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Acta Anaesthesiol Scand 2003 Jan;47(1):106-9
Department of Anesthesiology, Virgen de la Luz Hospital, Cuenca, Spain.
[Medline record in process]
Gaucher's disease is a rare genetic disorder characterized by lack or functional insufficiency of glucocerebrosidase, an enzyme accountable for intracellular hydrolysis of glucosyl ceramide and other glycosphingolipids, which results in macrophage storage in the mononuclear-macrophage system. The severity of Gaucher's disease is correlated with the extent to which the central nervous system is involved. It is associated with the so-called Gaucher's cells in the bone marrow, but is specifically diagnosed by showing enzyme acid beta-glucosidase activity in a sample of blood leukocyte or cultured macrophages from skin biopsy. In the last 10 years, an enzyme replacement therapy (alglucerase) for the disease has been available, which has significantly changed approaches to its treatment. Here we report the case of a 56-year-old female patient with type I Gaucher's disease who underwent surgery for subcapital hip fracture with subarachnoid anesthesia. Type I Gaucher's disease clinical and pathophysiologic aspects relevant to anesthetic management are discussed. As very few similar cases have been reported in the anesthesiology literature, it is our belief that the present case may help to elucidate some controversial issues relating to the perioperative anesthetic management of patients with type I Gaucher's disease.
PMID: 12492809, UI: 22380190
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Acta Anaesthesiol Scand 2003 Jan;47(1):94-7
Division of Pain Management, Department of Anaesthesiology, University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong.
Three patients were referred to our pain clinic with evidence of complex regional pain syndrome in their extremities. Two presented at the atrophic stage with joint contractures. Multiple analgesics had been prescribed without long-lasting relief. Physiotherapy was required to improve physical activity but was severely limited by pain. We instituted local anaesthetic infusion with the possibility of self-supplementation to facilitate physiotherapy; two via brachial plexus catheters for hand pain and one via epidural catheter for knee pain. Although their resultant pain scores were variable after cessation of local anaesthetic infusion, all the affected joints exhibited marked improvement in range of movement. We propose that this technique is a useful option for patients in all stages of complex regional pain syndrome where the emphasis is now directed toward functional improvement.
PMID: 12492805, UI: 22380186
Acta Anaesthesiol Scand 2003 Jan;47(1):84-9
Department of Anesthesia and Intensive Care, and Department of Surgery, Hopital Cochin, Universite Rene Descartes, Paris.
BACKGROUND: Two opioid regimens, computer-simulated to provide optimal general anesthesia in combination with propofol, were compared using clinical criteria. METHODS: Fifty patients undergoing thyroid surgery were blindly, prospectively and randomly allocated to receive either (a) i.v. remifentanil (1.5 micro g kg-1, followed by 0.2 micro g kg-1 min-1) or (b) i.v. sufentanil (0.2 micro g kg-1 followed by 0.2 micro g kg-1 h-1). Remifentanil infusion was stopped at the last skin suture. Sufentanil infusion was stopped 30 min before the end of surgery. Intravenous propofol was titrated to keep BIS at 50+/-5. Remifentanil and sufentanil groups were compared with regards to (a) propofol delivery, (b) hemodynamic and recovery variables, and (c) effect-site propofol levels during a steady-state period for effect-site remifentanil and sufentanil levels. P<0.05 was significant. RESULTS: Groups were similar in demographic data; types and durations of surgery; total propofol consumption; and response, extubation and emergence times. During the steady-state period for the opioid delivery, the remifentanil and sufentanil effect-site levels were 5.3 ng ml-1 and 0.18 ng ml-1, respectively (potency ratio=30). In both opioid groups, in accordance with previous computer-simulations, the effect-site propofol concentrations remained (a) within a narrow range unaffected by surgical stimuli, (b) significantly smaller in the remifentanil group than in the sufentanil group, but (c) smaller than expected from previous computer-simulations. More patients required ephedrine following induction of anesthesia in the remifentanil compared with the sufentanil group. CONCLUSIONS: The present clinical trial conducted in thyroid surgery is consistent with previous computer-simulated opioid-propofol combinations with respect to intraoperative and recovery variables. Effect-site propofol ranges were, however, lower than expected.
PMID: 12492803, UI: 22380184
Acta Anaesthesiol Scand 2003 Jan;47(1):13-9
Department of Anesthesiology and Intensive Care, Department of Surgery, and The Division for Ambulatory Surgery, University Hospital, Orebro, Sweden.
BACKGROUND: Inguinal herniorrhaphy is commonly performed as an outpatient procedure. Spinal anesthesia offers some advantages over general anesthesia in this setting. METHODS: Forty patients were randomly divided into two groups according to a double-blind protocol: Group L had spinal anesthesia with bupivacaine 6.0 mg and Group H with bupivacaine 7.5 mg; in both groups, fentanyl 25 micro g was added to the spinal anesthetic. The sensory block was measured by 'pin-prick' and the motor block was evaluated by a modified Bromage scale. RESULTS: No differences were seen in the spread, duration and regression of sensory block between the groups on the operated side. A greater number of patients required analgesics during the operation in Group L (6) compared with Group H (1) (P<0.05). The return of the modified Bromage scale to grade 0 was earlier in Group L than in Group H (P<0.05) but the time to mobilization and discharge was similar. Seven patients (17%) needed to be catheterized and two had the catheter retained overnight. Times to home discharge (median) were 350 and 445 min, respectively, in Groups L and H. Postoperatively and during the first week, visual analog pain scores, analgesic requirements and side-effects were similar between the groups. In Group H, 95% of the patients and in Group L 85% would have the same anesthetic again if operated upon for a similar procedure. CONCLUSIONS: Spinal anesthesia with bupivacaine 7.5 mg and fentanyl offers an alternative to general or local anesthesia for ambulatory inguinal herniorrhaphy. However, the long discharge times and risk for urinary retention restrict its routine use in all patients.
