Ultimo Aggiornamento: 31 Dicembre 2002

29 citations found

Acta Anaesthesiol Scand 2002 May;46(5):620

Caesarean section in a parturient with severe pulmonary hypertension - epidural ropivaccaine of continuous spinal anaesthesia.

Cohen Y, Rudick V

[Medline record in process]

PMID: 12027863, UI: 22023609

Acta Anaesthesiol Scand 2002 May;46(5):618-9

Total intravenous anaesthesia and the use of an intubating laryngeal mask in a patient with osteogenesis imperfecta.

Karabiyik L, Parpucu M, Kurtipek O

Department of Anaesthesiology, Ministry of Health Ankara Training and Research Hospital, Ankara, Turkey.

[Medline record in process]

Osteogenesis imperfecta is a genetically determined rare disease of the connective tissue, associated with abnormalities of type 1 collagen. The primary bone lesion is the lack of normal ossification of the endochondrial bone. Patients with osteogenesis imperfecta present several problems for anaesthetists. They have a tendency to develop malignant or non-malignant hyperthermia. During laryngoscopy and tracheal intubation, the mandible, teeth and cervical spine may be fractured or injured, and mucosal bruising or bleeding may occur. Renal or ureteral stones are common. The main problems are thus with airway control and intubation, and the risk of anaesthetic agents triggering malignant hyperthermia. We describe the successful anaesthetic management of a patient with osteogenesis imperfecta, undergoing nephrolithotomy and ureterolithotomy with total intravenous anaesthesia including propofol, remifentanil and cisatracurium, using an intubating laryngeal mask.

PMID: 12027862, UI: 22023608

Acta Anaesthesiol Scand 2002 May;46(5):599-602

Effect of alkalinization and/or hyaluronidase adjuvancy on a local anesthetic mixture for sub-Tenon's ophthalmic block.

Moharib MM, Mitra S, Rizvi SG

Departments of Anesthesia/ICU, Ophthalmology and Epidemiology and Medical Statistics, Sultan Qaboos University Hospital, Oman.

[Medline record in process]

BACKGROUND AND OBJECTIVES: pH adjustment and/or addition of hyaluronidase to local anesthetic drugs decrease the time to onset and prolong the duration of regional anesthetic techniques for ocular surgery. The objective of this study was to investigate whether these factors are effective also in sub-Tenon's block. METHODS: Sixty patients were randomly assigned to four groups in a double blind, prospective fashion, and received 5.125 ml mixtures as follows: 2.5 ml lignocaine 2%, 2.5 ml bupivacaine 0.5% and 0.125 ml isotonic saline (group LB); 2.5 ml lignocaine 2%, 2.5 ml bupivacaine 0.5%, 15 IU hyaluronidase/ml and 0.125 ml isotonic saline (group LBH); 2.5 ml lignocaine 2%, 2.5 ml bupivacaine 0.5% and 0.125 ml sodium bicarbonate 8.4% (group LBpH); and 2.5 ml lignocaine 2%, 2.5 ml bupivacaine 0.5%, 15 IU hyaluronidase/ml and 0.125 ml sodium bicarbonate 8.4% (group LBHpH). This measurement was based on one quadrant sub-Tenon's block. Akinesia was assessed every 30 s. RESULTS: No statistically significant differences were found between the groups regarding mean times to onset and to complete akinesia. Group LBH displayed a significantly lower frequency of patients experiencing pain and a lower need for rescue medication during surgery than the other groups. CONCLUSION: pH adjustment and/or addition of hyaluronidase to a mixture of lignocaine and bupivacaine did not shorten the time to onset of akinesia following sub-Tenon's technique. However, the addition of hyaluronidase was associated with a lower fraction of patients experiencing pain during surgery.

PMID: 12027856, UI: 22023602

Acta Anaesthesiol Scand 2002 May;46(5):585-91

Local metabolic changes in subcutaneous adipose tissue during intravenous and epidural analgesia.

Ederoth P, Flisberg P, Ungerstedt U, Nordstrom CH, Lundberg J

Departments of Anesthesiology and Intensive Care and Neurosurgery, Lund University Hospital, Sweden and Department of Pharmacology, Karolinska Institute, Stockholm.

