Quality assurance in anaesthetic practice: comparison
between two methods in detecting complications.
Niskanen M, Tuovinen T, Purhonen S, Vauhkonen S, Hendolin
H
Department of Anaesthesiology and Intensive Care, Kuopio
University Hospital, Kuopio, Finland.
[Medline record in process]
BACKGROUND: Reliable identification and documentation of
complications is an essential part of a well-functioning
quality system (QS) in anaesthetic practice. The criteria
for the complications have to be appropriate. The QS of
Kuopio University Hospital fulfils the ISO 9002 standard.
The validity of the recordings in the QS was ascertained
by comparing the routine recordings with external assessment.
METHODS: Three types of complications were predefined: minor,
severe and those specific for regional anaesthesia. A total
of 1006 anaesthetic charts, including general, regional
and intravenous anaesthesia, were randomly selected and
retrospectively screened by an external assessor. The retrospective
assessment of complications was compared to the recordings
in the data management system for operative procedures (DMS)
as a part of routine quality assurance. Cohen's kappa statistics
was used to indicate agreement between two raters. RESULTS:
Both methods identified complications in 115 procedures
(11.4%). The methods, however, did not identify complications
in same procedures. There was a fairly close agreement (P
< 0.001) between the methods in detecting all (Cohen's
kappa 0.72), minor (0.67) and severe (0.66) complications
and those specific for regional anaesthesia (0.78). Fifty-eight
complications were detected either by retrospective assessment
or routine reporting, i.e. the two raters disagreed in 58
complications. Thirteen severe complications recorded in
the DMS could not be retrospectively identified. The agreement
did not depend on ASA class, the urgency or the length of
procedures or on the type of anaesthesia. CONCLUSIONS: The
agreement between external assessment and routine reporting
was fairly good, however, there were still some relatively
large differences. The selection and definitions of complications
need to be reassessed.
PMID: 12139548, UI: 22135067
Acta Anaesthesiol Scand 2002 Aug;46(7):875-81
Lipid solubility- and concentration-dependent attenuation
of in vitro natural killer cell cytotoxicity by local anesthetics.
Krog J, Hokland M, Ahlburg P, Parner E, Tonnesen E
Department of Anesthesiology and Intensive Care, Aarhus
University Hospital, Institute of Medical Microbiology and
Immunology, The Bartholin Building, and Department of Biostatistics,
Aarhus University, Denmark.
[Medline record in process]
BACKGROUND: Natural killer (NK) cells constitute an essential
component of the innate immune system in the defence against
infected and malignant cells. In this study the in vitro
effect on NK cell activity of three different local anesthetics
with different lipid solubility was investigated. METHODS:
Venous blood from seven healthy volunteers was incubated
with three amide local anesthetics with three different
concentrations of lipid solubility: lidocaine 0.50, 1.00
and 2.00 mg/ml, ropivacaine 0.375, 0.75 and 1.50 mg/ml,
and bupivacaine 0.25, 0.50 and 1.00 mg/ml. After 1 h of
incubation, mononuclear cells were isolated and cryopreserved
until tested for NK cell cytotoxicity in a 4-h 51Cr-release
assay against K-562 target cells. Natural killer cell cytotoxicity
of mononuclear cells incubated with isotonic saline was
used as the control. RESULTS: A significant suppression
in NK cell cytotoxicity was demonstrated for all three local
anesthetic agents when the NK cell cytotoxicity was compared
with the cytotoxicity estimated after incubation with the
isotonic saline (P<0.004). Moreover a significant lipid
solubility-dependent effect (P=0.0001) as well as an overall
concentration-dependent effect (P<0.0001) on the NK cell
cytotoxicity was found. CONCLUSION: The results of the present
in vitro study suggest a negative association between the
estimated NK cell cytotoxicity and the lipid solubility
as well as the concentrations of the three local anesthetic
agents tested.
PMID: 12139545, UI: 22135064
Acta Anaesthesiol Scand 2002 Aug;46(7):866-74
Interpretation of radial pulse contour during fentanyl/nitrous
oxide anesthesia and mechanical ventilation.
Soderstrom S, Sellgren J, Aneman A, Ponten J
Department of Anesthesiology and Intensive Care, Sahlgrenska
University Hospital, Goteborg, Sweden.
[Medline record in process]
BACKGROUND: Peripheral arterial blood pressure is not a
reliable substitute for proximal aortic pressure. Recognition
of this phenomenon is important for correct appreciation
of cardiac afterload. Our aim was to evaluate the utility
of the radial pulse wave to better understand ventriculo-vascular
coupling during anesthesia. METHODS: We observed the differences
between aortic systolic pressure (AoSAP, tipmanometry) and
radial systolic pressure in 15 patients, (including two
women) aged 53-78 years, before coronary artery bypass surgery.
We studied the induction of anesthesia with fentanyl (20
microg kg-1), moderate volume loading, and thereafter the
addition of 70% nitrous oxide. The circulatory effects of
mechanical ventilation were studied by doubling the tidal
volumes. Pulse wave contours were assessed by calculation
of radical and aortic augmentation indices (AI), which measure
the second systolic pressure peak. RESULTS: Radial systolic
pressure was higher than AoSAP in the control situation
(8+/-2 mmHg), and this SAP gradient increased further with
fentanyl (12+/-2 mmHg). The gradient persisted throughout
the study, but was partially reduced by volume loading and
nitrous oxide, respectively. Radial augmentation index was
the only parameter remaining in a stepwise multivariate
model to explain the variance in the SAP gradient (r2=0.48).
Radial augmentation index also correlated with aortic pulse
pressure (r2=0.71). Mechanical ventilation had significant
and similar effects on pulse wave augmentation both in the
aorta and in the radial artery, and did not affect the radial
to aortic SAP gradient. CONCLUSION: These elderly coronary
patients had stiff vasculature (high aortic AI) and considerable
pulse wave reflection, which was beneficially delayed by
fentanyl. Changes in the radial pulse wave augmentation
during mechanical ventilation were mainly a result of cyclic
changes in the stroke volume, and were seldom associated
with an increased systolic pressure gradient from the aorta
to the radial artery.
PMID: 12139544, UI: 22135063
Acta Anaesthesiol Scand 2002 Aug;46(7):836-44
Influence of non-volatile anesthetics on the migration
behavior of the human breast cancer cell line MDA-MB-468.
Institute of Immunology and Institute of Anesthesiology,
University of Witten/Herdecke, Witten, Germany.
[Medline record in process]
BACKGROUND: Anesthetic agents are known to influence functions
of the immune system. Anesthetic drugs also support cancer
progression by suppressing the activity of immune cells.
In breast carcinoma an increase in expression of peripheral-type
benzodiazepine receptors (PBR) and the gamma aminobutyl
acid (GABA) level has been discovered. Therefore, an investigation
of a direct influence of GABA-A agonist propofol, GABA-A
and PBR-agonist etomidate, and the local anesthetic drug
lidocaine, which can also bind to the GABA-A receptor and
PBR, on migration of breast carcinoma cells was performed.
