Incidence and severity of postoperative nausea and vomiting
are similar after metoclopramide 20 mg and ondansetron 8
mg given by the end of laparoscopic cholecystectomies.
Quaynor H, Raeder JC
Department of Anesthesia, Kongsberg Hospital, Ullevaal
University Hospital, Oslo, Norway. hen-qua@frisurf.no
BACKGROUND: Ondansetron has a well documented antiemetic
prophylactic effect, whereas in most studies of postoperative
nausea and vomiting (PONV), metoclopramide is less efficacious.
This can be attributed to the short-lasting effect of metoclopramide
when a low dose is given at the beginning of surgery. We
wanted to test a 20-mg dose of metoclopramide given at the
end of surgery, using ondansetron 8 mg as a reference. METHODS:
122 patients scheduled for elective laparoscopic cholecystectomy
under general anesthesia were studied in a randomized, double-blind
study design. At the end of the procedure, the patients
received either metoclopramide 20 mg or ondansetron 8 mg
intravenously. The patients were observed for 24 h for PONV,
pain, side-effects and need for rescue antiemetic medication.
RESULTS: No significant differences in the incidence of
PONV or need for rescue antiemetic treatment was observed
in the 0-24 h postoperative study period. The overall incidence
of PONV was 43% in the ondansetron group and 47% in the
metoclopramide group. The ondansetron patients had a significantly
higher incidence of moderate or strong pain during the postoperative
observation period (61% vs. 35% in the metoclopramide group)
(P < 0.05). No significant differences in side-effects
between the groups were observed. CONCLUSIONS: Metoclopramide
20 mg i.v. given at the end of laparoscopic cholecystectomy
resulted in a similar incidence of PONV compared with ondansetron
8 mg. The patients receiving metoclopramide had less pain
than the patients receiving ondansetron.
Publication Types:
Clinical trial
Randomized controlled trial
PMID: 11903083, UI: 21900165
Acta Anaesthesiol Scand 2002 Jan;46(1):100-2
The neck crease as a landmark of Chassaignac's tubercle
in stellate ganglion block: anatomical and radiological
evaluation.
Cha YD, Lee SK, Kim TJ, Han TH
Department of Anesthesiology, Inha University Hospital,
Inha University College of Medicine, Incheon, Seoul, Korea.
BACKGROUND: Stellate ganglion block (SGB) is most commonly
performed at the transverse process of the sixth cervical
vertebra, the identification of which could be difficult
in patients with short and wide necks. This study was conducted
to evaluate whether the neck skin crease is a reliable indicator
of the C6 level. METHODS: Forty-nine relatively obese pain
clinic patients were investigated. They assumed a standard
position for SGB. A radiopaque wire was placed along the
neck skin crease caudad to the thyroid cartilage. Next,
a radiopaque indicator was placed on the skin above the
tubercle found to be most prominent by palpation. X-rays
of the neck were obtained after each procedure. RESULTS:
The probability that the neck crease would cross C5, C6
and C7 was 16%, 71%, and 12%, respectively. The most prominent
tubercle corresponded to the C5, C6 and C7 levels in 16%,
69% and l4% of cases, respectively. CONCLUSION: The studied
means to identify the C6 transverse process was found to
correlate well with each other (P<0.001). Since in 30%
of cases the C6 process could not be identified by any of
the studied means, radiological guidance is recommended
in order to ensure optimal safety and efficacy of SGB in
selected cases.
PMID: 11903081, UI: 21900163
Acta Anaesthesiol Scand 2002 Jan;46(1):95-9
Post-operative analgesia following total knee replacement:
an evaluation of the addition of an obturator nerve block
to combined femoral and sciatic nerve block.
McNamee DA, Parks L, Milligan KR
Department of Anaesthetics and Intensive Care Medicine,
Queens University of Belfast, Northern Ireland, UK. d.mcnamee@ukgateway.net
BACKGROUND: Femoral and sciatic nerve block may not provide
complete post-operative analgesia following total knee replacement.