[Medline record in process]

BACKGROUND: This clinical study aimed at investigating the impact of postoperative thoracic epidural analgesia on extracellular glycerol concentration and glucose metabolism in subcutaneous adipose tissue, using the microdialysis technique. The sympathetic nervous activity, which can be attenuated by epidural anesthesia, influences lipolysis and the release of glycerol. METHODS: Fourteen patients who underwent major abdominal or thoraco-abdominal surgery were studied postoperatively over 3 days. For postoperative analgesia the patients were prospectively randomized to receive either thoracic epidural analgesia with a bupivacaine/morphine infusion (EPI-group, n=6) or a continuous i.v. infusion of morphine (MO-group, n=8). The concentration of glycerol, glucose and lactate in the abdominal and deltoid subcutaneous adipose tissue were measured using a microdialysis technique. RESULTS: The abdominal glycerol levels were equal in both groups. In the deltoid region of the EPI-group, glycerol concentrations started to increase on Day 2, and reached significantly higher levels on Day 3 compared with the MO-group. The glucose and lactate levels showed no differences between groups in the two regions. CONCLUSION: The uniform glycerol levels in abdominal subcutaneous adipose tissue in conjunction with the difference in glycerol levels in the deltoid area indicate that the local lipolysis is different in the two study groups. This might be explained by a regional metabolic influence of thoracic epidural analgesia, possibly via the sympathetic nervous system.

PMID: 12027854, UI: 22023600

Acta Anaesthesiol Scand 2002 May;46(5):529-536

Airway closure in anesthetized infants and children: influence of inspiratory pressures and volumes.

Thorsteinsson A, Werner O, Jonmarker C, Larsson A

Department of Anesthesia and Intensive Care, Landspitalinn University Hospital, Iceland, Department of Anesthesia and Intensive Care, University Hospital, Lund, Sweden, Department of Anesthesiology, Children's Hospital and Regional Medical Center, Seattle, USA and Department of Anesthesiology, Gentofte University Hospital, Hellerup, Denmark.

[Record supplied by publisher]

BACKGROUND: Cyclic opening and closing of lung units during tidal breathing may be an important cause of iatrogenic lung injury. We hypothesized that airway closure is uncommon in children with healthy lungs when inspiratory pressures are kept low, but paradoxically may occur when inspiratory pressures are increased. METHODS: Elastic equilibrium volume (EEV) and closing capacity (CC) were measured with a tracer gas (SF6) technique in 11 anesthetized, muscle-relaxed, endotracheally intubated and artificially ventilated healthy children, aged 0.6-13 years. Airway closing was studied in a randomized order at two inflation pressures, +20 or +30 cmH2O, and CC and CC/EEV were calculated from the plots obtained when the lungs were exsufflated to -20 cmH2O. (CC/EEV >1 indicates that airway closure might occur during tidal breathing). Furthermore, a measure of uneven ventilation, multiple breath alveolar mixing efficiency (MBAME), was obtained. RESULTS: Airway closure within the tidal volume (CC/EEV >1) was observed in four and eight children (not significant, NS) after 20 and 30 cmH2O inflation, respectively. However, CC30/EEV was >CC20/EEV in all children (P</=0.001). The MBAME was 75+/-7% (normal) and did not correlate with CC/EEV. CONCLUSION: Airway closure within tidal volumes may occur in artificially ventilated healthy children during ventilation with low inspiratory pressure. However, the risk of airway closure and thus opening within the tidal volume increases when the inspiratory pressures are increased.

PMID: 12027847

Acta Anaesthesiol Scand 2002 May;46(5):506-11

The sevoflurane saving capacity of a new anaesthetic agent conserving device compared with a low flow circle system.

Enlund M, Lambert H, Wiklund L

University Department of Anaesthesia & Intensive Care, Uppsala, and Hudson RCI AB, Upplands Vasby, Sweden.

