Ultimo Aggiornamento: 31 Dicembre 2002

45 citations found

Anaesthesia 2002 Mar;57(3):284-313

A new clinical sign during one-lung anaesthesia: fact or fiction?

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PMID: 11879226

Anaesthesia 2002 Mar;57(3):256-263

Evaluation in an anaesthetic simulator of a prototype of a new drug administration system designed to reduce error*

Merry AF, Webster CS, Weller J, Henderson S, Robinson B

Clinical Associate Professor, and Research Fellow, Department of Anaesthesia, Green Lane Hospital, Private Bag 92189, Auckland 1130, New Zealand Department of Pharmacology, School of Medicine, University of Auckland, Auckland, New Zealand Specialist Anaesthetist, Director, Department of Anaesthesia, and Director, National Human-Patient Simulation Centre, Wellington Hospital, Wellington, New Zealand.

[Record supplied by publisher]

Ten anaesthetists were observed while providing anaesthesia for two simulated surgical procedures, twice using conventional methods and twice using a prototype of a new drug administration system designed to reduce error. Aspects of each method were rated by users on 10-cm visual analogue scales (10 being best) and comments were invited. Median safety scores were 7.7 cm (range 4.3--8.9) for the new system and 4.6 cm (1.3--8.2) for conventional methods (p = 0.009). The new system was compared favourably with conventional methods in respect of safety (p = 0.005), clinical acceptability (p = 0.008), organisation and layout (p = 0.047), and acceptability for use on patients (p = 0.005). The new system saved time in the preparation of drugs both before anaesthesia (105 vs. 346 s; p < 0.001) and during anaesthesia (20 vs. 104 s; p < 0.001). Comments facilitated development of the system and the evaluation endorsed proceeding to a clinical trial.

PMID: 11879216

Anaesthesia 2002 Mar;57(3):212-217

Remifentanil-sevoflurane anaesthesia for laparoscopic cholecystectomy: comparison of three dose regimens.

van Delden PG, Houweling PL, Bencini AF, Ephraim EP, Frietman RC, van Niekerk J, van Stolk MA, Verheijen R, Wajer OJ, Mulder PG

Gelre ziekenhuisen Apeldoorn Diakonessenhuis Utrecht Martini ziekenhuis Groningen Ziekenhuis de Heel Zaandam Atrium Heerlen Bosch Medicentrum's Hertogenbosch St Franciscus Gasthuis Rotterdam Medisch Spectrum Twente Enschede Ziekenhuis Rivierenland Tiel 0 Erasmus University Rotterdam, Department of Epidemiology and Biostatistics, the Netherlands.

[Record supplied by publisher]

The objective of this study was to determine a dosing regimen for remifentanil-sevoflurane anaesthesia that achieves an optimal balance between quality of anaesthesia and time to recovery. Patients undergoing elective laparoscopic cholecystectomy were randomly allocated to receive 0.4, 0.8 or 1.2 MAC (minimal alveolar concentration) of sevoflurane combined with remifentanil as required to maintain stable anaesthesia. For induction of anaesthesia, the remifentanil dose was 25 &mgr;g.kgminus sign1.hminus sign1 and the mean propofol dose which was required to obtain loss of consciousness was 1.59 mg.kgminus sign1. During the maintenance phase, the mean remifentanil dose was 16.0, 14.1 and 13.0 &mgr;g.kgminus sign1.hminus sign1 for the 0.4, 0.8 and 1.2 MAC groups, respectively. The mean sevoflurane maintenance dose was 0.91, 1.24 and 2.1% end-tidal for the 0.4, 0.8 and 1.2 MAC groups, respectively. The incidence of somatic responses was significantly higher in the 0.4 MAC sevoflurane group. Recovery times were significantly faster in the 0.4 compared to the 0.8 and 1.2blankMAC groups and in the 0.8 compared to the 1.2 MAC group. The combination of 14 &mgr;g.kgminus sign1. hminus sign1 remifentanil and 1.24% end-tidal sevoflurane achieved the optimal balance between the quality, and recovery from anaesthesia.

PMID: 11879208

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Br J Anaesth 2002 Feb;88(2):303-4

Blood pressure manipulation during loco-regional anaesthetic carotid surgery.

Imray CH, Mead MK, Thacker AJ, Dimitri WR

[Medline record in process]

Publication Types:

• Letter

PMID: 11883391, UI: 21867456

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Br J Anaesth 2002 Feb;88(2):255-63

Differential effects of intravenous anaesthetic agents on the response of rat mesenteric microcirculation in vivo after haemorrhage.

Brookes ZL, Brown NJ, Reilly CS

Division of Clinical Sciences, University of Sheffield, Royal Hallamshire Hospital, UK.

