children aged 2 mo to 5 yr who were scheduled for lower abdominal surgery. General anesthesia was induced using sevoflurane and was followed by the insertion of a transesophageal Doppler probe. Caudal anesthesia was performed using 1 mL/kg of 0.25% bupivacaine with 1/200,000 epinephrine. Hemodynamic variables were collected before and after caudal anesthesia. No complications arose during insertion of the probe. The mean time between the two sets of measurements was 15 min. Heart rate, systolic, diastolic, and mean arterial blood pressures were not modified by caudal anesthesia. Descending aortic blood flow increased significantly from 1.14 to 1.92 L/min. (P = 0.0002). Aortic ejection volume increased from 8.5 to 14.5 mL (P = 0.0002). Aortic vascular resistances decreased from 6279 to 3901 dynes. s(-1). m(-5) (P = 0.005). Caudal anesthesia did not affect heart rate and mean arterial blood pressure but induced a significant increase in descending aortic blood flow. IMPLICATIONS: Although pediatric caudal anesthesia does not alter heart rate nor arterial blood pressure, significant changes occur in regional blood flow distribution. Descending aortic blood flow increases significantly after caudal anesthesia, whereas lower body vascular resistances decrease.

PMID: 11973181, UI: 21968998

Anesth Analg 2002 May;94(5):1155-60

Permission and assent for clinical research in pediatric anesthesia.

Erb TO, Schulman SR, Sugarman J

Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina.

[Medline record in process]

IMPLICATIONS: This article discusses the process and specific nature of informed consent for clinical research in pediatric anesthesia. For informed consent to be meaningful, permission from the child's proxy must be obtained and the child's assent must be tailored in a manner that is sensitive to the abilities of children.

PMID: 11973179, UI: 21968996

Anesth Analg 2002 May;94(5):1137-1140

Vascular Responsiveness to Brachial Artery Infusions of Phenylephrine During Isoflurane and Desflurane Anesthesia.

Arain SR, Williams DJ, Robinson BJ, Uhrich TD, Ebert TJ

Department of Anesthesiology, The Medical College of Wisconsin and Veterans Affairs Medical Center, Milwaukee.

[Record supplied by publisher]

Compared with equi-minimum alveolar anesthetic concentration (MAC) isoflurane, desflurane is associated with greater levels of sympathetic nerve activity in humans but similar reductions in blood pressure. To explore these divergent effects, we evaluated vascular alpha(1)-adrenoceptor responses in the human forearm during isoflurane and desflurane anesthesia to determine if alpha(1)-adrenoceptor responses were more substantially attenuated during desflurane administration. Bilateral forearm venous occlusion plethysmography was used to examine arterial blood flow and to determine changes in forearm vascular resistance during brachial artery infusions of saline and phenylephrine (0.2, 0.4, 0.8, and 1.6 &mgr;g/min) in 22 conscious subjects and during anesthesia with 0.65 and 1.3 MAC isoflurane or desflurane. Infusion of phenylephrine into the brachial artery increased the forearm vascular resistance in a dose-dependent manner. The arterial response to phenylephrine was significantly attenuated by 0.65 and 1.3 MAC desflurane and similarly attenuated during 1.3 MAC isoflurane (P < 0.05). Impaired arterial alpha(1)-adrenoceptor responsiveness occurred during desflurane. However, this effect was statistically similar (P > 0.05) to the impaired responses during isoflurane. Blood pressure decreases during volatile anesthesia may be, in part, caused by decreased alpha(1)-adrenoceptor responsiveness. IMPLICATIONS: alpha-receptors on blood vessels regulate constriction and dilation and therefore modulate blood pressure. This research indicates that vasoconstriction via the alpha(1)-receptor vascular response is impaired during isoflurane and desflurane anesthesia.

PMID: 11973175

Anesth Analg 2002 May;94(5):1107-1112

Pulmonary Gas Exchange in Coronary Artery Surgery Patients During Sevoflurane and Isoflurane Anesthesia.

