Patients undergoing non-cardiac surgical procedures who carry coronary artery
stents have to be classified as high risk patients. Perioperative myocardial
infarction and severe bleeding are possible. Therefore, anaesthetic management
directed by invasive monitoring, ECG ST analysis, transesophageal echocardiography
and referral to an intensive care unit are absolutely justified. The urgency
of the surgical procedure, perioperative risk and an antiplatelet regimen
have to be discussed with the patient and the surgeon in advance. In the case
of cardiac complications, rapid therapy by an interventional cardiologist
must be available.
Publication Types:
Review
Review, tutorial
PMID: 11824079, UI: 21682725
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Anaesthesist 2001 Dec;50(12):933-6
[Transtracheal oxygenation in respiratory tract obstruction from a hypopharyngeal
tumor].
[Article in German]
Schwarzkopf K, Muller A, Preussler N, Schreiber T, Leopold U, Gottschall
R
Klinik fur Anasthesiologie und Intensivtherapie, Klinikum der Friedrich-Schiller-Universitat,
Bachstrasse 18, 07740 Jena. konrad.schwarzkopf@med.uni-jena.de
A 42-year-old male with a history of chronic alcoholism was admitted to the
department of otolaryngology with acute respiratory insufficiency and generalised
cyanosis due to a respiratory obstruction by a large tumour of the hypopharynx.
Because of the size and location of the tumour and the risk of bleeding, orotracheal
intubation by direct laryngoscopy was considered almost impossible. To improve
oxygenation cricothyroidal punction and oxygen insufflation was done immediately
and SpO2 increased from 56% to 82%. Awake fiberoptic nasotracheal intubation
was performed under topical anaesthesia, then general anaesthesia was induced
and controlled ventilation was started. After surgical tracheotomy the patient
was transferred to an intensive care unit and 12 h later the patient was discharged
from the ICU.
PMID: 11824078, UI: 21682724
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Anesthesiology 2001 Sep;Suppl:B1-30
Abstracts of the American Society of Critical Care Anesthesiologists 14th
annual meeting. New Orleans, Louisiana, USA. October 12, 2001.
Publication Types:
Congresses
Overall
PMID: 11858235, UI: 21846849
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Ann Fr Anesth Reanim 2001 Dec;20(10):f206-9
[A case of benign ventricular tachycardia in anesthesia].
[Article in French]
Benkhadra S, Laurent G, Cottin Y, Auvray L, Freysz M
Departement d'anesthesie-reanimation, hopital general, CHU, 21033 Dijon,
France.
PMID: 11803860, UI: 21663116
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Ann Fr Anesth Reanim 2001 Dec;20(10):f202-3
[The blue line of the crest..].
[Article in Fre nch]
Zetlaoui PJ
Publication Types:
Review
Review, tutorial
PMID: 11803858, UI: 21663114
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Ann Fr Anesth Reanim 2001 Dec;20(10):f196-201
[Risk management in anesthesia].
[Article in French]
Sfez M, Serezat M
Clinique de la Muette, 46, rue Nicolo, 75116, Paris, France.
Publication Types:
Review
Review, tutorial
PMID: 11803857, UI: 21663113
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Ann Fr Anesth Reanim 2001 Dec;20(10):f188-95
[Antiplatelet agents in the perioperative period].
[Article in French]
Publication Types:
Review
Review, tutorial
PMID: 11803856, UI: 21663112
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Ann Fr Anesth Reanim 2001 Dec;20(10):874-5
[Circulatory arrest in the course of anesthesia for a child with mastocytosis].
[Article in French]
Tirel O, Chaumont A, Ecoffey C
Publication Types:
Letter
PMID: 11803853, UI: 21663109
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Ann Fr Anesth Reanim 2001 Dec;20(10):872-4
[The management of neurosurgical patients operated in the seated position].
[Article in French]
Law-Koune JD, Michel-Cherqui M, Gaillard S, Fischler M
Publication Types:
Letter
PMID: 11803852, UI: 21663108
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Ann Fr Anesth Reanim 2001 Dec;20(10):870-1
[A diagnostic exclusion which has to be taken into account]!