[Medline record in process]

BACKGROUND: An anaesthetic agent conserving device (ACD) has been added to a Bain system to approach the agent-saving capacity of a low flow circle system. METHODS: Randomly selected ASA physical status I patients received a standardized anaesthetic with sevoflurane in air/O2 through either a circle system with 1.5 l/min fresh gas flow (n = 8), or through a Bain system with an added ACD with fresh gas flow 4.4-6.4 l/min (n = 8). A target controlled infusion of remifentanil was used for analgesia. RESULTS: The median sevoflurane consumption was 19.7 and 22.0 ml/MAC/h with the low flow circle system and the Bain system + ACD, respectively (P=0.10, Mann-Whitney U-test), or when adjusted for weight 0.25 and 0.28 ml/MAC/h/kg (P=0.26, Mann-Whitney U-test). CONCLUSION: The expenditure of sevoflurane with a Bain system + ACD was close to that in a circle system with 1.5 l/min fresh gas flow. It is thereby possible to use sevoflurane to all its potential, performing for example rapid alterations in end-tidal concentration using high fresh gas flows by combining a Bain system with an ACD. Although the price is not decided for this not yet commercially available device, a potential for a lower cost exists. Additionally, there will be no concerns of toxic compounds produced in the absorber.

PMID: 12027843, UI: 22023589

Acta Anaesthesiol Scand 2002 May;46(5):500-5

Soda lime temperatures during low-flow sevoflurane anaesthesia and differences in dead-space.

Luttropp HH, Johansson A

Department of Anesthesiology and Intensive Care, Lund University Hospital, Lund, Sweden.

[Medline record in process]

BACKGROUND: Sevoflurane degrades during low-flow anaesthesia to compound A, and high carbon dioxide absorbent temperatures cause increased degradation. The purpose of this investigation was to determine if larger tidal volumes, without increasing alveolar ventilation, decrease the temperature in the carbon dioxide absorber during low- and minimal-flow sevoflurane anaesthesia. METHODS: Prospective, randomized study, including 45 patients (ASA 1-2), scheduled for elective general or urology surgery. The patients were randomly assigned to one of three treatments. Patients in group 1 (NDS) received fresh gas flow of 1 litre/min without using additional dead-space volumes. In group 2 (DS + 1.0), the patients received fresh gas flow of 1 litre/min using additional dead-space volumes, placed between the Y-piece and the HME, and patients in group 3 (DS + 0.5) received the same technique with a fresh gas flow of 0.5 litre/min. The soda lime temperatures, dead-space volumes, end-tidal carbon dioxide, sevoflurane concentrations, ventilation volumes and pressures, absorbent weight and ear temperatures were measured. RESULTS: The maximum temperature of the soda lime was 44.1 +/- 1.1 degrees C in the NDS group, 37.8 +/- 0.8 degrees C in the DS + 1.0 group and 38.5 +/- 2.7 degrees C in the DS + 0.5 group (P<0.0001). The dead-space volume between the Y-piece the tracheal tube was 164 +/- 69 ml in the DS + 1.0 group and 196 +/- 15 ml in the DS + 0.5 group (P<0.05). The ventilator pressure were higher in the DS groups compared with the NDS group (P<0.001). Soda lime weight increased in all groups. End-tidal carbon dioxide, sevoflurane concentrations and ear temperatures were similar between the groups. CONCLUSION: Increasing dead-space volumes can reduce carbon dioxide absorber temperature during low- and minimal-flow sevoflurane anaesthesia.

PMID: 12027842, UI: 22023588

Acta Anaesthesiol Scand 2002 May;46(5):481-487

Microvascular changes during anesthesia: sevoflurane compared with propofol.

Bruegger D, Bauer A, Finsterer U, Bernasconi P, Kreimeier U, Christ F

Clinic for Anesthesiology, Ludwig Maximilians University Munich, Germany.

[Record supplied by publisher]

BACKGROUND: We have developed a non-invasive computer-assisted venous congestion plethysmograph to measure the microvascular parameters in the lower limbs. This enables the assessment of microvascular changes following the induction of standardized anesthesia with either sevoflurane or propofol. METHODS: In a prospective randomized trial we measured the capillary filtration coefficient (CFC), isovolumetric venous pressure (Pvi), an index of the balance of Starling forces, and limb blood flow 24 h preoperatively, immediately after induction of anesthesia and on the 1st and 2nd postoperative day. Anesthesia was maintained with either 1.0% sevoflurane and 5 &mgr;g/kg/h remifentanil or propofol (3 mg/kg/h), and 5 &mgr;g/kg/h remifentanil in 20 female patients undergoing breast surgery. RESULTS: Preoperatively we found no significant differences between the mean CFC values of the sevoflurane group (3.7+/-0.3 ml/min 100 ml tissue/mmHg x 10-3=CFCU) and the propofol group (3.5+/-0.3 CFCU). In the sevoflurane group CFC decreased significantly to 2.9+/-0.2 CFCU, whereas it was unchanged in the propofol group. Both groups revealed a significant reduction in Pvi during steady-state anesthesia. Limb blood flow remained unchanged. There was an overall significant positive correlation between the perioperative fluid substitution and the difference between the preoperative and intraoperative CFC values (r = 0.64, P<0.01). CONCLUSION: The decreased CFC in response to sevoflurane may result in less extravasation of fluids into the interstitial space, thereby reducing intraoperative fluid requirements. These data suggest that sevoflurane may be the preferred anesthetic agent in subjects susceptible to large intraoperative fluid shifts.