This study was designed to evaluate whether the addition
of an obturator nerve block to combined femoral and sciatic
nerve block improves the quality of post-operative analgesia
following primary total knee replacement. METHODS: Sixty
patients were randomised into one of two groups: combined
femoral and sciatic nerve block with 15 ml 0.75% ropivacaine
to each nerve or combined femoral and sciatic nerve block
with 15 ml 0.75% ropivacaine to each nerve and an obturator
nerve block with 5 ml 0.75% ropivacaine. RESULTS: Peripheral
nerve blocks were successful in 85% of patients. The group
which received the obturator nerve block showed a significant
increase in the time until their first request for analgesia
(mean 257.0 vs. 433.6 min) and a significant reduction in
the total requirements for morphine throughout the study
period (mean 83.8 vs. 63.0 mg) (P<0.05). There were no
systemic or neurological sequelae in any of the groups.
CONCLUSIONS: The addition of an obturator nerve block to
femoral and sciatic blockade improved post-operative analgesia
following total knee replacement.
Publication Types:
Clinical trial
Randomized controlled trial
PMID: 11903080, UI: 21900162
Acta Anaesthesiol Scand 2002 Jan;46(1):64-7
Effect of amino acid solutions on intraoperative hypothermia
and postoperative shivering. Comparison of two anesthetic
regimens.
Sahin A, Aypar U
Hacettepe University, Department of Anesthesiology and
Reanimation, Ankara, Turkey. asahin@hacettepe.edu.tr
BACKGROUND: Intraoperative hypothermia is a major adverse
effect of general anesthesia. The different anesthetics
may influence thermoregulation differently. Proteins or
amino acids have been postulated to stimulate heat production.
The purpose of this study is to compare the effects of intraoperative
administration of amino acid solutions on intraoperative
hypothermia and postoperative shivering in two different
anesthetic regimens. METHODS: Forty ASA I-III craniotomy
patients were assigned to four groups of 10 patients in
a randomized prospective study, as follows: ISO - isoflurane-based
anesthesia; PRO - propofol-based anesthesia; ISO + AA -
Isoflurane-based anesthesia with supplementation of amino
acid infusion; PRO + AA - Isoflurane-based anesthesia with
supplementation of amino acid infusion. Hemodynamic parameters,
esophageal temperature and postoperative shivering scores
were recorded. RESULTS: Core temperatures were higher during
emergence in amino acid-treated propofol group, compared
with the other groups. The core temperature decreased significantly
in three groups throughout the operation, except the in
amino acid-treated propofol group. The shivering intensity
was less in the amino acid-treated groups. CONCLUSION: The
anesthetic method may influence the thermic effect of amino
acids under general anesthesia. Propofol anesthesia has
more thermogenic effect than isoflurane when combined with
amino acid solutions.
Publication Types:
Clinical trial
Randomized controlled trial
PMID: 11903074, UI: 21900156
Anaesth Intensive Care 2002 Apr;30(2):250-1
ENT vs anaesthesia "straight" laryngoscopes.
Henderson JJ
[Medline record in process]
Publication Types:
Letter
PMID: 12002940, UI: 21997622
Anaesth Intensive Care 2002 Apr;30(2):183-91
Theoretical aspects of P-glycoprotein mediated drug efflux
on the distribution volume of anaesthetic-related drugs
in the brain.
Upton RN
Department of Anaesthesia and Intensive Care, Royal Adelaide
Hospital, University of Adelaide, South Australia.
[Medline record in process]
P-glycoprotein in the membranes of endothelial cells actively
transports some drugs out of the brain. The theoretical
effect of P-glycoprotein mediated drug efflux on the cerebral
distribution volumes of drugs was examined, with particular
emphasis on anaesthetic-related drugs (often characterized
by moderate to high permeability across the blood brain
barrier due to their lipophilicity and intermediate molecular
weight). An analytical equation for the cerebral distribution
volume in the presence of the efflux was derived, and validated
by modelling the same system using differential equations.
The efflux was shown to lower both the membrane and intracellular
drug concentrations in parallel, and to reduce the time
required for brain:blood equilibration. The net effect of
the efflux was governed by the ratio of the P-glycoprotein
drug clearance from the membrane (Pcl) and the permeability
of the membrane (PS). It was therefore a balance between
the rate that a drug could be pumped out of the membrane
by the efflux system, and the rate that the drug leaked
back in due to the permeability of the membrane for the
drug. The effect of the efflux was therefore more pronounced
for drugs with membrane-limited cerebral kinetics (e.g.
morphine), but was nevertheless significant for drugs with
more flow-limited kinetics (e.g fentanyl). The cerebral
distribution volume was also influenced by the free fraction
in blood and the free fraction in the intracellular space
in the conventional manner. There are no theoretical limitations
to the P-glycoprotein system influencing the cerebral distribution
volume of moderately lipophilic anaesthetic-related drugs.
