Ultimo Aggiornamento: 31 Dicembre 2002

29 citations found

Acta Anaesthesiol Scand 2002 Jul;46(6):753-4

Repeat cesarean section in a morbidly obese parturient: a new anesthetic option.

Kuczkowski KM, Benumof JL

Departments of Anesthesiology and Reproductive Medicine, University of California San Diego, CA, USA.

[Medline record in process]

Combined spinal epidural anesthesia (CSEA) has become an increasingly popular anesthetic technique for repeat cesarean section. However, the advantages of this technique have not routinely been available to morbidly obese patients because of the lack of an appropriately long needle. We present a case of a morbidly obese parturient who underwent repeat cesarean section under CSEA conducted with the recently introduced (and commercially available) CSEA needle set, specifically designed for morbidly obese patients.

PMID: 12059905, UI: 22054551

Acta Anaesthesiol Scand 2002 Jul;46(6):751-2

Anterior ischemic optic neuropathy after emergency caesarean section under epidural anesthesia.

Gupta M, Puri P, Rennie IG

Department of Ophthalmology, Royal Hallamshire Hospital, Sheffield, England.

[Medline record in process]

We report a case of non arteritic anterior ischemic optic neuropathy following caesarean delivery in a patient who had epidural analgesia. There was doubt as to whether it was subdural. The patient underwent caesarean section because of second stage non-progression of labor. We discuss the possible etiology of this unpleasant complication.

PMID: 12059904, UI: 22054550

Acta Anaesthesiol Scand 2002 Jul;46(6):713-6

Hepatic function during xenon anesthesia in pigs.

Reinelt H, Marx T, Kotzerke J, Topalidis P, Luederwald S, Armbruster S, Schirmer U, Schmidt M

University of Ulm, Department of Cardiac Anesthesia, Steinhoevelstr, Germany.

[Medline record in process]

BACKGROUND: Inhalation anesthetics decrease liver perfusion and oxygen consumption by changing the distribution pattern of perfusion between the hepatic artery and the portal vein and by direct effects on liver cells. The effects of xenon on liver perfusion and function have been not investigated until now. METHODS: Fourteen pigs were randomly assigned to two groups to receive either 73-78% xenon or 75% nitrogen in oxygen with additional supplementation of pentobarbital and buprenorphine. Microspheres were used to determine the arterial perfusion of the liver and splanchnic organs. Oxygen contents were measured by catheterization of the portal and a liver vein. Lactate and glucose plasma concentrations were measured in hepatic, mixed venous and arterial blood. Alanine aminotransferase (ALT) and lactate dehydrogenase (LOH) plasma concentrations were measured in arterial blood. Urea production rates were calculated to assess hepatic metabolic function. RESULTS: Significant higher oxygen contents were found in the liver venous blood during xenon anesthesia. No differences were found in any other investigated parameters. CONCLUSION: Higher oxygen content in liver venous blood observed during xenon anesthesia was not induced by changes in hepatic perfusion distribution or by an impairment of liver metabolic capacity. However, it can be explained by similar results known from inhalation anesthesia. Additionally, the effect can be caused by the reduction of plasma catecholamine concentrations during xenon anesthesia.

PMID: 12059897, UI: 22054543

Acta Anaesthesiol Scand 2002 Jul;46(6):703-706

Intraocular pressure more reduced during anesthesia with propofol than with sevoflurane: both combined with remifentanil.

Schafer R, Klett J, Auffarth G, Polarz H, Volcker HE, Martin E, Bottiger BW

Departments of Anaesthesiology and Ophthalmology, University of Heidelberg, Germany.

[Record supplied by publisher]

BACKGROUND: Short-acting anesthetic agents are suitable and commonly used in ocular surgery. Propofol and remifentanil are known to reduce intraocular pressure (IOP), but no information is available regarding the effects of sevoflurane combined with remifentanil on IOP. METHODS: Therefore, a prospective, randomized study was conducted to compare the effects on IOP of two different anesthetic techniques: one based on a total intravenous anesthesia with propofol (Group P, bolus 1.5-2.0 mg/kg, maintenance 3.0-7.0 mg/kg/h); and the other based on sevoflurane (Group S, inhalational induction, end-tidal concentration 0.7-1.2 vol.%). An infusion of remifentanil (10 &mgr;g/kg/h) was used with both techniques. In ASA I-III patients with normal IOP undergoing elective cataract surgery, using an applanation tonometer, IOP was measured contralateral to the operated eye at nine predefined time points before, during and after anesthesia. RESULTS: The two groups (n=20 each) were comparable with regard to demographic data and hemodynamic variables. Baseline IOP was 14.2+/-2.8 mmHg (Group P) and 14.1+/-2.4 mmHg (Group S; NS). During and following the induction of anesthesia, IOP was reduced in both groups. Intraocular pressure was significantly lower in Group P (6.0+/-3.2 mmHg) than in Group S (8.9+/-3.4 mmHg) during the induction of anesthesia. CONCLUSION: In patients undergoing cataract surgery under general anesthesia with tracheal intubation, anesthetic regimens with propofol as well as with sevoflurane, both combined with remifentanil, decrease IOP significantly. The decrease in IOP was significantly more pronounced in the propofol group than in the sevoflurane group.