[Article in French]
Brabis-Henner A, Begert M, Ragage JP
Publication Types:
Letter
PMID: 11803850, UI: 21663106
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Ann Fr Anesth Reanim 2001 Dec;20(10):869
[Pulmonary embolism discovered during induction of anesthesia for cholecystectomy].
[Article in French]
Mesbahi S, Louet J, Riou F
Publication Types:
Letter
PMID: 11803849, UI: 21663105
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Ann Fr Anesth Reanim 2001 Dec;20(10):865-8
[Acute pulmonary edema from inhalation of the bite-block after anesthesia
with a laryngeal mask].
[Article in French]
Banchereau F, Marie S, Pez H, Boully-Balihaut A, Tueux O
Departement d'anesthesie-reanimation I, centre hospitalier universitaire,
groupe Pellegrin, Place Amelie Raba-Leon, 33000 Bordeaux, France.
We report a case of acute pulmonary oedema, consecutive to upper airway obstruction
due to the inhalation of the laryngeal mask airway (LMA) bite block during
recovery. The LMA was used for general anaesthesia with the bite-block provided
in France. No trouble occurred during LMA insertion and anaesthesia. Symptomatic
treatment provided complete resolution within a few days.
PMID: 11803848, UI: 21663104
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Ann Fr Anesth Reanim 2001 Dec;20(10):838-52
[Malignant hyperthermia: new developments in diagnosis and clinical management].
[Article in French]
Depret T, Krivosic-Horber R
Departement d'anesthesie-reanimation chirurgicale I, hopital R. Salengro,
boulevard E. Laine, CHRU, 59037 Lille, France.
OBJECTIVE: To analyse the current knowledge concerning anaesthetic malignant
hyperthermia. DATA SOURCES: References were obtained from computerized bibliographic
research (Medline), recent review articles, the library of the service and
personal files. DATA SYNTHESIS: Knowledge to possess, about the diagnosis
and treatment of the acute hyperthermia crises and about "safe-anaesthesia"
for malignant hyperthermia susceptible patients, are explained. The pathophysiology
chapter give information about the calcium's transport and the defect existing
in MH. Molecular genetics of MH find linkage to the region encoding the RyR1.
The profile of hyperthermia episodes has changed over time due to the endtidal
carbon dioxide-monitoring. Clinical aspects of MH are exposed. The treatment
of the acute hyperthermia crises consist mainly to stop all triggering agents
instantly and infuse dantrolene sodium. The gold standard for the diagnosis
of malignant hyperthermia susceptibility relies on the in vitro contracture
test (halothane and caffeine). Associated to genetic studies, it could lead
to an non-invasive screening of the MH susceptibility. A protocol for "safe-anaesthesia"
is proposed. Some syndromes with features similar to those of MH should be
known (central core disease and exertionnal rhabdomyolysis).
Publication Types:
Review
Review, tutorial
PMID: 11803844, UI: 21663100
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Can J An aesth 2002 Jan;49(1):91-5
Effective nasotracheal intubation using a modified transillumination technique.
Favaro R, Tordiglione P, Di Lascio F, Colagiovanni D, Esposito G, Quaranta
S, Gasparetto A
Department of Anesthesiology and Intensive Care, University of Rome, La Sapienza,
Rome, Italy.
PURPOSE: Difficult intubation is a major problem in anesthesia. In case of
limited mouth opening only a few intubating devices are available. Our study
was designed to evaluate the effectiveness and safety of a modified transillumination
technique for nasotracheal intubation (NTI). METHODS: One hundred twenty-three
patients needing NTI were studied, 76 in group A: NTI with no expected intubation
difficulty; and 47 in group B: limited mouth opening (<20 mm). All intubations
were performed with the Trachlight(TM). Patients in group A were under general
anesthesia while deep sedation (maintaining spontaneous breathing) was used
in patients in group B. The standard transillumination technique was modified
by keeping the metallic stylet in place and personalizing the length and the
angle of the short arm of the J shaped endotracheal tube-transillumination
lightwand (ETT-TL) assembly. RESULTS: The overall rate of success was 98.4%
and 92.6% of intubations were successful on the first attempt. The average
duration of intubation was 28 sec +/- 15 sec. Success rate and duration of
intubation were similar in both groups. CONCLUSION: Modification of the technique
facilitated transillumination and placement of the ETT. The simplicity and
high success rate of NTI by transillumination with the TL suggest our modified
technique is a valuable alternative for NTI in patients with difficult airway.