[Medline record in process]

BACKGROUND: The differential effects of i.v. anaesthesia on the response of the mesenteric microcirculation after haemorrhage in vivo are previously unexplored. METHODS: Male Wistar rats (n=56) were anaesthetized intravenously either with propofol and fentanyl (propofol/fentanyl), ketamine or thiopental. A tracheostomy and carotid cannulation were performed and the mesentery surgically prepared for observation of the microcirculation using fluorescent in vivo microscopy. Animals were allocated to one of three groups: control, haemorrhage or haemorrhage re-infusion. RESULTS: After haemorrhage, the response of the microcirculation differed during propofol/fentanyl, ketamine and thiopental anaesthesia. During propofol/fentanyl anaesthesia there was constriction of arterioles (-16.7 (3.9)%), venules (-5.9 (1.7)) and capillaries (-16.3 (2.8)) (n=12). During ketamine and thiopental anaesthesia both constriction and dilation was observed. After haemorrhage and re-infusion, macromolecular leak occurred from venules during propofol/fentanyl and thiopental anaesthesia (P<0.05), but not during ketamine anaesthesia. CONCLUSION: In summary, i.v. anaesthetic agents differentially alter the response of the mesenteric microcirculation to haemorrhage.

PMID: 11883388, UI: 21867442

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Br J Anaesth 2002 Feb;88(2):175-83

Model-based administration of inhalation anaesthesia. 4. Applying the system model.

Lerou JG, Verheijen R, Booij LH

Institute for Anaesthesiology, University of Nijmegen, The Netherlands.

[Medline record in process]

BACKGROUND: We developed and tested a simple dosing strategy for rapid induction with isoflurane followed by maintenance under minimal-flow conditions, that is 0.5 litre min(-1) total fresh gas flow (FGF). An end-expired concentration was to be achieved within 5 min in a desired therapeutic window, that is 0.8-1.1 vol%, and to be maintained within it for at least 30 min. METHODS: With our new model we computed a three-stage regimen using one fixed vaporizer setting: 3 vol% isoflurane in a FGF of 3 and 1.5 litre min(-1), each for 3 min, and 0.5 litre min thereafter. The ratio of nitrous oxide:oxygen was, consecutively, 2:1, 2:1, and 2:3. We evaluated this scheme in 58 adult patients (body mass 74 (SD 13) kg), mostly during eye and ear, nose, and throat surgery. RESULTS: Measured oxygen (33-45 vol%) and nitrous oxide concentrations (66-50 vol%) evolved in accordance with those computed. In five patients with a median of body mass 92 kg (range 76-126 kg), inspired oxygen concentrations decreased to less than 30 vol%. End-expired isoflurane concentration entered the window after 2 min (range 1.0-5.67 min) and attained its maximum, that is 0.96 vol% (0.8-1.2 vol%), after 3.45 min (1.67-6.33 min). The mean end-expired concentration was in the desired window from 3-60 min and an average of 72% of individual measurements were within the window from 3-30 min. The scheme was adapted in six patients (excluded from analysis) because of hypotension. CONCLUSION: The regimen is easily remembered, reliable, and lends itself to alternative strategies, but must be guided by the monitoring of gas and vapour concentrations and haemodynamic variables.

PMID: 11883384, UI: 21867432

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Br J Anaesth 2002 Jan;88(1):38-45

Predictive performance of a physiological model for enflurane closed-circuit anaesthesia: effects of continuous cardiac output measurements and age-related solubility data.

Vermeulen PM, Kalkman CJ, Dirksen R, Knape JT, Moons KG, Borm GF

Division of Peri-operative Care, Anaesthesia and Pain Medicine, University Medical Centre Utrecht (UMCU), The Netherlands.

[Medline record in process]

BACKGROUND: The disposition of inhalation anaesthetics is governed by the factors described in the Fick principle. METHODS: We have recalibrated a previously validated physiological model for enflurane closed-circuit inhalation anaesthesia, using individual continuous cardiac output measurements as well as age-related enflurane solubility coefficients as inputs to the model. Two model versions using 'calculated' (Brody's formula) or 'measured' (thoracic electrical bioimpedance) cardiac output values, and two versions with 'standard' (fixed) or 'age-related' solubility coefficients were formulated. RESULTS: Data from 62 ophthalmic surgical patients were used to validate the predictive performance of the four model versions. The root mean squared errors (total error) and scatters (error variation) were similar with the extended model versions, but the group biases (systematic error component) were significantly less with the model versions that included age-related solubility compared with the versions using standard solubility coefficients (bias -0.76/-0.78% vs -3.44/-3.60%). CONCLUSION: The inclusion of age-related solubility coefficients but not of continuous cardiac output measurements improves the predictive performance of the physiological model for closed-circuit inhalation anaesthetic conditions in routine clinical practice.

