The influence of abdominoplasty surgery on assessment
of level of subarachnoid block.
Joshi P, Thomas DI
Publication Types:
Letter
PMID: 12004820, UI: 21999610
Anaesthesia 2002 May;57(5):514-5; discussion 515
Epidural fixation.
Cowan CM, Delarghy A, Barclay PM
Publication Types:
Letter
PMID: 12004819, UI: 21999609
Anaesthesia 2002 May;57(5):511-2; discussion 512
Paravertebral block.
Tighe SQ
Publication Types:
Letter
PMID: 11966569, UI: 21963390
Anaesthesia 2002 May;57(5):510; discussion 510
Pre-oxygenation.
Bhogal H
Publication Types:
Letter
PMID: 11966565, UI: 21963386
Anaesthesia 2002 May;57(5):446-50
Comparison of sevoflurane and nitrous oxide mixture with
nitrous oxide alone for inhalation conscious sedation in
children having dental treatment: a randomised controlled
trial.
We studied 411 children aged 3-10 years who were referred
for dental treatment. They were randomly allocated to have
inhalation conscious sedation with either sevoflurane/nitrous
oxide mixture or nitrous oxide alone. Dental treatment was
satisfactorily completed in 215/241 children who were given
sevoflurane/nitrous oxide mixture (89%) compared with 89/170
who were given nitrous oxide alone (52%) (Chi square 70.3,
p < 0.0001). All children remained conscious and responsive
to verbal contact throughout the treatment and in the recovery
room. No adverse side-effects were recorded in either group
and there were no significant differences in oxygen saturation,
heart rate, recovery profile, or time to discharge home
between the groups. The study concluded that, for every
100 children treated with sevoflurane/nitrous oxide mixture,
37 children would be saved a general anaesthetic if given
combined sevoflurane and nitrous oxide mixture rather than
nitrous oxide alone. The use of sevoflurane in low concentrations
0.1-0.3% to supplement nitrous oxide and oxygen for inhalation
conscious sedation is safe, practical, and significantly
more effective than nitrous oxide alone in children having
dental treatment.
[Analysis of the anesthesiologist's vigilance with an
eye-tracking device. A pilot study for evaluation of the
method under the conditions of a modern operating theatre.]
[Article in German]
Schulz-Stubner S, Jungk A, Kunitz O, Rossaint R
Klinik fur Anasthesiologie am Universitatsklinikum, RWTH
Aachen. schust@t-online.de
INTRODUCTION: With the inclusion of new monitoring devices
over the last two decades, the distribution of the anesthesiologists
vigilance has changed which might influence the ergonomic
profile of an optimal anesthesia workstation. The aim of
this pilot study was the evaluation of an eyetracking device
to analyze the vigilance distribution of an anesthesiologist
during routine cases in an operating theatre of the 21st
century. MATERIAL AND METHODS: Five anesthesiologist with
different levels of training were followed during different
types of surgery using a video camera-based eye-tracking
system. The films were analyzed by an independent observer
and rated according to defined regions of interest (ROI).
Then typical scan-paths were identified and quantitatively
analyzed. RESULTS: The eye-tracking studies proved to be
technically of high quality but were time-consuming. Only
few disturbances to the operating room (OR) personnel were
recorded according to their subjective impressions but bias
of behaviour due to the measurement procedure itself cannot
be completely excluded. The vigilance of the anesthesiologist
towards different factors was dependent on the level of
professional training, the type of anesthesia and the type
of surgery. Certain factors such as documentation (10-15%)
or external disturbances (approximately 20%) proved to be
relatively constant. Typical scan-paths could also be identified.
CONCLUSION: Eye-tracking studies proved to be a suitable
way to analyze the distribution of vigilance of anesthesiologists
in a modern operating theatre. For further studies examining
the influence of detailed modifications of the OR environment,
a standardized study design with the same level of education,
the same anesthesia technique and the same surgical procedure
needs to be chosen.
PMID: 11993079, UI: 21989446
Anaesthesist 2002 Mar;51(3):175-9
[Postoperative pain therapy in minimally invasive direct
coronary arterial bypass surgery. I.v. opioid patient-controlled
analgesia versus intercostal block.]
[Article in German]
Behnke H, Geldner G, Cornelissen J, Kahl M, Moller F,
Cremer J, Wulf H
OBJECTIVE: Lately introduced cardiosurgical procedures
such as MIDCAB enable an early extubation immediately after
surgery. This also requires an adequate anesthesia regime
and especially a sufficient postoperative analgesia. Patient
controlled analgesia (PCA) and intercostal nerve blockade
(ICB) were evaluated for their suitability for postoperative
pain relief in patients undergoing a MIDCAB procedure. MATERIAL
AND METHODS: After approval by the local ethic committee
and obtaining written informed consent 43 patients were
included in this study. Anesthesia was induced and maintained
in a total intravenous standardised manner with propofol,
remifentanil, cisatracurium and additionally glyceroltrinitrate,
clonidine and esmolol were given as needed. After revascularisation
patients were randomly assigned to one of two groups receiving
either 7.5 mg piritramid i.v. before extubation and continuing
a PCA with 2 mg boli and a 10 min lockout, or an ICB with
ropivacaine 1% (4 times 5 ml). Additionally all patients
received 1 g paracetamol rectally before induction of anesthesia
and 1 g metamizol i.v. at the end of surgery. A rescue medication
of 3.75 mg piritramid i.v. was allowed. A pain score (NRS
0-10), the Aldrete score (AS 0-12) and oxygen saturation
were obtained 1, 4, and 8 h after extubation. RESULTS: The
ICB group showed a significantly greater pain reduction
in the first (5.8 +/- 1.8 vs. 7.3 +/- 1.9; P < 0.02)
and fourth h (3.6 +/- 1.3 vs. 4.6 +/- 1.4; P < 0.02),
respectively. Transfer to an intermediate care ward one
hr after extubation was achieved more often in the ICB group
according to the AS (ICB 9.6 +/- 1.5 vs. PCA 8.9 +/- 1.2;
P < 0.05), too. There was no difference with respect
to the oxygen saturation. The additional piritramid demand
was 9.3 mg in the ICP group and 5 mg in the PCA group in
the first 8 hours postoperative. CONCLUSION: ICB gives a
better pain relief in the early postoperative phase after
MIDCAB procedures compared to a PCA. Both regimes are adequate
in order to provide a sufficient pain relief and help to
avoid prolonged postoperative mechanical ventilation. These
will enable an early transfer of patients to an intermediate
care station and save ICU capacity.