PMID: 12002926, UI: 21997608
Anaesth Intensive Care 2002 Apr;30(2):153-9
The effect of anaesthetic technique on postoperative nausea
and vomiting after day-case gynaecological laparoscopy.
Paech MJ, Lee BH, Evans SF
Department of Anaesthesia, King Edward Memorial Hospital
for Women, Perth, Western Australia.
[Medline record in process]
Gynaecological surgery is of high emetogenic potential
and both total intravenous anaesthesia (TIVA) and prophylactic
antiemetic therapy may reduce the incidence of postoperative
nausea and vomiting (PONV). We studied 144 patients scheduled
for day-case gynaecological laparoscopy in a randomized
trial comparing balanced inhalational anaesthesia and prophylactic
dolasetron (group I+D) with propofol TIVA and dolasetron
(group T+D) or TIVA alone (group T). The primary outcome
of "complete response" (no vomiting, no treatment
for PONV) was not significantly different among groups (34%,
51%, 32%; groups I+D vs T+D vs T, P=0.12). During the first
hour after surgery, group I+D had nausea of greater severity
(P<0.03). During hospital admission, group T had more
vomiting (P<0.03). From discharge until 24 hours postoperatively,
55% of group I+D experience nausea and 38% vomited. The
incidence and severity of nausea were significantly lower
in the TIVA groups (P<0.04 and <0.05 respectively).
There were no significant differences between groups T+D
and T, although comparing all groups the complete response
rate was highest and the post-discharge incidence and severity
of nausea lowest in group T+D. In conclusion, propofol TIVA,
with or without dolasetron, reduced postoperative nausea,
but not perioperative vomiting or antiemetic requirement,
when compared with inhalational anaesthesia plus dolasetron.
PMID: 12002921, UI: 21997603
Br J Anaesth 2002 Mar;88(3):454; discussion 454
Measuring the cost of inhaled anaesthetics.
Zych Z
[Medline record in process]
Publication Types:
Letter
PMID: 11990286, UI: 21985665
Br J Anaesth 2002 Mar;88(3):445-50
The British Journal of Anaesthesia. An informal history
of the first 25 years.
Norman J
[Medline record in process]
In 1961, some 7 months after starting anaesthesia in the
Leeds General Infirmary, I took out a subscription to the
British Journal of Anaesthesia. It cost Pound Sterling3.15s.0d
(Pound Sterling3.75) a year. The publishers John Sherratt
and Son of Altringham) sent me the back numbers from the
start of that year. I first had a paper published in the
journal in 1965; first refereed a paper in 1969; joined
the editorial board in 1975; and lasted there until 1998.
The following account of the early years of the journal
derives from the journal itself, and from records, letters
and minutes of meetings kindly given to me by Dr Edmund
Riding and Professor Andrew Hunter when they demitted offices
with the journal. The history cannot be complete. Sadly,
the earliest minutes books are lost. But there is much of
interest covering the times when anaesthesia developed from
the rag-and-bottle inhalation era to the use of intravenous
anaesthetics, neuromuscular blocking agents, ventilators
and monitoring. Thoracic and neurosurgical anaesthesia were
revolutionized; cardiac surgery became possible; and resuscitation
with intravenous fluids, blood and plasma all developed.
Antibiotics improved care. Anaesthetists pioneered intensive
care and latterly extended their roles in pain relief outside
the operating theatre. All these developments have appeared
in papers at some time in this journal. This is a personal
view of the journal over its first 25 years: there will
be errors and misinterpretations--these are mine.
PMID: 11990283, UI: 21985662
Br J Anaesth 2002 Mar;88(3):438-40
Lumbar ependymoma presenting with paraplegia following
attempted spinal anaesthesia.
Jaeger M, Rickels E, Schmidt A, Samii M, Blomer U
Department of Neurosurgery, University of Leipzig, Germany.
[Medline record in process]
Neurological deterioration from intraspinal haematoma following
insertion of a spinal needle is extremely rare. We present
the case of a 28-yr-old female, who presented with complete
paraplegia following attempted spinal anaesthesia for delivery
of her third child. Space-occupying iatrogenic spinal haemorrhage
from a previously undiagnosed lumbar ependymoma was found
to be the precipitating cause. Following laminotomy with
blood clot and tumour removal her neurological function
improved.
