Panning B, Jaeger K, Ruschulte H, Enlund M, Gisvold SE
Publication Types:
Letter
PMID: 11939931, UI: 21937487
Acta Anaesthesiol Scand 2002 Mar;46(3):332-3
One-lung ventilation of a preterm newborn during esophageal
atresia and tracheoesophageal fistula repair.
Tercan E, Sungun MB, Boyaci A, Kucukaydin M
Department of Anesthesiology and Reanimation, Erciyes University,
Medical Faculty, Kayseri, Turkey.
In this paper, we assessed the anesthesia management of
a male, a 34-week gestation age newborn, weighing 1500 g,
who has esophageal atresia and tracheoesophageal fistula
localized just above the carina. Endotracheal intubation
and intermittent positive pressure ventilation caused air
leakage through the fistula into the stomach, causing abdominal
distention. One-lung ventilation by left main bronchus intubation
eliminated this problem.
PMID: 11939927, UI: 21937483
Acta Anaesthesiol Scand 2002 Mar;46(3):329-31
Continuous spinal analgesia for labor and delivery in
a parturient with hypertrophic obstructive cardiomyopathy.
Okutomi T, Kikuchi S, Amano K, Okamoto H, Hoka S
Department of Anesthesiology, Kitasato University School
of Medicine, Sagamihara, Kanagawa, Japan. toshiyukiokutomi@hotmail.com
Induction of labor under analgesia was planned for a 30-year-old-primiparous
patient with hypertrophic obstructive cardiomyopathy (HOCM),
as her fetal evaluation revealed intrauterine growth restriction
at 38 weeks' gestation. However, regional analgesia during
labor may present a potential risk for hemodynamic instability
in patients with HOCM due to the possibility of a sympathetic
block, as a result of vasodilation associated with the administration
of local anesthesia. This case report demonstrates the successful
management of the patient with analgesia provided by a continuous
spinal catheter dosed with a continuous infusion of fentanyl
and supplemental meperidine. Fetal surveillance monitoring
included fetal pulse oximetry in addition to conventional
cardiotocography, on the basis of which cesarean section
was avoided.
PMID: 11939926, UI: 21937482
Acta Anaesthesiol Scand 2002 Mar;46(3):289-96
Computer-aided ventilator resetting is feasible on the
basis of a physiological profile.
Uttman L, Jonson B
Department of Clinical Physiology, University Hospital,
Lund, Sweden. leif.uttman@klinfys.lu.se
BACKGROUND: Ventilator resetting is frequently needed to
adjust tidal volume, pressure and gas exchange. The system
comprising lungs and ventilator is so complex that a trial
and error strategy is often applied. Comprehensive characterization
of lung physiology is feasible by monitoring. The hypothesis
that the effect of ventilator resetting could be predicted
by computer simulation based on a physiological profile
was tested in healthy pigs. METHODS: Flow, pressure and
CO2 signals were recorded in 7 ventilated pigs. Elastic
recoil pressure was measured at postinspiratory and post-expiratory
pauses. Inspiratory and expiratory resistance as a function
of volume and compliance were calculated. CO2 elimination
per breath was expressed as a function of tidal volume.
Calculating pressure and flow moment by moment simulated
the effect of ventilator action, when respiratory rate was
varied between 10 and 30 min(-1) and minute volume was changed
so as to maintain PaCO2. Predicted values of peak airway
pressure, plateau pressure, and CO2 elimination were compared
to values measured after resetting. RESULTS: With 95% confidence,
predicted pressures and CO2 elimination deviated from measured
values with < 1 cm H2O and < 6%, respectively. CONCLUSION:
It is feasible to predict effects of ventilator resetting
on the basis of a physiological profile at least in health.
PMID: 11939920, UI: 21937476
Acta Anaesthesiol Scand 2002 Mar;46(3):279-82
Detecting postoperative urinary retention with an ultrasound
scanner.
