Ultimo Aggiornamento: 31 Dicembre 2002

41 citations found

Acta Anaesthesiol Scand 2002 May;46(5):616-7

Tachycardia and convulsions induced by accidental intravascular ropivacaine injection during sciatic block.

Petitjeans F, Mion G, Puidupin M, Tourtier JP, Hutson C, Saissy JM

Department of Anesthesia and Intensive Care, Begin Military Hospital, Saint Mande, France. cpetitjeans@wanadoo.fr

Ropivacaine, a recently introduced local anesthetic of the amide family (1), seems to show less toxicity than bupivacaine (2-4). Nevertheless, both neurologic and cardiovascular toxicities are possible. Six cases of ropivacaine-induced convulsions have previously been reported (5-10), of which three cases also showed cardiovascular toxicity. In three cases, total plasma concentrations were measured (Table 1).

PMID: 12027861, UI: 22023607

Acta Anaesthesiol Scand 2002 May;46(5):611-5

Catheter-related epidural abscesses -- don't wait for neurological deficits.

Royakkers AA, Willigers H, van der Ven AJ, Wilmink J, Durieux M, van Kleef M

Department of Anesthesiology, University Hospital Maastricht, Maastricht, The Netherlands. a.royakkers@planet.nl

Epidural abscess is a rare but serious complication of epidural anesthesia for peri- and postoperative analgesia. It is feared because of possible persistent neurological deficits. Epidural abscess presents mostly with a classic triad of symptoms: back pain, fever and variable neurological signs and symptoms. When neurologic signs or symptoms develop, MRI scanning is the diagnostic procedure of choice. The therapy of choice is intravenous antibiotics for more than 4 weeks with or without a laminectomy or drainage. In the present paper we describe three patients with epidural abscesses presented during a time period of 1 year in our hospital. In each case, patients developed local signs of infection and systemic signs, but no neurological symptoms. Based on these cases and a review of the literature, we propose that MRI scanning should be strongly considered when patients present with systemic and local signs, even in the absence of neurological deficits.

PMID: 12027860, UI: 22023606

Acta Anaesthesiol Scand 2002 May;46(5):609-10

Altered response to intravenous thiopental and succinylcholine in acute amphetamine abuse.

Stibolt O, Wachowiak-Andersen G

Department M, Copenhagen Hospital Corporation, Sct. Hans Hospital, Roskilde, Denmark.

Substance abuse has become increasingly prevalent: illegal drugs have profound and varied physiologic effects which create a large potential for anesthetic problems and complications (1). Amphetamine is a strong sympathomimetic and may therefore influence the course of anesthesia. We report the case of a patient with acute amphetamine abuse presenting difficulties during anesthesia.

PMID: 12027859, UI: 22023605

Acta Anaesthesiol Scand 2002 May;46(5):603-6

Coiling of lumbar epidural catheters.

Lim YJ, Bahk JH, Ahn WS, Lee SC

Department of Anesthesiology and Clinical Research Institute, Seoul National University Hospital, Korea. limyjin@snu.ac.kr

BACKGROUND: The difficulties in threading an epidural catheter to vertebral levels remote to the puncture level have been well documented. This study was undertaken to determine the length that a single orifice epidural catheter can be threaded into the lumbar space without coiling (coiling length), and whether this is affected by the direction of the epidural needle bevel. METHODS: Forty-five young male patients scheduled for surgery under epidural analgesia were enrolled. The epidural space was identified using a midline approach at the L(2-3) or L(3-4) interspace with the loss of resistance to air technique. A 19-G single-orifice epidural catheter (Flextip Plus, Arrow International, Inc, Reading, PA, USA) was inserted through a Tuohy needle oriented either cephalad (n=20) or caudad (n=25). During insertion, the path and the position of the catheter tip was determined by fluoroscopy using iohexol dye. RESULTS: The median coiling length was 2.8 cm, ranging from 1.0 to 8.0 cm. Only 13% of epidural catheters could be threaded 4 cm beyond the tip of the needle without coiling. No significant difference was found in coiling length between the cephalad group (2.9 cm) and the caudad group (2.5 cm). CONCLUSION: This study demonstrates that coiling length is independent of whether the bevel of the Tuohy needle is directed cephalad or caudad. We recommend that an optimal insertion depth of an end-hole single orifice catheter is 3 cm.

Publication Types:

• Clinical trial

PMID: 12027857, UI: 22023603

Acta Anaesthesiol Scand 2002 May;46(5):561-6

Monitoring arterial blood pressure during whole body hyperthermia.

Kerner T, Deja M, Ahlers O, Hildebrandt B, Dieing A, Riess H, Wust P, Gerlach H

Department of Anesthesiology and Critical Care Medicine, Charite Medical Center, Virchow Hospital, Humboldt University, Berlin. thoralf.kerner@charite.de

BACKGROUND: For monitoring of arterial blood pressure (ABP) during whole body hyperthermia (WBH) different methods have been recommended. This investigation was performed to evaluate the agreement of invasive measurements at various sites, and to compare invasive and non-invasive methods of ABP monitoring under conditions of a heat-induced extreme vasodilation. METHODS: In 19 patients, 48 treatments with WBH were performed. Measurements of ABP in the radial and femoral artery by oscillometry and by sphygmomanometry were taken at four temperature levels during WBH (37, 40, 41.8 and 39 degrees C). RESULTS: Significant differences were observed between invasive and non-invasive methods for systolic ABP, with higher values for non-invasive measurements. When compared with both invasive measurements for diastolic blood pressures, sphygmomanometry gave higher values and oscillometry gave lower values. Sphygmomanometry also showed higher values for mean ABP compared with all other techniques, while measurements in radial and femoral artery and by oscillometry only differed by approximately 5 mmHg. CONCLUSION: The mean arterial pressure and not the systolic and/or diastolic pressure should guide hemodynamic management during WBH. The sphygmomanometric technique is not recommended for use during hyperthermia.

Publication Types:

• Clinical trial

PMID: 12027851, UI: 22023597

Acta Anaesthesiol Scand 2002 May;46(5):552-60

Effect of CO(2) pneumoperitoneum on ventilation-perfusion relationships during laparoscopic cholecystectomy.

