HOMEPAGEMEDNEMOABSTRACTSANESTESIARIANIMAZIONET.DOLORE
TERAPIA IPERBARICAFARMACOLOGIAEMERGENZECERCALINKSCONTATTI

ANESTESIA

RIANIMAZIONE

TERAPIA DEL DOLORE

AVVELENAMENTI

 
ABSTRACTS DI ANESTESIA - FEBBRAIO 2002

Ultimo Aggiornamento: 31 Dicembre 2002

Anesth Analg 2002 Feb;94(2):479-80

Local anesthetic toxicity: different mechanisms for different end points.

Weinberg G

University of Illinois, Chief, Anesthesia, Chicago VA, Westside Division, Chicago, IL. Department of Anesthesiology and Intensive Care Medicine, Kanazawa University School of Medicine, Kanazawa, Japan.

[Medline record in process]

PMID: 11812729, UI: 21670897


Anesth Analg 2002 Feb;94(2):432-437

The Timing of Intravenous Crystalloid Administration and Incidence of Cardiovascular Side Effects During Spinal Anesthesia: The Results from a Randomized Controlled Trial.

Mojica JL, Melendez HJ, Bautista LE

Department of Surgery, School of Medicine, Universidad Industrial de Santander.

[Record supplied by publisher]

We conducted a randomized clinical trial to evaluate the efficacy of crystalloids in preventing spinal-induced hypotension (SIH) and cardiovascular side effects (CVSE) in a group of surgical patients. Participants were assigned to receive lactated Ringer?s solution at 1?2 mL/min (Placebo group, n = 142); lactated Ringer?s at 20 mL/kg starting 20 min before spinal block (n = 130); or lactated Ringer?s at 20 mL/kg starting at the time of spinal block (n = 132). SIH was defined as a decrease of ?30% in baseline systolic blood pressure, and CVSE as SIH plus nausea, vomiting, or faintness requiring treatment. The incidence of SIH was similar in all treatment groups. Compared to placebo, crystalloid administration at the time of spinal block resulted in a significant reduction in the proportion of patients developing CVSE from 9.9% to 2.3%. The corresponding relative proportion was 0.23 (95% confidence interval, 0.07?0.78; P = 0.019), and one additional case of CVSE was avoided for each 13 patients receiving crystalloids at the time of spinal block instead of placebo. Administration of crystalloids at the time of spinal block seems to be effective because it provides additional intravascular fluids during the period of highest risk of CVSE after spinal anesthesia. IMPLICATIONS: Crystalloids are frequently administered to nonobstetric patients minutes before spinal anesthesia to prevent cardiovascular side effects (CVSE). This randomized controlled trial shows that although crystalloids administered before spinal block result in no clinical benefit, they significantly reduce the risk of CVSE when administered at the time of spinal block.

PMID: 11812714


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Anesth Analg 2002 Feb;94(2):415-6

Discitis associated with pregnancy and spinal anesthesia.

Bajwa ZH, Ho C, Grush A, Kleefield J, Warfield CA

Department of Anesthesia and Critical Care, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachussetts.

[Medline record in process]

Discitis (inflammation of the intervertebral disk) most commonly develops as a rare complication of bacterial infection or chemical or mechanical irritation during spine surgery (1) with a postoperative incidence of 1%-2.8% (2). It is also a complication of discography-the intradiscal injection of saline or contrast material (3). The incidence of postdiscography discitis is 1%-4% (3); no cases have been reported when prophylactic antibiotics have been used, supporting the theory of bacterial contamination (3). Although it is controversial whether discitis can be caused by an aseptic or infectious process, recent data suggest that persistent discitis is almost always bacterial (4). Honan et al. (5) reported 16 cases of spontaneous discitis and reviewed another 52 patients from the literature. In their series, patients tended to have one or more comorbid conditions, such as diabetes, vertebral fracture, or a preexisting spine injury. Spontaneous discitis has also been associated with advanced age, IV drug abuse, IV access contamination, urinary tract infection, and immunocompromised states (5,6). No cases of infectious discitis associated with pregnancy and spinal anesthesia have been reported in the English literature. Discitis presents as spasmodic pain in the back that may be referred to the hips or groin (7). The pain may radiate to the lower extremities. The erythrocyte sedimentation rate is usually increased. Radiological changes in discitis include narrowing of the intervertebral disk space, vertebral sclerosis, and erosion of the end plates. The best diagnostic measure may be magnetic resonance imaging (MRI) or a combination of bone and gallium scanning (2). The mainstay for discitis treatment is pain control and antibiotics; surgical intervention is usually not required. Complications of discitis include intervertebral fusion, epidural abscess, and paralysis. IMPLICATIONS: This is a case report of a disk infection (discitis) caused by the bacteria, Streptococcus bovis after spinal anesthesia for cesarean delivery. S. bovis rarely causes discitis, and spinal anesthesia for labor and delivery has not been reported as a cause of discitis.

PMID: 11812710, UI: 21670878


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Anesth Analg 2002 Feb;94(2):385-8

The Effects of Intravenous Anesthetics and Lidocaine on Proliferation of Cultured Type II Pneumocytes and Lung Fibroblasts.

Nishina K, Mikawa K, Morikawa O, Obara H, Mason RJ

Department of Anesthesia and Perioperative Medicine, Faculty of Medical Sciences, Kobe University Graduate School of Medicine, Kobe, Japan.

[Medline record in process]

Type II pneumocytes synthesize surfactant and differentiate into type I pneumocytes to maintain the epithelium (1). Alveolar type II cell proliferation is required for reepithelization after acute lung injury (ALI) and is thought to minimize the subsequent fibrotic response (1). Keratinocyte growth factor (KGF) and hepatocyte growth factor (HGF) are among the most potent mitogen for type II epithelial cells, but not for fibroblasts in the lung (1). These growth factors attenuate several experimental ALI models by promoting epithelial repair (2,3). Thus, KGF and HGF may be a promising therapeutic approach to ALI. Critically ill patients with ALI often receive IV anesthetics or sedatives to facilitate mechanical ventilation. Furthermore, these patients sometimes undergo bronchoscopy under local anesthesia to obtain bronchoalveolar lavage fluid or to remove respiratory secretions. Several IV and local anesthetics inhibit pro-liferation of various cells including epithelium (4,5). If these anesthetics impede proliferation of type II pneumocytes, this suppressive effect may be a disadvantage for alveolar reepithelization in the course of recovery from ALI. In this study, we examined the effects of midazolam, propofol, ketamine, thiopental, and lidocaine on proliferation of type II alveolar epithelial cells using in vitro culture system. Because fibroblast proliferation is a key event in late phase of ALI, inhibition of this fibroproliferation is probably beneficial. Thus, we further determined whether these anesthetics could regulate proliferation of lung fibroblasts. In the current study, rolipram was used as a positive control. In our previous preliminary experiment, we found that rolipram, a phosphodiesterase inhibitor type IV, augments spontaneous or KGF-/HGF-promoted type II cell proliferation (6). IMPLICATIONS: Midazolam, ketamine, thiopental, propofol, or lidocaine did not inhibit proliferation of cultured rat type II pneumocytes. Our findings suggest that these anesthetics do not impede alveolar reepithelization after acute lung injury.

PMID: 11812704, UI: 21670872


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Anesth Analg 2002 Feb;94(2):369-71

Electrocardiographic electrodes provide the same results as expensive special sensors in the routine monitoring of anesthetic depth.

Hemmerling TM, Harvey P

Department of Anesthesiology and Biomedical Department, Universite de Montreal, Quebec, Canada.

[Medline record in process]

The Bispectral Index (BIS) is a mathematically derived electroencephalographic (EEG) derivative that has been introduced to monitor depth of anesthesia (1,2). The A-2000 BIS monitoring system (Aspect Medical Systems, Inc., Newton, MA) is currently the only commercially available system to monitor depth of anesthesia. In several studies, its propensity to optimize the use of hypnotics to maintain and achieve a certain depth of anesthesia has been described (3,4). Some studies have even proposed that the routine use of the monitoring system can decrease awareness (1,5), an increasing factor in malpractice claims. The cost-benefit calculations for BIS monitoring suffer from the fact that like its predecessor, the 1000-A BIS monitor, the A-2000 BIS monitoring system demands the use of expensive, special electrodes (6). Although the application of the single-use BIS sensor is very comfortable and easy to use, its high price of approximately $10-20 US prevents many anesthesiologists from using it. Furthermore, whereas the former model of the monitor (1000-A BIS monitor; Aspect Medical Systems, Inc.) used standardized connectors, which allowed the use of other electrodes such as electrocardiogram (ECG), the new monitoring system makes this very difficult because of special connectors that match the equivalent connector at the proximal BIS sensor site. The purpose of this prospective study was to compare BIS values derived from the original BIS sensor with BIS values derived from commercially available ECG electrodes. This comparison was made possible by designing and manufacturing a connector allowing the use of ECG electrodes. IMPLICATIONS: The Bispectral Index (BIS) monitor adequately monitors depth of anesthesia. The routine use of this monitor has been hampered by the benefit-cost equation because only special expensive electrodes can be used. We examined the agreement of BIS values obtained by original sensor electrodes and commercial electrocardiogram (ECG) electrodes. These ECG electrodes can replace more expensive BIS sensors.

