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Anaesthesist 2002 Jun;51(6):491-2
Medizinische Klinik, Klinikum Innenstadt, Ziemssentrasse 1, 80336, Munchen, Germany.
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PMID: 12452166, UI: 22339309
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Anaesthesist 2002 Jun;51(6):447
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PMID: 12452143, UI: 22338039
Anesth Analg 2002 Dec;95(6):1826-7
Neuromuscular Research Group (NRG), Department of Anesthesiology, Universite de Montreal, Canada. Department of Anaesthesiology and Intensive Care Medicine, Karl Franzens University, Graz, Austria.
PMID: 12456479, UI: 22344082
Anesth Analg 2002 Dec;95(6):1793-805
Department of Anesthesiology and Pain Management, Southwestern Center for Minimally Invasive Surgery, and Bariatric Program, University of Texas Southwestern Medical Center at Dallas.
PMID: 12456461, UI: 22344064
Anesth Analg 2002 Dec;95(6):1772-6
Department of Anesthesiology, Critical Care and Emergency Medicine, The Leopold-Franzens University Innsbruck, Austria.
Administration of 100% oxygen before tracheal extubation is common clinical practice. We determined the effect of this technique on postoperative gas exchange in a porcine model using the multiple inert gas elimination technique. After general anesthesia with mechanical ventilation for a period of 30 min (inspiratory fraction of oxygen of 0.3), anesthesia was discontinued, and the pigs were randomized to an inspiratory fraction of oxygen of 0.3 or 1.0 until they could be safely extubated. Thirty minutes after extubation while breathing air, blood flow to poorly ventilated units had significantly increased in pigs that had been administered 100% oxygen as compared with those receiving 30% oxygen (17% +/- 15% versus 7% +/- 5%; P = 0.009). We conclude that exposure to 100% oxygen before extubation may cause an undesirable alteration in gas exchange. IMPLICATIONS: Blood flow to lung units with a low V(A)/Q ratio was significantly larger in pigs that had been exposed to 100% oxygen before extubation as compared with those exposed to 30% oxygen before extubation.
PMID: 12456457, UI: 22344060
Anesth Analg 2002 Dec;95(6):1767-9
Departments of Anesthesiology and Intensive Care Medicine and Medical Statistics, University of Cologne, Cologne, Germany.
We surveyed current German practice in postoperative epidural analgesia (EA). Of 300 questionnaires sent anonymously, 147 (49%) were returned fully completed. A 24-h acute pain service (APS) was offered in 41% of German hospitals. Seventy percent of the large teaching hospitals (>1000 beds) offered an APS, whereas just 9% of the hospitals of <500 beds provided an APS. Small-size hospitals (<200 beds) preferred ropivacaine as the local anesthetic (LA) in contrast to large teaching hospitals using more bupivacaine than ropivacaine. In the general ward setting, 36% of the respondents used plain LA, and 64% combined the LA with an opioid. If ropivacaine was used, 0.2% was the most popular concentration (78%), combined with morphine (17%), fentanyl (14%), or sufentanil (75%). If bupivacaine was used, 0.25% was the preferred concentration (30%), combined with morphine (40%), fentanyl (8%), or sufentanil (60%). On wards, 58% of German anesthetic departments used continuous epidural infusion, 57% bolus doses, and 20% patient-controlled EA mode. We conclude that the availability of a 24-h APS (41%) in German hospitals corresponds favorably to international data. EA with the combination of LAs and opioids was the most common modality in the ward setting. IMPLICATIONS: We surveyed current German practice in postoperative epidural analgesia. We found that the availability of a 24-h acute pain service (41%) in German hospitals corresponds favorably to international practice. Epidural analgesia with the combination of local anesthetics and opioids was the most common modality in the ward setting.
PMID: 12456455, UI: 22344058
Anesth Analg 2002 Dec;95(6):1757-62
Department of Orthopedics, St. Goran Hospital.
The thermic effect of amino acids is augmented under general anesthesia and counteracts hypothermia. Mild hypothermia may increase surgical bleeding. We studied whether amino acids also induce thermogenesis under spinal anesthesia and whether this endogenous heat production reduces bleeding during hip arthroplasty. Rectal temperature, oxygen uptake, and perioperative bleeding were measured in 22 patients receiving an IV amino acid mixture (Vamin 18((R)), 240 kJ/h) for 1 h before and then during spinal anesthesia and in 24 control patients receiving acetated Ringer's solution. Blood loss was calculated after surgery by weighing the swabs and the content of the suction tubes after subtraction of the saline used. After surgery, the closed drains were weighed after 24 h. In the amino acid group, the preanesthesia temperature increased by 0.4 degrees C +/- 0.2 degrees C (P < 0.01) and was unchanged in controls. At end of surgery, core temperature had decreased by 0.9 degrees C +/- 0.4 degrees C in controls and by 0.4 degrees C +/- 0.3 degrees C in the amino acid patients (P < 0.01). Oxygen uptake increased by 26 +/- 7 mL/min, or 16% +/- 5% (P < 0.05), from baseline in the amino acid patients, whereas it was unchanged in the controls. Blood loss during surgery was significantly larger in the control patients (702 +/- 344 mL) than in the amino acid patients (516 +/- 272 mL) (P < 0.05). After surgery, there were no significant differences in shed blood volume. In conclusion, amino acid infusion also induced a thermogenic response under spinal anesthesia. In addition, the prevention of temperature decrease during spinal anesthesia seemed to have a positive effect on intraoperative blood loss. IMPLICATIONS: Infusion of a balanced mixture of amino acids during spinal anesthesia prevented core body temperature decrease. Bleeding was also less pronounced.
PMID: 12456453, UI: 22344056
Anesth Analg 2002 Dec;95(6):1746-51
Department of Anesthesiology, and INSERM, The University of Grenoble School of Medicine, Grenoble, France.
Sustained hyperventilation has a time-limited effect on cerebrovascular dynamics. We investigated whether this effect was similar among brain regions by measuring regional cerebral blood volume (CBV) with steady-state susceptibility contrast magnetic resonance imaging during 3 h of hyperventilation. Regional CBV was determined in nine thiopental-anesthetized, mechanically-ventilated rats every 30 min in the dorsoparietal neocortex, the corpus striatum, and the cerebellum. The corpus striatum was the only brain region showing a stable reduction in CBV during the hypocapnic episode (PaCO(2), 24 +/- 3 mm Hg). In contrast, neocortex and, to a lesser extent, cerebellum exhibited a progressive return toward normal values despite continued hypocapnia. No evidence of a rebound in CBV was found on return to normal ventilation in the three brain regions. We conclude that sustained hyperventilation can lead to an uneven change in the reduction of CBV, possibly because of differences of brain vessels in their sensitivity to extracellular pH. Our results in neocortex confirm the transient effect of sustained hyperventilation on cerebral hemodynamics. IMPLICATIONS: Sustained hyperventilation has a transient effect in decreasing cerebral blood volume (CBV). Using susceptibility contrast magnetic resonance imaging in thiopental-anesthetized rats, we found differences between brain regions in their transient CBV response to sustained hyperventilation.
PMID: 12456451, UI: 22344054
Anesth Analg 2002 Dec;95(6):1731-8
Department of Anesthesiology, University Hospital, Switzerland.
IMPLICATIONS: The study goal was to show how Balanced Scorecard, a modern management tool based on score numbers, can efficiently be applied to a university anesthesiology department. Nineteen score numbers were established in four perspectives. Meaningful results were obtained with limited resources to support a process of innovation and improvement.
