Ultimo Aggiornamento: 31 Dicembre 2002

13 citations found

Anaesthesist 2002 Apr;51(4):324

[Discussion on cuffed or uncuffed tubes is superfluous. Further remarks on the paper by T. Erb and F. J. Frei Anaesthesist (2001) 50:395-400.]

Schultz-Coulon HJ

Publication Types:

• Letter

PMID: 12063726, UI: 22059552

Anaesthesist 2002 Apr;51(4):321-3

[Tubes with cuffs in newborn and young children are a risk! Remarks on the paper by T. Erb and F. J. Frei (Anaesthesist (2001) 50:395-400.]

Holzki J

Publication Types:

• Letter

PMID: 12063725, UI: 22059551

Anaesthesist 2002 Apr;51(4):320

[Greater caution using tubes with cuffs. Remarks on the paper "The use of cuffed endotracheal tubes in infants and small children" by T. Erb and F. J. Frei (Anaesthesist (2001) 50:395-400.]

Hoeve LJ

Publication Types:

• Letter

PMID: 12063724, UI: 22059550

Anaesthesist 2002 Apr;51(4):285-91

[The effect of anesthetics on control of respiration.]

Sarton E, Romberg R, Nieuwenhuijs D, Teppema LJ, Vuyk J, Schraag S, Dahan A

Abteilung fur Anasthesiologie, Universitatsklinik Leiden, Leiden, Niederlande.

Ventilatory control in humans depends on complex mechanisms which aim to maintain a cellular CO2-, O2- and H(+)-homeostasis under physiological conditions. This regulation is based on chemical control which predominantly acts via peripheral chemoreceptors in the carotid bodies and central chemoreceptors in the ventral medulla of the brainstem on the one hand, and behavioural control on the other, by which it is possible to adapt respiration to conditions of daily living. The influence of anaesthesia and related conditions may depress respiration and have a sustained effect on ventilatory control. Perioperative respiratory depression remains a serious clinical problem in perioperative medicine. This review will give an overview of ventilatory control and discuss the most relevant responses, describe the effects of pain, anaesthetics and opioids on ventilatory control and their interaction. The current body of knowledge is put into perspective to identify patients at risk for perioperative respiratory depression.

Publication Types:

• Review
• Review, tutorial

PMID: 12063719, UI: 22059545

Anaesthesist 2002 Apr;51(4):239-47

[Man at risk. Preventive strategies and risk management for patient safety.]

Grube C, Schaper N, Graf BM

Klinik fur Anaesthesiologie, Ruprecht-Karls-Universitat Heidelberg Im Neuenheimer Feld 110, 69120 Heidelberg. Christoph_Grube@med.uni-heidelberg.de

Anaesthesia-related risk has been significantly reduced within the last decade. Nevertheless the risk and the possibility of dying or suffering permanent damage still exist. To improve patient safety, risk assessment and analysis must lead to the development of preventive strategies. For this purpose anaesthesia can rely on the concepts of other "high reliability" organisations such as aviation or nuclear power plants. Analyses of critical incidents in the different fields confirm that next to technical problems human factors account for most of the preventable mishaps. Human factors are responsible for individual mistakes as well as for organisational errors. Therefore besides traditional concepts of risk reduction (e.g. guidelines) new strategies (e.g. full-scale simulation) must be applied to minimise the negative impact of human factors on patient safety. Risk management has to consider technical, organisational and human factors to implement a higher standard of patient safety.

Publication Types:

• Review
• Review, tutorial

PMID: 12063713, UI: 22059539

Anaesthesist 2002 Apr;51(4):237-8

[Risk management in anesthesiology--a continuing challenge.]

Martin E

Publication Types:

• Editorial

PMID: 12063712, UI: 22059538

Ann Fr Anesth Reanim 2002 May;21 Suppl 1:7s-23s

Reducing the risk of anaphylaxis during anaesthesia. Abbreviated text.

[Medline record in process]

PMID: 12091990, UI: 22087349

Eur J Anaesthesiol 2002 May;19(5):350-6

Comparison of the effects of remifentanil or fentanyl on anaesthetic induction characteristics of propofol, thiopental or etomidate.

