Sevoflurane drawover anaesthesia with two Oxford Miniature Vaporizers in
series.
Brook PN, Perndt H
Department of Anaesthesia, Royal Hobart Hospital, Tasmania.
[Medline record in process]
The output of sevoflurane from a drawover system utilizing two Oxford Miniature
Vaporizers (OMVs) in series has been shown in bench-testing to be predictable.
We have shown that adequate anaesthesia can be achieved with one vaporizer
in most situations if an intravenous induction is used. Occasionally a second
vaporizer is necessary to deepen the level of anaesthesia. For an inhalational
technique to be successful it is necessary to use both vaporizers from the
outset. Under these conditions, adequate operating conditions are easily produced.
The method could be useful in field or military applications.
PMID: 11771606, UI: 21627417
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Anaesth Intensive Care 2001 Dec;29(6):595-9
Post dural puncture headache following combined spinal epidural or epidural
anaesthesia in obstetric patients.
van de Velde M, Teunkens A, Hanssens M, van Assche FA, Vandermeersch E
Department of Anaesthesiology, Obstetrics and Gynaecology, Katholieke Universiteit
Leuven and University Hospitals Gasthuisberg, Belgium.
[Medline record in process]
A retrospective review of obstetric anaesthesia charts was performed for
all parturients receiving regional anaesthesia over a 22-month period. The
incidence of headache, post dural puncture headache (PDPH) and various other
complications of regional anaesthesia that had been prospectively assessed
were noted, as was the anaesthetic technique used (epidural or combined spinal
epidural (CSE)). PDPH was rare (0.44%) and occurred with similar frequency
in those managed with either epidural or CSE anaesthesia or analgesia. The
pencil-point spinal needle gauge (27 or 29) did not influence the incidence
of PDPH. Following a CSE technique, the epidural catheter more reliably produced
effective analgesia/anaesthesia as compared with a standard epidural technique
(1.49% versus 3.18% incidence of replaced catheters respectively). We conclude,
based on the results of this retrospective review, that CSE is acceptable
with respect to the occurrence of PDPH and that it is possible it is advantageous
in relation to the correct placement of the epidural catheter
PMID: 11771601, UI: 21627412
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Anaesth Intensive Care 2001 Dec;29(6):579-84
Propofol anaesthesia via target controlled infusion or manually controlled
infusion: effects on the bispectral index as a measure of anaesthetic depth.
Gale T, Leslie K, Kluger M
Department of Anaesthesia and Pain Management, Royal Melbourne Hospital,
Victoria, Australia.
[Medline record in process]
Target controlled infusions (TCI) of propofol allow anaesthetists to target
constant blood concentrations and respond promptly to signs of inappropriate
anaesthetic depth. Studies comparing propofol TCI with manually controlled
infusion (MCI) reported similar control of anaesthesia, but did not use an
objective measure of anaesthetic depth. We therefore tested whether the Bispectral
Index (BIS), an electroencephalographic (EEG) variable, is more stable during
propofol TCI or MCI. Forty patients received midazolam and fentanyl before
induction and were randomized to TCI or MCI. Target propofol concentrations
in the TCI group were 3 to 8 microg/ml. The MCI group received propofol bolu s
(approximately 2 mg/kg) and infusion (3 to 10 mg/kg/h). Neuromuscular blockade
was achieved with rocuronium. Following endotracheal intubation, nitrous oxide
(66%) in oxygen was delivered and propofol infusion and fentanyl boluses were
titrated against clinical signs. Blood pressure, heart rate and EEG were recorded,
although the anaesthetist was blind to BIS values. The ideal BIS for general
anaesthesia was defined as 50. Performance error, absolute performance error,
wobble and divergence of BIS, and maximum changes in blood pressure and heart
rate were compared using two-sample t-tests or rank-sum tests where appropriate.
There was no difference in absolute performance errors during maintenance
of anaesthesia with propofol TCI or MCI (23 +/- 11% vs 23 +/- 9%; P=0.97).
The two groups did not differ significantly in performance error, wobble,
divergence on haemodynamic changes. We conclude that TCI and MCI result in
similar depth of anaesthesia and haemodynamic stability when titrated against
traditional clinical signs.
PMID: 11771598, UI: 21627409
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Anaesthesia 2001 Dec;56(12):1216
Tackling rare syndromes.
Hamilton AG
Publication Types:
Letter
PMID: 11766687, UI: 21614127
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Anaesthesia 2001 Dec;56(12):1215-6
Anaesthetic management for a patient with WAGR syndrome.
Yanagidate F, Dohi S, Iizawa A
Publication Types:
Letter
PMID: 11766686, UI: 21614126
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Anaes thesia 2001 Dec;56(12):1213-4
Anaesthetic drug information leaflets - for the patient or for the doctor?
Bamgbade O
Publication Types:
Letter
PMID: 11766682, UI: 21614121
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Anaesthesia 2001 Dec;56(12):1211
Diagnosing epidural haematomas.
Crowe S
Publication Types:
Letter
PMID: 11736788, UI: 21599034
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Anaesthesia 2001 Dec;56(12):1210-1
Obtaining a full medical history.
Stone J
Publication Types:
Letter
PMID: 11736787, UI: 21599033
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Anaesthesia 2001 Dec;56(12):1184-8
Somatic paravertebral nerve blockade. Incidence of failed block and complications.
Naja Z, Lonnqvist PA
Department of Anaesthesia and Intensive Care, Makassed General Hospital,
Beirut, Lebanon.