METHODS: MDA-MB-468 cells were incubated with anesthetic
agents using clinically relevant concentrations (propofol
3, 6, 9 mg/l, etomidate 2, 3, 4 mg/l, and lidocaine 1.25,
2.5, 5 mg/l). Locomotion was investigated in a three-dimensional
collagen matrix using time-lapse video microscopy and computer-assisted
cell-tracking. RESULTS: The percentage of migrating cells
(57.4+/-1.9) as well as the velocity (0.22+/-0.09 microm/min)
and distance migrated (89.4+/-66.8 microm/10 h) increased
in the presence of propofol in a dose-dependent manner (up
to 74.4+/-7.5, 0.30+/-0.09, 143.8+/-89.1, respectively)
compared with the long chain triglyceride (LCT) control.
In contrast, no influence of etomidate on the number of
migrating cells could be observed. The velocity and distance
migrated at 3 and 4 mg/l were found to be statistically
significantly enhanced. Treatment with lidocaine caused
an increase in the percentage of migrating cells (up to
75.0+/-5.6) in velocity dose dependently (up to 0.33+/-0.06)
and in distance migrated (up to 151.5+/-92.9). CONCLUSION:
These results show that different anesthetic drugs are able
to modulate the migratory machinery of human breast carcinoma
cells in vitro.
PMID: 12139540, UI: 22135059
Acta Anaesthesiol Scand 2002 Aug;46(7):799-805
Survey of epidural analgesia management in general intensive
care units in England.
Low JH
Intensive Care Unit, Nuffield Department of Anesthetics.
The John Radcliffe Hospital, Oxford, UK.
[Medline record in process]
BACKGROUND: The management of epidural analgesia is controversial.
Many intensive care unit (ICU) patients may benefit from
this form of analgesia but have one or more contraindications
to its use. Sepsis, coagulopathy, insertion in a sedated,
ventilated patient, and lack of consent are common problems
in ICU patients. Little has been published to help guide
practice in this area. I wished to establish the current
practice of the management of epidural analgesia in general
ICUs in England when relative or absolute contraindications
occur, in order to determine the current standard of care
for placement and use of epidural analgesia in ICU patients.
METHODS: A postal questionnaire survey of the management
of epidural analgesia in critically ill patients was sent
to the named clinical director of all (216) general ICUs
in England. RESULTS: Responses were received from 159 (75%)
units: 89% of responding units use epidural analgesia but
only 51(32%) have a written policy covering its use. Anesthetists
or intensivists with an anesthetic background sited all
epidural catheters; 68% of units would not site an epidural
in a patient with positive blood cultures; but only 52%
considered culture negative sepsis (systemic signs of sepsis
with no organism isolated) to be a contraindication. Neither
lack of consent nor the need for anticoagulation after the
catheter had been sited were considered contraindications
to inserting an epidural catheter by the majority of respondents.
Although 71% of the units would remove an epidural catheter
if a patient developed positive blood cultures after it
had been sited, the majority of the ICUs did not consider
culture negative sepsis and the need for anticoagulation
contraindications to maintain a previously sited epidural.
CONCLUSIONS: Practice varied considerably with little consensus.
Although all the respondents use epidural analgesia in critically
ill patients, the indications and contraindications to epidural
analgesia remain controversial, and further research is
required to help define the role of epidural analgesia in
this high-risk group.
PMID: 12139534, UI: 22135053
Acta Anaesthesiol Scand 2002 Aug;46(7):785-8
When is an anesthesiologist needed in a helicopter emergency
medical service in northern Norway?
Nielsen EW, Ulvik A, Carlsen AW, Rannestad B
Department of Anesthesiology, Nordland Central Hospital,
Bodo and University of Tromso, Tromso, Norway.
[Medline record in process]
BACKGROUND: A national air ambulance service, including
helicopters and airplanes, was implemented in Norway in
1988. The main intention was to offer advanced medical services
when needed. All helicopters are manned by anesthesiologists.
Catchment areas for the 11 helicopters span from cities
to scarcely populated areas, particularly in the north.
Our aim was to assess what proportion of ambulance missions
carried out by the rescue helicopter in Bodo, northern Norway,
delivered advanced medical treatment needing the skills
of an anesthesiologist. METHODS: Flight and ambulance records
(n = 2078) from 1988 and 1990-98 (10 years) were analyzed
retrospectively. Inter-hospital transfers (n = 147) and
search- and rescue missions (n = 332) were not included.
According to the level of medical treatment given missions
were categorized into three groups (A, B and C). Treatment
in groups A and B would not require an anesthesiologist.
RESULTS: Two thousand and seventy-eight ambulance missions
carried 2166 patients (114 per 100 000 per year). Median
take-off and on-scene times were 29 and 55 min, respectively.
Seven hundred and fifty-five patients (35%) suffered from
cardiovascular disease, 495 (23%) were injured and 250 (12%)
were parturients. One hundred and seven patients (5.0%)
received advanced prehospital emergency treatment requiring
an anesthesiologist. Forty-five of the 107 patients survived
to discharge from hospital, amongst whom 28 had received
intravenous nitroglycerin for angina or suspected myocardial
infarction. CONCLUSION: In our rural area, with a widely
scattered population, 95% of patients received medical treatment
not requiring an anesthesiologist. A selective use of the
anesthesiologist seems indicated.
PMID: 12139531, UI: 22135050
Anaesthesia 2002 Aug;57(8):839-841
Pediatric Anaesthesia (4th edition).
[Record supplied by publisher]
PMID: 12133109
Anaesthesia 2002 Aug;57(8):839-841
Anaesthesia for the High Risk Patient.
[Record supplied by publisher]
PMID: 12133108
Anaesthesia 2002 Aug;57(8):818-838
Pump activated by a foot switch pedal for controlled administration
of local anaesthetic drugs.
[Record supplied by publisher]
PMID: 12133107
Anaesthesia 2002 Aug;57(8):747-50
Neopterin as a marker of immunostimulation: an investigation
in anaesthetic workplaces.
Personnel working in operating theatres and recovery rooms
are exposed to a variety of noxious substances. The results
of studies of the effects of occupational exposure on immune
parameters are conflicting. Neopterin is an acknowledged
marker of immunostimulation. Urinary neopterin levels of
58 anaesthetists and anaesthetic nurses were measured over
a 3-week period. Neopterin analyses were performed using
high performance liquid chromatography. Neopterin levels
were within the normal range for all subjects. Younger subjects
(aged </= 35 years) had significantly higher urinary
neopterin concentrations than older subjects (aged >
35 years). The present study is the first to investigate
the influence of anaesthetic exposure on neopterin levels.
No evidence of immunostimulation was found.
PMID: 12133085, UI: 22128333
Anaesthesia 2002 Aug;57(8):736-9
The effects of nitrous oxide on the auditory evoked potential
index during sevoflurane anaesthesia.