PMID: 12456449, UI: 22344052
Anesth Analg 2002 Dec;95(6):1680-5
Faculty of Pharmaceutical Sciences, Laboratory of Medical Biochemistry and Clinical Analysis, and University Hospital, Department of Anesthesia, Ghent University, Ghent, Belgium.
There is concern about the toxicity of Compound (Co) A. Absorbents differ in the production of Co A during minimal-flow sevoflurane anesthesia. Strong alkali-free Amsorb((R)) does not produce Co A. It was our aim to study Superia((R)), another new NaOH- and KOH-free CO(2) absorbent, in minimal-flow anesthesia, compared with KOH-free Sofnolime((R)). After Ethics Committee approval, 14 consenting adult patients were included randomly by using Superia or Sofnolime as the CO(2) absorbent in the compact 750-mL canister of an ADU ventilator. After propofol and remifentanil administration, sevoflurane was given in oxygen and air (500 mL/min; fraction of inspired oxygen, 0.4), aiming at an end-tidal concentration of 2.3%-2.5%; ventilation aimed for 33-35 mm Hg PETCO(2). Compound A inspired (Co A(insp)) and expired (Co A(exp)) samples were taken for analysis, and canister temperatures were measured for 150 min. Statistical analysis was performed with the Friedman test or the Mann-Whitney U-test where appropriate. Correction for multiple testing was used. In the Superia group, no significant amount of Co A was formed, whereas in the Sofnolime group, maximum median (range) inspiratory values of 25 ppm (16 ppm) were found. The intergroup difference was P < 0.05. No difference was noticed between the two groups for the canister CO(2) absorbent temperature. IMPLICATIONS: During minimal-flow 2.3%-2.5% end-tidal sevoflurane, no compound A (Co A) is formed with the NaOH- and KOH-free CO(2) absorbent Superia. Although Co A values with KOH-free Sofnolime are still within reported safe limits, Superia is definitely an alternative for safe clinical practice.
PMID: 12456439, UI: 22344042
Anesth Analg 2002 Dec;95(6):1661-6
Departments of Anesthesiology and Pharmacology, University of Occupational and Environmental Health, School of Medicine, Kitakyushu, Japan.
We studied the effects of alphaxalone, a neurosteroid anesthetic, on norepinephrine transporter (NET) function in cultured bovine adrenal medullary cells and the effect of a bolus injection of alphaxalone on blood pressure and serum norepinephrine (NE) levels in anesthetized rats. Alphaxalone (10-100 micro M) inhibited the desipramine-sensitive uptake of [(3)H]-NE by bovine adrenal medullary cells in a concentration-dependent manner. Eadie-Hofstee analysis of [(3)H]-NE uptake showed that alphaxalone increased the apparent Michaelis constant without altering the maximal velocity, indicating that inhibition occurred via competition for the NET. Alphaxalone inhibited the specific binding of [(3)H]-desipramine to plasma membranes isolated from bovine adrenal medulla. Scatchard analysis of [(3)H]-desipramine binding revealed that alphaxalone increased the apparent dissociation constant for binding without altering maximal binding, indicating competitive inhibition. Bolus IV administration of alphaxalone had little effect on blood pressure but slightly, and significantly, increased the serum NE levels in anesthetized rats. These findings suggest that alphaxalone competitively inhibits NET function by interfering with both desipramine binding and NE recognition on the NET in adrenal medullary cells and probably in sympathetic neurons. IMPLICATIONS: Alphaxalone inhibited the desipramine-sensitive uptake of [(3)H]-norepinephrine (NE) by interfering with desipramine binding in bovine adrenal medullary cells. A bolus IV administration of alphaxalone slightly and significantly increased the serum NE levels in anesthetized rats. These findings suggest that alphaxalone competitively inhibits NE transporter function probably in sympathetic neurons.
PMID: 12456434, UI: 22344037
Anesth Analg 2002 Dec;95(6):1650-5
Department of Anesthesiology and Intensive Care Medicine, Karolinska Hospital and Institute, Stockholm, Sweden.
We studied relaxation of airway smooth muscle by sevoflurane, desflurane, and halothane in isolated guinea pig bronchi. Ring preparations were mounted in tissue baths filled with physiological salt solution and continuously aerated with 5% CO(2) in oxygen. Electrical field stimulation induced contractions sensitive to tetrodotoxin, indicating nerve-mediated responses. These consisted of an atropine-sensitive cholinergic phase and a nonadrenergic noncholinergic (NANC) phase sensitive to SR48968, a neurokinin-2 receptor antagonist. Anesthetics were added to the gas aerating the tissue baths. Sevoflurane and desflurane at 1.0 minimum alveolar anesthetic concentration and halothane at 1.0-2.0 minimum alveolar anesthetic concentrations inhibited both cholinergic and NANC contractions to electrical field stimulation. None of the anesthetics affected responses to exogenously applied neurokinin A, a likely mediator of NANC contractions, suggesting prejunctional inhibition of NANC neurotransmission. The anesthetics did not affect the initiation of contractile responses to leukotriene C(4) (LTC(4)), a mediator of asthmatic bronchoconstriction. However, sevoflurane and desflurane both relaxed bronchi in a steady-state contraction achieved by LTC(4). Surprisingly, halothane did not relax LTC(4) contractions. Concerning LTC(4)-elicited bronchoconstriction, sevoflurane and desflurane were more potent airway smooth muscle relaxants in vitro. IMPLICATIONS: Halothane, sevoflurane, and desflurane attenuated airway smooth muscle tone via inhibition of cholinergic and nonadrenergic noncholinergic neurotransmission. Sevoflurane and desflurane reduced leukotriene C(4)-induced bronchoconstriction, whereas halothane did not. This indicates a beneficial role for sevoflurane and desflurane in asthmatics.
PMID: 12456432, UI: 22344035
Anesth Analg 2002 Dec;95(6):1629-36
Department of Anesthesiology, University of Regensburg, Germany.
Sevoflurane and desflurane modulate autonomic nervous activity by different mechanisms. We tested the hypothesis that these anesthetics also exhibit different effects on short-term baroreflex regulation of arterial blood pressure. Forty ASA physical status I patients, aged 20 to 42 yr, were randomly assigned to receive either 1.0 minimum alveolar anesthetic concentration of sevoflurane or desflurane for the maintenance of anesthesia. Patients were studied during awake conditions and 20 min after the anesthesia induction using sinusoidal neck suction at 0.2 Hz (baroreflex response mediated mainly by vagal activity) and 0.1 Hz (baroreflex response mediated by vagal and sympathetic activity), whereas respiratory frequency was fixed at 0.25 Hz. RR interval and arterial blood pressure responses were evaluated by power spectral analysis and complex transfer function analysis. Sevoflurane and desflurane did not disturb the linear relationship between baroreceptor stimulation and effector response, expressed as squared coherence of signals, i.e., the equivalent of the correlation coefficient of power spectra. Sevoflurane and desflurane depressed the response of the heart rate to neck suction in a similar way without affecting the time delay between baroreceptor stimulation and vagal-mediated cardiac response. The gain of the transfer function between neck suction and oscillation in arterial blood pressure at 0.1 Hz decreased with sevoflurane and desflurane to comparable values. Both anesthetics increased the delay of systolic blood pressure response to baroreceptor stimulation from approximately 3.5 to 4.3 s. Baroreflex-mediated short-term control of arterial blood pressure is similar between desflurane and sevoflurane during steady-state conditions. IMPLICATIONS: Despite exhibiting different effects on autonomic activity, sevoflurane and desflurane depress the baroreflex-mediated short-term control of heart rate and blood pressure in a similar manner.