Publication Types:
Clinical trial
PMID: 11993078, UI: 21989445
Anaesthesist 2002 Mar;51(3):166-74
[Allocation of responsibility for positioning patients
for surgery and liability for damages consequent on faulty
positioning.]
[Article in German]
Weissauer W
walther.weissauer@tin.it
The cooperation of surgeon and anaesthetist in positioning
of the patient is subject to the principles of horizontal
division of labour recognized in the interdisciplinary agreement
and confirmed by the legislature: anaesthetist and surgeon
carry out their respective tasks independently of each other,
each bearing full responsibility for their own work (principle
of strict separation of functions), they tailor their procedures
to fit in with each other (duty of coordination), and each
is entitled to expect and rely on due care in the other
(principle of trust). In the case of conflict--when the
best position for the specific intervention leads to a higher
anaesthesiological risk--the principle of predominance of
the actual requirements applies. If no agreement is reached
it is incumbent on the surgeon to make the decision; this
means that the surgeon bears the medical and legal responsibility
for appropriate deliberation. Faults in organization are
regarded under the law as faulty treatment. Anaesthetist
and surgeon are each responsible for their own errors. According
to the interdisciplinary agreements, positioning and checks
on position are the task of the surgeon, while the anaesthetist
is responsible for the "infusion arm". This does
not exclude the possibility that anaesthetist and surgeon
may agree on a different division of labour in the operating
room. The patient bears the burden of proof that errors
were committed in a case for damages. The doctor does, however,
have to prove that the patient was correctly positioned.
The demands of jurisdiction in terms of documentation of
the positioning and of presentation of evidence are practically
oriented and can basically be met. The same is true of the
information supplied to the patient on the risk that positioning
can cause harm. The doctor is obliged to supply evidence
of the patient's substantive consent and the provision of
information that this implies.
Publication Types:
Review
Review, tutorial
PMID: 11993077, UI: 21989444
Anesth Analg 2002 Jun;94(6):1672
Hypoxic gas flow caused by malfunction of the proportioning
system of anesthesia machines.
Ishikawa S, Nakazawa K, Makita K
Department of Anesthesiology and Critical Medicine, Tokyo
Medical and Dental University, School of Medicine, Tokyo,
Japan.
[Medline record in process]
PMID: 12032057, UI: 22027041
Anesth Analg 2002 Jun;94(6):1669
Cognitive failures after general anesthesia are probably
not related to the type of anesthetic used.
Basgul E, Akinci SB
Department of Anesthesiology and Reanimation, Hacettepe
University, Ankara, Turkey. Professor and Holder of the
Margaret Milam McDermott Distinguished Chair in Anesthesiology,
University of Texas Southwestern Medical Center at Dallas,
Dallas, Texas.
[Medline record in process]
PMID: 12032051, UI: 22027035
Anesth Analg 2002 Jun;94(6):1661-8
The society of pediatric anesthesia: fifteenth annual
meeting, new orleans, louisiana, october 12, 2001.
Kern FH
Department of Anesthesiology, Duke University Medical Center,
Durham, North Carolina.
[Medline record in process]
PMID: 12032049, UI: 22027033
Anesth Analg 2002 Jun;94(6):1625-7
Subdural hygroma: a rare complication of spinal anesthesia.
Van Den Berg JS, Sijbrandy SE, Meijer AH, Oostdijk AH
Departments of Neurology, Radiology, Anaesthesiology, and
Nuclear Medicine, Isala Kliniek, Zwolle, The Netherlands.
[Medline record in process]
IMPLICATIONS: We describe a patient with frontal hygroma
after spinal anesthesia-a rare complication. This condition
should be considered in patients after spinal anesthesia
with persisting orthostatic headache. Risk factors include
ventriculo-peritoneal shunt or brain atrophy caused by old
age.
PMID: 12032041, UI: 22027025
Anesth Analg 2002 Jun;94(6):1617-20
Small-dose propofol sedation attenuates the formation
of reactive oxygen species in tourniquet-induced ischemia-reperfusion
injury under spinal anesthesia.
Cheng YJ, Wang YP, Chien CT, Chen CF
Department of Anesthesiology and Office for Medical Research
Administration, National Taiwan University Hospital, and
Department of Physiology, College of Medicine, National
Taiwan University, Taipei, Taiwan.
[Medline record in process]
The release of a tourniquet produces reactive oxygen species
(ROS), which can cause ischemia-reperfusion injury. We investigated
the effects on ROS production in 22 adult ASA physical status
I-II patients sedated with small-dose propofol infusion
and IV midazolam undergoing elective total knee replacement
under intrathecal anesthesia, allocated randomly to one
of two groups. In the Propofol group, sedation was performed
with propofol 0.2 mg/kg followed by infusion at a rate of
2 mg. kg(-1). h(-1). In the Control group, IV midazolam
5 mg was given. ROS production was measured by lucigenin
chemiluminescence analysis. Blood samples were obtained
from the radial artery after spinal anesthesia, 1 min before
release of the tourniquet and 5 and 20 min after reperfusion.
The ischemic time was approximately 70 min. ROS production
decreased nonsignificantly before reperfusion in both groups
but increased significantly 5 and 20 min after reperfusion
in the Midazolam group. In the Propofol group, no significant
increase of ROS production was found. We conclude that small-dose
propofol infusion attenuates ROS production in tourniquet-induced
ischemia-reperfusion injury. IMPLICATIONS: Small-dose propofol
sedation, compared with IV midazolam, attenuates free radical
production after release of the tourniquet during total
knee replacement under spinal anesthesia.
PMID: 12032039, UI: 22027023
Anesth Analg 2002 Jun;94(6):1614-6
Epidural morphine delays the onset of tourniquet pain
during epidural lidocaine anesthesia.
Cherng CH, Wong CS, Chang FL, Ho ST, Lee CH
Departments of Anesthesiology and Orthopedics, Tri-Service
General Hospital, National Defense Medical Center, Taipei,
Taiwan.
