Alternative coupling systems for regional anaesthetic
equipment.
Wildsmith JA
Publication Types:
Letter
PMID: 12109428, UI: 22103855
Anaesthesia 2002 Jul;57(7):712; discussion 713
Anions and the anaesthetist 1.
Guest T, Venn R, Forni LG
Publication Types:
Letter
PMID: 12109419, UI: 22103838
Anaesthesia 2002 Jul;57(7):712-3; discussion 713
Anions and the anaesthetist 2.
Vincent A
Publication Types:
Letter
PMID: 12109418, UI: 22103839
Anaesthesia 2002 Jul;57(7):711-2
Will competency assessment improve the training and skills
of the trainee anaesthetist?
Patel BS, Feerick A
Publication Types:
Letter
PMID: 12109417, UI: 22103836
Anaesthesia 2002 Jul;57(7):697-701
Patient feedback on the anaesthetist's performance during
the pre-operative visit.
Carnie J
Birmingham Heartlands and Solihull NHS Hospitals, Bordesley
Green East, Birmingham B9 5SS, UK. CarnieJ@heartsol.wmids.nhs.uk
A questionnaire was devised from guidelines published by
the Royal College of Anaesthetists and the Association of
Anaesthetists of Great Britain and Ireland for the conduct
of the pre-operative interview and conduct of anaesthesia.
The responses to the questionnaire formed the basis of an
accumulative record of patient feedback on individual anaesthetist's
performance and used as one component of annual appraisal.
The median "desired answer" and "overall
dissatisfaction" percentages, and the "desired
: undesired answer" ratio for consultants and non-training
grade doctors from 835 patients at a large Acute District
General Hospital were 92%, 0.6% and 12:1, respectively.
PMID: 12109415, UI: 22103833
Anaesthesia 2002 Jul;57(7):690-2
Use of the common gas outlet for the administration of
supplemental oxygen during Caesarean section under regional
anaesthesia.
Stone AG, Howell PR
Bart's and the London School of Anaesthesia, Royal London
Hospital, London E1 1BB, UK.
A postal survey investigating the administration of supplemental
oxygen to women undergoing Caesarean section under regional
anaesthesia was sent to 262 lead consultant obstetric anaesthetists
in the UK. Two hundred and fifteen (82) completed questionnaires
were returned. In 139 units (65) supplemental oxygen was
administered routinely to all Caesarean sections under regional
techniques, while in 71 (33), supplemental oxygen was given
only if the procedure is an emergency or if there was evidence
of fetal or maternal compromise. In 196 units (91), the
common gas outlet was used as the source of supplemental
oxygen, with the standard anaesthetic breathing circuit
disconnected in 194 (90) and the vaporisers left on the
back bar in 191 (89). Critical incidents had occurred in
39 (18) of units using the common gas outlet as a source
of supplemental oxygen and 63 (30) had experience of critical
incidents with this practice in a non-obstetric setting.
We suggest that supplemental oxygen is more safely administered
from a separate and dedicated source.
PMID: 12109413, UI: 22103831
Br Dent J 2002 Jun 15;192(11):607
General anaesthesia.
Culver PA
[Medline record in process]
Publication Types:
Letter
PMID: 12108939, UI: 22101257
Br J Anaesth 2002 May;88(5):743; discussion 744
In defence of paravertebral blockade.
Thomas PW, Sanders D, Sweeting CJ, Berrisford RG
Publication Types:
Letter
PMID: 12067025, UI: 22061773
Br J Anaesth 2002 May;88(5):734-8
Peripartum management of a patient with Glanzmann's thrombasthenia
using Thrombelastograph.
Monte S, Lyons G
Department of Obstetric Anaesthesia, St James' University
Hospital, Leeds, UK.
We describe the perioperative management of a 31-yr-old
primipara with Glanzmann's thrombasthenia, who required
urgent Caesarean delivery at 33 weeks' gestation. Peripartum
haemorrhage was inevitable and was pre-empted by transfusion
of multiple blood products, the effects of which were monitored
by Thrombelastograph. The blood products given are discussed.
