Anaesthetic history of a patient: 250 anaesthetics in
30 years.
[Record supplied by publisher]
PMID: 11872000
Anaesthesia 2002 Feb;57(2):205-206
A--Q alphabetic anaesthetic assessment algorithm.
[Record supplied by publisher]
PMID: 11871994
Anaesthesia 2002 Feb;57(2):204-205
Cheese, drug labels and anaesthetic room error.
[Record supplied by publisher]
PMID: 11871993
Anaesthesia 2002 Feb;57(2):192-193
Anaesthetic machine safety -- the story continues.
[Record supplied by publisher]
PMID: 11871977
Anaesthesia 2002 Feb;57(2):191-192
Phantom anaesthetic vapour.
[Record supplied by publisher]
PMID: 11871975
Anaesthesia 2002 Feb;57(2):187-188
Anaesthesia induction rooms -- sheer luxury.
[Record supplied by publisher]
PMID: 11871969
Anaesthesia 2002 Feb;57(2):185-186
Manpower requirements when implementing a partial shift
system for anaesthetic juniors.
[Record supplied by publisher]
PMID: 11871966
Anaesthesia 2002 Feb;57(2):176-179
Effect of videotape feedback on anaesthetists' performance
while managing simulated anaesthetic crises: a multicentre
study.
Byrne AJ, Sellen AJ, Jones JG, Aitkenhead AR, Hussain
S, Gilder F, Smith HL, Ribes P
Consultant Anaesthetist, and Specialist Registrar, Department
of Anaesthesia, Morriston Hospital, Swansea SA6 6NL, UK
Research Scientist, Hewlett-Packard Laboratories, Filton
Road, Stoke Gifford, Bristol BS34 8QZ, UK Professor, and
Specialist Registrar, University Department of Anaesthesia,
Addenbrooke's Hospital, Cambridge CB2 2QQ, UK Professor,
and Specialist Registrar, Division of Anaesthesia and Intensive
Care, Queen's Medical Centre, Nottingham NG7 2UH, UK Specialist
Registrar, Department of Anaesthesia, Peterborough General
Hospital, Thorpe Road, Peterborough PE3 6DA, UK.
[Record supplied by publisher]
The aim of this study was to examine the performance of
anaesthetists while managing simulated anaesthetic crises
and to see whether their performance was improved by reviewing
their own performances recorded on videotape. Thirty-two
subjects from four hospitals were allocated randomly to
one of two groups, with each subject completing five simulations
in a single session. Individuals in the first group completed
five simulations with only a short discussion between each
simulation. Those in the second group were allowed to review
their own performance on videotape between each of the simulations.
Performance was measured by both 'time to solve the problem'
and mental workload, using anaesthetic chart error as a
secondary task. Those trainees exposed to videotape feedback
had a shorter median 'time to solve' and a smaller decrease
in chart error when compared to those not exposed to video
feedback. However, the differences were not statistically
significant, confirming the difficulties encountered by
other groups in designing valid tests of the performance
of anaesthetists.
PMID: 11871957
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Anaesthesia 2002 Feb;57(2):140-54
Anions and the anaesthetist.
Maloney DG, Appadurai IR, Vaughan RS
Specialist Registrar and Consultant Anaesthetist, Department
of Anaesthetics, University Hospital of Wales, Heath Park,
Cardiff CF14 4XW, UK.
[Medline record in process]
Anions are the negative components of most chemical structures
and play many important physiological and pharmacological
roles that are of interest to the anaesthetist. Their relevance
is reviewed with a particular emphasis on the inorganic
anions (halides, bicarbonate, phosphate and sulphate) and
the significance and limitations of the anion gap. Organic
anions (albumin, lactate) are also discussed, albeit briefly.
The suitability of anions for their role in neurotransmission
and acidminus signbase balance is outlined.
PMID: 11871951, UI: 21861111
Anaesthesia 2002 Feb;57(2):123-127
Orotracheal fibreoptic intubation for rapid sequence induction
of anaesthesia.
Pandit JJ, Dravid RM, Iyer R, Popat MT
Consultant, Nuffield Department of Anaesthetics, John Radcliffe
Hospital, Headley Way, Oxford OX 9DU, UK Consultant, Department
of Anaesthetics, Kettering General Hospital, Kettering,
UK Consultant, Department of Anaesthetics, Royal Hasler
Hospital, Gosport, UK.
[Record supplied by publisher]
We assessed whether flexible fibreoptic-guided orotracheal
intubation could be rapidly and successfully achieved during
a simulated rapid sequence induction in 30 anaesthetised
and paralysed patients. Rapid sequence induction was simulated
by applying practised cricoid pressure. Using ablankflexible
fibreoptic laryngoscope with camera and closed circuit television,
an anaesthetist experienced with the technique performed
orotracheal endoscopy and intubation with a cuffed 7.0-mm
Portex tracheal tube through a VBM Bronchoscope Airway.
Fibreoptic intubation was successful at the first attempt
in 28 patients (93%); two patients required two attempts.
Mean (SD) time from removal of the facemask from the patient's
face to the appearance of carbon dioxide in the expired
breath after intubation was 111 (46) s (median 100 s; range
54--195 s). There were one or more difficulties in 13 patients
(43%). These difficulties were largely avoidable and included
problems with fibreoptic equipment, the Bronchoscope Airway,
copious secretions, cricoid pressure or railroading of the
tracheal tube. Flexible fibreoptic-guided orotracheal intubation
may have a place in the management of failed intubation
during a rapid sequence induction.
PMID: 11871948
Anaesthesia 2002 Feb;57(2):116-122
Personality testing and profiling for anaesthetic job
recruitment: attitudes of anaesthetic specialists/consultants
in New Zealand and Scotland.
Kluger MT, Watson D, Laidlaw TM, Fletcher T
Specialist Anaesthetist and Quality and Research Nurse
Specialist, Department of Anaesthesia, North Shore Hospital,
Auckland, New Zealand Consultant Anaesthetist, Department
of Anaesthesia, Critical Care and Pain Medicine, Royal Infirmary
of Edinburgh, Edinburgh, UK Clinical Psychologist, Department
of Psychology, Imperial College, London, UK.
[Record supplied by publisher]
Specialist/consultant anaesthetists based in New Zealand
and Scotland were sent a reply paid postal questionnaire
asking about their attitudes to personality testing and
personality types in the recruitment process for registrars
and specialists. The questionnaire consisted of nine Likert-style
questions and 14 visual analogue questions. The overall
response rate was 65% (523/808). The responses to all the
questions were broadly similar in the two countries. Personality
testing was deemed of use in recruiting trainees and specialists,
with a slightly greater proportion considering personality
traits more important than academic achievement. An overwhelming
majority believed the presence of an adverse personality
trait would influence an appointment process, but few believed
that the personality makeup of anaesthetists influenced
the way in which they react toblankstressful situations.
A slight majority considered the interview process a poor
predictor of personality. New Zealand anaesthetists rated
independence, orderliness, compassion, empathy, reflectiveness
and patience higher than did anaesthetists in Scotland.
In contrast, anaesthetists in Scotland rated pragmatism,
as opposed to perfection, as a more important characteristic
than did the New Zealand specialists. Personality assessment,
although not effective as the sole tool for candidateblankselection,
may have a role in the process of anaesthetic job recruitment
and warrants furtherblankinvestigation.
PMID: 11871947
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Anaesthesia 2002 Jan;57(1):98-9
Warning stickers and epidural haematomas.
Newton KM, Orilikowski CE
Publication Types:
Letter
PMID: 11848072, UI: 21836584
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Anaesthesia 2002 Jan;57(1):98
False positive epidural catheter aspiration tests in CSE.
Sodhi V, Sarang K, Fernando R
Publication Types:
Letter
PMID: 11848071, UI: 21836583
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Anaesthesia 2002 Jan;57(1):95
Incorrectly colour coded flow meters.
Reddy R, Thacker AJ
Publication Types:
Letter
PMID: 11848068, UI: 21836580
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Anaesthesia 2002 Jan;57(1):100
Gas analyser connector.
Rocheteau M
Publication Types:
Letter
PMID: 11848061, UI: 21836587
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Anaesthesia 2002 Jan;57(1):94-5
A critical incident: manufacturing or human error?
Mills SJ
Publication Types:
Letter
PMID: 11843759, UI: 21832548
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Anaesthesia 2002 Jan;57(1):92-3
A highly mobile laryngeal tumour: inspiratory stridor
and coughing attacks.
de Boer HD, van Diejen D, Gielen MJ, Eisink RJ
Publication Types:
Letter
PMID: 11843756, UI: 21832545
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Anaesthesia 2002 Jan;57(1):70-6
Assessment of diaphragm function after stellate ganglion
block using magnetic stimulation.