PMID: 11812701, UI: 21670869


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Anesth Analg 2002 Feb;94(2):360-1

Anesthesia for electroconvulsive therapy in obese patients.

Kadar AG, Ing CH, White PF, Wakefield CA, Kramer BA, Clark K

Departments of Anesthesiology and Pain Management and Psychiatry, Cedars Sinai Medical Center, Los Angeles, California.

[Medline record in process]

IMPLICATIONS: Obese patients have successfully undergone over 650 consecutive uncomplicated ECT treatments without any special precautions at two major U.S. medical centers.

PMID: 11812699, UI: 21670867


Anesth Analg 2002 Feb;94(2):351-354

Chloroprocaine is Less Painful than Lidocaine for Skin Infiltration Anesthesia.

Marica LS, O?Day T, Janosky JE, Nystrom EU

Department of Anesthesiology, The Western Pennsylvania Hospital, Pittsburgh, Pennsylvania.

[Record supplied by publisher]

Skin infiltration of local anesthetics causes pain. In a double-blinded protocol, 22 volunteers received random intradermal injections to the volar surface of the forearm with each of the following solutions: normal saline solution 0.9% (NSS), lidocaine 1% (L), lidocaine 1% and sodium bicarbonate 8.4% (L+BIC), 2-chloroprocaine 2% (CP), 2-chloroprocaine 2% and sodium bicarbonate 8.4% (CP+BIC), and NaCHO(3) 8.4% (BIC). Initially, each volunteer received an open-labeled injection of NSS. A 100-mm visual analog scale (VAS, 1?100) was used to assess pain with each injection. The pH of each solution was stable for the length of the study. Repeated measures of variance were used for analysis. The VAS scores (mean ? SD) for open-label and blinded NSS injections were 15.5 ? 15.9 and 14.0 ? 18.1, respectively. The scores for the studied solutions were as follows: BIC, 47.2 ? 25.5; L, 25.8 ? 27.6; L+BIC, 16.0 ? 14.2; CP, 8.6 ? 7.4; and CP+BIC, 6.8 ? 6.7. No significant difference was found between CP and alkalinized CP, but the injection of both solutions was significantly less painful than that of all other solutions (P < 0.05). The pH of the solutions was not related to the pain score. We found that chloroprocaine caused less pain at injection than the more commonly used lidocaine. IMPLICATIONS: Using 2-chloroprocaine can diminish pain caused by the intradermal injection of lidocaine. pH variations of the solution did not relate to the pain profile of the local anesthetic.

PMID: 11812697


Anesth Analg 2002 Feb;94(2):346-350

Small-Dose Selective Spinal Anesthesia for Short-Duration Outpatient Laparoscopy: Recovery Characteristics Compared with Desflurane Anesthesia.

Lennox PH, Vaghadia H, Henderson C, Martin L, Mitchell GW

Departments of Anesthesia, Health Care and Epidemiology, and Gynecology, Vancouver General Hospital, University of British Columbia, Vancouver BC, Canada.

[Record supplied by publisher]

We conducted a randomized controlled trial to compare the recovery characteristics of selective spinal anesthesia (SSA) and desflurane anesthesia (DES) in outpatient gynecological laparoscopy. Twenty ASA physical status I patients undergoing gynecological laparoscopy were randomized to receive either SSA with lidocaine 10 mg + sufentanil 10 ?g or general anesthesia with DES and N(2)O. Intraoperative conditions, recovery times, postanesthesia recovery scores, and postoperative outcomes were recorded. Intraoperative conditions were comparable in both groups. All patients in the SSA group were awake and oriented at the end of surgery, whereas patients in the DES group required 7 ? 2 min for extubation and orientation. SSA patients had a significantly shorter time to straight leg raising (3 ? 1 min versus 9 ? 4 min; P < 0.0001) and to ambulation (3 ? 0.9 min versus 59 ? 16 min; P < 0.0001) compared with the DES group. SSA patients had significantly less postoperative pain than DES patients (P < 0.05). We concluded that SSA was an effec-tive alternative to DES for outpatient gynecological laparoscopy. IMPLICATIONS: This study compared the use of a desflurane general anesthetic to a small-dose spinal anesthetic in ambulatory gynecological laparoscopy. Using the spinal technique, patients can walk from the operating room table to a stretcher on completion of surgery. Their recovery time was similar to that of the desflurane group.

PMID: 11812696


Anesth Analg 2002 Feb;94(2):325-330

The Inhibition of the N-Methyl-D-Aspartate Receptor Channel by Local Anesthetics in Mouse CA1 Pyramidal Neurons.

Nishizawa N, Shirasaki T, Nakao S, Matsuda H, Shingu K

Departments of Anesthesiology and Physiology, Kansai Medical University, Moriguchi-City, Osaka, Japan.

[Record supplied by publisher]

Although the effects of local anesthetics on sodium channels and various other channels and receptors have been intensively investigated, there is little information available about their effects on N-methyl-D-aspartate (NMDA) receptors. We examined the effects of four local anesthetics (procaine, tetracaine, bupivacaine, and lidocaine) on NMDA-induced currents by using a whole-cell patch-clamp technique in dissociated mouse hippocampal pyramidal neurons. Procaine and tetracaine produced a reversible and concentration-dependent inhibition of NMDA-induced currents, but lidocaine showed little inhibition at 1 mM or less. The half-maximal inhibition values (mM; mean ? SEM) for procaine, tetracaine, bupivacaine, and lidocaine at -60 mV were 0.296 ? 0.031, 0.637 ? 0.044, 2.781 ? 0.940 (extrapolated data), and 7.766 ? 14.093 (extrapolated data), respectively. Procaine 0.2 mM reduced the maximal NMDA-induced currents without affecting the 50% effective concentration values for NMDA. The inhibition by procaine exhibited voltage dependence and was more effective at negative potentials. These results indicate a noncompetitive antagonism of procaine on NMDA receptors and suggest that the inhibition is the result of a channel-blocking mechanism. IMPLICATIONS: We examined the effects of four local anesthetics (procaine, tetracaine, bupivacaine, and lidocaine) on NMDA-induced currents by using a whole-cell patch-clamp technique in dissociated mouse hippocampal pyramidal neurons. Both procaine and tetracaine produced a reversible and concentration-dependent inhibition of the NMDA-induced currents.

PMID: 11812692


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Anesth Analg 2002 Feb;94(2):319-24

The neurotoxicity of local anesthetics on growing neurons: a comparative study of lidocaine, bupivacaine, mepivacaine, and ropivacaine.

Radwan IA, Saito S, Goto F

Department of Anesthesiology & Reanimatology, Gunma University School of Medicine, Gunma, Japan.

[Medline record in process]

Local anesthetics can be neurotoxic. To test the hypothesis that exposure to local anesthetics produces morphological changes in growing neurons and to compare this neurotoxic potential between different local anesthetics, we performed in vitro cell biological experiments with isolated dorsal root ganglion neurons from chick embryos. The effects of lidocaine, bupivacaine, mepivacaine, and ropivacaine were examined microscopically and quantitatively assessed using the growth cone collapse assay. We observed that all local anesthetics produced growth cone collapse and neurite degeneration. However, they showed significant differences in the dose response. The IC(50) values were approximately, 10(-2.8) M for lidocaine, 10(-2.6) M for bupivacaine, 10(-1.6) M for mepivacaine, and 10(-2.5) M for ropivacaine at 15 min exposure. Some reversibility was observed after replacement of the media. At 20 h after washout, bupivacaine and ropivacaine showed insignificant percentage growth cone collapse in comparison to their control values whereas those for lidocaine and mepivacaine were significantly higher than the control values. Larger concentrations of the nerve growth factor (NGF) did not improve this reversibility. In conclusion, local anesthetics produced morphological changes in growing neurons with significantly different IC(50). The reversibility of these changes differed among the four drugs and was not influenced by the NGF concentration. IMPLICATIONS: Local anesthetics induce growth cone collapse and neurite degeneration in the growing neurons. Mepivacaine was safer than lidocaine, bupivacaine, and ropivacaine for the primary cultured chick neurons.

PMID: 11812691, UI: 21670859


Anesth Analg 2002 Feb;94(2):313-318

The Anesthetic Mechanism of Urethane: The Effects on Neurotransmitter-Gated Ion Channels.

Hara K, Harris RA

Waggoner Center for Alcohol and Addiction Research and Institute for Cellular and Molecular Biology, University of Texas at Austin, Austin, Texas.

[Record supplied by publisher]

Urethane is widely used as an anesthetic for animal studies because of its minimal effects on cardiovascular and respiratory systems and maintenance of spinal reflexes. Despite its usefulness in animal research, there are no reports concerning its molecular actions. We designed this study to determine whether urethane affects neurotransmitter-gated ion channels. We examined the effects of urethane on recombinant ?-aminobutyric acid(A), glycine, N-methyl-D-aspartate, ?-amino-3-hydroxy-5-methyl-4-isoxazole propionic acid, and neuronal nicotinic acetylcholine receptors expressed in Xenopus oocytes. Urethane potentiated the functions of neuronal nicotinic acetylcholine, ?-aminobutyric acid(A), and glycine receptors, and it inhibited N-methyl-D-aspartate and ?-amino-3-hydroxy-5-methyl-4-isoxazole propionic acid receptors in a concentration-dependent manner. At concentrations close to anesthetic 50% effective concentration, urethane had modest effects on all channels tested, suggesting the lack of a single predominant target for its action. This may account for its usefulness as a veterinary anesthetic. However, a large concentration of urethane exerts marked effects on all channels. These findings not only give insight into the molecular mechanism of anesthetics but also caution that neurophysiologic measurements from animals anesthetized with urethane may be complicated by the effects of urethane on multiple neurotransmitter systems. Our results also suggest that small changes in multiple receptor systems can produce anesthesia. IMPLICATIONS: Urethane modestly affects multiple neurotransmitter systems at an anesthetic concentration. Our findings suggest that these degenerate effects of urethane can produce anesthesia and that urethane has a potential to influence neuronal measurements made in in vivo preparations.