PMID: 12059895

Acta Anaesthesiol Scand 2002 Jul;46(6):674-678

Improved long-lasting postoperative analgesia, recovery function and patient satisfaction after inguinal hernia repair with inguinal field block compared with general anesthesia.

Aasbo V V, Thuen A, Raeder J

Department of Anesthesia and Surgery, Ostfold Hospital, Fredrikstad, Norway, and Department of Anesthesia, Ulleval University Hospital, Norway.

[Record supplied by publisher]

BACKGROUND: Inguinal hernia repair is a common surgical procedure, and different types of anesthetic techniques are in use. We wanted to test if preoperative inguinal field block (IFB) with ropivacaine would provide benefits in the postoperative period compared with general anesthesia and wound infiltration. METHODS: Sixty patients scheduled for inguinal hernia repair were randomized to receive general anesthesia with wound infiltration postoperatively, or inguinal field block (IFB) before surgery, with no or only light sedation intraoperatively. General anesthesia was induced with midazolam, fentanyl and propofol, maintained with propofol and alfentanil, and supplemented with nitrous oxide in oxygen through a laryngeal mask. The IFB was performed by an anesthesiologist, with 50-60 ml ropivacaine and 5 mg/ml with a dedicated technique. RESULTS: All significant differences were in favor of the IFB group: less pain (visual analog scale, verbal pain score) postoperatively and until day 7, faster mobilization with less pain, lower analgesic consumption, and higher patient satisfaction. CONCLUSION: Preoperative inguinal field block for hernia repair provides benefits for patients in terms of faster recovery, less pain, better mobilization and higher satisfaction throughout the whole first postoperative week.

PMID: 12059890

Acta Anaesthesiol Scand 2002 Jul;46(6):666-73

Electrophysiologic cardiac effects of the new local anesthetic IQB-9302 and of bupivacaine in the anesthetised dog.

Gomez De Segura IA, Vazquez I, Benito J, Galiano A, De Miguel E

Research Unit, La Paz University Hospital, Madrid, Spain.

[Medline record in process]

BACKGROUND: Local anesthetics are not free from potentially fatal complications. Therefore every new local anesthetic should be tested to demonstrate a lower, or at least similar, degree of toxicity over clinically used analogs. Most toxic effects from local anesthetics affect the cardiac electrophysiologic function, so the aim of this study was to characterize the electrophysiologic effects of a new long-acting local anesthetic (IQB-9302, Ciprocaine), and compare them with those of bupivacaine in the anesthetized dog. METHODS: Eight Beagle dogs received three increasing infusion doses of either IQB-9302 or bupivacaine. Under isoflurane anesthesia, dogs were instrumented to monitor cardiovascular (cardiac output, arterial and venous blood pressures) and cardiac electrophysiologic data (sinus and atrioventricular (AV) node function, atrial, nodal and ventricular conduction times, and refractoriness). RESULTS: Only the highest dose of both drugs induced hemodynamic or electrophysiologic alterations: cardiac output and heart rate were reduced while blood pressures remained unchanged. Atrial and intranodal conduction times and atrial refractoriness increased similarly with both anesthetics, but to a slightly lesser extent with IQB-9302. Significant increases in His-Purkinje and intraventricular conduction times were the most severe noxious effects and occurred only with large doses of either drug. IQB-9302 was slightly less toxic than bupivacaine and, unlike this latter drug, potentially fatal arrhythmias were not induced. CONCLUSION: IQB-9302 has hemodynamic and cardiac electrophysiologic effects similar to those caused by bupivacaine. Nevertheless, slightly less toxic effects were derived from IQB-9302 administration than with bupivacaine, and, unlike the latter, the former might be less proarrhytmogenic. The new long-acting local anesthetic IQB-9302 may offer clinical advantages compared with bupivacaine.

PMID: 12059889, UI: 22054535

Anaesthesia 2002 Jul;57(7):710-731

A new device to reduce consumption of a halogenated anaesthetic agent.

[Record supplied by publisher]

PMID: 12059837

Anaesthesia 2002 Jul;57(7):710-731

Consent for anaesthesia.

[Record supplied by publisher]

PMID: 12059830

Anaesthesia 2002 Jul;57(7):686-9

Leakage and absorption of isoflurane by different types of anaesthetic circuit and monitoring tubing.