Publication Types:
Clinical trial
PMID: 11782336, UI: 21642024
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Can J Anaesth 2002 Jan;49(1):57-61
Addition of bupivacaine 1.25 mg to fentanyl confers no advantage over fentanyl
alone for intrathecal analgesia in early labour.
Lim EH, Sia AT, Wong K, Tan HM
Department of Anaesthesia, KK Women's and Children's Hospital, Singapore.
PURPOSE: a) To evaluate the effect of adding 1.25 mg of bupivacaine to intrathecal
fentanyl on the duration of analgesia in an Asian population and b) to examine
if the baricity of the local anesthetic at this dose has any bearing on the
duration and quality of block. METHODS: Forty-eight parturients in early labour
received combined spinal epidural (CSE) analgesia to evaluate a) the effect
of adding 1.25 mg of bupivacaine to intrathecal (IT) fentanyl 25 microg on
the duration of analgesia and b) the effect of baricity of intrathecal local
anesthetic on the duration and quality of the block. Patients were randomly
allocated to receive: IT fentanyl 25 microg plus normal saline (Group f, n=16),
IT fentanyl 25 microg plus plain bupivacaine 1.25 mg (Group f+pb, n=16) and
IT fentanyl 25 microg plus heavy bupivacaine 1.25 mg (Group f+hb, n=16). The
two components of the IT injectate (total of 2.25 mL) were given sequentially.
RESULTS: Group f+hb had the lowest sensory dermatomal block (T7 vs T4 (Group
f), T5 (Group f+pb), P <0.01). There were no differences in the duration
of analgesia and incidence of side effects among the groups. CONCLUSION: We
found no advantage of adding 1.25 mg bupivacaine to fentanyl 25 microg. At
this dose, the baricity of bupivacaine has no effect on the duration of analgesia.
Publication Types:
Clinical trial
Randomized controlled trial
PMID: 11782329, UI: 21642017
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Can J Anaesth 2002 Jan;49(1):19-24
Fat embolism syndrome and elective knee arthroplasty.
Jenkins K, Chung F, Wennberg R, Etchells EE, Davey R
Department of Anesthesia, University of Toronto, Toronto Western Hospital,
Toronto, Ontario, Canada.
PURPOSE: To report a case of fat embolism syndrome (FES) following elective
left knee arthroplasty and review the diagnosis, investigation, prevention
and perioperative management of this condition. CLINICAL FEATURES: A 76-yr-old
lady presented for left total knee arthroplasty under general anesthesia.
After an uneventful anesthetic and initial recovery, she developed respiratory
and neurological complications six hours postoperatively necessitating supportive
care in the intensive care unit. Following extensive investigation, a clinical
diagnosis of FES was made 48 hr postoperatively supported by the development
of diffuse encephalopathy, thrombocytopenia, hypoxemia, chest petechiae and
chest x-ray changes. A magnetic resonance imaging scan five days postoperatively
confirmed this diagnosis. Her postoperative course showed gradual improvement
consistent with a slowly resolving encephalopathy. Previous published cases
of FES associated with knee arthroplasty present either with intraoperative
cardiorespiratory collapse or, as with this patient, in the postoperative
period with respiratory, cardiovascular and/or cerebral dysfunction. CONCLUSIONS:
The clinical diagnosis of FES is essentially one of exclusion, supported by
laboratory and radiological investigations. Preoperative identification of
at-risk patients, use of appropriate invasive perioperative monitoring and
modified surgical techniques may minimize the development of the syndrome.
Treatment is supportive.
PMID: 11782324, UI: 21642012
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Can J Anaesth 2002 Jan;49(1):13-8
Titration of isoflurane using BIS index improves early recovery of elderly
patients undergoing orthopedic surgeries.