PMID: 12492791, UI: 22380172
Acta Anaesthesiol Scand 2003 Jan;47(1):3-12
University of South Florida, Tampa, and the Aldrete Pain Center, Santa Rosa Beach, Florida, FL, USA.
Of late, regional anesthesia has enjoyed unprecedented popularity; this increase in cases has brought a higher frequency of instances of neurological deficit and arachnoiditis that may appear as transient nerve root irritation, cauda equina, and conus medullaris syndromes, and later as radiculitis, clumped nerve roots, fibrosis, scarring dural sac deformities, pachymeningitis, pseudomeningocele, and syringomyelia, etc., all associated with arachnoiditis. Arachnoiditis may be caused by infections, myelograms (mostly from oil-based dyes), blood in the intrathecal space, neuroirritant, neurotoxic and/or neurolytic substances, surgical interventions in the spine, intrathecal corticosteroids, and trauma. Regarding regional anesthesia in the neuroaxis, arachnoiditis has resulted from epidural abscesses, traumatic punctures (blood), local anesthetics, detergents, antiseptics or other substances unintentionally injected into the spinal canal. Direct trauma to nerve roots or the spinal cord may be manifested as paraesthesia that has not been considered an injurious event; however, it usually implies dural penetration, as there are no nerve roots in the epidural space posteriorly. Sudden severe headache while or shortly after an epidural block using the loss of resistance to air approach usually suggests pneumocephalus from an intradural injection of air. Burning severe pain in the lower back and lower extremities, dysesthesia and numbness not following the usual dermatome distribution, along with bladder, bowel and/or sexual dysfunction, are the most common symptoms of direct trauma to the spinal cord. Such patients should be subjected to a neurological examination followed by an MRI of the effected area. Further spinal procedures are best avoided and the prompt administration of IV corticosteroids and NSAIDs need to be considered in the hope of preventing the inflammatory response from evolving into the proliferative phase of arachnoiditis.
PMID: 12492790, UI: 22380171
Acta Anaesthesiol Scand 2003 Jan;47(1):1-2
Department of Surgical Gastroenterology, Hvidovre University Hospital, Hvidovre, and Danish Hernia Database, Denmark and Department of Anaesthesiology, Glostrup County University Hospital, Glostrup, Denmark.
PMID: 12492789, UI: 22380170
Anaesth Intensive Care 2002 Jun;30(3):391
Publication Types:
PMID: 12075662, UI: 22070890
Anaesth Intensive Care 2002 Jun;30(3):388-9
PMID: 12075659, UI: 22070887
Anaesth Intensive Care 2002 Jun;30(3):386-7
PMID: 12075656, UI: 22070884
Anaesth Intensive Care 2002 Jun;30(3):367-9
Freeman Hospital, High Heaton, Newcastle-upon Tyne, United Kingdom.
A case is reported in which metoclopramide, midazolam, propofol, and pethidine were injected arterially during the course of anaesthesia, resulting in oedema and discolouration of the hand initially, but no long-term sequelae. An AVI 470 pump (3M Corporation) was used to control the infusion, andprevented backflow through a cannula which was unintentionally sited in an artery rather than a vein. Few anaesthetic drugs have their effects well documented when given arterially, and in particular, there were no previous reported cases involving metoclopramide in this context. The pharmacology of metoclopramide is discussed with reference to the drug's known effects on vascular beds and platelet function.
PMID: 12075648, UI: 22070876
Anaesth Intensive Care 2002 Jun;30(3):331-7
Department of Anaesthesia, Ludwig Maximilians University, Munich, Germany.
We investigated ropivacaine 75 mg/ml in comparison with bupivacaine 5 mg/ml in patients receiving interscalene brachial plexus block (ISB) and general anaesthesia. In this randomized, double-blind, prospective clinical trial, each patient received an ISB block according to the technique originally described by Winnie and a catheter technique as per Meier. The rapidity of onset and the quality of sensory and motor block were determined. After general anaesthesia had been induced further parameters evaluated were consumption of local anaesthetic, opioid and neuromuscular blocking drug. After arrival in the recovery room, the patients were assessed for intensity of pain using a visual analog scale (VAS). One hundred and twenty patients were included in the study. The onset and development of sensory block was similar in both groups. Development and quality of motor block was also nearly identical for both local anaesthetics. Consumption of neuromuscular blocking drug and opioid did not differ between ropivacaine and bupivacaine. In the recovery room the mean pain score was less than 25 in both groups. There were no significant differences in terms of onset and quality of sensory or motor block during the intraoperative and early postoperative period. In addition we did not identify any side-effects related to the administration of the local anaesthetics. Ropivacaine 7.5 mg/ml and bupivacaine 5mg/ml proved to be nearly indistinguishable when administered for interscalene brachial plexus block.
PMID: 12075641, UI: 22070869
Anaesth Intensive Care 2002 Jun;30(3):326-30
Department of Anaesthesiology, The University of Hong Kong, Queen Mary Hospital, Pokfulam.