Rosseland LA, Stubhaug A, Breivik H
Department of Anesthesia, Lillehammer Hospital, Lillehammer,
Norway. leiv.arne.rosseland@rikshospitalet.no
BACKGROUND: Retention of urine is a common postoperative
problem associated with risk of overdistention and permanent
detrusor damage. Prevention of urinary retention by insertion
of indwelling catheter may increase the risk of urinary
infection. We have performed a reliability test of an ultrasound
scanner, implemented in the postoperative monitoring equipment.
METHODS: Patients were monitored after different types of
surgery under spinal anesthesia with an ultrasound scanner
in the postanesthesia care unit (PACU). PATIENTS: Patients
who according to current guidelines required a urinary bladder
catheter, were scanned before a catheter was inserted and
urine volume was measured. These two urine volumes were
compared and analyzed for agreement. RESULTS: Nineteen female
and 17 male patients were included. The mean difference
between ultrasound estimates and catheter urine volume measurements
was - 21.5 mL, and limits of agreement, calculated as a
95% confidence interval, were - 147 and + 104 mL. This means
that the urine volume estimated by ultrasound was on average
21.5 mL smaller than the urine volume when the bladder was
emptied. CONCLUSION: This study confirms a good agreement
between the ultrasound scanner estimates of urinary bladder
volume and urine volume measured after emptying the bladder.
Nurses in the PACU could operate the ultrasound scanner
after a brief instruction and training period. Considering
the potentially serious long-term consequences of undiagnosed
postoperative urinary retention, introducing this equipment
for routine monitoring of urinary bladder volume should
be considered.
PMID: 11939918, UI: 21937474
Acta Anaesthesiol Scand 2002 Mar;46(3):252-6
Effect of sevoflurane on the mid-latency auditory evoked
potentials measured by a new fast extracting monitor.
Alpiger S, Helbo-Hansen HS, Jensen EW
Department of Anesthesiology and Intensive Care Medicine,
Odense University Hospital, Odense, Denmark. alpiger@dadlnet.dk
BACKGROUND: Mid-latency auditory evoked potentials (MLAEP)
are widely suppressed during general anesthesia and may
therefore be useful for assessment of the depth of anesthesia.
However, interpretation of amplitudes and latencies in the
AEP signal is time consuming. A new monitor (A-line) that
quantifies the MLAEP into an index has therefore been developed.
The present study aimed to assess the precision of a prototype
of the new monitor and to test the hypothesis that the depth
of anesthesia index shows a graded response with changing
steady-state end-expiratory concentrations of sevoflurane.
METHODS: We studied 10 ASA physical status I or II patients
undergoing elective hysterectomy under combined epidural
and general anesthesia by sevoflurane. Baseline auditory
evoked potentials were recorded in the conscious patient
immediately before induction of general anesthesia. Depth
of anesthesia indices were recorded before anesthesia and
at decreasing end-expiratory steady-state sevoflurane concentrations
of 2.0%, 1.5%, 1.0% and 0.5%. All indices were recorded
in duplicate 6 s apart. By use of an autoregressive model
with exogenous input (ARX-model), the monitor extracted
the AEP within 6 s. The depth of anesthesia AEP index calculated
in this way was defined as the A-line ARX index (AAI). RESULTS:
Approximately 95% of the differences between repeated recordings
were 5 AAI-units or less. A wide interindividual variation
was observed at each observation point. AAI at 1%, 1.5%
and 2% end-expiratory concentration was significantly less
than the baseline AAI obtained before induction of anesthesia
(P < 0.001). AAI did not change significantly in the
1-2% concentration range. CONCLUSION: The new monitor was
precise. Attenuation of the A-line ARX-index (AAI) for mid-latency
auditory evoked potentials (MLAEP) during general anesthesia
was profound. However, the monitor did not show a graded
response with changing end-expiratory steady-state concentrations
of sevoflurane.