Smith C, Flynn C, Wardall G, Broome IJ

Specialist registrar in Anaesthesia, Ninewells Hospital, Dundee, UK Specialist registrar in Anaesthetics, University of Queensland, Australia Consultant Anaesthetist, Falkirk and District Royal Infirmary, Falkirk, FK1 5QE, UK.

[Medline record in process]

Conductive rubber anaesthetic circuit tubing both absorbs volatile agents and leaks these agents through its walls. We quantified the leakage and absorption properties of the most commonly used plastic materials used to make breathing circuit tubing, relative to conductive rubber. We then compared two different types of plastic tubes used to carry gas to volatile agent monitors; one made of polyvinyl chloride, the other made of polyvinyl chloride lined internally with a thin layer of polyethylene. We found that the three commonly used plastic types used to make anaesthetic circuit tubing all leak less volatile anaesthetic through their walls than conductive rubber. Polyethylene and polypropylene tubing absorb significantly less volatile anaesthetic than conductive rubber; however, this is not the case with polyvinyl chloride tubing. Differences in the leakage and absorption properties of polyvinyl chloride monitoring tubing are not significantly changed by the addition of a thin internal layer of polyethylene. It is therefore not worthwhile incorporating this feature into production.

PMID: 12059828, UI: 22054669

Anaesthesia 2002 Jul;57(7):663-666

Monitoring pollution by proton-transfer-reaction mass spectrometry during paediatric anaesthesia with positive pressure ventilation via the laryngeal mask airway or uncuffed tracheal tube.

Rieder J, Keller C, Brimacombe J, Gruber G, Lirk P, Summer G, Amann A

Resident, Associate Professor, Medical Student and Lecturer in Biochemistry, Department of Anaesthesia and Intensive Care Medicine, Leopold-Franzens University, Innsbruck 6020, Austria Professor, University of Queensland and James Cook University, Cairns Base Hospital, Cairns 4870, Australia.

[Record supplied by publisher]

Twenty children aged 2-66 months were randomly allocated for airway management with either the laryngeal mask airway or uncuffed tracheal tube using intermittent positive pressure ventilation with a tidal volume of 8 ml.kg-1 and a respiratory rate adjusted to maintain end-expiratory carbon dioxide concentration at 5.3 kPa. Induction was with fentanyl/propofol and maintenance was with sevoflurane 2.5% in oxygen/air. The airway device was removed when the patients were awake and the patients were transferred to the postanaesthesia care unit 10 min later. Air was sampled from a point 1.5 m above the floor at a location remote from the ventilation outlet and analysed using a proton-transfer-reaction mass spectrometer capable of continuous trace gas analysis at the parts per billion volume (ppbv) level. The concentration of sevoflurane was recorded every minute during three consecutive phases: for 5 min before the introduction of sevoflurane (background); after introduction of sevoflurane until removal of the airway device (intra-operative); and every minute after removal until the concentration returned to background levels. Median (interquartile range [range]) intra-operative sevoflurane concentrations were 200-400 times higher than background values for the laryngeal mask airway 1 (1-2 [0-3]) ppbv vs. 404 (278-523 [83-983]) ppbv, respectively, and the tracheal tube 2 (1-3 [0-5]) ppbv vs. 396 (204-589 [107-1735]) ppbv (both p < 0.0001), and returned to background values within 5 min of removal. There were no differences in sevoflurane concentration between devices intra-operatively or after removal. The performance of the proton-transfer-reaction mass spectrometer was identical at the start and end of the 30-day study. We conclude that peri-operative sevoflurane concentration in a modern operating theatre is similar for the laryngeal mask airway and the uncuffed tracheal tube in paediatric patients receiving intermittent positive pressure ventilation. Intra-operative sevoflurane concentrations are five times lower than occupational safety limit requirements, and 1000 times lower 5 min after removal of the airway device with the patient awake. The proton-transfer-reaction mass spectrometer has potential for monitoring air quality in the operating theatre.

PMID: 12059825

Anaesthesia 2002 Jul;57(7):654-8

Measurement of systemic oxygen uptake during low-flow anaesthesia with a standard technique vs. a novel method.

Leonard IE, Weitkamp B, Jones K, Aittomaki J, Myles PS

Clinical Fellow, Consultant Anaesthetist and Consultant Anaesthetist & Director of Research, Department of Anaesthesia and Pain Management, Alfred Hospital, Commercial Road, Prahran, Melbourne, Victoria 3181, Australia.

[Medline record in process]

We assessed agreement between measurement of systemic oxygen uptake using the Fick-derived method, and a novel method described by Biro, based on the difference in oxygen concentrations of the delivered fresh gas and the gas circulating in the circle system. Twenty-nine patients undergoing elective cardiac surgery were studied during stable haemodynamic and ventilatory conditions. Systemic oxygen uptake was measured using the two methods in each patient before and after cardiopulmonary bypass. Limits of agreement were found to be wide (-162 to 311 ml.min-1 before bypass, and -257 to 401 ml.min-1 after bypass), indicating poor agreement between the methods. No significant difference was found between the pre- and post cardiopulmonary bypass values for each method. We conclude that the Biro method, although attractive in terms of its simplicity, is an unreliable measure of systemic oxygen uptake under these conditions.