PMID: 11883377, UI: 21873316

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Br J Anaesth 2002 Jan;88(1):24-37

Model-based administration of inhalation anaesthesia. 3. Validating the system model.

Lerou JG, Booij LH

Institute for Anaesthesiology, University of Nijmegen, The Netherlands.

[Medline record in process]

BACKGROUND: We quantified the predictive performance of our computer model of the administration of inhalation anaesthesia from a Datex-Ohmeda Modulus CD circle-absorber system. METHODS: In 50 patients, desflurane anaesthesia was maintained with a fresh-gas flow (FGF) of 0.5 litres min(-1) of both nitrous oxide and oxygen, preceded by fast (n=14) or slow (n=36) induction: FGF greater than total ventilation, Group F; FGF equal to 1.0 litres min(-1), Group S. The two versions of the model studied differed in the size of their inter-tissue diffusion, as 0 (version 1) and 3% (version 2) of the cardiac output was shifted from the viscera to adipose tissue. Model performance was judged by comparing measured and predicted gas concentrations in terms of three variables for each gas concentration in each patient: root mean squared error (rmse=total error), bias (mean predicted - measured) (systematic error), and scatter (error around bias). These variables were then averaged over all patients. These measures were calculated overall, and separately for each group and each stage (1 = induction or 2 = maintenance). RESULTS: Model predictions were in reasonable to very good agreement with clinically obtained data. Version 2 performed better than version 1. Differences between groups were not demonstrated. The model performed better for stage 2, but only for desflurane. In group S, results (mean (SD); as percentages of the measured values for nitrous oxide, oxygen and desflurane) in the order rmse, bias, and scatter were for end-tidal concentrations of nitrous oxide: 8 (4), 8 (5), 2 (1)%; oxygen: 11 (4), -10 (6), 2 (1.1)%; nitrogen: 0.9 (0.6), -0.8 (0.6), 0.2 (0.1) vol%; carbon dioxide: 1.8 (0.6), 1.8 (0.6), 0.2 (0.1) vol%; desflurane, stage 2: 8 (4), 4 (7), 4 (2)%, vs 15 (6), -10 (8), 9 (4)% for stage 1. CONCLUSION: Administration of inhalation anaesthesia can be based on version 2 of this model, but must be guided by active monitoring.

PMID: 11883376, UI: 21873315

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Br J Anaesth 2002 Jan;88(1):18-23

Effects of high inspired oxygen fraction during elective caesarean section under spinal anaesthesia on maternal and fetal oxygenation and lipid peroxidation.

Khaw KS, Wang CC, Ngan Kee WD, Pang CP, Rogers MS

Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, China.

[Medline record in process]

BACKGROUND: Oxygen supplementation is given routinely to parturients undergoing Caesarean section under regional anaesthesia. While the aim is to improve fetal oxygenation, inspiring a high oxygen fraction (FIO2) can also increase free radical activity and lipid peroxidation in both the mother and baby. In this prospective, randomized, double-blind study, we investigated the effect of high inspired oxygen fraction (FIO2) on maternal and fetal oxygenation and oxygen free radical activity in parturients having Caesarean section under spinal anaesthesia. METHODS: Forty-four healthy parturients were randomized to breathe either 21% (air group) or 60% oxygen (oxygen group) intraoperatively via a ventimask. Maternal arterial blood was collected at 5-min intervals from baseline until delivery, and umbilical arterial and venous blood was collected at delivery. We measured blood gases and the products of lipid peroxidation (8-isoprostane, malondialdehyde (MDA), hydroperoxide (OHP)) and purine metabolites. RESULTS: At delivery, the oxygen group had greater maternal arterial PO2 [mean 30.0 (SD 6.3) vs 14.2 (1.9) kPa; mean difference 15.8 kPa, 95% confidence interval 12.9-18.7 kPa, P<0.001] and greater umbilical venous PO2 [4.8 (1.0) vs 4.0 (1.4) kPa; mean difference 0.8 kPa, 95% confidence interval 0.0-1.5 kPa, P=0.04] compared with the air group. Maternal and umbilical plasma concentrations of lipid peroxides (8-isoprostane, MDA, OHP) were greater in the oxygen group than in the air group (P<0.05). CONCLUSIONS: We conclude that breathing high FIO2 modestly increased fetal oxygenation but caused a concomitant increase in oxygen free radical activity in both mother and fetus.

PMID: 11883375, UI: 21873314

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Br J Anaesth 2002 Jan;88(1):46-55

Fresh gas flow is not the only determinant of volatile agent consumption: a multi-centre study of low-flow anaesthesia.