PMID: 11939914, UI: 21937470
Acta Anaesthesiol Scand 2002 Mar;46(3):245-51
Comparison of auditory evoked potentials and the A-line
ARX Index for monitoring the hypnotic level during sevoflurane
and propofol induction.
Litvan H, Jensen EW, Revuelta M, Henneberg SW, Paniagua
P, Campos JM, Martinez P, Caminal P, Villar Landeira JM
Hospital Santa Creu i Sant Pau, Barcelona and Polytechnic
University of Catalonia, Spain. hlitvan@hsp.santpau.es
BACKGROUND: Extraction of the middle latency auditory evoked
potentials (AEP) by an auto regressive model with exogenous
input (ARX) enables extraction of the AEP within 1.7 s.
In this way, the depth of hypnosis can be monitored at almost
real-time. However, the identification and the interpretation
of the appropriate signals of the AEP could be difficult
to perform during the anesthesia procedure. This problem
was addressed by defining an index which reflected the peak
amplitudes and latencies of the AEP, developed to improve
the clinical interpretation of the AEP. This index was defined
as the A-line Arx Index (AAI). METHODS: The AEP and AAI
were compared with the Modified Observers Assessment of
Alertness and Sedation Scale (MOAAS) in 24 patients scheduled
for cardiac surgery, anesthetized with propofol or sevoflurane.
RESULTS: When comparing the AEP peak latencies and amplitudes
and the AAI, measured at MOAAS level 5 and level 1, significant
differences were achieved. (mean(SD) Nb latency: MOAAS 5
51.1 (7.3) ms vs. MOAAS 1: 68.6 (8.1) ms; AAI: MOAAS 5 74.9
(13.3) vs. MOAAS 1 20.7 (4.7)). Among the recorded parameters,
the AAI was the best predictor of the awake/anesthetized
states. CONCLUSION: We conclude that both the AAI values
and the AEP peak latencies and amplitudes correlated well
with the MOAAS levels 5 (awake) and 1 (anesthetized).
Publication Types:
Clinical trial
Randomized controlled trial
PMID: 11939913, UI: 21937469
Acta Anaesthesiol Scand 2002 Mar;46(3):232-7
Superior prolonged antiemetic prophylaxis with a four-drug
multimodal regimen - comparison with propofol or placebo.
Hammas B, Thorn SE, Wattwil M
Department of Anesthesia and Intensive Care, Orebro Medical
Center Hospital, Orebro, Sweden.
BACKGROUND: The purpose of this study was to compare the
effects of a low-dose propofol infusion with a four-drug
multimodal regimen for prophylaxis of postoperative nausea
and vomiting (PONV). METHODS: : PONV was studied in two
patient groups with a known high incidence. Through a stratified
randomization, 60 patients undergoing breast surgery and
120 patients undergoing abdominal surgery were randomized
to three groups of equal size: the propofol group (P), the
multidrug group (M) and the control group (C). All patients
received general anesthesia, induction with propofol and
maintenance with sevoflurane. After induction, patients
in the P group received a continuous infusion of propofol
1 mg/kg/h during the operation and the first 4 postoperative
h. Patients in the M group received dexamethasone 4 mg and
three antiemetics, ondansetron 4 mg, droperidol 1.25 mg
and metoclopramide 10 mg i.v. In the control group no prophylaxis
was given. Nausea and pain were evaluated by incidence and
a visual analog scale (0-10 cm). All emetic episodes were
noted by the staff during the first 4 h and by the patients
during the next 20 h. RESULTS: The overall incidence of
PONV during the first 24 h postoperatively was significantly
lower in the M group (24%) than in the P group (49%) (P<0.01)
or the C group (70%) (P<0.001). The incidence of PONV
increased significantly both in patients undergoing breast
surgery and abdominal surgery after termination of propofol.
The number of patients who vomited was significantly lower
in the M group, both in breast surgery patients (5%) and
abdominal surgery patients (3%) compared to patients in
the propofol groups (breast 16% NS; abdominal 29%, P<0.05)
and in the control groups (breast 37%, P<0.01; abdominal
29%, P<0.01). CONCLUSION: The incidence of PONV is very
high in patients undergoing breast and abdominal surgery.