[Medline record in process]
We conducted a randomized, double-blinded study to examine
the onset time of tourniquet pain during epidural lidocaine
anesthesia either with or without morphine in the epidural
solution. Forty-five patients undergoing knee surgery with
a thigh tourniquet were randomly allocated into 3 groups
of 15 patients each: epidural morphine (EM; epidural administration
of 17 mL of 2% lidocaine plus 2 mg of morphine, followed
by IV injection of 0.2 mL of normal saline), IV morphine
(IVM; 17 mL of 2% lidocaine plus 0.2 mL of normal saline,
followed by IVM 2 mg IV), and control (17 mL of 2% lidocaine
plus 0.2 mL of normal saline, followed by 0.2 mL of normal
saline IV). The onset time of tourniquet pain was recorded.
The level of sensory block was determined by the pinprick
method at the occurrence of tourniquet pain. Hemodynamic
changes and side effects of EM were also recorded. The onset
time of tourniquet pain from both the epidural injection
and the tourniquet inflation were significantly longer in
the EM group (103 +/- 15 min and 80 +/- 15 min, respectively)
compared with the IVM group (74 +/- 12 min and 50 +/- 12
min, respectively; P < 0.05) and the Control group (67
+/- 9 min and 45 +/- 9 min, respectively; P < 0.05).
The level of sensory block at the onset of tourniquet pain
and hemodynamic changes were not different among the three
groups. Only two and three patients in the EM group complained
of nausea/vomiting and pruritus, respectively. Respiratory
depression was not observed in any patient. We conclude
that epidural injection of the mixture of 2 mg of morphine
and 2% lidocaine solution delayed the onset of tourniquet
pain during epidural lidocaine anesthesia without significant
morphine-related side effects. IMPLICATIONS: We examined
the effect of epidural morphine on the onset of tourniquet
pain during epidural lidocaine anesthesia. We found that
the addition of 2 mg of morphine to epidural 2% lidocaine
significantly delayed the onset of tourniquet pain without
increasing morphine-related side effects.
PMID: 12032038, UI: 22027022
Anesth Analg 2002 Jun;94(6):1598-1605
Epinephrine Markedly Improves Thoracic Epidural Analgesia
Produced by a Small-Dose Infusion of Ropivacaine, Fentanyl,
and Epinephrine After Major Thoracic or Abdominal Surgery:
A Randomized, Double-Blinded Crossover Study With and Without
Epinephrine.
Niemi G, Breivik H
Department of Anesthesiology, Rikshospitalet University
Hospital, Oslo, Norway.
[Record supplied by publisher]
We have shown that epinephrine markedly improves the analgesic
effect of a thoracic epidural infusion of bupivacaine and
fentanyl. Ropivacaine has an intrinsic vasoconstrictive
effect, and epinephrine may therefore not have the same
pharmacokinetic interaction in a ropivacaine-fentanyl infusion;
but a possible spinal cord alpha(2)-agonist effect of epinephrine
would give the same positive pharmacodynamic interaction
with ropivacaine and fentanyl during epidural analgesia.
In a prospective, randomized, crossover study, a thoracic
epidural infusion of ropivacaine 1 mg/mL and fentanyl 2
&mgr;g/mL with or without epinephrine 2 &mgr;g/mL was given
to 12 patients in a double-blinded manner after major thoracic
or upper abdominal surgery. Main outcome measures were pain
intensity at rest and when coughing, evaluated on a visual
analog scale. Extent of sensory blockade was evaluated by
determining dermatomal hypoesthesia to cold. Pain increased
(P < 0.001) and hypoesthetic dermatomal segments decreased
(P < 0.001) when epinephrine was omitted from the triple
epidural infusion. After 3 h without epinephrine, pain intensity
when coughing was unacceptable despite rescue analgesia.
After restarting the triple epidural mixture with epinephrine,
pain was again reduced to mild pain when coughing, and the
sensory blockade was restored. The mixture with epinephrine
caused less nausea and facilitated mobilization. We conclude
that epinephrine improves the pain relief and reduces the
side effects of a thoracic epidural infusion of ropivacaine
and fentanyl after major thoracic or upper abdominal surgery.
IMPLICATIONS: Epidural epinephrine markedly improves the
pain relief and sensory blockade of a small-dose thoracic
epidural infusion of ropivacaine and fentanyl. Nausea was
reduced, and mobilization of the patients was facilitated.
PMID: 12032036
Anesth Analg 2002 Jun;94(6):1595-7
Anesthetic Considerations for a Patient with Compound
Heterozygous Medium-Chain Acyl-CoA Dehydrogenase Deficiency.
Wang SY, Kannan S, Shay D, Segal S, Datta S, Tsen L
Department of Anesthesiology, Perioperative and Pain Medicine,
Brigham and Women's Hospital, Harvard Medical School, Boston,
Massachusetts.
[Medline record in process]
IMPLICATIONS: We describe the anesthetic management of
a parturient with compound heterozygous medium chain acyl-CoA
dehydrogenase deficiency, the most common disorder of fatty
acid metabolism.
PMID: 12032035, UI: 22027019
Anesth Analg 2002 Jun;94(6):1566-9
Acute Vision Impairment: Does It Affect an Anesthesiologist's
Ability to Intubate the Trachea?
Tessler MJ, Trihas ST, Overbury O, Ducruet T
Departments of Anesthesia, Ophthalmology, and Clinical
Epidemiology, Sir Mortimer B. Davis Jewish General Hospital
and McGill University, Montreal, Quebec, Canada.
[Medline record in process]
The result of impaired vision on an anesthesiologist's
ability to intubate the trachea is unknown. We studied 12
attending staff anesthesiologists as they intubated 2 anesthesia
mannequins (A and B) under 6 conditions. The conditions
were: 1) usual vision, 2) central-vision loss with 20/500
bilaterally and a 24 degrees central scotoma, 3) peripheral-field
loss with 20/20 bilaterally and a 7 degrees visual field,
4) peripheral-field loss with 20/20 bilaterally and a 3.5
degrees visual field, 5) central-vision loss with 20/200
bilaterally and a 12 degrees central scotoma, and 6) right
eye ocular media opacity and 20/70 left eye usual acuity.
The time to intubation was recorded by stopwatch from gripping
the laryngoscope until the anesthesiologist signaled that
the endotracheal tube was properly placed in the trachea.