Barr G, Anderson R, Jakobsson J
[Medline record in process]
We have studied the effects of nitrous oxide on the auditory
evoked response index (AAItrade mark-index) derived from
the A-line monitoring device during sevoflurane anaesthesia
in 21 patients undergoing minor ambulatory surgery. During
sevoflurane anaesthesia with an AAItrade mark-index <
30, the addition or withdrawal of nitrous oxide in a concentration
of 66% end tidal did not show any linear dose dependent
change in AAItrade mark-index. However, comparing nitrous
oxide > 40% to nitrous oxide < 10% end tidal concentration
the AAItrade mark-index did decrease, p < 0.05. The AAItrade
mark-index is either non-linear at deeper anaesthetic levels
or is insensitive to the anaesthetic effects of nitrous
oxide in terms of MAC-multiples.
PMID: 12133083, UI: 22128331
Anaesthesia 2002 Aug;57(8):733-735
Academic anaesthesia - alive and kicking?
[Record supplied by publisher]
PMID: 12133082
Anesth Analg 2002 Jul;95(1):257
Knotting of an epidural catheter like a tie.
Karraz MA
Publication Types:
Letter
PMID: 12088992, UI: 22083418
Anesth Analg 2002 Jul;95(1):256; discussion 256
Bicarbonate administration is potentially harmful in patients
with moderate acidosis.
Soto R
Publication Types:
Letter
PMID: 12088990, UI: 22083416
Anesth Analg 2002 Jul;95(1):255
Can BIS monitoring delay the development of clinical judgment?
Rosen AS
Publication Types:
Letter
PMID: 12088986, UI: 22083412
Anesth Analg 2002 Jul;95(1):252-3; discussion
253
Popliteal block as an alternative to Labat's approach.
Fernandez-Guisasola J
Publication Types:
Letter
PMID: 12088982, UI: 22083408
Anesth Analg 2002 Jul;95(1):238-42, table of contents
Rapid deflation of the bronchial cuff of the double-lumen
tube after decreasing the concentration of inspired nitrous
oxide.
Karasawa F, Takita A, Takamatsu I, Mori T, Oshima T, Kawatani
Y
Department of Anesthesiology, National Defense Medical
College, Tokorozawa, Saitama 359-8513, Japan. karasawa@me.ndmc.ac.jp
Deflationary phenomena of the endotracheal tube cuff may
occur after inspired nitrous oxide (N(2)O) concentrations
are reduced, but deflationary phenomena of the double-lumen
tube (DLT) cuff have not been investigated. In this study,
tracheal and bronchial cuffs of left-sided Mallinckrodt
(Athlone, Ireland) DLTs were inflated with air, 40% N(2)O,
or 67% N(2)O (Air, N40, or N67 groups, respectively) in
24 patients undergoing thoracic surgery; 40 min later, O(2)
was substituted for N(2)O in some of the patients in the
N40 group (N40-c group). Intracuff gas volumes, N(2)O concentrations,
and cuff compliance were also measured. Both tracheal and
bronchial cuff pressures significantly increased in the
Air group but decreased in the N67 group. Neither pressure
significantly changed in the N40 group, but both decreased
in the N40-c group after terminating N(2)O anesthesia; the
time required for bronchial cuff pressures to decrease by
half (12.0 +/- 5.5 min) was less than that for tracheal
cuff pressures (31.2 +/- 11.0 min, P < 0.01). The volume
change in the N40-c group was not significantly different
between the tracheal and bronchial cuffs, but tracheal cuff
compliance was significantly higher than bronchial compliance.
Therefore, filling DLT cuffs with 40% N(2)O stabilizes cuff
pressure during anesthesia with 67% N(2)O, but bronchial
cuffs deflate more quickly than tracheal cuffs after cessation
of N(2)O administration through smaller compliance. IMPLICATIONS:
We demonstrated that after cessation of nitrous oxide (N(2)O)
administration, bronchial N(2)O-filled cuffs of the double-lumen
tube deflate more rapidly than tracheal cuffs. To avoid
insufficient separation of the lungs by the bronchial cuff,
a frequent check of the cuff pressure is recommended after
the inspired N(2)O concentration is decreased.
Publication Types:
Clinical trial
Randomized controlled trial
PMID: 12088977, UI: 22083403
Anesth Analg 2002 Jul;95(1):219-23, table of contents
Levobupivacaine for axillary brachial plexus block: a
pharmacokinetic and clinical comparison in patients with
normal renal function or renal disease.
Crews JC, Weller RS, Moss J, James RL
Department of Anesthesiology, Wake Forest University School
of Medicine, Medical Center Boulevard, Winston-Salem, NC
27157-1009, USA. jcrews@wfubmc.edu
We compared the pharmacokinetics and clinical characteristics
of 0.5% levobupivacaine for axillary block in patients with
normal renal function versus patients with end-stage renal
disease (ESRD). Twenty patients with normal renal function
and eight patients with ESRD received an axillary block
with 50-60 mL of 0.5% levobupivacaine. Patients were evaluated
for onset and duration of sensory/motor block. Eleven patients
with normal renal function and eight patients with ESRD
underwent pharmacokinetic analysis. No differences between
groups were found in the onset, duration, or quality of
block. The median time to sensory block was 12.5 min and
12.9 min, and mean duration of the block was 19 h and 22
h in normal versus ESRD patients, respectively. No significant
differences in noncompartmental pharmacokinetic variables
(median) were found between normal and ESRD patients with
an AUC(0-t) (microg. h(-1). mL(-1)) of 11 and 13, peak concentration
(C(max)) (microg/mL) of 1.2 and 1.6, and a time to peak
concentration (T(max)) (min) of 55 and 48, respectively.
This study demonstrates the clinical efficacy and equivalence
of the pharmacokinetic characteristics of 0.5% levobupivacaine
for axillary brachial plexus block in patients with ESRD
and normal renal function. IMPLICATIONS: This study demonstrates
the clinical efficacy and equivalence of the pharmacokinetic
characteristics of 0.5% levobupivacaine for axillary brachial
plexus block in patients with renal disease and normal renal
function.
Publication Types:
Clinical trial
PMID: 12088972, UI: 22083398
Anesth Analg 2002 Jul;95(1):214-8, table of contents
New landmarks for the anterior approach to the sciatic
nerve block: imaging and clinical study.
Van Elstraete AC, Poey C, Lebrun T, Pastureau F
Department of Anesthesiology, Saint-Paul Medical-Surgical
Center, Clairiere, 97200 Fort-de-France, Martinique, France.
alainvanel@hotmail.com
In this study, we assessed the reliability of the inguinal
crease and femoral artery as anatomic landmarks for the
anterior approach to the sciatic nerve and determined the
optimal position of the leg during this approach. An imaging
study was conducted before the clinical study. The sciatic
nerve was located twice in 20 patients undergoing ankle
or foot surgery, once with the leg in the neutral position
and once with the leg in the externally rotated position.