The failure rate and complications following thoracic and lumbar paravertebral
blocks performed in 620 adults and 42 children were recorded. The technique
failure rate in adults was 6.1%. No failures occurred in children. The complications
recorded were: inadvertent vascular puncture (6.8%); hypotension (4.0%); haematoma
(2.4%); pain at site of skin puncture (1.3%); signs of epidural or intrathecal
spread (1.0%); pleural puncture (0.8%); pneumothorax (0.5%). No complications
were noted in the children. The use of a bilateral paravertebral technique
was found approximately to double the likelihood of inadvertent vascular puncture
(9% vs. 5%) and to cause an eight-fold increase in pleural puncture and pneumothorax
(3% vs. 0.4%), when compared with unilateral blocks. The incidence of other
complications was similar between bilateral and unilateral blocks.
Publication Types:
Clinical trial
PMID: 11736777, UI: 21599023
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Anaesthesist 2001 Nov;50(11):884-6
[Epileptoform EEG activity: occurrence under sevoflurane and not during
propofol application remarks on the article of B. Schultz et al., Anaesthesist
(2001) 50:43-45].
[Article in German]
Hofmann U, Sandtner W
Publication Types:
Letter
PMID: 11760485, UI: 21597287
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Anaesthesist 2001 Nov;50(11):881-3
[The new international guidelines for cardiopulmonary resuscitation. Remarks
on the article of V. Wenzel at al., Anaesthesist (2001) 50: 342-357].
[Article in German]
Jalinski W
Publication Types:
Letter
PMID: 11760484, UI: 21597286
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Anaesthesist 2001 Nov;50(11):869-80
[Early contributions from Erlangen to the theory and practice of general
anesthesia with ether and chloroform. 2. The animal experiments of Ernst von
Bibra and Emil Harless].
[Article in German]
von Hintzenstern U, Petermann H, Schwarz W
Abteilung fur Anasthesie und perioperative Medizin des Krankenhauses Forchheim.
v.hintzenstern@fen-net.de
Just three mon ths after the first application of sulphuric ether to a patient
in german-speaking countries the monography Die Wirkung des Schwefelathers
in chemischer und physiologischer Beziehung was published. In this book Ernst
von Bibra and Emil Harless presented their experimental research on the effects
of ether on humans and compared it to those on animals. The contents of the
book are described. The authors "Theory on the action of ether"
will be discussed in the context of contemporary criticism. Their hypothesis
affected the discussion on the mechanisms of anaesthetic action up to the
twentieth century.
Publication Types:
Historical article
PMID: 11760483, UI: 21597285
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Anaesthesist 2001 Nov;50(11):861-8
[Latex allergy. Perioperative management in anesthesia and cardiac anesthesia].
The frequency of perioperative allergic responses to latex has markedly increased
over the last 10 years. High risk groups to develop sensitivity to latex include
healthcare workers, workers in the latex industry, children suffering from
congenital malformations such as spina bifida or urogenital deformities and
patients who have undergone multiple surgical procedures. During surgery,
patients have contact to a variety of products containing latex. To prevent
anaphylactic reactions, all hospitals have to develop strategies to identify
and manage patients sensitised to latex or belonging to high risk groups.
The aim of this paper is to describe safe perioperative management in a latex-free
environment.
PMID: 11760482, UI: 21597284
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Anaesthesist 2001 Nov;50(11):846-51
[Patient surgical masks during regional anesthesia. Hygenic necessity or
dispensable ritual]?
[Article in German]
Lahme T, Jung WK, Wilhelm W, Larsen R
Klinik fur Anasthesiologie und Intensivmedizin, Universitatskliniken des
Saarlandes, 66421 Homburg. thomas.lahme@freenet.de
OBJECTIVE: The use of surgical face masks (SFM) is believed to minimize the
transmission of oro- and nasopharyngeal bacteria to wounds and surgical instruments.
However, there are disadvantages for patients undergoing regional anaesthesia
and wearing masks: deficient assessment of lip cyanosis, anxiety, retention
of CO2, costs. Up to now no studies have been published investigating whether
or not SFMs, worn by patients during regional anaesthesia, will reduce bacterial
convection. METHODS: We investigated 72 patients during aseptic operations:
24 individuals with regional anaesthesia and SFMs, 22 individuals with regional
anaesthesia without SFMs and 26 patients undergoing general anaesthesia. Using
an air sampler (volumetric impaction method) 100 L air were collected on blood
agar over 2 min. After incubation at 37 degrees C over 60 h the colony forming
units (CFU) were counted and differentiated. Airborne culturable bacteria
were sampled over the operation field, on the anaesthetic side of the surgical
curtain, as well as 10 cm before and to the side of the patients mouth. RESULTS:
At all 4 locations there were no significant differences in the number of
CFUs between patients wearing a SFM or not (e.g. over the operation field:
patient with SFM 5.5 +/- 1.1; no SFM 4.8 +/- 1.2; mean +/- SEM). Significan tly
more CFUs were detected in patients undergoing general anaesthesia (p <
or = 0.05). The extent of the operation did not correlate with the number
of CFUs; however, we observed a trend that more CFUs were detected with an
increasing number of persons working in the operating room. CONCLUSION: Surgical
face masks worn by patients during regional anaesthesia, did not reduce the
concentration of airborne bacteria over the operation field in our study.
Thus they are dispensable. A higher airborne germ concentration has been detected
in patients during general anaesthesia. The reasons for this finding are unknown,
but it may be discussed as being a result of a higher activity and number
of staff involved during general anaesthesia causing more air turbulence.
PMID: 11760479, UI: 21597281
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Anesth Analg 2002 Jan;94(1):233
A safe anesthetic method using caudal block and ketamine for the child with
congenital myotonic dystrophy.