Department of Anaesthetics, University Department of Surgical
and Anaesthetic Sciences, K Floor, Royal Hallamshire Hospital,
Glossop Road, Sheffield S10 2JF, UK.
Stellate ganglion block is a procedure frequently used
for the management of patients with chronic sympathetically
mediated pain affecting the arm, neck or head. We studied
the effect of stellate ganglion block on ipsilateral phrenic
nerve function, and hence diaphragmatic strength, in 11
adult patients with chronic sympathetically mediated pain.
Pre- and post-block forced vital capacity (FVC) measurements
were recorded using a pneumotachograph and a Magstim nerve
stimulator was used to generate pre- and post-block twitch
mouth pressures (P(TWM)). This device can be used to stimulate
the phrenic nerves and hence the diaphragm. The resulting
change in airway pressure was measured at the mouth and
has previously been shown to reflect diaphragm strength.
There was no statistically significant difference in FVC
or P(TWM) pre- or post stellate ganglion block. In conclusion,
a stellate ganglion block has no adverse effect on ipsilateral
phrenic nerve function or diaphragm strength in healthy
adult patients.
Publication Types:
Clinical trial
PMID: 11843747, UI: 21832536
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Anesth Analg 2002 Mar;94(3):767-8
Withdrawal of antihypertensive drugs before anesthesia.
Prys-Roberts C
Bristol Royal Infirmary, Bristol, UK. Pitie Hospital, Paris,
France.
[Medline record in process]
PMID: 11867420, UI: 21855835
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Anesth Analg 2002 Mar;94(3):741-8
The effects of abdominal opening on respiratory mechanics
during general anesthesia in normal and morbidly obese patients:
a comparative study.
Auler JO Jr, Miyoshi E, Fernandes CR, Bensenor FE, Elias
L, Bonassa J
Department of Anesthesia, Hospital das Clinicas da Faculdade
de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil.
[Medline record in process]
Morbid obesity has a profound effect on respiratory mechanics
and gas exchange. However, most studies were performed in
morbidly obese patients before or after anesthesia. We tested
the hypothesis that anesthesia and abdominal opening could
modify the elastic and resistive properties of the respiratory
system. Eleven morbidly obese and eight normal-weight patients
scheduled for gastric binding and cancer treatment, respectively,
under laparotomy were studied. Respiratory mechanics, partitioned
into its lung and chest wall components, were investigated
during surgery by means of the end-inspiratory inflation
occlusion method and esophageal balloon at five time points.
Static respiratory and lung compliance were markedly reduced
in obese patients; on the contrary, static compliance of
chest wall presented comparable values in both groups. Obese
patients also presented higher resistances of the total
respiratory system, lung and chest wall, as well as "additional"
lung resistance. Mainly in obese patients, laparotomy provoked
a significant increase in lung compliance and decrease in
"additional" lung resistance 1 h after the peritoneum
was opened, which returned to original values after the
peritoneum had been closed (P < 0.005). In obese patients,
low respiratory compliance and higher airway resistance
were mainly determined by the lung component.
PMID: 11867409, UI: 21855824
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Anesth Analg 2002 Mar;94(3):723-8
Assessing sedation with regional anesthesia: inter-rater
agreement on a modified Wilson sedation scale.
Nemethy M, Paroli L, Williams-Russo PG, Blanck TJ
Departments of Medicine and Anesthesiology, Hospital for
Special Surgery, Cornell University Medical College, New
York, New York.
[Medline record in process]
A valid and reliable means for measuring sedation during
regional anesthesia would be valuable for both research
and practice. Current methods of monitoring sedation include
machine-, patient-, and observer-based assessment. The reliability
of machine-based methods is limited at lower levels of sedation,
whereas patient-based methods are impractical at higher
levels. Observer-based methods offer the best alternative
for assessing sedation during regional anesthesia; however,
their reliability has not been adequately documented. We
examined the interrater reliability of the Wilson sedation
scale. Sedation was assessed by pairs of anesthesia care
providers in 100 patients undergoing surgical procedures
with regional anesthesia. On the basis of the findings,
the scale was modified, and 50 additional patients were
assessed. The study protocol called for a series of standardized
stimuli administered by a research assistant. Raters were
blinded to each other's ratings. Interrater reliability
was assessed by using the kappa statistic, a measure of
actual agreement beyond agreement by chance. When continuing
checks on its operationalization and reliability are included,
the modified Wilson scale provides a simple and reliable
means by which to assess and monitor intraoperative sedation.
IMPLICATIONS: We evaluated the interrater reliability of
the Wilson scale for measuring sedation during regional
anesthesia. Paired anesthesia care providers' ratings of
patient sedation indicated very good interrater reliability
in both the original scale and a modified version. The modified
Wilson scale provides a quick noninvasive means of monitoring
sedation during regional anesthesia.
PMID: 11867405, UI: 21855820
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Anesth Analg 2002 Mar;94(3):717-22
The efficacy of hemodynamic and T-wave criteria for detecting
intravascular injection of epinephrine test dose in propofol-anesthetized
adults.
Takahashi S, Tanaka M, Toyooka H
Department of Anesthesiology, Institute of Clinical Medicine,
University of Tsukuba, Tsukuba.
[Medline record in process]
A recent study demonstrated 100% effectiveness of hemodynamic
criteria during propofol anesthesia, when a full dose of
an epinephrine (15 microg)-containing test dose was injected
intravascularly. We designed this dose-response study to
determine minimal effective epinephrine doses and efficacies
of hemodynamic and T-wave criteria for detecting intravascular
injection of the epinephrine test dose in propofol-anesthetized
adults. Eighty healthy adult patients were randomly assigned
to one of four groups according to a simulated IV test dose
using propofol (133 microg center dot kg(-1) center dot
min(-1)) and nitrous oxide (FIO(2) = 0.33) anesthesia after
endotracheal intubation (n = 20 each). The Saline group
received 3 mL of normal saline IV; the Epinephrine-15 group
received 3 mL of 1.5% lidocaine containing 15 microg epinephrine;
and the Epinephrine-10 and -5 groups received 2 and 1 mL
of the test dose of the identical components, respectively.
Heart rate (HR), systolic blood pressure (SBP), and lead
II of the electrocardiogram were recorded continuously for
5 min after the IV injection of the study drug via a peripheral
vein. Sensitivities and specificities of 100% were obtained
based on the modified HR (positive if greater-than-or-equal10
bpm increase) and the T-wave (positive if greater-than-or-equal25%
in amplitude) criteria if greater-than-or-equal5 microg
of epinephrine was injected IV. Based on the SBP criterion
(positive if greater-than-or-equal15 mm Hg increase), however,
100% sensitivity and specificity were associated only with
greater-than-or-equal10 microg of epinephrine doses. These
results suggest that the minimal effective epinephrine doses
for detecting unintentional intravascular injection are
5 microg based on the HR and T-wave criteria, and 10 microg
based on the SBP criterion in adult patients anesthetized
with propofol and nitrous oxide. IMPLICATIONS: Accidental
migration of an epidural catheter into a blood vessel is
often detected by hemodynamic changes after injecting an
epidural test dose containing epinephrine. Our results suggest
that 5 microg of epinephrine is not adequate to reliably
produce hemodynamic and T-wave alterations in adult patients
during propofol anesthesia.
PMID: 11867404, UI: 21855819
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Anesth Analg 2002 Mar;94(3):661-6
Cerebral blood volume and blood flow responses to hyperventilation
in brain tumors during isoflurane or propofol anesthesia.
Cenic A, Craen RA, Lee TY, Gelb AW
Department of Radiology and Lawson Research Institute,
St. Joseph's Health Centre, Imaging Research Laboratories,
Robart's Research Institute and Department of Medical Biophysics,
University of Western Ontario, London.
[Medline record in process]
Using computerized tomography, we measured absolute cerebral
blood flow (CBF) and cerebral blood volume (CBV) in tumor,
peri-tumor, and contralateral normal regions, at normocapnia
and hypocapnia, in 16 rabbits with brain tumors (VX2 carcinoma),
under isoflurane or propofol anesthesia. In both anesthetic
groups, CBV and CBF were highest in the tumor region and
lowest in the contralateral normal tissue. For isoflurane,
a significant decrease in both CBV and CBF was observed
in all tissue regions with hyperventilation (P < 0.05),
but without accompanying changes in intracranial pressure.