PMID: 12456429, UI: 22344032
Anesth Analg 2002 Dec;95(6):1616-21
Department of Anaesthesia, Christchurch Hospital, and Christchurch School of Medicine and Health Sciences, Christchurch, New Zealand.
A computer program that models anesthetic uptake and distribution has been in use in our department for 20 yr as a teaching tool. New anesthesia machines that electronically measure fresh gas flow rates and vaporizer settings allowed us to assess the performance of this model during clinical anesthesia. Gas flow, vaporizer settings, and end-tidal concentrations were collected from the anesthesia machine (Datex S/5 ADU) at 10-s intervals during 30 elective anesthetics. These were entered into the uptake model. Expired anesthetic vapor concentrations were calculated and compared with actual values as measured by the patient monitor (Datex AS/3). Sevoflurane was used in 16 patients and isoflurane in 14 patients. For all patients, the median performance error was -0.24%, the median absolute performance error was 13.7%, divergence was 2.3%/h, and wobble was 3.1%. There was no significant difference between sevoflurane and isoflurane. This model predicted expired concentrations well in these patients. These results are similar to those seen when comparing calculated and actual propofol concentrations in propofol infusion systems and meet published guidelines for the accuracy of models used in target-controlled anesthesia systems. This model may be useful for predicting responses to changes in fresh gas and vapor settings. IMPLICATIONS: We compared measured inhaled anesthetic concentrations with those predicted by a model. The method used for comparison has been used to study models of propofol administration. Our model predicts expired isoflurane and sevoflurane concentrations at least as well as common propofol models predict arterial propofol concentrations.
PMID: 12456427, UI: 22344030
Anesth Analg 2002 Dec;95(6):1607-10
Department of Anesthesiology, University of Hirosaki School of Medicine, Hirosaki, Japan.
Previous reports suggest that the effects of propofol, ketamine, and thiopental on airway tone may be because of modulation of parasympathetic activity. We examined if these anesthetics interact with recombinant human M1-M3 muscarinic receptors expressed in Chinese hamster ovary cells (CHO-M1, M2, and M3) using the displacement of 0.4 nM of l-[N-methyl-(3)H]scopolamine methyl chloride([(3)H]NMS). In addition, functional studies were performed by fluorometrically monitoring methacholine (1 mM) stimulated intracellular Ca(2+) ([Ca(2+)](i)) responses. Ketamine concentration dependently displaced [(3)H]NMS binding to CHO-M1, M2, and M3 cells with affinity, pK(i) (mean K(i)) values of 4.34 +/- 0.14 (45 micro M), 3.53 +/- 0.10 (294 micro M), and 3.61 +/- 0.02 (246 micro M), respectively. The effects at M1 were in the clinical range. Ketamine did not affect either basal or methacholine stimulated increase in [Ca(2+)](i) in CHO-M1 cells. Thiopental significantly displaced [(3)H]NMS binding to M3 (pKi [mean Ki] = 4.12 +/- 0.06 [75 micro M]) but not M1 or M2 receptors. Thiopental (10(-5)-10(-3) M) concentration dependently inhibited methacholine stimulated increase in [Ca(2+)](i) in CHO-M3 cells. Propofol and barbituric acid did not interact with any muscarinic receptor subtype. We suggest that at the level of [Ca(2+)](I), thiopental may possess M3 antagonist activity, whereas there are no functional consequences of the interaction of ketamine with the M1 receptor. IMPLICATIONS: In this study using recombinant human M1-M3 muscarinic receptors, we show that for agonist-stimulated increases in intracellular Ca(2+) thiopental acts as a M3 antagonist.
PMID: 12456425, UI: 22344028
Anesth Analg 2002 Dec;95(6):1596-600
Departments of Anesthesiology and Orthopedic Surgery, Allegheny General Hospital, Pittsburgh, Pennsylvania.
Minidose lidocaine-fentanyl spinal anesthesia (SAB(MLF)) is a safe, effective, and efficient anesthetic for ambulatory surgery. Unfortunately, it has a frequent incidence of pruritus and a substantial incidence of nausea and vomiting. Nalbuphine is effective in treating or preventing pruritus after intrathecal or epidural morphine but may or may not have a beneficial effect on nausea and vomiting. Droperidol has demonstrated antiemetic efficacy with neuraxial opiates. In this study, we examined the prophylactic use of nalbuphine alone compared with nalbuphine with droperidol after SAB(MLF). One-hundred-twenty-four patients having outpatient knee arthroscopy under SAB(MLF) with 20 mg of lidocaine 0.5% and 20 micro g of fentanyl were randomized to receive IV at the end of surgery either 4 mg of nalbuphine (Group N) or droperidol 0.625 mg plus nalbuphine 4 mg (Group ND). The incidences of early (before discharge) and late onset nausea were, respectively, 18% versus 5% and 32% versus 13%. The postoperative incidences of pruritus were 61% versus 40%, whereas 19% of patients in Group N compared with 2% of patients in Group ND requested treatment for this. Group ND had lower pain scores and had a longer delay until first use of analgesic. There were no differences in average times to discharge. The only side effect of the medications was an increased drowsiness in Group ND. In conclusion, as prophylactic medication for use in conjunction with SAB(MLF), the addition of droperidol 0.625 mg to nalbuphine 4 mg was superior to nalbuphine alone. The combination provided for reduced postoperative nausea, pruritus, and pain-benefits that persisted after discharge home. The combination also avoided isolated cases of extreme delay in discharge. IMPLICATIONS: Droperidol in combination with nalbuphine enhances analgesia and is more effective than nalbuphine alone in preventing pruritus, nausea, and vomiting after minidose lidocaine-fentanyl spinal anesthesia.
PMID: 12456423, UI: 22344026
Anesth Analg 2002 Dec;95(6):1577-81
Departments of Anesthesiology and Pediatric Cardiology, Duke University, Durham, North Carolina.
In children, radiofrequency catheter ablation (RFCA) is typically performed under general anesthesia. With the use of volatile anesthetics, postoperative nausea and vomiting (PONV) are common, with an incidence of emesis as frequent as 60%. We tested the hypothesis that a propofol (PRO)-based anesthetic would have a less frequent incidence of PONV than an isoflurane (ISO)-based anesthetic. Patients were randomly assigned to receive either an ISO- or PRO-based anesthetic. Prophylactic ondansetron was given to all patients and droperidol was used as a rescue antiemetic postoperatively while PONV was monitored postoperatively for 18 h. The incidence of nausea, vomiting, use of rescue antiemetic drugs, and sedation scores were recorded. The cost for the anesthetic was also calculated. Fifty-six subjects were included in this study. The cumulative incidence of PONV was significantly more frequent in group ISO (63% nausea/55% emesis) compared with group PRO (21% nausea/6% emesis). After the administration of droperidol, further vomiting occurred in 70% of the patients in group ISO versus 0% of the patients in group PRO. We conclude that RFCA using ISO has a high PONV risk and the prophylactic use of ondansetron as well as antiemetic therapy with droperidol are ineffective. In contrast, a PRO-based anesthetic is highly effective in preventing PONV in children undergoing RFCA. IMPLICATIONS: In children undergoing radiofrequency catheter ablation and receiving prophylactic ondansetron, a frequent incidence (60%) of postoperative vomiting was observed under an isoflurane-based anesthetic, whereas the incidence was significantly reduced to a very low level (5%) under a propofol-based anesthetic.