Shiraishi M, Minami K, Kadaya T
Department of Anesthesiology, University of Occupational and Environmental
Health, School of Medicine, Nippon Steel Yawata Memorial Hospital, Kitakyushu,
Japan. Department of Anesthesia, Nippon Steel Yawata Memorial Hospital, Kitakyushu,
Japan.
[Medline record in process]
PMID: 11772836, UI: 21633753
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Anesth Analg 2002 Jan;94(1):199-202
Suprascapular nerve block for ipsilateral shoulder pain after thoracotomy
with thoracic epidural analgesia: a double-blind comparison of 0.5% bupivacaine
and 0.9% saline.
Tan N, Agnew NM, Scawn ND, Pennefather SH, Chester M, Russell GN
Departme nt of Anaesthesia and The National Refractory Angina Centre, The
Cardiothoracic Centre Liverpool NHS Trust, Liverpool, England.
[Medline record in process]
Despite receiving thoracic epidural analgesia, severe ipsilateral shoulder
pain is common in patients after thoracotomy. We recruited 44 patients into
a double-blinded randomized placebo-controlled study to investigate whether
suprascapular nerve block would treat postthoracotomy shoulder pain effectively.
All patients received a standard anesthetic with a midthoracic epidural. Thirty
patients who experienced shoulder pain within 2 h of surgery were randomly
assigned to receive a suprascapular nerve block with either 10 mL of 0.5%
bupivacaine or 10 mL of 0.9% saline. Shoulder pain was assessed before nerve
blockade, at 30 min, and then hourly for 6 h after the block using a visual
analog scale (VAS) and a 5-point verbal ranking score (VRS). The incidence
of shoulder pain before nerve block was 78%. There was no significant decrease
in either VAS or VRS in the Bupivacaine group. These results suggest that
this pain is unlikely to originate in the shoulder and lead us to question
the role of a somatic afferent in referred visceral pain. We conclude that
suprascapular nerve block does not treat ipsilateral shoulder pain after thoracotomy
in patients with an effective thoracic epidural. IMPLICATIONS: This randomized,
double-blinded, placebo-controlled trial showed that suprascapular nerve block
does not treat the severe ipsilateral shoulder pain that patients experience
after thoracotomy. This has implications for established theories of referred
pain and indicates that this pain is unlikely to originate in the shoulder.
PMID: 11772828, UI: 21633745
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Anesth Analg 2002 Jan;94(1):194-8
Levobupivacaine versus racemic bupivacaine for spinal anesthesia.
Division of Anesthesiology and Intensive Care Medicine, Vienna City Hospital
Floridsdorf.
[Medline record in process]
Levobupivacaine is the pure S(-)-enantiomer of racemic bupivacaine but is
less toxic to the heart and central nervous system. Although it has recently
been introduced for routine obstetric and nonobstetric epidural anesthesia,
comparative clinical studies on its intrathecal administration are not available.
We therefore performed this prospective randomized double-blinded study to
evaluate the anesthetic potencies and hemodynamics of intrathecal levobupivacaine
compared with racemic bupivacaine. Eighty patients undergoing elective hip
replacement received either 3.5 mL levobupivacaine 0.5% isobaric or 3.5 mL
bupivacaine 0.5% isobaric. Sensory blockade was verified with the pinprick
test; motor blockade was documented by using a modified Bromage score. Hemodynamic
variables (e.g., blood pressure, heart rate, pulse oximetry) were also recorded.
Intergroup differences between levobupivacaine and bupivacaine were insignificant
both with regard to the onset time and the duration of sensory and motor blockade
(11 +/- 6 versus 13 +/- 8 min; 10 +/- 7 versus 9 +/- 7 min; 228 +/- 77 versus
237 +/- 88 min; 280 +/- 84 versus 284 +/- 80 min). Both groups showed slight
reductions in heart rate and mean arterial pressure, but there was no intergroup
difference in hemodynamics. We conclude that intrathecal levobupivacaine is
equal in efficacy to, but less toxic than, racemic bupivacaine. IMPLICATIONS:
Levobupivacaine, the pure S(-)-enantiomer of racemic bupivacaine is an equally
effective local anesthetic for spinal anesthesia compared with racemic bupivacaine.
PMID: 11772827, UI : 21633744
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Anesth Analg 2002 Jan;94(1):179-83, table of contents
Ropivacaine 0.075% and bupivacaine 0.075% with fentanyl 2 microg/mL are
equivalent for labor epidural analgesia.
Owen MD, Thomas JA, Smith T, Harris LC, D'Angelo R
Department of Anesthesiology, Section of Obstetric Anesthesia, Wake Forest
University School of Medicine, Winston-Salem, North Carolina 27157-1009, USA.
mowen@wfubmc.edu
[Medline record in process]
Fifty percent effective dose estimates for ropivacaine and bupivacaine suggest
that ropivacaine is 40% less potent than bupivacaine to initiate labor analgesia.
At clinically used concentrations, however, the drugs seem indistinguishable
for initiating and maintaining labor analgesia. We designed this study to
evaluate a concentration near the reported 50% effective dose values for ropivacaine
and bupivacaine in an attempt to detect differences between the drugs during
routine clinical use. Fifty-nine nulliparous women in labor were randomized
to receive 0.075% ropivacaine or bupivacaine, each with fentanyl 2 microg/mL.