PMID: 12027839

Acta Anaesthesiol Scand 2002 May;46(5):479-80

Microvascular changes and anesthesia.

Hahn RG

Karolinska institute, Stockholm, Sweden.

[Medline record in process]

PMID: 12027838, UI: 22023584

Anaesth Intensive Care 2001 Dec;29(6):644-67

Abstracts of the Combined Scientific Meeting of Australian and New Zealand College of Anaesthetists and the Hong Kong College of Anaesthesiologists. May 5-9, 2001. Hong Kong.

Publication Types:

• Congresses
• Overall

PMID: 12022133, UI: 22016861

Anaesth Intensive Care 2001 Dec;29(6):670-1

Unexpected difficulty administering an epidural top-up for caesarean section.

Lim PC, Cyna A

Publication Types:

• Letter

PMID: 11771619, UI: 21627430

Anaesthesist 2002 Feb;51(2):144-61; quiz 161, 163

[Anesthesia for endoscopic surgery.]

Kocian R, Chollet-Rivier M, Spahn DR

Service d'anesthesiologie, Hopital universitaire (CHUV), Rue du Bugnon 46, 1011 Lausanne, Schweiz. roman.kocian@chuv.hospvd.ch

Publication Types:

• Review
• Review, tutorial

PMID: 11963308, UI: 21960618

Anaesthesist 2002 Feb;51(2):110-5

[Participation--oriented analysis of the anesthesia workplace. A work system for anesthesia in a multidisciplinary operating room.]

Held J, Bruesch M, Zollinger A, Pasch T, Krueger H

Institut fur Hygiene und Arbeitsphysiologie, Eidgenossische Technische Hochschule Zurich, Clausiusstrasse 25, 8092 Zurich. held@iha.bepr.ethz.ch

INTRODUCTION: The aim of this study was the detection and understanding of weak points in the ergonomic design of anaesthesia workplaces in a multidisciplinary operating room facility. METHODS: Analysis of workplaces and of working processes by means of observations, computer-supported task recording and video-photo documentation. During guided interviews the participants were provided with material for naming-by-pointing and drawing. Subsequently, the background of the problems encountered and possible improvements were visualised. RESULTS: Important deficits were devices not positioned within reach and view, difficulties in operating the lines connecting the patient and the devices, and inconsistent workplace layouts. These were caused by erroneous planning of the facility and disregarding ergonomic principles in equipment design. The initial improvements implemented were the development of a new concept for a flexible equipment positioning and the design of a tool for cable handling. DISCUSSION AND CONCLUSION: Although from the very beginning of the study the anaesthesia personnel quoted the handling of the lines connecting patients and devices as the main cause for working difficulties, the external ergonomist could contribute to a broader view of the problems. The method presented here initiated a mutual learning process between ergonomist and users and resulted in a common understanding of the problems and their causes. Compared to the traditional consulting process, more time and efforts were necessary but were offset by the users' acceptance of the improvements and the prevention of design errors.

PMID: 11963302, UI: 21960612

Anaesthesist 2002 Feb;51(2):103-9

[Obstetric analgesia and anesthesia in Switzerland in 1999.]