PMID: 12067020, UI: 22061769
Br J Anaesth 2002 May;88(5):726-8
Airway management in an infant with congenital centrofacial
dysgenesia.
Carenzi B, Corso RM, Stellino V, Carlino GD, Tonini C,
Rossini L, Gentili G
Department of Neurosurgery, A.S.L. Citta di Bologna, Ospedale
Bellaria-C.A. Pizzardi, Italy.
The use of a laryngeal mask airway (LMA) on two occasions,
in a 53-day-old and 270-day-old male infant with Tessier
N.3 and N.4 facial defects, using sedation and topical anaesthesia
is described. The LMA was used to manage the airway and
facilitate inhalation induction of anaesthesia as the facial
deformities were thought to be too extensive for the safe
use of a facemask. The LMA is an alternative to a facemask
and secures the airway and facilitates the inhalation induction
of anaesthesia in paediatric patients with severe facial
deformities.
PMID: 12067017, UI: 22061766
Br J Anaesth 2002 May;88(5):722-4
Management of massive air leak following intubation injury
in a very low birth weight infant.
Mendez R, Pensado A, Tellado M, Somoza I, Liras J, Pais
E, Vela D
Department of Pediatric Surgery, Children's Hospital Teresa
Herrera, A Coruna, Spain.
Perforation of an infant's trachea after orotracheal intubation
for general anaesthesia is a rarely described serious complication.
This article reports an unusual case of laceration of the
trachea in an 8-week-old infant with a history of prolonged
neonatal intubation needed to treat hyaline membrane disease.
After diagnosis the tracheal injury was managed conservatively.
Factors involved in the occurrence of the injury and its
management are discussed.
PMID: 12067015, UI: 22061764
Br J Anaesth 2002 May;88(5):711-3
The output of two sevoflurane vaporizers in the presence
of helium.
Carvalho B, Sanders D
Department of Anaesthesia, Royal Devon and Exeter Healthcare
NHS Trust, Exeter, UK.
BACKGROUND: Modern vaporizers are designed to deliver accurate
and stable concentrations of volatile anaesthetic agents.
Carrier gas composition may adversely affect the output
from vaporizers. No previous study has tested helium in
combination with sevoflurane vaporizers, a clinically useful
combination especially in anaesthesia for upper airway obstruction.
METHODS: This study evaluated the effect of increasing helium
concentrations, carrier gas flow rates and varying the vaporizer
dial setting on the output from Blease Datum and Drager
Vapor 19.3 sevoflurane vaporizers. RESULTS: The presence
of helium in the carrier gas had negligible effects on the
output from both of the sevoflurane vaporizers tested. Carrier
gas flow rates had the greatest effect on output but changes
were within +/- 10% of baseline. CONCLUSION: Helium/oxygen
mixtures can be used with these vaporizers without adversely
affecting their performance.
Publication Types:
Evaluation studies
PMID: 12067011, UI: 22061760
Br J Anaesth 2002 May;88(5):632-6
Ultrasonographic assessment of topographic anatomy in
volunteers suggests a modification of the infraclavicular
vertical brachial plexus block.
Greher M, Retzl G, Niel P, Kamolz L, Marhofer P, Kapral
S
Department of Anaesthesia and General Intensive Care, University
Hospital of Vienna, Austria.
BACKGROUND: The infraclavicular vertical brachial plexus
block, first described by Kilka and coworkers, offers a
more proximal spread of anaesthesia for the upper extremity
than the classic axillary approach. In this technique, the
puncture site is defined as lying at the exact centre of
an infraclavicular line (k) between the jugular fossa and
the ventral process of the acromion. Our study was designed
to determine whether the point so defined (P) corresponds
with the optimal puncture site determined sonographically
(S) and to develop an improved prediction model. METHOD:
High-resolution ultrasonography was carried out in 59 volunteers
to visualize the plexus. Sonography-derived distances and
morphometric measurements were used to test accuracy and
calculate multiple regressions. RESULTS: We found a clear
trend towards a more lateral puncture site. In women, S
was significantly (P<0.001) lateral (8 mm) to P. The
overall accuracy of the infraclavicular vertical brachial
plexus block technique was not sufficient to predict the
optimal puncture site reliably. Our resulting improved prediction
model is valid for both sexes and is based not just on the
centre point but on the absolute length of k (22-22.5 cm).