PMID: 12456419, UI: 22344022
Anesth Analg 2002 Dec;95(6):1540-6
Anesthesiology Research Laboratory, Departments of Anesthesiology and Physiology, and &Verbar||Cardiovascular Research Center, Medical College of Wisconsin, Milwaukee, Wisconsin.
Cardiac ischemia/reperfusion (IR) injury is associated with mitochondrial (m)Ca(2+) overload. Anesthetic preconditioning (APC) attenuates IR injury. We hypothesized that mCa(2+) overload is decreased by APC in association with mitochondrial adenosine triphosphate-sensitive K(+) (mK(ATP)) channel opening. By use of indo-1 fluorescence, m[Ca(2+)] was measured in 40 guinea pig Langendorff-prepared hearts. Control (CON) hearts received no treatment for 50 min before IR; APC hearts were exposed to 1.2 mM (8.8 vol%) sevoflurane for 15 min; APC + 5-hydroxydecanoate (5-HD) hearts received 200 micro M 5-HD from 5 min before to 15 min after sevoflurane exposure; and 5-HD hearts received 5-HD for 35 min. Sevoflurane was washed out for 30 min and 5-HD for 15 min before 30 min of global ischemia and 120 min of reperfusion. During ischemia, the peak m[Ca(2+)] accumulation was decreased by APC from 489 +/- 37 nM (CON) to 355 +/- 28 nM (P < 0.05); this was abolished by 5-HD (475 +/- 38 nM m[Ca(2+)]). APC resulted in improved function and reduced infarct size on reperfusion, which also was blocked by 5-HD. 5-HD pretreatment alone did not affect m[Ca(2+)] (470 +/- 34 nM) or IR injury. Thus, preservation of function and morphology on reperfusion is associated with attenuated mCa(2+) accumulation during ischemia. Reversal by 5-HD suggests that APC may be triggered by opening mK(ATP) channels. IMPLICATIONS:Myocardial ischemia/reperfusion injury is associated with mitochondrial Ca(2+) overload. Mitochondrial [Ca(2+)] and function were measured in guinea pig isolated hearts. Anesthetic preconditioning attenuated mitochondrial Ca(2+) overload during ischemia, improved function, and reduced infarct size. Reversal by 5-hydroxydecanoate suggests that anesthetic preconditioning may be triggered by mitochondrial adenosine triphosphate-sensitive K channel opening.
PMID: 12456413, UI: 22344016
Anesth Analg 2002 Dec;95(6):1474-5
Department of Anesthesiology and Pain Management, The University of Texas Southwestern Medical Center at Dallas, Texas.
PMID: 12456403, UI: 22344006
Anesth Analg 2002 Nov;95(5):1460
PMID: 12401647, UI: 22288666
Anesth Analg 2002 Nov;95(5):1442-5, table of contents
Department of Anesthesiology and Critical Care Medicine, Gifu University School of Medicine, 40 Tsukasamachi, Gifu-City, Gifu 500-8705, Japan. oshimat@cc.gifu-u.ac.jp
We have hypothesized that the 5-hydroxytrypta-mine-1A receptor agonist tandospirone reduces postoperative nausea and vomiting (PONV). In a double-blinded, randomized design, 3 groups of 30 patients each received 1 of the following oral medications 90 min before arrival in the operating room, together with famotidine 20 mg: 1) placebo (P group), 2) tandospirone 10 mg (T10 group), or 3) tandospirone 30 mg (T30 group). Standard anesthetic regimens and techniques were applied for all patients. All episodes of PONV were recorded during the following time intervals: 0-3 h and 3-24 h after the end of general anesthesia. The incidence of a complete response, defined as no PONV and no need for other rescue antiemetics, was significantly more frequent in the T30 group than in the P group during 0-24 h (P = 0.019), especially during 3-24 h (P = 0.007) after general anesthesia. In conclusion, premedication with oral tandospirone is effective against PONV in patients undergoing tympanoplasty under general anesthesia. IMPLICATIONS: Oral tandospirone reduced the incidence of postoperative nausea and vomiting without significant adverse effects in adults undergoing tympanoplasty under general anesthesia.
PMID: 12401641, UI: 22288660
Anesth Analg 2002 Nov;95(5):1432-6, table of contents
Department of Anaesthesiology and Intensive Care, University of Munster, Albert-Schweitzer-Strasse 31, 48149 Munster, Germany. d.enk@t-online.de
Our hypothesis was that nasopharyngeal passage of an endotracheal tube can be facilitated by a nasopharyngeal airway (Wendl tube) acting as a "pathfinder." Accordingly, we performed a randomized, controlled trial with blinded assessment of nasopharyngeal bleeding and contamination of the tip of the endotracheal tube. After the induction of anesthesia, a Wendl tube (28 Ch) was inserted into the more patent nostril. In the control group (n = 30), the Wendl tube was retrieved before nasopharyngeal passage was attempted with an endotracheal tube (inner diameter, 7.0 mm). In the intervention group (n = 30), the Wendl tube was kept in position and only its adjustable flange was removed. Then, we inserted the tip of the endotracheal tube into the trailing end of the Wendl tube. Subsequently, the endotracheal tube was advanced under visual control to the oropharynx guided by the Wendl tube. After the endotracheal tube was positioned in the oropharynx, the Wendl tube was removed and intubation completed. Six hours after surgery, we determined the patients' nasal pain. The "pathfinder" technique reduced the incidence (P < 0.001) and severity (P = 0.001) of bleeding, decreased tube contamination with blood and mucus (P < 0.001), and diminished postoperative nasal pain (P = 0.036). IMPLICATIONS: Nasopharyngeal passage of an endotracheal tube can be facilitated by a flexible Wendl tube (nasopharyngeal airway) covering and guiding the rigid tube tip. This technique is helpful in reducing the incidence and severity of nosebleeds and in minimizing contamination of the tip of the endotracheal tube with blood and mucus.
PMID: 12401639, UI: 22288658
Anesth Analg 2002 Nov;95(5):1428-31, table of contents
Department of Anesthesiology and Resuscitation, Erasmus Hospital, Free University of Brussels, Lennik Street 808, B-1070 Brussels, Belgium. ppandin@ulb.ac.be
IMPLICATIONS: The authors describe a modified technique of posterior approach to the lumbar plexus in the psoas compartment which allows nerve stimulation for the location of the plexus and catheter placement for extended-duration surgery and postoperative patient-controlled regional analgesia. A frequent incidence of total lumbar plexus block was observed.