Coetzee JF, Stewart LJ

Department of Anesthesiology, Faculty of Medicine, University of Stellenbosch, Tygerberg, South Africa.

[Medline record in process]

METHODS: Seven academic centres studied 302 patients, using desflurane, enflurane, halothane, or isoflurane using circle-systems and Drager Julian anaesthetic machines, with fresh gas flows (V(F)) of 3, 1, and 0.5 litre min(-1). Volatile agent partial pressures in the breathing system were recorded and agent consumptions measured by weighing. RESULTS: At these flows, desflurane consumption depended on V(F). In contrast, halothane consumption was not influenced by V(F). Isoflurane and enflurane showed differences in consumption between flows of 0.5 and 3 litre min(-1). Stepwise linear regression suggested that besides V(F), other factors influenced consumption of the more soluble agents (sex, age, weight, height, altitude, and temperature). The partial pressure ratios were independent of V(F) for desflurane (end-tidal to fresh gas=0.8), but the ratios of the more soluble agents varied with V(F) (end-tidal to fresh gas=0.3-0.7). CONCLUSIONS: At V(F) that involves significant re-breathing, consumption of soluble agents depends only partially on V(F). These results can be explained using Mapleson's hydraulic analogue model.

PMID: 11881883, UI: 21873317

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Br J Anaesth 2002 Jan;88(1):141-3

Recurrent neurological symptoms in a patient following repeat combined spinal and epidural anaesthesia.

Sakura S, Toyota K, Doi K, Saito Y

Department of Anesthesiology, Shimane Medical University, Izumo City, Japan.

[Medline record in process]

A healthy woman developed neurological symptoms after two consecutive Caesarean sections under combined spinal and epidural anaesthesia. Amethocaine was used for spinal anaesthesia and mepivacaine for epidural anaesthesia on both occasions, and a combination of fentanyl and bupivacaine was continuously infused for pain relief after the second. Her symptoms on both occasions were similar, including pain in the buttocks of 7-11 days duration and numbness in the sacral area of 5-6 months.

PMID: 11881871, UI: 21873332

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Br J Anaesth 2001 Oct;87(4):648

Renal dysfunction following anaesthesia and surgery.

Bolsin S, Orford N

[Medline record in process]

Publication Types:

• Letter

PMID: 11878743, UI: 21867531

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Br J Anaesth 2001 Oct;87(4):647-8

Assessment instruments used during anaesthetic simulation.

McGaghie W C, Issenberg S B, Gordon D L, Petrusa E R

[Medline record in process]

Publication Types:

• Letter

PMID: 11878742, UI: 21867530

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Br J Anaesth 2001 Oct;87(4):633-5

Comparison of patient-controlled epidural analgesia with and without night-time infusion following gastrectomy.

Komatsu H, Matsumoto S, Mitsuhata H

Department of Anesthesiology, Akita University School of Medicine, Japan.

[Medline record in process]

To assess the analgesic efficacy and side effects of a supplemental night-time infusion in patient-controlled epidural analgesia (PCEA) after gastrectomy, we carried out a randomized, double-blind study. The number of requests were lower (P<0.005) in the PCEA plus night-time infusion group than in the PCEA alone group during the postoperative nights. Patients who had a PCEA plus night-time continuous infusion, slept with fewer interruptions than those who had only the PCEA. VAS pain scores on coughing were significantly lower (P<0.05) in the PCEA plus infusion group than in the PCEA alone group during the night following postoperative day 1. In conclusion, a night-time infusion in PCEA following gastrectomy decreases the incidence of postoperative pain, provides a better sleep pattern, and reduces the degree of the pain associated with coughing during the night.

PMID: 11878737, UI: 21867525

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Br J Anaesth 2001 Oct;87(4):602-7

Viscosity and density of common anaesthetic gases: implications for flow measurements.

Habre W, Asztalos T, Sly P D, Petak F

Paediatric Anaesthesia Unit, Geneva Children's Hospital, Switzerland.

[Medline record in process]

Although viscosity (mu) is a crucial factor in measurements of flow with a pneumotachograph, and density (rho) also plays a role in the presence of turbulent flow, these material constants are not available for the volatile anaesthetic agents commonly administered in clinical practice. Thus, we determined experimentally mu and rho of pure volatile anaesthetic agents. Input impedance of a rigid-wall polyethylene tube (Zt) was measured when the tube was filled with various mixtures of carrier gases (air, 100% oxygen, 50% oxygen+50% nitrogen) to which different concentrations of volatile anaesthetic inhalation agents (halothane, isoflurane, sevoflurane, and desflurane) had been added. Mu and rho were calculated from real and imaginary portions of Zt, respectively, using the appropriate physical equations. Multiple linear regression was applied to estimate mu and rho of pure volatile agents. Viscosity values of pure volatile agents were markedly lower than those for oxygen or nitrogen. Clinically applied concentrations, however, did not markedly affect the viscosity of the gas mixture (maximum of 3.5% decrease in mu for 2 MAC desflurane). In contrast, all of the volatile agents significantly affected rho even at routinely used concentrations. Our results suggest that the composition of the carrier gas has a greater impact on viscosity than the amount and nature of the volatile anaesthetic agent whereas density is more influenced by volatile agent concentrations. Thus, the need for a correction factor in flow measurements with a pneumotachograph depends far more on the carrier gas than the concentration of volatile agent administered, although the latter may play a role in particular experimental or clinical settings.