In the present study antiemetic prophylaxis with a combination
of droperidol, ondansetron, metoclopramide and dexamethasone
was more effective in preventing PONV, especially vomiting,
than a postoperative low-dose infusion of propofol, which
had a short lasting effect.
Publication Types:
Clinical trial
Randomized controlled trial
PMID: 11939911, UI: 21937467
Acta Anaesthesiol Scand 2002 Mar;46(3):229-31
Victims of awareness.
Lennmarken C, Bildfors K, Enlund G, Samuelsson P, Sandin
R
Department of Anesthesia and Intensive Care, Vrinnevisjukhuset,
Norrkoping, Sweden. Claes.Lennmarken@lio.se
BACKGROUND: Intraoperative awareness with explicit recall
may be followed by long-lasting mental symptoms. However,
the average risk for developing mental sequelae after awareness,
and the average severity and the duration of symptoms has
not previously been illustrated in a consecutive series
of awareness cases. METHODS: Nine patients among 18 consecutive,
prospectively identified cases of intraoperative awareness
with recall could be located after approximately 2 years
and agreed to an interview about possible persisting problems.
RESULTS: Four of the nine interviewed patients were still
severely disabled due to psychiatric/psychological sequelae.
All of these patients had experienced anxiety during the
period of awareness, but only one had complained about pain.
Another three patients had less severe, transient mental
symptoms, although they could cope with these in daily life.
Two patients denied any sequelae from their awareness episode.
CONCLUSIONS: Up to 3 weeks after their unsuccessful anesthetic,
repeated information and discussions had been offered. Despite
the fact that all patients at that time claimed to be satisfied
with this management, and eventually considered no further
contacts necessary, this was obviously inaccurate. Therefore,
professional psychiatric assessment, treatment and long-term
follow-up should constitute standard practice for all patients
who have experienced intraoperative awareness.
PMID: 11939910, UI: 21937466
Anaesthesia 2002 Apr;57(4):390-4
A pilot study of patient-led identification of the midline
of the lumbar spine.
Wills JS, Bowie R, Bogod DG
University Department of Anaesthesia and Intensive Care,
Queen's Medical Centre, Nottingham, UK.
The midline of the lumbar spine is usually identified by
palpation of the spinous processes. Placement of an epidural
or spinal needle is more difficult when these bony landmarks
are impalpable. This pilot study investigated the ability
of 50 healthy volunteers to identify the midline of their
own backs, using light touch or proprioception. The midline
as identified in this manner was compared with the 'gold
standard' as defined by the interspinous line. Sensation
to light touch was the most accurate, with 90% of the volunteers
able to identify the midline to within 6.5 mm. Proprioception
using a finger to touch the midline was less accurate. This
study was carried out on volunteers with palpable spinous
processes but suggests that, in certain circumstances, a
patient-led identification of the midline may be of value.
PMID: 11949643, UI: 21945391
Anaesthesia 2002 Apr;57(4):412-3
Reflection; end of an era and a new beginning!
Lahoud GY
Publication Types:
Letter
PMID: 11940005, UI: 21937625
Anaesthesia 2002 Apr;57(4):330-3
The cardiovascular response to insertion of the intubating
laryngeal mask airway.
Choyce A, Avidan MS, Harvey A, Patel C, Timberlake C,
Sarang K, Tilbrook L
Anaesthetic Department, Kings College Hospital, London
SE5 9RS, UK.
Sixty-one patients received a standardised anaesthetic
and were randomly assigned to three groups: tracheal intubation
via direct laryngoscopy, tracheal intubation via an intubating
laryngeal mask airway with immediate removal of the device,
and tracheal intubation via an intubating laryngeal mask
airway with delayed removal. The cardiovascular response
to intubation was of a similar magnitude in all groups,
although delayed removal of the intubating laryngeal mask
airway was associated with a second pressor response. Norepinephrine
changed significantly over time following direct laryngoscopy
and following immediate removal of the intubating laryngeal
mask airway, but not after delayed removal. The findings
of this study do not support using the intubating laryngeal
mask instead of direct laryngoscopy purely to decrease the
response to intubation.