PMID: 12401638, UI: 22288657
Anesth Analg 2002 Nov;95(5):1412-8, table of contents
Department of Anaesthesia and Intensive Care, Faculty of Medicine, Chinese University of Hong Kong, Prince of Wales Hospital, Sha Tin, New Territories, Special Administrative Region, Hong Kong. ukmorty@aol.com
We conducted a prospective, randomized, controlled trial to establish the effect of epidural blockade on isoflurane requirements for equivalent intraoperative electroencephalographic (EEG) suppression. Fifty patients undergoing abdominal hysterectomy received combined epidural and general anesthesia or general anesthesia alone with isoflurane and alfentanil. Isoflurane was administered by computer-controlled closed-loop feedback to maintain an EEG 95% spectral edge frequency of 17.5 Hz, a target chosen on the basis of a pilot study. In epidural patients, end-tidal isoflurane concentration (FE'(ISO)) was 0.19% smaller (95% confidence interval [CI], -0.32% to -0.06%; P < 0.01), mean arterial blood pressure was 17 mm Hg lower (95% CI, -24 to -9 mm Hg; P < 0.0001), and body temperature was 0.4 degrees C lower (95% CI, -0.7 to 0 degrees C; P < 0.05) than in controls. EEG bispectral index (BIS) was 4 points higher (95% CI, 1 to 7; P < 0.05). EEG median frequency and heart rate were similar in both groups. Epidural patients were 76% more likely (95% CI, 58% to 94%; P < 0.001) to require metaraminol for hypotension and were 28% more likely (95% CI, 3% to 53%; P < 0.05) to require glycopyrrolate for bradycardia. After surgery, the time to eye opening in epidural patients was 2.3 min shorter (95% CI, -4.2 to -0.5 min; P < 0.05). Time to eye opening correlated better with FE'(ISO) in the last 30 s of anesthesia (FE'(ISO) = 0.07 x time to eye opening + 0.31; r(2) = 0.59; P < 0.0001) than with BIS from the same period (BIS = 64 - 1.25 x time to eye opening; r(2) = 0.22; P < 0.001) (P < 0.0001). To maintain similar intraoperative spectral edge frequency, patients receiving combined epidural and general anesthesia require 21% less isoflurane than those receiving general anesthesia alone. This smaller isoflurane dose is associated with faster emergence from anesthesia. IMPLICATIONS: The dose of general anesthetic required to maintain similar intraoperative suppression of brain electrical activity is 21% less in patients with nerve blockade than in those without. This dose reduction results in faster waking times in patients with nerve blockade, which may reflect lighter intraoperative anesthesia. The dose of general anesthetic required to maintain similar intraoperative suppression of brain electrical activity is 21% less in patients with nerve blockade than in those without. This dose reduction results in faster waking times in patients with nerve blockade, which may reflect lighter intraoperative anesthesia.
PMID: 12401635, UI: 22288654
Anesth Analg 2002 Nov;95(5):1408-11, table of contents
Department of Anesthesia, Akita University School of Medicine, Hondo 1-1-1, Akita-city, Akita-010-8543, Japan. mtanaka@med.akita-u.ac.jp
Accidental intravascular injection of an epinephrine-containing test dose decreases the T-wave amplitude of a Lead II electrocardiogram (EKG) with 100% sensitivity and specificity on the basis of the T-wave criterion (positive if there is a > or =25% decrease in amplitude). We designed this study to test whether the choice of EKG lead would affect the efficacy of the simulated intravascular test dose in anesthetized patients. After an 8-h fast and no premedication, 35 healthy patients were anesthetized with end-tidal 2% sevoflurane and nitrous oxide after endotracheal intubation. When hemodynamic stability was obtained, all subjects received 3 mL of normal saline IV, followed 4 min later by 1.5% lidocaine 3 mL plus 15 microg of epinephrine (1:200,000) IV. Heart rate, systolic blood pressure, Leads II (n = 35) and V(5) (n = 35), and either Lead I (n = 17) or III (n = 18), whichever had the greater T-wave amplitude, were continuously recorded for 4 min after the saline and test-dose injections. An IV test dose produced significant increases in heart rate and systolic blood pressure and produced decreases in the T-wave amplitude of all EKG leads studied in all subjects, whereas IV saline elicited no changes in these variables. The maximum percentage decreases in T-wave amplitude of Leads II, I, III, and V(5) were -87% +/- 13%, -88% +/- 8%, -94% +/- 15%, and -86% +/- 16%, respectively (mean +/- SD; P > 0.05). There was no significant difference in temporal changes in T-wave amplitude among the 4 leads, and sensitivity and specificity were 100% on the basis of the T-wave criterion, irrespective of the lead examined. Our results indicate that Leads II, I, III, and V(5) of the EKG are equally effective for detecting intravascular injection of the epinephrine-containing test dose in sevoflurane-anesthetized adults. IMPLICATIONS: To determine whether an epidural catheter is in a blood vessel, an epidural test dose containing 15 microg of epinephrine is used. We found that decreases in the T-wave amplitude of Leads I, II, III, and V(5) of the electrocardiogram were equally sensitive and specific for detecting intravascular injection of the test dose in sevoflurane-anesthetized adult patients.
PMID: 12401634, UI: 22288653
Anesth Analg 2002 Nov;95(5):1402-7, table of contents
Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong, China. bblee@cuhk.edu.hk
The addition of epinephrine to ropivacaine has not been recommended because ropivacaine has intrinsic vasoconstrictor properties. However, few pharmacokinetic data are available on the addition of epinephrine to epidural ropivacaine in humans. In this prospective, double-blinded study, we randomized patients having elective abdominal hysterectomy to receive epidural ropivacaine 1.5 mg/kg, diluted in 15 mL, either with (epinephrine group, n = 12) or without (plain group, n = 12) epinephrine 5 microg/mL and then measured arterial and venous plasma concentrations of ropivacaine at intervals up to 180 min. We found that arterial and venous plasma ropivacaine concentrations were smaller in the epinephrine group compared with the plain group in the first 60 min after the drug administration (P < 0.01). Mean (+/- SD) maximum total plasma ropivacaine concentration was smaller in the epinephrine group (arterial, 0.92 +/- 0.32 microg/mL; venous, 0.82 +/- 0.33 microg/mL) compared with the plain group (1.31 +/- 0.39 microg/mL and 1.31 +/- 0.50 microg/mL, respectively; P = 0.01). Time to maximum total plasma ropivacaine concentration was not significantly different between groups (mean +/- SD; arterial, 16 +/- 2 min; venous, 23 +/- 2 min in the epinephrine group versus 9 +/- 2 min and 12 +/- 3 min, respectively, in the plain group; P = 0.08). Arterial plasma ropivacaine concentrations were larger than venous concentrations during the first hour (P < 0.01); the arterio-venous difference decreased exponentially, and the rate and magnitude of this decrease was unaffected by epinephrine. We conclude that the addition of epinephrine 5 microg/mL to ropivacaine reduced the early systemic plasma concentrations of ropivacaine after epidural injection and may be useful for decreasing the risk of toxicity from systemic absorption of epidural ropivacaine. IMPLICATIONS: The addition of epinephrine 5 microg/mL to epidural ropivacaine reduced the systemic arterial and venous plasma concentrations of ropivacaine in the first hour and the maximum plasma concentration of ropivacaine. Epinephrine may be a useful additive for reducing the risk of systemic toxicity when large doses of ropivacaine are given epidurally.
PMID: 12401633, UI: 22288652
Anesth Analg 2002 Nov;95(5):1384-8, table of contents
Department of Anesthesiology, Centre Hospitalier de l'Universite de Montreal, Hopital Notre-Dame, 1560 Sherbrooke East, Montreal, Canada, H2L 4M1.