Andersson L, Lagerstrand L, Thorne A, Sollevi A, Brodin LA, Odeberg-Wernerman S

Department of Anaesthesiology, Huddinge University Hospital, Stockholm, Sweden. lena.anderson@anaesth.hs.sll.se

BACKGROUND: Previous studies have shown that pneumoperitoneum transiently reduces venous admixture as assessed by a calculation based on the shunt formula, and increases arterial oxygen tension (PaO(2)) in patients without heart or lung disease. The aim of the present study was to further explore the relationship between ventilation-perfusion (V(A)/Q) before and during pneumoperitoneum by using the multiple inert gas technique. METHODS: Nine patients without heart or lung disease (ASA I), with a mean age of 42 years, scheduled for laparoscopic cholecystectomy were included. After premedication and induction of anaesthesia, radial artery and pulmonary artery catheters were introduced percutaneously. The V(A)Q relationships were evaluated by the multiple inert gas elimination technique before and during pneumoperitoneum to obtain a direct measure of the pulmonary shunt. RESULTS: Induction of pneumoperitoneum decreased the pulmonary shunt from 5.8 (4.5) to 4.1 (3.2)% (P<0.05) and increased PaO(2) from 21.7 (5.9) to 24.7 (4.8) kPa (P<0.01). During surgery, the shunt increased from 3.2 (2.8) to 5.2 (3.4)% to the same level as before pneumoperitoneum induction. No area with low V(A)Q was seen. Dead space ventilation amounted to 20.0 (1.2)% in the supine position and did not change during the investigation. CONCLUSIONS: In patients without heart or lung disease, pneumoperitoneum at an intra-abdominal pressure level of 11-13 mmHg causes a transient reduction of the pulmonary shunt. The mechanisms underlying the present finding remain to be elucidated.

Publication Types:

• Clinical trial

PMID: 12027850, UI: 22023596

Acta Anaesthesiol Scand 2002 May;46(5):547-51

Biochemical markers for brain damage after cardiac surgery -- time profile and correlation with cognitive dysfunction.

Rasmussen LS, Christiansen M, Eliasen K, Sander-Jensen K, Moller JT

Department of Anaesthesia, Centre of Head and Orthopaedics, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark. Isr@rh.dk

BACKGROUND: Cerebral dysfunction is common after cardiac surgery and may be reflected in increasing blood concentrations of neuron specific enolase (NSE) and S-100 beta protein. The aim of the study was to determine the optimal timing of blood sampling. METHODS: We studied 15 patients undergoing coronary artery bypass grafting. Serum concentrations of NSE and S-100 beta protein were measured before surgery and after 12, 18, 24, 30, and 36 h. Neuropsychological testing was performed before surgery, at discharge from hospital and after 3 months. RESULTS: Serum concentrations of both NSE and S-100 beta protein increased significantly. At the first postoperative test, seven patients had cognitive dysfunction and a significant correlation was found between the composite z-score and the increase in the NSE level after 36 h (R = 0.76, P=0.001). The median increase in NSE after 36 h was 4.1 microg/l in patients having cognitive dysfunction and 0.9 microg/l in the remaining patients (P<0.05). No significant correlation was found between cognitive dysfunction and the increase in S-100 beta protein. After 3 months, no statistically significant correlation was found between either NSE or S-100 beta protein and cognitive dysfunction. CONCLUSION: NSE seems to be a useful blood marker for early cognitive dysfunction after coronary artery bypass grafting, optimal timing of blood sampling being at approximately 36 h postoperatively.

Publication Types:

• Clinical trial

PMID: 12027849, UI: 22023595

Acta Anaesthesiol Scand 2002 May;46(5):512-8

The pharmacodynamics and pharmacokinetics of mivacurium in children.

OStergaard D, Gatke MR, Berg H, Rasmussen SN, Viby-Mogensen J

Danish Cholinesterase Research Unit, Department of Anaesthesia and Intensive Care, Copenhagen University Hospital, Rigshospitalet, Denmark. dooe@herlevhosp.kbhamt.dk

BACKGROUND: In children, onset time and duration of action of mivacurium are shorter than in adults. Some suggest that this is due to differences in plasma cholinesterase (pChe), whereas others indicate that there is no difference. The purpose of this study was to evaluate the pharmacodynamics and pharmacokinetics of mivacurium in phenotypically normal children aged 3-6 and 10-14 years old, respectively. METHODS: Ten children aged 3-6 years and 10 children aged 10-14 years were studied during halothane anaesthesia. Before induction of anaesthesia, a blood sample was drawn to measure the pChe activity and phenotype. The neuromuscular block was monitored at the thumb using train-of-four (TOF) nerve stimulation every 12 s and mechanomyography. The times to different levels of neuromuscular recovery following mivacurium 0.2 mg/kg were recorded. The concentrations in venous blood of the three isomers and the metabolites of mivacurium were measured. RESULTS: No statistically significant difference was found in pChe activity or in the pharmacodynamics of mivacurium. The onset time was 1.4 min (0.8-1.9) median (range) and 1.3 min (1.1-1.9) and the time to first response to TOF nerve stimulation was 9.6 min (6.5-12.6) and 10.5 min (7.0-14.0) in young and older children, respectively. The pharmacokinetic data were too sparse to allow analysis of the two age groups separately (8 and 8 patients), hence the data were pooled. The median clearances of the cis-cis, the cis-trans, and the trans-trans isomer were 5.5, 51.0 and 30.5 ml/kg/min, respectively. CONCLUSION: Our data indicate that there are no major differences in pharmacodynamics or pharmacokinetics of mivacurium between young (3-6 years) and older (10-14 years) children.

Publication Types:

• Clinical trial
• Randomized controlled trial

PMID: 12027844, UI: 22023590

Acta Anaesthesiol Scand 2002 May;46(5):495-9

Sevoflurane requirements during ambulatory surgery: a clinical study with and without AEP-index guidance.

Assareh H, Anderson RE, Uusijarvi J, Jakobsson J

Departments of Orthopaedics, Sabbatsberg Hospital, Stockholm, Sweden.

BACKGROUND: Several monitors have been developed to measure anesthetic depth. The auditory evoked response uses an auditory signal to actively test the level of brain activity. The aim of the present study was to determine whether sevoflurane titration with A-line auditory guidance from the evoked potential monitor would reduce gas consumption and improve recovery times. METHODS: Patients (n=60, aged 18-65 years) undergoing elective knee arthroscopy were randomized to titrate the main anesthetic sevoflurane with O2:N2O (1:2), either clinically (30 patients) or in combination with a target auditory evoked potential index of 30+/-5 (30 patients) using the A-line monitor (version 1.4, Danmeter A/S; Odense, Denmark). Induction was supplemented with fentanyl, and randomized to 0.05, 0.10 and 0.15 mg immediately before propofol (10 in each group). Sevoflurane consumption and emergence times were the primary and secondary study end-points. RESULTS: Guidance from the A-line monitor did not reduce the sevoflurane consumption time or the emergence, regardless of the fentanyl dose. However, it did reduce the time from the recovery room to discharge eligibility (P<0.05). Sevoflurane consumption decreased inversely with the fentanyl dose (P<0.01), with no impact on emergence times. CONCLUSION: The auditory evoked potential index provided by the A-line monitor does not decrease sevoflurane consumption or emergence times for ambulatory knee arthroscopy.