PMID: 12059823, UI: 22054664

Anaesthesia 2002 Jul;57(7):649-53

A comparison between midazolam co-induction and propofol predosing for the induction of anaesthesia in the elderly.

Jones NA, Elliott S, Knight J

Specialist Registrar in Anaesthesia and Consultant Anaesthetist, Department of Anaesthesia, Queen Alexandra Hospital, Portsmouth, Hampshire, UK.

[Medline record in process]

In a prospective, double-blind, randomised, placebo-controlled trial, we have compared the effects of midazolam co-induction with propofol predosing on the induction dose requirements of propofol in elderly patients. We enrolled 60 patients aged > 70 years, attending for urological surgery. The patients were allocated randomly to one of three groups, to receive either midazolam 0.02 mg.kg-1, propofol 0.25 mg.kg-1, or normal saline 2 ml (placebo) 2 min prior to induction of anaesthesia using propofol 1% infusion at 300 ml.h-1. The propofol dose requirements for induction were recorded for two end-points (loss of verbal contact and insertion of an oropharyngeal airway). Cardiovascular parameters were recorded at 1-min intervals for each patient until induction was complete. The midazolam group showed a significant reduction in propofol dose requirements for induction (p = 0.05) compared to the placebo group. The propofol group did not show a significant dose reduction compared to placebo. There were no demonstrable differences in terms of improved cardiovascular stability between groups. We conclude that propofol predosing does not significantly reduce the induction dose of propofol required in the elderly, and there were no cardiovascular benefits to either midazolam co-induction or propofol predosing in the elderly.

PMID: 12059822, UI: 22054663

Anaesthesia 2002 Jul;57(7):632-643

The variable effect of low-dose volatile anaesthetics on the acute ventilatory response to hypoxia in humans: a quantitative review.

Pandit JJ

Consultant Anaesthetist, Nuffield Department of Anaesthetics, John Radcliffe Hospital, Oxford OX3 9DU, UK.

[Record supplied by publisher]

The purpose of this study was to review published studies (identified by a Medline-assisted search) on the effect of pound 0.2 minimal alveolar concentration (MAC) halothane, isoflurane, enflurane and sevoflurane on the acute hypoxic ventilatory response in healthy subjects. Each article was examined for the anaesthetic agent, speed of hypoxic stimulus, background carbon dioxide and subject stimulation (audiovisual or painful). Analysis of variance was used to assess the significance of the influence of each of these factors on the standardised hypoxic response (the acute hypoxic ventilatory response in l.min-1 in the presence of anaesthetic, expressed as a fraction of the response without anaesthetic). There were 37 separate studies within 21 published articles. The main factor influencing standardised hypoxic response was anaesthetic agent (p < 0.002). A second influential factor was subject stimulation (p < 0.014), but the interaction term of agent and stimulation was also significant (p < 0.039), suggesting that the influence of stimulation varied with the agent used. Speed of hypoxia and background carbon dioxide had no influence. In contrast to previous authors' assertions that study conditions have a major impact on the acute ventilatory response to hypoxia, this review suggests that the main determinant is simply the anaesthetic agent used. The review also highlights important gaps in the research literature, which may direct future research in this field. In particular, it would seem important to investigate the influence of arousal when different anaesthetic agents are used.

PMID: 12059820

Anaesthesia 2002 Jul;57(7):629-631

Emergency physicians: additional providers of emergency anaesthesia?

[Record supplied by publisher]

PMID: 12059819

Br J Pharmacol 2002 Jun 4;136(4):540-549

Enhancement of delayed-rectifier potassium conductance by low concentrations of local anaesthetics in spinal sensory neurones.

Olschewski A, Wolff M, Brau ME, Hempelmann G, Vogel W, Safronov BV

Department of Anaesthesiology and Intensive Care Medicine, Justus-Liebig-University, 35392 Giessen, Germany. Department of Physiology, Justus-Liebig-University, 35392 Giessen, Germany. Instituto de Biologia Molecular e Celular (IBMC), 4150-180 Porto, Portugal.