The patient was lying supine. A 22-gauge, 150-mm insulated
b-beveled needle connected to a nerve stimulator was inserted
2.5 cm distal to the inguinal crease and 2.5 cm medial to
the femoral artery and was directed posteriorly and laterally
with a 10 degrees -15 degrees angle relative to the vertical
plane. The sciatic nerve was located in all patients at
a depth of 10.6 +/- 1.8 cm when the leg was in the neutral
position and 10.4 +/- 1.5 cm when the leg was in the externally
rotated position (not significant). In the neutral position
and in the externally rotated position, the time needed
to identify anatomic landmarks was 28 +/- 15 s and 26 +/-
14 s, respectively (not significant), and the time needed
to locate the sciatic nerve was 79 +/- 53 s and 46 +/- 25
s (P < 0.006), respectively. We conclude that the inguinal
crease and femoral artery are reliable and effective anatomic
landmarks for the anterior approach to the sciatic nerve
and that the optimal position of the leg is the externally
rotated position. IMPLICATIONS: This new anterior approach
to the sciatic nerve using the inguinal crease and femoral
artery as landmarks is an easy and reliable technique.
Publication Types:
Clinical trial
Randomized controlled trial
PMID: 12088971, UI: 22083397
Anesth Analg 2002 Jul;95(1):209-13, table of contents
Intrathecal versus intravenous fentanyl for supplementation
of subarachnoid block during cesarean delivery.
Department of Anesthesiology, Medical Center, American
University of Beirut, Beirut, Lebanon.
Forty-eight healthy parturients scheduled for elective
cesarean delivery were randomly allocated to receive intrathecally
either 12 mg of hyperbaric bupivacaine plus 12.5 microg
of fentanyl (n = 23) or bupivacaine alone (n = 25). In the
latter group, IV 12.5 microg of fentanyl was administered
immediately after spinal anesthesia. We compared the amount
of IV fentanyl required for supplementation of the spinal
anesthesia during surgery, the intraoperative visual analog
scale, the time to the first request for postoperative analgesia,
and the incidence of adverse effects. Additional IV fentanyl
supplementation amounting to a mean of 32 +/- 35 microg
was required in the IV Fentanyl group, whereas no supple-
mentation was required in the Intrathecal Fentanyl group
(P = 0.009). The time to the first request for postoperative
analgesia was significantly longer in the Intrathecal Fentanyl
group than in the IV Fentanyl group (159 +/- 39 min versus
119 +/- 44 min; P = 0.003). The incidence of systolic blood
pressure <90 mm Hg and the ephedrine requirements were
significantly higher in the IV Fentanyl group as compared
with the Intrathecal Fentanyl group (P = 0.01). Also, intraoperative
nausea and vomiting occurred less frequently in the Intrathecal
Fentanyl group compared with the IV Fentanyl group (8 of
23 vs 17 of 25; P = 0.02). IMPLICATIONS: Supplementation
of spinal bupivacaine anesthesia for cesarean delivery with
intrathecal fentanyl provides a better quality of anesthesia
and is associated with a decreased incidence of side effects
as compared with supplementation with the same dose of IV
fentanyl.
Publication Types:
Clinical trial
Randomized controlled trial
PMID: 12088970, UI: 22083396
Anesth Analg 2002 Jul;95(1):204-8, table of contents
The relative motor blocking potencies of epidural bupivacaine
and ropivacaine in labor.
Lacassie HJ, Columb MO, Lacassie HP, Lantadilla RA
Anesthesiology Department, Pontificia Universidad Catolica
de Chile, Marcoleta 367, 3rd Floor, Santiago, Chile. lacassie@med.puc.cl
Minimal local analgesic concentrations (MLAC) have been
used to determine the epidural analgesic potencies of bupivacaine
and ropivacaine. There are no reports of the motor blocking
potencies of these drugs. We sought to determine the motor
block MLAC of both drugs and their relative potency ratio.
Sixty ASA physical status I and II parturients were randomized
to one of two groups, during the first stage of labor. Each
received a 20-mL bolus of epidural bupivacaine or ropivacaine.
The first woman in each group received 0.35%. Up-down sequential
allocation was used to determine subsequent concentrations
at a testing interval of 0.025%. Effective motor block was
defined as a Bromage score <4 within 30 min. The up-down
sequences were analyzed by using the Dixon and Massey method
and probit regression to quantify the motor block minimal
local analgesic concentration. Two-sided P < 0.05 defined
significance. The motor block minimal local analgesic concentration
for bupivacaine was 0.326% (95% confidence interval [CI],
0.285-0.367) and for ropivacaine was 0.497% (95% CI, 0.431-0.563)
(P = 0.0008). The ropivacaine/bupivacaine potency ratio
was 0.66 (95% CI, 0.52-0.82). This is the first MLAC study
to estimate the motor blocking potencies of bupivacaine
and ropivacaine. Ropivacaine was significantly less potent
for motor block, at 66% that of bupivacaine. IMPLICATIONS:The
results of this study demonstrate that epidural ropivacaine
is less potent than epidural bupivacaine in producing motor
blockade during labor. The motor block potency relation
is similar to the sensory potency ratio for these two drugs.
Publication Types:
Clinical trial
Randomized controlled trial
PMID: 12088969, UI: 22083395
Anesth Analg 2002 Jul;95(1):151-7, table of contents
A new highly reliable instrument for the assessment of
pre- and postoperative gynecological pain.
Stener-Victorin E, Kowalski J, Lundeberg T
Department of Obstetrics and Gynecology, Goteborg University,
SE-413 45 Goteborg, Sweden. elisabet.stener-victorin@medstud.gu.se
In this study, we evaluated the reliability of a newly
developed method for pain assessment, which is based on
perceptual matching by Pain Matcher, Cefar Medical AB, Lund,
Sweden, during minor gynecological surgery. In addition,
the responsiveness to two different anesthetic methods-electro-acupuncture
or a fast-acting opiate, alfentanil, both in combination
with a paracervical block-was estimated by using Pain Matcher
and visual analog scale (VAS) assessments before and 2 h
after surgery. Two hundred-twenty-three women (aged 22-38
yr) participated. The results show that Pain Matcher is
a reliable method for pain assessments, with lack of random
individual disagreement and with no statistical evidence
of systematic disagreement in position or in concentration.
The augmented rank-order coefficient (r(a)) values were
excellent (0.95-1.00). When scales were used to detect true
changes over time, there was no clear indication of responsiveness,
mostly because of statistically significant random individual
changes. However, the individual changes were much smaller
for magnitude matching than for VAS. In conclusion, we would
recommend the use of perceptual matching by Pain Matcher
for pain assessment, because in this study it was a reliable
and powerful in test-retest situations and had smaller individual
changes than VAS after intervention. The Pain Matcher procedure
was well accepted by the patients, and the results suggest
that it may be useful when evaluating acute pre- and postoperative
pain. IMPLICATIONS: We evaluated a new instrument for pain
assessment. Our results show that this method is highly
reliable, is well tolerated by the patients, is reported
to be easy to use, and may be useful when evaluating acute
pre- and postoperative pain.