The mean +/- SD times to intubation for Mannequins A and
B were 16.0 +/- 3.3, 31.9 +/- 10.4, 26.4 +/- 9.0, 26.4 +/-
7.7, 22.4 +/- 5.1, 25.5 +/- 16.9 and 16.6 +/- 6.6, 26.9
+/- 10.0, 21.4 +/- 9.2, 21.4 +/- 5.8, 21.5 +/- 7.7, 17.7
+/- 5.1 s for the 6 conditions, respectively. Multiple analysis
of variance revealed a highly significant difference for
the time to successful intubation between the anesthesiologists'
usual vision and the vision-impaired conditions. There was
a significant improvement in time to successful intubation
from the first to subsequent intubation attempts. There
were also more esophageal intubations in the vision-impaired
conditions. This implies that anesthesiologists who develop
acute severe vision impairment might have more difficulty
intubating the trachea, which could initiate more critical
incidents. The results of this study cannot be applied to
anesthesiologists with chronic vision impairment. IMPLICATIONS:
We found that acute severe vision impairment adversely affects
the anesthesiologist's ability to intubate the trachea.
This implies that anesthesiologists with acute onset of
severe visual handicaps might have more difficulty intubating
the trachea, which could initiate more critical incidents.
PMID: 12032028, UI: 22027012
Anesth Analg 2002 Jun;94(6):1560-5
A comparison of the training value of two types of anesthesia
simulators: computer screen-based and mannequin-based simulators.
Nyssen AS, Larbuisson R, Janssens M, Pendeville P, Mayne
A
Department of Work Psychology, University of Liege.
[Medline record in process]
In this study, we compared two different training simulators
(the computer screen-based simulator versus the full-scale
simulator) with respect to training effectiveness in anesthesia
residents. Participants were evaluated in the management
of a simulated preprogrammed scenario of anaphylactic shock
using two variables: treatment score and diagnosis time.
Our results showed that simulators can contribute significantly
to the improvement of performance but that learning in treating
simulated crisis situations such as anaphylactic shock did
not significantly vary between full-scale and computer screen-based
simulators. Consequently, the initial decision on whether
to use a full-scale or computer screen-based training simulator
should be made on the basis of cost and learning objectives
rather than on the basis of technical or fidelity criteria.
Our results support the contention that screen-based simulators
are good devices to acquire technical skills of crisis management.
Mannequin-based simulators would probably provide better
training for behavioral aspects of crisis management, such
as communication, leadership, and interpersonal conflicts,
but this was not tested in the current study. IMPLICATIONS:
We compared two different training simulators (computer
screen-based versus full-scale) for training anesthesia
residents to better document the effectiveness of such devices
as training tools. This is an important issue, given the
extensive use and the high cost of mannequin-based simulators
in anesthesiology.
PMID: 12032027, UI: 22027011
Anesth Analg 2002 Jun;94(6):1547-52
Dextromethorphan reduces immediate and late postoperative
analgesic requirements and improves patients' subjective
scorings after epidural lidocaine and general anesthesia.
Weinbroum AA
Post-Anesthesia Care Unit, Tel Aviv Sourasky Medical Center,
and the Sackler Faculty of Medicine, Tel Aviv University,
Tel Aviv, Israel.
[Medline record in process]
Central N-methyl-D-aspartate receptors modulate postoperative
pain. We compared the effects of preincision oral dextromethorphan
(DM), an N-methyl-D-aspartate receptor antagonist, on postoperative
IV patient-controlled analgesia morphine demand and on subjective
variables in 80 patients undergoing lower-body procedures
who were randomly assigned to epidural lidocaine (LA; 16
mL, 1.6%) or general anesthesia (GA). The patients were
premedicated 90 min before surgery with placebo or DM 90
mg (20 patients per group) in a double-blinded manner. Postoperative
IV patient-controlled analgesia morphine administration
started when subjective pain intensity was >/=4 of 10
(visual analog scale) and lasted 2 h. Observation continued
up to 3 days, during which patients could use diclofenac.
LA-DM and GA-DM patients required 45%-50% less morphine
and diclofenac compared with their placebo counterparts
(P < 0.001). However, GA-DM patients made twice as many
attempts to self-administer morphine as LA-DM patients (P
= 0.005). Eight LA-DM versus two GA-DM patients (P <
0.01) used no morphine or diclofenac. All DM patients experienced
significantly (P < 0.001) less pain, were less sedated,
and felt better than their placebo counterparts; however,
compared with placebo, DM improved subjective scorings in
the GA patients more significantly (P < 0.05) than in
the LA patients. We conclude that oral DM 90 mg in patients
undergoing surgery under LA or GA reduces morphine and diclofenac
use by approximately 50% in the immediate and late postoperative
period compared with placebo. Subjectively scored levels
of pain, sedation, and well-being were better as well.
PMID: 12032024, UI: 22027008
Anesth Analg 2002 Jun;94(6):1530-3
Remifentanil dose/electroencephalogram bispectral response
during combined propofol/regional anesthesia.
Koitabashi T, Johansen JW, Sebel PS
Ichikawa General Hospital, Tokyo Dental College, Tokyo,
Japan.
[Medline record in process]
The effect of opioid administration on the bispectral index
(BIS) during general anesthesia is controversial. Several
investigators have reported BIS to be insensitive to opioid
addition, whereas others have found a hypnotic response.
We designed this study to examine the effect of remifentanil
on BIS during combined regional/general propofol anesthesia
under steady-state conditions. After Human Investigations
Committee approval, 19 healthy ASA physical status I or
II patients were enrolled in a prospective experimental
design. Regional anesthesia was initiated and general anesthesia
induced by using computer-assisted continuous infusion of
propofol. Propofol was incrementally adjusted to a BIS of
approximately 60. After 20 min at a stable propofol infusion
rate, a remifentanil computer-assisted continuous infusion
(effect-site target concentration of 0.5, 2.5, and then
10 ng/mL) was sequentially administered at stepped 15-min
intervals. BIS decreased from 56 +/- 2 to 44 +/- 1, 95%
spectral edge frequency from 17.9 +/- 0.5 Hz to 15.0 +/-
0.4 Hz, heart rate from 84 +/- 5 bpm to 62 +/- 4 bpm, and
mean arterial blood pressure from 93 +/- 4 mm Hg to 69 +/-
3 mm Hg with increasing remifentanil concentration. A significant
linear correlation between BIS, 95% spectral edge frequency,
heart rate, and log (remifentanil effect-site) concentration
was found. The change in baseline BIS was relatively modest
but significant, suggesting that remifentanil has some sedative/hypnotic
properties, or that it potentiates the hypnotic effect of
propofol. IMPLICATIONS: This experiment identified a significant,
dose-dependent decrease in bispectral index (BIS), 95% spectral
edge frequency, heart rate, and mean arterial blood pressure
with increasing remifentanil dose. The change in baseline
BIS was relatively modest but significant, suggesting that
remifentanil has some sedative/hypnotic properties, or that
it potentiates the hypnotic effect of propofol.