Publication Types:

• Clinical trial
• Randomized controlled trial

PMID: 12027841, UI: 22023587

Anaesthesia 2002 Jul;57(7):693-7

Closed loop control of sedation for colonoscopy using the Bispectral Index.

Leslie K, Absalom A, Kenny GN

University Department of Anaesthesia, Southern General Hospital, Glasgow, Scotland, UK. kate.leslie@mh.org.au

Sixteen patients undergoing colonoscopy were sedated with propofol using a closed-loop control system guided by the Bispectral Index (BIS). Propofol administration, via a target-controlled infusion, was controlled by a proportional-integral-differential control algorithm. The median (range) propofol target concentration during closed-loop control was 2.3 (1.7-3.6) microg.ml(-1). The performance characteristics of the system were excellent, with a median absolute performance error of 7 (1-15). Patients were drowsy yet rousable, with a median (range) BIS set-point of 80 (75-85). No patient became apnoeic, required airway support or became haemodynamically unstable whilst sedated. Eight patients moaned or moved during colonoscopy and four had recall. Median (range) time to full consciousness was 4 (2-20) min after the end of closed-loop control. Patient and surgeon satisfaction were high. We conclude that BIS may be a suitable control variable for closed-loop control of sedation with propofol.

Publication Types:

• Evaluation studies

PMID: 12109414, UI: 22103832

Anaesthesia 2002 Jul;57(7):721-2; discussion 722

Management of mobile laryngeal tumours.

Randhawa N, Semenov RA, Patel A

Publication Types:

• Letter

PMID: 12059840, UI: 22054680

Anaesthesia 2002 Jul;57(7):716-7

Coaxial breathing system outer tube occlusion: what goes in must come out.

Randhawa N, Semenov RA, Patel A

Publication Types:

• Letter

PMID: 12059831, UI: 22054671

Anaesthesia 2002 Jul;57(7):676-85

Off-pump coronary artery surgery.

Heames RM, Gill RS, Ohri SK, Hett DA

Department of Anaesthetics, Southampton General Hospital, Tremona Road, Southampton, SO16 6YD, UK.

Cardiopulmonary bypass has several associated deleterious effects that include a systemic inflammatory response, coagulopathy, central nervous system complications and a variable degree of end-organ damage. The recent upsurge in interest in "beating-heart" surgery attempts to avoid these deleterious effects. Advances in surgical technique, such as the use of intracoronary shunts and the Octopus retractor, have made beating-heart surgery a reality. The challenges for the anaesthetist are greater than for coronary artery surgery using cardiopulmonary bypass, and whilst some advantages are proven, such as the lack of the inflammatory response and the decreased need for blood or blood products, others have yet to be proved and there is a need for further research. The advantages and disadvantages need to be evaluated in randomised studies in order to confirm the safety and efficacy of these new techniques in terms of long-term graft patency and decreased morbidity.

Publication Types:

• Review
• Review, tutorial

PMID: 12059827, UI: 22054668

Anaesthesia 2002 Jul;57(7):667-75

John Snow, Thomas Wakley, and The Lancet.

Froggatt SP

The Queen's University-Belfast, Belfast, Northern Ireland, UK.

Publication Types:

• Biography
• Historical article
• Lectures

Personal Name as Subject:

• Snow J
• Wakley T

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Anesthesiology 2002 Jul;97(1):259-60

Spinal anesthesia for a patient with familial hyperkalemic periodic paralysis.

Weller JF, Elliott RA, Pronovost PJ

Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins Hospital, Baltimore, Maryland 21287-7294, USA.

PMID: 12131128, UI: 22122140

Anesthesiology 2002 Jul;97(1):215-52

The systemic inflammatory response to cardiac surgery: implications for the anesthesiologist.

Laffey JG, Boylan JF, Cheng DC

Department of Anesthesia and Intensive Care, University College Hospital, Galway, Ireland. j.laffey@ireland.com

Publication Types:

• Review
• Review, tutorial

PMID: 12131125, UI: 22122137

Anesthesiology 2002 Jul;97(1):177-82

Effect of intrathecal non-NMDA EAA receptor antagonist LY293558 in rats: a new class of drugs for spinal anesthesia.

Von Bergen NH, Subieta A, Brennan TJ

Department of Anesthesia, College of Medicine, University of Iowa, Iowa City, Iowa 52242-1079, USA.

BACKGROUND: Excitatory amino acid receptors are important for both sensory and motor function in the spinal cord. We studied the effects of intrathecal LY293558, a competitive non-N-methyl-D-aspartate excitatory amino acid receptor antagonist, on motor and sensory function in rats to determine whether drugs blocking these receptors could potentially be used as alternative agents to local anesthetics for spinal anesthesia. METHODS: Rats were tested before and 15-240 min after intrathecal injection of 5 nmol (in 10 microl) LY293558. Sensory function was tested at the hind paw using withdrawal response to pin prick and withdrawal to pinch with sharp forceps. Motor performance (ambulation, placing reflex, and Rotorod time), blood pressure, and heart rate were also evaluated. Some tests were repeated the next day. Responses after LY293558 were compared to injection of 40 microl bupivacaine, 0.75%. Pin-prick responses at the forepaw, chest, abdomen, hind leg, and hind paw were also examined after intrathecal LY293558. RESULTS: Intrathecal LY293558 blocked both sensory and motor responses through 180 min; complete recovery was present the following day. No change in blood pressure or heart rate occurred. The effects of LY293558 were more pronounced and sustained than those of bupivacaine. Segmental blockade of the response to pin prick was present after LY293558. CONCLUSION: Drugs like LY293558 that block alpha-amino-3-hydroxy-5-methyl-4-isoxazole-propionic acid (AMPA)/kainate receptors may be an alternative to local anesthetics for spinal anesthesia in humans.

