Severe bradycardia in a patient with myasthenia gravis
during transurethral ureterolithotripsic procedure under
spinal anaesthesia.
Inoue S, Shiomi T, Furuya H
[Medline record in process]
Publication Types:
Letter
PMID: 12075657, UI: 22070885
Anaesth Intensive Care 2002 Jun;30(3):386
Usage of digital cameras for preoperative dental evaluations
especially in emergency anaesthesia.
Toyoyama H, Kuki H, Toyoda Y
[Medline record in process]
Publication Types:
Letter
PMID: 12075655, UI: 22070883
Anaesth Intensive Care 2002 Jun;30(3):376-9
Total intravenous anaesthesia for tracheobronchial stenting
in children.
Choudhury M, Saxena N
Department of Cardiothoracic Anaesthesia, Cardiothoracic
and Sciences Centre, All India Institute of Medical Sciences,
Ansari Nagar, New Delhi.
[Medline record in process]
Stenosis and malacia of the tracheobronchial tree, most
often secondary to prolonged intubation, tracheostomy or
following correction of a congenital cardiac lesion, present
a significant therapeutic problem, especially when the lesions
are extensive. The utilization of self-expanding tracheobronchial
stents is a useful addition to the medical armamentarium
for maintenance of airways in these patients with major
airway stenosis and collapse. The majority of previous reported
cases of tracheobronchial stenting have been performed under
general anaesthesia with the help of rigid bronchoscopy
under direct vision. We conducted two cases of tracheobronchial
stenting in postoperative cardiosurgical babies under continuous
propofol infusion taking advantage of cardiovascular stability
during continuous infusion and rapid emergence after its
discontinuation.
PMID: 12075651, UI: 22070879
Anaesth Intensive Care 2002 Jun;30(3):372-5
Anaesthetic management of a patient with Emery-Dreifuss
muscular dystrophy.
Shende D, Agarwal R
Department of Anaesthesia and Intensive Care, All India
Institute of Medical Sciences, New Delhi.
[Medline record in process]
Emery-Dreifuss muscular dystrophy is a rare form of muscular
dystrophy associated with cardiac implications such as cardiomyopathy
and arrhythmias leading to sudden death. We describe the
anesthetic management of a patient with Emery-Dreifuss muscular
dystrophy who presented for orthopaedic surgery and discuss
the disorder and its potential anaesthetic implications.
PMID: 12075650, UI: 22070878
Anaesth Intensive Care 2002 Jun;30(3):364-6
Vancomycin reaction during spinal anaesthesia.
Duffy BL
Department of Anaesthesia, The Queen Elizabeth Hospital,
Woodville, South Australia.
[Medline record in process]
A 77-year-old female received uneventful spinal anaesthesia
for a total knee replacement. Upon the advice of the microbiologists
and at the request of the orthopaedic surgeon, a vancomycin
infusion was commenced prior to the application of the leg
tourniquet. Five minutes later, having received only 40
mg of the antibiotic dose, she became unconscious and suffered
severe cardiovascular collapse, from which she was resuscitated
with intravenous ephedrine and adrenaline.
PMID: 12075647, UI: 22070875
Anaesth Intensive Care 2002 Jun;30(3):355-9
Career choice influences in Australian anaesthetists.
Roberts LJ, Khursandi DC
Department of Anaesthesia, Sir Charles Gairdner Hospital,
Perth, Western Australia.
[Medline record in process]
All female members and a randomly selected group of male
members of the Australian Society of Anaesthetists (n =
488) were surveyed by questionnaire as part of a broader
study of gender issues in anaesthesia. This paper reports
on reasons for career choice and the importance of role
models. Responses were received from 199 women and 98 men
(60.9% of those surveyed), representing all States and one
Territory. Most males (95.9%) and a majority of females
(55.7%) worked full-time. Reasons for career choice varied
with gender, with a significantly greater proportion of
women (39.7%) than men (8.7%) choosing anaesthesia because
of controllable hours, particularly the ability to work
part-time. Experiences in anaesthesia during internship
and residency were important for 19.1% of women and 14.1%
of men, although very few mentioned undergraduate exposure.
Other important factors in career choice were the application
of physiology and pharmacology in patient care, practical
and procedural aspects of practice, and chance. A majority
of women (56%) and men (55%) named specific role models
who were influential and encouraging in their choice. These
results are similar to those of other studies.
PMID: 12075645, UI: 22070873
Anaesth Intensive Care 2002 Jun;30(3):316-20
Effectiveness of intravenous ephedrine infusion during
spinal anaesthesia for caesarean section based on maternal
hypotension, neonatal acid-base status and lactate levels.
Turkoz A, Togal T, Gokdeniz R, Toprak HI, Ersoy O
Inonu University Turgut Ozal Medical Centre, Department
of Anaesthesia, Turkey.
[Medline record in process]
Maternal cardiovascular changes and neonatal acid-base
status, including lactate levels, were assessed in 30 healthy
women undergoing elective caesarean section under spinal
anaesthesia. Patients were allocated randomly to receive
IV ephedrine infusion (n = 15) (5 mg.min(-1) immediately
after the spinal injection or bolus administration of IV
ephedrine (n = 15) (10 mg) in case of development of hypotension.
Maternal and neonatal blood pressure, heart rate and acid-base
status including lactate levels were compared between the
groups. Systolic blood pressure in the bolus group was significantly
lower when compared to the infusion group. Nausea was observed
in one patient (6%) in the infusion group and nausea and
vomiting were observed in 10 patients (66%) in the bolus
group. Although umbilical arterial pH values were significantly
lower in the bolus group, lactate levels were similar In
conclusion, ephedrine infusion prevented maternal hypotension,
reduced the incidence of nausea and vomiting and led to
improved umbilical blood pH during spinal anaesthesia for
caesarean section.
PMID: 12075638, UI: 22070866
Anaesthesia 2002 Jun;57(6):600-5
Partner anxiety prior to elective Caesarean section under
regional anaesthesia.
Taylor IR, Bullough AS, van Hamel JC, Campbell DN
Department of Anaesthesia, Southampton General Hospital,
UK. ianr@taylor400.fsnet.co.uk
[Medline record in process]
This study was designed to measure anxiety levels in 91
partners of women undergoing elective Caesarean section
under regional anaesthesia and to outline potential relieving
factors. Twenty-eight percent of partners were pathologically
anxious. There was a positive association between anxiety
and prior attendance at the anaesthetic assessment clinic
(p=0.008). There was no statistically significant association
between anxiety and education, occupation, gender, relationship
to the patient or previous attendance at Caesarean section.
Concern about a safe outcome for the mother and child caused
most anxiety, less being expressed regarding presence in
the operating theatre or anaesthesia per se. Over 70% of
partners expressed the view that attendance at the anaesthetic
assessment clinic or provision of written information would
reduce their anxiety.
PMID: 12073950, UI: 22066884
Anaesthesia 2002 Jun;57(6):593-6
Aseptic precautions for inserting an epidural catheter:
a survey of obstetric anaesthetists.
Sellors JE, Cyna AM, Simmons SW
Department of Obstetric Anaesthesia, Women and Children's
Hospital, Adelaide, SA, Australia.
[Medline record in process]
We performed a postal survey of Fellows of the Australian
and New Zealand College of Anaesthetists with a special
interest in obstetric practice, about their beliefs regarding
aseptic precautions for insertion of an epidural catheter
in the labour ward. Of the 435 consultant anaesthetists
surveyed, 367 responded (84%), revealing a wide variation
in practice. It was not thought to be essential practice
to remove a watch before washing hands by 51 respondents
(14%), to wear a facemask by 105 (29%) or to wear a sterile
gown by 45 (12%). Three anaesthetists (1%) did not believe
sterile gloves were essential. However, all respondents
indicated that an antiseptic skin preparation was essential.
Our results raise questions regarding an acceptable standard
of aseptic practice for the insertion of an epidural catheter
in labour and we propose a minimal standard of essential
precautions.
PMID: 12073948, UI: 22066882
Anaesthesia 2002 Jun;57(6):588-92
Circulatory, respiratory and metabolic changes after thigh
tourniquet release in combined epidural-propofol anaesthesia
with preservation of spontaneous respiration.
Anaesthesia, Centrl Aizu General Hospital, Aizuwakamatsu
city, Japan. iwana@onchikai.jp
[Medline record in process]
Twelve elderly patients undergoing total knee arthroplasty
received lumbar epidural anaesthesia and propofol infusion
at 5 mg.kg(-1).h(-1) following a 1.5-2.0 mg.kg(-1) bolus
dose with preservation of spontaneous respiration via a
laryngeal mask airway. Circulatory, respiratory and metabolic
variables were measured before and 1, 3, 5, 15 and 30 min
after release of a pneumatic thigh tourniquet. The blood
pressure was decreased at all time-points and the respiratory
rate increased at 1 min. The P(a)CO(2) was increased only
at 1 min. Arterial blood pH and base excess were decreased
at 1 and 3 min and 1, 3 and 5 min, respectively. Arterial
blood lactate levels were increased at all times. These
characteristics were considered to be identical to those
under regional anaesthesia with conscious spontaneous respiration,
showing that spontaneous respiration under this anaesthetic
regimen has a similar respiratory capacity to that of conscious
spontaneous respiration.
Verifying accurate placement of an epidural catheter tip
using electrical stimulation.
Tsui BC, Finucane B
Publication Types:
Letter
PMID: 12032053, UI: 22027037
Anesth Analg 2002 Jun;94(6):1652-5, table of contents
The effects of systolic arterial blood pressure variations
on postoperative nausea and vomiting.