Zwetsch-Rast G, Schneider MC, Siegemund M

Departement fur Anasthesie und Intensivmedizin Universitat Basel, Kantonsspital und Universitatsfrauenklinik Basel, Schweiz. zwetschg@uhbs.ch

QUESTION: This survey investigated the common practice of obstetric analgesia and anaesthesia in Swiss hospitals and evaluated the influence of the Swiss interest group for obstetric anaesthesia. METHODS: In March 1999 we submitted 145 questionnaires to all Swiss hospitals providing an obstetric service. RESULTS: The rate of epidural analgesia (EA) was higher in large hospitals (> 1,000 births/year) than in small services. EA was maintained by continuous infusion techniques in 53% of the responding hospitals. For elective caesarean section, spinal anaesthesia (SA) and EA were performed in 77% and 16% of the patients, respectively. General anaesthesia (5%) was only used in small hospitals (< 500 births/year). Emergency caesarean section was performed under SA in 75% of all hospitals and only in 25% was a general anaesthesia used. An already existing EA for labour analgesia was continued for anaesthesia for caesarean section in 63% of Swiss hospitals. CONCLUSIONS: Regional anaesthesia was most commonly used for obstetric anaesthesia in Swiss hospitals. Epidemiological studies, recommendations of the Swiss interest group for obstetric anaesthesia, as well as the expectations of pregnant women, increased the numbers of regional anaesthesia compared with the first survey in 1992.

PMID: 11963301, UI: 21960611

Ann Fr Anesth Reanim 2002 Mar;21(3):235-40

[Survey of bibliographic facilities offered in departments of anesthesia and intensive care of French univeristy hospitals.]

Lentschener C, Ozier Y, Conseiller C

Service d'anesthesie-reanimation, hopital Cochin, 123, boulevard de Port Royal, 75014 Paris, France. lentsche@club-internet.fr

OBJECTIVES: We assessed bibliographic facilities offered in departments of anaesthesia (DA) belonging to university hospitals in metropolitan France. METHODS: We mailed a questionnaire to the 76 heads of DA belonging to university hospitals in France to assess: a) which journals dealing with anaesthesia, analgesia, and critical care were available, on site, for consultation; b) whether a medical library existed within the institution; and c) whether all bibliographic informations required by any DA collaborators were charged to the institution. RESULTS: We received 67 replies (87%). High impact factor revues had the widest availability rates--Anesthesiology: 67 DA (100% of responses)--Anesthesia Analgesia: 66 DA (98.5%)--the British Journal of Anaesthesia: 63 DA (94%). The Annales Francaises d'Anesthesie et de Reanimation were available in 66 DA (98.5%). Ten journals in French were variably available--no journal: 1 DA (1.5%)--1 journal: 19 DA (28%)--2 journals: 34 DA (51%),--3 journals: 10 DA (15%)--4 journals: 3 DA (4%). Revues dealing with anaesthesia in specialised surgery were diversely available--neurosurgery: 7 DA (10%)--paediatrics: 10 DA (15%)--obstetrics: 11 DA (16%)--cardiovascular: 26 DA (39%). Revues dealing with pain management, regional anaesthesia or critical care were available in 29 DA (43%), 32 DA (47%), and 59 DA (91%), respectively. The European Journal of Anaesthesiology was available in 40 DA (60%). Thirty-nine DA (58%) took charge of all bibliographic informations required. No medical library existed in 4 university hospitals (6%). CONCLUSION: DA offers a wide variation in bibliographic facilities in French university hospitals.

PMID: 11963390, UI: 21960698

Ann Fr Anesth Reanim 2002 Mar;21(3):228-30

[Pneumocephalus after spinal anesthesia.]

Depret T, Le Falher G, Delecroix M, Brasdefer D, Krivosic-Horber R

Departement d'anesthesie-reanimation chirurgicale I, hopital R. Salengro, CHRU, 59037 Lille, France.

We report the case of a 76-year-old man who received a spinal anaesthesia for inguinal hernia repair surgery. A cranial CT scan which was performed because the patient complained of postoperative headache and hemiparesis showed an important pneumocephalus. Because postoperative questioning revealed that the patient had a chronic and neglected rhinorrhea, we hypothesise that this pneumocephalus was secondary to an old unknown osteodural leak with intracranial air entry secondary to the spinal anaesthesia-releated decrease in CSF pressure.

PMID: 11963388, UI: 21960696

Ann Fr Anesth Reanim 2002 Mar;21(3):224-7

[Orbital exenteration: an unusual cause of failure of assisted ventilation from a face mask.]