Loeckinger A, Keller C, Lindner KH, Kleinsasser A

Department of Anesthesiology, Critical Care and Emergency Medicine, The Leopold-Franzens University Innsbruck, Innsbruck, Austria.

[Record supplied by publisher]

As the surgical population ages, the number of patients presenting with coronary artery disease and age-related loss of pulmonary recoil will increase. Although their influence on gas exchange in this population remains unknown, sevoflurane and isoflurane are used for an increasing variety of surgical procedures. We examined pulmonary gas exchange (multiple inert gas elimination technique) in 30 patients presenting for coronary artery bypass grafting. After a baseline measurement taken during midazolam anesthesia, patients were continued on sevoflurane (n = 10), isoflurane (n = 10), or midazolam (n = 10) for 20 min, then a second measurement was taken. During sevoflurane and isoflurane anesthesia, blood flow to lung areas with a low ventilation/perfusion ratio (&OV0312;a/&OV0422;) was significantly increased in comparison with control. During sevoflurane anesthesia, blood flow to lung areas with a normal &OV0312;a/&OV0422; ratio (76 +/- 12 versus control: 89 +/- 5, mean +/- SD) and PaO(2) (138 +/- 31 versus control: 156 +/- 35 mm Hg, mean +/- SD) were depressed, whereas an increase in &OV0312;a/&OV0422;-dispersion (log SD(Q)) was observed during isoflurane anesthesia. We conclude that both sevoflurane and isoflurane alter the distribution of perfusion in the lung, but only sevoflurane significantly depresses PaO(2). IMPLICATIONS: Both sevoflurane and isoflurane modified pulmonary blood flow in patients with coronary artery disease, but only sevoflurane depresses arterial oxygenation in this population.

PMID: 11973170

Anesth Analg 2002 May;94(5):1065-71

The use of and preferences for the transesophageal echocardiogram and pulmonary artery catheter among cardiovascular anesthesiologists.

Jacka MJ, Cohen MM, To T, Devitt JH, Byrick R

Departments of Anesthesiology and Critical Care, University of Alberta, Edmonton, Alberta, Canada.

[Medline record in process]

The pulmonary artery catheter (PAC), although widely used in anesthesia for cardiac and vascular surgery, remains controversial. Use of transesophageal echocardiography (TEE) by cardiovascular anesthesiologists may be a substitute or a preference compared with the PAC, but this has been incompletely investigated. An anonymous, cross-sectional survey was mailed to anesthesiologists in Canada and the United States. Anesthesiologists described their use of the PAC and TEE during cardiac and vascular surgery, along with their demographic characteristics. Two hundred sixty-five (77%) of 345 anesthesiologists responded. All had the PAC available for use, and 56% had TEE available. Only 23 (11% overall) reported having undergone echocardiography training, half of whom had completed fellowships. Both the PAC and TEE were more often used in cardiac valvular surgery (P = 0.0001) than in aortocoronary bypass or abdominal vascular surgery. Among all anesthesiologists, the PAC remained the preferred monitor in either cardiac or vascular surgery (P = 0.0001), although many indicated a preference for neither monitor. Among anesthesiologists with echocardiography training, TEE was preferred (P = 0.0004). We found that TEE was accessible to more than half of the surveyed anesthesiologists in cardiovascular surgery, but relatively few of them had completed formal training in its use. Only those with completed formal TEE training indicated a significant preference for TEE use and also used it frequently. Given the continuing controversy about the appropriate application of the PAC, concern about the appropriate application of TEE is prudent. The PAC remains the more frequently used and preferred monitor among cardiovascular anesthesiologists. IMPLICATIONS: A survey of anesthesiologists found that pulmonary artery catheter monitoring is currently more frequently used compared with transesophageal echocardiography during cardiac and vascular surgery.