Pusch F, Berger A, Wildling E, Tiefenthaler W, Krafft
P
Department of Anesthesiology and General Intensive Care,
University of Vienna, Waeringer Guertel 18-20, A-1090 Vienna,
Austria. franz.pusch@univie.ac.at
In this clinical study, we tested the hypothesis that a
marked systolic blood pressure decrease >35% (DeltaSBP
>35%) from preanesthetic baseline during the induction
and maintenance of anesthesia is associated with more postoperative
nausea and vomiting (PONV). In 300 ASA physical status I
and II women undergoing elective gynecological surgery with
general anesthesia, the maximum DeltaSBP during the induction
as well as maintenance of general anesthesia were calculated.
Observers blinded to hemodynamic variables assessed the
incidence of PONV. The overall incidence of nausea (visual
analog scale >4) and vomiting within the immediate observation
period (0-2 h) was 39% and 25%, respectively. Frequency
of nausea and vomiting in the late observation period was
21% and 9%, respectively. Women with a DeltaSBP >35%
during the induction of anesthesia suffered from a more
frequent incidence of PONV within the immediate (57% versus
35% and 41% versus 22%, respectively; P < 0.01) and within
the late observation period (33% versus 18% and 19% versus
7%, respectively; P < or = 0.01). In women with a DeltaSBP
>35% during maintenance of anesthesia, a more frequent
incidence of nausea within the immediate observation period
(53% versus 36%; P < 0.05) was found. We conclude that
a maximum DeltaSBP >35% during the anesthetic induction
is associated with an increased incidence of PONV after
gynecological surgery during general anesthesia. IMPLICATIONS:
A prospective clinical investigation revealed that a marked
systolic blood pressure decrease >35% (DeltaSBP >35%)
during the induction of general anesthesia is associated
with an increased incidence of postoperative nausea and
vomiting (PONV). The association between a DeltaSBP >35%
during maintenance of general anesthesia and PONV is less
pronounced.
Publication Types:
Clinical trial
PMID: 12032046, UI: 22027030
Anesth Analg 2002 Jun;94(6):1639-45, table of
contents
The effectiveness of adjunctive hypnosis with surgical
patients: a meta-analysis.
Montgomery GH, David D, Winkel G, Silverstein JH, Bovbjerg
DH
Biobehavioral Medicine Program, Cancer Prevention and Control,
Derald H. Ruttenberg Cancer Center, Mount Sinai School of
Medicine, 1 Gustave L. Levy Place, New York, NY 10029-6574,
USA. guy.montgomery@mssm.edu
Hypnosis is a nonpharmacologic means for managing adverse
surgical side effects. Typically, reviews of the hypnosis
literature have been narrative in nature, focused on specific
outcome domains (e.g., patients' self-reported pain), and
rarely address the impact of different modes of the hypnosis
administration. Therefore, it is important to take a quantitative
approach to assessing the beneficial impact of adjunctive
hypnosis for surgical patients, as well as to examine whether
the beneficial impact of hypnosis goes beyond patients'
pain and method of the administration. We conducted meta-analyses
of published controlled studies (n = 20) that used hypnosis
with surgical patients to determine: 1) overall, whether
hypnosis has a significant beneficial impact, 2) whether
there are outcomes for which hypnosis is relatively more
effective, and 3) whether the method of hypnotic induction
(live versus audiotape) affects hypnosis efficacy. Our results
revealed a significant effect size (D = 1.20), indicating
that surgical patients in hypnosis treatment groups had
better outcomes than 89% of patients in control groups.
No significant differences were found between clinical outcome
categories or between methods of the induction of hypnosis.
These results support the position that hypnosis is an effective
adjunctive procedure for a wide variety of surgical patients.
IMPLICATIONS: A meta-analytical review of studies using
hypnosis with surgical patients was performed to determine
the effectiveness of the procedure. The results indicated
that patients in hypnosis treatment groups had better clinical
outcomes than 89% of patients in control groups. These data
strongly support the use of hypnosis with surgical patients.
Publication Types:
Meta-analysis
PMID: 12032044, UI: 22027028
Anesth Analg 2002 Jun;94(6):1606-13, table of
contents
Continuous psoas compartment block for postoperative analgesia
after total hip arthroplasty: new landmarks, technical guidelines,
and clinical evaluation.
Capdevila X, Macaire P, Dadure C, Choquet O, Biboulet
P, Ryckwaert Y, D'Athis F
Department of Anesthesia and Critical Care Medicine, Lapeyronie
University Hospital, 371 Avenue du Doyen Gaston Giraud,
34295 Montpellier Cedex, France. x-capdevila@chu-montpellier.fr
A computed tomographic scan was obtained in 35 patients
to measure the depth and the relationship of the branches
of the lumbar plexus to the posterior superior iliac spine
projection and the vertebral column. In addition, we prospectively
studied 80 patients scheduled for total hip arthroplasty
who received a continuous psoas compartment block (CPCB)
in the postoperative period. CPCB was performed after surgical
procedures by using modified Winnie's landmarks and nerve
stimulation. From 5 to 8 cm of catheter was inserted. Radiographs
were obtained after injection of 10 mL of contrast medium.
An initial loading dose (0.4 mL/kg) of 0.2% ropivacaine
was injected, followed by continuous infusion of 0.2% ropivacaine
for 48 h. The depth of the lumbar plexus and the distance
between the lumbar plexus and the L4 transverse process
were measured. Visual analog scale values of pain at 1,
12, 24, and 48 h were obtained at rest and during mobilization.
Amounts of rescue analgesia were also recorded. Sensory
blockade of the principal branches of the lumbosacral plexus
was noted at 1 and 24 h, as were adverse events related
to the technique. There was a significant difference between
men and women in depth of the lumbar plexus (median values,
85 vs 70 mm for men and women, respectively). There was
a positive correlation between the body mass index and skin-lumbar
plexus distances. In contrast, there was no difference regarding
the distance between the transverse process of L4 and the
lumbar plexus. The catheter tip lay within the psoas major
muscle in 74% of the patients and between the psoas and
quadratus lumborum muscles in 22%. In three patients, the
catheter was improperly positioned. At 1 h, sensory blockade
of the femoral, obturator, and lateral femoral cutaneous
nerves was successful in, respectively, 95%, 90%, and 85%
of patients. At 24 h, these rates were 88%, 88%, and 83%,
respectively. During the 48-h study period, median visual
analog scale values of pain were approximately 10 mm at
rest and from 18 to 25 mm during physiotherapy. Five patients
received 5 mg of morphine at 1 h. Five cases of unilateral
epidural anesthesia were noted after the bolus injection.
We conclude that CPCB with 0.2% ropivacaine allows optimal
analgesia after hip arthroplasty, with few side effects
and a small failure rate. Before lumbar plexus branch stimulation
and catheter insertion, anesthesiologists should be aware
of the L4 transverse process location and lumbar plexus
depth. IMPLICATIONS: Lumbar plexus depth is correlated with
the patient's body mass index and differs between men and
women, but this is not true of the lumbar plexus-transverse
process distance. Considering new landmarks, a continuous
psoas compartment block promotes optimal analgesia after
hip arthroplasty, with few side effects.
Publication Types:
Clinical trial
Evaluation studies
Randomized controlled trial
PMID: 12032037, UI: 22027021
Anesth Analg 2002 Jun;94(6):1589-92, table of
contents
Central neuraxial blockade promotes external cephalic
version success after a failed attempt.
Cherayil G, Feinberg B, Robinson J, Tsen LC
Department of Anesthesiology, Harvard Medical School, Brigham
and Women's Hospital, CWN-L1, Boston, MA 02115, USA.
External cephalic version (ECV) has been successfully used
to decrease the fetal and maternal morbidity and costs of
cesarean delivery. As there are limited data regarding the
use of central neuraxial blockade in the setting of previously
failed ECV attempts, we sought to evaluate the efficacy
and safety of spinal and epidural anesthesia in this setting.
A retrospective review of all ECV attempts performed by
a single experienced obstetrician between 1995 and 1999
was conducted. Standardized tocolytic and anesthetic regimens
were used. A total of 77 patients underwent ECV attempts;
of these, 37 (48%) were unsuccessful, 15 of which consented
to further attempts with anesthesia. Neuraxial anesthesia
was associated with frequent ECV success in both multiparous
4/4 (100%) and nulliparous 9/11 (82%) parturients. Overall
5/6 (83%) and 8/9 (89%) (P = NS) ECV attempts were successful
with spinal and epidural anesthesia, respectively, with
2/5 (40%) and 6/8 (75%) (P = NS) resulting in vaginal deliveries.
One successful ECV in the epidural group had an urgent cesarean
delivery for persistent fetal bradycardia with good neonatal
and maternal outcomes. We conclude central neuraxial anesthesia
promotes successful ECV after previously failed ECV attempts.
IMPLICATIONS: Our retrospective analysis of central neuraxial
techniques, both epidural and spinal anesthesia, noted a
significant success rate in the setting of previously failed
external cephalic version attempts.
PMID: 12032033, UI: 22027017
Anesth Analg 2002 Jun;94(6):1586-8, table of contents
Propofol reduces spinal motor neuron excitability in humans.
Kakinohana M, Fuchigami T, Nakamura S, Kawabata T, Sugahara
K
Division of Anesthesia, Okinawa Prefectural Miyako Hospital,
Okinawa, Japan. mnb-shk@ryukyu.ne.jp
IMPLICATIONS: We investigated in humans whether changes
in spinal motor neuron excitability correlate with the predicted
propofol concentration (Cpt) achieved by a target-controlled
infusion system. Propofol suppressed F-wave persistence
in a Cpt-dependent manner, indicating that propofol depresses
spinal motor neuron excitability at clinically relevant
concentrations.
Publication Types:
Clinical trial
PMID: 12032032, UI: 22027016
Anesth Analg 2002 Jun;94(6):1534-6, table of contents
An unusual presentation of end-tidal carbon dioxide after
esophageal intubation.
Bigeleisen PB
Department of Anesthesiology, University of Rochester School
of Medicine and Dentistry, Strong Memorial Hospital, 601
Elmwood Avenue, Rochester, NY 14642, USA. Paul_Bigeleisen@urmc.rochester.edu
IMPLICATIONS: This article discusses the inherent danger
of general anesthesia and the need for a variety of tools
to safely manage the airway.