Wong J, Song D, Blanshard H, Grady D, Chung F
Department of Anesthesia, Toronto Western Hospital, University Health Network,
University of Toronto, Toronto, Ontario, Canada. jean_wong@yahoo.com
PURPOSE: This study was designed to investigate the effect of bispectral
index (BIS) monitoring on the recovery profiles, level of postoperative cognitive
dysfunction, and anesthetic drug requirements of elderly patients undergoing
elective orthopedic surgery with general anesthesia. METHODS: Sixty-eight
patients over the age of 60 were randomized into one of two groups. In the
standard practice (SP) group, the anesthesiologists were blinded to the BIS
value, and isoflurane was titrated according to standard clinical practice.
In the BIS group, isoflurane was titrated to maintain a BIS value between
50-60. RESULTS: The total isoflurane usage was 30% lower in the BIS group
compared to the SP group (5.6 +/- 3 vs 7.7 +/- 3 mL, P <0.05). The time
to orientation was faster in the BIS group compared to the SP group (9.5 +/-
3 vs 13.1 +/- 4 min, P <0.001). There were no differences in the postoperative
psychometric tests between the two groups. CONCLUSIONS: There was no difference
in the level of postoperative cognitive dysfunction between the two groups.
However, titration of isoflurane using the BIS index decreased utilization
of isoflurane and contributed to faster emergence of elderly patients undergoing
elective knee or hip replacement surgery.
Publication Types:
Clinical trial
Randomized controlled trial
PMID: 11782323, UI: 21642011
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Can J Anaesth 2002 Jan;49(1):8-12
The oxygen concentrator is a suitable alternative to oxygen cylinders in
Nepal.
Shrestha BM, Singh BB, Gautam MP, Chand MB
Department of Anaesthesia, Bir Hospital, Kathmandu, Nepal. bisharadshrestha@hotmail.com
PURPOSE: To review the efficacy and reliability of oxygen concentrators used
over the last six years in Nepal. The apparatus used was a DeVilbiss(R) oxygen
concentrator that provided O(2) for anesthesia supplemented with compressed
air to drive a Penlon Manley Multivent Ventilator(R). It remains difficult
to supply oxygen in cylinders to peripheral hospitals in Nepal due to lack
of proper roads. METHODS: We conducted a retrospective analysis of a sample
of 378 cases anesthetized at the Bir Hospital and at a private hospital in
Kathmandu from April through October 1999. The Bain circuit or its modification
was used in adults, and Bain or Ayre's T piece in children. High flows from
the oxygen concentrator used with the Bain and Ayre's T-circuits were reduced
to 2 L/min, delivered through the halothane vaporizer, supplemented by room
air in the modified Bain circuit. Positive pressure ventilation was provided
with an Ambubag, Oxford Inflating Bellows or Penlon Manley Multivent Ventilator.
Blood pressure, electrocardiogram, FiO(2) and SpO(2) were monitored in all
cases. RESULTS: Surgery included urologic, general surgery, obstetrics and
gynecological procedures, neurosurgery and closed mitral valvotomy. Age ranged
from six months to 78 yr. The anesthetic time lasted from 45 min to 12 hr.
The FiO(2) ranged from 0.5 to 0.6 in the Bain and Ayre's T circuits, and from
0.34 to 0.40 in the modified Bain circuit with a flow of oxygen of 2 L/min
from the concentrator. CONCLUSION: With regular maintenance and servicing
done locally, the oxygen concentrator can be used safely in adults and children.
Use of the oxygen concentrator is a suitable alternative to oxygen cylinders
in the developing world.
PMID: 11782322, UI: 21642010
Eur J Anaesthesiol 2001 Nov;18 Suppl 23:4-9
An approach to quality management in anaesthesia: a focus on perioperative
care and outcome.
Dahmen KG, Albrecht DM
Department of Anaesthesiology and Intensive Care Medicine, University Hospital
'Carl-Gustav-Carus', Technical University Dresden, Fetscher Str. 74, D-01307
Dresden, Germany.