PMID: 11812690


Anesth Analg 2002 Feb;94(2):302-309

Transesophageal Echocardiography Interpretation: A Comparative Analysis Between Cardiac Anesthesiologists and Primary Echocardiographers.

Mathew JP, Fontes ML, Garwood S, Davis E, White WD, McCloskey G, Fitch JC, Afifi S, Lee DL, Kraker P, Rafferty TD, Barash PG, Gillam L, Prokop E

Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina and Yale University School of Medicine, New Haven, Connecticut.

[Record supplied by publisher]

Diagnostic interpretation of intraoperative transesophageal echocardiography (TEE) examinations may vary, particularly when the echocardiographer is also the anesthesiologist. We therefore evaluated the concordance of TEE interpretation as part of a process of continuous quality improvement (CQI). Ten cardiac anesthesiologists participating in a CQI program conducted 154 comprehensive TEE examinations, each consisting of 16 major fields describing cardiac anatomy and function. These examinations were subsequently interpreted off-line by two primary echocardiographers (a radiologist and a cardiologist). Agreement was assessed using the ? coefficient and percent agreement. Overall ? and percent agreement were 0.58 and 83% for anesthesiologists versus radiologist, 0.57 and 80% for anesthesiologists versus cardiologist, and 0.60 and 82% for radiologist versus cardiologist. Anesthesiologists with longer than 5 yr of TEE experience had higher levels of agreement with the radiologist when assessing the aorta, right atrium, pulmonary vein flow, transmitral flow, and fractional area change. Cardiac anesthesiologists supported by a CQI program interpret TEE examinations at a level comparable with physicians whose primary practice is echocardiography. Thus, the anesthesiologist and the intraoperative echocardiographer need not be mutually exclusive. IMPLICATIONS: Interpretation of intraoperative transesophageal echocardiograms can be reliably performed by cardiac anesthesiologists.

PMID: 11812688


Anesth Analg 2002 Feb;94(2):275-282

Thoracic Epidural Anesthesia for Cardiac Surgery: The Effects on Tracheal Intubation Time and Length of Hospital Stay.

Priestley MC, Cope L, Halliwell R, Gibson P, Chard RB, Skinner M, Klineberg PL

Departments of Anaesthesia, Cardiothoracic Surgery, and Cardiology, Westmead Hospital, Westmead, Australia.

[Record supplied by publisher]

Improvements in analgesia after major surgery may allow a more rapid recovery and shorter hospital stay. We performed a prospective randomized trial to study the effects of epidural analgesia on the length of hospital stay after coronary artery surgery. The anesthetic technique and postoperative mobilization were altered to facilitate early intensive care discharge and hospital discharge. Fifty patients received high (T1 to T4) thoracic epidural anesthesia (TEA) with ropivacaine 1% (4-mL bolus, 3?5 mL/h infusion), with fentanyl (100-?g bolus, 15?25 ?g/h infusion) and a propofol infusion (6 mg . kg(-1) . h(-1)). Another 50 patients (the General Anesthesia group) received fentanyl 15 ?g/kg and propofol (5 mg . kg(-1) . h(-1)), followed by IV morphine patient-controlled analgesia. The TEA group had lower visual analog scores with coughing postextubation (median, 0 vs 26 mm; P < 0.0001) and were extubated earlier (median hours [interquartile range], 3.2 [2.1?4.6] vs 6.7 [3.3?13.2]; P < 0.0001). More than half of all patients were discharged home on Postoperative Day 4 (24%) or 5 (33%), but there was no difference in the length of stay between the TEA group (median [interquartile range], Day 5 [5?6]) and the General Anesthesia group (median [interquartile range], Day 5 [4?7]). There were no differences in postoperative spirometry or chest radiograph changes or in markers for postoperative myocardial ischemia or infarction. No significant TEA-related complications occurred. In summary, TEA provided better analgesia and allowed earlier tracheal extubation but did not reduce the length of hospital stay after coronary artery surgery. IMPLICATIONS: We found that epidural analgesia was more effective than IV morphine for cardiac surgery. Epidural anesthesia also allowed earlier weaning from mechanical ventilation, but it did not affect hospital discharge time.

PMID: 11812684


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Anesth Analg 2002 Feb;94(2):271-4

Anesthesia for patients with congenital insensitivity to pain and anhidrosis: a questionnaire study in Japan.

Tomioka T, Awaya Y, Nihei K, Sekiyama H, Sawamura S, Hanaoka K

Department of Anesthesiology, Faculty of Medicine, The University of Tokyo.

[Medline record in process]

We investigated the anesthetic management of patients with congenital insensitivity to pain and anhidrosis (CIPA) in Japan. CIPA is a rare inherited disease characterized by a lack of pain sensation and thermoregulation. Although lacking pain sensation, some patients do have tactile hyperesthesia. Thus, anesthetics are a necessity during operations. We also determined that because patients with CIPA have problems with thermoregulation, temperature management is a concern during the perioperative period and sufficient sedation is necessary to avoid accidental fractures. Additionally, it was found that the use of muscle relaxants does not present a problem, malignant hyperthermia is not associated with CIPA, and that the possibility of abnormalities in the autonomic nervous system must be taken into consideration. Therefore, patients with CIPA can be safely managed with anesthesia. IMPLICATIONS: We investigated the anesthetic management of patients with congenital insensitivity to pain and anhidrosis. We clarified the following three important points: anesthesia is necessary, temperature management must be maintained, and there must be sufficient perioperative sedation in the anesthetic management of patients with congenital insensitivity to pain and anhidrosis.

PMID: 11812683, UI: 21670851


Anesth Analg 2002 Feb;94(2):243-249

Autoantibodies Associated with Volatile Anesthetic Hepatitis Found in the Sera of a Large Cohort of Pediatric Anesthesiologists.

Njoku DB, Greenberg RS, Bourdi M, Borkowf CB, Dake EM, Martin JL, Pohl LR

Departments of Anesthesiology and Critical Care Medicine and Pediatrics, The Johns Hopkins Medical Institutions, Baltimore, Maryland, the Molecular and Cellular Toxicology Section of the Laboratory of Molecular Immunology, and the Division of Epidemiology and Clinical Applications, Office of Biostatistics Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland.

[Record supplied by publisher]

Anesthetic-induced hepatitis is thought to have an immune-mediated basis, in part because many patients who develop hepatitis have serum autoantibodies that react with specific hepatic proteins. The present study shows that pediatric anesthesiologists also have these serum autoantibodies. Moreover, levels of these autoantibodies are higher than those of general anesthesiologists. We collected sera from 105 pediatric and 53 general anesthesiologists (including 3 nurse anesthetists), 20 halothane hepatitis patients, and 20 control individuals who were never exposed to inhaled anesthetics. Serum cytochrome P450 2E1 (P450 2E1) and 58-kd hepatic endoplasmic reticulum protein (ERp58) autoantibodies were measured by enzyme-linked immunosorbent assays. Positive values were 2 SD above median control values. Two multiple regression models were constructed. Pediatric anesthesiologists, like halothane hepatitis patients, had higher serum autoantibody levels of ERp58 and P450 2E1 than general anesthesiologists and controls, which was possibly because of their increased occupational exposures to anesthetics. Female anesthesiologists had higher levels of ERp58 autoantibodies than male anesthesiologists, whereas female pediatric anesthesiologists had higher levels of P450 2E1 autoantibodies than all other anesthesiologists. One female pediatric anesthesiologist had symptoms of hepatic injury. Because most anesthesiologists do not develop volatile anesthetic-induced hepatic injury, the findings suggest that pathogenic ERp58 and P450 2E1 autoantibodies may not directly cause volatile anesthetic hepatitis. Female anesthesiologists have high levels of these autoantibodies; however, the majority of these individuals do not develop hepatitis, suggesting that autoantibodies may not have a pathological role in volatile anesthetic-induced hepatitis. IMPLICATIONS: Environmental exposure of anesthesiology personnel to certain inhaled anesthetics can induce the formation of autoantibodies that have been associated with anesthetic hepatitis. Female anesthesiologists have high levels of these autoantibodies; however, the majority of these individuals do not develop hepatitis, suggesting that autoantibodies may not have a pathological role in volatile anesthetic-induced hepatitis.

PMID: 11812677


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Anesth Analg 2002 Jan;94(1):235

Capnography and severe COPD.

Broka SM, Boujlel S

Publication Types:

  • Letter

PMID: 11772840, UI: 21633757


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Anesth Analg 2002 Jan;94(1):233-4

Is it ethically correct to study the Quincke spinal needle in obstetric patients?