We found that for every 1 cm decrease in k the optimal puncture
site moved 2 mm laterally from the exact centre of k, and
for every 1 cm increase in k it moved 2 mm medially. CONCLUSIONS:
The suggested modification should help to increase the success
rate of the infraclavicular vertical brachial plexus block
while decreasing the rate of potentially severe complications,
although individual ultrasonographic guidance is to be recommended
whenever possible.
PMID: 12066998, UI: 22061747
Br J Anaesth 2002 May;88(5):621-4
Ultrasound-guided nerve blocks.
Peterson MK, Millar FA, Sheppard DG
Publication Types:
Comment
Editorial
PMID: 12066995, UI: 22061744
J Clin Monit Comput 2002 Jan;17(1):53-60
Application of artificial neural networks as an indicator
of awareness with recall during general anaesthesia.
Ranta SO, Hynynen M, Rasanen J
Department of Anaesthesia, Helsinki University Central
Hospital, Finland. seppo.ranta@hus.fi
[Medline record in process]
OBJECTIVE: Awareness with recall is a rare but serious
complication of general anaesthesia with an incidence ranging
from 0.1%-0.7%. In the absence of a reliable depth-of-anaesthesia
monitor, attempts have been made to predict awareness from
intraoperative haemodynamic monitoring data, with little
success. Artificial neural networks can sometimes detect
relationships between input and output variables even when
conventional methods fail. Therefore, we subjected standard
intraoperative monitoring data to both artificial neural
models and conventional statistical methods in an attempt
to predict awareness with recall. METHODS: Anaesthesia records
from 33 patients with awareness and 510 patients without
awareness were collected. Summary data (mean, maximum, and
minimum) of end-tidal carbon dioxide concentration, arterial
blood oxygen saturation, systolic and diastolic blood pressure,
and heart rate were calculated for each patient. These data
were subjected to an analysis by artificial neural networks
and by Poisson regression. RESULTS: The two best neural
models both had sensitivity and specificity of 23% and 98%,
respectively. The models have high specificity, and in view
of the low incidence of awareness, a high negative predictive
value. The prediction probabilities P(k) (SE) for the best
neural models were 0.66 (0.08) and 0.60 (0.10), respectively.
In the Poisson regression, there were significant differences
in systolic and diastolic blood pressures and heart rate
between patients with and without awareness. CONCLUSIONS:
A prediction indicating awareness by the network is very
suggestive of true awareness and recall. Blood pressure
and heart rate are significantly higher on average in patients
with awareness than in patients without. In an individual
patient, however, none of our artificial neural models can
detect awareness sufficiently reliably.
PMID: 12102250, UI: 22096563
J Clin Monit Comput 2002 Jan;17(1):31-6
Bayesian probabilistic network modeling of remifentanil
and propofol interaction on wakeup time after closed-loop
controlled anesthesia.
Bothtner U, Milne SE, Kenny GN, Georgieff M, Schraag S
Department of Anesthesiology, University of Ulm, Germany.
Ulrich.Bothner@medizin.uni-ulm.de
[Medline record in process]
OBJECTIVE: Until now, the knowledge of combining anesthetics
to obtain an adequate level of anesthesia and to economize
wakeup time has been empirical and difficult to represent
in quantitative models. Since there is no reason to expect
that the effect of non-opioid and opioid anesthetics can
be modeled in a simple linear manner, the use of a new computational
approach with Bayesian belief network software is demonstrated.
METHODS: A data set from a pharmacodynamic study was used
where remifentanil was randomly given in three fixed target
concentrations (2, 4, and 8 ng/ml) to 62 subjects. Target
concentrations of propofol were controlled according to
the closed-loop system feedback of the auditory evoked potential
index to render modeling unbiased by the level of anesthesia.