[Record supplied by publisher]
Health care systems throughout the world are faced with continuously rising
health care expenditure. In Germany, a fee per capita system will be introduced
by 2003 to keep the budgets for hospital care within limits. As a result,
numbers of hospital beds and hospitals will be cut in the coming years. On
the other hand, more and more patients and health care providers are asking
if they are really receiving an adequate value for their money in the treatment
they receive. All this will have a strong impact on the anaesthesiologist's
work and her/his perception of the different facets of quality. Quality has
various aspects for the anaesthesiologist. The patient as a customer should
not incur any detrimental effects after a surgical procedure, and is accompanied
by the anaesthesiologist throughout the perioperative setting. The surgeon
needs optimal conditions to perform a procedure. The hospital must balance
equally costs and income; this requires optimal operating room utilization.
Finally, health insurance companies and the government are responsible for
covering the cost of treatment according to the quality of the care delivered.
Quality assessment concerning structure, process and outcome has to tak e these
demands into account. Continuous quality improvement in the spirit of Deming's
'plan-do-check-act cycle' has to be part of anaesthesiologist's everyday routine.
In future, the traditional barriers between the specialities treating a patient
will be disrupted when reimbursement for treatment is made according to quality
and efficacy of treatment.
PMID: 11849273
J Cardiothorac Vasc Anesth 2002 Feb;16(1):21-26
To ventilate or not after minimally invasive direct coronary artery bypass
surgery: The role of epidural anesthesia.
de Vries AJ, Mariani MA, van Der Maaten JM, Loef BG, Lip H
Departments of Anesthesiology and Cardiothoracic Surgery, University Hospital
Groningen, Groningen, The Netherlands.
[Record supplied by publisher]
OBJECTIVE: To evaluate the effect of immediate postoperative extubation and
postoperative ventilation after minimally invasive direct coronary artery
bypass (MIDCAB) surgery and to assess the role of epidural anesthesia. DESIGN:
Randomized prospective study. SETTING: University hospital, single institution.
PARTICIPANTS: Patients (n = 90) scheduled for elective MIDCAB surgery. INTERVENTIONS:
Patients were divided into 3 groups: 30 patients had general anesthesia and
were extubated immediately after surgery (extubated group), 30 patients had
a thoracic epidural and general anesthesia and were extubated immediately
after surgery (epidural group), and 30 patients had general anesthesia and
were ventilated after surgery (intubated group). Measurements and Main Results:
With a similar cardiac index and less vasoactive medication, mean arterial
blood pressure (77 plus minus 8 mmHg [mean plus minus SD]) and heart rate
(76 plus minus 10 beats/min) in the epidural group were lower on the first
postoperative day than in the intubated group (83 plus minus 10 mmHg an d 81
plus minus 13 beats/min) and the extubated group (86 plus minus 10 mmHg and
83plus minus13) (p = 0.01 and p = 0.09). Oxygenation on the first postoperative
day was better in the epidural group than in the intubated group (14.8 plus
minus 3.8 kPa v 12.6 plus minus 3.2 kPa; p = 0.05). The epidural group and
the extubated group had a transient respiratory acidosis postoperatively.
Pain score in the epidural group was lower on the first postoperative day
than in the extubated group with general anesthesia (3.0 plus minus 1.6 visual
analog scale v 4.6 plus minus 1.8 visual analog scale; p = 0.01). Hospital
stay was shorter in the epidural group than in the ventilated group (5.9 plus
minus 2.4 days v 8.1 plus minus 5.3 days; p = 0.05) CONCLUSION: Immediate
postoperative extubation in patients with thoracic epidural anesthesia and
supplemental general anesthesia provides the most favorable clinical circumstances
after MIDCAB surgery. Copyright 2002, Elsevier Science (USA). All rights reserved.
PMID: 11854873
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J Cardiothorac Vasc Anesth 2002 Feb;16(1):15-20
Epidural anesthesia and analgesia: Effects on recovery from cardiac surgery.
Departments of Anesthesiology and Surgery, Dartmouth-Hitchcock Medical Center,
Lebanon; and Dartmouth Medical School, Hanover, NH.
[Medline record in process]
OBJECTIVE: To measure predefined clinical effects resulting from the use
of epidural anesthesia and analgesia during and after cardiac surgery. DESIGN:
Prospective, randomized, nonblinded clinical trial. SETTING: Single academic
medical center. PARTICIPANTS: Sixty patients scheduled for elective cardiac
surgery with cardiopulmonary bypass. INTERVENTI ONS: Sixty participants were
randomly assigned to 1 of 2 study groups: (1) A control group received general
anesthesia during surgery and intravenous opiate analgesia after surgery.