Devys JM, Bourdaud N, Baracco P, Plaud B

Departement d'anesthesiologie-reanimation-urgences, Fondation Adolphe de Rothschild, 25-29, rue Manin, 75940 Paris, France. jmdevys@fo-rothschild.fr

Orbitary exenteration for tumor may concern ethmoidal wall, and may create a large communication between the orbital cavity and the cavum. We present the case of a patient scheduled for ocular prosthetic surgery after an unilateral orbitary exenteration. After intravenous induction of the general anaesthesia, anaesthesiologist failed to achieve adequate facial mask ventilation because of a great gas leakage from cavum to orbital cavity. Inserting packing in the orbitary cavity allowed to decrease gas leakage and to get adequate facemask ventilation. We recommend orbitary radiographic and clinical evaluations for patient with orbitary exenteration before general anaesthesia to evaluate the communication between the orbital cavity and the cavum. Such an anatomic communication may result in inefficient facial mask ventilation.

PMID: 11963387, UI: 21960695

Ann Fr Anesth Reanim 2002 Mar;21(3):193-7

[Evaluation of regional anesthesia procedure in an emergency department.]

Fuzier R, Tissot B, Mercier-Fuzier V, Barbero C, Caussade D, Mengelle F, Villaceque E, Virenque C, Samii K, Ducasse JL

Service d'accueil des urgences, departement d'anesthesie-reanimation, 1, avenue J. Poulhes, 31403 Toulouse, France. fuzier.r@chu-toulouse.fr

OBJECTIVES: Evaluation of regional anaesthesia procedures for limb traumatic surgery performed in an emergency department. METHOD: Anaesthetic procedures concerning traumatic emergencies have been studied from 1995 to 2000. RESULTS: A 32% increase in anaesthesia practice was observed from 1995 (221) to 2000 (292) with a 52% increase in regional anaesthesia. Since 1996, regional anaesthesia represents more than 80% of the anaesthetic procedures and 90% for the upper limb surgery (66% of the surgical procedures). Axillary block (50%), interscalene brachial plexus block (15%) and combined sciatic and femoral nerve block (17%) were the main regional anaesthesia procedures. Spinal anaesthesia (9 cases) and intravenous locoregional anaesthesia (12 cases) were rarely used. CONCLUSION: In our study, regional anaesthesia is the most used technique when compared to general anaesthesia for emergency procedure. The anaesthetic staff has to be motivated and trained.

Publication Types:

• Evaluation studies

PMID: 11963382, UI: 21960690

Ann Fr Anesth Reanim 2002 Mar;21(3):182-3

[Medical journals and bibliographic databases at the disposal of university hospitals for anesthesiologists in metropolitan France.]

Haberer JP

Publication Types:

• Editorial

PMID: 11963380, UI: 21960688

Br J Anaesth 2002 Mar;88(3):459

Salim and Mahmood modification of RAE tubes.

Salim M

Publication Types:

• Letter

PMID: 11990294, UI: 21985673

Br J Anaesth 2002 Mar;88(3):457; discussion 457

Evaluation of the Greenbaum sub-tenon's block: a role in anticoagulated patients presenting for cataract surgery.

Berrington JS

Publication Types:

• Letter

PMID: 11990292, UI: 21985670

Br J Anaesth 2002 Mar;88(3):384-8

Abdominal pressure during laparoscopy: effects of fentanyl.

Drummond GB, Duncan MK

Department of Anaesthesia, Critical Care and Pain Medicine, Royal Infirmary, Edinburgh, UK.

BACKGROUND: In patients breathing spontaneously during anaesthesia, expiration is active and opioids enhance this effect. The mechanical consequences are not well characterized. METHODS: We studied 14 patients undergoing laparoscopy for minor gynaecological procedures, anaesthetized with isoflurane in nitrous oxide, and breathing spontaneously through a laryngeal mask airway. We made direct recordings of intra-abdominal pressure and respiratory flow before and after giving fentanyl 25 microg i.v. RESULTS: Satisfactory records were obtained in 11 patients. Before fentanyl, the abdominal pressure changes were small and had an inconsistent pattern, increasing in inspiration in seven patients and during expiration in five. After fentanyl, an increase in pressure during inspiration was seen in only two patients, and the intra-abdominal pressure during expiration was increased. The mean value of maximum abdominal pressure (which always occurred during expiration) increased from 17 (SD 5) cm H2O before to 25 (9) cm H2O after fentanyl (P<0.01). CONCLUSIONS: Direct measurements support previous findings that opioids stimulate active phasic expiratory activity and can cause large increases in abdominal pressure.