After epidural placement and the administration of a lidocaine/epinephrine
test dose, 20 mL of study solution was administered and a patient-controlled
epidural infusion was initiated with the following settings: 6 mL/h basal
rate, 5 mL bolus, 10 min lockout, and 30 mL/h limit. Breakthrough pain was
treated with 10-mL boluses of study solution. By using a study design to detect
a 40% difference in hourly drug use between groups, we found no statistically
significant differences in the amount of local anesthetic used, verbal pain
scores, sensory levels, motor blockade, labor duration, mode of delivery,
side effects, or patient satisfaction. We conclude that 0.075% ro pivacaine
and bupivacaine, with fentanyl, are equally effective for labor analgesia
using the patient-controlled epidural analgesia technique. IMPLICATIONS: At
small concentrations, ropivacaine and bupivacaine when combined with fentanyl
are equally effective for labor analgesia. Patients self-administered similar
volumes of 0.075% ropivacaine or bupivacaine solutions containing fentanyl
(2 microg/mL) suggesting that at this concentration, and with the addition
of fentanyl, ropivacaine and bupivacaine can be used interchangeably.
PMID: 11772824, UI: 21633741
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Anesth Analg 2002 Jan;94(1):169-73
The influence of nicardipine-, nitroglycerin-, and prostaglandin e(1)-induced
hypotension on cerebral pressure autoregulation in adult patients during propofol-fentanyl
anesthesia.
Departments of Emergency and Critical Care Medicine and Anesthesiology, Niigata
University Faculty of Medicine, Niigata, Japan.
[Medline record in process]
We investigated the influence of drug-induced hypotension at a mean arterial
pressure (MAP) of 60-70 mm Hg on cerebral pressure autoregulation in 45 adult
patients during propofol-fentanyl anesthesia. Time-averaged mean blood flow
velocity in the right middle cerebral artery (Vmca) was continuously measured
at a PaCO(2) of 39-40 mm Hg by using transcranial Doppler ultrasonography.
Hypotension was induced and maintained with a continuous infusion of nicardipine,
nitroglycerin, or prostaglandin E(1). Cerebral autoregulation was tested by
a slow continuous infusion of phenylephrine to induce an increase in MAP of
20-30 mm Hg. From the simultaneously recorded data of Vmca and MAP, cerebral
vascular resistance (CVR) was calcu lated as MAP/Vmca. Furthermore, the index
of autoregulation (IOR) was calculated as DeltaCVR/DeltaMAP, where DeltaCVR
= change in CVR and DeltaMAP = change in MAP. The test was performed twice
for each condition on each patient: baseline and hypotension. The IOR during
baseline was similar among the groups. During nitroglycerin- and prostaglandin
E(1)-induced hypotension, IOR was not different from baseline. In contrast,
during nicardipine-induced hypotension, IOR significantly decreased compared
with baseline (0.37 +/- 0.08 versus 0.83 +/- 0.07, P < 0.01). In conclusion,
nicardipine, but not nitroglycerin or prostaglandin E(1), significantly attenuates
cerebral pressure autoregulation during propofol-fentanyl anesthesia. IMPLICATIONS:
Vasodilators may influence cerebral autoregulation by changing cerebral vascular
tone. Nicardipine, but not nitroglycerin or prostaglandin E(1), attenuated
cerebral pressure autoregulation in normal adult patients during propofol-fentanyl
anesthesia.
PMID: 11772822, UI: 21633739
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Anesth Analg 2002 Jan;94(1):149-53
The use of a human patient simulator in the evaluation of and development
of a remedial prescription for an anesthesiologist with lapsed medical skills.
Rosenblatt MA, Abrams KJ
Department of Anesthesiology, The Mount Sinai School of Medicine, New York,
New York.
[Medline record in process]
The New York State Society of Anesthesiologists' Committee on Continuing
Medical Education and Remediation has been charged by the Office of Professional
Medical Conduct of the New York State Department of Health to develop a remediation
program for individuals ordered into retraining. We describe the development
of an anesthesiology-specific evaluation to identif y areas of deficiency to
both determine a candidate's suitability, as well as to facilitate the creation
of an appropriate prescription for retraining. A human patient simulator was
used to aid in the gathering of information during the evaluation process.
Specifically, the use of simulation allowed the exploration of a candidate's
preparation, approach to clinical situations, technical abilities, response
to clinical problems, ability to problem solve, and accuracy of medical record
keeping. Human patient simulation should be considered a valuable tool in
the process of evaluating physicians with lapsed medical skills.
PMID: 11772818, UI: 21633735
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Anesth Analg 2002 Jan;94(1):112-6, table of contents
Esmolol and anesthetic requirement for loss of responsiveness during propofol
anesthesia.
Orme R, Leslie K, Umranikar A, Ugoni A
Department of Anaesthesia, Ballarat Base Hospital, Ballarat, Victoria, Australia.
[Medline record in process]
The administration of esmolol decreases the propofol blood concentration,
preventing movement after skin incision during propofol/morphine/nitrous oxide
anesthesia. However, interaction with esmolol has not been tested when propofol
is infused alone. Accordingly, we tested the hypothesis that esmolol decreases
the propofol blood concentration, preventing response to command (CP50-awake)
when propofol is infused alone in healthy patients presenting for minor surgery.
With approval and consent, we studied 30 healthy patients, who were randomized
to esmolol bolus (1 mg/kg) and then infusion (250 microg x kg(-1) x min(-1))
or placebo. Five minutes later, a target-controlled infusion of propofol was
commenced. Ten minutes later, responsiveness was assessed by a blinded obse rver.
Oxygen saturation, heart rate, and noninvasive arterial blood pressure were
recorded every 2 min. Arterial blood samples were taken at 5 and 10 min of
propofol infusion for propofol assay. Results were analyzed with a generalized
linear regression model: P <0.05 was considered statistically significant.