[Record supplied by publisher]

Combining the patch-clamp recordings in slice preparation with the 'entire soma isolation' method we studied action of several local anaesthetics on delayed-rectifier K(+) currents in spinal dorsal horn neurones. Bupivacaine, lidocaine and mepivacaine at low concentrations (1 - 100 &mgr;M) enhanced delayed-rectifier K(+) current in intact neurones within the spinal cord slice, while exhibiting a partial blocking effect at higher concentrations (>100 &mgr;M). In isolated somata 0.1 - 10 &mgr;M bupivacaine enhanced delayed-rectifier K(+) current by shifting its steady-state activation characteristic and the voltage-dependence of the activation time constant to more negative potentials by 10 - 20 mV. Detailed analysis has revealed that bupivacaine also increased the maximum delayed-rectifier K(+) conductance by changing the open probability, rather than the unitary conductance, of the channel. It is concluded that local anaesthetics show a dual effect on delayed-rectifier K(+) currents by potentiating them at low concentrations and partially suppressing at high concentrations. The phenomenon observed demonstrated the complex action of local anaesthetics during spinal and epidural anaesthesia, which is not restricted to a suppression of Na(+) conductance only.

PMID: 12055132

Can J Anaesth 2002 May;49(5):498-9

Best evidence in anesthetic practice. Prognosis: cognitive function at hospital discharge predicts long-term cognitive function after coronary artery bypass surgery.

Hall R

[Record supplied by publisher]

Publication Types:

• Comment

PMID: 12058690, UI: 22053771

Can J Anaesth 2002 May;49(5):526-7; discussion 527

Positioning the double-lumen endobronchial tube.

Bahk JH, Ryu HG, Ham BM

Publication Types:

• Letter

PMID: 11983675, UI: 21978969

Can J Anaesth 2002 May;49(5):458-60

The bispectral index response to tracheal intubation is similar in normotensive and hypertensive patients.

Nakayama M, Ichinose H, Yamamoto S, Kanaya N, Namiki A

Department of Anesthesiology, Sapporo Medical University School of Medicine, Sapporo, Japan. miyab@zc4.so-net.ne.jp

PURPOSE: To compare the hemodynamic and bispectral index (BIS) responses to tracheal intubation in normotensive and hypertensive patients. METHOD: Three minutes after induction of anesthesia with thiamylal and fentanyl, tracheal intubation was performed in 24 normotensive and 22 hypertensive patients. Heart rate (HR), mean arterial pressure (MAP), and BIS were measured every minute. RESULTS: Tracheal intubation increased HR, MAP, and BIS in both normotensive and hypertensive patients. The increase in MAP was significantly greater in hypertensive patients than in normotensive patients, but there were no differences in HR or BIS in the two groups of patients. CONCLUSION: Patients with and without hypertension exhibit the same arousal response (as measured by BIS) to tracheal intubation despite the enhanced vasopressor response in hypertensive patients.

Publication Types:

• Clinical trial

PMID: 11983658, UI: 21978952

Can J Anaesth 2002 May;49(5):453-7

Nausea and vomiting after laparoscopic surgery are not associated with an increased peripheral release of serotonin.

Nicole PC, Trepanier CA, Lessard MR

Department of Anesthesiology, Hopital de l'Enfant-Jesus du Centre hospitalier affilie universitaire de Quebec (CHA), Laval University, Quebec, Quebec, Canada. piernicol@sympatico.ca

PURPOSE: To determine whether patients suffering postoperative nausea and vomiting (PONV) present a different serotonin release pattern from those who do not present this complication. METHODS: Forty-eight consecutive women undergoing outpatient laparoscopic tubal ligation were enrolled in this prospective, cumulative case-control study. The study compared serotonin activity in 15 patients totally free of emetic symptoms (asymptomatic group) and, among patients with PONV (n = 33), those 15 who presented the most severe symptoms (PONV group). Patients were anesthetized with a regimen including sufentanil (0.1-0.3 microg x kg(-1)) plus thiopental (3-5 mg x kg(-1)) for induction and isoflurane (0.6-1%) in nitrous oxide (60%) for maintenance. Peripheral serotonin activity was assessed by measurement with high-performance liquid chromatography of serotonin's principal urinary metabolite: 5-hydroxyindoacetic acid (5-HIAA) corrected for urinary creatinine. RESULTS: The preoperative and postoperative urinary 5-HIAA:creatinine ratios were 6.9 ng x microg(-1) (confidence interval; CI 95%, 2.7-11.0) and 5.9 ng x microg(-1) (CI 95%, 2.4-9.4) respectively in the asymptomatic group (P = 0.69), and were 5.1 ng x microg(-1) (CI 95%, 2.5-7.7) and 5.6 ng x micro(-1) (CI 95%, 3.4-7.7) respectively in the PONV group (P = 0.75). There was also no difference between groups in the variation of 5-HIAA:creatinine ratios from the preoperative to the postoperative period (P = 0.21). CONCLUSION: PONV after laparoscopic tubal ligation are not associated with an increased urinary excretion of serotonin metabolites. Patients with severe PONV present a peripheral serotonin release comparable to asymptomatic patients.

Publication Types:

• Clinical trial

PMID: 11983657, UI: 21978951

Can J Anaesth 2002 May;49(5):443-7

Science, pseudoscience and Sellick.