The aim of this study was to determine the extent of unnecessary investigation performed as part of the preoperative preparation of elective surgical patients in a teaching hospital and to audit the effect of guidelines and education designed to reduce unnecessary investigation. Guidelines were developed for preoperative anaesthetic investigation for elective surgical procedures in patients over one year of age according to internationally accepted criteria, with some adjustment for local differences in patient morbidity. Forrms outlining these criteria were placed in all operating theatres and anaesthetists were asked to determine whether tests performed were indicated or not, according to these criteria, over a two-week period, in each patient undergoing elective surgery. Tests indicated for surgical reasons were excluded. These same guidelines were then issued to all surgical departments along with explanatory lectures. The audit was repeated six months later and results compared. The incidence of over-investigation decreased from 13.8% to 11.6% (P = 0.03) without a significant increase in under-investigation (0.7 v 1.0%; P = 0.2). This study highlights the incidence of unwarranted screening tests in patients presenting for elective surgery and the role of protocols and ongoing education in reducing this incidence.
PMID: 12075640, UI: 22070868
Anaesth Intensive Care 2002 Jun;30(3):321-5
Department of Anaesthesia, Women's and Children's Hospital, Adelaide, South Australia.
This prospective randomized controlled double-blind trial was performed to investigate whether glyceryl trinitrate (GTN) ointment, applied ten minutes after the removal of a eutectic mixture of local anaesthetic cream, lignocaine/ prilocaine (EMLA), influences site selection for intravenous cannulation in children. Eighty children aged between five and 15 years, having general surgery as day patients, received EMLA cream on both hands for 90 minutes prior to transfer to the theatre suite. Acting as their own controls, the children received GTN on one hand, and placebo on the other, after removal of the EMLA cream and ten minutes prior to the insertion of an intravenous cannula. The application of GTN or placebo to left or right hand was blinded and randomized. At induction, the hand with the visually best quality veins was selected and cannulated. The primary outcome was selection between the EMLA/GTN hand and EMLA/placebo hand. The selection having been made, the number of attempts at cannulation, ease of insertion and pain scores (VAS) for cannulation were also recorded. The choice of hand was positively influenced by the use of GTN, with the GTN hand chosen in 51 of 72 (70%) children who completed the protocol (P = 0.001). The findings of this study suggest that the application of GTN after EMLA removal may be clinically useful in aiding cannulation in children.
PMID: 12075639, UI: 22070867
Anaesth Intensive Care 2002 Jun;30(3):261
Geoffrey Kaye Museum of Anaesthetic History.
PMID: 12075631, UI: 22070859
Anaesthesia 2003 Jan;58(1):101
University of California San Diego, San Diego, California, USA, E-mail: kkuczkowski@ucsd.edu
PMID: 12492692, UI: 22380342
Anaesthesia 2003 Jan;58(1):96
Burnley General Hospital, Burnley, UK.
PMID: 12492685, UI: 22380335
Anaesthesia 2003 Jan;58(1):95
Catholic University 'Sacred Heart', 00168 - Rome, Italy E-mail: sistermorphine@tiscali.it
PMID: 12492683, UI: 22380333
Anaesthesia 2003 Jan;58(1):24-7
The aim of this study was to determine the effect of nitrous oxide on cerebral blood flow velocity in children anaesthetised with desflurane. Eighteen healthy children scheduled for elective surgery were enrolled into the study. Anaesthesia was induced using sevoflurane, and a caudal block was performed following tracheal intubation. Anaesthesia was maintained with 1 age-adjusted MAC desflurane. A transcranial Doppler probe was used to measure middle cerebral artery blood flow velocity. Each patient was randomised to receive a sequence of either air/nitrous oxide/air or nitrous oxide/air/nitrous oxide in 30% oxygen. Fifteen minutes after each change in the nitrous oxide concentration, three measurements of cerebral blood flow velocity, blood pressure and heart rate were recorded. Neither the addition nor removal of nitrous oxide caused any significant changes in middle cerebral artery blood flow velocity, heart rate or blood pressure. This may be due to a more potent cerebral vasodilatory effect of desflurane in children.
PMID: 12492665, UI: 22380315
Anaesthesia 2003 Jan;58(1):11-6
Advances in technology have resulted in the development of several depth-of-anaesthesia monitors. Whether any of these monitors can reduce the incidence of awareness is an important issue for anaesthetists and their patients. We therefore surveyed a random selection of anaesthetists, asking for their opinions of awareness and depth-of-anaesthesia monitoring in current clinical practice. Approximately half (52%) of the anaesthetists surveyed had experienced a patient with awareness. Anaesthetists considered that they had a lower incidence of awareness in their own practice when compared with others, 1:5000 vs. 1:10 000 (p < 0.001). Anaesthetists rated awareness on an11-point scale as only a moderate problem, median (interquartile range) 5 (2-7). Older anaesthetists were less likely to rate the importance of awareness highly (p = 0.009) and to use awareness monitoring (p = 0.001). Anaesthetists are prepared to use depth-of-anaesthesia monitoring more widely if it can be shown to prevent most cases of awareness in routine practice.
PMID: 12492663, UI: 22380313
Anaesthesia 2002 Nov;57(11):1119-28
Department of Anaesthetics, North Hampshire Hospital, Basingstoke, UK.