(2) A treatment group received thoracic epidural anesthesia combined with
general anesthesia during surgery and epidural analgesia for the first 24
postoperative hours. Measurements and Main Results: Primary study measurements
were planned to evaluate recovery from surgery and included time to tracheal
extubation, duration of postoperative intensive care unit stay, duration of
postoperative hospitalization, pain control, urinary free cortisol, cardiopulmonary
complication rate, and total hospital charges. No statistically significant
differences between the 2 study groups were found in these main measurements.
CONCLUSIONS: The clinical course of elective cardiac surgical patients who
receive epidural anesthesia during surgery and epidural analgesia after surgery
is comparable to that of patients managed with general anesthesia alone during
surgery followed by parenteral opiate analgesia after surgery. Copyright 2002,
Elsevier Science (USA). All rights reserved.
PMID: 11854872, UI: 21843330
JAMA 2002 Feb 20;287(7):816
JAMA 100 Years Ago: Skilled Anesthetizers.
[Record supplied by publisher]
PMID: 11851556
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Lancet 2002 Feb 9;359(9305):532
Monitored anaesthesia in elderly ophthalmic patients.
Malhotra SK, Dutta A, Gupta A
Departments of Anaesthesia and Intensive Care, Postgraduate Institute of
Medical Education and Research, 160012, Chandigarh, India
[Medline record in process]
PMID: 11853842, UI: 21843661
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Obstet Gynecol 2002 Feb;99(2):369-70
ACOG Committee Opinion number 269 February 2002. Analgesia and cesarean
delivery rates. American College of Obstetricians and Gynecologists.
Various studies report conflicting data with regard to the level of risk
of cesarean delivery for nulliparous women who receive epidural analgesia
before 5 cm of cervical dilatation. As a result, some institutions are requiring
that laboring women reach 4-5 cm of dilatation before receiving epidural analgesia.
The American College of Obstetricians and Gynecologists wishes to reaffirm
the opinion published jointly with the American Society of Anesthesiologists
that while under a physician's care, in the absence of a medical contraindication,
maternal request is a sufficient medical indication for pain relief during
labor. Decisions regarding analgesia should be coordinated among the obstetrician,
the anesthesiologist, the patient, and support personnel.
Publication Types:
Guideline
Practice guideline
PMID: 11814523, UI: 21674801
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Paediatr Anaesth 2002 Jan;12(1):86
Local anaesthesia toxicity is additive: a concern for neonatal caudal anaesthesia?
Abouleish AE, Nguyen NH
Department of Anaesthesiology The University of Texas Medical Branch Galveston,
TX, USA.
[Medline record in process]
PMID: 11849585, UI: 21839889
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Paediatr Anaesth 2002 Jan;12(1):85
Adjunctive peribulbar anaesthesia for paediatric ophthalmic surgery: are
the r isks justified?
Anaesthetic management of a case of nesidioblastosis for subtotal pancreatectomy.
Mali M, Bagry H, Vas L
Bai Jerbai Wadia Hospital For Children, Acharya Donde Marg, Parel, Mumbai,
India.
[Medline record in process]
Hyperinsulinism is a rare cause of severe persistent hypoglycaemia in the
neonatal period. It is associated with a high incidence of brain damage and
mental retardation as a consequence of repeated episodes of hypoglycaemia.
Subtotal to near total pancreatectomy is indicated as a matter of urgency
to decrease the amount of circulating insulin. The perioperative management
of a 45-day-old, 5 kg male infant with hyperinsulinaemia (nesidioblastosis)
is described. He had a history of generalized tonic clonic seizures 4 h after
birth. The blood sugar at that time was 0.66 mmol x l(-1) (12 mg x dl(-1))
and serum calcium was 2.4 mmol x l(-1) (9.82 mg x dl(-1)). The insulin : glucose
ratio was 1.6 (normal < 0.4). Occasional episodes of hypoglycaemia persisted
in spite of medical line of management with intravenous dextrose 12%, 2 h
gastric tube feeds, hydrocortisone (5 mg x kg(-1) x day(-1) i.v.) and oral
diazoxide 10 mg x kg(-1), 8 h for 3 weeks. A CT scan and USG did not reveal
any abnormality of the pancreas. However, the EEG varied from one of abnormally
low amplitude to an isoelectric record. Renal, liver function tests and coagulation
profile were normal. The patient was scheduled for elective subtotal pancreatectomy.