PMID: 11973164, UI: 21968981

Ann Fr Anesth Reanim 2002 Feb;21(2):90-102

[Anesthesia-resuscitation for intracranial expansive processes in children.]

Meyer P, Orliaguet G, Blanot S, Cuttaree H, Jarreau MM, Charron B, Carli P

Departement d'anesthesie-reanimation chirurgicale, secteur pediatrique, CHU Necker-Enfants Malades, 149, rue de Sevres 75015 Paris, France. philippe.meyer@nck.ap-hop-paris.fr

The most frequent space-occupying cerebral lesions in children are brain tumors, mostly posterior fossa tumors and haematoma resulting from arteriovenous malformation rupture. They result in intracranial hypertension, directly or by compression of the cerebrospinal fluid pathway resulting in hydrocephalus. Their localization and compressive effects are responsible for specific neurological deficits and general problems. Posterior fossa lesions carry a high risk of obstructive hydrocephalus, cranial nerves palsy and brain stem compression, pituitary and chiasmatic tumors a risk of blindness, pituitary deficiency and diabetes insipidus, and cortical tumors a risk of motor deficit and epilepsy. All these parameters must be analyzed before choosing anaesthetic protocols, and surgical techniques. In the presence of life-threatening intracranial hypertension, emergency anaesthetic induction, tracheal intubation and ventilation are life-saving. The specific treatment consists in either hydrocephalus derivation, initial medical treatment with osmotherapy, or rarely surgical removal. In other situations, surgical process requires a highly deep, stable anaesthesia with perfect control of cerebral haemodynamics. Surgical positioning is complex for these long lasting procedures and carries specific risks. The most common is venous air embolism in the sitting position that must be prevented by the use of specific measures. In the postoperative period, the risk of neurological and general complications commands close surveillance, fast track extubation must be adapted on an individual basis.

Publication Types:

• Review
• Review, tutorial

PMID: 11915482, UI: 21913610

Ann Fr Anesth Reanim 2002 Feb;21(2):78-83

[Cerebrospinal fluid shunting: anesthetic particularities.]

Sesay M, Tentillier M, Mehsen M, Marguinaud E, Stockle M, Crozat P, Dubicq J, Boulard G, Maurette P

Departement d'anesthesie-reanimation 3, Hopital Pellegrin, 33076 Bordeaux, France.

The symptomatic treatment of hydrocephalus remains cerebrospinal fluid (CSF) drainage to an external reservoir (external CSF drainage) or to an internal cavity mainly the peritoneum or the right atrium via a unidirectional valve (internal CSF drainage) and finally by endoscopic ventriculocisternostomy. Local anaesthesia is adequate for external CSF drainage in adults and children above 10 years while general anaesthesia is required in all other cases. The main problems encountered in these patients are difficult intubation and full stomach associated with increased intracranial pressure. The anaesthetic approach should favour homeostasis. With the exception of ketamine and enflurane, the majority of anaesthetic drugs can be used. Anti-epileptic drug are mandatory. Antibioprophylaxis mainly against staphylococcus is systematic in internal CSF drainage. Rapid emergence from anaesthesia and extubation should be encouraged. Complications (infectious, mechanical and bleeding kinds) are frequent and are often the cause of reinterventions or revisions of the device, exposing the patients to iterative anaesthesia. Furthermore, patients with shunts are at risk of malfunction of the device when exposed to situations like pregnancy, magnetic resonance imaging, or laparoscopy. Under these circumstances, it is recommended to associate the neurosurgical team in the management of these patients and to verify that the shunt is working well before and after the procedure or event.

Publication Types:

• Review
• Review, tutorial

PMID: 11915480, UI: 21913608

Ann Fr Anesth Reanim 2002 Feb;21(2):73-7

[The specificity of neurosurgical anesthesia for the child.]