PMID: 11878731, UI: 21867519

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Br J Anaesth 2001 Oct;87(4):584-7

Comparison of articaine and bupivacaine/lidocaine for single medial canthus peribulbar anaesthesia.

Allman K G, McFadyen J G, Armstrong J, Sturrock G D, Wilson I H

Department of Anaesthesia, Royal Devon and Exeter Hospital, Exeter, UK.

[Medline record in process]

In a single-centre, randomized, double-blind study, we compared the efficacy of 2% articaine with that of a mixture of 0.5% bupivacaine and 2% lidocaine for peribulbar anaesthesia in cataract surgery, using a single medial canthus injection technique. Eighty-two patients were allocated randomly to receive 7-9 ml of a mixture of 0.5% bupivacaine and 2% lidocaine or an equal volume of 2% articaine with 1:200,000 epinephrine. Hyaluronidase 30 iu ml(-1) was added to both solutions. The degree of akinesia was scored 1, 5 and 10 min after the block, at the end of surgery and at discharge from the day case unit. Primary outcome measures were the difference in ocular movement scores 5 min after block and the need for supplementary inferolateral injections. There was greater akinesia in the articaine group at 5 min (P=0.01). Ten patients (24%) in the articaine group and 21 patients (51%) in the bupivacaine/lidocaine group required a supplementary injection (P=0.02). The mean (SD) volume of local anaesthetic required to achieve adequate block for surgery was 9.7 (2.1) ml in the articaine group and 11.0 (2.2) ml in the bupivacaine/lidocaine group (P=0.01). There was a faster offset of akinesia after surgery in the articaine group (P=0.01). There were no differences between groups in the incidence of reported pain or of minor complications. In our study, 2% articaine with 1:200,000 epinephrine was safe and efficacious for single medial canthus peribulbar anaesthesia.

PMID: 11878728, UI: 21867516

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Br J Anaesth 2001 Oct;87(4):577-83

Effect of peri- and postoperative epidural anaesthesia on pain and gastrointestinal function after abdominal hysterectomy.

Jorgensen H, Fomsgaard J S, Dirks J, Wetterslev J, Andreasson B, Dahl J B

Department of Anaesthesiology and Intensive Care, Herlev University Hospital, Copenhagen County, Denmark.

[Medline record in process]

In a double blind study we have investigated the effects of epidural local anaesthesia (LA), when added to general anaesthesia (GA) and postoperative paracetamol and NSAID, on postoperative pain and gastrointestinal function in patients undergoing open hysterectomy. Sixty patients were randomized into three study groups: GA, and postoperative paracetamol and NSAID (GA, n=20); GA, paracetamol, NSAID, intraoperative epidural lidocaine and 24-h postoperative epidural saline (Saline, n=20); or GA, paracetamol, NSAID, intraoperative epidural lidocaine and 24-h postoperative epidural bupivacaine (Bupi, n=20). Patients were observed for 72 h postoperatively. Pain at rest, during cough, and mobilization, request for supplementary morphine, and time to first postoperative flatus, was reduced in patients receiving 24-h postoperative epidural anaesthesia, compared with the two other groups. However, these effects of epidural LA, were not sustained beyond the period of infusion, and no differences in PONV, time to first postoperative defecation, mobilization or time to discharge from hospital were observed between groups. A 24 h postoperative epidural infusion with bupivacaine, when added to postoperative paracetamol and NSAID, reduces pain and opioid requirements, but has only limited effects on gastrointestinal function and patient recovery.

PMID: 11878727, UI: 21867515

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Br J Anaesth 2001 Oct;87(4):559-63

Measuring the costs of inhaled anaesthetics.

Lockwood G G, White D C

Department of Anaesthesia, Imperial College School of Medicine, Hammersmith Hospital, London, UK.