Whilst conducting a randomised controlled trial into the effects of combination anti-emetics, we endeavoured to confirm that our patient groups were matched using the predictive scoring systems for postoperative nausea and vomiting (PONV) and postoperative vomiting (POV) reported in the literature. One hundred and seventy-seven female patients attending for day case gynaecological surgery were studied and their individual risks of PONV and POV were calculated using four predictive models for PONV and two predictive models for POV. The scoring systems were then evaluated to see if agreement existed between them using the method described by Bland and Altman. Bias and 95% limits of agreement were calculated for each combination. Agreement between scoring systems was poor. As the scoring systems gave widely divergent predictions, we concluded that the predictive risk for PONV or POV would be dependent upon the scoring system chosen, thus limiting their usefulness in this role.
PMID: 12428640, UI: 22315676
Anaesthesia 2002 Nov;57(11):1144
PMID: 12392475, UI: 22280192
Anaesthesia 2002 Nov;57(11):1142
PMID: 12392469, UI: 22280186
Anaesthesia 2002 Nov;57(11):1134-5
PMID: 12392459, UI: 22280176
Anaesthesia 2002 Nov;57(11):1090-3
Llandough Hospital and University of Wales College of Medicine, Department of Anaesthetics and Intensive Care Medicine, University Hospital of Wales, Heath Park, Cardiff CF14 4XW, UK.
Accidental oesophageal intubation is still an important cause of anaesthetic morbidity and mortality. This study investigated the use of impedance respirometry to determine the position of a tracheal tube. Seventy-nine patients undergoing general anaesthesia requiring tracheal intubation with muscle relaxation were recruited to the study. After pre-oxygenation, tracheal tubes were placed in both the oesophagus and trachea; a breathing system was attached to one tube chosen randomly. A blinded observer was required to correctly identify the position of the tube within six tidal ventilations. The position of every tube connected to the breathing system was correctly identified. The median time to correctly identify tracheal and oesophageal tubes was 3 and 5 s, respectively. The median number of breaths to identify tracheal and oesophageal tubes was two for both groups. Every tube position was identified within the required six breaths. Impedance respirometry is a reliable method for diagnosing tracheal tube position.
PMID: 12392456, UI: 22280173
Anaesthesia 2002 Nov;57(11):1052-9
Department of Anaesthesiology and Intensive Care, Kuopio University Hospital, PO Box 1777, FIN-70211 Kuopio, Finland.
We assessed the predictive value of intra-operative quality indicators (incidents) with respect to outcome (hospital mortality) and resource utilisation (length of stay in the postanaesthesia care unit and in hospital). Institutional data obtained from reports of a quality system that complies with the ISO 9002 standard were evaluated retrospectively. Incidents occurred in 2009 of 25 091 anaesthetics. Mortality was higher after incidents than after uneventful anaesthetics, but in multivariate analysis the incidents did not contribute to mortality. Length of stay in the postanaesthesia care unit and hospital were longer after incidents (p < 0.001 for both). In multivariate analysis, incidents independently contributed to length of stay in the postanaesthesia care unit among ASA I-III patients (p < 0.05, 0.001 and 0.001, respectively) and to length of hospital stay among ASA II-III patients undergoing scheduled operations (p < 0.05 and < 0.01, respectively). Intra-operative incidents are associated with increased resource utilisation following surgery.
PMID: 12392452, UI: 22280169
Anaesthesist 2002 Dec;51(12):1006-14
Klinik fur Anaesthesie und Allgemeine Intensivmedizin, Universitat Wien.
Recent developments in blockade techniques are based on the possibilities offered by modern sonography.With high frequency linear probes, the smallest tissue structures, such as peripheral nerves, in areas close to the surface can be visualised.This is the prerequisite for ultrasound-guided blockade techniques which has now been established for available peripheral blockades.These techniques are basically far superior to all other assist methods of peripheral blockades, because they allow a success rate close to 100%, a short preparation time and a reduction in the use of local anaesthetic agents.Apart from these, one particularly important aspect is that they reduce the risks of local anaesthesia procedures by direct imaging of neighbouring anatomical structures. In this article the theoretical basis of ultrasound techniques and their practical use in local anaesthesia will be presented.
PMID: 12486590, UI: 22372858
Anaesthesist 2002 Dec;51(12):993-5
Klinik fur Anasthesiologie und Operative Intensivmedizin der Universitat zu Koln.
In our hospital hyperbaric Carbostesin 0.5%((R)) (AstraZeneca) had been substituted by hyperbaric Bucain 0.5%((R)) (Curasan) and both drugs were believed to be identical in their actions.However, both local anaesthetics differ in the amount of glucose they contain. We report about three patients who underwent cesarian section under spinal anaesthesia. In two patients we observed an insufficient spread of spinal anaesthesia after administration of hyperbaric Bucain 0.5%((R)).The third patient received the normally used combination of hyperbaric Carbostesin 0.5%((R)) and fentanyl and the subarachnoid block proceeded completely uneventfully. According to the literature the clinical efficacy of hyperbaric Carbostesin 0.5%((R)) and hyperbaric Bucain 0.5%((R)) should be identical and therefore a critical dilution of the Bucain should not have occurred because of the addition of fentanyl.
PMID: 12486588, UI: 22372856
Anaesthesist 2002 Dec;51(12):989-92
Anaesthesieabteilung,Orthopadische Klinik Kassel.