Bissonnette B

Divisions of Neurosurgical Anaesthesia and Cardiovascular Anaesthesia Research, Department of Anaesthesia, Hospital for Sick Children, Toronto, Ontario, Canada, M5G 1X8. bruno@anaes.sickkids.on.ca

Anaesthesia for paediatric neurosurgical procedures presents an interesting challenge to the anaesthesiologist. The child is not simply a small adult. At birth the central nervous system (CNS) development is incomplete and will not be mature until the end of the first year of life. Because of this delay in the maturation of the CNS, several specific pathophysiological and psychological differences ensue. Although one has little control on the child primary lesion, the selection of an anaesthetic technique designed to protect the perilesional area and the recognition of perioperative events and changes may well have a profound effect in the reduction or prevention of significant morbidity. Current neuroanaesthestic practice is based on the understanding of cerebral anatomy and physiology. Paediatric neuroanaesthesiologists must face the added challenge of the physiological differences between developing children and their adult counterparts.

Publication Types:

• Review
• Review, tutorial

PMID: 11915479, UI: 21913607

Ann Fr Anesth Reanim 2002 Feb;21(2):71-2

[Pediatric neuroanesthesia.]

Krivosic-Horber R, Riegel B, Ravussin P

Publication Types:

• Editorial

PMID: 11915478, UI: 21913606

Ann Fr Anesth Reanim 2002 Feb;21(2):170-8

[Anesthetic particularities of stereotaxic neurosurgery.]

Debailleul AM, Bortlein ML, Touzet G, Krivosic-Horber R

Departement d'anesthesie-reanimation chirurgicale 1, hopital Roger Salengro, CHRU Lille, rue E. Laine, 59037 Lille, France. am-debailleul@chru-lille.fr

Functional neurosurgery procedures are long and specific. Cooperation of the patient may be necessary during surgery. The interference of anaesthetic agents with electrophysiological monitoring should be as little as possible. Local anaesthesia combined with intravenous sedation is often used, but general anaesthesia is more comfortable and secure. Since awakening during the procedure is generally planed, it has to be quick, reliable and of excellent quality. These requirements are fulfilled by the association of propofol by target-controlled infusion (TCI) and a continuous infusion of remifentanil.

Publication Types:

• Review
• Review, tutorial

PMID: 11915477, UI: 21913620

Ann Fr Anesth Reanim 2002 Feb;21(2):111-8

[Anesthetic management for craniosynostosis.]

Orliaguet G, Meyer P, Blanot S

Departement d'anesthesie-reanimation, hopital Necker-Enfants Malades, 149, rue de Sevres, 75743 Paris, France. gilles.orliaguet@nck.ap-hop-paris.fr

Surgical procedures for correction of craniosynostosis are performed in young infants with a small blood volume and represent major surgery with extensive blood loss. An accurate determination and a precise restoration of blood losses represent the major concern for the anaesthetist during this surgery. The preoperative assessment of these patients is usually simple, except in the cases where the craniosynostosis is associated with other congenital malformations. The anaesthetist should keep in mind that intracranial hypertension may be associated with craniosysnostosis, which modify the anaesthetic management, especially the induction of anaesthesia. Even though the psychological impact of a craniosynostosis should be taken into consideration, surgery is most often indicated for functional considerations, therefore parents should be informed of the risks related to the procedure. During the postoperative period the major concerns are related to the possibility of a persistent bleeding, which usually decreases and disappears over the first 12 hours.

Publication Types:

• Review
• Review, tutorial

PMID: 11915469, UI: 21913612

Ann Fr Anesth Reanim 2002 Feb;21(2):103-10

[Surgery for craniosynostosis: timing and technique.]