Heard CM, Fletcher JE

Publication Types:

  • Letter

PMID: 11772837, UI: 21633754


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Anesth Analg 2002 Jan;94(1):231-2, table of contents

Difficult endotracheal intubation as a result of penetrating cranio-facial injury by an arrow.

Joly LM, Oswald AM, Disdet M, Raggueneau JL

Departement d'Anesthesie-Reanimation, Centre Hospitalier Sainte Anne, 75674 Paris Cedex 14, France. joly@chsa.broca.inserm.fr

Penetrating injury of the face and airway may make endotracheal intubation difficult or impossible. We report the case of a patient who attempted to commit suicide with a crossbow. Surgery under general anesthesia was required to remove the arrow. The oral intubation route was impossible, and a fiberoptic nasal intubation under local anesthesia was performed. IMPLICATIONS:We report a case of a 42-yr-old patient who underwent surgery for a penetrating craniofacial injury caused by an arrow. Because of the median vertical trajectory of the arrow (from the chin to the frontal skull), only the right nasal approach was accessible for endotracheal intubation. Fiberoptic nasal intubation and securing the airway under local anesthesia are described.

PMID: 11772835, UI: 21633752


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Anesth Analg 2002 Jan;94(1):227-30, table of contents

Alkalinization of intracuff lidocaine improves endotracheal tube-induced emergence phenomena.

Estebe JP, Dollo G, Le Corre P, Le Naoures A, Chevanne F, Le Verge R, Ecoffey C

Service d'Anesthesie Reanimation Chirurgicale 2 , Universite de Rennes, Rennes, France. jean-pierre.estebe@chu-rennes.fr

We sought to evaluate the effect of filling an endotracheal tube cuff with 40 mg lidocaine alone (Group L) or alkalinized lidocaine (Group LB) in comparison to an Air Control group (Group C) on adverse emergence phenomena in a randomized controlled study (n = 25 in each group). The incidence of sore throat was decreased for Group LB in comparison to Group L during the 24 postextubation hours. The difference between Group L and Group C remained significant in the two postextubation hours only. Plasma lidocaine levels increased when lidocaine was alkalinized (C(max) were 62.5 +/- 34.0 ng/mL and 3.2 +/- 1.0 ng/mL for Groups LB and L, respectively). Cough and restlessness before tracheal extubation were decreased in Group LB compared with Group L and in Group L compared with Group C. Nausea, postoperative vomiting, dysphonia, and hoarseness were increased after extubation in Group C compared with the liquid groups, and a better tolerance was recorded with Group LB compared with Group L. The increase of arterial blood pressure and cardiac frequencies during the extubation period was less in the liquid groups than in the control group and less in Group LB compared with Group L. We concluded that use of intracuff alkalinized lidocaine is an effective adjunct to endotracheal intubation. IMPLICATIONS: Use of 40 mg of alkalinized lidocaine, rather than lidocaine or air, to fill the endotracheal tube cuff reduces the incidence of sore throat in the postoperative period. This approach also decreases hemodynamic effects, restlessness, dysphonia, and hoarseness.

Publication Types:

  • Clinical trial
  • Randomized controlled trial

PMID: 11772834, UI: 21633751


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Anesth Analg 2002 Jan;94(1):221-6, table of contents

Thermoregulatory response to intraoperative head-down tilt.

Nakajima Y, Mizobe T, Matsukawa T, Sessler DI, Kitamura Y, Tanaka Y

Department of Anesthesiology, Kyoto Prefectural University of Medicine, Kyoto, Japan.

Thermoregulation interacts with cardiovascular regulation within the central nervous system. We therefore evaluated the effects of head-down tilt on intraoperative thermal and cardiovascular regulation. Thirty-two patients undergoing lower-abdominal surgery were randomly assigned to the 1) supine, 2) 15 degrees -20 degrees head-down tilt, 3) leg-up, or 4) combination of leg-up and head-down tilt position. Core temperature and forearm minus fingertip skin-temperature gradients (an index of peripheral vasoconstriction) were monitored for 3 h after the induction of combined general and lumbar epidural anesthesia. We also determined cardiac output and central-venous and esophageal pressures. Neither right atrial transmural pressure nor cardiac index was altered in the Head-Down Tilt group, but both increased significantly in the Leg-Up groups. The vasoconstriction threshold was reduced in both leg-up positions but was not significantly decreased by head-down tilt. Final core temperatures were 35.2 degrees C +/- 0.2 degrees C (mean +/- SEM) in the Supine group, 35.0 degrees C +/- 0.2 degrees C in the Head-Down Tilt group, 34.2 degrees C +/- 0.2 degrees C in the Leg-Up group (P < 0.05 compared with supine), and 34.3 degrees C +/- 0.2 degrees C when leg-up and head-down tilt were combined (P < 0.05 compared with supine). These results confirm that elevating the legs increases right atrial transmural pressure, reduces the vasoconstriction threshold, and aggravates intraoperative hypothermia. Surprisingly, maintaining a head-down tilt did not increase right atrial pressure. IMPLICATIONS: Intraoperative hypothermia is exaggerated when patients are maintained in the leg-up position because the vasoconstriction threshold is reduced. However, head-down tilt (Trendelenburg position) does not reduce the vasoconstriction threshold or aggravate hypothermia. The head-down tilt position thus does not require special perioperative thermal precautions or management unless the leg-up position is used simultaneously.

Publication Types:

  • Clinical trial
  • Randomized controlled trial

PMID: 11772833, UI: 21633750


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Anesth Analg 2002 Jan;94(1):213-4, table of contents

Transient neurological symptoms after subarachnoid meperidine.

Lewis WR, Perrino AC Jr

Department of Anesthesiology, VA Connecticut Healthcare System, West Haven, Connecticut 06516, USA. Wilfred.Lewis@med.va.gov

IMPLICATIONS: The syndrome of transient neurological symptoms (TNS) after subarachnoid use of local anesthetics, particularly lidocaine, has been well described. This syndrome has not been reported with the subarachnoid use of opioids. This case report describes TNS that occurred after administration of subarachnoid meperidine, an opioid with local anesthetic properties.

PMID: 11772831, UI: 21633748


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Anesth Analg 2002 Jan;94(1):188-93, table of contents

Hyperbaric spinal levobupivacaine: a comparison to racemic bupivacaine in volunteers.

Alley EA, Kopacz DJ, McDonald SB, Liu SS

Department of Anesthesiology, Virginia Mason Medical Center, Seattle, Washington 98111, USA.

Levobupivacaine is the isolated S-enantiomer of bupivacaine and may be a favorable alternative to spinal bupivacaine. However, its clinical efficacy relative to bupivacaine and its dose-response characteristics, in spinal anesthesia, must first be known. This double-blinded, randomized, cross-over study was designed to compare the clinical efficacy of hyperbaric levobupivacaine and bupivacaine for spinal anesthesia. Eighteen healthy volunteers were randomized into three equal groups to receive two spinal anesthetics, one with bupivacaine and the other with levobupivacaine, of equal-milligram doses (4, 8, or 12 mg). We assessed blockade quality and duration with pinprick, transcutaneous electrical stimulation, thigh tourniquet, abdominal and quadriceps muscle strength, modified Bromage scale, and time until achievement of discharge criteria. Sensory and motor block were similar between the same doses of levobupivacaine and bupivacaine (P > 0.56 to 0.86). For example, in the 12-mg groups of levobupivacaine versus bupivacaine, mean duration of tolerance to transcutaneous electrical stimulation at T12 was 100 min for both. The duration of motor block at the quadriceps was 71 versus 73 min, and time until achievement of discharge criteria was 164 min for both. Hyperbaric spinal levobupivacaine has equivalent clinical efficacy to racemic bupivacaine for spinal anesthesia in doses from 4 to 12 mg. IMPLICATIONS: Hyperbaric spinal levobupivacaine has equivalent clinical efficacy to hyperbaric spinal bupivacaine over the 4-12-mg ranges.

Publication Types:

  • Clinical trial
  • Randomized controlled trial

PMID: 11772826, UI: 21633743


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Anesth Analg 2002 Jan;94(1):123-4, table of contents

Prolongation of rapacuronium neuromuscular blockade by clindamycin and magnesium.

Sloan PA, Rasul M

University of Kentucky College of Medicine, Lexington, Kentucky 40536, USA. PaulSloan@prodigy.net

IMPLICATIONS: We report a prolonged neuromuscular block with the nondepolarizing muscle relaxant rapacuronium in the presence of clindamycin. Even when using "short-acting" muscle relaxants, the anesthesiologist must routinely monitor the neuromuscular function.

PMID: 11772813, UI: 21633730


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Anesth Analg 2002 Jan;94(1):106-11, table of contents

Dolasetron for preventing postanesthetic shivering.

Piper SN, Rohm KD, Maleck WH, Fent MT, Suttner SW, Boldt J

Department of Anesthesiology and Critical Care Medicine, Klinikum Ludwigshafen, Ludwigshafen, Germany.