Publication Types:
Clinical trial
Evaluation studies
Randomized controlled trial
PMID: 12088960, UI: 22083386
Anesth Analg 2002 Jul;95(1):119-22, table of contents
Can succinylcholine be used safely in hyperkalemic patients?
Schow AJ, Lubarsky DA, Olson RP, Gan TJ
Department of Anesthesiology, Duke University Medical Center,
Durham, NC 27710, USA.
The use of succinylcholine in hyperkalemic patients (serum
potassium >5.5 mEq/L) is often viewed as relatively contraindicated,
although there are no systematic data to define what preoperative
potassium level is safe. We retrospectively reviewed more
than 40,000 general anesthetics administered over 70 mo
in which succinylcholine was given at the induction. This
search yielded 38 patients with a preoperative potassium
of 5.6 mEq/L or greater. Survival of the anesthetic was
100%, and no dysrhythmias or other major morbidity were
documented upon manual review of the intraoperative automated
record keeper charts or the patient medical records. These
data allow a 95% confidence interval assessment of maximal
risk for an event of 7.9%, which is not negligible, but
which almost certainly grossly overestimates the risk for
patients with moderately increased potassium levels. A prospective
trial to definitively assess the safety margin for succinylcholine
use in hyperkalemic patients would be difficult. Therefore,
these data, taken in the context of a compelling case for
rapid intubating conditions without long-term paralysis,
suggest safety in succinylcholine use in patients with modest
hyperkalemia. IMPLICATIONS: In a review of more than 40,000
general anesthetics in which succinylcholine was given at
induction, 38 patients had a preoperative potassium of 5.6
mEq/L or greater. All patients survived the anesthetic with
no dysrhythmias or other major morbidity documented. Succinylcholine
may be appropriate and safe for use in certain patients
with moderate hyperkalemia.
PMID: 12088954, UI: 22083380
Anesth Analg 2002 Jul;95(1):114-8, table of contents
Small-dose ketamine improves the postoperative state of
depressed patients.
Kudoh A, Takahira Y, Katagai H, Takazawa T
Department of Anesthesiology, Hakodate Watanabe Hospital,
Aomori, Japan.
We investigated whether ketamine is suitable for depressed
patients who had undergone orthopedic surgery. We studied
70 patients with major depression and 25 patients as the
control (Group C). The depressed patients were divided randomly
into two groups; patients in Group A (n = 35) were induced
with propofol, fentanyl, and ketamine and patients in Group
B (n = 35) were induced with propofol and fentanyl, and
all patients were maintained with 1.5%-2.0% isoflurane plus
nitrous oxide. The mean Hamilton Depression Rating (HDR)
score was 12.7 +/- 5.4 for Group A and 12.3 +/- 6.0 for
Group B 2 days before surgery and 9.9 +/- 4.1 for Group
A and 14.4 +/- 3.8 for Group B 1 day after surgery. The
HDR score in Group A 1 day after surgery was significantly
(P < 0.05) lower than that in Group B. The HDR score
in Group C was 4.2 +/- 1.7 2 days before surgery and 4.8
+/- 1.6 1 day after surgery. Depressed mood, suicidal tendencies,
somatic anxiety, and hypochondriasis significantly decreased
in Group A as compared with Group B. Postoperative pain
scores in Group A at 8 and 16 h after the end of anesthesia
were 26.6 +/- 8.7 and 24.9 +/- 8.2, respectively, which
were significantly (P < 0.05) lower than 34.3 +/- 12.0
and 31.1 +/- 8.8 in Group B. In conclusion, small-dose ketamine
improved the postoperative depressive state and relieved
postoperative pain in depressed patients. IMPLICATIONS:
NMDA receptor antagonists are reported to be effective for
improving depression. It remains unclear whether ketamine,
which is an NMDA receptor antagonist, postoperatively affects
the psychological state in depressed patients. We investigated
the effect of 1.0 mg/kg of ketamine on postoperative outcomes
in depressed patients.
Publication Types:
Clinical trial
Randomized controlled trial
PMID: 12088953, UI: 22083379
Anesth Analg 2002 Jul;95(1):109-13, table of contents
Sensitivity to vecuronium in seropositive and seronegative
patients with myasthenia gravis.
Itoh H, Shibata K, Nitta S
Department of Anesthesiology and Intensive care Medicine,
Kanazawa University School of Medicine, 13-1 Takara-machi,
Kanazawa 920-8641, Japan. hironori@med.kanazawa-u.ac.jp
Patients with myasthenia gravis (MG) are hypersensitive
to nondepolarizing neuromuscular blocking drugs. Although
antibodies to the acetylcholine receptor (AChR) often are
observed in MG patients, 10% to 30% of patients do not show
an anti-AChR antibody. Little is known about differences
in sensitivity to nondepolarizing neuromuscular blocking
drugs between MG patients with and without anti-AChR antibody.
Hypothesizing that seronegative patients are as sensitive
to vecuronium as seropositive patients, we assessed sensitivity
in seropositive and seronegative MG patients and in non-MG
patients (n = 8 each). During anesthesia with sevoflurane
(2.5%) and nitrous oxide (60%) in oxygen, neuromuscular
transmission was monitored by measuring the twitch tension
of the adductor pollicis muscle with supramaximal stimulation.
After baseline measurements, 10 microg/kg IV dose increments
of vecuronium were administered sequentially until blockade
exceeded 90%. The degree of blockade and onset time after
the initial 10 microg/kg of vecuronium were assessed, and
doses required to exceed 90% blockade were recorded. In
addition, effective doses of 50% and 95% for vecuronium
were calculated from a single data point. Both types of
MG patients showed increased sensitivity to vecuronium compared
with non-MG patients. IMPLICATIONS: Hypothesizing that seronegative
patients are as sensitive to vecuronium as seropositive
patients, we assessed sensitivity in seropositive and seronegative
myasthenia gravis (MG) patients and in non-MG patients.
They were, indeed, both equally sensitive to vecuronium.
Publication Types:
Clinical trial
PMID: 12088952, UI: 22083378
Anesth Analg 2002 Jul;95(1):62-6, table of contents
An evaluation of a virtual reality airway simulator.
Rowe R, Cohen RA
Departments of Anesthesiology and Diagnostic Imaging, Children's
Hospital Oakland, Oakland, CA 94609, USA. cho.dr.rwr@cho.org
In this research, we sought to test the hypothesis that
the AccuTouch Flexible Bronchoscopy Simulator (Simulator)
is an effective way to teach clinicians the psychomotor
skills necessary to use the fiberoptic bronchoscope as an
instrument for intubating the trachea of a pediatric patient.