Dhellemmes P, Pellerin P, Vinchon M, Capon N

Service de neurochirurgie, hopital Roger Salengro, CHRU, 59037 Lille, France. p-dhellemmes@chru-lille.fr

Craniosynostoses are a group of diseases, the presentation of which differs markedly on account of the cranial suture involved. Their impact is cosmetic, cerebral, and ophthalmologic. Syndromic craniosynostoses associate a more or less pronounced faciostenosis, which requires surgical correction as well, because of cosmetic, ophthalmologic or airway problems. Surgical treatment depends on the type of the craniosynostosis and the patient's age; ideally, the child should be operated between 3 and 12 months. This surgery requires a perfect collaboration between neurosurgeon, plastic surgeon, and anaesthesiologist. Surgical correction allows in large measures the preservation of intellect, sight, and body image.

Publication Types:

• Review
• Review, tutorial

PMID: 11915468, UI: 21913611

Paediatr Anaesth 2002 Mar;12(3):287

An abnormal dentition in progeria.

Arai T, Yamashita M

Publication Types:

• Letter

PMID: 11903946, UI: 21901923

Paediatr Anaesth 2002 Mar;12(3):267-71

Preoperative oral granisetron for the prevention of vomiting following paediatric surgery.

Fujii Y, Tanaka H

Department of Anaesthesiology, Toride Kyodo General Hospital, Toride City, Ibaraki, Japan. yfujii@igaku.md.tsukuba.ac.jp

BACKGROUND: We evaluated the efficacy of granisetron, 5-hydroxytryptamine type 3 receptor antagonist, given orally, preoperatively, for the prevention of postoperative vomiting in children undergoing general anaesthesia for surgery (inguinal hernia, phimosis-circumcision). METHODS: In a randomized, double-blinded manner, 100 children, ASA physical status I, aged 4-11 years, received orally placebo or granisetron at three different doses (20 microg x kg(-1), 40 microg x kg(-1), 80 microg x kg(-1)) 60 min before surgery (n=25 of each). The same standard general anaesthetic technique was used. RESULTS: The percentage of patients being emesis-free during 0-6 h after anaesthesia was 56% with placebo, 64% with graniseron 20 microg x kg(-1) (P=0.773), 88% with granisetron 40 microg x kg(-1) (P=0.027) and 92% with granisetron 80 microg x kg(-1) (P=0.01); the corresponding rate during 6-24 h after anaesthesia was 60%, 68% (P=0.768), 92% (P=0.02) and 92% (P=0.02) (P-values versus placebo). No clinically serious adverse events were observed in any of the groups. CONCLUSIONS: In summary, preoperative oral granisetron 40 microg x kg(-1) is effective for the prevention of vomiting following paediatric surgery (inguinal hernia, phimosis-circumcision). Increasing the doses to 80 microg x kg(-1) provides no demonstrable additional benefit.

Publication Types:

• Clinical trial
• Randomized controlled trial

PMID: 11903942, UI: 21901919

Paediatr Anaesth 2002 Mar;12(3):255-60

Ilioinguinal and iliohypogastric nerve block revisited: single shot versus double shot technique for hernia repair in children.

Lim SL, Ng Sb A, Tan GM

Department of Paediatric Anaesthesia, KK Women's and Children's Hospital, Singapore, Singapore. limsl@kkh.com.sg

BACKGROUND: We attempted to determine the efficacy of a one plane ilioinguinal and iliohypogastric nerve block with a single shot and double shot techniques. METHODS: In a randomized single blind study, 90 children, aged 2-12 years, received a single shot (SS) or a double shot (DS) technique for ilioinguinal and iliohypogastric (IG-IH) nerve block for inguinal hernia repair. In the SS group, 0.25 ml x kg(-1) of 0.25% bupivacaine was given one fingerbreadth medial to the anterior superior iliac spine under the external oblique aponeurosis. In the DS group, one-third of the total dose of bupivacaine was given as for the SS group. The remaining two-thirds was deposited 0.5 cm above and lateral to the mid-inguinal point deep to the external oblique aponeurosis. RESULTS: The success rates of both techniques were similar, at 72%, although the presence of local anaesthetic in the inguinal canal was significantly higher with the DS technique. The incidence of femoral nerve block was 4.5% with the SS and 9% with the DS technique (P > 0.05). Parental satisfaction with postoperative pain relief was high, at 94%. CONCLUSIONS: The DS technique, while technically more difficult, does not improve the success rate of the IG-IH nerve block compared with the SS technique.