PMID: 11990280, UI: 21985659
Br J Anaesth 2002 Mar;88(3):430-3
Effects of remifentanil and alfentanil on the cardiovascular
responses to induction of anaesthesia and tracheal intubation
in the elderly.
University Department of Anaesthesia, Critical Care and
Pain Management, University Hospitals of Leicester, Leicester
Royal Infirmary, UK.
[Medline record in process]
BACKGROUND: We compared the effects of remifentanil and
alfentanil on arterial pressure and heart rate at induction
of anaesthesia and tracheal intubation in 40 ASA I-III patients
aged greater than 65 yr, in a randomized double-blind study.
METHODS: Patients received either remifentanil 0.5 microg
kg(-1) over 30 s, followed by an infusion of 0.1 microg
kg min(-1) (group R) or alfentanil 10 microg kg(-1) over
30 s, followed by an infusion of saline (group A). Anaesthesia
was then induced with propofol, rocuronium, and 1% isoflurane
with 66% nitrous oxide in oxygen. RESULTS: Systolic arterial
pressure (SAP) and mean arterial pressure (MAP) decreased
after the induction of anaesthesia (P<0.05) and increased
for 3 min after intubation in both groups (P<0.05), but
remained below baseline values throughout. Heart rate remained
stable after induction of anaesthesia but increased significantly
from baseline after intubation for 1 and 4 min in groups
R and A, respectively (P<0.05). There were no significant
between-group differences in SAP, MAP, and heart rate. Diastolic
pressure was significantly higher in group A than group
R at 4 and 5 min after intubation (P<0.05). Hypotension
(SAP < 100 mm Hg) occurred in four patients in group
R and three patients in group A. CONCLUSIONS: Remifentanil
and alfentanil similarly attenuate the pressor response
to laryngoscopy and intubation, but the incidence of hypotension
confirms that both drugs should be used with caution in
elderly patients.
PMID: 11990278, UI: 21985657
Br J Anaesth 2002 Mar;88(3):418-29
The role of non-technical skills in anaesthesia: a review
of current literature.
Department of Psychology, University of Aberdeen, King's
College, UK.
[Medline record in process]
PMID: 11990277, UI: 21985656
Br J Anaesth 2002 Mar;88(3):394-8
Effect of different pulses of nitric oxide on venous admixture
in the anaesthetized horse.
Heinonen E, Nyman G, Merilainen P, Hogman M
Department of Medical Cell Biology, Uppsala University,
Sweden.
[Medline record in process]
BACKGROUND: Dependent atelectatic lung areas open towards
the end of inspiration when the lung opening pressure increases,
and recollapse during expiration. We hypothesized that inhaled
nitric oxide (NO) counteracts hypoxic vasoconstriction in
these collapsing lung areas, resulting in increased pulmonary
shunt perfusion. METHODS: We administered NO as a pulse
and varied the pulse timing during inspiration in equine
anaesthesia, where atelectasis develops regularly. Six spontaneously
breathing standard breed trotters were studied under isoflurane
anaesthesia in lateral recumbency. NO pulsed into the first
30% of inspiration (group NOp1) was assumed to affect open
lung areas. To cover more open lung areas NO was then pulsed
into the first 60% of inspiration (group NOp2). In a third
group, administration between 50 and 80% of inspiration
was aimed at the intermittently opening lung areas (group
NOp3). RESULTS: With NOp1, venous admixture decreased by
8 (2)% (mean (SEM), P=0.045) and with NOp2 by 10 (1)% (P=0.01).
With NOp3, venous admixture reduction was insignificant.
CONCLUSIONS: Pulsed administration of NO in early inspiration
is optimal in reducing right to left vascular shunt in atelectatic
equine lung. This reduction is positively correlated with
the magnitude of the initial shunt. With administration
in early inspiration, NO is mostly taken up by the lung.
This prevents NO accumulation and NO2 formation in rebreathing
circuits. These findings may be important in humans when
atelectasis occurs increasingly with overweight and age
during anaesthesia, but also in postoperative intensive
care and in ARDS.