However, the percent reduction in regional CBF with hypocapnia
was two times larger than that observed in the CBV response
(P < 0.01). In contrast, there were no significant changes
in CBV and CBF in the Propofol group with hyperventilation
for all regions (P > 0.10). In addition, there were no
differences between CBV values for isoflurane at hypocapnia
when compared with CBV values for propofol at normo- or
hypocapnia (P > 0.34 and P > 0.35, respectively, in
the tumor regions). Our results indicate that propofol increases
cerebral vascular tone in both neoplastic and normal tissue
vessels compared with isoflurane. CBV and CBF during normocapnia
were significantly greater in all regions (tumor, peri-tumor,
and contralateral normal tissue) with isoflurane than with
propofol. CBV and CBF remained responsive to hyperventilation
only with isoflurane. IMPLICATIONS: In rabbits with brain
tumors, brain blood flow and volume were significantly larger
in all regions (tumor, peri-tumor, and contralateral normal
tissue) with isoflurane than with propofol during normocapnia,
and remained responsive to a reduction in PaCO(2). Consequently,
during hypocapnia, brain blood flow and volume values with
isoflurane were similar to values with propofol.
PMID: 11867393, UI: 21855808
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Anesth Analg 2002 Mar;94(3):650-4
Cerebral hyperemia during recovery from general anesthesia
in neurosurgical patients.
Bruder N, Pellissier D, Grillot P, Gouin F
Departement d'Anesthesie-Reanimation, CHU Timone, 13385
Marseille Cedex, France.
[Medline record in process]
Changes in the cerebral circulation during recovery from
neurosurgical anesthesia are poorly understood. We used
transcranial Doppler to compare cerebral blood flow velocity
changes (Vmca) during recovery after anesthesia. In the
first part of the study, 30 patients were randomized to
propofol- or isoflurane-based anesthesia. Vmca, mean arterial
pressure (MAP), and CO(2) partial pressure (PaCO(2)) were
measured before anesthesia, at tracheal extubation, at 5
to 60 min after extubation, and at 24 h after anesthesia.
There was a 60% increase in Vmca above the awake value at
extubation. The increase in Vmca was significant at least
for 30 min after extubation. There was no difference between
the Propofol and Isoflurane anesthesia groups. There was
no correlation between Vmca and MAP or PaCO(2) at any time.
In the second part of the study, Vmca, MAP, and jugular
venous bulb saturation in oxygen (SjvO(2)) were measured
after isoflurane anesthesia. SjvO(2) increased significantly
at extubation, consistent with cerebral hyperemia. In conclusion,
cerebral hyperemia occurs during recovery from general anesthesia
independently of the anesthetic technique or hemodynamic
or ventilatory changes. It is speculated that cerebral hyperemia
is a nonspecific response to stress during emergence from
anesthesia. IMPLICATIONS: Cerebral hyperemia occurs during
emergence from general anesthesia. It might be one mechanism
of cerebral complications in the early postoperative period.
PMID: 11867391, UI: 21855806
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Anesth Analg 2002 Mar;94(3):619-25
Tramadol Has No Effect on Cortical Renal Blood Flow---Despite
Increased Serum Catecholamine Levels---in Anesthetized Rats:
Implications for Analgesia in Renal Insufficiency.
Nagaoka E, Minami K, Shiga Y, Uezono Y, Shiraishi M, Aoyama
K, Shigematsu A
Department of Anesthesiology, University of Occupational
and Environmental Health, School of Medicine, Kitakyushu,
Japan.
[Medline record in process]
Tramadol is an analgesic that inhibits norepinephrine (NE)
reuptake. Although NE released from renal sympathetic nerves
causes renal hypoperfusion, the effects of tramadol on renal
hemodynamics have not been well characterized. We investigated
the effects of tramadol on renal blood flow (RBF), mean
arterial blood pressure (MAP), and heart rate (HR) by using
a laser Doppler flowmeter, both in normal anesthetized rats
and in rats with experimentally-induced nephritis secondary
to anti-Thy 1.1 antibody administration. We also studied
the effects of tramadol on serum NE levels. Tramadol increased
MAP and decreased HR without changing RBF in normal rats
at clinical doses. Serum NE levels increased up to 176%
of control after a 2 mg/kg bolus injection of tramadol.
Continuously infused, increasing doses of tramadol (0.5--4
mg center dot kg(-1) center dot h(-1)) did not affect MAP,
HR, or RBF. Tramadol also increased MAP and decreased HR
without changing RBF in rats with experimentally induced
renal insufficiency. These findings suggest that a bolus
injection of tramadol does not alter RBF, although it causes
a decrease in HR and an increase in MAP and serum NE in
both normal rats and in rats with renal insufficiency. These
results suggest that tramadol may have little effect on
RBF during the postoperative period. IMPLICATIONS: A bolus
and continuous injection of tramadol does not alter renal
blood flow (RBF) in normal rats. A bolus injection of tramadol
has little effect on RBF in rats with experimentally induced
renal insufficiency. These results suggest that tramadol
would be a safe analgesic for maintaining RBF during the
postoperative period.
PMID: 11867386, UI: 21855801
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Anesth Analg 2002 Mar;94(3):615-8
Preoperative clonidine blunts hyperadrenergic and hyperdynamic
responses to prolonged tourniquet pressure during general
anesthesia.
Zalunardo MP, Serafino D, Szelloe P, Weisser F, Zollinger
A, Seifert B, Pasch T
Institute of Anesthesiology, University Hospital, Zurich,
Switzerland.
[Medline record in process]
Although the mechanism of tourniquet-induced hypertension
is still unclear, plasma norepinephrine concentrations continuously
increase in parallel to arterial blood pressure during tourniquet
inflation. Clonidine attenuates hyperadrenergic and hyperdynamic
responses. We investigated the effects of clonidine on prolonged
tourniquet inflation. Twenty-nine patients scheduled for
elective orthopedic surgery were randomly assigned to receive
IV clonidine (3 microg/kg; n = 14) or placebo (n = 15) before
tourniquet inflation of the lower limbs under general anesthesia
in a double-blinded manner. Arterial blood pressure, heart
rate, epinephrine, and norepinephrine plasma concentrations
were measured before tourniquet inflation, 60 min after
tourniquet inflation, just before tourniquet deflation,
and 20 min after tourniquet deflation. Mean arterial blood
pressure and norepinephrine plasma-concentrations were significantly
lower in the Clonidine group compared with Control after
60 min tourniquet inflation (P = 0.016; P = 0.006). Immediately
before deflation of the tourniquet, the difference for mean
arterial pressure between groups was even more pronounced
(P = 0.005). Twenty minutes after deflation mean arterial
blood pressure in the Control group was still increased
and significantly higher compared with the Clonidine group
(P = 0.002). In conclusion, preoperative IV clonidine blunts
hyperadrenergic and hyperdynamic responses resulting from
prolonged tourniquet inflation under general anesthesia
in ASA class I--II patients. IMPLICATIONS: Tourniquet inflation
is associated with a continuous increase in arterial blood
pressure and sympathetic outflow. This study shows that
IV clonidine effectively blunts increases of both arterial
blood pressure and plasma norepinephrine concentrations.
PMID: 11867385, UI: 21855800
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Anesth Analg 2002 Mar;94(3):604-8
Muscle relaxation does not alter hypnotic level during
propofol anesthesia.
Greif R, Greenwald S, Schweitzer E, Laciny S, Rajek A,
Caldwell JE, Sessler DI
Department of Anesthesiology and Intensive Care Medicine,
Donauspital-SMZO, Vienna, Austria.
[Medline record in process]
Electromyographic (EMG) activity can contaminate electroencephalographic
signals. Paralysis may therefore reduce the Bispectral Index
(BIS) by alleviating artifact from muscles lying near the
electrodes. Paralysis may also reduce signals from muscle
stretch receptors that normally contribute to arousal. We
therefore tested the hypothesis that nondepolarizing neuromuscular
block reduces BIS. Ten volunteers were anesthetized with
propofol at a target effect site concentration of 3.8 plus
minus 0.4 microg/mL. A mivacurium infusion was adjusted
to vary the first twitch (T1) in a train-of-four to 80%,
30%, 20%, 15%, 10%, 5%, or 2% of the prerelaxant intensity.
At each randomly assigned T1, we measured BIS and frontal-temporal
EMG intensity. BIS averaged 95 plus minus 4 before induction
of anesthesia, and decreased significantly to 40 plus minus
5 after propofol administration. However, there were no
significant differences at the designated block levels.