This is a case report of transient neurologic symptoms (TNS) after spinal anesthesia with 4% hyperbaric mepivacaine,which have not been reported before.The patient was a 44-year-old man with a meniscus lesion who received spinal anesthesia with 80 mg 4% mepivacaine while undergoing knee arthroscopy. A L3-L4 mid-line approach was used with a 26-gauge Quincke needle and a 21-gauge introducer.The local anaesthetic was injected over approximately 30 s with the aperture of the Quincke needle in a cephalad direction. A transient pain syndrome was observed 4 h after spinal anesthesia, which included symmetric pain and/or dysesthesia in the buttocks and posterior thighs appearing 4 h after recovery from the spinal anesthesia and had a duration of 2 days.The patient stated that the pain radiated through the hips, buttocks, and posterior thighs and extended past the buttocks and lower legs.The pain was described as strong and aching,occasionally decreasing when walking around. It responded well to NSAID and resolved spontaneously within 3 days.No other neurologic symptoms or signs were noted.
PMID: 12486587, UI: 22372855
Anaesthesist 2002 Dec;51(12):980-8
Klinik fur Anaesthesiologie und Intensivmedizin, Universitatskliniken des Saarlandes, Homburg/Saar.
INTRODUCTION. The Narcotrend(tm) is a new EEG monitor designed to measure the hypnotic component of anaesthesia;however,a major clinical evaluation is still missing.This prospective multicentre study was designed to investigate the feasibility of Narcotrend monitoring in a large number of patients under different clinical conditions and to define its impact on recovery times after propofol-based total intravenous anaesthesia. METHODS. After legal authority approval and patients'informed consent had been obtained, total intravenous anaesthesia was induced and maintained with propofol and an opioid analgesic at the discretion of the attending anaesthesiologist. In the first 10-15 patients of each centre the anaesthesiologist was blinded to the Narcotrend recordings and propofol was dosed according to clinical needs.In the following patients propofol was infused at a rate sufficient to achieve a target Narcotrend stage of D or E. With termination of propofol infusion,recovery times were recorded and analysed for the patients with or without Narcotrend monitoring; in addition,recovery times were analysed depending on the Narcotrend stage at the moment of termination of propofol infusion. RESULTS. In total, 4,630 adult patients were studied at 46 institutions, 521 without and 4,109 with Narcotrend monitoring.Demographic data and duration of anaesthesia were comparable.Emergence from anaesthesia was significantly shorter in Narcotrend monitored patients, e.g.opening eyes after 9.8+/-5.9 (mean+/-SD) vs.11.8+/-7.1min.In addition,awakening was significantly more rapid when the propofol infusion was stopped at a lower level of hypnosis as indicated by Narcotrend monitoring, e.g.opening eyes after 7.1+/-4.5min with stage C instead of 17.0+/-7.4 min with stage F. CONCLUSIONS. The EEG monitor Narcotrend can be used for adult patients of different ages and during various surgical procedures.Narcotrend monitoring facilitates a reduction of recovery times after propofol-based total intravenous anaesthesia,presumably by allowing for an individual titration of the propofol dosage.Moreover, it appears that the profile of recovery can be optimised when at the end of surgery,the propofol infusion is controlled to Narcotrend stage C instead of D,E,or F.
PMID: 12486586, UI: 22372854
Anaesthesist 2002 Dec;51(12):973-9
Klinik fur Anasthesiologie, Friedrich-Alexander-Universitat Erlangen-Nurnberg, Erlangen.
BACKGROUND. Opioids contribute to postoperative nausea and vomiting (PONV). An intraoperative analgesia with S-(+)-ketamine will make opioid administration dispensable and may reduce postoperative analgesic requirements.The aim of the study was to record the incidence and intensity of PONV following a total intravenous anesthesia (TIVA) with S-(+)-ketamine/propofol (K/P) or alfentanil/propofol (A/P) as well as recovery from anaesthesia. PATIENTS AND METHODS. A total of 145 patients received a TIVA with K/P or A/P.Recovery time,PONV, intensity of pain and overall acceptance of the delivered anaesthesia were recorded. RESULTS. Recovery times were prolonged in the K/P group.Both groups had a comparable incidence of PONV (26% and 22% for K/P vs A/P, respectively), the intensity was low in both groups with a VAS of <6/100 mm at all times.The intensity of postoperative pain and analgesic requirement did not differ. Overall acceptance of the delivered anaesthesia was lower in the K/P group.Unpleasant dreams were not more common in the K/P group. CONCLUSIONS. A TIVA with K/P did not reduce PONV when compared to A/P, but prolonged recovery.
PMID: 12486585, UI: 22372853
Br J Anaesth 2003 Jan;90(1):110-1
Taunton, UK.
PMID: 12488399, UI: 22375939
Br J Anaesth 2003 Jan;90(1):109-10
Brasschaat, Belgium and Wurzburg, Germany.
PMID: 12488398, UI: 22375938
Br J Anaesth 2003 Jan;90(1):107
Middlesbrough, UK Wirral, UK Liverpool, UK.