PMID: 11990273, UI: 21985652
Br J Anaesth 2002 Mar;88(3):379-83
Addition of meperidine to bupivacaine for spinal anaesthesia
for Caesarean section.
Yu SC, Ngan Kee WD, Kwan AS
Department of Anaesthesia and Intensive Care, The Chinese
University of Hong Kong, Prince of Wales Hospital, Sha Tin,
Hong Kong SAR, People's Republic of China.
[Medline record in process]
BACKGROUND: In a prospective, randomized, double-blind,
placebo-controlled trial, we investigated the effect of
adding meperidine 10 mg to intrathecal bupivacaine on the
duration of early postoperative analgesia in 40 patients
having elective Caesarean section under spinal anaesthesia.
METHODS: Patients received intrathecal injection of 0.5%
hyperbaric bupivacaine 2.0 ml plus either normal saline
0.2 ml (saline group) or 5% meperidine 0.2 ml (meperidine
group). After operation, all patients were given i.v. patient-controlled
analgesia using morphine. RESULTS: The duration of effective
analgesia, defined as the time from intrathecal injection
to first patient-controlled analgesia demand, was greater
in the meperidine group (mean 234 min, 95% confidence interval
200-269 min) compared with the saline group (mean 125 min,
95% confidence interval 111-138 min; P<0.001). The 24
h morphine requirement was similar in the two groups. The
meperidine group had a greater incidence of intraoperative
nausea or vomiting compared with the saline group (11 vs
3; P=0.02). CONCLUSION: Addition of meperidine 10 mg to
intrathecal bupivacaine for Caesarean section is associated
with prolonged postoperative analgesia but with greater
intraoperative nausea and vomiting.
PMID: 11990270, UI: 21985649
Br J Anaesth 2002 Mar;88(3):362-8
Recovery of memory after general anaesthesia: clinical
findings and somatosensory evoked responses.
Rundshagen I, Schnabel K, Schulte am Esch J
Department of Anaesthesiology, University Hospital Charite,
Berlin, Germany.
[Medline record in process]
BACKGROUND: Mid-latency somatosensory evoked responses
are used to monitor the integrity of the sensory pathways
intra-operatively. They can quantify the effects of anaesthetics
on the central nervous system. Mid-latency auditory evoked
responses have been related to cognition during anaesthesia,
but there are no detailed studies using median nerve somatosensory
evoked responses (MnSSER). METHODS: We studied 49 patients
during recovery from general anaesthesia (isoflurane/nitrous
oxide or propofol) to assess implicit and explicit memory
function in relation to mid-latency MnSSER. The MnSSER recordings
were made before anaesthesia, during steady-state anaesthesia,
and at the end of the recovery period. The patients were
interviewed 24 h later about their memory for the immediate
wake up phase. Statistical analysis was by multivariate
analysis of variance. RESULTS: Out of 49 patients, 23 recalled
the recovery period, 11 had implicit memory for an object
shown to them during the recovery period, and 15 did not
have any memory for the recovery period. At RECOVERY the
patients with recall had significantly shorter MnSSER latencies
N45 and P50 and inter-wave conduction times LatN35-LatP45
than patients without memory (P<0.05). CONCLUSIONS: We
conclude that MnSSER components warrant further investigation
for studying the effects of anaesthetic drugs on cognitive
function.
PMID: 11990267, UI: 21985646
Br J Anaesth 2002 Mar;88(3):357-61
Cerebrovascular carbon dioxide reactivity in children
anaesthetized with sevoflurane.
Rowney DA, Fairgrieve R, Bissonnette B
Department of Anaesthesia, The Hospital for Sick Children,
University of Toronto, Ontario, Canada,.
[Medline record in process]
BACKGROUND: To determine the effects of sevoflurane on
cerebrovascular carbon dioxide reactivity (CCO2R), middle
cerebral artery blood flow velocity (CBFV) was measured
at different levels of PE'CO2 by transcranial Doppler sonography
in 16 ASA I or II children, aged 18 months to 7 yr undergoing
elective urological surgery. METHODS: Anaesthesia comprised
1.0 MAC sevoflurane and air in 30% oxygen delivered through
an Ayre's T piece by intermittent positive-pressure ventilation,
and a caudal epidural block with 0.25% bupivacaine 1.0 ml
kg(-1) without epinephrine. PE'CO2 was randomly adjusted
to 25, 35, 45 and 55 mm Hg (3.3, 4.6, 5.9 and 7.2 kPa) with
an exogenous source of CO2, while maintaining ventilation
variables constant. RESULTS: CBFV increased as PE'CO2 increased
from 25 to 35, and to 45 mm Hg (P<0.001), but did not
increase significantly with an increase in PE'CO2 from 45
to 55 mm Hg. Mean heart rate and arterial pressure remained
constant. CONCLUSION: CCO2R is preserved in healthy children
anaesthetized with 1.0 MAC sevoflurane.