[Medline record in process]

The cost of inhalation anaesthesia has received considerable study and is undoubtedly reduced by the use of low fresh gas flows. However, comparison between anaesthetics of the economies achievable has only been made by computer modelling. We have computed anaesthetic usage for MAC-equivalent anaesthesia with isoflurane, desflurane, and sevoflurane in closed and open breathing systems. We have compared these data with those derived during clinical anaesthesia administered using a computer-controlled closed system that measures anaesthetic usage and inspired concentrations. The inspired concentrations allow the usage that would have occurred in an open system to be calculated. Our computed predictions lie within the 95% confidence intervals of the measured data. Using prices current in our institution, sevoflurane and desflurane would cost approximately twice as much as isoflurane in open systems but only about 50% more than isoflurane in closed systems. Thus computer predictions have been validated by patient measurements and the cost saving achieved by reducing the fresh gas flow is greater with less soluble anaesthetics.

PMID: 11878724, UI: 21867512

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Br J Anaesth 2001 Oct;87(4):549-58

Anaphylaxis during anaesthesia. Results of a two-year survey in France.

Laxenaire M C, Mertes P M

Departement d'Anesthesie-reanimation, CHU de Nancy, Hjpital Central, France.

[Medline record in process]

Between January 1, 1997 and December 31, 1998, 467 patients were referred to one of the allergo-anaesthesia centres of the French GERAP (Groupe d'Etudes des Reactions Anaphylactoides Peranesthesiques) network and were diagnosed as having anaphylaxis during anaesthesia. Diagnosis was established on the basis of clinical history, skin tests and/or a specific IgE assay. The most frequent cause of anaphylaxis was a neuromuscular blocking agent (69.2%). Latex was less frequently incriminated (12.1%) than in previous reports. A significant difference was observed between the incidence of anaphylactic reactions observed with each neuromuscular blocking agent and the number of patients who received each drug during anaesthesia in France throughout the study period (P<0.0001). Succinylcholine and rocuronium were most frequently incriminated. Clinical reactions to neuromuscular blocking drugs were more severe than to latex. The diagnostic value of specific IgE assays was confirmed. These results are consistent with changes in the epidemiology of anaphylaxis related to anaesthesia and are an incentive for the further development of allergo-anaesthesia clinical networks.

PMID: 11878723, UI: 21867511

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Br J Anaesth 2001 Oct;87(4):533-6

Time to light the grey touchpaper! The challenge of anaesthesia in the elderly.

Severn A M

[Medline record in process]

Publication Types:

• Editorial

PMID: 11878720, UI: 21867508

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Br J Anaesth 2001 Dec;87(6):943

Asystole during anaesthetic induction with remifentanil and sevoflurane.

Kurdi O, Deleuze A, Marret E, Bonnet F

[Medline record in process]

Publication Types:

• Letter

PMID: 11878707, UI: 21867495

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Br J Anaesth 2001 Dec;87(6):935-6

Epidural analgesia in a child with sickle cell disease complicated by acute abdominal pain and priapism.

Labat F, Dubousset A M, Baujard C, Wasier A P, Benhamou D, Cucchiaro G

Departement d'Anesthesie et Reanimation, Centre Hospitalier Universitaire de Bicetre, Le Kremlin Bicetre, France.

[Medline record in process]

We describe a case of a 9-yr-old child with sickle cell disease complicated by abdominal vaso-occlusive crisis and priapism. Both complications were successfully treated with a combination of epidural local anesthetics and morphine.

PMID: 11878700, UI: 21867488

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Br J Anaesth 2001 Dec;87(6):866-9

No clinical evidence of acute opioid tolerance after remifentanil-based anaesthesia.

Cortinez L I, Brandes V, Munoz H R, Guerrero M E, Mur M

Hospital Clinico Universidad Catolica de Chile, Departamento de Anestesiologia, Santiago.

[Medline record in process]

We have prospectively assessed whether remifentanil-based anaesthesia is associated with clinically relevant acute opioid tolerance, expressed as greater postoperative pain scores or morphine consumption. Sixty patients undergoing elective gynaecological, non-laparoscopic, surgery were randomly assigned to receive remifentanil (group R, n=30) or sevoflurane (group S, n=30) based anaesthesia. Postoperative analgesia was provided with morphine through a patient-controlled infusion device. Mean (SD) remifentanil infusion rate in group R was 0.23 (0.10) microg kg(-1) min(-1) and mean inspired fraction of sevoflurane in group S was 1.75 (0.70)%. Mean (SD) cumulative morphine consumption during the first 24 postoperative hours was similar between groups: 28.0 (14.2) mg (group R) vs 28.6 (12.4) mg (group S). Pain scores, were also similar between groups during this period. These data do not support the development of acute opioid tolerance after remifentanil-based anaesthesia in this type of surgery.

PMID: 11878688, UI: 21867476

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Br J Anaesth 2001 Dec;87(6):855-9

Postoperative changes in visual evoked potentials and cognitive function tests following sevoflurane anaesthesia.