PMID: 12131120, UI: 22122132

Anesthesiology 2002 Jul;97(1):157-61

Differences in systemic opioid use do not explain increased fever incidence in parturients receiving epidural analgesia.

Gross JB, Cohen AP, Lang JM, Frigoletto FD, Lieberman ES

Department of Anesthesiology, University of Connecticut School of Medicine, Farmington, Connecticut 06030-2015, USA. gross@sun.uchc.edu

BACKGROUND: It has been hypothesized that an increased incidence of fever in patients receiving epidural analgesia might result not from epidural per se, but rather from the antipyretic effect of opioids preferentially administered to women in the no-epidural group. If this were the case, then one would expect the incidence of fever in parturients who did not receive systemic opioids to be independent of whether they received epidural analgesia. METHODS: Using a cohort study design, the authors evaluated the records of 1,233 nulliparous patients whose labor analgesia was managed with (1) no medication (N = 170); (2) 10 mg intravenous systemic nalbuphine plus 10 mg intramuscular every 3 to 4 h as required (N = 327); (3) epidural analgesia with continuous infusion of 0.125% bupivacaine with 2 microg/ml fentanyl (N = 278); or (4) patients who received both systemic nalbuphine and epidural analgesia (N = 458). Fever was diagnosed if the maximum temperature during labor exceeded 100.4 degrees F (38 degrees C). RESULTS: The incidence of fever did not differ according to nalbuphine administration for women not receiving epidural analgesia (1% no nalbuphine, 0.3% with nalbuphine, P = 0.27) or for women receiving epidural analgesia (17% no nalbuphine, 17% with nalbuphine, P = 1.0). However, the incidence of fever differed significantly between patients who received no analgesia as compared to those who received epidural analgesia alone (1% vs. 17%, P = 10(-6)). Controlling for confounding did not alter these associations. CONCLUSIONS: Our findings suggest that an antipyretic effect of nalbuphine in patients who do not receive an epidural does not explain the greater incidence of fever observed in women who receive epidural analgesia for labor.

PMID: 12131117, UI: 22122129

Anesthesiology 2002 Jul;97(1):108-15

Anesthetic-related cardiac arrest and its mortality: a report covering 72,959 anesthetics over 10 years from a US teaching hospital.

Newland MC, Ellis SJ, Lydiatt CA, Peters KR, Tinker JH, Romberger DJ, Ullrich FA, Anderson JR

Department of Anesthesiology, University of Nebraska Medical Center, Omaha, Nebraska 68198-4455, USA. mnewland@unmc.edu

BACKGROUND: A prospective and retrospective case analysis study of all perioperative cardiac arrests occurring during a 10-yr period from 1989 to 1999 was done to determine the incidence, cause, and outcome of cardiac arrests attributable to anesthesia. METHODS: One hundred forty-four cases of cardiac arrest within 24 h of surgery were identified over a 10-yr period from an anesthesia database of 72,959 anesthetics. Case abstracts were reviewed by a Study Commission composed of external and internal members in order to judge which cardiac arrests were anesthesia-attributable and which were anesthesia-contributory. The rates of anesthesia-attributable and anesthesia-contributory cardiac arrest were estimated. RESULTS: Fifteen cardiac arrests out of a total number of 144 were judged to be related to anesthesia. Five cardiac arrests were anesthesia-attributable, resulting in an anesthesia-attributable cardiac arrest rate of 0.69 per 10,000 anesthetics (95% confidence interval, 0.085-1.29). Ten cardiac arrests were found to be anesthesia-contributory, resulting in an anesthesia-contributory rate of 1.37 per 10,000 anesthetics (95% confidence interval, 0.52-2.22). Causes of the cardiac arrests included medication-related events (40%), complications associated with central venous access (20%), problems in airway management (20%), unknown or possible vagal reaction in (13%), and one perioperative myocardial infarction. The risk of death related to anesthesia-attributable perioperative cardiac arrest was 0.55 per 10,000 anesthetics (95% confidence interval, 0.011-1.09). CONCLUSIONS: Most perioperative cardiac arrests were related to medication administration, airway management, and technical problems of central venous access. Improvements focused on these three areas may result in better outcomes.

PMID: 12131111, UI: 22122123

Anesthesiology 2002 Jul;97(1):90-5

The influence of mild hypothermia on the pharmacokinetics and time course of action of neostigmine in anesthetized volunteers.

Heier T, Clough D, Wright PM, Sharma ML, Sessler DI, Caldwell JE

Department of Anesthesia and Perioperative Care, University of California, San Francisco, California 94143-0648, USA.

BACKGROUND: The pharmacokinetics, maximum effect, and time course of action of neostigmine were studied in seven human volunteers. METHODS: Each volunteer was studied twice, during both normothermia and hypothermia. Anesthesia was induced with 30 microg/kg alfentanil and 3 mg/kg propofol, and was maintained with 60-70% nitrous oxide and 0.7-0.9% isoflurane. The mechanical response of the adductor pollicis to train-of-four stimulation of the ulnar nerve was recorded, and central body temperature maintained stable at either less than 34.5 degrees C or greater than 36.5 degrees C by surface cooling or warming. Before neostigmine administration, a stable 5% twitch height was obtained by an infusion of vecuronium, and the infusion rate remained unchanged thereafter. Neostigmine, 70 microg/kg, was then infused over 2 min, and blood samples for estimation of neostigmine concentrations were collected at intervals for 240 min. RESULTS: With hypothermia, the central volume of distribution of neostigmine decreased by 38%, and onset time of maximum effect increased (4.6 vs. 5.6 min). Hypothermia did not change the clearance (696 ml/min), maximum effect, or duration of action of neostigmine. CONCLUSIONS: The efficacy of neostigmine as an antagonist of vecuronium-induced neuromuscular block is not altered by mild hypothermia.

PMID: 12131108, UI: 22122120

Anesthesiology 2002 Jul;97(1):82-9

Patient State Index: titration of delivery and recovery from propofol, alfentanil, and nitrous oxide anesthesia.