Sevoflurane (SEVO) provides faster emergence than isoflurane (ISO). This advantage is thought to magnify with increased duration of exposure. In addition, SEVO has several of the characteristics of an ideal neuroanesthetic. We designed a prospective, randomized, double-blinded study to compare the recovery profile of SEVO versus ISO in neurosurgery. Sixty patients undergoing intracranial surgery were enrolled. They were randomized to receive SEVO or ISO in 40% oxygen as part of a balanced anesthetic regimen. The anesthetic concentration (0.5 to 1.0 minimum alveolar anesthetic concentration [MAC]) was adjusted to maintain mean arterial blood pressure within 20% of the preinduction baseline. At the end of the surgery, neuromuscular blockade was reversed, anesthetics were discontinued without prior tapering, and fresh gas flow was increased to 10 L/min. Recovery end-points were measured as the time from closure of the anesthetic vaporizer. Mean MAC-hours were identical in both groups (4.7). Patients in the SEVO group demonstrated a shorter time to emergence (P = 0.02) and for response to command (squeeze hand, P = 0.03; move feet, P = 0.01). Patients in the SEVO group obtained a Glasgow coma scale score of >/=10 5 min before patients in the ISO group (P = 0.04). Obtaining an early neurological examination can be critical in neurosurgical patients. The observed difference in emergence between SEVO and ISO could therefore be of clinical importance. IMPLICATIONS: The low-solubility anesthetic, sevoflurane, provides faster recovery and postoperative neurological assessment than isoflurane after long-duration (4.7 MAC-h) intracranial surgery.
PMID: 12401630, UI: 22288649
Anesth Analg 2002 Nov;95(5):1351-7, table of contents
National Institute of Dental and Craniofacial Research/NIH, 19 Center Drive, Room 1N-117, Bethesda, MD 20892, USA.
Peripheral neuronal barrage from tissue injury produces central nervous system changes that contribute to the maintenance of postoperative pain. The therapeutic approaches to blocking these central changes remain controversial, because previous studies have not differentiated presurgical interventions from those administered after tissue injury, yet before pain onset. In this study, we evaluated the relative contributions of blockade of nociceptive input during surgery or during the immediate postoperative period on pain suppression. Subjects were randomly allocated to one of four groups: preoperative 2% lidocaine, postoperative 0.5% bupivacaine, both, or placebo injections. General anesthesia was induced and third molars extracted. Pain was assessed over 4 h and at 24 and 48 h. The beta-endorphin in blood samples increased twofold during surgery, which is indicative of activation of the peripheral nociceptive barrage in response to painful stimuli. Pain was decreased in the immediate postoperative period in the bupivacaine groups, whereas it increased in the lidocaine group over time. Pain intensity was less 48 h after surgery in the groups whose postoperative pain was blocked by the administration of bupivacaine, but no effect was demonstrated for the preoperative administration of lidocaine alone. These results in the oral surgery pain model suggest that minimizing the peripheral nociceptive barrage during the immediate postoperative period decreases pain at later time periods. In contrast, blocking the intraoperative nociceptive barrage does not appear to contribute significantly to the subsequent reduction in pain. IMPLICATIONS: Suppression of postoperative pain immediately after surgery attenuates the pain experienced 1 to 2 days after surgery. These findings suggest that pain after minor surgery can be prevented by blocking the development of pain processes that amplify pain for days after surgery.
PMID: 12401625, UI: 22288644
Anesth Analg 2002 Nov;95(5):1344-50, table of contents
Department of Anesthesia and Critical Care, Clinica Universitaria, University of Navarre, Navarre, Spain.
Epidural ropivacaine has not been compared with bupivacaine for postthoracotomy analgesia. Eighty patients undergoing elective lung surgery were randomized in a double-blinded manner to receive one of three solutions for high thoracic epidural analgesia. A continuous epidural infusion of 0.1 mL. kg(-1). h(-1) of either 0.2% ropivacaine, 0.15% ropivacaine/fentanyl 5 micro g/mL, or 0.1% bupivacaine/fentanyl 5 micro g/mL was started at admission to the intensive care unit. We assessed pain scores (rest and spirometry), IV morphine consumption, spirometry, hand grip strength, PaCO(2), heart rate, blood pressure, respiratory rate, and side effects (sedation, nausea, vomiting, and pruritus) for 48 h. Thoracic epidural ropivacaine/fentanyl provided adequate pain relief similar to bupivacaine/fentanyl during the first 2 postoperative days after posterolateral thoracotomy. The use of plain 0.2% ropivacaine was associated with worse pain control during spirometry, larger consumption of IV morphine, and increased incidence of postoperative nausea and vomiting. Morphine requirements were larger in the ropivacaine group, with no differences between bupivacaine/fentanyl and ropivacaine/fentanyl groups. Patients in the ropivacaine group experienced more pain and performed worse in spirometry than patients who received epidural fentanyl. There was no significant difference in motor block. We conclude that epidural ropivacaine/fentanyl offers no clinical advantage compared with bupivacaine/fentanyl for postthoracotomy analgesia. IMPLICATIONS: Thoracic epidural ropivacaine/fentanyl provided adequate pain relief and similar analgesia to bupivacaine/fentanyl during the first 2 postoperative days after posterolateral thoracotomy. Plain 0.2% ropivacaine was associated with worse pain control and an increased incidence of postoperative nausea and vomiting. We conclude that epidural ropivacaine/fentanyl offers no clinical advantage compared with bupivacaine/fentanyl for postthoracotomy analgesia.
PMID: 12401624, UI: 22288643
Anesth Analg 2002 Nov;95(5):1331-6, table of contents
Department of Anesthesiology, University of Florida College of Medicine, Gainesville, FL 32610-0254, USA.
Portable pumps used for local anesthetic infusion during continuous regional analgesia are gaining acceptance. These pumps are often used for ambulatory patients who are medically unsupervised throughout most of the infusion. However, the performance of these pumps, which infuse potentially toxic medication, has not been independently investigated. We investigated the flow rate accuracy, consistency, and profiles of various portable pumps often used for local anesthetic infusion during continuous regional analgesia. By using a computer/scale combination within a laboratory to record infusion rates, 6 pumps were tested with their flow regulators at expected (30 degrees-32 degrees C) and increased (34 degrees-36 degrees C) temperatures. Infusion rate accuracy differed significantly among the pumps, exhibiting flow rates within +/-15% of their expected rate for 18%-100% of their infusion duration. An increase in temperature also affected pumps to differing degrees, with infusion rates increasing from 0% to 25% for each model tested. These results suggest that factors such as flow rate accuracy and consistency, infusion profile, and temperature sensitivity should be considered when choosing and using a portable infusion pump for local anesthetic administration. IMPLICATIONS: Portable pumps often used for local anesthetic infusion during continuous regional analgesia exhibit varying degrees of delivery rate accuracy and consistency. Furthermore, increases in temperature result in an increased infusion rate for various pumps investigated. These factors should be taken into consideration when choosing and using a portable infusion pump.
PMID: 12401621, UI: 22288640
Anesth Analg 2002 Nov;95(5):1282-4, table of contents
Department of Chemical Physics and Physicochemical Separation Methods, Faculty of Chemistry, Maria Curie-Sklodowska University, PL 20-031 Lublin, pl. Marii Curie-Sklodowskiej 3, Poland. dawid@hermes.umcs.lublin.pl
We studied the changes in the propofol concentration in the cerebrospinal fluid (CSF) in 14 patients, undergoing elective intracranial procedures, who were anesthetized with propofol administered by target-controlled infusion. During anesthesia, fentanyl and cisatracurium were administered as required. After intubation of the trachea, the lungs of the patients were ventilated to normocapnia with an oxygen-air mixture (FIO(2) = 0.33). Arterial blood and CSF samples (from an intraventricular drain) were collected between 90-180 min after the induction of anesthesia. Blood propofol concentrations were stable, between 5.0 +/- 1.89 and 4.5 +/- 1.7 microg/mL (mean +/- SD). There was a significant decrease in the CSF propofol concentration, from 52.2 +/- 35.01 ng/mL at 90 min to 28.6 +/- 21.9 ng/mL at 150 min (P < 0.05). The CSF propofol concentration at 180 min (21.4 +/- 14.0 ng/mL) was not significantly different from the concentration at 150 min. Some possible reasons for this decrease after commencing continuous intraventricular drainage are discussed. IMPLICATIONS: Propofol concentrations in the cerebrospinal fluid in neurosurgical patients Propofol concentration in cerebrospinal fluid of investigated patients decreased significantly after starting intraventricular drainage, despite relatively steady blood propofol concentrations. These results supplement the limited information about propofol pharmacokinetics in the human central nervous system.