Iohom G, Collins I, Murphy D, Awad I, O'Connor G, McCarthy N, Shorten G

Department of Anaesthesia and Intensive Care Medicine, Cork University Hospital and National University of Ireland, Republic of Ireland.

[Medline record in process]

We tested the hypothesis that minor disturbance of the visual pathway persists following general anaesthesia even when clinical discharge criteria are met. To test this, we measured visual evoked potentials (VEPs) in 13 ASA I or II patients who did not receive any pre-anaesthetic medication and underwent sevoflurane anaesthesia. VEPs were recorded on four occasions, before anaesthesia and at 30, 60, and 90 min after emergence from anaesthesia. Patients completed visual analogue scales (VAS) for sedation and anxiety, a Trieger Dot Test (TDT) and a Digit Symbol Substitution Test (DSST) immediately before each VEP recording. These results were compared using Student's t-test. P<0.05 was considered significant. VEP latency was prolonged (P<0.001) and amplitude diminished (P<0.05) at 30, 60, and 90 min after emergence from anaesthesia, when VAS scores for sedation and anxiety, TDT, and DSST had returned to pre-anaesthetic levels.

PMID: 11878686, UI: 21867474

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Br J Anaesth 2001 Dec;87(6):813-5

Comparative mortality in anaesthesia.

Jones R S

[Medline record in process]

Publication Types:

• Editorial

PMID: 11878679, UI: 21867467

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Br J Anaesth 2001 Dec;87(6):811-3

Central noradrenergic neurones and the mechanism of general anaesthesia.

Hirota K, Kushikata T

[Medline record in process]

Publication Types:

• Editorial

PMID: 11878678, UI: 21867466

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Br J Anaesth 2002 Feb;88(2):307-8

Informed consent for regional anaesthesia.

Crowe S

[Medline record in process]

Publication Types:

• Letter

PMID: 11878673, UI: 21867461

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Br J Anaesth 2002 Feb;88(2):285-7

Effect of spinal anaesthesia on plasma concentrations of glutathione S-transferase.

Ray DC, Robbins AG, Howie AF, Beckett GJ, Drummond GB

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

[Medline record in process]

BACKGROUND: Plasma glutathione S-transferase (GST) concentration measurement is a sensitive and specific index of hepatocellular injury. GST concentration increases after anaesthesia with most volatile anaesthetic agents, but not after propofol. Such increases are thought to result from reduced liver blood flow. The effect on GST concentration of spinal (subarachnoid) anaesthesia, which might also reduce liver blood flow, is not known. METHODS: We studied the effects of spinal anaesthesia on GST concentrations measured by specific radioimmunoassay in 33 patients undergoing intermediate orthopaedic, general or gynaecological surgery. GST concentrations were measured before anaesthesia and 3, 6 and 24 h after induction of anaesthesia. Hypotension (systolic blood pressure <70% of pre-induction value) was rapidly corrected with i.v. ephedrine. RESULTS: Mean duration of surgery was 41 min (range 11-80). No increase in GST concentration was observed at any time, but at 24 h GST concentration was significantly reduced (P<0.05). One patient in whom hypotension was not treated developed a greatly increased GST concentration at 3 h. CONCLUSION: We found no association between spinal anaesthesia and disturbance of hepatocellular integrity when hypotension does not occur or is rapidly corrected.

PMID: 11878663, UI: 21867448

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Br J Anaesth 2002 Feb;88(2):280-3

Improvement of information gained from the pre-anaesthetic visit through a quality-assurance programme.

Ausset S, Bouaziz H, Brosseau M, Kinirons B, Benhamou D

Department d'Anesthesie Reanimation, Hjpital Antoine Beclere, Clamart, France.

[Medline record in process]

BACKGROUND: Pre-anaesthetic evaluation is a fundamental component of anaesthetic practice. The aims of the present study were to assess the quality of the preoperative anaesthetic information gathered and to observe the quality profile after the introduction of a standardized form. This occurred through a four-step quality assurance programme over a 4-yr period. METHODS: The proportion of cases in which a complete recording of data was collected at the preoperative assessment was evaluated by searching in each patient's medical record for what was considered to be the minimum information required to provide satisfactory perioperative care. Fifteen criteria were selected. The recovery profile for each indicator and a global quality index (GQI expressed in %) for each patient's record were collected. In phase 1, the existing situation was assessed. Next, a standardized pre-anaesthetic form (PAF 1) was designed and its implementation evaluated (Phase 2). Phase 3 was performed 16 months after implementation of PAF 1 to assess the long-term value. The form was revised (PAF 2) and its use evaluated again 6 months later (Phase 4). For each evaluation, the records of a 1-month period were examined. Overall 1129 medical records were audited. RESULTS: The GQI increased significantly from 62 to 88% with similar changes for both elective and emergency cases. The recovery profile was improved for most indicators. CONCLUSIONS: We conclude that the quality of information recorded from the pre-anaesthetic visit is improved by using a standardized form. This will hopefully help to improve patient outcome and facilitate computerization of the anaesthetic record.