Frontal-temporal EMG intensity averaged 47 plus minus 3
dB before induction of anesthesia, and decreased significantly
to 27 plus minus 1 dB after propofol administration. However,
there were no significant differences at the designated
block levels. These data suggest that the BIS level and
EMG tone are unaltered by mivacurium administration during
propofol anesthesia. IMPLICATIONS: Neuromuscular block level
did not alter Bispectral Index (BIS) during propofol anesthesia,
either by reducing electromyographic artifact or by decreasing
afferent neuronal input. The BIS will thus comparably estimate
sedation in deeply unconscious patients who are paralyzed,
partially paralyzed, or unparalyzed.
PMID: 11867383, UI: 21855798
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Anesth Analg 2002 Mar;94(3):573-6
Pretreatment before succinylcholine for outpatient anesthesia?
Mencke T, Schreiber JU, Becker C, Bolte M, Fuchs-Buder
T
Department of Anesthesia and Critical Care Medicine, University
of the Saarland, Saar, Germany.
[Medline record in process]
IMPLICATIONS: This study demonstrated that pretreatment
of succinylcholine with rocuronium failed to decrease the
incidence or the severity of postoperative myalgia. However,
in most patients, pretreatment was associated with muscle
weakness before loss of consciousness. Thus, there is no
convincing evidence supporting routine pretreatment with
succinylcholine.
PMID: 11867378, UI: 21855793
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Anesth Analg 2002 Mar;94(3):569-72
Physostigmine does not antagonize sevoflurane anesthesia
assessed by bispectral index or enhances recovery.
Paraskeva A, Papilas K, Fassoulaki A, Melemeni A, Papadopoulos
G
Department of Anesthesiology, St Savas Hospital, Athens.
[Medline record in process]
In this double-blinded study, we investigated the effect
of physostigmine on sevoflurane anesthesia and recovery.
Forty female patients scheduled for breast biopsy were randomly
assigned to receive either physostigmine 2 mg IV or an equal
volume of normal saline after skin closure. Anesthesia was
induced and maintained with sevoflurane in oxygen. After
skin closure, a steady state of 0.6% inspired and end-tidal
sevoflurane concentration was obtained, heart rate, blood
pressure, and Bispectral index (BIS) baseline values were
recorded, and physostigmine or normal saline was administered.
Hemodynamics and BIS values were also recorded 5, 8, and
10 min after treatments. Anesthesia was discontinued, and
orientation, sedation, sitting ability, and "picking
up matches" scores were recorded immediately after
extubation and 15 and 30 min later. No differences were
found between the two groups in BIS (69, 70, 70, and 71
in the Physostigmine group versus 70, 74, 75, and 76 in
the Control group) or blood pressure. Only heart rate was
increased 8 min after physostigmine (P < 0.05 versus
the control). Scores assessing early recovery were similar
in the two groups at all time points. We conclude that physostigmine
does not change BIS or enhance recovery after sevoflurane
anesthesia. IMPLICATIONS: This double-blinded, randomized
study investigated the impact of physostigmine of BIS values
during 0.6% sevoflurane anesthesia as well as in the postoperative
recovery, when sevoflurane is administered as a sole anesthetic.
Physostigmine has no effect on BIS values or on the tests
assessing recovery.
PMID: 11867377, UI: 21855792
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Anesth Analg 2002 Mar;94(3):565-8
Selective spinal anesthesia versus desflurane anesthesia
in short duration outpatient gynecological laparoscopy:
a pharmacoeconomic comparison.
Lennox PH, Chilvers C, Vaghadia H
Department of Anesthesia, Vancouver General Hospital, University
of British Columbia, Vancouver, BC, Canada.
[Medline record in process]
We compared the cost and effectiveness of selective spinal
anesthesia (SSA) with a desflurane-based general anesthetic
(DES) for outpatient gynecological laparoscopy. A prospective
analysis was undertaken of 10 patients randomized to receive
SSA and compared with 10 patients randomized to receive
DES. The groups were well matched in their demographic characteristics.
The mean cost (in 2000 Canadian dollar values) of anesthesia
supplies, drugs, and nursing for the SSA group of $62.31
was less than that for the DES group of $92.31 (P < 0.01).
Recovery costs of both groups were similar. Time to administer
anesthesia and time spent in the postanesthetic care unit
were also similar. Postoperative analgesia was required
by 50% of the DES group but in no patient receiving SSA
(P < 0.01). SSA is a cost-effective alternative to DES
in these patients. IMPLICATIONS: Small-dose spinal anesthesia
is an effective alternative to a desflurane general anesthetic
in terms of cost and recovery profiles in ambulatory gynecological
laparoscopy.
PMID: 11867376, UI: 21855791
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Anesth Analg 2002 Mar;94(3):494-9
The effect of chin lift, jaw thrust, and continuous positive
airway pressure on the size of the glottic opening and on
stridor score in anesthetized, spontaneously breathing children.
Meier S, Geiduschek J, Paganoni R, Fuehrmeyer F, Reber
A
Department of Anaesthesia, University Children's Hospital
of Basel, Switzerland.
[Medline record in process]
Chin lift and jaw thrust are two common maneuvers used
to improve the patency of the upper airway during general
anesthesia. We investigated the effect of these maneuvers
combined with continuous positive airway pressure (CPAP)
on the size of glottic opening and on stridor score. Forty
children, aged 2--9 yr, premedicated with midazolam and
spontaneously breathing end-tidal 1% halothane and equal
parts of nitrous oxide and oxygen, were studied. A flexible
fiberoptic bronchoscope was placed via mask and one nostril
to the level of the junction of the soft palate and oropharynx.
Video recordings and simultaneous stridor scores were obtained
during six conditions: 1) chin unsupported, 2) manual chin
lift, 3) chin lift and CPAP 10 cm H(2)O, 4) repeat chin
unsupported, 5) manual jaw thrust, and 6) jaw thrust and
CPAP 10 cm H(2)O. Videos were analyzed to determine the
percentage of glottic opening (POGO) score. POGO score increased
(P < 0.05) in Conditions 2, 3, 5, and 6. With increasing
POGO score there was a decrease in stridor score (P <
0.05). IMPLICATIONS: Chin lift and jaw thrust maneuvers
combined with continuous positive airway pressure improve
the view of the glottic opening as viewed by flexible nasal
laryngoscopy and decrease stridor in anesthetized, spontaneously
breathing children.
PMID: 11867364, UI: 21855779
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Anesthesiology 2002 Mar;96(3):769-70
Clinical and experimental research in anesthesiology in
europe at the change of the millennium.
Maleck WH, Boldt J
[Medline record in process]
PMID: 11873059, UI: 21861203
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Anesthesiology 2002 Mar;96(3):699-704
The Diverse Actions of Volatile and Gaseous Anesthetics
on Human-cloned 5-Hydroxytryptamine3 Receptors Expressed
in Xenopus Oocytes.
Suzuki T, Koyama H, Sugimoto M, Uchida I, Mashimo T
Department of Anesthesiology, Osaka University Medical
School, Osaka, Japan.
[Medline record in process]
BACKGROUND: General anesthetics can modulate the 5-hydroxytryptamine
type 3 (5-HT3) receptor, which may be involved in processes
mediating nausea and vomiting, and peripheral nociception.
The effects of the new volatile anesthetic sevoflurane and
the gaseous anesthetics nitrous oxide (N2O) and xenon (Xe)
on the 5-HT3 receptor have not been well-characterized.
METHODS: Homomeric human-cloned 5-HT3A receptors were expressed
in Xenopus oocytes. The effects of halothane, isoflurane,
sevoflurane, N2O, and Xe on 5-HT-induced currents were studied
using a two-electrode, voltage clamping technique. RESULTS:
Halothane (1%) and isoflurane (1%) potentiated 1 mum 5-HT-induced
currents to 182 +/- 12 and 117 +/- 2%, respectively. In
contrast, sevoflurane (1%), N2O (70%), and Xe (70%) inhibited
5-HT-induced currents to 76 +/- 1, 77 +/- 4, and 34 +/-
4%, respectively. The inhibitory effects were noncompetitive
for sevoflurane and competitive for N2O and Xe. None of
these inhibitory effects showed voltage dependency. CONCLUSION:
Inhalational general anesthetics produce diverse effects
on the 5-HT3 receptor. Both halothane and isoflurane enhanced
5-HT3 receptor function in a concentration-dependent manner,
which is consistent with previous studies. Sevoflurane inhibited
the 5-HT3 receptor noncompetitively, whereas N2O and Xe
inhibited the 5-HT3 receptor competitively, suggesting the
inhibitory mechanism of sevoflurane might be different from
those of N2O and Xe.