PMID: 12032021, UI: 22027005
Anesth Analg 2002 Jun;94(6):1495-9, table of contents
Acetylcholine receptors do not mediate isoflurane's actions
on spinal cord in vitro.
Wong SM, Sonner JM, Kendig JJ
Department of Anesthesia, Stanford University School of
Medicine, Stanford, CA 94305-5117, USA.
Extensive studies on anesthetic mechanisms have focused
on the nicotinic acetylcholine receptor, and to a lesser
extent on the muscarinic receptor. We designed the present
study to test the hypothesis that cholinergic receptors
mediate some of the depressant actions of a volatile anesthetic
in rat spinal cord. The cord was removed from 2- to 7-day-old
rats and superfused in vitro; ventral root potentials were
evoked by stimulating a lumbar dorsal root and recording
from the corresponding ipsilateral ventral root. Both nicotine
and muscarine depressed the nociceptive-related slow ventral
root potential (sVRP). The nicotinic antagonists mecamylamine,
methyllycaconitine, dihydro-beta-erythroidine, and the muscarinic
antagonist atropine blocked the depressant effects of the
respective agonists. Isoflurane 0.3 mini- mum alveolar anesthetic
concentration depressed the sVRP area to approximately 40%
of control. None of the antagonists changed the extent of
isoflurane depression of the sVRP. The depressant actions
of cholinergic agonists suggest that cholinergic receptors
are important in spinal neurotransmission, but the lack
of interaction between antagonists and isoflurane suggests
that cholinergic receptors have little part in mediating
the actions of this anesthetic in spinal cord. Because minimum
alveolar anesthetic concentration is determined primarily
in spinal cord, cholinergic receptors may be eliminated
as molecular targets for this anesthetic end-point. IMPLICATIONS:
Neither nicotinic nor muscarinic acetylcholine receptor
antagonists altered spinal cord actions of isoflurane, suggesting
that these receptors have little role in isoflurane actions
in spinal cord. Cholinergic receptors thus may be eliminated
as molecular targets in determining the anesthetic end-point
of immobility in response to a noxious stimulus (minimum
alveolar anesthetic concentration).
PMID: 12032014, UI: 22026998
Anesth Analg 2002 Jun;94(6):1489-94, table of
contents
Music and preoperative anxiety: a randomized, controlled
study.
Wang SM, Kulkarni L, Dolev J, Kain ZN
Department of Anesthesiology, Yale University School of
Medicine, 333 Cedar Street, New Haven, CT 06510, USA.
Music may decrease the anxiety experienced by patients
before surgery. Previous studies of this issue were hindered
with multiple methodological problems. In this investigation,
we examined this hypothesis while using a rigorous study
design and objective outcome measures. Adult patients undergoing
anesthesia and surgery were randomly assigned to two study
groups. Subjects in Group 1 (n = 48) listened to a 30-min
patient-selected music session, and subjects in Group 2
(n = 45) received no intervention. By using self-report
validated behavioral (State-Trait Anxiety Inventory) and
physiological measures of anxiety (heart rate, blood pressure,
and electrodermal activity and serum cortisol, epinephrine,
and norepinephrine), patients were evaluated before, during,
and after administration of the intervention. We found that
after intervention, subjects in the Music group reported
significantly lower anxiety levels as compared with the
Control group (F(1,91) = 15.4, P = 0.001). That is, the
postintervention anxiety level of subjects in the Music
group decreased by 16% as compared with the preintervention
level, whereas the anxiety level of the Control group did
not change significantly. Two-way repeated-measures analysis
of variance performed for the electrodermal activity, blood
pressure, heart rate, cortisol, and catecholamine data demonstrated
no group difference and no time x group interaction (P =
not significant). In conclusion, under the conditions of
this study, patients who listened to music before surgery
reported lower levels of state anxiety. Physiological outcomes
did not differ, however, between the two study groups. IMPLICATIONS:
Patients who listen to music of their choice during the
preoperative period report less anxiety.
Publication Types:
Clinical trial
Randomized controlled trial
PMID: 12032013, UI: 22026997
Anesth Analg 2002 Jun;94(6):1474-8, table of contents
The bispectral index and explicit recall during the intraoperative
wake-up test for scoliosis surgery.
Department of Anesthesia, Children's Hospital and Harvard
Medical School, 300 Longwood Avenue, Boston, MA 02115, USA.
mary.mccann@tch.harvard.edu
In this prospective study, we evaluated the bispectral
index (BIS) and postoperative recall during the intraoperative
wake-up examination in 34 children and adolescents undergoing
scoliosis surgery. Each anesthesiologist was blinded to
BIS values throughout surgery and the wake-up test. The
BIS, mean arterial blood pressure, and heart rate were compared
at: before starting the wake-up test, patient movement to
command, and after the patient was reanesthetized. The anesthetic
technique for Group 1 was small-dose isoflurane, nitrous
oxide, fentanyl, and midazolam and for Group 2 was nitrous
oxide, fentanyl, and midazolam. Controlled hypotension was
used for all cases. At patient movement to command, the
patients were told a specific color to remember (teal) and
on the second postoperative day were interviewed for explicit
recall of the color and other intraoperative events. A total
of 37 wake-up tests were performed in 34 patients. There
was a significant increase in both groups of BIS (P <
0.001), mean arterial blood pressure (P < 0.001), and
heart rate (P < 0.01) at the time of purposeful patient
movement followed by a significant decline in BIS after
reintroduction of anesthesia (P < 0.01). No patient recalled
intraoperative pain, one patient recalled the wake-up test
but not the color, and five patients recalled the specified
color. We conclude that BIS may be a useful clinical monitor
for predicting patient movement to command during the intraoperative
wake-up test, particularly when controlled hypotension is
used and hemodynamic responses to emergence of anesthesia
are blunted. IMPLICATIONS: The relationship between bispectral
index (BIS) and purposeful intraoperative patient movement
is consistent with previous BIS utility studies. We conclude
that BIS may be a useful clinical monitor for predicting
patient movement to command during the intraoperative wake-up
test, particularly when controlled hypotension is used and
hemodynamic responses to emergence of anesthesia are blunted.
PMID: 12032010, UI: 22026994
Anesth Analg 2002 Jun;94(6):1421-6, table of contents
Propofol alters left atrial function evaluated with pressure-volume
relations in vivo.
Department of Anesthesiology, Medical College of Wisconsin,
8701 Watertown Plank Road, Milwaukee, WI 53226, USA.
The effects of IV anesthetics on left atrial (LA) function
in vivo are unknown. We tested the hypothesis that propofol
alters LA mechanics evaluated with pressure-volume relations
in barbiturate-anesthetized dogs (n = 9) instrumented for
measurement of aortic, LA, and left ventricular (LV) pressures
(micromanometers) and LA volume (epicardial orthogonal sonomicrometers).
LA myocardial contractility (E(es)) and dynamic chamber
stiffness were assessed with end-systolic and end-reservoir
pressure-volume relations, respectively. Relaxation was
determined from the slope of LA pressure decline after contraction
corrected for peak LA pressure. LA stroke work and reservoir
function were assessed by A and V loop area, respectively,
from the steady-state pressure-volume diagram. LA-LV coupling
was determined by the ratio of E(es) to LV elastance. Dogs
received propofol (5, 10, 20, or 40 mg. kg(-1). h(-1)) in
a random manner, and LA function was determined after a
15-min equilibration at each dose. Propofol decreased heart
rate, mean arterial blood pressure, and the maximal rate
of increase of LV pressure. Propofol caused dose-related
reductions in E(es), dynamic chamber stiffness, and E(es)/LV
elastance. An increase in V loop area and declines in LA
stroke work, emptying fraction, and the active LA contribution
to LV filling also occurred. Relaxation was unchanged. The
results indicate that propofol depresses LA myocardial contractility,
reduces dynamic chamber stiffness, maintains reservoir function,
and impairs LA-LV coupling but does not alter LA relaxation
in vivo. IMPLICATIONS: Propofol depresses contractile function
of left atrial (LA) myocardium, impairs mechanical matching
between the LA and the left ventricular (LV), and reduces
the active LA contribution to LV filling in vivo. Compensatory
decreases in chamber stiffness contribute to relative maintenance
of LA reservoir function during the administration of propofol.
PMID: 12031999, UI: 22026983
Anesth Analg 2002 Jun;94(6):1416-20, table of
contents
An increase in body temperature during radiofrequency
ablation of liver tumors.
Sawada M, Watanabe S, Tsuda H, Kano T
Department of Anesthesiology, Kurume University School
of Medicine, Asahimachi 67, Kurume, Fukuoka 830-0011, Japan.
mmss416@hotmail.com
Radiofrequency ablation (RFA) therapy using an active needle
electrode inserted into liver tumors has been used clinically.
To avoid hyperthermia, we investigated the relationship
between the total output energy of the applied radiofrequency
wave and changes in body temperature (BT) in patients receiving
RFA. Fifteen patients undergoing RFA of liver tumors with
general anesthesia were enrolled. The total output energy
of radiofrequency waves was calculated from the power and
duration of RFA. Changes in rectal (T(rect)) and tympanic
temperatures were measured throughout the study. The mean
number of liver tumors per patient was 1.7 +/- 1.3. The
mean RFA time was 30.0 +/- 26.3 min. The mean total output
energy was 125,935 +/- 114,506 J. The mean value of T(rect)
increased from 36.3 degrees C +/- 0.5 degrees C to 37.0
degrees C +/- 1.0 degrees C (P < 0.01). A linear correlation
was obtained between the total output energy and the changes
in T(rect), indicating that T(rect) increased approximately
by 1 degrees C for every 3000 J/kg of total output energy.