PMID: 11990266, UI: 21985645
Br J Anaesth 2002 Mar;88(3):338-44
Use of a high-fidelity simulator to develop testing of
the technical performance of novice anaesthetists.
Forrest FC, Taylor MA, Postlethwaite K, Aspinall R
Sir Humphry Davy Department of Anaesthesia, Bristol Royal
Infirmary, UK.
[Medline record in process]
BACKGROUND: We used the Delphi technique to gain a consensus
from 26 consultant anaesthetists about technical tasks during
general anaesthesia. We then developed a technical scoring
system to assess anaesthetists undertaking general anaesthesia
with rapid sequence induction. METHODS: We then followed
the performance of six novice anaesthetists on five occasions
during their first 3 months of training. At each, visit
each novice 'anaesthetized' the Human Patient Simulator
at Bristol Medical Simulator Centre. For comparison seven
post-fellowship anaesthetists were scored on one occasion.
RESULTS: Novice scores improved significantly over the 12-week
period (P<0.01). A significant difference was also found
between the final novice scores and the post-fellowship
subjects (P<0.05). CONCLUSIONS: These findings suggest
that simulation can be used to observe and quantify technical
performance.
PMID: 11990263, UI: 21985642
Br J Anaesth 2002 Mar;88(3):334-7
Anaesthesia and the Internet.
Nyabadza M, Das S
[Medline record in process]
Publication Types:
Editorial
PMID: 11990262, UI: 21985641
Eur J Anaesthesiol 2002 Feb;19(2):93-8
Anaesthetic management and outcome in right-lobe living
liver-donor surgery.
Cammu G, Troisi R, Cuomo O, de Hemptinne B, Di Florio
E, Mortier E
Ghent University Hospital, Department of Anaesthesia, Belgium.
Guy.Cammu@olvz-aalst.be
[Medline record in process]
BACKGROUND AND OBJECTIVE: We reviewed retrospectively the
anaesthetic management and perioperative course of eight
right hepatectomies for living liver donation. METHODS:
After preoperative psychiatric evaluation, eight ASA I-II
individuals donated the right lobe of their liver to a family
member. A graft-recipient body weight ratio of 0.8-1.0%
was required for patient selection. Indications for liver
transplantation were: hepatitis C viral-related cirrhosis
in six patients; combined hepatitis C and B viral cirrhosis
in one patient; multifocal hepatocellular carcinoma--four
lesions, involving both liver lobes--of hepatitis C viral-related
cirrhosis in another patient. Indication for adult-to-adult
living-donor liver transplantation was retained in the latter
because of rapid deterioration of liver disease, rare recipient's
blood group and extended, unresectable hepatocellular carcinoma.
Hepatitis C viral-related cirrhosis was casually the primary
indication for adult-to-adult living-donor liver transplantation
in this group. The condition of the donated hepatic lobe
was optimized by appropriate drug and perfusion management.
Preoperative investigations included: blood tests (full
cell count and film, thyroid function tests, pregnancy tests,
full virological tests and bacteriological cultures, and
immunological typing), chest radiograph, electrocardiogram
plus Doppler cardiac ultrasound, spirometry, aminopyrine
breath test, liver Doppler examination, magnetic resonance
imaging, angiography and cholangiography and a volumetric
study of the whole liver and the right lobe. Haemoglobin
and lactate concentrations, liver function tests and international
normalized ratio were measured before and after operation.
The volume and weight of the resected right lobe was calculated.
Anaesthesia was induced with propofol 300 mL h(-1) and sufentanil
0.3 microg kg(-1) intravenously; cisatracurium, 0.15 mg
kg(-1), was given to facilitate tracheal intubation. Anaesthesia
was maintained during normocapnic ventilation of the lungs
with oxygen 40% in air, isoflurane 1-1.5 MAC and sufentanil.