Publication Types:
Clinical trial
Randomized controlled trial
PMID: 11939990, UI: 21937610
Anaesthesia 2002 Apr;57(4):319-25
Osteocalcin and the hormonal, inflammatory and metabolic
response to major orthopaedic surgery.
Nicholson G, Bryant AE, Macdonald IA, Hall GM
Senior Lecturer, Department of Anaesthesia, St George's
Hospital Medical School, London SW17 0RE, UK. gnichols@sghms.ac.uk
Plasma osteocalcin, a marker of osteoblastic activity,
decreases after major abdominal and gynaecological surgery.
Increased cortisol secretion and other hormonal and inflammatory
components of the peri-operative stress response may play
a role in mediating this response. We assessed the effects
of three different anaesthetic techniques on peri-operative
osteocalcin concentrations. Thirty-six female patients undergoing
elective total hip replacement were randomly assigned to
receive propofol, propofol plus 'three-in-one' block or
etomidate as part of a general anaesthetic technique. We
measured plasma osteocalcin and serum cortisol, bone specific
alkaline phosphatase, interleukin-6, plasma epinephrine,
norepinephrine, plasma glucose and cystatin C concentrations
for up to 3 days after surgery. Etomidate successfully inhibited
the cortisol response to surgery but plasma osteocalcin
declined in all patients. This was accompanied by increased
plasma catecholamines, interleukin-6 and glucose concentrations,
and decreased cystatin C-values. Inhibition of the cortisol
response to surgery failed to prevent a decrease in plasma
osteocalcin concentrations after surgery, suggesting that
other factors such as cytokines or catecholamines may play
a significant role.
Publication Types:
Clinical trial
Randomized controlled trial
PMID: 11939988, UI: 21937608
Anaesthesia 2002 Apr;57(4):317-8
Up, up and away: watching the Caesarean section rate rise.
May AE, Yentis SM
Publication Types:
Editorial
PMID: 11939987, UI: 21937607
Anesthesiology 2002 May;96(5):1281
The virtual anesthesia machine.
Olympio MA
[Medline record in process]
PMID: 11981181, UI: 21976919
Anesthesiology 2002 May;96(5):1268-70
Mitochondrial defects and anesthetic sensitivity.
Morgan PG, Hoppel CL, Sedensky MM
Department of Anesthesiology, University Hospitals, Cleveland,
Ohio.
[Medline record in process]
PMID: 11981173, UI: 21976911
Anesthesiology 2002 May;96(5):1183-1190
Propofol Anesthesia Compared to Awake Reduces Infarct
Size in Rats.
Gelb AW, Bayona NA, Wilson JX, Cechetto DF
Department of Anatomy and Cell Biology, University of Western
Ontario, London, Ontario, Canada.
[Record supplied by publisher]
BACKGROUND: Propofol has not been studied directly in animals
subject to cerebral ischemia in the conscious state. Strokes
are usually induced in animals while they are anesthetized,
making it difficult to eliminate anesthetic interactions
as a complicating factor. Therefore, to compare the neuroprotective
effects of propofol to the unanesthetized state, experiments
were performed using a model that induces a stroke in the
conscious rat. METHODS: Cerebral ischemia was induced in
awake Wistar rats by a local intracerebral injection of
the potent vasoconstrictor endothelin. Four days before
the strokes were induced, a guide cannula was implanted
for the injection of endothelin. On the day of the experiment,
endothelin (6.0 pmol in 3 &mgr;l) was injected into the
striatum. Propofol (25 or 15 mg. kg-1. h-1) or intralipid
(vehicle) were infused for 4 h starting immediately after
the endothelin injection. In another series, the propofol
infusion was begun 1 h after the endothelin injection and
continued for 4 h. Three days later, the animals were killed,
and the brains were sectioned and stained. RESULTS: The
propofol group (25 mg. kg-1. h-1) had a significantly reduced
infarct size (0.7 +/- 0.21 mm3, first 4 h; 0.27 +/- 0.07
mm3, started 1 h after initiation of infarct) compared with
the intralipid controls (3.40 +/- 0.53 mm3). To exclude
a direct interaction between propofol and endothelin, in
thiobutabarbital anesthetized rats, endothelin-induced cerebral
vasoconstriction was examined using videomicroscopy, with
or without propofol. Propofol had no effect on the magnitude
or time course of the endothelin-induced vasoconstriction.