The increase in BT during RFA of liver tumors under general
anesthesia is predictable. Close observation of total output
energy delivered and BT are required, and preparation of
cooling measures is important, in RFA of liver tumors. IMPLICATIONS:
The increase in body temperature (BT) is predictable during
radiofrequency ablation (RFA) of liver tumors under general
anesthesia. Close observation of total output energy delivered
and BT are required, and preparation of cooling measures
is important, in RFA of liver tumors.
Publication Types:
Clinical trial
PMID: 12031998, UI: 22026982
Anesth Analg 2002 Jun;94(6):1395-401, table of
contents
Slow rewarming has no effects on the decrease in jugular
venous oxygen hemoglobin saturation and long-term cognitive
outcome in diabetic patients.
Kadoi Y, Saito S, Goto F, Fujita N
Department of Anesthesiology and Reanimatology, Gunma University
School of Medicine, 3-39-22 Showa-machi, Maebashi, Gunma
371-8511, Japan. kadoi@med.gunma-u.ac.jp
The purpose of this study was to examine the effects of
rewarming rate on internal jugular venous oxygen hemoglobin
saturation (SjvO(2)) during the rewarming period, and long-term
cognitive outcome in diabetic patients. We studied 30 diabetic
patients scheduled for elective coronary artery bypass graft
surgery. As a control, 30 age-matched nondiabetic patients
were identified. The diabetic patients were randomly divided
into two groups: the Slow Rewarming group (n = 15) (mean
rewarming speed: 0.22 degrees +/- 0.07 degrees C/min, mean
+/- SD) or the Standard Rewarming group (Standard group)
(n = 15) (mean rewarming speed: 0.46 degrees +/- 0.09 degrees
C/min, mean +/- SD). After the induction of anesthesia,
a fiberoptic oximetry catheter was inserted into the right
jugular bulb to monitor SjvO(2) continuously. Hemodynamic
variables and arterial and jugular venous blood gases were
measured at nine time points. All patients underwent a battery
of neurologic and neuropsychologic tests on the day before
the operation and at 4 mo after surgery. The SjvO(2) values
in the Standard group were decreased during the rewarming
period compared with at the induction of anesthesia (P <
0.05). There was a significant difference in the SjvO(2)
value in the Control group between standard rewarming and
slow rewarming during rewarming periods (Standard Control
group: 51% +/- 8%, Slow Control groups: 58% +/- 5%) (P <
0.05). However, there was no difference in the SjvO(2) value
in diabetic patients between standard rewarming and slow
rewarming during the rewarming period. The rewarming rates
(odds ratio: 0.8; 95% confidence interval: 0.5-1.3; P =
0.6) had no correlation with cognitive impairment at 4 mo
after the surgery. Diabetes (odds ratio: 1.6; 95% confidence
interval: 0.9-2.6; P = 0.04) was a factor in relation to
cognitive impairment at 4 mo after the surgery. We concluded
that a slow rewarming rate had no effects on the reduction
in SjvO(2) value and long-term cognitive outcome in diabetic
patients. IMPLICATIONS: We examined the effects of rewarming
rate on internal jugular venous oxygen hemoglobin saturation
in diabetic and nondiabetic patients during the rewarming
period and long-term cognitive outcome. Slow rewarming could
not prevent the frequency of the reduction in internal jugular
venous oxygen hemoglobin saturation and adverse cognitive
outcome in diabetic patients.
Publication Types:
Clinical trial
Randomized controlled trial
PMID: 12031995, UI: 22026979
Anesth Analg 2002 Jun;94(6):1389-94, table of
contents
Differential cerebral gene expression during cardiopulmonary
bypass in the rat: evidence for apoptosis?
Sato Y, Laskowitz DT, Bennett ER, Newman MF, Warner DS,
Grocott HP
Department of Anesthesiology, Duke University Medical Center,
Durham, NC 27710, USA.
Cardiopulmonary bypass (CPB) is associated with a spectrum
of cerebral injuries. The molecular changes in the brain
that might contribute to these injuries are not clearly
known. We sought to determine whether the expression of
apoptotic genes is increased after CPB in the rat. Rats
(n = 7) were subjected to 90 min of normothermic CPB. A
group of sham-operated rats (n = 7) served as non-CPB controls.
After a 3-h post-CPB period of recovery, their brains were
removed, homogenized, and processed for messenger RNA (mRNA)
extraction. By using a ribonuclease protection assay, the
ratios of both pro- and antiapoptotic mRNA (bcl-x, bcl-2,
bax, caspase 2, and caspase 3) to the housekeeping glyceraldehyde
phosphate dehydrogenase (GAPDH) gene were determined. Additionally,
Western immunoblotting was performed to detect the presence
of activated caspase 3, a protein central in the apoptotic
process. Compared with the non-CPB controls, the CPB group
had significantly increased levels of apoptotic/GAPDH mRNA
ratios (bcl-x, 0.414 +/- 0.152 CPB versus 0.251 +/- 0.051
non-CPB, P = 0.048; caspase 2, 0.030 +/- 0.014 CPB versus
0.018 +/- 0.005 non-CPB, P = 0.048; bax, 0.106 +/- 0.035
CPB versus 0.066 +/- 0.009 non-CPB, P = 0.009; bcl-2, 0.011
+/- 0.006 CPB versus 0.006 +/- 0.002 non-CPB, P = 0.035).
However, no activated caspase 3 protein was detected in
either group. Elucidating the molecular biological sequelae
of CPB may aid in the understanding of the pathophysiology
of cardiac surgery-associated cerebral injury and, in doing
so, may be useful in identifying potential therapeutic targets
for pharmacologic neuroprotection. IMPLICATIONS: Cardiopulmonary
bypass (CPB) appears to induce transcription of pro- and
antiapoptotic genes in the rat brain, but caspase-mediated
apoptosis itself does not appear to be activated. Elucidating
the molecular biological sequelae of CPB may aid in the
understanding of the pathophysiology of cardiac surgery-associated
cerebral injury and, in doing so, may be useful in identifying
potential therapeutic targets for pharmacologic neuroprotection.
PMID: 12031994, UI: 22026978
Br J Anaesth 2002 May;88(5):700-7
Heat stroke: implications for critical care and anaesthesia.
Grogan H, Hopkins PM
Department of Anaesthesia, Leeds Teaching Hospital Trust,
UK.
[Medline record in process]
PMID: 12067009, UI: 22061758
Br J Anaesth 2002 May;88(5):676-8
Comparison of articaine and bupivacaine/lidocaine for
peribulbar anaesthesia by inferotemporal injection.
Allman KG, Barker LL, Werrett GC, Gouws P, Sturrock GD,
Wilson IH
Department of Anaesthesia, Royal Devon and Exeter Hospital,
UK.
[Medline record in process]
BACKGROUND: Articaine is a novel amide local anaesthetic
with a shorter duration of action than prilocaine. METHODS:
In a randomized, double-blind study we compared the efficacy
of 2% articaine with epinephrine 1:200,000 with a mixture
of 0.5% bupivacaine and 2% lidocaine with epinephrine 1:200,000
for peribulbar anaesthesia in cataract surgery using a single
inferotemporal injection. Eighty-two patients were randomly
allocated to one of two groups to receive peribulbar anaesthesia
with 6-7 ml of articaine or a bupivacaine/lidocaine mixture.
Both solutions contained hyaluronidase 30 iu ml(-1). Ocular
movement was scored at 2 min intervals up to 10 min, at
the end of surgery and at time of discharge from hospital.
Time to readiness for surgery and any complications (proptosis,
chemosis, pain) were recorded. RESULTS: The articaine group
demonstrated a rapid onset of peribulbar block with mean
time (SD) to readiness for surgery of 4.2 (4.5) min compared
with 7.2 (5.7) min in the bupivacaine/lidocaine group (P=0.0095).
The block obtained in the articaine group was dense with
eye movement scores at 2, 4, 6, 8 and 10 min all significantly
reduced (P<0.01 at each interval). There was also a faster
offset of the block in the articaine group (P=0.0009). There
was no difference in incidence of minor complications between
the groups. CONCLUSIONS: Two per cent articaine is safe
and effective for peribulbar anaesthesia by inferotemporal
injection and is a suitable alternative to the traditional
mixture of 0.5% bupivacaine and 2% lidocaine.
PMID: 12067005, UI: 22061754
Br J Anaesth 2002 May;88(5):659-68
Volatile anaesthetics may be the main cause of early but
not delayed postoperative vomiting: a randomized controlled
trial of factorial design.
Apfel CC, Kranke P, Katz MH, Goepfert C, Papenfuss T,
Rauch S, Heineck R, Greim CA, Roewer N
Department of Anaesthesiology, Julius-Maximilians-University
of Wuerzburg, Germany.
[Medline record in process]
BACKGROUND: Despite intensive research, the main causes
of postoperative nausea and vomiting (PONV) remain unclear.
We sought to quantify the relative importance of operative,
anaesthetic and patient-specific risk factors to the development
of PONV. METHODS: We conducted a randomized controlled trial
of 1180 children and adults at high risk for PONV scheduled
for elective surgery. Using a five-way factorial design,
we randomly assigned subjects by gender who were undergoing
specific operative procedures, to receive various combinations
of anaesthetics, opioids, and prophylactic antiemetics.
RESULTS: Of the 1180 patients, 355 (30.1% 95% CI (27.5-32.7%))
had at least one episode of postoperative vomiting (PV)
within 24 h post-anaesthesia. In the early postoperative
period (0-2 h), the leading risk factor for vomiting was
the use of volatile anaesthetics, with similar odds ratios
(OR (95% CI)) being found for isoflurane (19.8 (7.7-51.2)),
enflurane (16.1 (6.2-41.8)) and sevoflurane (14.5 (5.6-37.4)).