Pediatric residents with no prior experience in fiberoptic
bronchoscopy were studied. Residents performed fiberoptic
intubation on children undergoing general anesthesia. Tapes
of these intubations were analyzed for: time to visualization
of the carina, and number and time that the bronchoscope
tip hit the mucosa. Residents were then trained on the Simulator.
Performance of fiberoptic intubation on a subsequent child
was compared. Training on the Simulator was the only instruction
that the residents received between the two cases. A control
group of residents performed two consecutive intubations
without training on the Simulator between cases. Residents
studied an average of 17 cases, and spent 39 min on the
Simulator. Performance was markedly improved after the Simulator.
Time to completion of successful intubation with a bronchoscope
was reduced from 5.15 to 0.88 min (P < 0.001). The number
of times that the tip of the bronchoscope hit the mucosa
was reduced from 21.4 to 3.0 (P < 0.001). The amount
of time that the resident spent viewing the mucosa decreased
from 2.24 to 0.19 min (P < 0.001). The percent of time
viewing the channel of the airway increased from 58.5% to
80.4% (P = 0.004). This bronchoscopy simulator was very
effective in teaching residents the psychomotor skills necessary
for fiberoptic intubation. Significant improvement was seen
in time to completion of endotracheal intubation, as well
as other performance indicators. IMPLICATIONS: This research
showed that the AccuTouch Bronchoscopy Simulator is an effective
way to teach the psychomotor skills necessary to intubate
the trachea of patients using a fiberoptic bronchoscope.
The residents that practiced on the Simulator dramatically
improved their skills compared with a control group of residents.
PMID: 12088944, UI: 22083370
Ann Fr Anesth Reanim 2002 Apr;21(4):341-2
[Spinal clonidine: potential consequences for fetal monitoring.]
[Article in French]
Deleuze A, Marret E, Lamonerie L, Bonnet F
Publication Types:
Letter
PMID: 12033108, UI: 22029865
Ann Fr Anesth Reanim 2002 Apr;21(4):340-1
[Paracervical block: an alternative for peridural anesthesia
in obstetrics?]
[Article in French]
Sleth JC
Publication Types:
Letter
PMID: 12033107, UI: 22029864
Ann Fr Anesth Reanim 2002 Apr;21(4):299-302
[Severe hypothermia associated with cesarean section under
spinal anesthesia.]
[Article in French]
Peillon P, Dounas M, Lebonhomme JJ, Guittard Y
Service d'anesthesie-reanimation, centre hospitalier general
de Lagny-Marne la Vallee, 31, avenue du General Leclerc,
77405 Lagny, France. ppeillon@ch-lagny77.fr
Temperature monitoring and prevention of hypothermia are
rarely used during spinal anaesthesia for caesarean section
because hypothermia risk is considered very low. However,
in same conditions, we observed two cases of severe hypothermia.
We report these two cases and discuss the effects of spinal
anaesthesia on thermoregulatory system. Hypothermia seems
explained by the effects of perimedullar anaesthesia that
decrease the shivering and the vasoconstriction thresholds.
These effects are potentiated by morphinomimetic adjunction.
At last, we recall prophylactics measures.
PMID: 12033098, UI: 22029855
Ann Fr Anesth Reanim 2002 Apr;21(4):249-55
[Anesthesia induction with sevoflurane in adult patients
with predictive signs of difficult intubation.]
[Article in French]
Cros AM, Chopin F, Lopez C, Kays C
Departement d'anesthesie-reanimation IV, hopital Pellegrin-Enfants,
33076 Bordeaux, France. anne-marie.cros@chu-bordeaux.fr
OBJECTIVE: This work was carried out to study induction
with sevoflurane in adult patients with predictive signs
of difficult intubation. STUDY DESIGN: Randomised prospective
study. PATIENTS AND METHODS: The study had two parts. Part
I: 15 patients without predictive signs of difficult intubation
but with a cervical collar. Eight patients were anaesthetised
with propofol 3 mg.kg-1 and fentanyl 2 micrograms.kg-1,
seven with sevoflurane 8%. Part II: 20 patients with predictive
signs of difficult intubation anaesthetised with sevoflurane
8%. RESULTS: In part I, all patients were intubated, the
time for intubation was longer with sevoflurane, 6 vs 4
min. They were apneic only in the propofol group. After
intubation, 7 cases of coughing (4 severe) occurred in the
propofol group and 3 moderate coughing in the sevoflurane
group. In part II, one patient experienced considerable
agitation after oral airway insertion and was excluded.
Other patients were intubated with sevoflurane. Seven patients
were intubated with a bougie, three patients through an
intubating LMA and one patient with a rigid bronchoscope.
The other patients were intubated with a Macintosh blade.
The mean time for intubation was 10 +/- 7 min and end tidal
sevoflurane concentration after intubation was 4 +/- 0.6%.
After intubation, 7 cases of coughing (3 severe) occurred
but no desaturation < 95%. No significant haemodynamic
variations occurred. CONCLUSION: Induction with sevoflurane
8% allowed tracheal intubation without major incidents.
All patients breathed spontaneously. Sevoflurane can be
recommended for induction in cases of predictive difficult
intubation.
Publication Types:
Clinical trial
Randomized controlled trial
PMID: 12033092, UI: 22029849
J Neurosurg 2002 Jul;97(1):241; discussion 241
Hypotensive anesthesia.
Marshman L
[Medline record in process]
Publication Types:
Letter
PMID: 12134928, UI: 22129961
Paediatr Anaesth 2002 Jul;12(6):556-8
Epidural anaesthesia in a child with possible spinal muscular
atrophy.
Veen A, Molenbuur B, Richardson FJ
Department of Pediatrics, Division of Intensive Care, University
Hospital/Beatrix Children's Hospital Groningen, the Netherlands,
Department of Anaesthesiology, University Hospital Groningen,
Groningen, the Netherlands.
[Medline record in process]
Spinal muscular atrophy (SMA) is a rare lower motor neurone
disease in which anaesthetic management is often difficult
as a result of muscle weakness and hypersensitivity to neuromuscular
blocking agents. Neuraxial anaesthesia is controversial
in these patients; however, some cases have been reported
in which neuraxial anaesthesia has been used without neurological
sequelae. We describe a 7-year-old patient with possible
SMA scheduled for a Grice-arthrodesis. Because of previous
prolonged postoperative drowsiness and poor oral intake,
we decided to use an epidural technique with sevoflurane
sedation and spontaneous ventilation to avoid the use of
muscle relaxants and systemic opioids and consequently admission
to the intensive care unit. After 3 days, the epidural analgesia
was stopped and the patient regained her preoperative motor
function within 5 h. Despite the controversy surrounding
the use of neuraxial techniques in neuromuscular disease,
we found no well-founded basis for this in patients with
SMA in the literature.