PMID: 12032020, UI: 22027004
Anesth Analg 2002 Jun;94(6):1521-9
The incidence and risk factors for hypotension after spinal
anesthesia induction: an analysis with automated data collection.
Hartmann B, Junger A, Klasen J, Benson M, Jost A, Banzhaf
A, Hempelmann G
Department of Anesthesiology and Intensive Care Medicine,
Justus-Liebig-University Giessen, Germany.
[Medline record in process]
We sought to identify factors that are associated with
hypotension after the induction of spinal anesthesia (SpA)
by using an anesthesia information management system. Hypotension
was defined as a decrease of mean arterial blood pressure
of more than 30% within a 10-min interval, and relevance
was defined as a therapeutic intervention with fluids or
pressors within 20 min. From January 1, 1997, to August
5, 2000, data sets from 3315 patients receiving SpA were
recorded on-line by using the automatic anesthesia record
keeping system NarkoData. Hypotension meeting the predefined
criteria occurred in 166 (5.4%) patients. Twenty-nine patient-,
surgery-, and anesthesia-related variables were studied
by using univariate analysis for a possible association
with the occurrence of hypotension after SpA. Logistic regression
with a forward stepwise algorithm was performed to identify
independent variables (P < 0.05). The discriminative
power of the logistic regression model was checked with
a receiver operating characteristic curve. Calibration was
tested with the Hosmer-Lemeshow goodness-of-fit test. The
univariate analysis identified the following variables to
be associated with hypotension after SpA: age, weight, height,
body mass index, amount of plain bupivacaine 0.5% used for
SpA, amount of colloid infusion before puncture, chronic
alcohol consumption, ASA physical status, history of hypertension,
urgency of surgery, surgical department, sensory block height
of anesthesia, and frequency of puncture. In the multivariate
analysis, independent factors for relevant hypotension after
SpA consisted of three patient-related variables ("chronic
alcohol consumption," odds ratio [OR] = 3.05; "history
of hypertension," OR = 2.21; and the metric variable
"body mass index," OR = 1.08) and two anesthesia-related
variables ("sensory block height," OR = 2.32;
and "urgency of surgery," OR = 2.84). The area
of 0.68 (95% confidence interval, 0.63-0.72) below the receiver
operating characteristic curve was significantly greater
than 0.5 (P < 0.01). The goodness-of-fit test showed
a good calibration of the model (H = 4.3, df = 7, P = 0.7;
C = 7.3, df = 8, P = 0.51). This study contributes to the
identification of patients with a high risk for hypotension
after SpA induction, with the risk increasing two- or threefold
with each additional risk factor. IMPLICATIONS: By using
automated data collection, 5 (chronic alcohol consumption,
history of hypertension, body mass index, sensory block
height, and urgency of surgery) of 29 variables could be
detected as having an association with hypotension after
spinal anesthesia induction. The knowledge of these risk
factors should be useful in increasing vigilance in those
patients most at risk for hypotension, in allowing a more
timely therapeutic intervention, or even in suggesting the
use of alternative methods of spinal anesthesia, such as
titrated continuous or small-dose spinal anesthesia.
PMID: 12032019, UI: 22027003
Anesth Analg 2002 Jun;94(6):1500-4
Acetylcholine receptors do not mediate the immobilization
produced by inhaled anesthetics.
Eger EI 2nd, Zhang Y, Laster M, Flood P, Kendig JJ, Sonner
JM
Department of Anesthesia and Perioperative Care, University
of California, San Francisco.
[Medline record in process]
Acetylcholine receptors transmit excitatory impulses, are
broadly distributed throughout the central nervous system,
and are particularly sensitive to the depressant effects
of inhaled anesthetics. Thus these receptors are potential
mediators of the immobility produced by inhaled anesthetics.
We tested this potential in rats by giving intraperitoneal
atropine, scopolamine, and mecamylamine to block muscarinic
(atropine and scopolamine) and neuronal nicotinic (mecamylamine)
acetylcholine receptors. Block with scopolamine (up to 100
mg/kg), atropine (10 mg/kg), mecamylamine (up to 4 mg/kg),
or atropine (10 mg/kg) plus mecamylamine (up to 4 mg/kg)
did not significantly decrease the isoflurane concentration
required to suppress movement to noxious stimulation (minimum
alveolar anesthetic concentration). We also gave atropine
intrathecally, finding that the infusions that did not cause
permanent paralysis produced slight or no decreases in the
minimum alveolar anesthetic concentration. We conclude that
acetylcholine receptors do not seem to play a role as mediators
of immobilization by inhaled anesthetics. IMPLICATIONS:
Inhaled anesthetics produce two crucial effects: amnesia
and immobility in the face of noxious stimulation. Block
of muscarinic and neuronal nicotinic acetylcholine receptors
in rats does not significantly decrease the isoflurane concentration
required to suppress movement to stimulation. Thus, acetylcholine
receptors do not seem to play a major role as mediators
of the immobilization produced by inhaled anesthetics. Their
capacity to mediate other effects of inhaled anesthetics
(e.g., amnesia) remains to be tested.
PMID: 12032015, UI: 22026999
Anesth Analg 2002 Jun;94(6):1484-8
Lidocaine Iontophoresis Versus Eutectic Mixture of Local
Anesthetics (EMLA((R))) for IV Placement in Children.
Galinkin JL, Rose JB, Harris K, Watcha MF
University of Pennsylvania and Children's Hospital of Philadelphia,
Philadelphia, Pennsylvania.