The probability of response to command decreased with increasing propofol
blood concentration (CP50-awake = 3.42 microg/mL). Esmolol did not alter the
relative risk of response to command. We conclude that the previously observed
effect of esmolol on propofol CP50 was not caused by an interaction between
these two drugs. IMPLICATIONS: There is no evidence to suggest that esmolol,
an ultra-short-acting cardioselective beta-blocker, affects anesthetic requirement
for loss of responsiveness during propofol anesthesia.
PMID: 11772811, UI: 21633728
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Anesth Analg 2002 Jan;94(1):89-93
Tissue antioxidant capacity during anesthesia: propofol enhances in vivo
red cell and tissue antioxidant capacity in a rat model.
Runzer TD, Ansley DM, Godin DV, Chambers GK
Departments of Anesthesia, University of British Columbia, Canada.
[Medline record in process]
The effects of anesthesia on ischemia-reperfusion injury are of considerable
scientific and clinical interest. We examined the effects of propofol (known
to possess antioxidant activity) and halothane (devoid of antioxidant activity
in vitro) on tissue and red blood cell (RBC) antioxidant capacity. Adult male
Wistar rats were anesthetized with halothane 0.5%-1.0% (n = 7), propofol 500
microg x kg(-1) x min(-1) with halothane 0.25%-0.5% (small-dose propofol;
n = 9), or propofol 2000 microg x kg(-1) x min(-1) (large-dose propofol; n
= 8) for 45 min. B lood and tissue samples of liver, kidney, heart, and lung
were then harvested for in vitro exposure to a peroxidizing agent. Red cell
malondialdehyde and tissue thiobarbituric acid reactive substances were determined
spectrophotometrically. Antioxidant capacities of blood and tissues in the
Large-Dose Propofol group, and of blood and all tissues except lung in the
Small-Dose Propofol group, were increased significantly compared with halothane
(P < 0.003). The increases in tissue antioxidant capacities varied in their
magnitude: RBC > liver > kidney > heart > lung. There was a high
correlation between changes in RBC susceptibility to oxidative damage and
corresponding changes in tissues. These findings demonstrate that large-dose
propofol significantly enhances tissue antioxidant capacity, and RBC antioxidant
capacity can serve as a functional measure of tissue activity, in vivo. IMPLICATIONS:
We designed this study to investigate the antioxidant effects of propofol
in various tissues in a rat model. Pretreatment of animals with propofol led
to a reduction in the susceptibility to an in vitro oxidative stress of five
different tissues investigated, demonstrating the drug's ability to limit
oxidative injury. This may have future application in limiting organ dysfunction
after periods of tissue ischemia (which results in oxidative damage).
PMID: 11772807, UI: 21633724
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Anesth Analg 2002 Jan;94(1):84-8
The repolarizing effects of volatile anesthetics on porcine tracheal and
bronchial smooth muscle cells.
Yamakage M, Chen X, Kimura A, Iwasaki S, Namiki A
Department of Anesthesiology, Sapporo Medical University School of Medicine,
Sapporo, Hokkaido, Japan. yamakage@sapmed.ac.jp
[Medline record i n process]
This study was conducted to determine the effects of volatile anesthetics
(potent bronchodilators) on membrane potentials in porcine tracheal and bronchial
smooth muscle cells. We used a current-clamp technique to examine the effects
of the volatile anesthetics isoflurane (1.5 minimum alveolar anesthetic concentration
[MAC]) and sevoflurane (1.5 MAC) on membrane potentials of porcine tracheal
and bronchial (third- to fifth-generation) smooth muscle cells depolarized
by a muscarinic agonist, carbachol (1 microM). The effects of volatile anesthetics
on muscarinic receptor binding affinity were also investigated by using a
radiolabeled receptor assay technique. The volatile anesthetics isoflurane
and sevoflurane induced significant repolarization of the depolarized cell
membranes in the trachea (from -19.8 to -23.6 mV and to -24.8 mV, respectively)
and bronchus (from -24.7 to -29.3 mV and -30.4 mV, respectively) without affecting
carbachol binding affinity to the muscarinic receptor. The repolarizing effect
was abolished by a Ca(2+)-activated Cl(-) channel blocker, niflumic acid.
These results indicate that volatile anesthetic-induced repolarization of
airway smooth muscle cell membranes might be caused by a change in Ca(2+)-activated
Cl(-) channel activity and that the different repolarized effects of the volatile
anesthetics could in part contribute to the different effects of volatile
anesthetics on tracheal and bronchial smooth muscle contractions. IMPLICATIONS:
By use of a current-clamp technique, the volatile anesthetics isoflurane and
sevoflurane repolarized porcine airway smooth muscle cell membranes depolarized
by a muscarinic agonist. This effect might be caused mainly by change in Ca(2+)-activated
Cl(-) channel activity, not in K(+) channel activity.
PMID: 11772806, UI: 21633723
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Anesth Analg 2002 Jan;94(1):79-83
The inhibitory effects of anesthetics and ethanol on substance p receptors
expressed in Xenopus oocytes.
Minami K, Shiraishi M, Uezono Y, Ueno S, Shigematsu A
Departments of Anesthesiology and Pharmacology, University of Occupational
and Environmental Health School of Medicine, Kitakyushu, Japan.