Maltby JR, Beriault MT

Publication Types:

• Editorial

PMID: 11983655, UI: 21978949

Can J Anaesth 2002 Mar;49(3):276-82

The appropriateness of the pulmonary artery catheter in cardiovascular surgery.

Jacka MJ, Cohen MM, To T, Devitt JH, Byrick R

Department of Anaesthesia and Critical Care, University of Toronto, Canada. mjjacka@powersurfr.com

PURPOSE: The pulmonary artery catheter (PAC) is commonly used in anesthesiology and critical care, but its appropriate (where benefit exceeds risk) application is unknown. This study describes current clinical practice attitudes among anesthesiologists in cardiac and vascular surgery in an effort to determine the most appropriate indications for use of the PAC. METHODS: Anonymous, cross-sectional, mailed survey of anesthesiologists in Canada and the USA. Opinions of anesthesiologists about the appropriateness of PAC application were assessed in 36 clinical scenarios, using a nine-point Likert scale. The RAND method was adapted to identify appropriate, inappropriate, and uncertain indications for PAC application. RESULTS: Seventy-seven percent of 345 anesthesiologists responded. They agreed strongly (87%) that use of the PAC is appropriate in patients with severe ventricular impairment and unstable angina. Agreement was also present with ventricular impairment (74%) or unstable angina (55%) alone, but was less strong. A majority (53%) rated the PAC as not appropriate in the routine patient without complicating risk factors. Those who used the PAC more frequently, who had a greater practice volume, and who practised in Canada rated PAC use to be more appropriate in more scenarios. Those who did more continuing medical education rated PAC use to be less appropriate. CONCLUSIONS: While the ideal evaluation of the PAC in clinical practice would be a randomized controlled trial, such an undertaking is time-consuming, expensive, of limited generalizability, and requires clinical equipoise. This study found strong agreement that PAC application is appropriate in some patient scenarios, and agreement that it is inappropriate in others. Description of current practice using this method may identify scenarios where randomized evaluation of the PAC, or other technologies, is likely unnecessary, and others where it is highly likely to be highly beneficial.

PMID: 11861346, UI: 21849820

Can J Anaesth 2002 Mar;49(3):270-5

Active warming of saline or blood is ineffective when standard infusion tubing is used: an experimental study.

Bissonnette B, Paut O

Department of Anaesthesia, The Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada. bruno@anaes.sickkids.on.ca

PURPOSE: To determine the effect of infusion rate, tubing length and fluid composition on the temperature of the infusate reaching the distal end of an infusion tubing with and without active fluid warming. METHODS: Warmed normal saline (W-NS) and packed red blood cells (W-PRBC), were infused with a fluid warmer through a modified infusion set. The fluids were delivered at eight infusion rates from 50 to 999 mL x hr(-1). The infusate temperature was monitored at 20 cm intervals on the iv tubing. The same temperature monitoring protocol was applied to PRBC without warmer (NoW-PRBC). RESULTS: In W-NS and W-PRBC groups, there was a decrease in the infusate temperature, at each flow rate, from the drip chamber to the distal end of tubing ( P <0.001). In NoW-PRBC group, there was a rapid increase in the infusate temperature from the bag to the drip chamber ( P <0.001). Thereafter, there was no change in temperature, except at the 999 mL x hr(-1) infusion rate, where a slight increase in the infusate temperature throughout the tubing was shown. In W-NS and W-PRBC groups increasing the flow rate produced a significant increase in the infusate temperature, at each measurement point ( P <0.001). In the NoW-PRBC group, increasing the flow rate did not alter the infusate temperature. The fluid composition did not influence the infusate temperature. CONCLUSION: There is an important heat exchange within the tubing, which is aggravated at low flow rates. At infusion rates appropriate for pediatric anesthesia the clinical and economic value of fluid warming without the use of heated extension tubing is questionable.

PMID: 11861345, UI: 21849819

Chest 2002 Jun;121(6):2032-5

Four-step local anesthesia and sedation for thoracoscopic diagnosis and management of pleural diseases(*).

Migliore M, Giuliano R, Aziz T, Saad RA, Sgalambro F

Section of General Thoracic Surgery (Drs. Migliore, Giuliano, Aziz, and Saad), Department of Surgery, University of Catania, Catania. Currently at the Cardio-thoracic Center, The Freeman Hospital, Newcastle upon Tyne, UK.