Time to open eyes was measured to represent wakeup time
after surgery. The NETICA version 1.37 software was used
on a personal computer for network building, validation,
and prediction. RESULTS: After the learning phase, the network
was used to generate a series of random cases whose probability
distribution matches that of the compiled network. The sampling
algorithms used are precise, so that the frequencies of
the simulated cases will exactly approach the probabilities
of the network and that of the data learned. The graphical
display of the predicted wakeup time shows less variability
but a more complex interaction pattern than with the unadjusted
original data. CONCLUSIONS: Model building and evaluation
with Bayesian networks does not depend on underlying linear
relationships. Bayesian relationships represent true features
of the represented data sample. Data may be sparse, uncertain,
stochastic, or imprecise. Multiple platform software that
is easy to use is increasingly available. Bayesian networks
promise to be versatile tools for building valid, nonlinear,
predictive instruments to further gain insight into the
complex interaction of anesthetics.
PMID: 12102247, UI: 22096560
Neurosci Lett 2002 May 31;325(1):17-20
The association of cholecystokinin-A receptor expression
with the responsiveness of electroacupuncture analgesic
effects in rat.
Lee G, Rho S, Shin M, Hong M, Min B, Bae H
Department of East-West Medicine, Graduate School, Kyunghee
University, Seoul, South Korea.
The purpose of this study is to determine whether the level
of cholecystokinin (CCK) receptor expression causes the
differences between the responder and non-responder to electroacupuncture
mediated analgesic effects. Male Sprague-Dawley rats were
stimulated at the Zusanli (ST36) acupoint in the absence
of any anesthetics and holders. The tail flick latency test
was performed to quantify analgesic effects and then the
responder and non-responder groups were classified. The
hypothalamus of each group was dissected and RNA was purified.
The amount of mRNA expression of CCK-A and CCK-B receptors
was determined by reverse transcription-polymerase chain
reaction. The results show that CCK-A receptors are significantly
more expressed in non-responders than responders, whereas
CCK-B receptor expression is similar in both groups.
PMID: 12023057, UI: 22018343
Obstet Gynecol 2002 Jul;100(1):177-91
ACOG Practice Bulletin. Obstetric analgesial and anesthesia.
Goetzl LM
[Medline record in process]
Labor results in severe pain for many women. There is no
other circumstance in which it is considered acceptable
for a person to experience untreated severe pain, amenable
to safe intervention, while under a physician's care. In
the absence of a medical contraindication, maternal request
is a sufficient medical indication for pain relief during
labor. Pain management should be provided whenever it is
medically indicated. The purpose of this document is to
help obstetrician-gynecologists understand the available
methods of pain relief to facilitate communication with
their colleagues in the field of anesthesia, thereby, optimizing
patient comfort while minimizing the potential for maternal
and neonatal morbidity and mortality.
Publication Types:
Guideline
Practice guideline
PMID: 12100826, UI: 22096084
Obstet Gynecol 2002 Jul;100(1):46-50
Epidural analgesia lengthens the friedman active phase
of labor.
Alexander JM, Sharma SK, McIntire DD, Leveno KJ
Department of Obstetrics and Gynecology, The University
of Texas Southwestern Medical Center at Dallas, Dallas,
Texas, USA
[Medline record in process]
OBJECTIVE:To estimate the effect of epidural analgesia
on the Friedman labor curve.METHODS:This study was a secondary
analysis of a previously reported randomized trial of the
effects of patient-controlled epidural analgesia during
labor compared with patient-controlled meperidine on cesarean
delivery rate. All subjects had a singleton, cephalic, nonanomalous
fetus at or beyond 37 weeks' gestation. This secondary analysis
was limited to women who had cervical dilatation commencing
of at least 3 cm (ie, active phase of labor).RESULTS:A total
of 459 women were randomized. Twenty-five women were excluded
for a cervix less than 3 cm dilated, leaving 220 women allocated
to patient-controlled epidural analgesia and 214 to patient-controlled
intravenous meperidine available for analysis. There were
no significant demographic differences between the two groups,
including age, race, gestational age, and cervix on admission.
The active phase of labor was 1 hour longer in the epidural-treated
group (6.0 +/- 3.2 hours versus 5.0 +/- 3.2 hours, P <.001).