PMID: 12401611, UI: 22288630
Anesth Analg 2002 Nov;95(5):1253-7, table of contents
Department of Anesthesiology, Duke University Medical Center, Durham, NC 27710, USA. bucke001@mc.duke.edu
Spinal anesthesia with the local anesthetic lidocaine has come under scrutiny because it is associated with transient neurologic symptoms (TNS). We designed this study to prospectively compare the efficacy of ropivacaine as an alternative to lidocaine in patients undergoing elective outpatient anorectal procedures. Seventy-two patients were randomized to receive either hyperbaric lidocaine 25 mg with fentanyl 20 microg (n = 37) or hyperbaric ropivacaine 4 mg with fentanyl 20 microg (n = 35). Patients were examined for motor block, sensory block, and block duration. Patients were contacted at 24, 48, 72, and 168 h and questioned about their perceptions of pain after the spinal with specific questions designed to diagnose TNS. There were no patients with TNS in either group. There was no significant difference between the lidocaine and ropivacaine groups in any of the outcomes studied. In conclusion, intrathecal hyperbaric small-dose ropivacaine with fentanyl is an acceptable anesthetic for anorectal surgery. IMPLICATIONS: In this prospective trial, small-dose ropivacaine with fentanyl was as effective as small-dose lidocaine with fentanyl for anorectal procedures in the ambulatory setting.
PMID: 12401606, UI: 22288625
Anesthesiology 2002 Nov;97(5):1303-5
Department of Anaesthesia, Intensive Care and Pain Medicine, St. Vincent's University Hospital, Dublin, Ireland. honan@iol.ie
PMID: 12411818, UI: 22299397
Anesthesiology 2002 Nov;97(5):1295-301
Department of Anesthesia, College of Medicine, University of Iowa Health Care, Iowa City 52242-1079, USA. javier-campos@uioa.edu
PMID: 12411817, UI: 22299396
Anesthesiology 2002 Nov;97(5):1245-9
Department of Anesthesiology, Emergency Medicine and Surgery, Centre Hospitalier Universitaire (CHU) Pitie-Salpetriere, Paris, France. xavier.paqueron@psl.ap-hop-paris.fr
BACKGROUND: Upper limb trauma occurs frequently in elderly patients for whom peripheral nerve blocks are often preferred for anesthesia. The characteristics of such regional blocks have, however, never been described in an elderly population. Therefore, the authors assessed prospectively the onset and duration of upper extremity peripheral nerve block (the mid-humeral block) in elderly and young patients undergoing emergency upper extremity surgery. METHODS: Consecutive patients aged > 70 yr or < 70 yr received a mid-humeral block with a small volume of ropivacaine, 0.75%. Five milliliters was injected onto each of the musculocutaneous, radial, ulnar, and median nerves. Time to complete sensory and motor block and durations of complete sensory and motor block were assessed. Results are shown as median and its 95% confidence interval. RESULTS: Median ages were 77 yr (95% CI, 72-81 yr) and 39 yr (95% CI, 27-46 yr) in the two groups. Both groups had similar times to complete sensory blockade. The elderly group had longer durations of complete sensory (390 min [range, 280-435 min] vs.150 min [range, 105-160 min]; P< 0.05) and motor (357 min [range, 270-475 min] vs. 150 min [range, 90-210 min]; P< 0.05) blockade. Duration of complete sensory block was significantly correlated with age (rho = 0.56; P< 0.05). CONCLUSIONS: Age is a major determinant of duration of complete motor and sensory blockade with peripheral nerve block, perhaps reflecting increased sensitivity to conduction failure from local anesthetic agents in peripheral nerves in the elderly population.
PMID: 12411811, UI: 22299390
Other Formats: Links:
BMJ 2002 Nov 2;325(7371):1037
PMID: 12411376, UI: 22299544
Br J Anaesth 2002 Dec;89(6):917-9
Evaluation and Audit Unit, University Department of Anaesthesia, Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL, UK. Department of Anaesthesia, Salisbury Hospital, Salisbury, UK.
BACKGROUND: Information on anaesthesia interventions, plans and risks is needed by patients and carers alike and is a key component of the Good Practice In Consent initiative. Existing information materials may under-represent what patients are able to contribute. METHOD: UK anaesthetic departments were surveyed on provision of written patient information. The response rate was 66% (177/267). RESULTS: Fifty-five per cent of respondents reported providing patient information materials for planned surgical admission, mainly on general anaesthesia, regional analgesia and pain. A minority provided information for children and for critical care patients. Few (32%) had sought feedback from patients, and few used existing sources of guidance. Most (85%) wanted improvements, with a four-to-one majority favouring central resources developed by The Royal College of Anaesthetists. CONCLUSIONS: Working in parallel does not give our hospitals excellent, effective patient information materials. Demand exists for The Royal College of Anaesthetists to lead in this area. Working in partnership with patients and taking into account existing written guidance is important but has often been overlooked.
PMID: 12453937, UI: 22340783
Br J Anaesth 2002 Dec;89(6):904-16
Department of Anaesthesia and Intensive Care Medicine, St George's Hospital Medical School, Cranmer Terrace, London SW17 0RE, UK. Department of Neurology, Charing Cross Hospital, Fulham Palace Road, London W6 8RF, UK.
Parkinson's disease is an increasingly common disease of elderly patients who present a particular anaesthetic challenge. This review explores the epidemiology, aetiology, pathogenesis, and pathophysiology of the condition, particularly the possible role of genetic factors. The clinical features are described in detail and recent advances in medical management are highlighted. Controversies surrounding the use of the newer drugs and possible advances in neurosurgical interventions are discussed. Particular anaesthetic problems in patients with Parkinson's disease are respiratory, cardiovascular, and neurological. Potential drug interactions are described and recommendations are made about suitable anaesthetic techniques.
PMID: 12453936, UI: 22340782
Br J Anaesth 2002 Dec;89(6):863-72
Department of Anaesthesiology, St Gallen Cantonal Hospital, Rorschacherstrasse 95, CH-9007 St Gallen, Switzerland. Picker Institute Europe, Zug, Switzerland.
BACKGROUND: We describe the development and comparison of a psychometric questionnaire on patient satisfaction with anaesthesia care among six hospitals. METHODS: We used a rigorous protocol: generation of items, construction of the pilot questionnaire, pilot study, statistical analysis (construct validity, factor analysis, reliability analysis), compilation of the final questionnaire, main study, repeated analysis of construct validity and reliability. We compared the mean total problem score and the scores for the dimensions: 'Information/Involvement in decision-making', and 'Continuity of personal care by anaesthetist'. The influence of potential confounding variables was tested (multiple linear regression). RESULTS: The average problem score from all hospitals was 18.6%. Most problems are mentioned in the dimensions 'Information/Involvement in decision-making' (mean problem score: 30.9%) and 'Continuity of personal care by anaesthetist' (mean problem score: 32.2%). The overall assessment of the quality of anaesthesia care was good to excellent in 98.7% of cases. The most important dimension was 'Information/Involvement in decision-making'. The mean total problem score was significantly lower for two hospitals than the total mean for all hospitals (significantly higher at two hospitals) (P<0.05). Amongst the confounding variables considered, age, sex, subjective state of health, type of anaesthesia and level of education had an influence on the total problem score and the two dimensions mentioned. There were only marginal differences with and without the influence of the confounding variables for the different hospitals. CONCLUSIONS: A psychometric questionnaire on patient satisfaction with anaesthesia care must cover areas such as patient information, involvement in decision-making, and contact with the anaesthetist. The assessment using summed scores for dimensions is more informative than a global summed rating. There were significant differences between hospitals. Moreover, the high problem scores indicate a great potential for improvement at all hospitals.