A dose-response relationship was present for the use of
volatile anaesthetics. In contrast, no dose response existed
for propofol anaesthesia. In the delayed postoperative period
(2-24 h), the main predictors were being a child (5.7 (3.0-10.9)),
PONV in the early period (3.4 (2.4-4.7)) and the use of
postoperative opioids (2.5 (1.7-3.7)). The influence of
the antiemetics was considerably smaller and did not interact
with anaesthetic or surgical variables. CONCLUSION: Volatile
anaesthetics were the leading cause of early postoperative
vomiting. The pro-emetic effect was larger than other risk
factors. In patients at high risk for PONV, it would therefore
make better sense to avoid inhalational anaesthesia rather
than simply to add an antiemetic, which may still be needed
to prevent or treat delayed vomiting.
PMID: 12067003, UI: 22061752
Br J Anaesth 2002 May;88(5):649-52
Respiratory response to skin incision during anaesthesia
with infusions of propofol and alfentanil.
Dockery MP, Drummond GB
University Department of Anaesthesia, Critical Care, and
Pain Medicine, Royal Infirmary of Edinburgh, UK.
[Medline record in process]
BACKGROUND: The ventilatory response to skin incision during
anaesthesia with enflurane is an increase in tidal volume
without a change in frequency. As opioids affect respiratory
frequency and also affect the processing of pain, we investigated
if the breathing response to a painful stimulus could be
different during anaesthesia using opioids. METHODS: We
studied 12 patients during anaesthesia with target-controlled
infusions of propofol (plasma target concentration 4-6 microg
ml(-1)) and alfentanil (plasma target concentration 40-60
ng ml(-1)), having varicose vein surgery. RESULTS: After
the initial skin incision, tidal volume increased promptly
by 17 (4, 81)% (median, quartile values) (P<0.01). Respiratory
frequency changed variably with no significant change overall
[median change 2 (-8, +50)%]. The duration of inspiration
was virtually unaltered, and the duration of expiration
decreased gradually by 5 (-7, 32)%. Patients who showed
more response also showed more change in tidal volume, so
that there was a significant relationship between increased
inspiratory flow rate and reduced expiratory time (P<0.05).
CONCLUSIONS: During opioid anaesthesia, the mechanism of
ventilatory increase after stimulation involves changes
in both drive and timing of breathing. This pattern of response
does not resemble the changes seen during anaesthesia with
potent volatile agents.
PMID: 12067001, UI: 22061750
Br J Anaesth 2002 May;88(5):644-8
EEG signal processing in anaesthesia. Use of a neural
network technique for monitoring depth of anaesthesia.
Ortolani O, Conti A, Di Filippo A, Adembri C, Moraldi
E, Evangelisti A, Maggini M, Roberts SJ
Dipartimento Area Critica Medico Chirurgica, Universita
di Firenze, Italy.
[Medline record in process]
BACKGROUND: The Bispectral Index (BIS) is a proprietary
index of anaesthesia depth, which is correlated with the
level of consciousness and probability of intraoperative
recall. The present study investigates the use of a neural
network technique to obtain a non-proprietary index of the
depth of anaesthesia from the processed EEG data. METHODS:
Two hundred patients, who underwent general abdominal surgery,
were recruited for our trial. For anaesthesia we used a
total i.v. technique, tracheal intubation, and artificial
ventilation. Fourteen EEG variables, including the BIS,
were extracted from the EEG, monitored with an EEG computerized
monitor, and then stored on a computer. Data from 150 patients
were used to train the neural network. All the variables,
excluding the BIS, were used as input data in the neural
network. The output targets of the network were provided
by anaesthesia scores ranging from 10 to 100 assigned by
the anaesthesiologist according to the observer's assessment
of alertness and sedation (OAA/S) and other clinical means
of assessing depth of anaesthesia. Data from the other 50
patients were used to test the model and for statistical
analysis. RESULTS: The artificial neural network was successfully
trained to predict an anaesthesia depth index, the NED (neural
network evaluated depth), ranging from 0 to 100. The correlation
coefficient between the NED and the BIS over the test set
was 0.94 (P<0.0001). CONCLUSION: We have developed a
neural network model, which evaluates 13 processed EEG parameters
to produce an index of anaesthesia depth, which correlates
very well with the BIS during total i.v. anaesthesia with
propofol.
PMID: 12067000, UI: 22061749
Br J Anaesth 2002 May;88(5):627-31
Implanted cardiac pacemakers and defibrillators in anaesthetic
practice.
Senthuran S, Toff WD, Vuylsteke A, Solesbury PM, Menon
DK
[Medline record in process]
Publication Types:
Editorial
PMID: 12066997, UI: 22061746
Br J Anaesth 2002 May;88(5):624-7
Effects of anaesthetic agents on airway smooth muscles.
Yamakage M
[Medline record in process]
Publication Types:
Editorial
PMID: 12066996, UI: 22061745
Br J Anaesth 2002 Apr;88(4):613-4; doscussion
614
Anaesthesia for cataract surgery.
Calenda E
Publication Types:
Letter
PMID: 12066755, UI: 22061572
Br J Anaesth 2002 Apr;88(4):612-3; discussion
613
Combined epidural and general anaesthesia in a patient
with a transplanted heart undergoing upper abdominal surgery.
Xenon increases total body oxygen consumption during isoflurane
anaesthesia in dogs.
Picker O, Schindler AW, Schwarte LA, Preckel B, Schlack
W, Scheeren TW, Thamer V
Department of Anaesthesiology, Heinrich-Heine-University,
Dusseldorf, Germany.
BACKGROUND: This study was designed to examine whether
the coupling between oxygen consumption (VO2) and cardiac
output (CO) is maintained during xenon anaesthesia. METHODS:
We studied the relationship between VO2 (indirect calorimetry)
and CO (ultrasound flowmetry) by adding xenon to isoflurane
anaesthesia in five chronically instrumented dogs. Different
mixtures of xenon (70% and 50%) and isoflurane (0-1.4%)
were compared with isoflurane alone (1.4% and 2.8%). In
addition, the autonomic nervous system was blocked (using
hexamethonium) to study its influence on VO2 and CO during
xenon anaesthesia. RESULTS: Mean (SEM) VO2 increased from
3.4 (0.1) ml kg(-1) min(-1) during 1.4% isoflurane to 3.7
(0.2) and 4.0 (0.1) ml kg(-1) min(-1) after addition of
70% and 50% xenon, respectively (P<0.05), whereas CO
and arterial pressure remained essentially unchanged. In
contrast, 2.8% isoflurane reduced both, VO2 [from 3.4 (0.1)
to 3.1 (0.1) ml kg(-1) min(-1)] and CO [from 96 (5) to 70
(3) ml kg(-1) min(-1)] (P<0.05). VO2 and CO correlated
closely during isoflurane anaesthesia alone and also in
the presence of xenon (r2=0.94 and 0.97, respectively),
but the regression lines relating CO to VO2 differed significantly
between conditions, with the line in the presence of xenon
showing a 0.3-0.6 ml kg(-1) min(-1) greater VO2 for any
given CO. Following ganglionic blockade, 50% and 70% xenon
elicited a similar increase in VO2, while CO and blood pressure
were unchanged. CONCLUSIONS: Metabolic regulation of blood
flow is maintained during xenon anaesthesia, but cardiovascular
stability is accompanied by increased VO2. The increase
in VO2 is independent of the autonomic nervous system and
is probably caused by direct stimulation of the cellular
metabolic rate.
PMID: 12066732, UI: 22061549
Br J Anaesth 2002 Apr;88(4):540-5
Increased airway resistance during xenon anaesthesia in
pigs is attributed to physical properties of the gas.
Baumert JH, Reyle-Hahn M, Hecker K, Tenbrinck R, Kuhlen
R, Rossaint R
Clinic for Anaesthesiology, Klinikum der RWTH Aachen, Germany.
BACKGROUND: In this study we investigated the effects of
the physical properties of xenon on respiratory mechanisms
in pigs. METHODS: With institutional approval, 10 female
pigs (mean 25.2 (SD 2.5) kg) were anaesthetized with thiopental,
remifentanil, and pancuronium. Gas flow and pressure were
recorded continuously at the proximal end of the tracheal
tube during constant flow ventilation for control, with
100% oxygen (control), followed by 1.5% isoflurane in 70/30%
nitrogen/oxygen, 1.0% isoflurane in 70/30% nitrous oxide/oxygen,
and 70/30% xenon/oxygen in random order. Compliance (C)
and resistance (R) were calculated using a single compartment
model. Resistance was corrected for gas viscosities eta
and also for densities pho and viscosities eta as (pho*eta)(1/2)
to compare assumptions of laminar and mixed flow in the
airways. RESULTS: With constant flow ventilation, xenon
increases inspiratory pressure compared with other gas mixtures.
There were no significant differences in resistance, corrected
for laminar or mixed flow, between the gas mixtures. Xenon
anaesthesia did not affect compliance. CONCLUSIONS: The
increase in airway pressure observed with xenon anaesthesia
is attributed completely to its higher density and viscosity.
Therefore, determination of airway resistance must take
into account the physical properties of the gas. Xenon does
not exert any major effect on airway diameter.
PMID: 12066731, UI: 22061548
Br J Anaesth 2002 Apr;88(4):527-33
Randomized crossover comparison of the proseal with the
classic laryngeal mask airway in unparalysed anaesthetized
patients.
BACKGROUND: The ProSeal is a wire-reinforced laryngeal
mask airway with an additional drain tube that leads to
the distal tip of the laryngeal cuff. The design should
improve the seal with the larynx. METHODS: The ProSeal and
classic laryngeal mask airways were compared in 180 patients
in a randomized crossover study. Patients were anaesthetized
without neuromuscular blocking drugs. RESULTS: The ProSeal
took more time and more attempts to insert successfully
than the classic laryngeal mask airway. Insertion was successful
on the first attempt in 81% of cases with the ProSeal and
90% with the classic laryngeal mask airway. The ProSeal
required more air to achieve an intracuff pressure of 60
cm H2O (6 ml more for size 4 and 12 ml more for size 5).