We designed this study to assess the efficacy of dolasetron compared with clonidine and placebo in prophylaxis of postanesthetic shivering. We included 90 patients undergoing elective abdominal or urologic surgery. The patients were randomly assigned to one three groups (each group n = 30) using a double-blinded study protocol: Group A received 12.5 mg dolasetron, Group B 3 microg/kg clonidine, and Group C saline 0.9% as placebo. The medication was given after the induction of anesthesia. Postanesthetic shivering was judged by using a five-point scale. In the Clonidine group, 86.6% showed no shivering, whereas in the Dolasetron and Placebo groups, only 63.3% and 66.6%, respectively, were symptom free. Only clonidine, but not dolasetron, significantly reduced the incidence and the severity of shivering. We conclude that clonidine is effective in preventing shivering when given before surgery, whereas dolasetron, at the dose used, is not effective. IMPLICATIONS: Shivering, an irregular muscular fasciculation lasting longer than 15 s, is a common complication secondary to general anesthesia. We compared dolasetron with clonidine (an established antishivering drug) in the prevention of postanesthetic shivering. Dolasetron 12.5 mg was not effective.

Publication Types:

  • Clinical trial
  • Randomized controlled trial

PMID: 11772810, UI: 21633727


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Anesth Analg 2002 Jan;94(1):65-70, table of contents

Ambulatory discharge after long-acting peripheral nerve blockade: 2382 blocks with ropivacaine.

Klein SM, Nielsen KC, Greengrass RA, Warner DS, Martin A, Steele SM

Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina 27710, USA. klein006@mc.duke.edu

Discharging patients with a long-acting peripheral nerve block remains controversial. Concerns about accidental injury of the limb or surgical site because of an insensate extremity are common despite a lack of data on the subject. We report a study examining the efficacy and complications of discharge after long-acting block. This prospective study included 1791 patients receiving an upper or lower extremity nerve block with 0.5% ropivacaine and discharged the day of surgery. Efficacy (conversion to general anesthesia and opioid use), persistent motor or sensory weakness, complications, satisfaction, and unscheduled health care visits were assessed in the postanesthesia care unit (PACU) and at 24 h and 7 days postoperatively using a detailed questionnaire. There were 2382 blocks placed: 1119 upper extremity blocks and 1263 lower extremity blocks. Efficacy was demonstrated by a small conversion to general anesthesia (1%-6%) and a lack of patients requiring opioids in the PACU (89%-92%). A large percentage of patients continued to use opioids at 7 days (17%-22%). Despite the requirement for opioids, satisfaction with the anesthesia experience was high at 24 h and 7 days (Liekert scale [1-5] mean at 24 h, 4.88 +/- 0.44; mean at 7 days, 4.77 +/- 0.69) and most (98%) would choose the same anesthetic again. Thirty-seven patients (1.6%) were identified with symptoms or complaints at 7 days. After review, 6 of them (0.25%) had a persistent paresthesia that may have been related to the block or discharge. We conclude that long-acting peripheral nerve blockade may be safely used in the ambulatory setting with a high degree of efficacy, safety, and satisfaction. This technique is associated with an infrequent incidence of neurologic complications and injuries. Given the frequent incidence of persistent pain at 7 days, prolongation of the analgesia would be beneficial. IMPLICATIONS: This study demonstrates that long-acting peripheral nerve blockade may be safely used in the ambulatory setting with a high degree of efficacy and satisfaction. This technique is associated with an infrequent incidence of neurologic complications and injuries despite discharge with an insensate extremity. The frequent incidence of pain at 7 days suggests that longer-acting local anesthetics are still needed.

PMID: 11772802, UI: 21633719


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Anesth Analg 2002 Jan;94(1):44-9, table of contents

The pharmacokinetics of epsilon-aminocaproic acid in children undergoing surgical repair of congenital heart defects.

Ririe DG, James RL, O'Brien JJ, Lin YA, Bennett J, Barclay D, Hines MH, Butterworth JF

Department of Anesthesiology, Wake Forest University School of Medicine, Winston-Salem, North Carolina 27157-1009, USA. dririe@wfubmc.edu

epsilon-Aminocaproic acid (epsilonACA) is often administered to children undergoing cardiac surgery by using empiric dosing techniques. We hypothesized that children would have different pharmacokinetic variables and require a dosing scheme different from adults to maintain stable and effective serum epsilonACA concentrations. Eight patients were enrolled in our study. epsilonACA 50 mg/kg was administered three times IV: before, during, and after cardiopulmonary bypass (CPB). Nine serum samples were obtained. epsilonACA plasma concentrations were measured by using high-performance liquid chromatography, and pharmacokinetic modeling was done by using NONMEM. The best fit was seen with a two-compartment model with volume of distribution (V(1)) adjusted for weight and CPB. Compared with published results in adults, modeling suggests that weight-adjusted V(1) is larger in children than in adults before, during, and after CPB. Clearance from the central compartment (k(10)) was also greater in children than adults, and declined during CPB. Redistribution rates from the central compartment, k(12) and k(21), were greater in children and not affected by CPB. We modeled several different dosing regimens for epsilonACA based on the larger V(1), and higher redistribution and clearance variables. We conclude that, because of the developmental differences in pharmacokinetic variables of epsilonACA, when compared with adult patients, a larger initial dose and faster infusion rate as well as an addi-tional dose on CPB are needed to maintain similar concentrations. IMPLICATIONS: Pharmacokinetic modeling of epsilon-aminocaproic acid in children undergoing cardiac surgery suggests that there are developmental differences in pharmacokinetic variables. Based on these data, a dosing modification in children is suggested which may better maintain serum concentrations in children when compared with adults.

PMID: 11772798, UI: 21633715


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Anesth Analg 2002 Jan;94(1):31-6, table of contents

Oral midazolam premedication in preadolescents and adolescents.

Brosius KK, Bannister CF

Department of Anesthesiology, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, Georgia, USA.

We sought to determine the influence of preoperative oral midazolam on 1) sedation score, 2) measures of anesthetic emergence, 3) recovery times, and 4) bispectral index (BIS) measurements during sevoflurane/N(2)O anesthesia in adolescent patients. Fifty ASA I and II patients 10-18 yr of age were enrolled in a prospective double-blinded study. Patients were randomized to receive either 20 mg of midazolam (M group) or midazolam vehicle (P group) as premedication. Before the induction, sedation scores and BIS values were determined in all patients. After inhaled induction and intubation, expired sevoflurane was stabilized at 3% in 60% N(2)O and the corresponding BIS (BIS I) recorded. Upon completion of surgery, sevoflurane was stabilized at 0.5% and the BIS (BIS E) again recorded. Plasma midazolam levels were measured at the time of BIS I and BIS E. There were no significant differences between groups in awakening time, sevoflurane/N(2)O awakening concentrations, time to postanesthesia care unit discharge, or BIS I and BIS E measurements. Sedation scores and preinduction BIS values were significantly lower in Group M than in Group P, although only 40% of midazolam-treated patients exhibited detectable sedation, with marked interindividual variability in achieved plasma midazolam levels. Detectable preoperative sedation was predictive of delayed emergence. IMPLICATIONS: We demonstrated a measurable sedative effect of oral midazolam in adolescents which correlated with simultaneous bispectral index (BIS) measurement. Considering the overall group, midazolam premedication did not affect intraoperative BIS, emergence times, or recovery times compared with placebo controls. Detectable preoperative sedation, and not merely midazolam administration, was predictive of prolonged emergence.

Publication Types:

  • Clinical trial
  • Randomized controlled trial

PMID: 11772796, UI: 21633713


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Anesthesiology 2002 Feb;96(2):515

High Incidence of Cardiac Arrest following Spinal Anesthesia.

Pollard JB

[Medline record in process]

PMID: 11818793, UI: 21676126


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Anesthesiology 2002 Feb;96(2):508-9

Brain Tumor Presenting with Fatal Herniation following Delivery under Epidural Anesthesia.

Su TM, Lan CM, Yang LC, Lee TC, Wang KW, Hung KS

Department of Neurosurgery, Chang Gung Memorial Hospital, Kaohsiung, Taiwan.

[Medline record in process]

PMID: 11818788, UI: 21676121


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Anesthesiology 2002 Feb;96(2):497-503

Anesthetic management of deep hypothermic circulatory arrest for cerebral aneurysm clipping.

Young WL, Lawton MT, Gupta DK, Hashimoto T

Departments of Anesthesia and Perioperative Care, Neurological Surgery, and Neurology, and the Center for Cerebrovascular Research, University of California, San Francisco, San Francisco, California.

[Medline record in process]

PMID: 11818785, UI: 21676118


Anesthesiology 2002 Feb;96(2):485-496

Practice Advisory for Preanesthesia Evaluation: A Report by the American Society of Anesthesiologists Task Force on Preanesthesia Evaluation.

[Record supplied by publisher]

PMID: 11818784


Anesthesiology 2002 Feb;96(2):458-466

Inhibitory Effects of Volatile Anesthetics on K+ and Cl? Channel Currents in Porcine Tracheal and Bronchial Smooth Muscle.