[Medline record in process]
The neuropeptide substance P (SP) modulates nociceptive transmission within
the spinal cord. SP is unique to a subpopulation of C fibers found within
primary afferent nerves. However, the effects of anesthetics on the SP receptor
(SPR) are not clear. In this study, we investigated the effects of volatile
anesthetics and ethanol on SPR expressed in Xenopus oocytes. We examined the
effects of halothane, isoflurane, enflurane, diethyl ether, and ethanol on
SP-induced currents mediated by SPR expressed in Xenopus oocytes, by using
a whole-cell voltage clamp. All the volatile anesthetics tested, and ethanol,
inhibited SPR-induced Ca(2+)-activated Cl(-) currents at pharmacologically
relevant concentrations. The protein kinase C inhibitor bisindolylmaleimide
I (bisindolylmaleimide) enhanced the SP-induced Cl(-) currents. However, bisindolylmaleimide
abolished the inhibitory effects on SPR of the volatile anesthetics examined
and of ethanol. These results demonstrate that halothane, isoflurane, enflurane,
diethyl ether, and ethanol inhibit the function of SPR and suggest that activation
of protein kinase C is involved in the mechanism of action of anesthetics
and ethanol on the inhibitory effects of SPR. IMPLICATIONS: We examined the
effects of halothane, isoflurane, enflurane, diethyl ether, and ethanol on
substance P receptor (SPR) expressed in Xenopus oocytes, by using a whole-cell
voltage clamp. All the anesthetic s and ethanol inhibited SPR function, and
the protein kinase C (PKC) inhibitor abolished these inhibitions. These results
suggest that anesthetics and ethanol inhibit SPR function via PKC.
PMID: 11772805, UI: 21633722
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Anesth Analg 2002 Jan;94(1):77-8
Epidural hematoma after outpatient epidural anesthesia.
Gilbert A, Owens BD, Mulroy MF
Department of Anesthesiology, Virginia Mason Medical Center, Seattle, Washington.
[Medline record in process]
Epidural hematoma is a rare event after spinal or epidural anesthesia in
healthy patients without coagulopathy or traumatic needle insertion (1,2).
We present a case of a healthy patient who experienced an acute lumbar epidural
hematoma after epidural anesthesia for an outpatient knee arthroscopy. IMPLICATIONS:
Epidural hematoma is a rare complication of epidural anesthesia in healthy
patients. Expedient diagnosis and treatment are essential to avoid permanent
neurologic deficits. In an outpatient setting, patients should be instructed
to communicate symptoms of severe back pain or weakness early.
PMID: 11772804, UI: 21633721
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Anesth Analg 2002 Jan;94(1):71-6
Peripheral nerve blockade with long-acting local anesthetics: a survey of
the society for ambulatory anesthesia.
Klein SM, Pietrobon R, Nielsen KC, Warner DS, Greengrass RA, Steele SM
Departments of Anesthesiology and Surgery, Duke University Medical Center,
Durham, North Carolina.
[Medline record in process]
Despite the growth of ambulatory anesthesia and the renewed popularity of
regional techniques, there is little current informa tion concerning outpatient
regional anesthesia practices or attitudes about discharge with an insensate
extremity. We present results from a survey sent to all members of the Society
for Ambulatory Anesthesia (SAMBA). The survey was mailed in January 2001 to
2373 SAMBA members, along with a self-addressed stamped return envelope. After
3 mo, 1078 surveys were returned (response rate 45%). Respondents indicated
that they were most likely to perform axillary (77%), interscalene (67%),
and ankle blocks (68%) on ambulatory patients. They were less likely to perform
lower extremity conduction blocks in ambulatory patients (femoral blocks,
40%; all other types of blocks, <23%]. Eighty-five percent of respondents
discharged patients with long-acting blocks, but this was mainly limited to
three types. Of the 16% who never or rarely discharged patients with long-acting
blocks, the primary reasons were concern about patient injury (49%) and the
inability for patients to care for themselves (28%). Only 22% of office-based
anesthesiologists would perform upper extremity blocks and only 28% would
perform lower extremity blocks (P < 0.001). This survey demonstrates that
use of regional anesthesia in outpatients is common but restricted to a few
techniques. Discharge with an insensate upper extremity is prevalent but discharge
with an insensate lower extremity is not common and remains controversial.
Despite the reasoning for the reported practices, randomized data are necessary
to confirm the validity of these concerns. IMPLICATIONS: This survey demonstrates
that use of regional anesthesia in outpatients is common but restricted to
a few techniques. Discharge with an insensate upper extremity is common but
discharge with an insensate lower extremity is not prevalent and remains controversial.
PMID: 11772803, UI: 21633720
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Anesth Analg 2002 Jan;94(1):60-4
The assessment of postural stability after ambulatory anesthesia: a comparison
of desflurane with propofol.
Song D, Chung F, Wong J, Yogendran S
Department of Anesthesia, Toronto Western Hospital, University of Toronto,
Toronto, Ontario, Canada.
[Medline record in process]
We designed this study to evaluate postural stability in outpatients after
either desflurane or propofol anesthesia. After IRB approval, 120 consenting
women undergoing gynecological laparoscopic procedures were randomly assigned
to receive either desflurane or propofol-based general anesthesia. After surgery,
patients' postural stability was measured as body sway velocity by using a
computerized force platform in the following conditions: 1) standing on a
firm surface with eyes open versus closed and 2) standing on a foam surface
with eyes open versus closed. These measurements were made before anesthesia,
immediately after the patient achieved a Post-Anesthesia Discharge Score of
9, and at actual discharge home. At the time patients first achieved a Post-Anesthesia
Discharge Score of 9, the body sway in the Propofol group was significantly
more than in the Desflurane group when patients were asked to stand on a foam
surface with eyes closed (testing the ability of using vestibular information
for balance control). We concluded that the desflurane-based anesthetic was
associated with better postural control than the propofol-based anesthetic
in the early recovery period after outpatient gynecological laparoscopic procedures.
IMPLICATIONS: The residual effects of the short-acting general anesthetics
desflurane and propofol on patient's balance function during recovery after
surgery were assessed with a computerized force platform. The results showed
that desflurane seemed to be associated with better postural control than
propofol in the early recovery period.