PMID: 12488396, UI: 22375936
Br J Anaesth 2003 Jan;90(1):96-8
The Royal Brompton Hospital, Sydney Street, London SW3 6NP, UK. Royal Gwent Hospital, Cardiff Road, Newport NP20 2UB, UK E-mail: davidjwilliams@doctors.org.uk
We describe an adult patient with gastric volvulus caused by a congenital diaphragmatic hernia. Anaesthetic management was complicated by cardiovascular instability, respiratory distress and unexpectedly difficult intubation. Br J Anaesth 2003; 90: 96-8
PMID: 12488389, UI: 22375929
Br J Anaesth 2003 Jan;90(1):84-86
Department of Chemical Physics and Physicochemical Separation Methods, Faculty of Chemistry, Maria Curie-Sklodowska University, 20-031 Lublin, pl. Marii Curie-Sklodowskiej 3, Poland. Department of Anaesthesiology and Intensive Therapy and Department of Neurosurgery and Paediatric Neurosurgery, University School of Medicine, 20-090 Lublin, Jaczewskiego 8, Poland E-mail: dawid@hermes.umcs.lublin.pl
[Record supplied by publisher]
BACKGROUND: The aim of this paper is to compare the propofol concentration in blood and cerebrospinal fluid (CSF) in patients scheduled for different neurosurgical procedures and anaesthetized using propofol as part of a total intravenous anaesthesia technique. METHODS: Thirty-nine patients (ASA I-III) scheduled for elective intracranial procedures, were studied. Propofol was infused initially at 12 mg kg(-1) h(-1) and then reduced in steps to 9 and 6 mg kg(-1) h(-1). During anaesthesia, bolus doses of fentanyl and cis-atracurium were administered as necessary. After tracheal intubation the lungs were ventilated to achieve normocapnia with an oxygen-air mixture (FI(O(2))=0.33). Arterial blood and CSF samples for propofol examination were obtained simultaneously directly after intracranial drainage insertion and measured using high-performance liquid chromatography. The patients were divided into two groups depending on the type of neurosurgery. The Aneurysm group consisted of 13 patients who were surgically treated for ruptured intracranial aneurysm. The Tumour group was composed of 26 patients who were undergoing elective posterior fossa extra-axial tumour removal. RESULTS: Blood propofol concentrations in both groups did not differ significantly (P>0.05). The propofol concentration in CSF was 86.62 (SD 37.99) ng ml(-1) in the Aneurysm group and 50.81 (26.10) ng ml(-1) in the Tumour group (P<0.005). CONCLUSIONS: Intracranial pathology may influence CSF propofol concentration. However, the observed discrepancies may also result from quantitative differences in CSF composition and from restricted diffusion of the drug in the CSF. Br J Anaesth 2003; 90: 84-6
PMID: 12488384
Br J Anaesth 2003 Jan;90(1):58-61
Department of Anaesthesiology, Kyoto Prefectural University of Medicine, Kyoto, Japan. Department of Anaesthesia, Yamanashi Medical University, Yamanishi, JapanCorresponding author: Department of Anaesthesiology, Kyoto Prefectural University of Medicine, Kawaramachi Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan. E-mail: nakajima@koto.kpu-m.ac.jp
BACKGROUND: Intravenous amino acid infusion during general anaesthesia prevents decreases in core temperature resulting from increased energy expenditure and heat accumulation. METHODS: We investigated whether such stimulation also occurs during spinal anaesthesia, which blocks sympathetic nervous activity. We examined the effect of i.v. amino acid infusion on changes in core temperature during spinal anaesthesia. Thirty-five patients were divided into two groups: an i.v. amino acid infusion group (4 kJ kg(-1) h(-1) starting 2 h before surgery); and a saline infusion group. Tympanic membrane core temperature, forearm-fingertip temperature gradient (an index of peripheral vasoconstriction) and mean skin temperature were measured for 90 min after the onset of spinal anaesthesia. RESULTS: Changes in mean arterial pressure and heart rate did not differ significantly between the groups during the study period. Mean final core temperature 90 min after induction of spinal anaesthesia was 35.8 (SEM 0.1) degrees C in the saline group and 36.6 (0.1) degrees C in the amino acid group (P<0.05). The increased level of oxygen consumption in the amino acid group compared with the saline group was preserved even after the onset of spinal anaesthesia. The thermal vasoconstriction threshold, defined as the tympanic membrane temperature that triggered a rapid increase in forearm-fingertip temperature gradient, was increased in the amino acid group [36.8 (0.1) degrees C] compared with the saline group [36.5 (0.1) degrees C] (P<0.05). CONCLUSIONS: Preoperative infusion of amino acids effectively prevents spinal anaesthesia-induced hypothermia by maintaining a higher metabolic rate and increasing the threshold core temperature for thermal vasoconstriction. Br J Anaesth 2003; 90: 58-61
PMID: 12488380
Br J Anaesth 2003 Jan;90(1):43-47
Department of Surgery, Wellington School of Medicine, Otago University, Private Bag 7343, Wellington South, New Zealand. Magill Department of Anaesthetics, Chelsea and Westminster Hospital, London, UK. Department of Clinical Engineering, Charing Cross Hospital, London, UK. Department of Medical Education, Northern General Hospital, Sheffield, UK E-mail: jennifer.weller@wnmeds.ac.nz