PMID: 12139600, UI: 22136206
Paediatr Anaesth 2002 Jul;12(6):511-518
Mivacurium infusion requirement and spontaneous recovery
of neuromuscular transmission in children anaesthetized
with nitrous oxide and fentanyl, halothane, isoflurane or
sevoflurane.
Woloszczuk-Gebicka B
Department of Anaesthesiology and Intensive Therapy, Memorial
Children's Health Institute, Warsaw, Poland.
[Record supplied by publisher]
Background: Forty children, aged 3-11 years, ASA I or II,
were allocated at random to receive N2O/O2-fentanyl or 1
MAC halothane, isoflurane or sevoflurane-N2O/O2 anaesthesia.
Mivacurium was used for muscle relaxation. Methods: Electromyographic
response of the adductor pollicis to train-of-four (TOF)
stimulation, 2 Hz for 2 s, applied to the ulnar nerve at
10-s intervals was recorded using the Relaxograph (Datex,
Helsinki, Finland). An intubating dose of mivacurium, 0.2
mg.kg-1 was given, and when T1 returned to 5%, muscle relaxation
was maintained by continuous infusion of mivacurium, adjusted
manually to maintain a stable 90-99% block. Results: Halothane,
isoflurane and sevoflurane groups had lower infusion requirements
for mivacurium than the N2O-fentanyl group (P=0.000083).
Mivacurium requirement was 18.8 +/- 6.8, 10.8 +/- 4.2, 6.9
+/- 3.9 and 9.6 +/- 5.6 &mgr;g.kg-1.min-1 for children receiving
N2O/O2-fentanyl, halothane, isoflurane and sevoflurane anaesthesia,
respectively. Conclusions: Spontaneous recovery from T1=10%
to TOF ratio=0.7 was insignificantly prolonged from 6.3
to 12.5 min in the fentanyl group to 7-16.5 min in children
anaesthetized with inhalational anaesthetics.
PMID: 12139592
Paediatr Anaesth 2002 Jul;12(6):499-506
Pulmonary volume recruitment manoeuvre restores pulmonary
compliance and resistance after apnoea in anaesthetized
lambs.
Russell FE, Van Der Walt JH, Jacob J, Slater AJ, Baghurst
P
Department of Paediatric Anaesthesia, Women's and Children's
Hospital, Adelaide, Australia.
[Medline record in process]
Background: We studied the effects of an episode of induced
apnoea on the dynamic compliance (Crs) and resistance (Rrs)
of the respiratory system in anaesthetized lambs and investigated
the mechanisms underlying the effectiveness of a timed reexpansion
inspiratory manoeuvre (TRIM). Methods: Following 2 min of
apnoea, three manoeuvres were randomly performed: (i) control:
reventilated without TRIM using initial settings and gas
composition of 30% oxygen in 70% nitrous oxide; (b) T1:
TRIM with 30% oxygen in 70% nitrous oxide, followed by reventilation
with the initial settings; and (c) T2: preoxygenate with
100% oxygen, apnoea, then TRIM with 100% oxygen, then reventilation
with 100% oxygen at the initial settings. The percentage
change in Crs and Rrs was calculated at first breath, second
breath, 10, 20, 40, 60, 90, 120 and 180 s postapnoea. Results:
Mean control decreased 15% and did not return to baseline
during the study period. TRIM increased mean Crs in T1 and
T2 by 8% and 9%, respectively, at first breath and returned
to baseline and did not deteriorate for the remainder of
the study period. Mean Rrs in the control group increased
20% and did not return to baseline during the study period.
Mean Rrs in T1 and T2 initially increased 17% and 27%, respectively,
at first breath and returned to baseline within 40 s. Conclusions:
These results demonstrate that significant deterioration
occurs in Crs and Rrs following 2 min of apnoea in anaesthetized
lambs, which is not corrected with normal ventilation but
is rapidly and completely reversed with a TRIM. This supports
our hypothesis that volume recruitment of alveoli is an
effective manoeuvre in restoring lung function. The practice
of preoxygenation is also reinforced as the lambs maintained
maximal oxygen saturation if they were ventilated with 100%
oxygen prior to the 2 min of apnoea.
PMID: 12139590, UI: 22136196
Paediatr Anaesth 2002 Jul;12(6):478-88
Anaesthetic care during minimally invasive neurosurgical
procedures in infants and children.
Johnson JO, Jimenez DF, Tobias JD
Department of Anesthesiology, The University of Missouri,
Columbia, Missouri, USA, Department of Pediatrics, The University
of Missouri, Columbia, Missouri, USA, Department of Neurosurgery,
The University of Missouri, Columbia, Missouri, USA.
[Medline record in process]
PMID: 12139587, UI: 22136193
Reg Anesth Pain Med 2002 May-Jun;27(3):336-7
Sub-Tenon infiltration to relieve postoperative pain in
a child.
Calenda E, Cabot A
Publication Types:
Letter
PMID: 12016622, UI: 22012113
Reg Anesth Pain Med 2002 May-Jun;27(3):335
Unreliability of sharp pinprick sensation.
Russell IF
Publication Types:
Letter
PMID: 12016620, UI: 22012111
Reg Anesth Pain Med 2002 May-Jun;27(3):333-4
The sciatic nerve block: a new posterior approach to sacral
plexus.
Some historical perspectives on axillary plexus block.
Thompson GE
Publication Types:
Historical article
Letter
PMID: 12016617, UI: 22012108
Reg Anesth Pain Med 2002 May-Jun;27(3):332-3
Dissociation of paresthesia, motor response, and success
of axillary block--another factor besides needle proximity.
Moon JK
Publication Types:
Letter
PMID: 12016616, UI: 22012107
Reg Anesth Pain Med 2002 May-Jun;27(3):330-2
The art and science of using a peripheral nerve stimulator:
how close is close enough?
Lang SA
Publication Types:
Letter
PMID: 12016615, UI: 22012106
Reg Anesth Pain Med 2002 May-Jun;27(3):327; discussion
327-8
Peripheral nerve stimulation and axillary brachial plexus
block.
Sia S
Publication Types:
Letter
PMID: 12016611, UI: 22012102
Reg Anesth Pain Med 2002 May-Jun;27(3):322-6
The contribution of John Lundy in the development of peripheral
and neuraxial nerve blocks at the Mayo Clinic: 1925-1940.
Kopp SL, Horlocker TT, Bacon DR
Department of Anesthesiology, Mayo Clinic, Rochester, Minnesota
55905, USA. Kopp.sandra@mayo.edu
Publication Types:
Biography
Historical article
Personal Name as Subject:
Lundy J
PMID: 12016610, UI: 22012101
Reg Anesth Pain Med 2002 May-Jun;27(3):313-5
Mandibular nerve block treatment for trismus associated
with hypoxic-ischemic encephalopathy.