The anaesthetic management with emphasis on glucose homeostasis and fluid
balance is discussed.
PMID: 11849582, UI: 21839886
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Paediatr Anaesth 2002 Jan;12(1):59-64
Effect of general and epidural anaesthesia on thyroid hormones and immunity
in neonates.
Gasparoni A, Ciardelli L, De Amici D, Castellazzi AM, Autelli M, Bottino
R, Polito E, Bartoli A, Rondini G, Chirico G
Research Laboratories, Policlinico San Matteo, IRCCS, Pavia, Italy. a.gasp@tin.it
[Medline record in process]
BACKGROUND: The aim of this study was to verify if variations of thyroid
hormones related to circumstances of delivery and mode of maternal anaesthesia
can contribute to neonatal neutrophil respiratory burst and natural killer
cell activity. METHODS: We evaluated 10 infants born by vaginal delivery (group
A), 10 infants born by caesarean section after epidural anaesthesia with lidocaine
(group B) and 10 infants born by caesarean section after general anaesthesia
with sevoflurane (group C). RESULTS: A significant reduction of neutrophil
respiratory burst test was found in groups A and C compared with group B.
Natural killer cell (NK) activity with an effector : target ratio of 30 :
1 (NK30) and 10 : 1 (NK10) was significantly higher in group A compared with
the B and C groups. In addition, thyroid stimulating hormone (TSH) concentration
was significantly reduced in group A compared with the B and C groups. A significant
negative correlation was found between TSH and NK30 or NK10. CONCLUSIONS:
Our results suggest that the mode of delivery and anaesthesia can significantly
modify the endocrine-immune system in the newborn. Caesarean section delivery
with regional anaesthesia seems to produce fewer modifications of neonatal
immune function compared wi th general anaesthesia.
PMID: 11849577, UI: 21839881
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Paediatr Anaesth 2002 Jan;12(1):26-8
Oral midazolam with an antacid may increase the speed of onset of sedation
in children prior to general anaesthesia.
Lammers CR, Rosner JL, Crockett DE, Chhokra R, Brock-Utne JG
Department of Anesthesia, Stanford University Medical Center, Stanford, CA
94305-5640, USA.
[Medline record in process]
BACKGROUND: The aim of the study was to see whether sodium citrate solution
would speed the gastric absorption of oral midazolam. METHODS: Forty presurgical
ASA I and II patients (aged 2-6 years) were randomly assigned to one of two
groups. Group I received midazolam 0.5 mg x kg(-1) mixed with sodium citrate
while group II (control) received midazolam 0.5 mg x kg(-1) mixed with Hawaiian
fruit punch. RESULTS: There was no statistical difference between the ages,
weights, preoperative sedation and anxiety scores in the two groups. After
premedication, the onset of sedation (mean +/- SD) measured by the first change
in sedation score was found to be significantly faster (P < 0.05) in group
I (17.8 +/- 7.11) compared with group II (21.9 +/- 5.34). There was no statistical
difference in anxiety at any time intervals, separation or induction scoring
for both groups. Gastric volumes and the pH of gastric aspirates between the
two groups were not statistically significant. CONCLUSIONS: The time to onset
of sedation can potentially be shortened, by using a preparation of intravenous
midazolam and antacid, given orally.
TUTTO
IL MATERIALE CONTENUTO IN QUESTO SITO E' STATO REPERITO IN RETE. GLI AUTORI
NON SI ASSUMONO RESPONSABILITA' PER
DANNI A TERZI DERIVATI DA USO IMPROPRIO O ILLEGALE DELLE INFORMAZIONI
RIPORTATE O DA ERRORI RELATIVI AL LORO CONTENUTO.