Chen X, Yamakage M, Namiki A

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

[Record supplied by publisher]

BACKGROUND: K+ and Ca2+-activated Cl? (ClCa) channel currents have been shown to contribute to the alteration of membrane electrical activity in airway smooth muscle. This study was conducted to investigate the effects of volatile anesthetics, which are potent bronchodilators, on the activities of these channels in porcine tracheal and bronchial smooth muscles. METHODS: Whole-cell patch clamp recording techniques were used to investigate the effects of superfused isoflurane (0?1.5 minimum alveolar concentration) or sevoflurane (0?1.5 minimum alveolar concentration) on K+ and ClCa channel currents in dispersed smooth muscle cells. RESULTS: Isoflurane and sevoflurane inhibited whole-cell K+ currents to a greater degree in tracheal versus bronchial smooth muscle cells. More than 60% of the total K+ currents in tracheal smooth muscle appeared to be mediated through delayed rectifier K+ channels compared with less than 40% in bronchial smooth muscle. The inhibitory effects of the anesthetics were greater on the delayed rectifier K+ channels than on the remaining K+ channels. Cl? currents through ClCa channels were significantly inhibited by the anesthetics. The inhibitory potencies of the anesthetics on the ClCa channels were not different in tracheal and bronchial smooth muscle cells. CONCLUSIONS: Volatile anesthetics isoflurane and sevoflurane significantly inhibited Cl? currents through ClCa channels, and the inhibitory effect is consistent with the relaxant effect of volatile anesthetics in airway smooth muscle. Different distributions and different anesthetic sensitivities of K+ channel subtypes could play a role in the different inhibitory effects of the anesthetics on tracheal and bronchial smooth muscle contractions.

PMID: 11818782


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Anesthesiology 2002 Feb;96(2):442-9

Volume Kinetic Analysis of the Distribution of 0.9% Saline in Conscious versus Isoflurane-anesthetized Sheep.

Brauer KI, Svensen C, Hahn RG, Traber LD, Prough DS

Department of Anesthesiology, The University of Texas Medical Branch, Galveston, Texas.

[Medline record in process]

BACKGROUND: The distribution and elimination of 0.9% saline given by intravenous infusion has not been compared between the conscious state and during inhalational anesthesia. METHODS: Six adult sheep received an intravenous infusion of 25 ml/kg of 0.9% saline over 20 min in the conscious state and also during isoflurane anesthesia and mechanical ventilation. The distribution and elimination of infused fluid were studied by volume kinetics based on serial analysis of hemoglobin dilution in arterial blood and by mass balance that incorporated volume calculations derived from volume kinetic analysis and measurements of urinary volumes. RESULTS: The mass balance calculations indicated only minor differences in the time course of plasma volume expansion between the conscious and anesthetized states. However, isoflurane anesthesia markedly reduced urinary volume (median, 9 vs. 863 ml; P < 0.03). In conscious sheep, the central and peripheral volume expansion predicted by volume kinetics agreed well with the calculations based on mass balance. However, during isoflurane anesthesia and mechanical ventilation, calculation using volume kinetic analysis of the variable kr, an elimination factor that, in conscious humans and sheep, is closely related to urinary excretion, represented both urinary excretion and peripheral accumulation of fluid. This suggests that the previous assumption that kr approximates urinary excretion of infused fluid requires modification, i.e., kr simply reflects net fluid movement out of plasma. CONCLUSIONS: In both conscious and anesthetized, mechanically ventilated sheep, infusion of 0.9% saline resulted in minimal expansion of plasma volume over a 3-h interval. In conscious sheep, infused 0.9% saline was rapidly eliminated from the plasma volume by urinary excretion; in contrast, the combination of isoflurane anesthesia and mechanical ventilation reduced urinary excretion and promoted peripheral accumulation of fluid.

PMID: 11818780, UI: 21676113


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Anesthesiology 2002 Feb;96(2):400-8

Efficient Trial Design for Eliciting a Pharmacokinetic- Pharmacodynamic Model-based Response Surface Describing the Interaction between Two Intravenous Anesthetic Drugs.

Short TG, Ho TY, Minto CF, Schnider TW, Shafer SL

Palo Alto Veterans Administration Health Care Center, Palo Alto, California.

[Medline record in process]

BACKGROUND: The authors published a pharmacokinetic- pharmacodynamic model for two drugs based on response surface methodology. Because of the complexity of the model, they performed a simulation study to answer two questions about use of the model: (1) which study design would be most satisfactory; and (2) how many patients would need to be studied to adequately describe an entire response surface. METHODS: Data were simulated using realistic variability for two hypothetical intravenous anesthetic drugs that interact synergistically and that could be given by computer-controlled infusion. Three trial designs were simulated, one that made a series of parallel slices of the response surface, one that crisscrossed the response surface, and one that made a series of radial slices across the surface. Series of 5, 10, 20, and 40 "subjects" were simulated. A pooled data approach was used to assess the ability of the various trial designs and numbers of subjects to adequately identify the interaction response surface and estimate the original response surface. RESULTS: The crisscross design was shown to be the most robust in terms of its ability to both discriminate the correct order of the interaction term and to discriminate the original response surface using the least number of patients. Twenty subjects would be required to adequately define a surface using the crisscross study design, and 40 subjects would be required using the other trial designs. CONCLUSIONS: The results showed that a number of trial designs would be viable, but a design that crossed the surface in a crisscross fashion would give the most robust result with the least patients.

PMID: 11818774, UI: 21676107


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Anesthesiology 2002 Feb;96(2):306-12

Transcutaneous electrical stimulation of an auricular acupuncture point decreases anesthetic requirement.

Greif R, Laciny S, Mokhtarani M, Doufas AG, Bakhshandeh M, Dorfer L, Sessler DI

Department of Anesthesia and Perioperative Care, University of California-San Francisco, San Francisco, California.

[Medline record in process]

BACKGROUND: German anesthesiologists have long used transcutaneous electrical stimulation of an acupuncture point near the tragus to reduce anesthetic requirement in unblinded and uncontrolled trials. This is known as auricular electrically stimulated analgesia. The authors therefore tested the hypothesis that auricular electrically stimulated analgesia reduces anesthetic requirement. METHODS: In a randomized, double-blind, crossover trial, volunteers were anesthetized twice with desflurane. Electrical stimulation of an auricular acupuncture point in the vicinity of the tragus was used on 1 randomly assigned day, and no electrical stimulation of the same point was used on the other study day. Treatment consisted of bilateral electrical stimulation of the lateralization control point, 3 cm anterior to the tragus. The 10-mA current was set to 299 Hz on the dominant side of the face and to 149 Hz on the contralateral side. Anesthetic requirement was determined by the Dixon up-and-down method and was defined by the average desflurane concentration required to prevent purposeful movement of the extremities in response to noxious electrical stimulation. RESULTS: Ten men and 10 women completed the protocol. Electrical stimulation of the lateralization control point reduced anesthetic requirement by 11 +/- 7% (P < 0.001), with the reduction being similar in women and men. Women required more desflurane to prevent movement on the control day than the men (5.5 +/- 1.0 vs. 4.6 +/- 0.6 vol%; P = 0.028). CONCLUSION: This double-blinded trial with an objective outcome demonstrates that electrical stimulation of the lateralization control point significantly reduces anesthetic requirement.

PMID: 11818761, UI: 21676094


Anesthesiology 2002 Feb;96(2):289-295

A Multicenter Study Comparing the ProSealTM and ClassicTM Laryngeal Mask Airway in Anesthetized, Nonparalyzed Patients.

Brimacombe J, Keller C, Fullekrug B, Agro F, Rosenblatt W, Dierdorf SF, Garcia De Lucas E, Capdevilla X, Brimacombe N

University of Queensland, Cairns Base Hospital, Cairns, Australia.

[Record supplied by publisher]

BACKGROUND: The laryngeal mask airway ProSeal? (PLMA?), a new laryngeal mask device, was compared with the laryngeal mask airway Classic? (LMA?) with respect to: (1) insertion success rates and times; (2) efficacy of seal; (3) fiberoptically determined anatomic position; (4) orogastric tube insertion success rates and times; (5) total intraoperative complications; and (6) postoperative sore throat in nonparalyzed adult patients undergoing general anesthesia, hypothesizing that these would be different. METHODS: Three hundred eighty-four nonparalyzed anesthetized adult patients (American Society of Anesthesiologists physical status I?II) were randomly allocated to the PLMA? or LMA? for airway management. In addition, 50% of patients were randomized for orogastric tube placement. Unblinded observers collected intraoperative data, and blinded observers collected postoperative data. RESULTS: First-attempt insertion success rates (91 vs. 82%, P = 0.015) were higher for the LMA?, but after three attempts success rates were similar (LMA?, 100%; PLMA?, 98%). Less time was required to achieve an effective airway with the LMA? (31 +/- 30 vs. 41 +/- 49 s; P = 0.02). The PLMA? formed a more effective seal (27 +/- 7 vs. 22 +/- 6 cm H2O; P < 0.0001). Fiberoptically determined anatomic position was better with the LMA? (P < 0.0001). Orogastric tube insertion was more successful after two attempts (88 vs. 55%; P < 0.0001) and quicker (22 +/- 18 vs. 38 +/- 56 s) with the PLMA?. During maintenance, the PLMA? failed twice (leak, stridor) and the LMA? failed once (laryngospasm). Total intraoperative complications were similar for both groups. The incidence of postoperative sore throat was similar. CONCLUSION: In anesthetized, nonparalyzed patients, the LMA? is easier and quicker to insert, but the PLMA? forms a better seal and facilitates easier and quicker orogastric tube placement. The incidence of total intraoperative complications and postoperative sore throat are similar.

PMID: 11818758


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Anesthesiology 2002 Feb;96(2):261-3

Genetics infuses new life into human physiology: implications of the human genome project for anesthesiology and perioperative medicine.

Schwinn DA, Booth JV

[Medline record in process]

PMID: 11818753, UI: 21676086


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BMJ 2002 Jan 19;324(7330):170

Anaesthetic machines and anti-hypoxia devices. When is an anti-hypoxia device not an anti-hypoxia device?