Laryngeal seal pressure was better with the ProSeal than
the classic laryngeal mask airway. Median seal pressure
was 29 cm H2O with the ProSeal and 18 cm H2O with the classic
laryngeal mask airway. Laryngeal seal pressure was greater
than 20 cm H2O in 87% of patients with the ProSeal and 41%
with the classic laryngeal mask airway. Laryngeal seal pressure
was greater than 40 cm H2O in 21% of patients with the ProSeal
and in none of the patients with the classic laryngeal mask.
Once placed, the ProSeal remained a stable and effective
airway. Gastric tube insertion through the drain tube was
attempted in 147 cases and was successful in 135 (92%).
CONCLUSION: The ProSeal is more difficult to insert than
the classic laryngeal mask airway but allows positive pressure
ventilation more reliably than the classic laryngeal mask
airway.
Publication Types:
Clinical trial
Multicenter study
Randomized controlled trial
PMID: 12066729, UI: 22061546
Br J Anaesth 2002 Apr;88(4):516-9
Comparison of mepivacaine and lidocaine for intravenous
regional anaesthesia: pharmacokinetic study and clinical
correlation.
Prieto-Alvarez P, Calas-Guerra A, Fuentes-Bellido J, Martinez-Verdera
E, Benet-Catala A, Lorenzo-Foz JP
Service of Anaesthesiology, Resuscitation and Pain Clinic,
Hospital Universitario Sant Joan de Reus, Tarragona, Spain.
BACKGROUND: Limitations to the use of lidocaine for intravenous
regional anaesthesia (IVRA) include lack of optimal intraoperative
analgesia and systemic toxic reactions. This randomized
double-blind study was conducted to compare intraoperative
and postoperative analgesia, adverse effects, and plasma
concentrations of mepivacaine or lidocaine, on release of
the tourniquet in patients undergoing IVRA for distal upper
limb surgery. METHODS: Forty-two adult patients were randomly
allocated to receive either a 0.5% lidocaine solution 3
mg kg(-1) (n=20) or mepivacaine 5 mg kg(-1) (n=22). Plasma
concentrations of both anaesthetic agents were measured
at 5, 10, 20, 30, 45, and 60 min after deflation of the
tourniquet by gas chromatography. RESULTS: Although plasma
concentrations of mepivacaine and lidocaine were comparable
5 min after deflation, concentrations of lidocaine decreased
significantly thereafter, whereas plasma concentrations
of mepivacaine were similar over the 60-min study period.
Supplementary analgesia during the intraoperative period
was required by 45% of patients in the lidocaine group as
compared with 9% in the mepivacaine group (P=0.02). No adverse
effects were observed in patients given mepivacaine. In
the lidocaine group, adverse effects were observed in 10%
of the patients. The total ischaemia time, volume of the
local anaesthetic, and duration of the surgical procedure
were not significantly different between the two groups.
CONCLUSIONS: Mepivacaine 5 mg kg(-1) ensured better intraoperative
analgesia than lidocaine 3 mg kg(-1) when used for IVRA.
Plasma concentrations of lidocaine decreased significantly
between 5 and 60 min following tourniquet deflation, whereas
blood concentrations of mepivacaine remained below the toxic
concentration.
Publication Types:
Clinical trial
Randomized controlled trial
PMID: 12066727, UI: 22061544
Br J Anaesth 2002 Apr;88(4):502-7
Effect of sevoflurane/nitrous oxide versus propofol anaesthesia
on somatosensory evoked potential monitoring of the spinal
cord during surgery to correct scoliosis.
Ku AS, Hu Y, Irwin MG, Chow B, Gunawardene S, Tan EE,
Luk KD
Department of Anaesthesiology, Queen Mary Hospital, Hong
Kong.
BACKGROUND: Use of intraoperative somatosensory evoked
potential (SSEP) monitoring is helpful in spinal corrective
surgery but may be affected by anaesthetic drugs. An anaesthetic
technique that has less effect on SSEP or allows faster
recovery is an advantage. We compared the effects on SSEP
and the clinical recovery profiles of sevoflurane/nitrous
oxide and propofol anaesthesia during surgery to correct
scoliosis. METHODS: Twenty adolescent patients were randomized
into two groups of 10. One group received sevoflurane-nitrous
oxide anaesthesia and the other received propofol i.v. anaesthesia.
An alfentanil infusion was used for analgesia in both groups.
RESULTS: Changes in anaesthetic concentration produced little
effect on the latency of SSEP, but the effect on the variability
of SSEP amplitude was significant (P<0.05). Sevoflurane
produced a faster decrease in SSEP and a faster recovery
than propofol (P<0.05). On emergence, patients who received
sevoflurane tended to have shorter recovery times to eye
opening (mean 5.1 vs 20.6 min, P=0.09) and toe movement
(mean 7.9 vs 15.7 min, P=0.22). Those who had received sevoflurane
were significantly more lucid and cooperative in recovery.
CONCLUSIONS: Sevoflurane produces a faster decrease and
recovery of SSEP amplitude as well as a better conscious
state on emergence than propofol.
Publication Types:
Clinical trial
Randomized controlled trial
PMID: 12066725, UI: 22061542
Can J Anaesth 2002 Jun;49(6):641
Problems with CO(2) monitoring in a Siemens Kion anesthesia
machine.
Oyston J
Toronto, Ontario.
[Medline record in process]
PMID: 12067889, UI: 22062778
Can J Anaesth 2002 Jun;49(6):641-2
Relationship between body mass index and ventilation with
the Laryngeal Tube(R) in 228 anesthetized paralyzed patients:
a pilot study.
Agro FE, Galli B, Cataldo R, Carassiti M, Barzoi G, Ravussin
P, Petitti T
Rome, Italy.
[Medline record in process]
PMID: 12067888, UI: 22062777
Can J Anaesth 2002 Jun;49(6):639-40
A continuous perineural infusion of local anesthetic provides
effective postoperative pain management after lower limb
amputation.
Lennox PH, Winkelaar GB, Umedaly H, Hsiang YN
Vancouver, British Columbia.
[Medline record in process]
PMID: 12067886, UI: 22062775
Can J Anaesth 2002 Jun;49(6):638-9
Does propofol anesthesia increase agitation in neurosurgical
patients? - a pilot study.
Kanaya N, Kuroda H, Nakayama M, Homma Y, Namiki A
Sapporo, Japan.
[Medline record in process]
PMID: 12067885, UI: 22062774
Can J Anaesth 2002 Jun;49(6):636-7
The incidence of failed spinal anesthesia, postdural puncture
headache and backache is similar with Atraucan and Whitacre
spinal needles.
Pan PH, Fragneto R, Moore C, Ross V, Justis G
Winston-Salem, North Carolina Lexington, Kentucky Richmond,
Virginia.
[Medline record in process]
PMID: 12067883, UI: 22062772
Can J Anaesth 2002 Jun;49(6):620-2
Best evidence in anesthetic practice: Harm: albumin neither
increases nor decreases mortality in critically ill patients.
Bryson GL, Choi PT
Ottawa, Ontario Hamilton, Ontario.
[Medline record in process]
PMID: 12067877, UI: 22062766
Can J Anaesth 2002 Jun;49(6):588-99
Prophylactic ephedrine prevents hypotension during spinal
anesthesia for Cesarean delivery but does not improve neonatal
outcome: a quantitative systematic review: [L'administration
prophylactique d'ephedrine previent l'hypotension pendant
la rachianesthesie pour Cesarienne, mais n'ameliore pas
l'evolution neonatale : une revue methodique quantitative].
Lee A, Ngan Kee WD, Gin T
Department of Anaesthesia, Intensive Care, The Chinese
University of Hong Kong, Prince of Wales Hospital, Shatin,
Nt, Hong Kong, China.
[Medline record in process]
PURPOSE: The objective of this systematic review was to
assess the effectiveness and safety of ephedrine compared
with control when given prophylactically to prevent hypotension
during spinal anesthesia for Cesarean delivery. SOURCE:
Randomized, controlled trials obtained through MEDLINE,
EMBASE, the Cochrane Controlled Trials Registry, contact
with leading experts, and a reference list of published
articles were analyzed. The following keywords were utilized:
spinal anesthesia, hypotension, Cesarean section, pregnancy
complications, pregnancy outcome, fetal outcome, neonatal
outcome, umbilical blood cord gases, vasopressor and ephedrine.
Clinical trials were considered if they compared prophylactic
ephedrine, given by any dose or route, vs control. Principal
findings: The 14 clinical trials identified included data
from a total of 641 patients. Ephedrine was more effective
than control for preventing hypotension (relative risk [RR],
0.73; 95% confidence interval [CI], 0.63 to 0.86). Most
importantly, there was no difference in the risk of fetal
acidosis, defined as umbilical arterial pH < 7.2 (RR,
1.36; 95% CI, 0.55 to 3.35) or the incidence of low Apgar
scores (< 7 or < 8) at one minute (RR, 0.77; 95% CI,
0.29 to 2.06) and five minutes (RR, 0.72; 95% CI, 0.24 to
2.19). CONCLUSIONS: Prophylactic ephedrine is more effective
than control for preventing hypotension during spinal anesthesia
for elective Cesarean delivery but a clinically relevant
positive effect on neonatal outcome was not observed. Therefore,
the routine use of prophylactic ephedrine to prevent any
adverse effects of maternal hypotension following spinal
anesthesia for Cesarean delivery is not supported by the
current systematic review.
PMID: 12067872, UI: 22062761
Can J Anaesth 2002 Jun;49(6):583-587
Factors associated with refusal to enter a clinical trial:
epidural anesthesia is a deterrent to participation: [Les
facteurs associes au refus de participer a un essai clinique
: l'anesthesie peridurale est un element dissuasif].