PMID: 11873047, UI: 21861191
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Anesthesiology 2002 Mar;96(3):681-7
Extracellular Magnesium Ion Modifies the Actions of Volatile
Anesthetics in Area CA1 of Rat Hippocampus In Vitro.
Sasaki R, Hirota K, Roth SH, Yamazaki M
Department of Anesthesiology, Toyama Medical and Pharmaceutical
University School of Medicine, Toyama, Japan.
[Medline record in process]
BACKGROUND: Magnesium ion (Mg2+) is involved in important
processes as modulation of ion channels, receptors, neurotransmitter
release, and cell excitability in the central nervous system.
Although extracellular Mg2+ concentration ([Mg2+]o) can
be altered during general anesthesia, there has been no
evidence for [Mg2+]o-dependent modification of anesthetic
actions on neural excitability in central nervous system
preparations. The purpose of current study was to determine
whether the effects of volatile anesthetics are [Mg2+]o-dependent
in mammalian central nervous system. METHODS: Extracellular
electrophysiologic recordings from CA1 neurons in rat hippocampal
slices were used to investigate the effects of [Mg2+]o and
anesthetics on population spike amplitude and excitatory
postsynaptic potential slope. RESULTS: The depression of
population spike amplitudes and excitatory postsynaptic
potential slopes by volatile anesthetics were significantly
dependent on [Mg2+]o. The effects were attenuated in the
presence of a constant [Mg2+]o/extracellular Ca2+ concentration
ratio. However, neither N-methyl-d-aspartate receptor antagonists
nor a non-N-methyl-d-aspartate receptor antagonist altered
the [Mg2+]o-dependent anesthetic-induced depression of population
spikes. Volatile anesthetics produced minimal effects on
input-output (excitatory postsynaptic potential-population
spike) relations or the threshold for population spike generation.
The effects were not modified by changes in [Mg2+]o. In
addition, the population spike amplitudes, elicited via
antidromic (nonsynaptic) stimulation, were not influenced
by [Mg2+]o in the presence of volatile anesthetics. CONCLUSIONS:
These results provide support that alteration of [Mg2+]o
modifies the actions of volatile anesthetics on synaptic
transmission and that the effects could be, at least in
part, a result of presynaptic Ca2+ channel-related mechanisms.
PMID: 11873045, UI: 21861189
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Anesthesiology 2002 Mar;96(3):588-94
Implicit Memory for Words Played during Isoflurane- or
Propofol-based Anesthesia: The Lexical Decision Task.
Munte S, Schmidt M, Meyer M, Nager W, Lullwitz E, Munte
TF, Piepenbrock S
Department of Anaesthesia, Medical School of Hanover, Hanover,
Germany.
[Medline record in process]
BACKGROUND: Unconscious processing of words during general
anesthesia has been suggested after surgery with several
tests of implicit memory. Patients can neither recall those
words nor do they have explicit memories of other intraoperative
events. It is unclear to what degree information is processed
during general anesthesia and which tests are best suited
to detect implicit memory. In the current study, a lexical
decision paradigm not previously used to demonstrate implicit
memory during anesthesia was used. METHODS: Sixty patients
undergoing lumbar disc surgery were assigned to receive
isoflurane infusion- or propofol infusion-based anesthesia
combined with alfentanil infusions and a nitrous oxide-oxygen
mixture. A control group of 10 medical students listened
to tapes without receiving anesthesia. Two tapes, each containing
a list of 30 low-frequency German nouns repeated for 15
min, were prepared, with half of the patients listening
to tape A and the other half listening to tape B during
the operation. Exposure time was 15 min from the time of
skin incision onward. In the test phase, approximately 7
h later, words from lists A and B plus 60 nonwords were
presented in random order by a computer program. Subjects
were asked to indicate, by pressing one of two response
buttons, whether the spoken word was or was not a legal
German word (lexical decision). RESULTS: A recognition test
revealed chance recognition for words presented during anesthesia.
Lexical decision responses, however, were slightly faster
to primed (previously presented) words than to unprimed
(not previously presented) words when the entire group of
patients was tested, suggesting a small implicit memory
effect, which barely failed to reach the significance level.
When the two medication groups were tested separately, no
significant implicit memory effect could be ascertained
statistically. The effects of previous exposure were much
more pronounced in the control group. CONCLUSIONS: Balanced
anesthesia techniques with isoflurane or propofol lead to
only a minimal, statistically borderline implicit memory
effect in the lexical decision paradigm.
PMID: 11873032, UI: 21861176
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Anesthesiology 2002 Mar;96(3):565-75
Development and evaluation of a graphical anesthesia drug
display.
Department of Anesthesiology, School of Medicine, University
of Utah, Salt Lake City, Utah.
[Medline record in process]
BACKGROUND: Usable real-time displays of intravenous anesthetic
concentrations and effects could significantly enhance intraoperative
clinical decision-making. Pharmacokinetic models are available
to estimate past, present, and future drug effect-site concentrations,
and pharmacodynamic models are available to predict the
drug's associated physiologic effects. METHODS: An interdisciplinary
research team (bioengineering, architecture, anesthesiology,
computer engineering, and cognitive psychology) developed
a graphic display that presents the real-time effect-site
concentrations, normalized to the drugs' EC95, of intravenous
drugs. Graphical metaphors were created to show the drugs'
pharmacodynamics. To evaluate the effect of the display
on the management of total intravenous anesthesia, 15 anesthesiologists
participated in a computer-based simulation study. The participants
cared for patients during two experimental conditions: with
and without the drug display. RESULTS: With the drug display,
clinicians administered more bolus doses of remifentanil
during anesthesia maintenance. There was a significantly
lower variation in the predicted effect-site concentrations
for remifentanil and propofol, and effect-site concentrations
were maintained closer to the drugs' EC95. There was no
significant difference in the simulated patient heart rate
and blood pressure with respect to experimental condition.
The perceived performance for the participants was increased
with the drug display, whereas mental demand, effort, and
frustration level were reduced. In a postsimulation questionnaire,
participants rated the display to be a useful addition to
anesthesia monitoring. CONCLUSIONS: The drug display altered
simulated clinical practice. These results, which will inform
the next iteration of designs and evaluations, suggest promise
for this approach to drug data visualization.
PMID: 11873029, UI: 21861173
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Anesthesiology 2002 Mar;96(3):555-64
The Influence of Remifentanil on the Dynamic Relationship
between Sevoflurane and Surrogate Anesthetic Effect Measures
Derived from the EEG.
Olofsen E, Sleigh JW, Dahan A
Department of Anesthesiology, Leiden University Medical
Center, Leiden, The Netherlands.
[Medline record in process]
BACKGROUND: The authors modeled the influence of remifentanil
on the dynamics of sevoflurane using three parameters derived
from the electroencephalogram: 95% spectral edge frequency
(SEF), canonical univariate parameter (CUP), and Bispectral
Index (BIS). METHODS: Thirty-six patients with American
Society of Anesthesiologists physical status class I or
II were recruited, of which 12 received a target remifentanil
concentration of 0 ng/ml, eight 2 ng/ml, eight 4 ng/ml,
and another eight 8 ng/ml. Next (before surgery), several
step-wise changes in the end-tidal sevoflurane concentration
(FET,sevo) were performed. A data acquisition system simultaneously
recorded FET,sevo, the raw electroencephalogram, BIS, and
SEF. The authors used a combination of an effect compartment
and an inhibitory sigmoid EMAX model to describe the relation
between FET,sevo and BIS, SEF, and CUP. Model parameters
(t1/2ke0, EMAX, EMIN, C50, gamma, CUP weight factors) were
estimated using the population data analysis program NONMEM.
Significant remifentanil model parameter dependencies (P
< 0.01) were determined. RESULTS: Determined from SEF,
remifentanil had no effect on t1/2ke0 (1.91 +/- 0.26 min
[mean +/- standard error]) but caused an increase in C50
(baseline = 1.48 +/- 0.12%; 80% increase at 8 ng/ml) and
decrease in EMIN (baseline = 10.8 +/- 0.6 Hz; 80% reduction
at 8 ng/ml). Determined from CUP, remifentanil caused a
dose-dependent decrease in t1/2ke0 (baseline = 4.31 +/-
1.00 min; 60% decrease at 8 ng/ml), with no effect on C50
(baseline = 0.88 +/- 0.13%). Determined from BIS, remifentanil
caused a dose-dependent decrease in t1/2ke0 (baseline value
= 3.11 +/- 0.32 min; 40% decrease at 8 ng/ml), without affecting
C50 (baseline = 1.12 +/- 0.05%). Median R2 values of the
pooled data set were 0.815 for SEF, 0.933 for CUP (P <
0.01 vs. SEF), and 0.952 for BIS (P < 0.01 vs. SEF and
CUP). Addition of remifentanil increased the R2 values for
CUP only. CONCLUSIONS: Remifentanil accelerates sevoflurane
blood-brain equilibration without affecting its hypnotic
potency as determined from BIS and CUP. In terms of R2,
the authors' pharmacodynamic model describes the anesthetic-BIS
relation best.