Drover DR, Lemmens HJ, Pierce ET, Plourde G, Loyd G, Ornstein E, Prichep LS, Chabot RJ, Gugino L

Department of Anesthesia, Stanford Medical Center, Stanford University School of Medicine, California 94305-5640, USA. ddrover@leland.stanford.edu

BACKGROUND: The Patient State Index (PSI) uses derived quantitative electroencephalogram features in a multivariate algorithm that varies as a function of hypnotic state. Data are recorded from two anterior, one midline central, and one midline posterior scalp locations. PSI has been demonstrated to have a significant relation to level of hypnosis during intravenous propofol, inhalation, and nitrous oxide-narcotic anesthesia. This multisite study evaluated the utility of PSI monitoring as an adjunct to standard anesthetic practice for guiding the delivery of propofol and alfentanil to accelerate emergence from anesthesia. METHODS: Three hundred six patients were enrolled in this multicenter prospective randomized clinical study. Using continuous monitoring throughout the period of propofol-alfentanil-nitrous oxide anesthesia delivery, PSI guidance was compared with use of standard practice guidelines (both before [historic controls] and after exposure to the PSA 4000 monitor [Physiometrix, Inc., N. Billerica, MA; standard practice controls]). Anesthesia was always administered with the aim of providing hemodynamic stability, with rapid recovery. RESULTS: No significant differences were found for demographic variables or for site. The PSI group received significantly less propofol than the standard practice control group (11.9 microg x kg(-1) x min(-1); P < 0.01) and historic control group (18.2 microg x kg(-1) x min(-1); P < 0.001). Verbal response time, emergence time, extubation time, and eligibility for operating room discharge time were all significantly shorter for the PSI group compared with the historic control (3.3-3.8 min; P < 0.001) and standard practice control (1.4-1.5 min; P < 0.05 or P < 0.01) groups. No significant differences in the number of unwanted somatic events or hemodynamic instability and no incidences of reported awareness were found. CONCLUSIONS: Patient State Index-directed titration of propofol delivery resulted in faster emergence and recovery from propofol-alfentanil-nitrous oxide anesthesia, with modest decrease in the amount of propofol delivered, without increasing the number of unwanted events.

Publication Types:

• Clinical trial
• Multicenter study
• Randomized controlled trial

PMID: 12131107, UI: 22122119

Anesthesiology 2002 Jul;97(1):75-81

Positioning in anesthesiology: toward a better understanding of stretch-induced perioperative neuropathies.

Coppieters MW, Van de Velde M, Stappaerts KH

Department of Rehabilitation Sciences, Faculty of Physical Education and Physiotherapy, University of Leuven, Leuven, Belgium. michel.coppieters@flok.kuleuven.ac.be

BACKGROUND: Stretch-induced neuropathy of the brachial plexus and median nerve in conventional perioperative care remains a relatively frequent and poorly understood complication. Guidelines for positioning have been formulated, although the protective effect of most recommendations remains unexamined. The similarity between the stipulated potentially dangerous positions and the components of the brachial plexus tension test (BPTT) justified the analysis of the BPTT to quantify the impact of various arm and neck positions on the peripheral nervous system. METHODS: Four variations of the BPTT in three different shoulder positions were performed in 25 asymptomatic male participants. The impact of arm and neck positions on the peripheral nervous system was evaluated by analyzing the maximal available range of motion, pain intensity, and type of elicited symptoms during the BPTT. RESULTS: Cervical contralateral lateral flexion, lateral rotation of the shoulder and fixation of the shoulder girdle in a neutral position in combination with shoulder abduction, and wrist extension all significantly reduced the available range of motion. Elbow extension also challenged the nervous system substantially. A cumulative impact could be observed when different components were simultaneously added, and a neutralizing effect was noted when an adjacent region allowed for unloading of the nervous system. CONCLUSIONS: The experimental findings support the experientially based guidelines for positioning. Especially when simultaneously applied, submaximal joint positions easily load the nervous system, which may substantially compromise vital physiologic processes in and around the nerve. Therefore, even when the positioning of all upper limb joints is carefully considered, complete prevention of perioperative neuropathy seems almost inconceivable.

PMID: 12131106, UI: 22122118

Anesthesiology 2002 Jul;97(1):66-74

Eliminating intensive postoperative care in same-day surgery patients using short-acting anesthetics.

Apfelbaum JL, Walawander CA, Grasela TH, Wise P, McLeskey C, Roizen MF, Wetchler BV, Korttila K

Department of Anesthesia and Critical Care, University of Chicago Hospitals and Clinics, Illinois, 60637, USA. jeffa@airway.uchicago.edu

BACKGROUND: A multidisciplinary effort was undertaken to determine whether patients could safely bypass the postanesthesia care unit (PACU) after same-day surgery by moving to an earlier time point evaluation of recovery criteria. METHODS: A prospective, outcomes research study with a baseline month, an intervention month, and a follow-up month was designed. Five surgical centers (three community-based hospitals and two freestanding ambulatory surgical centers) were utilized. Two thousand five hundred eight patients were involved in the baseline period, and 2,354 were involved in the follow-up period. Outcome measures included PACU bypass rates and adverse events. Intervention consisted of a multidisciplinary educational program and routine feedback reports. RESULTS: The overall PACU bypass rate (58%) was significantly different from baseline (15.9%, P < 0.001), for patients to whom a general anesthetic was administered (0.4-31.8%, P < 0.001), and for those given other anesthetic techniques (monitored anesthesia care, regional or local anesthetics; 29.1-84.2%, P < 0.001). During the follow-up period, the average (SD) recovery duration for patients who bypassed the PACU was significantly shorter compared to that for patients who did not bypass, 84.6 (61.5) versus 175.1 (98.8) min, P < 0.001, with no change in patient outcome. Patients receiving only short-acting anesthetics were 78% more likely (P < 0.002) to bypass the PACU after adjusting for various surgical procedures. CONCLUSIONS: This study represents a substantial change in clinical practice in the perioperative setting. Same-day surgical patients given short-acting anesthetic agents and who are awake, alert, and mobile requiring no parenteral pain medications and with no bleeding or nausea at the end of an operative procedure can safely bypass the PACU.

PMID: 12131105, UI: 22122117

Anesthesiology 2002 Jul;97(1):15-23

Differential effects of anesthetics on mitochondrial K(ATP) channel activity and cardiomyocyte protection.