PMID: 11772801, UI: 21633718
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Anesth Analg 2002 Jan;94(1):16-21
Heart rate variability and arterial blood pressure variability show different
characteristic changes during hemorrhage in isoflurane-anesthetized, mechanically
ventilated dogs.
Kawase M, Komatsu T, Nishiwaki K, Kobayashi M, Kimura T, Shimada Y
Department of Anesthesiology and Intensive Care Unit, Tosei General Hospital,
Seto, Aichi, Japan.
[Medline record in process]
We assessed the changes in heart rate variability (HRV) and blood pressure
variability (BPV) as indices of autonomic nervous system and volume status
during hemorrhage in isoflurane-anesthetized, mechanically ventilated dogs.
Nine dogs were used. They were sequentially subjected to withdrawal of 30%
estimated blood volume and graded isoflurane inhalation of 1% and 2% followed
by discontinuation of isoflurane and retransfusion. The power spectra of HRV
and BPV were computed using the fast Fourier transformation, and were quantified
by determining the areas of the spectrum in two component widths: low-frequency
component (LF) (0.04-0.15 Hz) and high-frequency component (HF) (0.15-0.4
Hz). During hemorrhage and isoflurane anesthesia, both HRV-LF and HRV-HF were
decreased and plateaued at the smaller concentration of isoflurane, whereas
BPV-LF decreased concentration-dependently. BPV-HF showed a completely different
response and increased significantly during 2% isoflurane. We speculate that
HRV and BPV-LF would be affected by the autonomic nervous activity, whereas
BPV-HF would depend on relative/absolute change in circulating blood volume.
IMPLICATIONS: Power spectra of heart rate variability (HRV) and blood pressure
variability (BPV) were computed using the fast Fourier transformation. The
HRV and BPV showed their differential characteristics during hemorrhage, isoflurane
anesthesia, and retransfusion, and would help to assess changes in autonomic
nervous system and preload under mechanical ventilation.
PMID: 11772794, UI: 21633711
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Anesth Analg 2001 Dec;93(6):1623
Play stickers: pediatric mask induction made easy.
Malhotra SK, Dutta A, Kumar D
Publication Types:
Letter
PMID: 11726458, UI: 21583199
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Anesth Analg 2001 Dec;93(6):1618-20, table of contents
The use of a "reverse" axis (axillary-interscalene) block in a
patient presenting with fractures of the left shoulder and elbow.
Brown AR, Parker GC
College of Physicians & Surgeons, Columbia University, New York, New
York 10032, USA. arb6@columbia.edu
IMPLICATIONS: A patient presented for surgery to repair a fractured left
shoulder and elbow and requested regional anesthesia. Most upper extremity
operations require a single brachial plexus nerve block. The position of the
two fractures however required the use of two separate approaches, an interscalene
and an axillary approach.
PMID: 11726455, UI: 21583196
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Anesth Analg 2001 Dec;93(6):1578-9, table of contents
Body temperature and diaphoresis disturbances in a patient with arachnoiditis.
Couto da Silva JM, Couto da Silva JM Jr, Antonio Aldrete J
Department of Anesthesiology, University of Brasilia, Brasilia, Brazil.
IMPLICATIONS: Arachnoiditis, produced by different causes, is an inflammation
of the sac containing the spinal cord and nerve roots. Patients with this
disease have severe low back and leg pain, sweating and low grade fever. This
case had aberrant skin temperature and sweating in different parts of the
body.
PMID: 11726448, UI: 21583189
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Anesth Analg 2001 Dec;93(6):1486-8, table of contents
Minimally invasive direct coronary artery bypass surgery under high thoracic
epidural.
Paiste J, Bjerke RJ, Williams JP, Zenati MA, Nagy GE
Department of Anesthesiology and Critical Care Medicine, University of Pittsburgh
School of Medicine, PA 15240, USA. jupst8@imap.pitt.edu
IMPLICATIONS: This report describes the use of high-thoracic epidural anesthesia
for a patient undergoing minimally invasive direct coronary artery bypass.
Isolated bilateral paralysis of the hypoglossal nerve after transoral intubation
for general anesthesia.
Rubio-Nazabal E, Marey-Lopez J, Lopez-Facal S, Alvarez-Perez P, Martinez-Figueroa
A, Rey Del Corral P
Submitted for publication February 22, 2001.
[Medline record in process]
PMID: 11753027, UI: 21621192
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Anesthesiology 2002 Jan;96(1):202-31
Advances in neurobiology of the neuromuscular junction: implications for
the anesthesiologist.
Naguib M, Flood P, McArdle JJ, Brenner HR
Submitted for publication January 11, 2001.
[Medline record in process]
PMID: 11753022, UI: 21621187
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Anesthesiology 2002 Jan;96(1):173-82
Comparison of amsorb(r), sodalime, and baralyme(r) degradation of volatile
anesthetics and formation of carbon monoxide and compound a in Swine in vivo.
Kharasch ED, Powers KM, Artru AA
Submitted for publication May 1, 2001.
[Medline record in process]
BACKGROUND: Consequences of volatile anesthetic degradation by carbon dioxide
absorbents that contain strong base include formation of compound A from sevoflurane,
formation of carbon monoxide (CO) and CO toxicity from desflurane, enflurane
and isoflurane, delayed inhalation induction, and increased anesthetic costs.
Amsorb(R) (Armstrong Ltd., Coleraine, Northern Ireland) is a new absorbent
that does not contain strong base and does not form CO or compound A in vitro.