Publication Types:

• Clinical trial
• Randomized controlled trial

PMID: 11903940, UI: 21901917

Paediatr Anaesth 2002 Mar;12(3):235-42

Comparison of fast versus slow rewarming following acute moderate hypothermia in rats.

Eshel G, Reisler G, Berkovitch M, Shapira S, Grauer E, Barr J

Pediatric Intensive Care Unit, Assaf Harofeh Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Zerifin, Israel.

BACKGROUND: The aim of this study was to compare the biochemical and physiological responses of fast vs. slow rewarming from moderate hypothermia in anaesthetized rats. METHODS: Anaesthetized rats were surface cooled to 28 degrees C, for 20 min, then rewarmed either quickly over 30 min or slowly over 120 min with monitoring of vital signs, systemic vascular resistance (SVR), cardiac output, biochemical changes and activity for 31 days. RESULTS: At hypothermia, cardiac output decreased to 77 +/- 38 ml x min(-1) and lactate increased to 4.62 +/- 4.73 mmol x l(-)1. Fast rewarming caused an abrupt increase in cardiac output (270 +/- 24 ml x min(-1)) and a sharp drop in SVR (325.6 +/- 23.3 dyne x s(-1) x cm(-5)), compared with a smoother course with cardiac output (142 +/- 18 ml x min(-1), P < 0.01) and SVR (662.8 +/- 41.0 dyne x s(-1) x cm(-5), P < 0.01), measured during slow rewarming. Lactate failed to return to normal values (upon returning to normothermia) (2.5 +/- 0.75 mmol x l(-1)) only in the fast rewarming group. In both groups, activity in the open field was not different from control rats. CONCLUSIONS: In rats, moderate hypothermia for 20 min does not appear to cause lasting biochemical or behavioural consequences, whether rewarming lasted over 30 or 120 min. However, there was a greater early change in cardiac output and heart rate, due to systemic vasodilatation in the fast rewarming animals. These acute changes may have consequences in patients with compromised cardiovascular reserves.

PMID: 11903937, UI: 21901914

Paediatr Anaesth 2002 Mar;12(3):227-34

Difficult tracheal intubation induced by maxillary distraction devices in craniosynostosis syndromes.

Roche J, Frawley G, Heggie A

Great Ormond Street Hospital for Children, London, UK.

BACKGROUND: Difficult intubation occurred during anaesthesia for removal of maxillary distraction devices in five of seven children with syndromal craniosynostoses (four with Apert, two with Pfeiffer and one with Crouzon syndrome). METHODS: Intubation was assessed in terms of laryngeal view and an established intubation difficulty score and had been straightforward before device insertion. Difficulty was induced by trismus due to device insertion and by increased maxillary prominence. This was compounded by preexisting mandibular hypoplasia. Cephalometric analysis, with each child acting as their own control, demonstrated anterior displacement of the maxilla and increased maxillary vertical height, as well as increased protuberance of the maxillary incisors. RESULTS: All five difficult tracheal intubations were associated with preoperative Mallampati scores of 3 or 4 and the nine straightforward intubations with scores of 1 or 2. Maximal interincisor distance was less than the lower 95% confidence limit for age in all five children who were difficult to intubate at the time of device removal. No child had a failed intubation, but all had significantly increased intubation difficulty. CONCLUSIONS: In view of the risks of trauma, hypoxia and aspiration associated with difficult direct laryngoscopy, we recommend elective fibreoptic intubation at anaesthesia for removal of maxillary distraction osteogenesis devices in these children.

PMID: 11903936, UI: 21901913