Zaugg M, Lucchinetti E, Spahn DR, Pasch T, Garcia C, Schaub MC

Institute of Anesthesiology, University Hospital Zurich, Zurich, Switzerland. Michael.zaugg@ifa.usz.ch

BACKGROUND: Mitochondrial adenosine triphosphate-sensitive potassium (mitoK(ATP)) channels play a pivotal role in mediating cardiac preconditioning. The effects of intravenous anesthetics on this protective channel have not been investigated so far, but would be of importance with respect to experimental as well as clinical medicine. METHODS: Live cell microscopy was used to visualize and measure autofluorescence of flavoproteins, a direct reporter of mitoK(ATP) channel activity, in response to the direct and highly selective mitoK(ATP) channel opener diazoxide, or to diazoxide following exposure to various anesthetics commonly used in experimental and clinical medicine. A cellular model of ischemia with subsequent hypoosmolar trypan blue staining served to substantiate the effects of the anesthetics on mitoK(ATP) channels with respect to myocyte viability. RESULTS: Diazoxide-induced mitoK(ATP) channel opening was significantly inhibited by the anesthetics R-ketamine, and the barbiturates thiopental and pentobarbital. Conversely, urethane, 2,2,2-trichloroethanol (main metabolite of alpha-chloralose and chloral hydrate), and the opioid fentanyl potentiated the channel-opening effect of diazoxide, which was abrogated by coadministration of chelerythrine, a specific protein kinase C inhibitor. S-ketamine, propofol, xylazine, midazolam, and etomidate did not affect mitoK(ATP) channel activity. The significance of these modulatory effects of the anesthetics on mitoK(ATP) channel activity was substantiated in a cellular model of simulated ischemia, where diazoxide-induced cell protection was mitigated by R-ketamine and the barbiturates, while urethane, 2,2,2-trichloroethanol, and fentanyl potentiated myocyte protection. CONCLUSIONS: These results suggest distinctive actions of individual anesthetics on mitoK(ATP) channels and provide evidence that the choice of background anesthesia may play a role in cardiac protection in both experimental and clinical medicine.

PMID: 12131099, UI: 22122111

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Anesthesiology 2002 Jul;97(1):4-14

Volatile anesthetics mimic cardiac preconditioning by priming the activation of mitochondrial K(ATP) channels via multiple signaling pathways.

Zaugg M, Lucchinetti E, Spahn DR, Pasch T, Schaub MC

Institute of Anesthesiology, University Hospital Zurich, Zurich, Switzerland. Michael.zaugg@ifa.usz.ch

BACKGROUND: Volatile anesthetics induce pharmacological preconditioning in cardiac tissue. The purpose of this study was to test whether volatile anesthetics mediate this effect by activation of the mitochondrial adenosine triphosphate-sensitive potassium (mitoK(ATP)) or sarcolemmal K(ATP) (sarcK(ATP)) channel in rat ventricular myocytes and to evaluate the signaling pathways involved. METHODS: A cellular model of ischemia with subsequent hypoosmolar trypan blue staining served to determine the effects of 5-hydroxydecanoate, a selective mitoK(ATP) channel blocker, HMR-1098, a selective sarcK(ATP) channel blocker, diazoxide, a preconditioning mimicking agent, and various modulators of putative signaling pathways on cardioprotection elicited by sevoflurane and isoflurane. Microscopy was used to visualize and measure autofluorescence of flavoproteins, a direct index of mitoK(ATP) channel activity. RESULTS: Volatile anesthetics significantly enhanced diazoxide-mediated activation of mitoK(ATP) channels as assessed by autofluorescence of myocytes. Conversely, volatile anesthetics alone did not alter mitoK(ATP) channel activity, implying a priming effect of volatile anesthetics on mitoK(ATP) channels. Administration of the protein kinase C inhibitor chelerythrine completely blocked this effect. Also, pretreatment with volatile anesthetics potentiated diazoxide-mediated protection against ischemia, as indicated by a reduction in trypan blue-positive myocytes. Importantly, cardioprotection afforded by volatile anesthetics was unaffected by the sarcK(ATP) channel blocker HMR-1098 but sensitive to modulations of nitric oxide and adenosine-G(i) signaling pathways. CONCLUSIONS: Using autofluorescence in live cell imaging microscopy and a simulated model of ischemia, the authors present evidence that volatile anesthetics mediate their protection in cardiomyocytes by selectively priming mitoK(ATP) channels through multiple triggering protein kinase C-coupled signaling pathways. These observations provide important new insight into the mechanisms of anesthetic-induced preconditioning.

PMID: 12131097, UI: 22122109

Anesthesiology 2002 Jul;97(1):1-3

Editorial view: anesthetic preconditioning: serendipity and science.

Warltier DC, Kersten JR, Pagel PS, Gross GJ

Publication Types:

• Editorial

PMID: 12131096, UI: 22122108

Ann Fr Anesth Reanim 2002 May;21(5):414-7

[The use of glycopeptides in intensive care and anaesthesia.]

Gauzit R

Departement d'anesthesie-reanimation, CHU Jean-Verdier, avenue du 14-juillet, 93143 Bondy, France. remy.gauzit@jvr.ap-hop-paris.fr

With the objective of clarifying the modes of using glycopeptides in intensive care, a survey with a declared intention was performed in June 2001, in the form of a postal questionnaire; it was possible to exploit 742 answers. Analysis of the results showed that 15% of the doctors completing the questionnaire had not employed glycopeptides within the past six months. Preference was given to vancomycin, and 65% of practitioners prescribed this drug only, while 1% of them only prescribed teicoplanin. For vancomycin, a central route is used in 9 out of 10 cases, with a preference for continuous infusion (69% versus 48%). A loading dose is prescribed in 70% of continuous infusions (> or = 15 mg.kg-1 in 69% of cases), and in 19% of intermittent infusions (> or = 15 mg.kg-1 in 90% of cases). The mean vancomycin dosage is 30 mg.kg-1.d-1; in the case of intermittent administration this involves two (51%), three (17%) or four (27%) injections per day. The target concentrations are residual serum vancomycin levels of between 13.5 and 23.6 mg.L-1 with intermittent administration or plateau levels of 18.3 to 29.4 mg.L-1 with continuous infusion. Teicoplanin is administered intravenously (92%) and/or via the i.m. route (34%). The mean dosage is < 10 mg.kg-1.d-1 in seven out of ten cases. A loading dose is administered every 12 hours at the same dosage in 77% of cases (< or = 3 injections for 65% of prescribers). The residual teicoplanin concentrations sought are between 14.3 and 25 mg.L-1. Monitoring of serum levels is ensured at least once a week in 97% of cases with vancomycin and 66% of cases with teicoplanin. In conclusion, is seems that the methods of using glycopeptides vary considerably. The great heterogeneity of practices suggests a lack of compliance by prescribing practitioners with current recommendations. It also seems that a precise definition of the target plasma levels to be achieved in different indications is necessary.

PMID: 12078436, UI: 22074217

Ann Fr Anesth Reanim 2002 May;21(5):343-6

[Digestive endoscopies: who does what?]