This investigation compared Amsorb(R), Baralyme(R) (Chemetron Medical Division,
Allied Healthcare Products, St. Louis, MO), and sodalime effects on CO (from
desflurane and isoflurane) and compound A formation, carboxyhemoglobin (COHb)
concentrations, and anesthetic degradation in a clinically relevant porcine
in vivo model. METHODS: Pigs were anesthetized with desflurane, isoflurane,
or sevoflurane, using fresh or partially dehydrated Amsorb(R), Baralyme(R),
and new and old formulations of sodalime. Anesthetic concentrations in the
fresh (preabsorber), inspired (postabsorber), and end-tidal gas were measured,
as were inspired CO and compound A concentrations and blood oxyhemoglobin
and COHb concentrations. RESULTS: For desflurane and isoflurane, the order
of inspired CO and COHb formation was dehydrated Baralyme(R) >> soda-lime
> Amsorb(R). For desflurane and Baralyme(R), peak CO was 9,700 +/- 5,100
parts per million (ppm), and the increase in COHb was 37 +/- 14%. CO and COHb
increases were undetectable with Amsorb(R). Oxyhemoglobin desaturation occurred
with desflurane and Baralyme(R) but not Amsorb(R) or sodalime. The gap between
inspired and end-tidal desflurane and isoflurane did not differ between the
various dehydrated absorbents. Neither fresh nor dehydrated Amsorb(R) caused
compound A formation from sevoflurane. In contrast, Baralyme(R) and sodalime
caused 20-40 ppm compound A. The gap between inspired and end-tidal se voflurane
did not differ between fresh absorbents, but was Amsorb(R) < sodalime <
Baralyme(R) with dehydrated absorbents. CONCLUSION: Amsorb(R) caused minimal
if any CO formation, minimal compound A formation regardless of absorbent
hydration, and the least amount of sevoflurane degradation. An absorbent like
Amsorb(R), which does not contain strong base or cause anesthetic degradation
and formation of toxic products, may have benefit with respect to patient
safety, inhalation induction, and anesthetic consumption (cost).
PMID: 11753018, UI: 21621183
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Anesthesiology 2002 Jan;96(1):67-73
Closed-loop Control of Anesthesia Using Bispectral Index: Performance Assessment
in Patients Undergoing Major Orthopedic Surgery under Combined General and
Regional Anesthesia.
Absalom AR, Sutcliffe N, Kenny GN
Submitted for publication January 22, 2001.
[Medline record in process]
BACKGROUND: The Bispectral Index (BIS) is an electroencephalogram-derived
measure of anesthetic depth. A closed-loop anesthesia system was built using
BIS as the control variable, a proportional-integral-differential control
algorithm, and a propofol target-controlled infusion system as the control
actuator. Closed-loop performance was assessed in 10 adult patients. METHODS:
Ten adult patients scheduled to undergo elective hip or knee surgery were
enrolled. An epidural cannula was inserted, and 0.5% bupivacaine was used
to provide anesthesia to T8 before general anesthesia was induced using the
propofol target-controlled infusion system under manual control. After the
start of surgery, when anesthesia was clinically adequate, automatic control
of anesthesia was commenced using the BIS as the control variable. Adequacy
of a nesthesia during closed-loop control was assessed clinically and by calculating
the median performance error, the median absolute performance error, and the
mean offset of the control variable. RESULTS: The median performance error
and the median absolute performance error were 2.2 and 8.0%, respectively.
Mean offset of the BIS from the set point was 0.9. Cardiovascular parameters
were stable during closed-loop control. Operating conditions were adequate
in all patients but one, who began moving after 45 min of stable anesthesia.
No patients reported awareness or recall of intraoperative events. In three
patients, there was oscillation of the measured BIS around the set point.
CONCLUSIONS: The system was able to provide clinically adequate anesthesia
in 9 of 10 patients. Further studies are required to determine whether control
performance can be improved by alterations to the gain factors or by using
an effect site-targeted, target-controlled infusion propofol system.
PMID: 11753004, UI: 21621169
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Anesthesiology 2002 Jan;96(1):5-9
The effectiveness of video technology as an adjunct to teach and evaluate
epidural anesthesia performance skills.
BACKGROUND: Although video review has been used in teaching, it has not been
reported for use as an adjunct to teaching anesthesiology residents. The purpose
of the prospective, randomized, blinded study was to determine whether teaching
with video review improves epidural anesthesia skills of anesthesiology residents.
METHODS: Twenty-two second-year (CA-2) anesthesiology residents beginning
their fi rst obstetric anesthesia rotation were assigned to video or nonvideo
groups. All residents were filmed daily as they placed epidural analgesia.
Residents assigned to the video group reviewed their tapes twice a week with
an attending anesthesiologist, whereas residents assigned to the nonvideo
group never saw their films. Four experienced attending anesthesiologists
independently judged videotapes taken on days 1, 15, and 30 and scored the
residents for "overall" skill (range of summed overall grades, 0-40),
as well as on 13 predetermined criteria. RESULTS: As determined by kappa coefficients,
interrater reliability was high among the judges (k = 0.7-0.8). Residents
in the video group improved to a greater degree than residents in the nonvideo
group. On day 1, the median overall grades for the video and nonvideo groups
were 21 and 12, respectively. By day 15, the corresponding grades had increased
to 32 and 24, respectively (P < 0.01). However, overall median grades continued
to improve between days 15 and 30 in the video group only (P < 0.01). CONCLUSIONS:
Review of resident videotapes resulted in greater improvement in overall and
predetermined performance criteria. In addition, video review was helpful
in identifying skills that were inadequately learned, thus allowing for specific
teaching in those areas.
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.