[Medline record in process]
Pain during venipuncture is a major source of concern to
children and their caretakers. Iontophoresis is a novel
technique that uses an electrical current to facilitate
movement of solute ions (lidocaine) across the stratum corneum
barrier to provide dermal analgesia. In this study, we compared
dermal analgesia provided by lidocaine iontophoresis and
eutectic mixture of local anesthetics (EMLA((R))). After
informed consent, 26 children, aged 7-16 yr, who required
venous cannulation on multiple occasions, were enrolled
in this prospective, randomized, crossover study to receive
EMLA and iontophoresis on separate occasions. During a third
session, each subject received his or her preferred treatment.
Pain during venipuncture was assessed by the subject, parent,
observer, and technician performing the procedure, by use
of a 100-mm visual analog scale. The observer also used
the Children's Hospital of Eastern Ontario Pain Scale to
rate the subject's pain. Ratings of subject satisfaction
were also assessed. There were no significant differences
between the two groups in the subject-rated visual analog
scale or the Children's Hospital of Eastern Ontario Pain
Scale scores. Eleven (50%; 95% confidence interval [CI],
31%-69%) of the 22 subjects who completed both sessions
preferred iontophoresis. Five subjects (23%; 95% CI, 10%-44%),
including two who did not tolerate treatment with iontophoresis,
preferred EMLA, and six (27%; 95% CI, 13%-48%) had no preference
for the intervention to provide dermal analgesia. We conclude
that lidocaine iontophoresis provides similar pain relief
for insertion of IV catheters as EMLA and is a useful noninvasive
alternative to establish dermal analgesia for venous cannulation.
IMPLICATIONS: Iontophoresis is a technique that uses an
electrical current to facilitate movement of solute ions
(lidocaine) across the stratum corneum barrier to provide
dermal analgesia. Lidocaine iontophoresis provides similar
pain relief for insertion of IV catheters as eutectic mixture
of local anesthetics and is a useful noninvasive alternative
to establish dermal analgesia for venous cannulation.
PMID: 12032012, UI: 22026996
Anesth Analg 2002 Jun;94(6):1479-1483
The Hypnotic and Analgesic Effects of Oral Clonidine During
Sevoflurane Anesthesia in Children: A Dose-Response Study.
Inomata S, Kihara SI, Miyabe M, Sumiya K, Baba Y, Kohda
Y, Toyooka H
Departments of Anesthesiology and Clinical Pharmacy, the
University of Tsukuba, Tsukuba City, Ibaraki, Japan.
[Record supplied by publisher]
Although clonidine has both hypnotic and analgesic actions,
the dose relationship for each actions is still unknown
in a clinical setting when clonidine is used as a premedication
in children. We studied 80 ASA physical status I children
(age range, 3-8 yr). Subjects were randomly divided into
two groups (minimum alveolar anesthetic concentration [MAC]-Awake
group, n = 40; MAC-Tetanus group, n = 40). Each patient
received one dose of clonidine from 1 to 5 &mgr;g/kg orally,
100 min before arrival at the operating room. Anesthesia
was induced and maintained with sevoflurane in oxygen and
air. Before tracheal intubation, end-tidal sevoflurane was
decreased stepwise by 0.2% at the start of 1.2%, a verbal
command was given to the patients, and MAC-awake was determined
in each patient. We also investigated MAC-tetanus, determined
with transcutaneous electric tetanic stimulations, after
tracheal intubation in each patient by observing the motor
response to a transcutaneous electric tetanic stimulus to
the ulnar nerve at a sevoflurane concentration decreased
stepwise by 0.25% at the start of 2.75%. The initial reduction
in MAC-tetanus was not as steep as that in MAC-awake. Clonidine
reduced MAC-tetanus by 40% at the maximal dose of 5 &mgr;g/kg,
whereas MAC-awake was already reduced by 50% at 2 &mgr;g/kg.
We conclude that separate dose-response relationships for
oral clonidine are present regarding the hypnotic and analgesic
effects in children undergoing sevoflurane anesthesia. IMPLICATIONS:
Separate dose-response relationships for oral clonidine
were found regarding the hypnotic and analgesic effects
in children undergoing sevoflurane anesthesia.
PMID: 12032011
Anesth Analg 2002 Jun;94(6):1465-8
The minimum local anesthetic concentration of ropivacaine
for caudal analgesia in children.
Deng XM, Xiao WJ, Tang GZ, Luo MP, Xu KL
Department of Anesthesiology, Plastic Surgery Hospital,
Chinese Academy of Medical Sciences, Peking Union Medical
College, Beijing, China.
[Medline record in process]
Ropivacaine is a new long-acting amino-amide local anesthetic.
The concentrations of ropivacaine used in caudal analgesia
range from 0.1% to 0.5%. The purpose of this study was to
determine the minimum local analgesic concentration of ropivacaine
to provide caudal analgesia in children. In a prospective,
randomized, double-blinded clinical study, we studied 26
ASA grade I patients aged 1 to 5 yr who were scheduled for
hypospadias operation under general anesthesia with caudal
ropivacaine analgesia. General anesthesia was maintained
with an end-tidal enflurane concentration of 0.8% in 100%
oxygen (0.5 minimum alveolar anesthetic concentration [MAC]).
Each child received 1 mL/kg of ropivacaine solution through
a caudal catheter. The first child received ropivacaine
0.2%, and subsequent concentrations were determined by the
analgesic response of the previous patient to the initial
skin incision by use of Dixon's up-and-down sequential allocation.
The testing interval was set at 0.025%. The minimum local
analgesic concentration of ropivacaine for caudal analgesia
under general anesthesia with 0.5 MAC enflurane was 0.11%
(95% confidence interval [CI], 0.09%-0.12%), and the 95%
effective concentration was 0.13% (95% CI, 0.12%-0.21%).
In conclusion, the minimum local analgesic concentration
of ropivacaine to provide effective caudal analgesia in
children under general anesthesia with 0.5 MAC enflurane
was found to be 0.11% (95% CI, 0.09%-0.12%). IMPLICATIONS:
Ropivacaine is a new long-acting amino-amide local anesthetic.
The concentrations of ropivacaine used in caudal analgesia
ranged from 0.1% to 0.5%. This study determined the minimum
local analgesic concentration of ropivacaine to establish
effective caudal analgesia under general anesthesia with
0.5 minimum alveolar anesthetic concentration enflurane
in children.
PMID: 12032008, UI: 22026992
Anesth Analg 2002 Jun;94(6):1441-7
The effects of local anesthetics on perioperative coagulation,
inflammation, and microcirculation.