Lienhart A, Carli P, Marty J, Pourriat JL

Publication Types:

• Editorial

PMID: 12078424, UI: 22074205

Eur J Anaesthesiol 2002 Jul;19(7):530-2

Workforce and regional distribution of anaesthesiologists in Japan.

Taga K, Fujihara H, Baba H, Yamakura T, Shimoji K

[Medline record in process]

Publication Types:

• Letter

PMID: 12113619, UI: 22108336

Eur J Anaesthesiol 2002 Jul;19(7):528-9

Epidural anaesthesia for arthroscopic knee surgery in a patient with Takayasu's arteritis.

Karaca S, Akgun I

[Medline record in process]

Publication Types:

• Letter

PMID: 12113618, UI: 22108335

Eur J Anaesthesiol 2002 Jul;19(7):526-8

Acute abdomen after coronary artery bypass surgery masked by thoracic epidural analgesia.

Jankovic Z, Radojevic C, Neskovic V, Stamenkovic D

[Medline record in process]

Publication Types:

• Letter

PMID: 12113617, UI: 22108334

Eur J Anaesthesiol 2002 Jul;19(7):522-5

Effects of adding alfentanil or atracurium to lidocaine solution for intravenous regional anaesthesia.

Kurt N, Kurt I, Aygunes B, Oral H, Tulunay M

Adnan Menderes University, Department of Anaesthesiology and Reanimation, Faculty of Medicine, Aydin, Turkey. mnilkurt@yahoo.com

[Medline record in process]

BACKGROUND AND OBJECTIVE: The addition of alfentanil or atracurium to lidocaine solution for intravenous regional anaesthesia of the arm may have advantages with respect to improved muscle relaxation and better analgesia. The study investigates these possibilities. METHODS: We investigated 33 patients. Plain lidocaine solution was administered to Group 1 (n = 11). Alfentanil (0.5 mg) and atracurium (3 mg) were added to the lidocaine solution in Groups 2 (n = 11) and 3 (n = 11), respectively. The onset of sensory and motor block, intra- and postoperative pain scores, and the duration of postoperative analgesia were evaluated. RESULTS: There was a significant difference in the speed of the onset of sensory block in the hand, but not at the tourniquet site. The onset of the motor block, intra- and postoperative pain scores, and the duration of postoperative analgesia were similar in all groups. CONCLUSIONS: No clinical benefits of adding alfentanil or atracurium to lidocaine solution for intravenous regional anaesthesia of the arm could be shown.

PMID: 12113616, UI: 22108333

Eur J Anaesthesiol 2002 Jul;19(7):483-6

Flurbiprofen does not change the bispectral index and 95% spectral edge frequency during total intravenous anaesthesia with propofol and fentanyl.

Hirota K, Fukushi S, Baba S, Matsuki A

University of Hirosaki School of Medicine, Department of Anesthesiology, Japan.

[Medline record in process]

BACKGROUND AND OBJECTIVE: Previous studies have shown that general anaesthetic agents modulate the production of hypothalamic prostaglandins (PG) D2 and E2, which are mediators of sleep and wakefulness respectively. Although flurbiprofen, a cyclo-oxygenase inhibitor, is used clinically as a non-steroidal anti-inflammatory agent and postoperative analgesic, it reduces prostaglandin production. Thus, this agent may affect the depth of sedation during general anaesthesia. In this study, we examined if flurbiprofen affects the bispectral index, which correlates with sedation levels. METHODS: Fifteen patients who underwent elective surgery under total intravenous anaesthesia with propofol and fentanyl were studied. The sedation level was monitored using a bispectral index monitor. On attainment of stable haemodynamics and a bispectral index, patients were given flurbiprofen axetil 50 mg intravenously. A bispectral index and 95% spectral edge frequency were recorded before and 5, 10, 15, 20 and 30 min after flurbiprofen axetil intravenously. RESULTS: Bispectral indexes of 51.7 (95% CI: 47.3-56.8), 51.7 (47.1-56.3), 51.3 (46.3-56.3), 50.3 (45.8-54.2), 48.9 (43.6-54.1) and 50.3 (45.5-55.2) at 0, 5, 10, 15, 20, 30 min after flurbiprofen axetil intravenously were observed. There was no change in this or 95% spectral edge frequency. CONCLUSIONS: Clinical dose of flurbiprofen axetil does not alter the bispectral index and 95% spectral edge frequency under total intravenous anaesthesia with propofol and fentanyl.

PMID: 12113610, UI: 22108327

Eur J Pharmacol 2002 Jul 12;448(1):59-66

A comparative study of the effects of Cl(-) channel blockers on mesenteric vascular conductance in anaesthetized rat.

Parai K, Tabrizchi R

Division of Basic Medical Sciences, Faculty of Medicine, Memorial University of Newfoundland, Health Sciences Centre, NF, A1B 3V6, St. John's, Canada

[Medline record in process]

There is evidence to suggest that niflumic acid is capable of selectively inhibiting Ca(2+)-dependent Cl(-) channels. Furthermore, it has been demonstrated that niflumic acid is capable of antagonizing contractile responses due to activation of alpha(1)-adrenoceptor in mesenteric vasculature. Here, we have examined the effects of three Cl(-) channel blockers, niflumic acid, indanyloxyacetic acid 94 (IAA-94) and diphenylamine-2-carboxylic acid (DPC) on cirazoline-mediated vasoconstriction in mesenteric blood vessel in vivo. Infusion of cirazoline produced a dose-dependent increase in blood pressure, decrease in superior mesenteric blood flow, mesenteric vascular conductance and heart rate. While niflumic acid and IAA-94 did not have any impact on cirazoline-induced changes in blood pressure, DPC accentuated the pressor effect of cirazoline. Neither agent affected cirazoline-mediated reflex reduction in the heart rate. Niflumic acid, IAA-94 and DPC attenuated alpha(1)-adrenoceptor mediated decrease in mesenteric blood flow and vascular conductance. Based on the profile of the actions of these compounds, it may be suggested that IAA-94 did not appear to act as selective inhibitor of Ca(2+)-activated Cl(-) channels when compared to niflumic acid in the mesenteric blood vessels. In addition, while DPC seems to be as effective as niflumic acid in its effects on mesenteric blood vessels, its actions may be attributed to other pharmacological effects.

PMID: 12126972, UI: 22123262

J Cardiovasc Pharmacol 2002 Aug;40(2):210-9

Nitric oxide in responses of regional kidney blood flow to vasoactive agents in anesthetized rabbits.