Routine anaesthetic monitoring included electrocardiography,
pulse oximetry, invasive blood pressure, central venous
pressure, urine output, state of neuromuscular blockade
and core temperature. Periods of hypotension (<80% of
the preoperative blood pressure) or haemodynamic instability
(requiring inotropic or vasoactive support) were registered.
Total blood loss and transfusion (homologous, autologous
or cell-saver blood) requirements were measured; volume
replacements were derived. RESULTS: Data are presented as
mean (range). There was no morbidity or mortality and no
periods of intraoperative hypotension or haemodynamic instability.
The operation time averaged 619 (525-780)min. Four donors
were extubated in the operating room immediately after surgery;
the others were extubated in the intensive care unit, where
the mean extubation time was 16.3 (5-25)h after arrival.
The estimated blood loss was 967 (550-1,600)mL. No homologous
blood was administered; five donors received autologous
blood, intraoperatively; three donors received a cell-saver
blood transfusion. Intraoperative fluid replacement was
with crystalloids, colloids and 4% albumin. Total urine
output was 1,472 (700-3100)mL. Although intraoperative hypothermia
occurred all subjects were normothermic at the end of operation.
The pre- and immediately postoperative haemoglobin concentration
averaged 13.6 (9.8-15.6) and 10.5 (6.9-13.0)gdL(-1), respectively.
On the first postoperative day, the haemoglobin was 11.7
(8.4-15.1)gdL(-1). The donors' liver function tests were
transiently elevated in the initial postoperative period.
The intensive care unit discharge time was 2 (1-3) days.
The hospital stay was 13 (7-17) days. There was no morbidity
or mortality. CONCLUSIONS: The study demonstrates that right-lobe
living-donor surgery was well tolerated, without intraoperative
hypotension or haemodynamic instability, without perioperative
anaesthetic or surgical complications, and with an excellent
general outcome.
PMID: 11999608, UI: 21994236
Eur J Anaesthesiol 2002 Feb;19(2):88-92
Inhalation anaesthesia is cost-effective for ambulatory
surgery: a clinical comparison with propofol during elective
knee arthroscopy.
Dolk A, Cannerfelt R, Anderson RE, Jakobsson J
Departments of Orthopaedics, Sabbatsberg Hospital, Stockholm,
Sweden.
[Medline record in process]
BACKGROUND AND OBJECTIVE: Cost consciousness has become
increasingly important in anaesthesia as elsewhere in healthcare.
Cost-minimization with uncompromised patient safety and
quality requires systematic comparisons of alternative techniques.
Inhalation anaesthesia with desflurane or sevoflurane is
compared in this study with propofol delivered by the target
controlled infusion technique. Directly measured drug consumption
and costs and emergence times are compared. METHODS: Consumed
anaesthetics were measured during elective arthroscopy of
the knee, and costs were calculated for ASA I-II patients
(n = 102) randomized to 3 groups: one group received anaesthesia
using propofol administered by target controlled infusion,
the others inhalation anaesthesia with either desflurane
or sevoflurane in combination with nitrous oxide. A partial
rebreathing system was used with a laryngeal mask airway.
Vaporizers were weighed before and after each anaesthetic.
RESULTS: Anaesthetic duration, postoperative pain and emesis
as well as discharge time did not differ between groups.
Inhaled anaesthetic techniques with desflurane or sevoflurane
were associated with 2-3 min shorter emergence times (P
< 0.001) and approximately 45% lower cost for consumed
anaesthetics as compared with a propofol technique based
on target controlled infusion. The inclusion of waste costs
improved the cost reduction to 55%. CONCLUSIONS: For this
patient group, use of inhalation anaesthesia reduced drug
costs by half and shortened emergence times compared to
target controlled infusion with propofol with equal perioperative
patient conditions.
PMID: 11999607, UI: 21994235
Eur J Anaesthesiol 2002 Feb;19(2):85-7
Oasis or mirage? The safety of outpatient dental anaesthesia
in hospital.
Bricker S
[Medline record in process]
Publication Types:
Editorial
PMID: 11999606, UI: 21994234
Eur J Anaesthesiol 2002 Feb;19(2):154-5
Epidural anaesthesia in a patient with POEMS syndrome.