Salomons TV, Wowk AA, Fanning A, Chan VW, Katz J
Acute Pain Research Unit, Department of Anaesthesia and
Pain Management, University Health Network and Mount Sinai
Hospital, Toronto, Ontario, Canada. the Department of Anesthesia,
Our Lady's Hospital, Navan Ireland. the Regional Anesthesia
and Acute Pain Service, University Health Network, University
of Toronto, Toronto, Ontario, Canada. the Acute Pain Research
Unit, Department of Anaesthesia and Pain Management, University
Health Network and Mount Sinai Hospital, University of Toronto,
Toronto, Ontario, Canada.
[Record supplied by publisher]
PURPOSE: To compare patients who participate in a clinical
trial for pain management involving epidural anesthesia
to those who refuse and document their reasons for refusing.
METHODS: Demographic and health history information was
collected from 621 female patients who were screened for
inclusion in a pain management trial involving epidural
anesthesia. Patients who completed the clinical trial (n
= 149) were compared to those who consented to provide screening
information but did not enter the trial (n = 472). RESULTS:
Sixty-seven percent of women who refused cited unwillingness
to have an epidural as the reason for their decision. Non-Caucasians
(P < 0.01), patients with no history of mood/anxiety
disorders (P < 0.016) or systemic disease (P < 0.02),
and patients with certain types of pain (P < 0.02) were
more likely to refuse to participate in the clinical trial.
A longer duration between recruitment and surgery was also
found to be associated with higher participation rates (P
< 0.01). A logistic regression equation significantly
predicted which patients would participate or refuse (P
< 0.0001), indicating that a specific set of health and
demographic factors strongly influence the decision to participate
in a trial. CONCLUSIONS: The decision to participate in
a clinical trial is viewed as a risk/benefit analysis. Factors
such as short recruitment to surgery intervals and pre-existing
pain, which increase the salience of risks associated with
the trial, may result in lower participation rates. Overall,
epidural anesthesia is a strong deterrent to participation
in a clinical trial.
PMID: 12067871
Can J Anaesth 2002 Jun;49(6):545-53
Serious intraoperative problems - a five-year review of
83,844 anesthetics: [Problemes peroperatoires graves - une
revue de 83 844 anesthesies sur cinq ans].
Fasting S, Gisvold SE
Department of Anesthesia and Intensive Care, St. Olav's
Hospital, University Hospital of Trondheim, Trondheim, Norway.
[Medline record in process]
PURPOSE: The low incidence of mortality and major morbidity
in anesthesia makes it difficult to study the pattern of
potential accidents and to develop preventive strategies.
Anesthetic 'near-misses', however, occur more frequently.
Using data from a simple routine-based system of problem
reporting, we have analyzed the pattern and causes of serious
non-fatal problems, in order to improve preventive strategies.
METHODS: We prospectively recorded anesthesia-related information
from all anesthetics for five years. The data included intraoperative
problems, which were graded into four levels, according
to severity. We analyzed only the serious nonfatal problems,
which were sorted according to clinical presentation, and
also according to which factor was most important in the
development of the problem. We assessed any untoward consequences
for the patient, and whether the problems could have been
prevented. RESULTS: Serious problems were recorded in 315
cases out of 83,844 (0.4%). Anesthesia was considered the
major contributing factor in 111 cases. Difficult intubation,
difficult emergence from general anesthesia, allergic reactions,
arrhythmia and hypotension were the dominating problems.
Twenty-six anesthesia related problems resulted in changes
in level of postoperative care, and one patient later died
in the intensive care unit after anaphylactic shock. Eighty-two
problems could have been prevented by simple strategies.
CONCLUSION: Analysis of serious nonfatal problems during
anesthesia may contribute to improved preventive strategies.
Data from a routine-based system are suitable for this type
of analysis. Intubation, emergence, arrhythmia, hypotension
and anaphylaxis cause most serious problems, and should
be the object of preventive strategies.
PMID: 12067864, UI: 22062753
Can J Anaesth 2002 Jun;49(6):540-4
Le cout relatif de l'anesthesie pour la cholecystectomie
laparoscopique est peu eleve: [Relative anesthesia-cost
for laparoscopic cholecystectomy: fairly low].
Pradervand Mooser M, Gardaz JP, Capt H, Spahn DR
Du Service d'Anesthesiologie, Centre Hospitalier Universitaire
Vaudois, Lausanne, Suisse.
[Medline record in process]
PURPOSE: The relative contribution of anesthesia costs
to total perioperative costs is not known precisely. The
goal of this prospective study was to measure the proportion
of anesthesia costs relative to total hospital costs of
elective laparoscopic cholecystectomy (LC) for in-patients.
METHODS: With Institutional approval, the total hospital
costs of elective LC for 62 ASA I-III patients were analyzed.
All direct and indirect variable costs, including salaries
of anesthesia and surgery teams, were obtained for each
patient. Data are expressed as mean +/- SEM. RESULTS: Intraoperative
anesthesia costs as a percentage of the total hospital costs
equaled 10.5 +/- 0.3%. Postanesthesia care unit (PACU) cost
was 3.1 +/- 0.2%. The largest hospital cost category was
the operating room with 37.4 +/- 0.6%. The costs attributed
to the ward equaled 31.3 +/- 3%. Other costs were generated
by radiology (6.2 +/- 1.1%), laboratory (5.4 +/- 0.7%),
admission unit (3.4 +/- 0.2%), pharmacy (2.0 +/- 0.4%) and
administration (0.7 +/- 0.1%). CONCLUSION: Even if salaries
are included, anesthesia and PACU costs (13.6%) represent
a small portion only of total hospital costs. Cost savings
thus may result from improving operating room efficiency
and shortening of hospitalisation rather than programs aiming
at lowering anesthesia costs.
PMID: 12067863, UI: 22062752
Can J Anaesth 2002 Jun;49(6):536-9
Solving the problem of spinal-induced hypotension in obstetric
anesthesia/Traiter l'hypotension induite par la rachianesthesie
en obstetrique.
Macarthur A
Department of Anesthesia, Mount Sinai Hospital, Toronto,
Ontario, Canada.
[Medline record in process]
PMID: 12067862, UI: 22062751
Can J Anaesth 2002 Jun;49(6):533-5
The hidden cost of anesthesia/Le cout cache de l'anesthesie.
Bevan D
Department of Anesthesia, University Health Network, Toronto
General Hospital, Toronto, Ontario, Canada.
[Medline record in process]
PMID: 12067861, UI: 22062750
Eur J Anaesthesiol 2002 Apr;19(4):271-5
Fentanyl added to bupivacaine 0.05% or ropivacaine 0.05%
in patient-controlled epidural analgesia in labour.
Pirbudak L, Tuncer S, Kocoglu H, Goksu S, Celik C
Gaziantep University, Department of Anaesthesiology, Turkey.
gaziantepanestezi@hotmail.com
[Medline record in process]
BACKGROUND AND OBJECTIVE: Epidural analgesia is the most
effective method for pain relief during labour. The aim
was to elucidate the efficacy of ropivacaine 0.05% and bupivacaine
0.05%, which were both combined with fentanyl 0.00015% to
provide analgesia in labour. METHODS: Forty nulliparous
females were enrolled into the study. After insertion of
an epidural catheter, patients were randomly assigned into
two groups. Once the os uteri had dilated to 4-5 cm, a bolus
of bupivacaine 0.125% 10mL + fentanyl 50 microg (1 mL) in
Group 1 patients, and ropivacaine 0.125% 10mL + fentanyl
50 microg (1 mL) in Group 2 patients was administered via
the epidural catheter. Then, patient-controlled epidural
analgesia was started with a basal infusion of bupivacaine
0.05% 10 mLh(-1) + fentanyl 0.00015% 1.5 pgmL(-1) in Group
1, and ropivacaine 0.05% + fentanyl 1.5 microgmL(-1) in
Group 2. When needed, a 10 mL bolus infusion could be given
and the lockout time was 20 min. Maternal and fetal haemodynamic
variables were monitored before induction and subsequently
at 5 min intervals. Using a visual analogue scale assessed
the degree of pain. RESULTS: Maternal haemodynamic variables
and Apgar scores were not different between the two groups.
The second stage of the labour was shorter in Group 2 (P
< 0.01). There were no significant differences in patients'
assessment of motor block or mode of delivery between groups.
CONCLUSIONS: An epidural infusion (10 mLh(-1)) of bupivacaine
0.05% or ropivacaine 0.05% together with fentanyl 1.5 microg
mL(-1) provided good and safe analgesia during labour.
PMID: 12074416, UI: 22068940
Eur J Anaesthesiol 2002 Apr;19(4):263-70
Comparison of bupivacaine 0.2% and ropivacaine 0.2% combined
with fentanyl for epidural analgesia during labour.
Asik I, Goktug A, Gulay I, Alkis N, Uysalel A
University of Ankara, Department of Anesthesiology and
Intensive Care, Faculty of Medicine, Turkey. iasik@yahoo.com
[Medline record in process]
BACKGROUND AND OBJECTIVE: Recent clinical studies comparing
ropivacaine 0.25% with bupivacaine 0.25% reported not only
comparable analgesia, but also comparable motor block for
epidural analgesia during labour. An opioid can be combined
with local anaesthetic to reduce the incidence of side-effects
and to improve analgesia for the relief of labour pain.
The purpose of the study was to evaluate the effects of
epidural bupivacaine 0.2% compared with ropivacaine 0.2%
combined with fentanyl for the initiation and maintenance
of analgesia during labour and delivery. METHODS: Sixty
labouring nulliparous women were randomly allocated to receive
either bupivacaine 0.2% with fentanyl 2 microg mL(-1) (B/F),
or ropivacaine 0.2% with fentanyl 2 microg mL(-1) (R/F).