Rajapakse NW, Oliver JJ, Evans RG

Department of Physiology, Monash University, Victoria, Australia.

[Medline record in process]

SUMMARY: To determine whether differential release of nitric oxide underlies the diversity of regional kidney blood flow responses to vasoactive agents, this study examined how nitric oxide synthase blockade with IV NG-nitro-l-arginine (l-NNA), and also IV l-NNA plus co-infusion of glyceryl trinitrate, affected responses to renal arterial boluses and infusions of vasoactive agents. l-NNA, but not vehicle, or l-NNA plus glyceryl trinitrate, increased mean arterial pressure (35%) and reduced renal blood flow (20%), cortical perfusion (11%), and medullary perfusion (54%). l-NNA plus glyceryl trinitrate, but not l-NNA alone, blunted renal vasodilatation in response to boluses of bradykinin and acetylcholine, abolished increased medullary perfusion after bolus angiotensin II, and enhanced reductions in medullary perfusion, and to a lesser extent those in renal blood flow and cortical perfusion, during norepinephrine infusion. Neither l-NNA, nor l-NNA plus glyceryl trinitrate, affected responses to infusions of angiotensin II, [Phe2,Ile3,Orn8]-vasopressin, or endothelin-1. The data indicate roles for nitric oxide in angiotensin II-induced increases in medullary perfusion and in protecting medullary perfusion from norepinephrine-induced vasoconstriction. However, differential engagement of nitric oxide synthase cannot completely account for the diversity of responses of regional kidney perfusion to vasoactive agents. Effects of nitric oxide synthase blockade on renal vascular responses to vasoactive agents were revealed only when glyceryl trinitrate was co-infused to restore resting nitrergic vasodilator tone. This may reflect interactions between nitric oxide and other vasodilator mediators, in modulating renal hemodynamic responses to vasoactive agents.

PMID: 12131550, UI: 22125742

Neurosci Lett 2002 Aug 2;328(1):37-40

Absence of coherence between cervical and lumbar spinal cord dorsal surface potentials in the anaesthetized cat.

Manjarrez E, Perez H, Rojas-Piloni JG, Velez D, Martinez L, Flores A

Instituto de Fisiologia, Benemerita Universidad Autonoma de Puebla, 14 Sur 6301, Col. San Manuel, Apartado Postal 406, Pue. CP 72570, Puebla, Mexico

[Medline record in process]

Recordings of spontaneous cord dorsum potentials (CDPs) along the longitudinal axis of the spinal cord were made. These recordings were obtained from the surface of the dorsal horn at different points along the spinal cord caudally and cranially in relation to the point giving spontaneous potentials of maximal amplitude. We found two curves (lumbar and cervical) for the longitudinal distribution of the area of the power spectra of these recordings. Each of these curves had a symmetrical decrement on both sides of the position of the point for the maximal area of power. Such points were discovered on the L5-L7 and C3-C4 spinal segments. Spectral analysis of the spontaneous CDPs simultaneously recorded in both regions indicates no evidence of coherence, thus suggesting that the spontaneous CDPs recorded in the lumbar and cervical regions of the pentobarbitone-anaesthetized cat are generated by two independent populations of neurones not functionally interconnected between them.

PMID: 12123854, UI: 22120402

Reg Anesth Pain Med 2002 Jul-Aug;27(4):445-6

Horner's syndrome following epidural anesthesia with ropivacaine for cesarean delivery.

Zahn PK, Van Aken HK, Marcus AE

Department of Anesthesia and Intensive Care Medicine, University of Muenster, Muenster, Germany.

[Medline record in process]

PMID: 12132073, UI: 22127015

Reg Anesth Pain Med 2002 Jul-Aug;27(4):402-28

Brachial plexus anesthesia: Essentials of our current understanding.

Neal JM, Hebl JR, Gerancher JC, Hogan QH

Virginia Mason Medical Center (J.M.N), Seattle, Washington; Mayo Clinic (J.R.H.), Rochester, Minnesota; Wake Forest University (J.C.G.), Winston-Salem, North Carolina; and Medical College of Wisconsin (Q.H.H.), Milwaukee, Wisconsin.

[Medline record in process]

PMID: 12132064, UI: 22127006

Reg Anesth Pain Med 2002 Jul-Aug;27(4):380-4

Nefopam and tramadol for the prevention of shivering during neuraxial anesthesia.

Bilotta F, Pietropaoli P, Sanita' R, Liberatori G, Rosa G

Department of Anesthesia and Intensive Care, University of Rome "La Sapienza" (F.B., P.P., G.R.), Rome; and the Department of Anesthesia Policlinico Casilino (R.S., G.L.), Rome, Italy.

[Medline record in process]

BACKGROUND AND OBJECTIVES: In patients undergoing neuraxial anesthesia, heat loss and core-to-peripheral redistribution of body heat causes the core temperature to decrease. The shivering threshold is therefore reached soon, and more shivering is required to prevent further hypothermia. Because shivering has deleterious metabolic and cardiovascular effects, it should ideally be prevented by pharmacologic or other means. We evaluated the usefulness of intravenous (IV) nefopam and tramadol in preventing and reducing the severity of shivering in patients undergoing neuraxial anesthesia for orthopedic surgery. METHODS: Ninety patients, scheduled for neuraxial anesthesia (epidural or subarachnoid) for lower limb orthopedic surgery, were prospectively enrolled. Patients were randomly assigned to 1 of 3 groups. Immediately before neuraxial anesthesia, 30 patients received 0.15 mg/kg(-1) IV nefopam in 10 mL saline, 30 patients received 0.5 mg/kg(-1) IV tramadol in 10 mL saline, and a control group of 30 patients received 10 mL IV saline. Neuraxial anesthesia was induced at the L3-L4 or L4-L5 interspaces with 1 mg/kg(-1) mepivacaine for epidural anesthesia and 0.2 mg/kg(-1) for subarachnoid anesthesia. An investigator blinded to the antishivering drug injected recorded the frequency and degree of shivering. RESULTS: The overall frequency and the intensity of shivering was significantly lower in patients treated with nefopam than in those treated with tramadol or placebo (P <.05 and P <.01) and in patients treated with tramadol than in those treated with placebo (P <.05). CONCLUSIONS: As a pharmacologic means of preventing shivering in patients undergoing neuraxial anesthesia, nefopam may hold the greatest promise. Reg Anesth Pain Med 2002;27:380-384.

PMID: 12132062, UI: 22127004