BACKGROUND: There is increasing emphasis on performance-based assessment of clinical competence. The High Fidelity Patient Simulator (HPS) may be useful for assessment of clinical practice in anaesthesia, but needs formal evaluation of validity, reliability, feasibility and effect on learning. We set out to assess the reliability of a global rating scale for scoring simulator performance in crisis management. METHODS: Using a global rating scale, three judges independently rated videotapes of anaesthetists in simulated crises in the operating theatre. Five anaesthetists then independently rated subsets of these videotapes. RESULTS: There was good agreement between raters for medical management, behavioural attributes and overall performance. Agreement was high for both the initial judges and the five additional raters. CONCLUSIONS: Using a global scale to assess simulator performance, we found good inter-rater reliability for scoring performance in a crisis. We estimate that two judges should provide a reliable assessment. High fidelity simulation should be studied further for assessing clinical performance. Br J Anaesth 2003; 90: 43-7
PMID: 12488377
Br J Anaesth 2003 Jan;90(1):21-6
Department of Anesthesiology and Critical Care Medicine, Tokyo Medical and Dental University, School of Medicine, 1-5-45, Yushima, Bunkyo-ku, Tokyo 113-8519, Japan E-mail: ishikawa.mane@tmd.ac.jp
BACKGROUND: Arterial oxygenation can change during one-lung ventilation for reasons that are not fully understood. METHODS: We studied patients during anaesthesia and one-lung ventilation, with an inspiratory oxygen fraction of 0.8. Arterial blood gas values were recorded every 10 s with a continuous intra-arterial sensor. The non-dependent lung was compressed several times during the surgical procedure, using a retractor. The change in Pa(O(2)) during and after compression of the non-dependent lung was measured. RESULTS: Pa(O(2)) increased significantly when the non-dependent lung was compressed, and decreased when the compression was released. The first compression of the non-dependent lung transiently increased Pa(O(2)), but the effect of the second compression on oxygenation was more marked and persistent. Pa(O(2)) increased by more than 13 kPa at 10 min after the second compression in four patients (responder group). Arterial oxygenation improved markedly in patients in this group during the surgical procedure. CONCLUSION: Oxygenation can improve during one-lung ventilation in some patients. This improvement is partly related to a marked increase in Pa(O(2)) during compression of the non-dependent lung. Br J Anaesth 2003; 90: 21-6
PMID: 12488373, UI: 22375913
Br J Anaesth 2003 Jan;90(1):1-3
Department of Anaesthesia and Critical Care, Queen Elizabeth Hospital, Gayton Road, Kings Lynn PE30 4ET, UK E-mail: markblunt@eaicg.com
PMID: 12488368, UI: 22375908
Eur J Anaesthesiol 2002 Apr;19(4):308-10
PMID: 12074425, UI: 22068949
Eur J Anaesthesiol 2002 Apr;19(4):303-4; discussion 304
PMID: 12074422, UI: 22068946
J Cardiothorac Vasc Anesth 2002 Dec;16(6):792-3
HCI International Centre Clydebank, Scotland, UK.
PMID: 12486671, UI: 22373755
J Cardiothorac Vasc Anesth 2002 Dec;16(6):739-41
Departments of Anesthesiology and Cardiovascular Diseases, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia.
PMID: 12486657, UI: 22373741
J Cardiothorac Vasc Anesth 2002 Dec;16(6):731-6
Divisions of Pediatric Cardiovascular Anesthesiology and Congenital Heart Surgery, Texas Children's Hospital and Baylor College of Medicine, Houston TX.
OBJECTIVE: To compare the perioperative outcome of patients >/=13 years old undergoing surgery for congenital heart disease in a children's hospital by a dedicated congenital heart surgery and anesthesia team with procedure-matched younger control patients. DESIGN: Retrospective medical record review study. From October 1997 to July 2000, medical records of all patients >12 years old requiring cardiopulmonary bypass were reviewed. A control group of patients </=5 years old was reviewed, and 2 patients were matched to each older patient by diagnosis and surgical procedure. Data are reported as mean +/- SD. Older (study) patients were compared with younger (control) patients using t-test or chi square, with p </= 0.05 significant. SETTING: Medical school-affiliated tertiary-care children's hospital. PARTICIPANTS: Patients undergoing congenital heart surgery. MEASUREMENTS AND MAIN RESULTS: The study group (older patients) comprised 85 patients, and the control group (younger patients) comprised 170 patients. There were no intraoperative deaths. All major complications-cardiopulmonary resuscitation, neurologic injury, massive hemorrhage with sternotomy, femoral cannulation for emergent bypass, and severe episodes of hypotension on induction of anesthesia-occurred in older patients undergoing repeat sternotomy. CONCLUSION: Mortality and major morbidity were low in both groups; however, all major intraoperative incidents occurred in older repeat sternotomy patients, suggesting increased perioperative risk for adverse outcomes in these patients. Copyright 2002, Elsevier Science (USA). All rights reserved.
PMID: 12486655, UI: 22373739
J Cardiothorac Vasc Anesth 2002 Dec;16(6):709-714
Department of Anesthesia, University Hospital of Wales, United Kingdom.