Karaca S, Akgun I, Agritmis A
[Medline record in process]
Publication Types:
Letter
PMID: 11999604, UI: 21994251
Eur J Anaesthesiol 2002 Feb;19(2):150-2
General anaesthesia for emergency surgery during acute
organophosphate poisoning.
Shorter discharge time after regional or intravenous anaesthesia
in combination with laryngeal mask airway compared with
balanced anaesthesia with endotracheal intubation.
Junger A, Klasen J, Hartmann B, Benson M, Rohrig R, Kuhn
D, Hempelmann G
Universitatsklinik Giessen, Abt. Anaesthesiologie und Operative
Intensivmedizin, Giessen, Germany.
[Medline record in process]
BACKGROUND AND OBJECTIVE: The efficiency of operating room
times can be significantly improved using rapid changes
between operative procedures. We performed a retrospective
analysis using electronic anaesthesia charts that compared
anaesthesia-related times between the three most frequently
performed types of anaesthesia (for orthopaedic surgery)
to evaluate the potential for a quicker turn-around between
cases. METHODS: A total of 5614 anaesthetic procedures in
trauma-related orthopaedic surgery were performed from 1997
to 1999. All were documented with an automatic record-keeping
system. Data were compared for intravenous anaesthesia with
the laryngeal mask airway, balanced anaesthesia with tracheal
intubation and regional anaesthesia. The primary outcome
measure was the time needed for emergence from anaesthesia
after the end of surgery. Statistical evaluation was performed
with matched triples for all three types of anaesthesia
(155 triples for ambulatory surgery, 249 triples for in-patient
care). RESULTS: For ambulatory surgery, the induction time
was significantly shorter for general anaesthesia (23.7
min for intravenous anaesthesia, 22.7 min for balanced anaesthesia
techniques) compared with regional anaesthesia (27.2 min).
The time from the end of the surgical procedure to transfer
of the patient out of the operating room was shortest for
regional anaesthesia (6.3 min) compared with intravenous
anaesthesia (9.0 min) and balanced anaesthesia (12.5 min)
techniques. Results were comparable for in-patients: regional
anaesthesia required significantly longer for its induction,
but less time for patient discharge from the operating room.
CONCLUSIONS: The use of a regional anaesthesia technique
or one involving intravenous anaesthesia in combination
with the laryngeal mask airway may lead to a reduction in
discharge time compared with a balanced anaesthesia technique
with endotracheal intubation. Thus, improved use of resources
may be achieved.
PMID: 11999594, UI: 21994241
Eur J Anaesthesiol 2002 Feb;19(2):115-8
Intraoperative fetal oxygen saturation during Caesarean
section: general anaesthesia using sevoflurane with either
100% oxygen or 50% nitrous oxide in oxygen.
Parpaglioni R, Capogna G, Celleno D, Fusco P
AFaR-CRCCS Fatebenefratelli General Hospital, Department
of Anesthesiology and Intensive Care, Isola Tiberina, Rome,
Italy.
[Medline record in process]
BACKGROUND AND OBJECTIVE: The study was designed to evaluate
whether the administration of sevoflurane in 100% oxygen
for anaesthesia during Caesarean section would improve fetal
and neonatal oxygenation compared with the administration
of sevoflurane with 50% nitrous oxide in oxygen. METHODS:
The randomized, single-blind controlled study examined 24
mothers, ASA I-II, at term undergoing Caesarean section
who were allocated to receive sevoflurane in either 100%
oxygen (n = 13) or 50% nitrous oxide in oxygen (n= 11).
General anaesthesia was induced in both groups with thiopental
4-5 mg kg(-1) followed by succinylcholine 1.5 mg kg(-1)
to facilitate tracheal intubation. Parturients received
sevoflurane given either in 100% O2 or in a 50:50 nitrous
oxide and oxygen mixture, using 0.5-1.0% progressive incremental
dosing up to 1.5-2.0 MAC. Non-invasive fetal oxygen saturation
was measured between induction to delivery, and umbilical
artery and vein PaO2 were evaluated at birth. RESULTS: Intraoperative
fetal oxygen saturation increased in all patients after
maternal 100% oxygen administration (P < 0.01). Maternal
hyperoxygenation significantly increased the umbilical vein
and umbilical artery PaO2 and the umbilical artery SaO2
at birth (P < 0.0001). CONCLUSIONS: Maternal hyperoxygenation
significantly improves fetal as well as neonatal oxygenation.
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.