PMID: 11873028, UI: 21861172
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Anesthesiology 2002 Mar;96(3):546-51
Cesarean Delivery: A Randomized Trial of Epidural Analgesia
versus Intravenous Meperidine Analgesia during Labor in
Nulliparous Women.
Departments of Anesthesiology and Pain Management and Obstetrics
and Gynecology, University of Texas Southwestern Medical
Center, Dallas, Texas.
[Medline record in process]
BACKGROUND: Controversy concerning increased cesarean births
as a result of epidural analgesia for relief of labor pain
has been attributed, in large part, to difficulties interpreting
published studies because of design flaws. In this study,
the authors compared epidural analgesia to intravenous meperidine
analgesia using patient-controlled devices during labor
to evaluate the effects of labor epidural analgesia, primarily
on the rate of cesarean deliveries while minimizing limitations
attributable to study design. METHODS: Four hundred fifty-nine
nulliparous women in spontaneous labor at term were randomly
assigned to receive either epidural analgesia or intravenous
meperidine analgesia. Epidural analgesia was initiated with
0.25% bupivacaine and was maintained with 0.0625% bupivacaine
and fentanyl 2 mug/ml at 6 ml/h with 5-ml bolus doses every
15 min as needed using a patient-controlled pump. Women
in the intravenous analgesia group received 50 mg meperidine
with 25 mg promethazine hydrochloride as an initial bolus,
followed by 15 mg meperidine every 10 min as needed, using
a patient-controlled pump. A written procedural manual that
prescribed the intrapartum obstetric management was followed
for each woman randomized in the study. RESULTS: A total
of 226 women were randomized to receive epidural analgesia,
and 233 women were randomized to receive intravenous meperidine
analgesia. Protocol violations occurred in 8% (38 of 459)
of women. There was no difference in the rate of cesarean
deliveries between the two analgesia groups (epidural analgesia,
7% [16 of 226; 95% confidence interval, 4-11%] vs. intravenous
meperidine analgesia, 9% [20 of 233; 95% confidence interval,
5-13%]; P = 0.61). Significantly more women randomized to
epidural analgesia had forceps deliveries compared with
those randomized to meperidine analgesia (12% [26 of 226]
vs. 3% [7 of 233]; P < 0.001). Women who received epidural
analgesia reported lower pain scores during labor and delivery
compared with women who received intravenous meperidine
analgesia. CONCLUSIONS: Epidural analgesia compared with
intravenous meperidine analgesia during labor does not increase
cesarean deliveries in nulliparous women.
PMID: 11873026, UI: 21861170
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Anesthesiology 2002 Mar;96(3):536-41
Lung Function under High Thoracic Segmental Epidural Anesthesia
with Ropivacaine or Bupivacaine in Patients with Severe
Obstructive Pulmonary Disease Undergoing Breast Surgery.
Abteilung fur Anasthesiologie und Intensivmedizin, Universitat
Essen, Essen, Germany.
[Medline record in process]
BACKGROUND: Because general anesthesia with tracheal intubation
can elicit life-threatening bronchospasm in patients with
bronchial hyperreactivity, epidural anesthesia is often
preferred. However, segmental high thoracic epidural anesthesia
(sTEA) causes pulmonary sympathetic and respiratory motor
blockade. Whether it can be safely used for chest wall surgery
as a primary anesthetic technique in patients with chronic
obstructive pulmonary disease or asthma is unclear. Furthermore,
ropivacaine supposedly evokes less motor blockade than bupivacaine
and might minimize side effects. To test the feasibility
of the technique and the hypotheses that (1) sTEA with ropivacaine
or bupivacaine does not change lung function and (2) there
is no difference between sTEA with ropivacaine or bupivacaine,
the authors studied 20 patients with severe chronic obstructive
pulmonary disease (forced expiratory volume in 1 s [FEV1]
= 52.1 +/- 17.3% of predicted [mean +/- SD]) or asthma who
were undergoing breast surgery. METHODS: In a double-blind,
randomized fashion, sTEA was performed with 6.6 +/- 0.5
ml of either ropivacaine, 0.75% (n = 10), or bupivacaine,
0.75% (n = 10). FEV1, vital capacity, FEV1 over vital capacity,
spread of analgesia (pin prick), hand and foot skin temperatures,
mean arterial pressure, heart rate, and local anesthetic
plasma concentrations were measured with patients in the
sitting and supine positions before and during sTEA. RESULTS:
Segmental high thoracic epidural anesthesia (segmental spread
C4-T8 [bupivacaine] and C5-T9 [ropivacaine]) significantly
decreased FEV1 from 1.22 +/- 0.54 l (supine) to 1.09 +/-
0.56 l (ropivacaine) and from 1.23 +/- 0.49 l to 1.12 +/-
0.46 l (bupivacaine). In contrast, FEV1 over vital capacity
increased from 64.6 +/- 13.5 to 68.2 +/- 14.5% (ropivacaine)
and from 62.8 +/- 12.4 to 66.5 +/- 13.6% (bupivacaine).
There was no difference between ropivacaine and bupivacaine.
Skin temperatures increased significantly, whereas arterial
pressure and heart rate significantly decreased indicating
widespread sympathetic blockade. All 20 patients tolerated
surgery well. CONCLUSIONS: Despite sympathetic blockade,
sTEA does not increase airway obstruction and evokes only
a small decrease in FEV1 as a sign of mild respiratory motor
blockade with no difference between ropivacaine and bupivacaine.
Therefore, sTEA can be used in patients with severe chronic
obstructive pulmonary disease and asthma undergoing chest
wall surgery as an alternative technique to general anesthesia.
PMID: 11873024, UI: 21861168
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Anesthesiology 2002 Mar;96(3):5A-6A
This month in anesthesiology.
Henkel G
[Medline record in process]
PMID: 11873020, UI: 21861164
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BMJ 2002 Feb 23;324(7335):481
Postoperative starvation after gastrointestinal surgery.
Anaesthetic technique during gastrointestinal surgery has
postoperative effects.
Fawcett WJ, Jewsbury WE
[Medline record in process]
Publication Types:
Letter
PMID: 11863002, UI: 21849353
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BMJ 2002 Feb 9;324(7333):365
Patient safety is more important than efficiency.
Zorab JS
Publication Types:
Comment
Letter
PMID: 11834578, UI: 21823354
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Br Dent J 2002 Feb 9;192(3):161-3
Effects of dental local anaesthetics in cardiac transplant
recipients.
Meechan JG, Parry G, Rattray DT, Thomason JM
Oral and Maxillofacial Surgery, Dental School, University
of Newcastle upon Tyne. j.g.meechan@ncl.ac.uk
[Medline record in process]
OBJECTIVE: To investigate the cardiovascular responses
of cardiac transplant recipients to dental local anaesthetic
solutions with and without epinephrine (adrenaline). MATERIALS
AND METHODS: A clinical study employing 30 patients (20
cardiac transplant recipients and ten healthy) awaiting
gingival or minor oral surgery under local anaesthesia receiving
either 4.4 ml lidocaine (lignocaine) with 1:80,000 epinephrine
or 4.4 ml 3% prilocaine with 0.031 U/ml felypressin. RESULTS:
Cardiac transplant patients experienced a significant tachycardia
10 minutes after injection of the epinephrine-containing
solution. No significant change in heart rate was detected
after the injection of an epinephrine-free solution. Blood
pressure was not affected. Periodontal surgery did not affect
the responses to the local anaesthetics in the transplant
recipients. CONCLUSIONS: The cardiovascular response to
dental local anaesthesia in cardiac transplant recipients
is governed by the solution injected.
PMID: 11863154, UI: 21851929
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Br Dent J 2002 Feb 9;192(3):129-31
The provision of general anaesthesia in dental practice,
an end which had to come?
Landes DP
Department of Public Health, County Durham and Darlington
Health Authority. david.landes@public-health.durham.ha.northy.nhs.uk
[Medline record in process]
31 December 2001 was the final day on which a general anaesthetic
could be given in a dental practice in UK. Henceforth all
dental treatment requiring a general anaesthetic will have
to take place in a hospital setting, which has immediate
access to critical care facilities. This will mark the end
of the association between dental practice and general anaesthesia
which dates back to the very first recorded clinical procedure
performed under general anaesthesia, when in 1844, Horace
Wells an American dentist, had a tooth removed by his assistant
using nitrous oxide in Hartford, Connecticut, USA.