PMID: 11990271, UI: 21985650

Br J Anaesth 2002 Mar;88(3):369-73

Noise in the postanaesthesia care unit.

Allaouchiche B, Duflo F, Debon R, Bergeret A, Chassard D

Service d'Anesthesie-Reanimation, Hjpital de l'Hjtel-Dieu, Lyon, France.

BACKGROUND: Although the postanaesthesia care unit (PACU) can be noisy, the effect of noise on patients recovering from anaesthesia is unknown. We studied the sources and intensity of noise in the PACU and assessed its effect on patients' comfort. METHODS: We measured noise in a five-bed PACU with a sound level meter. Noise levels were obtained using an A-weighted setting (dBA) and peak sound using a linear scale (dBL). Leq (average noise level at 5-s intervals), maximun Leq (LeqMax), minimum Leq (LeqMin) and noise peaks (Lpc) were calculated. During recording, an independent observer noted the origin of sounds from alarms and noise above 65 dB intensity (P65dB). Two hours after leaving the PACU, patients were asked about their experience and to rank their complaints on a visual analogue scale (VAS) using unstructured and structured questionnaires. RESULTS: We made 20,187 measurements over 1678 min. The mean Leq, LeqMax and LeqMin were 67.1 (SD 5.0), 75.7 (4.8) and 48.6 (4.1) dBA respectively. The mean Lpc was 126.2 (4.3) dBL. Five per cent of the noise was at a level above 65 dBA. Staff conversation caused 56% of sounds greater than 65 dB and other noise sources (alarm, telephone, nursing care) were each less than 10% of these sounds. Five patients reported disturbance from noise. There was no significant difference in Leq measured for patients who found the PACU noisy and those who did not [59.5 (3.1) and 59.4 (2.4) dBA respectively]. Stepwise multiple logistic regression indicated that only pain was associated with discomfort. CONCLUSIONS: Even though sound in the PACU exceeded the internationally recommended intensity (40 dBA), it did not cause discomfort. Conversation was the most common cause of excess noise.

PMID: 11990268, UI: 21985647

Br J Pharmacol 2002 Jun 3;136(3):399-414

An investigation of the effects of zaprinast, a PDE inhibitor, on the nitrergic control of the urethra in anaesthetized female rats.

Wibberley A, Nunn PA, Naylor AM, Ramage AG

Department of Pharmacology, University College London, Royal Free Campus, Rowland Hill Street, Hampstead, London, NW3 2PF, U.K. Discovery Biology, Pfizer Global Research and Development, Ramsgate Road, Sandwich, Kent, CT13 9NJ, U.K. Current address: Department of Renal and Urology Research, GlaxoSmithKline Pharmaceuticals, 709 Swedeland Road, P.O. Box 1539, King of Prussia, Philadelphia, Pennsylvania, PA 19406-0939, U.S.A. Current address: Genitourinary Diseases Neurobiology Unit, Roche Biosciences, 3401 Hillview Avenue, Palo Alto, California, CA 94304-6980, U.S.A.

[Record supplied by publisher]

The effects of L-NAME and zaprinast were investigated (i.v.) on reflex-evoked changes in bladder and urethral pressures in urethane-anaesthetized female rats. L-NAME attenuated reflex-evoked urethral relaxations (65+/-10%), while zaprinast potentiated these responses (68+/-24%). L-NAME and zaprinast also increased baseline urethral pressure and urethral striated muscle (EUS-EMG) activity. These drugs had little effect on the bladder. Following pre-treatment with alpha-bungarotoxin (i.v.) to block urethral striated muscle, L-NAME and zaprinast failed to increase baseline urethral pressure. Further zaprinast failed to alter the size of reflex-evoked urethral relaxations. Intra-urethral zaprinast caused a significant increase while sodium nitroprusside (SNP) and isoprenaline caused decreases in urethral pressure (+14+/-3%, -25+/-5%, -29+/-7%, respectively). These changes were associated with increases in EUS-EMG activity. After chlorisondamine (i.v.), zaprinast caused a significant fall in urethral pressure, while the decrease in urethral pressure caused by SNP and isoprenaline was potentiated. No changes in EUS-EMG activity occurred. These results indicate that a nitrergic pathway mediates reflex-evoked urethral smooth muscle relaxations. The data also indicates that there is a background release of NO, which reduces sphincter skeletal muscle activity. Further, the ability of zaprinast to potentiate nitrergic evoked urethral relaxations involves an increase in striated muscle tone. This appears to be an indirect result of smooth muscle relaxation and is mediated, at least in part, by a chlorisondamine-sensitive mechanism.