[Medline record in process]

STUDY OBJECTIVE:s: Most thoracic surgeons perform thoracoscopy under general anesthesia using a double-lumen endotracheal tube. We describe our own technique for performing thoracoscopy under local anesthesia and sedation. Design, setting, patients: Forty-five patients underwent the procedure under local anesthesia and sedation (mean age, 64 years; age range, 40 to 92 years). A known history of cancer was present in 12 patients. American Society of Anesthesiology score was I in 1 patient, II in 16 patients, III in 22 patients, IV in 5 patients, and V in 1 patient. Premedication was comprised of droperidol, 5 mg, and atropine, 0.5 mg, administered 20 min before the scheduled operating room time. Sedation was maintained by diazepam injection, 3 mg. Four-step local anesthesia in the planned intercostal space using 10 mL of ropivacaine, 7.5 mg/mL, was performed. RESULTS: Mean operative time was 45.7 min (range, 20 to 90 min); mean time of anesthesia was 71.3 min (range, 30 to 150 min). Among patients with pleural effusion, 23 effusions were simple and 16 effusions were complex. Talc was administrated in 28 patients. Complications were intraoperative bleeding (one patient), hyperpyrexia (eight patients), and atrial fibrillation (two patients). The mean time for removal of the chest drain was 5.6 days (range, 2 to 13 days). Postoperative hospital stay was 6.4 days (range, 2 to 14 days). No hospital mortality occurred. Follow-up is complete in all patients (mean, 92.8 days; range, 31 to 270 days). CONCLUSION: Four-step local anesthesia and sedation is a simple and effective method of performing a video-assisted thoracic procedure to diagnose and treat simple thoracic pathologies.

PMID: 12065373, UI: 22060432

Paediatr Anaesth 2002 Jun;12(5):442-447

Emergence behaviour in children: defining the incidence of excitement and agitation following anaesthesia.

Cole JW, Murray DJ, McAllister JD, Hirshberg GE

Department of Anesthesiology, Washington University School of Medicine, St Louis Children's Hospital, St Louis, MO, USA.

[Record supplied by publisher]

Background: Children display a variety of behaviour during anaesthetic recovery. The purpose of this study was to study the frequency and duration of emergence behaviour in children following anaesthesia and the factors that alter the incidence of various emergence behaviour following anaesthesia. Methods: A prospective study of children who required outpatient lower abdominal surgery was designed to determine an incidence and duration of emergence agitation. We developed a 5-point scoring scale to study the postanaesthetic behaviour in these children. The scale included behaviour from asleep (score=1) to disorientation and severe restlessness (score=5). Children were scored by a blinded observer every 10 min during the first hour of recovery or until discharge from same day surgery. Results: We found 27 of 260 children experienced a period of severe restlessness and disorientation (score 5) during anaesthesia emergence. Thirty percent of the children (79/260) experienced a period of inconsolable crying or severe restlessness (score 4 or 5) following anaesthesia. The frequency of this behaviour was greatest on arrival in the recovery room, but many children who arrived asleep in the recovery room later experienced a period of agitation or inconsolable crying. Conclusions: Repeated assessments of behaviour following anaesthetic recovery are required to define an incidence and duration of emergence agitation. Emergence agitation occurs most frequently in the initial 10 min of recovery, but many children who arrive asleep experience agitation later during recovery.

PMID: 12060332

Paediatr Anaesth 2002 Jun;12(5):438-441

The reliability of endtidal CO2 in spontaneously breathing children during anaesthesia with Laryngeal Mask AirwayTM, low flow, sevoflurane and caudal epidural.

Aasheim P, Fasting S, Mostad U, Aadahl P

Department of Anaesthesiology and Intensive Care, Trondheim University Hospital, Trondheim, Norway.

[Record supplied by publisher]

Background: Noninvasive devices for monitoring endtidal CO2 (PECO2) are in common use in paediatric anaesthesia. Questions have been raised concerning the reliability of these devices in spontaneous breathing children during surgery. Our anaesthetic technique for elective infraumbilical surgery consists of spontaneous breathing through a Laryngeal Mask Airway (LMATM), low fresh gas flow, sevoflurane and a caudal epidural. We wanted to compare PECO2 and arterial CO2 (PaCO2) during surgery. Methods: Twenty children, aged 1-6 years, scheduled for infraumbilical surgery, were studied and one arterial sample was taken 45 min after induction of anaesthesia. PECO2, inspiratory PCO2, oxygen saturation, heart rate, respiratory rate, mean arterial blood pressure and expiratory sevoflurane concentration were measured every 5 min. The respiratory and circulatory parameters were stable during surgery. Results: The mean PaCO2 - PECO2 difference was 0.15 (0.16) kPa [1.1 (1.2 mmHg)]. Conclusions: PECO2 is a good indicator of PaCO2 in our anaesthetic setting.

PMID: 12060331

Paediatr Anaesth 2002 Jun;12(5):429-437

Side-effects after inhalational anaesthesia for paediatric cerebral magnetic resonance imaging.

Sandner-Kiesling A, Schwarz G, Vicenzi M, Fall A, James RL, Ebner F, List WF

Department of Anaesthesiology and Intensive Care Medicine, Karl Franzens University, Graz, Austria, MRI Institute, Karl Franzens University, Graz, Austria, Department of Anesthesiology, Wake Forest University School of Medicine, Winston-Salem, NC, USA.