PMID: 11863151, UI: 21851924
Br J Pharmacol 2002 Feb 4;135(4):876-882
Role of endothelin ET(A)- and ET(B)-receptors in haemodynamic
compensation following haemorrhage in anaesthetized rats.
Palacios B, Lim SL, Pang CC
Department of Pharmacology & Therapeutics, Faculty
of Medicine, The University of British Columbia, 2176 Health
Sciences Mall, Vancouver, B.C., Canada, V6T 1Z3.
[Record supplied by publisher]
This study examined the role of endothelin ET(A) and ET(B)
receptors on haemodynamic compensation following haemorrhage
(-17.5 ml kg(-1)) in thiobutabarbitone-anaesthetized rats.
Rats were divided into four groups (n=6 each): time-control,
haemorrhage-control, haemorrhage after treatment with FR
139317 (ET(A)-receptor antagonist), and haemorrhage after
treatment with BQ-788 (ET(B)-receptor antagonist). In the
time-control rats, there were no significant changes in
any haemodynamics for the duration of the experiments. Relative
to the time-control rats, rats given haemorrhage had reduced
mean arterial pressure (MAP), cardiac output (CO) and mean
circulatory filling pressure (MCFP), but increased systemic
vascular resistance (R(SV)). Venous resistance (R(V)) was
slightly (but insignificantly) reduced by haemorrhage. MAP,
however, gradually returned towards baseline (-17plus minus4
and -3plus minus2 mmHg at 10 and 60 min after haemorrhage,
respectively) as a result of a further increase in R(SV).
Pre-treatment with FR 139317 (i.v. 1 mg kg(-1), followed
by 1 mg kg(-1) h(-1)) accentuated haemorrhage-induced hypotension
through abolition of the increase in R(SV). FR 139317 did
not modify haemorrhage-induced changes in CO, MCFP and R(V).
Pre-treatment of BQ-788 (3 mg kg(-1)) did not affect MAP
or MCFP following haemorrhage; however, CO was lower, and
R(SV) as well as R(V) were higher relative to the readings
in the haemorrhaged-control rats. These results show that
following compensated haemorrhage, ET maintains arterial
resistance and blood pressure via the activation of ET(A)
but not ET(B) receptors.
PMID: 11861314
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Can J Anaesth 2002 Mar;49(3):312-4
Best evidence in anesthetic practice: Treatment: vasopressin
neither improves nor worsens survival from cardiac arrest.
Denault A, Beaulieu Y, Belisle S, Peachey G
Montreal, Quebec Hamilton, Ontario.
[Medline record in process]
PMID: 11861353, UI: 21849827
Can J Anaesth 2002 Mar;49(3):294-296
Survey of the members of the cardiovascular section of
the Canadian Anesthesiologists' Society on the use of perioperative
transesophageal echocardiography - a brief report : [Enquete
aupres des membres de la section cardio-vasculaire de la
Societe canadienne des anesthesiologistes sur l'usage de
l'echographie transosophagienne].
Lambert AS, Mazer CD, Duke PC
Departments of Anesthesia, St. Michael's Hospital, University
of Toronto, Toronto, Ontario. Winnipeg, Manitoba, Canada.
[Record supplied by publisher]
PURPOSE: Transesophageal echocardiography (TEE) is a useful
diagnostic and monitoring tool in the operating room. In
the United States, an increasing number of centres are training
anesthesiologists to preform intraoperative TEE. In Canada,
TEE has been slow to gain acceptance as an intraoperative
monitor and little information is available on its use by
the anesthesiologists across the country. METHODS: We surveyed
all members of the cardiovascular section of the Canadian
Anesthesiologists' Society, to find out how many perform
TEE, how they acquired their skills and how they use TEE
in their practice. RESULTS: The response rate was 48.4%.
Most respondents were Canadian-trained cardiac anesthesiologists
working in university centres. 91% of respondents stated
that their centres offer intraoperative TEE services. Of
those services, 35.1% were provided by anesthesiologists
only, 13% by cardiologists only, and 51.9% by both. 53.8%
of respondents have certification in intraoperative TEE
(NBE/SCA, ASE or Provincial College). 90% of respondents
use equipment that is less than five years old and multiplane
probes are used by almost everyone. There was strong support
for Canadian-based continuing medical education events in
perioperative TEE. CONCLUSION: TEE appears to be available
in most cardiac centres in Canada and anesthesiologists
are actively involved in providing intraoperative TEE services,
using state-of-the-art equipment. Many anesthesiologists
have formal training in TEE.
PMID: 11861349
Can J Anaesth 2002 Mar;49(3):287-293
Perioperative use of transesophageal echocardiography
by anesthesiologists: impact in noncardiac surgery and in
the intensive care unit : [L'utilisation perioperatoire
de l'echocardiographie transosophagienne par les anesthesiologistes
: les repercussions en chirurgie non cardiaque et a l'unite
des soins intensifs].
Department of Anesthesiology, Montreal Heart Institute
and the Departments of Anesthesiology and Medicine, Centre
Hospitalier de l'Universite de Montreal (CHUM), Hopital
Notre-Dame, Montreal, Quebec, Canada.
[Record supplied by publisher]
BACKGROUND: The American Society of Anesthesiologists (ASA)
has published practice guidelines for the use of perioperative
transesophageal echocardiography (TEE) but the role and
impact of TEE performed by anesthesiologists outside the
cardiac operating room (OR) is still poorly explored. We
report our experience in the use of TEE in the noncardiac
OR, the recovery room and in the intensive care unit (ICU)
in a university hospital, and analyze the impact of TEE
on clinical decision making. METHODS: Two hundred fourteen
patients were included and TEE indications were classified
prospectively according to the ASA guidelines. The examinations
and data sheets were reviewed by two anesthesiologists with
advanced training in TEE. For each examination, it was noted
if TEE altered the management according to five groups:
1) changing medical therapy; 2) changing surgical therapy;
3) confirmation of a diagnosis; 4) positioning of an intravascular
device; and 5) TEE used as a substitute to a pulmonary artery
catheter. RESULTS: Eighty-nine (37%), 67 (31%) and 58 (27%)
patients had category I, II and III indications. The impact
was more significant in category I where TEE altered therapy
60% of the time compared with 31% and 21% for categories
II and III (P < 0.001). The most frequent reason for
changing management was a modification in medical therapy
in 53 instances (45%). CONCLUSION: Our results confirm a
greater impact of TEE performed by anesthesiologists on
clinical management for category I compared to category
II and III indications in the noncardiac OR surgical setting
and in the ICU.
PMID: 11861348
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Can J Anaesth 2002 Mar;49(3):283-6
Ketamine anesthesia for pericardial window in a patient
with pericardial tamponade and severe COPD: [La ketamine
utilisee pour l'anesthesie d'une ponction pericardique chez
une patiente qui presente une tamponnade et une MPOC severe].
Aye T, Milne B
Department of Anesthesiology, Queen's University, Kingston,
Ontario, Canada.
[Medline record in process]
PURPOSE: To describe the use and concerns of ketamine anesthesia
for pericardial window in a patient with pericardial tamponade
and severe chronic obstructive pulmonary disease (COPD)
with CO(2) retention. Clinical features: A 73-yr-old woman
with long-standing COPD and cor pulmonale admitted with
pericardial effusion and tamponade had surgery for a pericardial
window receiving a total of ketamine 450 mg iv. Arterial
pCO(2) increased from 71.8 mmHg preoperatively to 96 mmHg
intraoperatively postdrainage of 1000 mL of effusion. Hemodynamic
stability and SpO(2) >93% were maintained. Intubation
was avoided and concerns of increased pulmonary vascular
resistance and potential for right ventricular failure in
an already compromised right ventricle were not observed
clinically. CONCLUSION: In this patient with pericardial
tamponade, COPD and CO(2) retention, the advantages of ketamine
included maintaining spontaneous ventilation, avoiding institution
and weaning of mechanical ventilation, bronchodilation and
relative preservation of the CO(2) response curve. Deleterious
effects on right ventricular afterload were not observed.
PMID: 11861347, UI: 21849821
Can J Anaesth 2002 Mar;49(3):262-269
Spinal anesthesia in 62 premature, former-premature or
young infants--technical aspects and pitfalls: [La rachianesthesie
chez 62 enfants prematures, anciens prematures ou jeunes
enfants - aspects techniques et pieges].