For the initiation of epidural analgesia, 8 mL of the study
solution was administered. Supplemental analgesia was obtained
with 4 mL of the study solution according to parturients'
needs when their pain was > or = 4 on a visual analogue
scale. Analgesia, hourly local anaesthetic use, motor block,
patient satisfaction and side-effects between groups were
evaluated during labour and at delivery. RESULTS: Sixty
patients were enrolled and 53 completed the study. No differences
in verbal pain scores, hourly local anaesthetic use or patient
satisfaction between groups were observed. However, motor
block was observed in 10 patients in the B/F group whereas
only two patients had motor block in the R/F group (P <
0.05). The incidence of instrumental delivery was also higher
in the B/F group than in the R/F group (P < 0.05). CONCLUSIONS:
The results suggest that epidural bupivacaine 0.2% and ropivacaine
0.2% combined with fentanyl produced equivalent analgesia
for pain relief during labour and delivery. It is concluded
that ropivacaine 0.2% combined with fentanyl 2 microg mL(-1)
provided effective analgesia with significantly less motor
block and need for an instrumental delivery than a bupivacaine/fentanyl
combination at the same concentrations during labour and
delivery.
PMID: 12074415, UI: 22068939
Eur J Anaesthesiol 2002 Apr;19(4):240-62
Allergic reactions occurring during anaesthesia.
Mertes PM, Laxenaire MC
CHU de Nancy, Hjpital Central, Departement d'Anesthesie-reanimation,
France.
[Medline record in process]
Anaphylactic reactions to anaesthetic and associated agents
used during the perioperative period have been reported
with increasing frequency in most developed countries. Any
drug administered in the perioperative period can potentially
produce life-threatening immune-mediated anaphylaxis. Most
published reports on the incidence of anaphylaxis come from
France, Australia, the UK and New Zealand. These reflect
an active policy of systematic clinical and/or laboratory
investigation of suspected immune-mediated reactions. The
estimated incidence of anaphylaxis ranges from 1:10,000
to 1:20,000. Muscle relaxants (69.1%) and latex (12.1%)
were the most frequently involved drugs according to the
most recent French epidemiological survey. Clinical symptoms
do not afford an easy distinction between immune-mediated
anaphylactic reactions and anaphylactoid reactions resulting
from direct non-specific histamine release. Moreover, when
restricted to a single clinical symptom, anaphylaxis can
easily be misdiagnosed. Pre- and postoperative investigation
must be performed to confirm the nature of the reaction,
the responsibility of the suspected drugs and to provide
precise recommendations for future anaesthetic procedures.
These include plasma histamine, tryptase and specific IgE
concentration determination at the time of the reaction
and at skin tests 6 weeks later. In addition, since no specific
treatment has been shown reliably to prevent the occurrence
of anaphylaxis, allergy assessment must be performed in
all high-risk patients. Treatment of anaphylaxis is aimed
at interrupting contact with the responsible antigen, inhibiting
mediator production and release, and modulating the effects
of released mediators. It must be initiated as quickly as
possible and relies on widely accepted principles. Finally,
the need for proper epidemiological studies and the relative
complexity of allergy investigation should be underscored.
They represent an incentive for further development of allergo-anaesthesiology
clinical networks to provide expert advice for anaesthetists
and allergologists.
PMID: 12074414, UI: 22068938
Eur J Anaesthesiol 2002 Mar;19(3):189-92
Subcutaneous epinephrine administration decreases lower
oesophageal sphincter pressure and gastro-oesophageal pressure
gradient in children under general anaesthesia.
Kohjitani A, Obara H
Kobe University School of Medicine, Department of Anaesthesiology,
Japan. atsushik@md.okayama-u.ac.jp
[Medline record in process]
BACKGROUND AND OBJECTIVE: Children are vulnerable to regurgitation
with a relatively high incidence of aspiration during general
anaesthesia which is attributed to the high intragastric
pressure, a short oesophagus, an immature laryngeal reflex
and incomplete lower oesophageal sphincter muscle function.
Subcutaneous administration of epinephrine is generally
used in surgery to decrease bleeding due to local vasoconstriction.
The effect of epinephrine on the sphincter muscle tone was
investigated during general anaesthesia in children. METHODS:
Ten children scheduled for skin graft or plastic surgery
of the ear were studied. A gastrointestinal pressure sensor
was inserted nasally, and the intraluminal pressures of
the lower oesophagus, lower oesophageal sphincter and stomach
were monitored under sevoflurane, nitrous oxide anaesthesia.
The effect of epinephrine on the lower oesophageal sphincter
muscle tone was measured. RESULTS: The resting pressure
of the lower oesophageal sphincter muscle tone significantly
decreased from 4.56 +/- 1.85 to 3.79 +/- 1.11 kPa after
3 microg kg(-1) epinephrine for 4 min. The barrier pressure
is the difference between the lower oesophageal sphincter
and intragastric pressure, and that decreased to 1.23 +/-
1.17 kPa from the 2.07 +/- 1.77 kPa resting level. The observations
implied that epinephrine had a long-lasting relaxing effect
on lower oesophageal sphincter muscle in children. CONCLUSIONS:
The observations may give some explanation about the mechanism
of gastro-oesophageal reflux during general anaesthesia,
especially in the participation of the adrenergic receptors.
PMID: 12071238, UI: 22066146
J Cardiothorac Vasc Anesth 2002 Jun;16(3):379-81
Con: Regional anesthesia is not an important component
of the anesthetic technique for pediatric patients undergoing
cardiac surgical procedures.
Holtby H
Department of Cardiac Anesthesia, Hospital for Sick Children,
and University of Toronto, Toronto, Ontario, Canada.
[Medline record in process]
PMID: 12073216, UI: 22067866
J Cardiothorac Vasc Anesth 2002 Jun;16(3):374-8
Pro: Regional anesthesia is an important component of
the anesthetic technique for pediatric patients undergoing
cardiac surgical procedures.
Rosen DA, Rosen KR, Hammer GB
Department of Anesthesiology, West Virginia University,
Morgantown, WV.
[Medline record in process]
PMID: 12073215, UI: 22067865
J Cardiothorac Vasc Anesth 2002 Jun;16(3):300-3
Does the reimbursement of anesthesiologists for intraoperative
transesophageal echocardiography promote increased utilization?
Morewood GH, Gallagher ME, Gaughan JP
Departments of Anesthesiology and Biostatistics, Temple
University School of Medicine, Philadelphia, PA.
[Medline record in process]
OBJECTIVE: To determine whether access to reimbursement
increases anesthesiologists' use of intraoperative transesophageal
echocardiography (TEE). DESIGN: Survey. SETTING: United
States. PARTICIPANTS: Members of the Society of Cardiovascular
Anesthesiologists, local Medicare carriers. INTERVENTIONS:
None. Measurements and Main Results: In year 2000, local
Medicare carrier policies specifically allowed some form
of reimbursement to the attending anesthesiologist for intraoperative
TEE in 15 states, but barred all forms of reimbursement
in 16 states and Puerto Rico. Data regarding utilization
and billing were available for 702 members of the Society
of Cardiovascular Anesthesiologists from these jurisdictions
who used TEE in their anesthetic practice. Billing patterns
were found to vary significantly according to the local
Medicare policy in effect (p = 0.004). Use of intraoperative
TEE was found to be unrelated, however, to the reimbursement
available from Medicare (p = 0.2 to 0.7). CONCLUSION: The
use of intraoperative TEE by anesthesiologists does not
seem to be related to the availability of reimbursement
from Medicare. Copyright 2002, Elsevier Science (USA). All
rights reserved.
PMID: 12073200, UI: 22067850
J Cardiothorac Vasc Anesth 2002 Jun;16(3):286-289
Sodium nitroprusside-induced, but not desflurane-induced,
hypotension decreases myocardial tissue oxygenation in dogs
anesthetized with 8% desflurane.
Hoffman WE, Albrecht RF 2nd, Jonjev ZS
Departments of Anesthesiology and Physiology, University
of Illinois at Chicago, Chicago, IL.
[Record supplied by publisher]
OBJECTIVE: To compare sodium nitroprusside (SNP)-induced
hypotension with desflurane-induced hypotension for the
effects on myocardial blood flow and tissue oxygenation
in dogs. DESIGN: Prospective, randomized, crossover, nonblinded.
SETTING: University teaching hospital. PARTICIPANTS: Male
nonpurpose-bred hounds (n = 8). INTERVENTIONS: Dogs were
anesthetized with 8% desflurane. Catheters were inserted
into the femoral artery and coronary sinus. A flow probe
was placed in the left anterior descending (LAD) branch
of the coronary artery. A sensor that measured myocardial
oxygen pressure (PmO(2)) was inserted into the myocardium
of the left ventricle. Myocardial oxygen consumption (M&Vdot;O(2))
was calculated as LAD flow x arterial - coronary sinus oxygen
content. Measurements and Main Results: Measurements were
made at baseline blood pressure levels of 99 mmHg (measure
1), during hypotension to 62 to 66 mmHg using intravenous
SNP or 14% desflurane (measure 2), and during SNP or 14%
desflurane with blood pressure support using phenylephrine
(measure 3). Each dog randomly received both hypotensive
treatments, separated by 1 hour. Baseline measures were
PmO(2) = 46 +/- 9 mmHg, LAD flow = 43 +/- 11 mL/min, and
M&Vdot;O(2) = 2.47 +/- 0.73 mL O(2)/min. During hypotension
induced with SNP, PmO(2) decreased 30% (p < 0.05), LAD
flow increased 40% (p < 0.05), and M&Vdot;O(2) did not
change. During hypotension induced with 14% desflurane,
PmO(2) did not change, and LAD flow and M&Vdot;O(2) decreased
25% and 40% (p < 0.05). Blood pressure support with phenylephrine
increased LAD flow and M&Vdot;O(2) but did not change PmO(2)
during SNP or 14% desflurane treatment. CONCLUSION: SNP-induced
hypotension produced myocardial vasodilation, but tissue
oxygenation was impaired. PmO(2) was maintained during desflurane-induced
hypotension. Copyright 2002, Elsevier Science (USA). All
rights reserved.
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.
