Ultimo Aggiornamento: 31 Dicembre 2002

18 citations found

A use for combined spinal epidural anaesthesia at last!

[Record supplied by publisher]

PMID: 12010281

Anaesthesia 2002 Jun;57(6):549-56

Awareness during general anaesthesia: a review of 81 cases from the Anaesthetic Incident Monitoring Study.

Bergman IJ, Kluger MT, Short TG

Department of Anaesthesia, Auckland Hospital, Auckland, New Zealand Department of Anaesthesia, North Shore Hospital, Private Bag 93-503, Takapuna, Auckland, New Zealand.

[Medline record in process]

Because of recent studies suggesting that awareness is still a major issue in anaesthetic practice, we reviewed 8372 incidents reported to the Anaesthetic Incident Monitoring Study. There were 81 cases in which peri-operative recall was consistent with awareness. There were 50 cases of definite awareness and 31 cases with a high probability of awareness. In 13 of the 81 incidents, the patients appeared to receive adequate doses of anaesthetic drugs. Where the cause could be determined, awareness was mainly due to drug error resulting in inadvertent paralysis of an awake patient (n = 32) and failure of delivery of volatile anaesthetic (n = 16). Less common causes included prolonged attempts at intubation of the trachea (n = 5), deliberate withdrawal of volatile anaesthetic (n = 4) or muscle relaxant apnoea with inadequate administration of hypnotic (n = 3). An objective central nervous system depth of anaesthesia monitor may have prevented 42 of these incidents and an improved drug administration system may have prevented 32. On the basis of these reports, we have developed guidelines that may have prevented the majority of these incidents.

PMID: 12010269, UI: 22005615

Anaesthesia 2002 May;57(5):519-20

Analysis of Internet usage by anaesthesia trainees in the UK and the USA.

Sanders JC

[Medline record in process]

Publication Types:

• Letter

PMID: 12004824, UI: 21999614

Anaesthesia 2002 May;57(5):517-8

Target-controlled infusions of propofol and remifentanil with closed-loop anaesthesia for hepatic resection.

Levack I, Crofts S, Tait I

[Medline record in process]

Publication Types:

• Letter

PMID: 12004821, UI: 21999611

Anaesthesia 2002 May;57(5):513; discussion 513-4

Glycopyrronium and hypotension following combined spinal-epidural anaesthesia.

Mandal NG

[Medline record in process]

Publication Types:

• Letter

PMID: 12004818, UI: 21999608

Anaesthesia 2002 May;57(5):493-500

Obstetric anaesthetists' workload.

Wee MY, Yentis SM, Thomas P

Poole Hospital NHS Trust, UK.

[Medline record in process]

The current recommendation of one consultant session per 500 deliveries with full sessional cover for units over 3000 deliveries is arbitrary and is not based on workload. The Audit Commission has questioned the wide variability of anaesthetic staffing on labour wards. The aim of this study was to investigate whether there is a relationship between current workload and obstetric anaesthetic staffing in five maternity units. In 1998, a 2-week diary of workload in the participating obstetric units was assessed in terms of staffing and clinical and nonclinical activities. The busiest time was 08:00 to 12:30. The working patterns between consultants and trainees varied considerably. Time spent on nonclinical activity by consultants averaged 51%. Any calculation of consultant sessions will need to take into account nonclinical activities. Other factors requiring consideration are the number of high-risk cases, as well as the number and experience of trainees.

PMID: 12004810, UI: 21999600

Anesth Analg 2002 May;94(5):1365-6; discussion 1366

Thoracic epidurals and coronary artery bypass grafting surgery.

Alston RP

Publication Types:

• Letter

PMID: 11973220, UI: 21969037

Anesth Analg 2002 May;94(5):1321-4, table of contents

A comparison of intertendinous and classical approaches to popliteal nerve block using magnetic resonance imaging simulation.

Hadzic A, Vloka JD, Singson R, Santos AC, Thys DM

St. Luke's-Roosevelt Hospital Center, College of Physicians and Surgeons, Columbia University, New York, NY 10025, USA. ah149@columbia.edu