Pollock CG

[Medline record in process]

Publication Types:

  • Letter

PMID: 11822338, UI: 21680047


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BMJ 2002 Jan 19;324(7330):169-70

Anaesthetic machines and anti-hypoxia devices. Interim solution is to remove nitrous oxide cylinders and pipelines and cap their connections.

Fielden JM

[Medline record in process]

Publication Types:

  • Letter

PMID: 11822337, UI: 21680046


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Can J Anaesth 2002 Feb;49(2):215-6

Myasthenie et anesthesie pour chirurgie abdominale en urgence. Anesthesia for urgent abdominal surgery and myasthenia gravis.

Devys JM, Debaene B, Plaud B

Paris, France Poitiers, France.

[Medline record in process]

PMID: 11823407, UI: 21681289


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Can J Anaesth 2002 Feb;49(2):207-9

Best evidence in anesthetic practice: Prevention: recombinant human activated protein C reduces mortality in severe sepsis.

Butler R, Laufer B

London, Ontario Montreal, Quebec.

[Medline record in process]

PMID: 11823403, UI: 21681285


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Can J Anaesth 2002 Feb;49(2):194-7

Caudal anesthesia reduces the minimum alveolar concentration of enflurane for laryngeal mask airway removal in boys : [L'anesthesie caudale permet de reduire la concentration alveolaire minimale d'enflurane pendant le retrait du masque larynge chez des garcons].

Xiao WJ, Deng XM, Tang GZ, Lu MP, Xu KL

Department of Anesthesiology, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China.

[Medline record in process]

PURPOSE: To investigate the effects of caudal analgesia on the minimal alveolar concentration of enflurane for laryngeal mask airway (LMA) smooth extubation (MACex). METHODS: We studied 50 nonpremedicated children, aged three to ten years, ASA physical status I, undergoing surgery for hypospadias repair. After a sevoflurane inhalation induction, children were randomized to receive LMA insertion with or without ropivacaine caudal analgesia. At the end of surgery, a predetermined end-tidal enflurane concentration was achieved, and the LMA was removed by an anesthesiologist blinded to group allocation. Each concentration at which LMA extubation was attempted was predetermined by the up-and-down method (with 0.1% as the step size). When LMA removal was accomplished without coughing, clenching teeth or gross purposeful muscular movements during or within one minute after removal, it was considered successful. RESULTS: MACex of enflurane for LMA removal in the group without caudal anesthesia was 1.04% (95% confidence interval, 1.00-1.10) and the LMA MACex of enflurane in the group with caudal anesthesia was 0.74% (95% confidence interval, 0.63-0.81). Caudal analgesia significantly reduced enflurane requirements by 29% (95% confidence interval, 22-36%). CONCLUSION: In conclusion, caudal analgesia significantly reduced the LMA MACex of enflurane by approximately 29%. Possible mechanisms may be related to the analgesic effect of caudal blockade or to the sedative properties of neuraxial anesthesia.

PMID: 11823400, UI: 21681282


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Can J Anaesth 2002 Feb;49(2):185-9

Baseline heart rate may predict hypotension after spinal anesthesia in prehydrated obstetrical patients : [La frequence cardiaque initiale peut etre predictive d'hypotension apres la rachianesthesie chez des patientes obstetricales prehydratees].

Frolich MA, Caton D

Departments of Anesthesiology and Obstetrics and Gynecology, University of Florida College of Medicine, Gainesville, Florida, USA.

[Medline record in process]

PURPOSE: Hypotension is the most frequent complication of spinal anesthesia in pregnant patients. This study was designed to identify patients at risk for postspinal hypotension based on preoperative vital signs before and after an orthostatic challenge. METHODS: Forty healthy women scheduled for elective Cesarean section were enrolled in this prospective trial. Blood pressure (BP) and heart rate (HR) were recorded with the patient in the lateral supine position and after standing up. After a bupivacaine spinal anesthetic, BP was obtained every two minutes for 30 min. Ephedrine treatment was administered based on the degree of hypotension observed. Hemodynamic parameters were correlated to ephedrine requirements (Spearman's rank order correlation). RESULTS: There was a significant correlation in baseline maternal HR and ephedrine requirements (P=0.005). The degree of orthostatic changes in mean arterial BP and HR did not correlate with postspinal hypotension. CONCLUSIONS: Baseline HR may be predictive of obstetric spinal hypotension. Higher baseline HR, possibly reflecting a higher sympathetic tone, may be a useful parameter to predict postspinal hypotension.

PMID: 11823398, UI: 21681280


Can J Anaesth 2002 Feb;49(2):169-172

Central nervous system side effects are less important after iv regional anesthesia with ropivacaine 0.2% compared to lidocaine 0.5% in volunteers: [Les effets secondaires neurologiques sont moins importants apres une anesthesie regionale iv realisee avec de la ropivacaine a 0,2 % comparee a la lidocaine a 0,5 %].

Atanassoff PG, Hartmannsgruber MW

Department of Anesthesiology Yale University School of Medicine New Haven Connecticut USA.

[Record supplied by publisher]

PURPOSE: Following release of a double tourniquet for intravenous regional anesthesia (IVRA), ropivacaine was shown to have a longer duration of action and less central nervous system (CNS) side effects than lidocaine. This study examines the correlation of CNS side effects to plasma levels of lidocaine 0.5% and ropivacaine 0.2% when injected intravenously for IVRA. METHODS: In a double-blind, cross-over study, ten volunteers received IVRA with 40 mL ropivacaine 0.2% or lidocaine 0.5% at least four days apart. Both cuffs of a double-cuff tourniquet remained inflated until they could no longer be tolerated. The incidence, duration and intensity of CNS side effects were recorded at three, ten, and 30 min after tourniquet release and correlated with simultaneous venous blood samples. RESULTS: There was a lower incidence of CNS side effects with ropivacaine (6/10 volunteers) when compared to lidocaine (10/10 volunteers). There was also less duration of these side effects (mean ? SD, 5.1 ? 5.2 min vs 11.7 ? 6.7 min). Measured total plasma levels were highest at ten minutes with ropivacaine 0.2% (1.2 ? 0.3 ?g?mL(-1)) and at three minutes with lidocaine 0.5% (1.7 ? 0.6 ?g?mL(-1)). Peak CNS symptoms correlated with measured venous plasma levels for lidocaine, but occurred earlier with ropivacaine. CONCLUSIONS: We observed a lower incidence of CNS side effects with ropivacaine as compared to lidocaine. Although ropivacaine's greater lipid solubility should, theoretically, lead to more CNS side effects, this was, likely, offset by slower release from tissues and lesser percentage of unbound (free) drug.

PMID: 11823395


Can J Anaesth 2002 Feb;49(2):165-168

The addition of tramadol to lidocaine does not reduce tourniquet and postoperative pain during iv regional anesthesia: [L'ajout de tramadol a la lidocaine ne reduit pas la douleur du garrot pendant l'anesthesie iv regionale, ni la douleur postoperatoire].

Langlois G, Estebe JP, Gentili ME, Kerdiles L, Mouilleron P, Ecoffey C

Department of Anesthesia, Intensive Care and Pain Clinic, (University of Rennes 1), University Hospital of Rennes, France, and the Centre Medico-Chirurgical Saint?Vincent, Saint-Gregoire, France.

[Record supplied by publisher]

PURPOSE: We conducted a prospective, randomized, double-blind study to determine whether the combination of tramadol with lidocaine 0.5% had an analgesic effect on tourniquet pain during iv regional anesthesia and also on postoperative pain. METHODS: Thirty patients scheduled for carpal tunnel decompression were included in the study. Each patient received 3 mg?kg(-1) of plain lidocaine 0.5% with 100 mg of tramadol (Group T) or 2 mL of isotonic saline (Group C). The mixture was injected into the isolated and exsanguinated arm. Pain was assessed using a linear visual analog scale and a verbal rate scale during the surgical procedure and the postoperative period (240 min) and subsequently at interview at 24 hr. Analgesic consumption was recorded. RESULT: There was no difference in the pain scales and analgesic request at any of the time periods studied. CONCLUSION: We conclude, therefore, that for carpal tunnel operation under iv regional anesthesia, the combination of tramadol and lidocaine is not more effective than lidocaine alone.

PMID: 11823394


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Can J Anaesth 2002 Feb;49(2):151-64

Calcium channels - basic aspects of their structure, function and gene encoding; anesthetic action on the channels - a review: [Revue : notions de base sur la structure, la fonction et l'encodage genetique des canaux calciques et action des anesthesiques sur ces canaux].

Yamakage M, Namiki A

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

[Medline record in process]

PURPOSE: To review recent findings concerning Ca(2+) channel subtype/structure/function from electrophysiological and molecular biological studies and to explain Ca(2+) channel diseases and the actions of anesthetics on Ca(2+) channels. SOURCE: The information was obtained from articles published recently and from our published work. Principal findings: Voltage-dependent Ca(2+) channels serve as one of the important mechanisms for Ca(2+) influx into the cells, enabling the regulation of intracellular concentration of free Ca(2+). Recent advances both in electrophysiology and in molecular biology have made it possible to observe channel activity directly and to investigate channel functions at molecular levels. The Ca(2+) channel can be divided into subtypes according to electrophysiological characteristics, and each subtype has its own gene. The L-type Ca(2+) channel is the target of a large number of clinically important drugs, especially dihydropyridines, and binding sites of Ca(2+) antagonists have been clarified. The effects of various kinds of anesthetics in a variety of cell types have been demonstrated, and some clinical effects of anesthetics can be explained by the effects on Ca(2+) channels. It has recently become apparent that some hereditary diseases such as hypokalemic periodic paralysis result from calcium channelopathies. CONCLUSION: Recent advances both in electrophysiology and in molecular biology have made it possible to clarify the Ca(2+) channel structures, functions, genes, and the anesthetic actions on the channels in detail. The effects of anesthetics on the Ca(2+) channels either of patients with hereditary channelopathies or using gene mutation techniques are left to be discovered.