PMID: 12453931, UI: 22340777
Br J Anaesth 2002 Dec;89(6):853-856
Department of Anaesthesiology and Intensive Care, Department of Clinical Neurophysiology and Department of Otorhinolaryngology, Kuopio University Hospital, PO Box 1777, FIN-70211 Kuopio, Finland Hannu Kokki, Kuopio University Hospital, PO Box 1777, FIN-70211 Helsinki, Finland.
[Record supplied by publisher]
BACKGROUND: Sevoflurane is a methyl ether anaesthetic commonly used for induction and maintenance of general anaesthesia in children. Sevoflurane is a non-irritant and acts quickly so induction is usually calm. However, inhalation induction with high concentrations of sevoflurane can cause convulsion-like movements and seizure-like changes in the electroencephalogram (EEG). Little is known about the EEG during maintenance of anaesthesia with sevoflurane, so we planned a prospective trial of sevoflurane maintenance after i.v. induction with benzodiazepine and barbiturate, which is another common induction technique in children. METHODS: EEG recordings were made before premedication with midazolam (0.1 mg kg(-1) i.v.), during induction of anaesthesia with thiopental (5 mg kg(-1)), and during maintenance with sevoflurane (2% end-tidal concentration in air/oxygen without nitrous oxide) in 30 generally healthy, 3- to 8-year-old children having adenoids removed. Noise-free EEG data of good quality were successfully recorded from all 30 children. RESULTS: Two independent neurophysiologists did not detect epileptiform discharges in any of the recordings. CONCLUSION: Premedication with midazolam, i.v. induction with thiopental and maintenance of anaesthesia with 2% sevoflurane in air does not cause epileptiform EEG patterns in children.
PMID: 12453929
Br J Anaesth 2002 Dec;89(6):825-31
Department of Anaesthesia and Intensive Care, University Hospital of Trondheim, N-7006 Trondheim, Norway sigurd.fasting@medisin.ntnu.no
BACKGROUND: Anaesthesia equipment problems may contribute to anaesthetic morbidity and mortality. The magnitude and pattern of these problems are not established. We wanted to analyse the frequency, type and severity of equipment-related problems in our department, and if additional efforts to improve safety were needed. METHODS: The study is based on a system in which anaesthesia-related data are recorded from all anaesthetic cases on a routine basis. The data include intraoperative problems and their severity. When a problem occurs, the anaesthetist responsible for the case writes a short description of the event on the anaesthetic chart. From all recorded cases of general and regional anaesthesia, we selected cases recorded with anaesthetic 'equipment/technical problems'. These charts were retrieved from departmental archives for analysis. RESULTS: From 83 154 anaesthetics, we found the frequency of anaesthetic equipment problems to be 0.05% during regional anaesthesia, and 0.23% during general anaesthesia. One-third of problems involved the anaesthesia machine, and in a quarter, human error was involved. No patient died and none suffered any lasting morbidity. CONCLUSION: The rate of equipment problems was low, and most often of low severity. Aside from improvements in routines for preoperative equipment checks, no specific strategies for problem reduction could be suggested. The incidence of equipment problems is not a good quality indicator because of the low rate of occurrence. However, recorded equipment problems may be useful for improving quality, by analysing causative factors, and suggesting preventative strategies.
PMID: 12453924, UI: 22340770
Br J Anaesth 2002 Sep;89(3):528-9
PMID: 12402744, UI: 22291118
Br J Anaesth 2002 Sep;89(3):438-41
Departments of Anaesthesiology and Pharmacology and Toxicology, University of Oulu, Finland.
BACKGROUND: Blockade of the ilioinguinal and iliohypogastric nerves is a useful procedure in paediatric patients undergoing inguinal surgery. Bupivacaine 2 mg kg-1 has been recommended for this block. We compared the plasma concentrations of ropivacaine and bupivacaine following an ilioinguinal-iliohypogastric block. METHODS: Forty children scheduled for elective inguinal surgery were randomized to receive 2 mg kg-1 of either 0.75% ropivacaine or 0.5% bupivacaine. Surgical anaesthesia was maintained with mask inhalation of oxygen, nitrous oxide and sevoflurane. Venous blood samples were drawn at regular intervals for up to 2 h and plasma was separated. Total venous plasma concentrations were determined by gas chromatography. RESULTS: The groups were similar with respect to age, weight and dose of local anaesthetic. The peak plasma concentration achieved was significantly higher in the bupivacaine group compared with the ropivacaine group (2.2 vs 1.2 micrograms ml-1, P = 0.025). The time to peak plasma concentration was significantly shorter in the bupivacaine group (24 vs 35 min, P = 0.024). The initial distribution half time of bupivacaine was significantly shorter (3.6 vs 6.5 min, P = 0.020) compared with that of ropivacaine. CONCLUSIONS: Bupivacaine is more rapidly absorbed from the injection site and leads to higher plasma concentrations than ropivacaine.
PMID: 12402722, UI: 22291096
Br J Anaesth 2002 Sep;89(3):369-72
PMID: 12402712, UI: 22291086
JAMA 2002 Nov 20;288(19):2404; discussion 2405
PMID: 12435246, UI: 22323489
Lancet 2002 Nov 2;360(9343):1426; discussion 1426-7
PMID: 12424017, UI: 22311612
Pediatrics 2002 Dec;110(6):1053-7
Department of Pediatrics, Orebro University Hospital, Orebro, Sweden. maria-gradin@telia.com
OBJECTIVE: A number of studies have shown that orally administered sweet-tasting solutions reduce signs of pain during painful procedures. The local anesthetic cream EMLA has recently been shown to be safe for use in neonates. This study compared the pain-reducing effect of orally administered glucose with that of EMLA cream during venipuncture in newborns. METHODS: Randomized, controlled, double-blind study including 201 newborns undergoing venipuncture for clinical purposes. Ninety-nine of the newborns received EMLA on the skin and orally administered placebo (sterile water), and 102 received glucose 30% orally and placebo (Unguentum Merck) on the skin. Symptoms associated with pain at venipuncture were measured with the Premature Infant Pain Profile (PIPP) scale (also validated for full-term infants). Heart rate and crying time were recorded. RESULTS: There were no differences in background variables between the 2 groups. The results shows that the PIPP scores were significantly lower in the glucose group (mean: 4.6) compared with the EMLA group (mean: 5.7). The duration of crying in the first 3 minutes was significantly lower in the glucose group (median: 1 second) than in the EMLA group (median: 18 seconds). There were significantly fewer patients in the glucose group who were scored having pain (defined as PIPP score above 6); 19.3% compared with 41.7% in the EMLA group. The changes in heart rate were similar in both groups. CONCLUSIONS: We found that glucose is effective in reducing symptoms associated with pain from venipuncture in newborns and seems to be better than the local anesthetic cream EMLA.
PMID: 12456899, UI: 22345093