CONCLUSIONS: The results show that concurrent or delayed
administration of propofol is neuroprotective.
PMID: 11981160
Anesthesiology 2002 May;96(5):1044-52
Anesthesiologist board certification and patient outcomes.
Silber JH, Kennedy SK, Even-Shoshan O, Chen W, Mosher
RE, Showan AM, Longnecker DE
Center for Outcomes Research, Department of Anesthesiology
and Critical Care Medicine, The Children's Hospital of Philadelphia,
Philadelphia, Pennsylvania.
[Medline record in process]
BACKGROUND: Board certification is often used as a surrogate
indicator of provider competence, although few outcome studies
have demonstrated its validity. The aim of this study was
to compare the outcomes of patients who underwent surgical
procedures under the care of an anesthesiologist with or
without board certification. METHODS: Medicare claims records
for 144,883 patients in Pennsylvania who underwent general
surgical or orthopedic procedures between 1991 and 1994
were used to determine provider-specific outcome rates adjusted
to account for patient severity and case mix, and hospital
characteristics. Outcomes of 8,894 cases involving midcareer
anesthesiologists, 11-25 yr from medical school graduation,
who lacked board certification were compared with all other
cases. Midcareer anesthesiologist cases were studied because
this group had sufficient time to become certified during
an era when obtaining certification was already considered
important, and consequently had the highest rate of board
certification. Mortality within 30 days of admission and
the failure-to-rescue rate (defined as the rate of death
after an in-hospital complication) were the two primary
outcome measures. RESULTS: Adjusted odds ratios for death
and failure to rescue were greater when care was delivered
by noncertified midcareer anesthesiologists (death = 1.13
[95% confidence interval, 1.00, 1.26], P < 0.04; failure
to rescue = 1.13 [95% confidence interval, 1.01, 1.27],
P < 0.04). Adjusting for international medical school
graduates did not change these results. CONCLUSIONS: When
anesthesiology board certification is very common, as in
midcareer practitioners, the lack of board certification
is associated with worse outcomes. However, the poor outcomes
associated with noncertified providers may be a result of
the hospitals at which they practice and not necessarily
their manner of practice.
PMID: 11981141, UI: 21976879
Anesthesiology 2002 May;96(5):1042-3
Platelets, perioperative hemostasis, and anesthesia.
Too limited a view of what clinical anesthesiology could
become.
Hartung J
Publication Types:
Letter
PMID: 11964618, UI: 21961261
Anesthesiology 2002 Apr;96(4):1025-7
Delayed emergence and St. John's wort.
Crowe S, McKeating K
Department of Anaesthesia, National Maternity Hospital,
Holles Street, Dublin, Ireland. suzbar@gofree.indigo.ie
PMID: 11964615, UI: 21961258
Can J Anaesth 2002 May;49(5):525-6
Efficacy of a combined technique using the Trachlight(TM)
together with direct laryngoscopy under simulated difficult
airway conditions in 350 anesthetized patients.
Agro F, Benumof JL, Carassiti M, Cataldo R, Gherardi S,
Barzoi G
Rome, Italy.