OBJECTIVE: To determine if the combined remifentanil and intrathecal morphine (RITM) anesthetic technique facilitates early extubation in patients undergoing coronary artery bypass graft (CABG) surgery. DESIGN: Prospective, randomized, controlled clinical trial. SETTING: Referral center for cardiothoracic surgery at a university hospital. PARTICIPANTS: Patients (n = 24) undergoing first-time elective CABG surgery. INTERVENTIONS: Two groups represented RITM (n = 12) and fentanyl-based (controls, n = 12) anesthesia. Premedication was standardized to temazepam, 0.4 mg/kg, and anesthesia was induced with etomidate, 0.3 mg/kg, in both groups. The RITM group received remifentanil, 1 &mgr;g/kg bolus followed by 0.25 to 1 &mgr;g/kg/min infusion, and intrathecal morphine, 2 mg. The control group received fentanyl, 12 &mgr;g/kg in 3 divided doses. Anesthesia was maintained with isoflurane and pancuronium in both groups. After completion of surgery, the remifentanil infusion was stopped. Complete reversal of muscle relaxation was ensured with a nerve stimulator, and a propofol infusion, 0.5 to 3 mg/kg/h, was started in both groups. All patients were transferred to the intensive care unit (ICU) to receive standardized postoperative care. Intensivists and ICU nurses were blinded to the group assignment. Propofol infusion was stopped, and the tracheal extubation was accomplished when extubation criteria were fulfilled. MEASUREMENTS AND MAIN RESULTS: Both groups were similar with respect to demographic data and surgical characteristics. Extubation times were 156 +/- 82 minutes and 258 +/- 91 minutes in the RITM and control groups (p = 0.012). Patients in the RITM group exhibited lower visual analog scale pain scores during the first 2 hours after extubation (p < 0.04). Morphine requirements during the 24 hours after extubation were 2.5 +/- 3 mg in the RITM group and 16 +/- 11 mg in the control group (p = 0.0018). Sedation scores were lower in the RITM group during the first 3 hours after extubation (p < 0.03). Pulmonary function tests as assessed by spirometry were better in the RITM group at 6 and 12 hours after extubation (p < 0.04). There were no significant differences in PaO(2) and PaCO(2) after extubation between the 2 groups. None of the patients had episodes of apnea during the immediate 24-hour postextubation period. Two patients from the RITM group required reintubation on the second and sixth postoperative days. There were no differences in ICU and hospital length of stay between the 2 groups. CONCLUSION: Implementation of the RITM technique provided earlier tracheal extubation, decreased level of sedation, excellent analgesia, and improved spirometry in the early postoperative period. The impact of RITM on ICU and hospital length of stay and potential cost benefits require further evaluation. Copyright 2002, Elsevier Science (USA). All rights reserved.
PMID: 12486651
J Cardiothorac Vasc Anesth 2002 Dec;16(6):703-708
Departments of Anesthesiology and Cardiothoracic Surgery, University Lubeck, Lubeck, Germany.
OBJECTIVE: To compare a remifentanil-clonidine-propofol regimen with conventional sufentanil-propofol anesthesia. DESIGN: Randomized, nonblinded trial. SETTING: A single university hospital. PARTICIPANTS: Male patients scheduled for coronary artery bypass graft (CABG) surgery. INTERVENTIONS: In the control group, anesthesia was induced with 0.5 &mgr;g/kg of sufentanil and 0.2 to 0.3 mg/kg of etomidate after preoxygenation. Propofol (50 to 100 &mgr;g/kg/min) and sufentanil (0.5 to 1.0 &mgr;g/kg/h) were started after endotracheal intubation. Sufentanil was stopped after aortic decannulation. In the remifentanil-clonidine group, anesthesia was started with remifentanil (0.15 to 0.3 &mgr;g/kg/min), followed by etomidate (0.2 to 0.3 mg/kg). Propofol was started at 50 to 100 &mgr;g/kg/min, and after endotracheal intubation, clonidine infusion was started (6 to 20 &mgr;g/h). Patients received piritramide (0.15 mg/kg) and metamizole (20 mg/kg) for transitional analgesia. In both groups, propofol infusion was reduced to 30 to 60 &mgr;g/kg/min at skin closure and stopped when assisted spontaneous breathing led to adequate gas exchange. MEASUREMENTS AND MAIN RESULTS: The main outcomes were recovery times; somatic variables; plasma catecholamine levels; and self-recorded pain, nausea, and vomiting. Patients in the remifentanil-clonidine group were extubated earlier and had lower plasma epinephrine and norepinephrine levels. After transitional analgesia, the remifentanil-clonidine patients had similar postoperative analgesic use and self-reported pain and side-effect scores. CONCLUSION: Compared with a sufentanil-propofol regimen, an anesthetic regimen for CABG surgery that combines remifentanil, clonidine, and propofol provides similar hemodynamics. The remifentanil-clonidine regimen reduces catecholamine levels and hastens recovery from anesthesia. Copyright 2002, Elsevier Science (USA). All rights reserved.
PMID: 12486650
J Cardiothorac Vasc Anesth 2002 Dec;16(6):679-84
Heart Center, University Hospital, Linkoping, Sweden.
OBJECTIVES: To evaluate the effects of long-term home self-treatment with thoracic epidural analgesia (TEA) on angina, quality of life, and safety. DESIGN: Prospective consecutive pilot study. SETTING: Department of Cardiology, Heart Center, Linkoping University Hospital. PARTICIPANTS: Between January 1998 and January 2000, 37 consecutive patients with refractory angina began treatment with TEA, using a subcutaneously tunnelled epidural catheter. INTERVENTIONS: The patients were trained to provide self-treatment at home with intermittent injections of bupivacaine. Data were collected until January 2001, and the follow-up for each patient was 1 to 3 years. MEASUREMENTS AND MAIN RESULTS: All but 1 of the patients improved symptomatically. The improvement was maintained throughout the treatment period (4 days to 3 years). The Canadian Cardiovascular Society angina class decreased from 3.6 to 1.7, frequency of anginal attacks decreased from 46 to 7 a week, nitroglycerin intake decreased from 32 to 5 a week, and the overall self-rated quality of life assessed by visual analog scale increased from 24 to 76 (all p < 0.001). No serious catheter-related complications occurred; however, 51% of the catheters became displaced and a new one had to be inserted during the study. CONCLUSION: Long-term self-administered home treatment with TEA seems to be an effective and safe adjuvant treatment for patients with refractory angina. It produces symptomatic relief of angina and improves the quality of life. Copyright 2002, Elsevier Science (USA). All rights reserved.
PMID: 12486646, UI: 22373730