The classical approach to sciatic nerve block in the popliteal fossa (popliteal block) often requires multiple attempts to localize the sciatic nerve. Recently, it has been suggested that an intertendinous approach to popliteal block may result in a more consistent localization of the sciatic nerve. In the current study, we compared anatomical landmarks for the intertendinous and classical approaches to popliteal block with respect to the accuracy in localizing the sciatic nerve using magnetic resonance imaging simulation. Two anesthesiologists experienced in popliteal block drew landmarks for the intertendinous and classical approaches on 10 volunteers; a 1.5 Tesla superconducting magnet was used to obtain simultaneous, 10-mm thick, fast-spin echo proton density transverse axial sequences of the lower extremities. Using these acquired images, the two approaches were simulated off-line using previously identified landmarks. The spatial relationships of the simulated needle paths to the nerves and vessels in the popliteal fossa, as well as other relevant structures, were measured and compared. Simulation of the intertendinous approach to popliteal block resulted in needle-to-sciatic nerve contact in 14 legs (70%) versus 5 legs (25%) when the classical approach was used (P < 0.05). We conclude that the intertendinous approach might result in a more consistent localization of the sciatic nerve and may decrease the risk of sciatic vessel puncture. IMPLICATIONS: A simulation of popliteal block using magnetic resonance imaging in volunteers suggests that using tendons of the hamstring muscles as the anatomical landmarks yields a more consistent localization of the sciatic nerve.

PMID: 11973213, UI: 21969030

Anesth Analg 2002 May;94(5):1315-7, table of contents

Pregnancy complicated by severe osteogenesis imperfecta: a report of two cases.

Vogel TM, Ratner EF, Thomas RC Jr, Chitkara U

Department of Anesthesia, Stanford University School of Medicine, Stanford, California, USA. vogeltm@anes.upmc.edu

IMPLICATIONS: This case report discusses the anesthetic management of two parturients with severe osteogenesis imperfecta who presented for cesarean delivery. Although the anesthetic management for milder forms of the disease has been previously reported, anesthetic options for cases of this severity have not.

PMID: 11973211, UI: 21969028

Anesth Analg 2002 May;94(5):1270-1, table of contents

Projected complex sensations after interscalene brachial plexus block.

Casutt M, Ekatodramis G, Maurer K, Borgeat A

Department of Anesthesiology, Orthopedic University Clinic Zurich/Balgrist, Zurich, Switzerland.

IMPLICATIONS: The development of projected complex sensations mimicking phantom pain after interscalene block is reported. The recognition of this entity is important because it may be confused with some other cardiac, esophageal, or visceral pathologies.

PMID: 11973203, UI: 21969020

Anesth Analg 2002 May;94(5):1253-8, table of contents

Selective and long-lasting neural blockade with resiniferatoxin prevents inflammatory pain hypersensitivity.

Kissin I, Bright CA, Bradley EL Jr

Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA. kissin@zeus.bwh.harvard.edu

Capsaicin can produce a selective and long-lasting neural blockade. Resiniferatoxin (RTX) is an ultrapotent vanilloid agonist with a unique spectrum of activities different from that of capsaicin. We sought to determine whether a single application of RTX to a peripheral nerve could completely prevent the long-lasting mechanical hyperalgesia caused by carrageenan injection. In rat experiments, RTX (0.001%) was administered percutaneously to the sciatic and saphenous nerves before the intraplantar injection of carrageenan. Responses to noxious mechanical (pressure on the paw) and thermal (hot plate) stimulations and changes in paw circumference were measured at various time intervals for 8 days after treatment. The administration of RTX resulted in mechanical and thermal hypoalgesia (for 2 and 8 days, respectively). Inflammatory hyperalgesia was completely prevented by the precarrageenan injection of RTX. Inflammatory enhancement of paw circumference was reduced by RTX (12.0 +/- 2.4 mm versus 6.9 +/- 3.4 mm, P < 0.005). We suggest that the selective nature of the effect of vanilloid agonists on nociception could provide an opportunity for prolonged neural blockade when early mobilization and/or preservation of protective sensation are required. IMPLICATIONS: We report that an ultrapotent vanilloid agonist resiniferatoxin can provide a selective and long-lasting neural blockade. Applied to the sciatic and saphenous nerves, it completely prevented pain hypersensitivity caused by prolonged inflammatory process (injection of carrageenan into the paw).

PMID: 11973200, UI: 21969017

Anesth Analg 2002 May;94(5):1244-8, table of contents

Environmental monitoring of sevoflurane and nitrous oxide using the cuffed oropharyngeal airway.

Gustorff B, Lorenzl N, Aram L, Krenn CG, Jobst BP, Hoerauf KH

Department of Anesthesia and Intensive Care B, Vienna General Hospital, University of Vienna, Austria.