[Record supplied by publisher]

Background: The aim of this study was to evaluate the type, incidence and duration of postprocedure side-effects in 168 children within the first 72 h after inhalational anaesthesia for magnetic resonance imaging (MRI). Methods: Premedication and induction followed standardized routines. Maintenance of anaesthesia was performed with inhalational anaesthetics solely: isoflurane (n=60 of 112; 53%), sevoflurane (n=32 of 112; 29%), desflurane (n=12 of 112; 11%) or halothane (n= 8 of 112; 7%) using a strapped on face mask (FiO2=0.4; flow 5 l.min-1). When indicated, gadolinium was administered (n=45; OF 112; 40%). Results: One hundred and twelve of 168 parents (67%) responded to questionnaires. In these 112 children, pathological MR findings were found supratentorially (n=31; 28%), infratentorially (n=9; 8%), extracerebrally (n=12; 11%) or combined (n=9; 8%). In 56 of these 112 children (50%), 14 different side-effects were reported. One hour after anaesthesia, 55 children suffered between one and four side-effects. Neurological side-effects were associated with age >/= 5 years (P < 0.01) or infratentorial pathophysiology (P < 0.01) and abdominal side-effects (P < 0.02), especially nausea (P < 0.001) with age >/= 5 years. Conclusions: Our findings indicate the need to inform parents of the incidence and variability of side-effects after inhalational anaesthesia for minimally invasive, diagnostic procedures, such as MRI.

PMID: 12060330

Paediatr Anaesth 2002 Jun;12(5):420-3

The size 1.5 Laryngeal Mask Airway (LMATM) in paediatric anaesthetic practice.

Bagshaw O

Birmingham Children's Hospital, Birmingham, UK.

[Medline record in process]

Background: The recently introduced size 1.5 laryngeal mask airway (LMATM) is specifically designed for use in children weighing 5-10 kg. Methods: We prospectively evaluated its use in 68 patients, mean age 8.7 months, who were undergoing a variety of routine surgical procedures. Results: The overall incidence of complications was high (42%) and was significantly more common in younger patients. Most of these related to poor positioning of the LMA, or airway problems such as obstruction or laryngospasm. Critical incidents occurred in seven patients, and all but one of these was related to the use of an LMA. Conclusions: The size 1.5 LMA is a useful addition to the range available, although the overall complication rate is considerable and is inversely related to the age of the child.

PMID: 12060328, UI: 22055497

Paediatr Anaesth 2002 Jun;12(5):411-415

Airway management in spontaneously breathing anaesthetized children: comparison of the Laryngeal Mask Airwaytrade mark with the cuffed oropharyngeal airway.

Mamaya B

Department of Anaesthesiology and Reanimatology, Latvian Medical Academy, Riga, Latvia.

[Record supplied by publisher]

Background: The efficacy and safety of the smallest size of the cuffed oropharyngeal airway (COPA) for school age, spontaneously breathing children was investigated and compared with the Laryngeal Mask Airway (LMAtrade mark). Methods: Seventy children of school age (7-16 years) were divided into two groups: the COPA (n=35) and the LMA (n=35). Induction was with propofol i.v. or halothane, nitrous oxide, oxygen and fentanyl. After depression of laryngopharyngeal reflexes, a COPA size 8 cm or an LMA was inserted. Ventilation was manually assisted until spontaneous breathing was established. For maintenance, propofol i.v. and fentanyl or halothane with nitrous oxide were used. Local anaesthesia or peripheral blocks were also used. Results: Both extratracheal airways had a highly successful insertion rate, but more positional manoeuvres to achieve a satisfactory airway were required with the COPA, 28.6% versus LMA 2.9%. The need to change the method of airway management was higher (8.6%) in the COPA group. After induction, the need for assisted ventilation was higher in the LMA group 54.3% versus 20% in the COPA group. Airway reaction to cuff inflation was higher in the LMA group 14.3% versus COPA 5.7%. Problems during surgery were similar, except continuous chin support to establish an effective airway was more frequent (11.4%) in the COPA group. In the postoperative period, blood on the device and incidence of sore throat were detected less in the COPA group. Conclusions: The COPA is a good extratracheal airway that provides new possibilities for airway management in school age children with an adequate and well sealed airway, during spontaneous breathing or during short-term assisted manual ventilation.

PMID: 12060326

Paediatr Anaesth 2002 Jun;12(5):388-397

Epidermolysis bullosa in children: pathophysiology, anaesthesia and pain management.

Herod J, Denyer J, Goldman A, Howard R

Department of Anaesthesia, Great Ormond Street Hospital for Children NHS Trust, London, UK, Department of Dermatology, Great Ormond Street Hospital for Children NHS Trust, London, UK, Symptom Care Team, Great Ormond Street Hospital for Children NHS Trust, London, UK.

[Record supplied by publisher]

PMID: 12060323