[Medline record in process]
PMID: 11983674, UI: 21978968
Can J Anaesth 2002 May;49(5):497-9
Best evidence in anesthetic practice: Prognosis: cognitive
function at hospital discharge predicts long-term cognitive
function after coronary artery bypass surgery.
Murkin J, Hall R
London, Ontario Halifax, Nova Scotia.
[Medline record in process]
PMID: 11983667, UI: 21978961
Can J Anaesth 2002 May;49(5):493-6
Anesthetic management of a parturient with Ehlers Danlos
syndrome type IV: [L'anesthesie d'une parturiente atteinte
du syndrome d'Ehlers Danlos de type IV].
Campbell N, Rosaeg OP
Department of Anesthesiology, The Ottawa Hospital, Ottawa,
Ontario, Canada.
[Medline record in process]
PURPOSE: To describe the anesthetic management of a parturient
with Ehlers Danlos syndrome (EDS) type IV. Clinical features:
A 29-yr-old pregnant woman with EDS type IV was seen in
the Obstetric Anesthesia Pre-assessment Clinic at 30 weeks
gestation. She had a history of vertebral artery dissection,
resulting in a transient neurological deficit at 22 yr of
age. She had a normal vaginal delivery with continuous epidural
analgesia for the delivery of her first child at 27 yr of
age, before the diagnosis of EDS was made. Recent fibroblast
culture demonstrated the production of abnormal procollagen
type III, which is pathognomonic for EDS type IV. The patient
and obstetrician preferred a repeat vaginal birth with instrumental
delivery in the second stage. Analgesia for labour and delivery
was provided with a continuous epidural infusion of ropivacaine
and fentanyl. She delivered a healthy female infant with
the use of outlet forceps, without complications. CONCLUSION:
A pre-delivery, multidisciplinary, individualized management
plan is required in patients with EDS, a rare disease with
variable clinical features. In the case described, continuous
epidural analgesia was effective and associated with excellent
maternal and fetal outcomes.
PMID: 11983666, UI: 21978960
Can J Anaesth 2002 May;49(5):490-2
Epidural analgesia does not prolong the third stage of
labour: [L'analgesie epidurale ne prolonge pas la delivrance
lors de l'accouchement].
Rosaeg OP, Campbell N, Crossan ML
Department of Anesthesiology, The Ottawa Hospital, University
of Ottawa, Ottawa, Ontario, Canada.
[Medline record in process]
PURPOSE: To investigate whether there is an association
between epidural analgesia and duration of third stage of
labour, and between epidural analgesia and type of placental
delivery (spontaneous vs expressed vs manual). METHODS:
We examined, retrospectively, the computerized labour and
delivery data of all 7,468 parturients who had vaginal deliveries
from 1996 to 1999 at the Civic Campus of the Ottawa Hospital.
RESULTS: There was no difference in duration of third stage
of labour between women with and without epidural pain relief
who had spontaneous or expressed (fundal pressure/gentle
cord traction) placental delivery. Duration of third stage
of labour was shorter in women with epidural analgesia requiring
manual removal of placenta. (25.3 min vs 40.1 min, P <
0.0001). The incidence of expressed placental delivery or
manual removal of placenta was not different between the
groups. CONCLUSIONS: We conclude that there is no clinically
important difference in duration of third stage of labour
between women with or without epidural analgesia who have
spontaneous placental delivery or placental expulsion with
fundal pressure/gentle cord traction. However, duration
of third stage of labour was shorter in women who received
epidural analgesia and required manual removal of the placenta.
PMID: 11983665, UI: 21978959
Can J Anaesth 2002 May;49(5):487-489
Continuous retrobulbar anesthesia for scleral buckling
surgery using an ultra-fine spinal anesthesia catheter:
[L'anesthesie retrobulbaire continue pendant le cerclage
scleral a l'aide d'un catheter ultra-fin pour la rachianesthesie].