Wilhelm W, Biedler A, Huppert A, Kreuer S, Bucheler O, Ziegenfuss T, Larsen R

University of Saarland, Department of Anaesthesiology and Intensive Care Medicine, Homburg/Saar, Germany. wolfram.wilhelm@t-online.de

[Medline record in process]

BACKGROUND AND OBJECTIVE: This prospective, randomized, double-blinded study was designed to compare the effects of remifentanil or fentanyl on anaesthetic induction characteristics of propofol, thiopental or etomidate. METHODS: Seventy-two patients were enrolled in six groups of 12 individuals each. In three groups, fentanyl was given as a bolus dose of 1.5 microg kg(-1), whereas the others received a remifentanil infusion at 0.5 microg kg(-1) min(-1). Five minutes later, propofol, thiopental or etomidate were titrated to a state of unresponsiveness. Assessment included the amounts of drug necessary for induction, haemodynamics and the times to apnoea, loss of eyelash reflex, and the release of a water-filled syringe held in the patient's hand. RESULTS: Induction times to loss of the eyelash reflex were significantly shorter in the remifentanil than in the fentanyl groups: with propofol 50.7 +/- 13.6s (mean +/- SD) versus 74.9 +/- 27.0s (P < 0.01), with thiopental 42.9 +/- 16.8s versus 77.2 +/- 27.8s (P < 0.01) and with etomidate 54.7 +/- 17.6s versus 72.3 +/- 24.0s (P < 0.05). The times to respiratory arrest or for the syringe to fall were significantly shorter with remifentanil than with fentanyl for propofol and for thiopental, but not for etomidate. In terms of dosages per kg body weight necessary to achieve unresponsiveness, less propofol (-29%, P < 0.05), thiopental (-25%, P < 0.05) or etomidate (-32%, P < 0.01) was necessary with remifentanil than with fentanyl. Haemodynamic responses to tracheal intubation were controlled more effectively with remifentanil. However, within the remifentanil groups, mean arterial pressure significantly decreased during induction: -26% with propofol, -181% with thiopental and -14% with etomidate (all P < 0.01). CONCLUSIONS: During anaesthetic induction, a remifentanil infusion of 0.5 microg kg(-1) min(-1) over 5 min is a suitable alternative to a 1.5 microg kg(-1) bolus dose of fentanyl: induction times are shorter with reduced amounts of propofol, thiopental or etomidate.

PMID: 12095015, UI: 22089447

Eur J Anaesthesiol 2002 Jun;19(6):460-2

Ventricular asystole and complete heart block after thoracic epidural analgesia for thymectomy.

Lin TC, Hsu CH, Kong SS, Cherng CH, Wong CS

[Medline record in process]

Publication Types:

• Letter

PMID: 12094924, UI: 22089356

Eur J Anaesthesiol 2002 Jun;19(6):452-4

Effect of aminophylline on recovery from sevoflurane anaesthesia.

Turan A, Memis D, Karamanlioglu B, Colak A, Pamukcu Z, Turan N

Trakya University, Medical Faculty, Department of Anaesthesiology and Reanimation, Edirne, Turkey. alpit@mynet.com

[Medline record in process]

BACKGROUND AND OBJECTIVE: In this randomized, double-blind study, we aimed to investigate the effect of aminophylline on recovery from sevoflurane. METHODS: One-hundred ASA I-II patients scheduled for elective surgery were randomly divided into two groups receiving either NaCl 0.9% (Group 1, n = 50) or aminophylline 5mg kg(-1) (Group 2, n = 50). All patients were premedicated with atropine 0.01 mgkg(-1) and midazolam 0.06mgkg(-1) intramuscularly. Anaesthesia was induced with propofol 2mg kg(-1) for muscle relaxation, and atracurium 0.5 mg kg(-1) was maintained with sevoflurane 2% in 50% oxygen and nitrous oxide. Further atracurium (0.1 mgkg(-1) was given when needed. Aminophylline or saline was given after sevoflurane was discontinued. Heart rate, mean arterial pressure, peripheral oxygen saturation, the duration of anaesthesia and recovery times (eye opening, verbal response, extubation and successful performance of arithmetical calculations) were recorded. RESULTS: There were no statistically significant differences in mean arterial pressure, peripheral oxygen saturation and anaesthesia time between the two groups. Heart rate increased significantly (P < 0.05) after aminophylline and was also higher than in the placebo group. Recovery times were significantly shorter (P < 0.001) in the patients receiving aminophylline. CONCLUSIONS: Aminophylline speeded recovery after sevoflurane anaesthesia and it may have some advantage in anaesthesia practice for patients.