We compared exposure to sevoflurane (SEV) and nitrous oxide (N(2)O) during ventilation using the cuffed oropharyngeal airway (COPA) with waste gas exposure using a conventional face mask (FM) without any additional airways or face straps and with the laryngeal mask airway (LMA). Trace concentrations of SEV and N(2)O were assessed by using a direct reading spectrometer during 33 surgical procedures under general anesthesia. Measurements were made at the patients' mouths and in the anesthesiologists' breathing zones. Mean +/- SD concentrations of SEV and N(2)O measured at the patients' mouths were comparable in the COPA (SEV, 8.1 +/- 12.2 ppm; N(2)O, 213.3 +/- 289.2 ppm) and LMA (SEV, 18.5 +/- 25.8 ppm; N(2)O, 283.4 +/- 361.0 ppm) groups but differed significantly from the FM group (SEV, 46.5 +/- 19.6 ppm; N(2)O, 750.7 +/- 308.3 ppm). These values resulted in a comparable contamination of the anesthesiologists' breathing zones (SEV, 0.5 +/- 0.2 ppm; N(2)O, 5.7 +/- 4.8 ppm) for the COPA group, compared with the LMA group (SEV, 1.0 +/- 0.9 ppm; N(2)O, 12.2 +/- 14.3 ppm). This differed significantly from the FM group (SEV, 2.2 +/- 0.9 ppm; N(2)O, 37.5 +/- 14.3 ppm). We conclude that the use of the COPA during short surgical interventions has an occupational safety comparable to that of the LMA and that both resulted in less contamination through waste anesthetic gases. Therefore, the COPA may be a valuable alternative to the conventional FM. IMPLICATIONS: In this study, we have shown that the occupational exposure to waste anesthetic gases is comparable when using the cuffed oropharyngeal airway (COPA) and the laryngeal mask airway and is increased when using the face mask. Therefore, the COPA may be a valuable alternative to the conventional face mask during short surgical procedures.

Publication Types:

• Clinical trial
• Randomized controlled trial

PMID: 11973198, UI: 21969015

Anesth Analg 2002 May;94(5):1169-72, table of contents

Caudal clonidine prolongs analgesia from caudal S(+)-ketamine in children.

Hager H, Marhofer P, Sitzwohl C, Adler L, Kettner S, Semsroth M

Department of Anesthesia and Intensive Care Medicine, University of Vienna, Austria.

We performed a prospective randomized double-blinded study to test preservative-free S(+)-ketamine alone or in combination with clonidine for intra- and postoperative caudal blockade in pediatric surgery over a 24-h period. Fifty-three children (1-72 mo) scheduled for inguinal hernia repair were caudally injected with either S(+)-ketamine 1 mg/kg alone (Group K) or with additional clonidine (Group C1 = 1 microg/kg; Group C2 = 2 microg/kg) during sevoflurane anesthesia via a laryngeal mask. Intraoperative monitoring included heart rate, blood pressure, and pulse oximetry; postoperative monitoring included a pain discomfort scale and a sedation score. No additional analgesic drugs were required during surgery. The mean duration of postoperative analgesia was 13.3 +/- 9.2 h in Group K, 22.7 +/- 3.5 h in Group C1, and 21.8 +/- 5.2 h in Group C2 (P < 0.0001, Group K versus other groups). Groups C1 and C2 received significantly fewer analgesics in the postoperative period than Group K (15% and 18% vs 63%; P < 0.01). The three groups had similar postoperative sedation scores. We conclude that the combination of S(+)-ketamine 1 mg/kg with clonidine 1 or 2 microg/kg for caudal blockade in children provides excellent analgesia without side effects over a 24-h period. IMPLICATIONS: Caudally administered preservative-free S(+)-ketamine combined with 1 or 2 microg/kg clonidine provides excellent perioperative analgesia in children and has minimal side effects.

Publication Types:

• Clinical trial
• Randomized controlled trial

PMID: 11973182, UI: 21968999

Anesth Analg 2002 May;94(5):1161-4, table of contents

Testing anal sphincter tone predicts the effectiveness of caudal analgesia in children.

Verghese ST, Mostello LA, Patel RI, Kaplan RF, Patel KM

Department of Anesthesiology, Children's National Medical Center, Washington, DC 20010, USA. sverghes@cnmc.org