Hahnenkamp K, Theilmeier G, Van Aken HK, Hoenemann CW
Department of Anesthesiology and Intensive Care Medicine,
University Hospital Muenster, Muenster, Germany.
[Medline record in process]
PMID: 12032003, UI: 22026987
Anesth Analg 2002 Jun;94(6):1409-15
Pulmonary artery catheter placement for elective coronary
artery bypass grafting: before or after anesthetic induction?
Wall MH, MacGregor DA, Kennedy DJ, James RL, Butterworth
J, Mallak KF, Royster RL
Departments of Anesthesiology (Sections on Critical Care
and Cardiothoracic Anesthesia) and Medicine (Pulmonary and
Critical Care Medicine), Wake Forest University School of
Medicine, Winston-Salem, North Carolina.
[Medline record in process]
Pulmonary arterial catheters (PACs) are often used during
and after coronary artery bypass grafting. We hypothesized
that placement of a PAC would be faster in anesthetized
patients. We further hypothesized that the presence or absence
of a PAC during the induction of anesthesia would make no
difference in hemodynamics, vasoactive drug use, or IV fluid
administration during the induction. Patients (n = 200)
undergoing elective coronary artery bypass grafting were
assigned to PAC insertion either before or after the induction
of anesthesia. Total time for PAC insertion, number of finder
needle and venous catheter insertion attempts, incidence
of carotid artery puncture, arrhythmias or ST segment changes,
arterial blood gas analysis, hemodynamic variables, IV fluids,
and vasoactive drugs required during and after the anesthetic
induction were recorded. Thirty-two different physicians
placed the PACs. PAC placement was faster (10 versus 12
min, P = 0.0003) and required fewer punctures with a finder
needle (P = 0.0107) in anesthetized patients. There were
no significant differences between groups in hemodynamic
values or use of vasoactive or anesthetic drugs or IV fluids
during the induction. There were also no significant differences
between groups in the incidence of myocardial ischemia,
arterial hypoxemia, or hypercarbia. Placement of a PAC before
the induction of anesthesia consumes more time and fails
to improve hemodynamic stability or lessen vasoactive drug
use during the induction of anesthesia. IMPLICATIONS: Insertion
of pulmonary artery catheters (PACs) before the induction
of anesthesia requires more needle sticks and takes longer
than insertion after the induction of anesthesia; moreover,
previous PAC insertion has no significant effect on hemodynamics
or use of vasoactive drugs or IV fluid associated with the
induction of anesthesia.
PMID: 12031997, UI: 22026981
Anesth Analg 2002 Jun;94(6):1384-8
American society of echocardiography and society of cardiovascular
anesthesiologists task force guidelines for training in
perioperative echocardiography.
Cahalan MK, Abel M, Goldman M, Pearlman A, Sears-Rogan
P, Russell I, Shanewise J, Stewart W, Troianos C
An unexplained death: Hannah Greener and chloroform.
Knight PR 3rd, Bacon DR
State University of New York at Buffalo and the Mayo Clinic,
Rochester, Minnesota 55905, USA.
Publication Types:
Historical article
PMID: 11981167, UI: 21976905
Anesthesiology 2002 May;96(5):1129-39
Assessment of the intrarater and interrater reliability
of an established clinical task analysis methodology.
Slagle J, Weinger MB, Dinh MT, Brumer VV, Williams K
Anesthesia Ergonomics Research Laboratory, Veterans Affairs
San Diego Healthcare System, San Diego, California 92161-5085,
USA.
BACKGROUND: Task analysis may be useful for assessing how
anesthesiologists alter their behavior in response to different
clinical situations. In this study, the authors examined
the intraobserver and interobserver reliability of an established
task analysis methodology. METHODS: During 20 routine anesthetic
procedures, a trained observer sat in the operating room
and categorized in real-time the anesthetist's activities
into 38 task categories. Two weeks later, the same observer
performed task analysis from videotapes obtained intraoperatively.
A different observer performed task analysis from the videotapes
on two separate occasions. Data were analyzed for percent
of time spent on each task category, average task duration,
and number of task occurrences. Rater reliability and agreement
were assessed using intraclass correlation coefficients.
RESULTS: Intrarater reliability was generally good for categorization
of percent time on task and task occurrence (mean intraclass
correlation coefficients of 0.84-0.97). There was a comparably
high concordance between real-time and video analyses. Interrater
reliability was generally good for percent time and task
occurrence measurements. However, the interrater reliability
of the task duration metric was unsatisfactory, primarily
because of the technique used to capture multitasking. CONCLUSIONS:
A task analysis technique used in anesthesia research for
several decades showed good intrarater reliability. Off-line
analysis of videotapes is a viable alternative to real-time
data collection. Acceptable interrater reliability requires
the use of strict task definitions, sophisticated software,
and rigorous observer training. New techniques must be developed
to more accurately capture multitasking. Substantial effort
is required to conduct task analyses that will have sufficient
reliability for purposes of research or clinical evaluation.
PMID: 11981153, UI: 21976891
Anesthesiology 2002 May;96(5):1115-22
Utility of whole blood hemostatometry using the clot signature
analyzer for assessment of hemostasis in cardiac surgery.
Faraday N, Guallar E, Sera VA, Bolton ED, Scharpf RB,
Cartarius AM, Emery K, Concord J, Kickler TS
Department of Anesthesiology, Johns Hopkins Medical Institutions,
Baltimore, Maryland 21287, USA. nfaraday@jhmi.edu
BACKGROUND: A hemostatic monitor capable of rapid, accurate
detection of clinical coagulopathy within the operating
room could improve management of bleeding after cardiopulmonary
bypass (CPB). The Clot Signature Analyzer is a hemostatometer
that measures global hemostasis in whole blood. The authors
hypothesized that point-of-care hemostatometry could detect
a clinical coagulopathic state in cardiac surgical patients.
METHODS: Fifty-seven adult patients scheduled for a variety
of elective cardiac surgical procedures were studied. Anesthesia,
CPB, heparin anticoagulation, protamine reversal, and transfusion
for post-CPB bleeding were all managed by standardized protocol.