Shenkman Z, Hoppenstein D, Litmanowitz I, Shorer S, Gutermacher
M, Lazar L, Erez I, Jedeikin R, Freud E
Departments of Anesthesia and Critical Care Medicine, Neonatal
Intensive Care Unit, and Pediatric Surgery, Meir Hospital,
Kfar Saba, Israel, and the Sackler Faculty of Medicine,
Tel Aviv University, Tel Aviv, Israel.
[Record supplied by publisher]
PURPOSE: To highlight technical aspects and pitfalls of
spinal anesthesia (SA) in infants. METHODS: The medical
history and perioperative course of all infants who underwent
SA over a 28-month period were collected (retrospectively
in the first 20). RESULTS: Sixty-two infants underwent surgery
under SA. Fifty-five were premature and former-premature,
postconceptional age 43.3 plus minus 5.0 weeks, weight 3261
plus minus 1243 g. Of these, 21 had co-existing disease:
cerebral (six), cardiac (nine), pulmonary (11) and urological
(six). Hyperbaric tetracaine or bupivacaine 1 mg*kg(-1)
with adrenaline was administered. Four infants (three premature)
required N(2)O supplementation and three needed general
anesthesia. The supplementation rate was similar or lower
than in previous studies. Postoperatively, all seven were
shown to have lower limb motor and sensory blockade. Complications
in premature patients included intraoperative hypoxemia
(two), apnea (two) and bradycardia (one). Postoperative
complications included bradycardia (three), hypoxemia (one)
and apnea and hypoxemia (one). The postoperative complication
rate was similar to previous studies. CONCLUSION: Successful
SA in infants depends on close attention to preoperative
assessment, appropriate patient positioning during and after
lumbar puncture, drug dosing and intra- and postoperative
cardiorespiratory monitoring. A relatively high dose of
hyperbaric solution of tetracaine or bupivacaine with adrenaline
should be administered.
PMID: 11861344
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Can J Anaesth 2002 Mar;49(3):232-6
The inter-rater and intra-rater reliability of a new Canadian
oral examination format in anesthesia is fair to good: [La
fiabilite interexaminateurs et intra-examinateurs d'un nouveau
modele d'examen oral canadien en anesthesie est de moyenne
a bonne].
Kearney RA, Puchalski SA, Yang HY, Skakun EN
Departments of Anesthesia University of Alberta, Edmonton,
Alberta, and McMaster University, The Division of Studies
in Medical Education, Hamilton, Ontario, Canada.
[Medline record in process]
PURPOSE: In response to the Royal College's request to
improve the validity and reliability of oral examinations,
the Examination Board in anesthesia proposed a structured
oral examination format. Prior to its introduction, we studied
this format in two residency programs to determine reliability
of the examiners. METHODS: Twenty faculty and 26 residents
from two Canadian residency programs participated (Sites
A and B). Pairs of examiners scored five or six residents
examined consecutively on two standardized questions using
global rating scales with anchored performance criteria.
Residents' performances were scored independently during
the examination (Time 1) and later from a videotaped recording
(Time 2). Correlations between scores of the pairs of examiners
and between scores of each examiner were determined. RESULTS:
Correlations demonstrating inter-rater agreement between
examiners at Site A ranged from -.324 to.915 (mean.506)
at Time 1. At Time 2, correlations ranged from.64 to.887
(mean.791). At Site B correlations ranged from.279 to.989
(mean.707) at Time 1 and at Time 2 correlations ranged from
-.271 to.924 (mean.477). Correlations demonstrating intra-rater
agreement of examiners at Site A ranged from.054 to.983
(mean.723) and at Site B correlations ranged from -.055
to.974 (mean.662). Correlations >0.4 were seen in 80%
of the scores and >0.7 in 50% indicating fair to good
intra-rater and inter-rater reliability using this format.
CONCLUSIONS: Despite the limitations of our study our results
compare favourably with those previously reported in anesthesia.
We recommend the adoption of this format to the Royal College
of Physicians and Surgeons of Canada Examination Board.
PMID: 11861339, UI: 21849813
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Eur J Pharmacol 2002 Feb 15;437(1-2):79-84
DOI, a 5-HT(2) receptor agonist, induces renal vasodilation
via nitric oxide in anesthetized dogs.
Tian RX, Kimura S, Kondou N, Fujisawa Y, Zhou MS, Yoneyama
H, Kosaka H, Rahman M, Nishiyama A, Abe Y
Department of Pharmacology, Kagawa Medical University,
1750-1 Ikenobe, Miki-cho, Kita-gun, 761-0793, Kagawa, Japan
[Medline record in process]
We have previously reported that (plus minus)-1-(2.5-dimethoxy-4-iodophenyl)-2-aminopropane
(DOI), a 5-HT(2) receptor agonist, induced renal vasodilation
in anesthetized dogs. The present study was designed to
investigate whether DOI-induced renal vasodilation might
be mediated by increased nitric oxide (NO) release/production
in renal tissue. The experiments were performed in anesthetized
dogs. A 23-gauge needle was inserted into the left renal
artery for infusion of drug solutions. Renal blood flow
was measured with an electromagnetic flowmeter. The microdialysis
probes were implanted into the renal cortex to collect the
dialysate for measurement of guanosine 3prime prime or minute,5prime
prime or minute-cyclic monophosphate (cGMP) and nitrite/nitrate
(NO(2)/NO(3)) concentration. Intrarenal infusion of DOI
at a rate of 5 mug/kg/min resulted in a significant increase,
by 30plus minus4%, in renal blood flow, indicating renal
vasodilation. The renal interstitial concentrations of NO(2)/NO(3)
and cGMP also increased by 70plus minus6% and 60plus minus6%,
respectively. These changes induced by DOI were completely
abolished by the intrarenal pretreatment with N(w)-nitro-L-arginine
methyl ester (L-NAME, a NO synthase inhibitor, 100 mug/kg/min)
or sarpogrelate (100 mug/kg/min, a highly selective 5-HT(2)
receptor antagonist). DOI infusion increased urine volume
and urinary excretion of Na(+), which were also blocked
by L-NAME or sarpogrelate. These results suggest that DOI
caused renal vasodilation due to increased NO release/production
by stimulation of 5-HT(2) receptors in the kidney. The natriuretic
effect of DOI might also be related to increased intrarenal
NO production.
PMID: 11864643, UI: 21853226
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Obstet Gynecol 2002 Mar;99(3):409-18
Risk factors for difficult delivery in nulliparas with
epidural analgesia in second stage of labor.
Fraser WD, Cayer M, Soeder BM, Turcot L, Marcoux S
, Quebec, Canada
[Medline record in process]
OBJECTIVE:To identify risk factors for difficult delivery
among nulliparas in the second stage of labor with continuous
epidural analgesia, and to develop a multivariable model
that is predictive of difficult delivery.METHODS:The database
is derived from a multicenter randomized trial of delayed
pushing for nulliparous women under continuous infusion
epidural. Members of this cohort (n = 1862) were randomly
divided into two groups: a "Model Development"
and a "Model Validation" group. We used univariate
and multivariable techniques to assess associations between
anthropometric, sociodemographic, and obstetric variables
and difficult delivery.RESULTS:With the referent defined
as the category of lesser risk, the developed model showed
that the risk of difficult delivery was increased for women
with height less than 160 cm (odds ratio [OR] 2.1, 90% confidence
interval [CI] 1.2, 3.4), prepregnancy weight greater than
65 kg (OR 1.6, 90% CI 1.0, 2.6), age greater than or equal
to 35 years (OR 3.0, 90% CI 1.1, 8.1), and gestational age
greater than or equal to 41 weeks (OR 1.8, 90% CI 1.1, 2.8).
Induction of epidural analgesia late in labor (greater than
or equal to 6 cm) was associated with a higher risk of difficult
delivery than induction between 3 and 5 cm (OR 1.9, 90%
CI 1.3, 2.8). An interval of greater than or equal to 360
minutes between epidural induction and full dilatation increased
the risk of difficult delivery (OR 3.8, 90% CI 1.5, 9.5).
Fetal station above +2 at full dilatation and a posterior
fetal position were both strongly associated with difficult
delivery (OR 2.7, 90% CI 1.4, 5.0, and OR 11.2, 90% CI 4.9,
25.6, respectively). For the multivariable predictive model,
when the sensitivity was 57%, the specificity was 75%, and
the positive predictive value was 35%.CONCLUSION:Our observations
concerning maternal characteristics and obstetric variables
are consistent with previous observations with the exception
of time of induction of the epidural. The predictive model
may be useful in defining high-risk populations for subsequent
intervention studies designed to assess approaches to reduce
difficult delivery.
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.