PMID: 12023943

Pediatrics 2002 May;109(5):894-7

A randomized, clinical trial of oral midazolam plus placebo versus oral midazolam plus oral transmucosal fentanyl for sedation during laceration repair.

Klein EJ, Diekema DS, Paris CA, Quan L, Cohen M, Seidel KD

Department of Pediatrics, University of Washington and Children's Hospital and Regional Medical Center, Seattle, Washington 98105-0371, USA. eklein@chmc.org

OBJECTIVE: To determine whether a combination of oral transmucosal fentanyl (Fentanyl Oralet, Abbott Laboratories, North Chicago, IL) plus oral midazolam has an acceptable safety profile and is more effective than oral midazolam alone for sedation during laceration repair in a pediatric emergency department (ED). METHODS: Randomized, double-blind, placebo-controlled, clinical trial. Patients between 2 and 8 years of age who weighed >10 kg and presented to the ED with a laceration in need of repair under sedation were eligible for inclusion. All patients received oral midazolam (0.5 mg/kg; maximum dose 10 mg) and either fentanyl (5-10 microg/kg) or placebo in oralet form. Data collected every 5 minutes included the following: heart rate, oxygen saturation, respiratory rate, pain as measured on a Children's Hospital of Eastern Ontario Pain Score (CHEOPS) scale (range: 4-13), and an activity scale (range: 1-5). Effectiveness of sedation was measured by CHEOPS and activity scores compared between the treatment groups. RESULTS: Fifty-one patients were randomized to receive oral midazolam plus fentanyl (N = 28) or oral midazolam plus placebo (N = 23). Age, weight, gender, or baseline pain and activity scores did not differ between the 2 groups. Seven patients in the fentanyl group vomited compared with 0 patients in the placebo group. Three patients in the fentanyl group and no patients in the placebo group had brief oxygen saturation below 93% on room air. The mean pain score within 5 minutes of the start of the procedure did not differ between the 2 groups (fentanyl group, 9.4 versus placebo group, 8.8). Mean activity scores within 5 minutes of the start of the procedure were also similar (fentanyl group, 4.3 versus placebo group, 4.3). CONCLUSIONS: The addition of oral transmucosal fentanyl to oral midazolam did not improve pain or activity scores in pediatric patients given sedation for laceration repair. Patients who received Fentanyl Oralet suffered significantly more side effects despite the relatively low doses administered in this study. Oral transmucosal fentanyl should not be used for procedural sedation in the ED.

Publication Types:

• Clinical trial
• Randomized controlled trial

PMID: 11986452, UI: 21982884

Reg Anesth Pain Med 2002 May-Jun;27(3):337

Ball implant filled with a local anesthetic in addition to peribulbar to relieve postoperative pain in a child.

Calenda E, Quintyn JC, Djimi H

[Medline record in process]

PMID: 12016623, UI: 22012114

Reg Anesth Pain Med 2002 May-Jun;27(3):336

Opioid and local anesthetic combination for brachial plexus block to provide postoperative analgesia.

Viel EJ, Cuvillon P, Eledjam JJ

[Medline record in process]

PMID: 12016621, UI: 22012112

Reg Anesth Pain Med 2002 May-Jun;27(3):328-9

Clinical value of adding sodium bicarbonate to local anesthetics.

Lambert DH

[Medline record in process]

PMID: 12016613, UI: 22012104

Reg Anesth Pain Med 2002 May-Jun;27(3):240-1

Imaging in regional anesthesia and pain medicine: We have much to learn.

Rathmell JP

Associate Editor, Imaging Section Regional Anesthesia and Pain Medicine Associate Professor of Anesthesiology University of Vermont College of Medicine Burlington, Vermont.

[Medline record in process]

PMID: 12016594, UI: 22012085