PMID: 11823393, UI: 21681275


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Can J Anaesth 2002 Feb;49(2):132-6

Antidepressant treatment for chronic depressed patients should not be discontinued prior to anesthesia: [Le traitement antidepresseur ne devrait pas etre interrompu avant l'anesthesie de patients atteints de depression chronique].

Kudoh A, Katagai H, Takazawa T

Departments of Anesthesiology, Hakodate Watanabe Hospital, and Hirosaki National Hospital, Hirosaki, Aomori, Japan.

[Medline record in process]

PURPOSE: To investigate whether antidepressants administered to patients for chronic depression patients should be continued or discontinued before anesthesia. RESULTS: We studied 80 depressed patients who were scheduled to undergo orthopedic surgery under general anesthesia. The patients were divided randomly into two groups; patients in Group A (n=40) continued antidepressants before surgery and patients in Group B (n=40) discontinued antidepressants 72 hr before surgery. Two (5%) out of 40 patients in Group A and eight (20%) out of 40 patients in Group B had deterioration of depressive symptoms (P=0.04). Delirium or confusion during the perioperative course occurred in five patients (13%) in Group A and in 12 (30%) in Group B (P=0.05). There were no significant differences in incidence (5 vs 6%) of hypotension and arrhythmias during anesthesia between the two groups. CONCLUSION: Antidepressants administered to depressed patients should be continued before anesthesia. Discontinuation of antidepressants did not increase the incidence of hypotension and arrhythmias during anesthesia, but increased symptoms of depression and delirium or confusion.

PMID: 11823389, UI: 21681271


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Can J Anaesth 2002 Feb;49(2):115-20

Should we use breathing filters in anesthesia?/Devrions-nous utiliser des filtres respiratoires en anesthesie ?

Lessard MR, Trepanier CA

Departement d'anesthesie-reanimation, Centre hospitalier affilie universitaire de Quebec, (hopital Enfant-Jesus), Universite Laval, Quebec, Quebec, Canada.

[Medline record in process]

PMID: 11823386, UI: 21681268


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J Oral Maxillofac Surg 2002 Jan;60(1):2-4; discussion 4-5

A comparison of endotracheal intubation and use of the laryngeal mask airway for ambulatory oral surgery patients.

Todd DW

PURPOSE: This study compared current experience with the laryngeal mask airway (LMA) to previous experience with endotracheal intubation for ambulatory patients receiving general anesthesia. PATIENTS AND METHODS: A retrospective comparison of 157 patients (50 endotracheal intubation [ET] and 107 LMA cases) was conducted. The subjects were American Association of Anesthesiologist (ASA) Class I and II patients who underwent outpatient general anesthesia for dentoalveolar surgery. Procedure time, recovery time, and cost of techniques were compared. RESULTS: The patients undergoing a variety of outpatient dentoalveolar surgical procedures under general anesthesia in the LMA group had a shorter procedure time than the ET group (40 vs 44 minutes) and had a significantly shorter recovery time (54 vs 67 minutes). In addition, compared with the cost of delivering care with ET, the LMA provided slightly lower cost per case ($20 to $30 per case compared with $35 to $80 per case), depending on the anesthetic technique used. Comparing the 2 techniques for removal of 4 impacted third molars (25 patients ET and 68 patients LMA) revealed a similar procedure time of 39 minutes for both groups, but a shorter recovery time for the LMA group (54 vs 68 minutes). CONCLUSIONS: Use of the LMA has advantages over endotracheal intubation for outpatients receiving general anesthesia for dentoalveolar surgery. Copyright 2002 American Association of Oral and Maxillofacial Surgeons J Oral Maxillofac Surg 60:2-4, 2002

PMID: 11756995, UI: 21629633


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Obstet Gynecol 2002 Jan;99(1):75-9

Dose-range effects of propofol for reducing emetic symptoms during cesarean delivery.

Fujii Y, Numazaki M

Department of Anesthesiology, University of Tsukuba Institute of Clinical Medicine, Tsukuba City, Ibaraki, Japan. yfujii@igaka.md.tsukuba.ac.jp

OBJECTIVE: To evaluate the efficacy and safety of propofol at subhypnotic doses for reducing emetic symptoms in parturients undergoing cesarean delivery under spinal anesthesia. METHODS: In a randomized, double-masked trial, 80 patients received lidocaine intravenously 0.1 mg/kg (for injection pain relief) followed by either placebo or propofol at three different doses (0.5 mg/kg per hour, 1.0 mg/kg per hour, 2.0 mg/kg per hour) (n = 20 in each group) immediately after clamping of the umbilical cord. Emetic episodes and safety assessments were performed during spinal anesthesia for cesarean delivery. To estimate a sufficient sample size, it was calculated that 20 patients per group would be required with alpha =.05 and beta =.2. RESULTS: The rate of patients experiencing no emetic symptoms in an intraoperative, postdelivery period was 45% with propofol 0.5 mg/kg per hour (P =.5), 80% with propofol 1.0 mg/kg per hour (P =.011), and 80% with propofol 2.0 mg/kg per hour (P =.011), compared with placebo (40%). No clinically serious adverse events caused by the study drugs were observed. CONCLUSION: Propofol 1.0 mg/kg per hour is the minimum effective subhypnotic dose for reducing emetic symptoms during cesarean delivery. Increasing the dose to 2.0 mg/kg per hour provides no further benefit.

PMID: 11777514, UI: 21636699


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Obstet Gynecol 2002 Jan;99(1):58-62

Dexamethasone for the prevention of nausea and vomiting after dilatation and curettage: a randomized controlled trial.

Fujii Y, Uemura A

Department of Anesthesiology, University of Tsukuba Institute of Clinical Medicine, Tsukuba City, Ibaraki, Japan. jfujii@igaku.tsukuba.ac.jp

OBJECTIVE: To evaluate the efficacy and safety of dexamethasone administered intravenously at three different doses (4 mg, 8 mg, 16 mg) for the prevention of nausea and vomiting after dilatation and curettage. METHODS: In a prospective, randomized, double-masked, placebo-controlled trial, 120 women received placebo or dexamethasone intravenously at doses of 4 mg, 8 mg, or 16 mg immediately before induction of anesthesia (n = 30 in each group). Propofol-based general anesthetic was used. Emetic episodes and safety assessments were performed. To estimate a sufficient sample size, it was calculated that 30 patients per group would be required with alpha =.05 and beta =.2. RESULTS: The rate of patients who were emesis-free (no nausea, retching, or vomiting) 0-24 hours after anesthesia was 57% with dexamethasone 4 mg (P =.796), 87% with dexamethasone 8 mg (P =.005), and 87% with dexamethasone 16 mg (P =.005), compared with placebo (50%). Patients who had received dexamethasone 8 mg or 16 mg were more satisfied than those who had received placebo (P <.05). No clinically important adverse events were observed in any of the groups. CONCLUSION: Dexamethasone 8 mg is an effective antiemetic for preventing postoperative nausea and vomiting 0-24 hours after anesthesia in women undergoing propofol-based general anesthesia for termination of pregnancy. Increasing the dose to 16 mg provided no additional benefit.

Publication Types:

  • Clinical trial
  • Randomized controlled trial

PMID: 11777511, UI: 21636696


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Obstet Gynecol 2002 Jan;99(1):29-34

Active pushing versus passive fetal descent in the second stage of labor: a randomized controlled trial.

Hansen SL, Clark SL, Foster JC

Intermountain Health Care, Salt Lake City, Utah, USA.

  1. OBJECTIVE: To compare perinatal outcomes among women with epidural anesthesia who were encouraged to push at complete dilatation with those who had a period of rest before pushing began. METHODS: After a power analysis to determine appropriate sample size (based upon an alpha error rate of.05% and 80% power), a prospective randomized trial of 252 women with epidural anesthesia was conducted. Patients were randomized to a rest period or immediate pushing at complete dilatation. Variables measured included rate of fetal descent, length of time of pushing, the number and type of fetal heart rate decelerations, Apgar scores, arterial cord pH values, perineal injuries, type of delivery, length of second stage, maternal fatigue, and endometritis. RESULTS: When a period of rest was used before pushing, we found a longer second stage, decreased pushing time, fewer decelerations, and, in primiparous women, less fatigue compared with control patients. Apgar scores, arterial cord pH values, rates of perineal injury, instrument delivery, and endometritis were similar in both groups. CONCLUSION: Delayed pushing was not associated with demonstrable adverse outcome, despite second-stage length of up to 4.9 hours. In select patients, such delay may be of benefit.

Publication Types:

  • Clinical trial
  • Randomized controlled trial

PMID: 11777506, UI: 21636691

 
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