In this study, we examined the effectiveness of caudal blocks and correlated it with the laxity of the patients' anal sphincter before emergence from anesthesia in 178 children undergoing inguinal and/or penile surgery. Bupivacaine 0.25% in a volume of 0.6-1.25 mL/kg was used in all patients. The presence of a lax anal sphincter at the end of surgery correlated significantly with the reduced administration of narcotics intraoperatively and in the postanesthesia care unit (P < 0.001). The sensitivity of the sphincter tone test was 98.1% with a 95% confidence interval (CI) ranging from 94.3% to 99.6%. The specificity of the test was 94.4% with a 95% CI of 72.0%-100%. The positive predictive value of this test in predicting adequate caudal block was excellent (99.4%) with a 95% CI of 96.1%-100%. The negative predictive value was better than average (85%) with a 95% CI of 62.9%-95.4%. We conclude that a lax anal sphincter can predict the effectiveness of analgesia after pediatric caudal blockade. A tight sphincter may suggest the need to repeat the block before the child awakens, or consider alternate methods of postoperative analgesia. IMPLICATIONS: A lax anal sphincter in children undergoing inguinal and/or penile surgery can predict the effectiveness of analgesia after pediatric caudal blockade.

PMID: 11973180, UI: 21968997

Anesth Analg 2002 May;94(5):1052-64

ACC/AHA Guideline Update for Perioperative Cardiovascular Evaluation for Noncardiac Surgery--Executive Summary. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Update the 1996 Guidelines on Perioperative Cardiovascular Evaluation for Noncardiac Surgery).

Eagle KA, Berger PB, Calkins H, Chaitman BR, Ewy GA, Fleischmann KE, Fleisher LA, Froehlich JB, Gusberg RJ, Leppo JA, Ryan T, Schlant RC, Winters WL Jr, Gibbons RJ, Antman EM, Alpert JS, Faxon DP, Fuster V, Gregoratos G, Jacobs AK, Hiratzka LF, Russell RO, Smith SC Jr

Publication Types:

• Guideline
• Practice guideline

PMID: 11973163, UI: 21968980

Anesth Analg 2002 May;94(5):1049-51

Self-determination is not an appropriate model for understanding parental permission and child assent.

Denham EJ, Nelson RM

Publication Types:

• Comment
• Editorial

PMID: 11973162, UI: 21968979

Eur J Pharmacol 2002 Apr 19;441(1-2):105-14

Gastric acid secretion stimulated by centrally injected nociceptin in urethane-anesthetized rats.

Ishihara S, Minowa S, Tsuchiya S, Horie S, Watanabe K, Murayama T

Laboratory of Chemical Pharmacology, Graduate School of Pharmaceutical Sciences, Chiba University, 263-8522, Chiba, Japan

[Medline record in process]

Nociceptin is a preferred endogenous ligand for the orphan opioid receptor-like 1 (ORL1) receptor. Central administration of nociceptin showed various pharmacological effects on analgesia, cardiovascular and renal responses, food intake, and so on. In the present study, we investigated the effect of nociceptin injected into the central nervous system (CNS) on gastric acid secretion in the perfused stomach of urethane-anesthetized rats. Injection of nociceptin (0.55-5.52 nmol per rat) into the fourth cerebroventricle stimulated gastric acid secretion and the secretion was inhibited in atropine-treated (1 mg/kg, i.v.) and vagotomized rats. The secretion induced by nociceptin (1.65 nmol) was not inhibited by the central injection of naloxone (275 nmol, a non-selective antagonist of opioid receptors). The secretion was significantly inhibited by the central injection of [Phe(1)psi(CH(2)-NH)Gly(2)]nociceptin-(1-13)-NH(2) ([F/G]nociceptin-(1-13), 0.21 nmol, an antagonist of ORL1 receptor), although [F/G]nociceptin-(1-13) alone at higher doses (2.10 and 7.31 nmol) markedly stimulated gastric acid secretion. In the 0-40 min period, the secretion induced by nociceptin was inhibited at least partially by CompB (68.8 nmol, a nonpeptidic antagonist of ORL1 receptor). Injection of nociceptin (5.52 nmol) into the lateral cerebroventricle also stimulated the secretion. Injection of nociceptin did not modify gastric acid secretion stimulated by 2-deoxy-D-glucose (200 mg/kg, i.v.). In conclusion, nociceptin injected into the CNS stimulated gastric acid secretion in rats via the ORL1 receptors and through mechanisms involving the vagus nerve.

PMID: 12007927, UI: 22003604

Neurosci Lett 2002 May 24;324(3):181-4

Propofol facilitates the development of long-term depression (LTD) and impairs the maintenance of long-term potentiation (LTP) in the CA1 region of the hippocampus of anesthetized rats.

Wei H, Xiong W, Yang S, Zhou Q, Liang C, Zeng BX, Xu L

Anesthesiological Section, Union Hospital affiliated to TongJi Medical College, Huazhong University of Technology, WuHan, PR China

[Medline record in process]

PMID: 12009518, UI: 22007871