Jonas JB, Jager M, Hemmerling TM
Department of Ophthalmology Eye Hospital, Faculty of Clinical
Medicine Mannheim, University of Heidelberg Mannheim, Germany,
and the Department Of Anesthesiology, Centre Hospitalier
de l'Universite de Montreal (CHUM), University of Montreal,
Montreal, Quebec, Canada.
[Record supplied by publisher]
PURPOSE: To evaluate a novel retrobulbar catheter technique
for intraoperative and postoperative analgesia in patients
undergoing scleral buckling procedures. METHODS: This prospective
noncomparative clinical interventional case-series study
included 43 consecutive patients undergoing scleral buckling
procedures as treatment of rhegmatogenous retinal detachments.
Using a commercially available retrobulbar needle with a
diameter of 0.80 mm and a length of 38 mm, 7 mL of local
anesthetic were injected into the retrobulbar space. Through
the same needle, a 28-gauge commercially available flexible
spinal anesthesia catheter was introduced into the retrobulbar
space, the needle was withdrawn, and the catheter was fixed.
The catheter was removed on the morning of the first postoperative
day. When the patients started to feel pain during or after
surgery, 2 mL of local anesthetic were re-injected through
the catheter. RESULTS: During surgery, 12 (27.9%) patients
received a pain-free re-injection through the retrobulbar
catheter resulting in a marked reduction of pain. Two (4.7%)
patients needed a second re-injection. In the postoperative
period, 23 (53.5%) patients experienced pain of grade 3
or higher 5.4 +/- 6.7 hr after start of surgery and received
a retrobulbar re-injection. Eleven (25.6%) patients asked
for a second postoperative re-injection, and four (9.3%)
patients received a third postoperative re-injection. Cardiopulmonary
and central nervous adverse effects were not noticed. CONCLUSIONS:
Use of an ultra-fine retrobulbar catheter for repeat intraoperative
and postoperative injections of local anesthetics is a simple
and effective method to achieve analgesia during and after
scleral buckling procedures.
PMID: 11983664
Can J Anaesth 2002 May;49(5):467-70
The anesthetic management of a patient with Emery-Dreifuss
muscular dystrophy for orthopedic surgery: [La prise en
charge anesthesique d'un patient de chirurgie orthopedique
atteint de dystrophie musculaire de Emery-Dreifuss].
Aldwinckle RJ, Carr AS
Department of Anaesthesia, Derriford Hospital, Derriford
Hospital, Plymouth, UK.
[Medline record in process]
PURPOSE: To report a patient with Emery-Dreifuss muscular
dystrophy (EDMD) coming for an orthopedic procedure, with
potential problems of sudden cardiac death, difficult airway,
and neuromuscular disorders who was managed successfully
by permanent pacemaker insertion, total iv anesthesia (TIVA),
laryngeal mask insertion (LMA) insertion and continuous
epidural blockade. Clinical features: A 22-yr-old man with
known EDMD presented for triple arthrodesis of his right
foot and fractional lengthening of his hamstrings bilaterally.
Anesthesia was induced with a TIVA technique, and maintained
throughout the operative period. A suspected difficult airway
was managed by the use of a LMA, and analgesia for the peri-,
and postoperative period provided by a continuous epidural
infusion. The patient's perioperative course was uneventful.
CONCLUSION: EDMD is a rare disorder. However, anesthesia
is often required for orthopedic procedures. This case report
illustrates the many potential difficulties that may be
encountered. Regional anesthesia combined with light general
anesthesia offers a method of avoiding many of these difficulties.
PMID: 11983660, UI: 21978954
J Oral Maxillofac Surg 2002 May;60(5):559-66
Anesthetic management for advanced rheumatoid arthritis
patients with acquired micrognathia undergoing temporomandibular
joint replacement.
Kohjitani A, Miyawaki T, Kasuya K, Mishima K, Sugahara
T, Shimada M
Department of Dental Anesthesiology, Okayama University
Hospital of Dentistry, Okayama, Japan. atsushik@md.okayama-u.ac.jp
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.