The rate of cervical dilation was significantly less with
epidural analgesia (1.4 cm/h versus 1.6 cm/h, P <.002).
The duration of the second stage tended to be longer in
the epidural group (1.1 +/- 1.5 hours versus 0.9 +/- 1.0
hours, P =.079).CONCLUSION:Epidural analgesia prolonged
the active phase of labor by 1 hour compared with Friedman's
original criteria.
Difficult airway management of a child impaled through
the neck.
Mohiuddin S, Martin TW, Mayhew JF
Publication Types:
Letter
PMID: 11982854, UI: 21980439
Paediatr Anaesth 2002 May;12(4):356-61
Traumatic aneurysm of the internal carotid artery in an
infant: a surprise diagnosis.
Chambers N, Hampson-Evans D, Patwardhan K, Murdoch L
Department of Anaesthesia and Paediatric Intensive Care,
St George's Healthcare NHS Trust, Tooting, London, UK.
Isolated aneurysm of the extracranial section of the internal
carotid artery has been reported in children but never,
to our knowledge, in an infant. It can represent a major
anaesthetic challenge with compromise of both airway and
cerebral perfusion and the associated risks of rupture.
We report on an 11-month-old infant, who had undergone an
examination under anaesthesia of her nose and throat for
epistaxis and gastrointestinal endoscopy due to apparent
gastrointestinal bleeding shortly before presenting to us
with signs of rapidly progressive upper airway obstruction.
Emergency examination under anaesthesia revealed a large
pulsatile mass in the posterior nasopharynx which, on subsequent
radiological investigation, was revealed to be a large pseudoaneurysm
of the right internal carotid artery, obstructing distal
flow. An apparently minor episode of trauma had occurred
around the time of the first nosebleed; she had allegedly
fallen onto her face with a spoon in her mouth.
PMID: 11982845, UI: 21980430
Paediatr Anaesth 2002 May;12(4):351-5
Myotonia dystrophica and spinal surgery.
Colovic V, Walker RW
Royal Manchester Children's Hospital, Pendlebury, Manchester,
UK.
Two cases of patients suffering from the congenital form
of myotonia dystrophica under going spinal surgery are presented.
Both patients had major complications, including cardiac
arrhythmias, postoperative wound infection and more minor
complications, such as sedation and opioid sensitivity.
However, the most notable complication resulting in long-term
morbidity was the deterioration of bulbar muscular function
in one of the patients. This resulted in recurrent aspiration
pneumonia and the need for a tracheostomy. This serious
complication has not previously been reported following
surgery.
PMID: 11982844, UI: 21980429
Paediatr Anaesth 2002 May;12(4):313-6
Diffusion of ketoprofen into the cerebrospinal fluid of
young children.
Kokki H, Karvinen M, Jekunen A
Department of Anaesthesiology and Intensive Care, Kuopio
University Hospital, Kuopio, Finland. hannu.kokki@kuh.fi
BACKGROUND: The objective was to examine whether or not
ketoprofen enters the cerebrospinal fluid after a single
oral dose of 1 mg.kg-1 syrup, and to find out what is the
lowest plasma concentration that will achieve a measurable
level in the cerebrospinal fluid. METHODS: We measured ketoprofen
concentrations both in plasma and cerebrospinal fluid of
10 young and healthy children (aged 9-86 months) after surgery
with spinal anaesthesia. Samples of cerebrospinal fluid
were collected 30 min after drug administration, at the
same time as venous blood samples. A validated high-performance
liquid chromatography method with a lower limit of 0.02
microg x ml(-1) was used to detect ketoprofen concentrations
in cerebrospinal fluid and plasma. RESULTS: Ketoprofen was
detectable in the cerebrospinal fluid only in the child
who had the highest plasma concentration, 7.4 microg x ml(-1),
while at plasma concentrations 6.5 microg x ml(-1) or less,
cerebrospinal fluid (CSF) concentrations remained unmeasurable.
The detected CSF/plasma ratio was 0.008. CONCLUSIONS: These
results indicate that ketoprofen at a dose of 1 mg x kg(-1)
is too low to produce measurable CSF levels within 30 min
of oral administration.
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.