PMID: 12094921, UI: 22089353

Eur J Anaesthesiol 2002 Jun;19(6):436-41

Psychomotor performance after short-term anaesthesia.

Haavisto E, Kauranen K

Oulu University Central Hospital, Department of Anaesthesiology, Finland.

[Medline record in process]

BACKGROUND AND OBJECTIVE: The aim was to examine the immediate effects of short-term anaesthesia on the different components of psychomotor performance of the upper extremity and cognitive functions, and to find out if there were any differences in the sensitivities of the different tests. The measured psychomotor aspects were simple reaction time, choice reaction time, speed of movement, index finger-tapping speed, co-ordination, visual spatial memory capacity, digit-symbol substitution and the Maddox Wing test. METHODS: The subjects were 30 female patients aged 24-50 yr who had been through a minor gynaecological operation. Anaesthesia had been induced with propofol and alfentanil. The measurements were mainly made with the HPM/BEP system, and the tests were performed 1 h before the anaesthesia and immediately after the wake-up. RESULTS: Short-term anaesthesia prolonged the simple reaction time by 7% and the choice reaction times by 25% (one-choice) and 7% (two-choice) and decreased the speed of movement by 10% (one-choice) and 19% (two-choice), index finger-tapping speed by 7% and co-ordination by 7%. In addition, visual spatial memory capacity decreased by 21%, digit-symbol substitution increased by 5% and the Maddox Wing test increased by 68%. CONCLUSIONS: Based on the results, it seems that short-term anaesthesia reduces both signal processing at the central level, and motor control and co-ordination of movements at the peripheral level, and has a decreasing effect on motor performance in the above-mentioned aspects measured immediately after wake-up.

PMID: 12094918, UI: 22089350

Eur J Anaesthesiol 2002 Jun;19(6):428-35

Effects of induction of anaesthesia with sufentanil and positive-pressure ventilation on the intra- to extrathoracic volume distribution.

von Spiegel T, Giannaris S, Schorn B, Scholz M, Wietasch GJ, Hoeft A

University of Bonn, Department of Anaesthesiology and Intensive Care Medicine, Germany. vspiegel@ukb.uni-bonn.de

[Medline record in process]

BACKGROUND AND OBJECTIVE: Induction of general anaesthesia in combination with positive-pressure ventilation is often associated with a significant decrease of arterial pressure. A decreased preload may contribute to this phenomenon. The aim was to investigate whether a change in cardiac filling occurs following the induction of general anaesthesia with sufentanil under typical clinical conditions. METHODS: Fifteen patients scheduled for elective coronary bypass grafting were studied immediately before surgery. In addition to standard monitors, a transpulmonary double-indicator dilution technique measured in vivo intrathoracic blood volume, global end-diastolic volume and total circulating blood volume. For induction of anaesthesia 2 microg kg(-1) sufentanil was given. Measurements were performed awake and after the induction of anaesthesia, intubation and mechanical ventilation of the lungs. RESULTS: To maintain arterial pressure during the induction period within -20% of baseline pressure, on average 22 +/- 6mLkg(-1) crystalloids and 8 +/- 6mLkg(-1) colloids were given. Despite these amounts of fluid, cardiac filling was decreased, whereas circulating blood volume increased significantly. Both central venous pressure and pulmonary capillary wedge pressure increased. CONCLUSIONS: Induction of general anaesthesia with positive-pressure ventilation is regularly associated with a blood volume shift from intra- to extrathoracic compartments. Even in low-dose opioid monoanaesthesia with sufentanil--often regarded as relatively inert in haemodynamic terms--the phenomenon could be demonstrated as the primary cause of the often-observed decrease of arterial pressure. It seems, therefore, rationally justified to restore cardiac filling by generous administration of intravenous fluids, at least in patients with unaffected cardiac pump function. During induction of anaesthesia, central venous pressure and pulmonary capillary wedge pressure do not reliably indicate cardiac filling.

PMID: 12094917, UI: 22089349

Pediatrics 2002 Jul;110(1 Pt 1):196-7; discussion 196-7

Epidural analgesia and fever.

Haque KN, Radford P

[Medline record in process]

Publication Types:

• Letter

PMID: 12093977, UI: 22089035