Clinical coagulopathy was defined by the need for platelet
or fresh frozen plasma transfusion. The Clot Signature Analyzer
collagen-induced thrombus formation (CITF) assay measured
platelet-mediated hemostasis in vitro. The activated clotting
time, platelet count, prothrombin time, activated partial
thromboplastin time, and fibrinogen concentration were also
measured. RESULTS: The postprotamine CITF was greater in
patients who required hemostatic transfusion than in those
who did not (17.6 +/- 8.0 min vs. 10.5 +/- 5.7 min, respectively;
P < 0.01). Postprotamine CITF values were highly correlated
with platelet and fresh frozen plasma transfusion (Spearman
r = 0.50, P < 0.001 and r = 0.40, P < 0.005, respectively).
Receiver operator characteristic curves showed a highly
significant relation between the postprotamine CITF and
intraoperative platelet and fresh frozen plasma transfusion
(area under the curve, 0.78-0.81, P < 0.005) with 60-80%
sensitivity, specificity, positive and negative predictive
values at cutoffs of 12-14 min. Logistic regression demonstrated
that the CITF was independently predictive of post-CPB hemostatic
transfusion, but standard hemostatic assays were not. CONCLUSIONS:
The Clot Signature Analyzer CITF detects a clinical coagulopathic
state after CPB and is independently predictive of the need
for hemostatic transfusion. Hemostatometry has potential
utility for monitoring hemostasis in cardiac surgery.
Publication Types:
Clinical trial
Evaluation studies
Randomized controlled trial
PMID: 11981151, UI: 21976889
Anesthesiology 2002 May;96(5):1109-14
Effects of clonidine on postoperative nausea and vomiting
in breast cancer surgery.
Oddby-Muhrbeck E, Eksborg S, Bergendahl HT, Muhrbeck O,
Lonnqvist PA
Department of Anesthesia and Intensive Care, Karolinska
Institutet Danderyd Hospital, Stockholm, Sweden. eva.oddby@ane.ds.sll.se
BACKGROUND: Postoperative nausea and vomiting (PONV) is
still common, especially among female patients. Our hypothesis
is that coinduction with clonidine reduces the incidence
of PONV in adult patients undergoing breast cancer surgery.
METHODS: Sixty-eight women premedicated with midazolam were
randomly allocated to coinduction with intravenous clonidine
(group C) or placebo (group P) in this prospective, double-blind
study. Anesthesia was standardized (laryngeal mask airway,
fentanyl, propofol, sevoflurane, nitrous oxide, and oxygen).
Hemodynamic parameters and the requirements for propofol,
sevoflurane, and the postoperative need for ketobemidone
were noted. The primary endpoints studied were the number
of PONV-free patients and patient satisfaction with respect
to PONV. RESULTS: Patients in group C had a significantly
reduced need for propofol (P < 0.04) and sevoflurane
(P < 0.01) and a reduced early need for ketobemidone
(P < 0.04). There were significantly more PONV-free patients
in group C compared with group P (20 and 11 of 30, respectively;
P < 0.04). The number needed to treat was 3.3 (95% confidence
interval, 1.8, 16.9). Intraoperative blood pressure, postoperative
heart rate, and postoperative blood pressure were all significantly
lower in group C compared with group P, but were not considered
to be of clinical importance. No negative side effects were
recorded. CONCLUSION: Coinduction with clonidine significantly
increased the number of PONV-free patients after breast
cancer surgery with general anesthesia.
Publication Types:
Clinical trial
Randomized controlled trial
PMID: 11981150, UI: 21976888
Anesthesiology 2002 May;96(5):1103-8
The influence of hyperoxic ventilation during sodium nitroprusside-induced
hypotension on skeletal muscle tissue oxygen tension.
Suttner SW, Lang K, Boldt J, Kumle B, Maleck WH, Piper
SN
Department of Anesthesiology and Intensive Care Medicine,
Klinikum der Stadt Ludwigshafen, Ludwigshafen, Germany.
sutner@gmx.de
BACKGROUND: Increasing inspired oxygen concentrations might
provide a simple and effective intervention to increase
oxygen tension in tissues during controlled hypotension.
To test this hypothesis, the influence of hyperoxic ventilation
(100% O2) on skeletal muscle oxygen partial pressure (Ptio2)
in patients receiving sodium nitroprusside-induced controlled
hypotension was studied. METHODS: Forty-two patients undergoing
radical prostatectomy were prospectively studied and randomly
divided into three groups as follows: (1) Controlled hypotension
induced by sodium nitroprusside (mean arterial blood pressure,
50 mmHg) and hyperoxic ventilation (CH-100%; n = 14); (2)
controlled hypotension and ventilation with 50% O2 in nitrous
oxide (CH-50%; n = 14); and (3) standard normotensive anesthesia
with 50% O2 in nitrous oxide (control; n = 14). Ptio2 values
were measured continuously in all patients using implantable
polarographic microprobes. Arterial blood gases and lactate
concentrations were analyzed in 30-min intervals. RESULTS:
Surgical blood loss and transfusion requirements were significantly
reduced in both groups receiving hypotensive anesthesia.
During surgery, arterial partial pressure of oxy-gen and
arterial oxygen content were significantly higher in patients
of the CH-100% group. Baseline values of Ptio2 were comparable
between the groups (CH-50%: 25.0 +/- 0.7 mmHg; CH-100%:
25.2 +/- 0.2 mmHg; control: 24.5 +/- 0.2 mmHg). After a
transient increase in Ptio2 in the CH-100% group during
normotension, Ptio2 values returned to baseline and remained
unchanged in the control group. Ptio2 decreased significantly
during the hypotensive period in the CH-50% group. The lowest
mean Ptio2 values were 15.0 +/- 4.1 mmHg in the CH-50% group,
24.2 +/- 4.9 mmHg in the CH-100% group, and 23.5 +/- 3.8
mmHg in the control group. There were no significant changes
in lactate plasma concentrations in any group throughout
the study period. CONCLUSIONS: Hyperoxic ventilation improved
skeletal muscle tissue oxygenation during sodium nitroprusside-induced
hypotension. This improved local tissue oxygenation seems
to be most likely due to an increase in convective oxygen
transport and the attenuation of hyperoxemia-induced arteriolar
vasoconstriction by sodium nitroprusside.
Publication Types:
Clinical trial
Randomized controlled trial
PMID: 11981149, UI: 21976887
Anesthesiology 2002 May;96(5):1039-41
Perioperative risk: how can we study the influence of
provider characteristics?
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.