Takemura H, Masuda Y, Yatsushiro R, Yamamoto N, Hosoyamada
A
Department of Anesthesiology, Showa University School of
Medicine, Tokyo, Japan. masuika@med.showa-u.ac.jp
BACKGROUND AND OBJECTIVES: We describe the use of mandibular
nerve block for the management of bilateral trismus associated
with hypoxic-ischemic encephalopathy. CASE REPORT: The patient
was a 65-year-old man with bilateral trismus due to hypoxic-ischemic
encephalopathy. Despite his impaired consciousness, we performed
fluoroscopically guided bilateral mandibular nerve block.
The bilateral symptoms were sufficiently improved, without
obvious side effects, by injecting a local anesthetic near
the right mandibular nerve and a neurolytic near the left
mandibular nerve. CONCLUSIONS: Mandibular nerve block may
be an effective treatment for patients with bilateral trismus
due to ischemic-encephalopathy, even when consciousness
is impaired.
PMID: 12016607, UI: 22012098
Reg Anesth Pain Med 2002 May-Jun;27(3):306-8
Combined use of ultrasonography and neurostimulation for
therapeutic phrenic nerve block.
Michalek P, Kautznerova D
Department of Anesthesiology and Intensive Care, Institute
for Clinical and Experimental Medicine, Prague, Czech Republic.
pafkam@seznam.cz
PMID: 12016605, UI: 22012096
Reg Anesth Pain Med 2002 May-Jun;27(3):284-8
Intrathecal hyperbaric bupivacaine dose response in postpartum
tubal ligation patients.
Huffnagle SL, Norris MC, Huffnagle HJ, Leighton BL, Arkoosh
VA
Department of Anesthesiology, Jefferson Medical College,
Thomas Jefferson University, Philadelphia, Pennsylvania
19107, USA. Suzanne.Huffnagle@mail.tju.edu
BACKGROUND AND OBJECTIVES: Because of its short duration,
hyperbaric lidocaine has been a popular intrathecal drug
to provide anesthesia for postpartum tubal ligation (PPTL).
However, reports of transient symptoms associated with its
use have prompted the search for alternative intrathecal
local anesthetics for short procedures. Hyperbaric bupivacaine
is rarely associated with transient neurologic symptoms,
and we designed this study to determine the optimal dose
of bupivacaine for PPTL that assures adequate sensory block
and allows the patient the shortest recovery time. METHODS:
Forty American Society of Anesthesiologists (ASA) I-II patients
undergoing spinal anesthesia for PPTL were randomly assigned
to receive 5.0, 7.5, 10.0, or 12.5 mg hyperbaric bupivacaine
in the right lateral position. RESULTS: Despite sensory
block above T-8 in all groups, 4 of the 5 patients in the
5-mg group developed blocks insufficiently dense for surgery
and required general anesthesia. Failed spinals occurred
evenly in the remaining groups. Motor regression was significantly
more rapid with decreasing doses of bupivacaine. Time in
the postanesthesia care unit (PACU) was shorter in the 7.5-mg
group. CONCLUSIONS: Hyperbaric bupivacaine 7.5 mg injected
in the lateral position provides adequate surgical anesthesia
for PPTL with a minimal duration of motor block and recovery
time.
Publication Types:
Clinical trial
Randomized controlled trial
PMID: 12016602, UI: 22012093
Reg Anesth Pain Med 2002 May-Jun;27(3):268-76
Effectiveness of cervical sympathetic ganglia block on
regeneration of the trigeminal nerve following transection
in rats.
Hanamatsu N, Yamashiro M, Sumitomo M, Furuya H
Department of Anesthesiology, School of Dentistry at Tokyo,
The Nippon Dental University, Tokyo, Japan.
BACKGROUND AND OBJECTIVES: Stellate ganglion block (SGB)
is one treatment option for human trigeminal nerve injury.
The aim of this study was to evaluate the effectiveness
of cervical sympathetic ganglia blocks (SB) by comparing
the recovery of severed nerves in 2 rat models, treated
or not treated by SB. METHODS: The infraorbital nerves (ION)
were cut in 108 rats. Fifty-four of them were treated daily
by SB for 30 days (SB group). The remainder were left untreated
(Control group). The stages of recovery were evaluated neurophysiologically
by measuring somatosensory evoked potentials (SEPs) and
were histologically analyzed via microscopic observation.
RESULTS: The neurophysiologic evaluation showed that SEP
amplitude was detected 1 month after cutting the ION in
the SB group, but not in the Control group. The average
recovery after 8 months was almost 100% in the SB group
and about 70% in the Control group. The histologic evaluation
showed no significant difference in the number of myelinated
nerve fibers per unit area between the 2 groups. However,
in the SB group, the mean diameter and distribution of diameters
of the myelinated fibers were greater, and myelinated fibers
of large diameter were observed at an early stage. CONCLUSIONS:
The findings suggest that cervical sympathetic nerve block
may accelerate the recovery and regeneration of severed
ION. The clinical correlation in patients with peripheral
trigeminal paralysis remains to be established.
PMID: 12016600, UI: 22012091
Reg Anesth Pain Med 2002 May-Jun;27(3):261-7
Percutaneous electrode guidance: a noninvasive technique
for prelocation of peripheral nerves to facilitate peripheral
plexus or nerve block.
Urmey WF, Grossi P
Regional Anesthesia and Pain Treatment Department, Instituto
Policlinico San Donato, Universita degli Stidi di Milano,
Milan, Italy. urmeyw@aol.com
BACKGROUND AND OBJECTIVES: Typically, peripheral nerve
block is done by approximating nerve location, usually by
use of anatomical landmarks. Precise nerve location has
been done by needle exploration. A new method, percutaneous
electrode guidance (PEG) of the block needle, was performed.
A transcutaneous stimulating cylindrical electrode was used
to indent the skin, locate the underlying nerve, and guide
a block needle near it. METHODS: PEG was used to prelocate
the desired nerve or neural plexus by use of a shielded
cylindrical electrode with a 1-mm-diameter conductive area
of skin contact at the distal end, the center of which contained
a 22-gauge (1/2 mm) hole, which precisely matched a shielded
conventional block needle. Transcutaneous stimulation began
at less than 10 mA and was decreased to minimal amperage
that elicited the desired motor response. Electrode position
was fixed, and electrode current was discontinued. A shielded
22-gauge block needle was advanced through the electrode
guide to near the underlying nerve. Initial needle current
was only 0.5 mA. Local anesthetic was injected to block
the targeted nerve or nerves. Standard sensory/motor testing
was performed at 20 minutes. RESULTS: Nine upper or lower
extremity blocks were performed on 7 patients. All were
successful. Minimal stimulating currents were 1.3 to 8.2
mA for transcutaneous electrode stimulation and 0.20 to
0.70 for needle stimulation. Needle depth was 0.4 to 1.1
cm beyond the electrode tip and correlated with minimal
electrode stimulating current. CONCLUSIONS: A smooth, metal-tipped
electrically shielded skin electrode probe can be used to
comfortably and accurately indent the skin over a desired
nerve or plexus, define its anatomical course, and subsequently
guide a block needle near it.
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.