PMID: 11878661, UI: 21867446

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Br J Anaesth 2002 Feb;88(2):184-7

Bispectral index monitoring during electroconvulsive therapy under propofol anaesthesia.

Gunawardane PO, Murphy PA, Sleigh JW

Department of Anaesthesia, Waikato Hospital, Hamilton, New Zealand.

[Medline record in process]

BACKGROUND: The accuracy of the bispectral index (BIS) as a monitor of consciousness has not been well studied in patients who have abnormal electroencephalograms (EEG). METHODS: We studied the changes in BIS, its subparameters, and spectral entropy of the EEG during 18 electroconvulsive treatments under propofol and succinylcholine anaesthesia. A single bifrontal EEG, and second subocular channel (for eye movement estimation) was recorded. RESULTS: The median (interquartile range) BIS value at re-awakening was only 57 (47-78)--thus more than a quarter of the patients woke at BIS values of less than 50. The changes in spectral entropy values were similar: 0.84 (0.68-0.99) at the start, 0.65 (0.42-0.88) at the point of loss-of-consciousness, 0.63 (0.47-0.79) during the seizures, and 0.58 (0.31-0.85) at awakening. CONCLUSIONS: Post-ictal slow-wave activity in the EEG (acting via the SynchFastSlow subparameter) may cause low BIS values that do not correspond to the patient's clinical level of consciousness. This may be important in the interpretation of the BIS in other groups of patients who have increased delta-band power in their EEG.

PMID: 11878652, UI: 21867433

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Br J Anaesth 2002 Feb;88(2):166-74

Can molecular similarity-activity models for intravenous general anaesthetics help explain their mechanism of action?

Sewell JC, Sear JW

Department of Biosciences, University of Hertfordshire, Hatfield, UK.

[Medline record in process]

BACKGROUND: The importance of molecular shape and electrostatic potential in determining the activities of 11 structurally-diverse i.v. general anaesthetics was investigated using computational chemistry techniques. METHODS: The free plasma anaesthetic concentrations that abolished the response to noxious stimulation were obtained from the literature. The similarities in the molecular shapes and electrostatic potentials of the agents to eltanolone (the most potent anaesthetic agent in the group) were calculated using Carbo indices, and correlated with in vivo potency. RESULTS: The best model obtained was based on the similarities of the anaesthetics to two eltanolone conformers (r2=0.820). This model correctly predicted the potencies of the R- and S-enantiomers of ketamine, but identified alphaxalone as an outlier. Exclusion of alphaxalone substantially improved the activity correlation (r2=0.972). A bench mark model based on octanol/water partition coefficients (r2=0.647) failed to predict the potency order of the ketamine enantiomers. CONCLUSIONS: The results demonstrate that a single activity model can be formulated for chiral and non-chiral i.v. anaesthetic agents using molecular similarity indices.

PMID: 11878651, UI: 21867431

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Br J Anaesth 2001 Nov;87(5):791-3

Unnecessary emergency caesarean section due to silent CTG during anaesthesia?

Immer-Bansi A, Immer F F, Henle S, Sporri S, Petersen-Felix S

Department of Anaesthesiology, University Hospital, Inselspital, Bern, Switzerland.

[Medline record in process]

We present a case of a probably unnecessary Caesarean section due to misinterpretation of the cardiotocography (CTG) trace during general anaesthesia. A 27-yr-old patient in her 30th week of an uneventful, normal first pregnancy presented with a deep venous thrombosis in the pelvic region. She was to undergo an emergency thrombectomy under general anaesthesia. During the operation, the CTG showed a lack of beat-to-beat heart rate variation (silent pattern CTG) with normal fetal heart rate. This silent CTG pattern was probably a result of the effect of general anaesthesia on the fetus. The CTG pattern was interpreted as indicating fetal distress, and an emergency Caesarean section was performed after the thrombectomy. The infant was apnoeic and had to be resuscitated and admitted to the neonatal intensive care unit. The pH at delivery was 7.23 and the baby was extubated 2 days later. Mother and child recovered without short-term sequelae. In the absence of alternative explanations, reduced fetal beat-to-beat variability with a normal baseline heart rate during general anaesthesia is probably normal.

PMID: 11878536, UI: 21867312

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Br J Anaesth 2001 Nov;87(5):787-90

The montgomery T-tube: anaesthetic problems and solutions.

Guha A, Mostafa S M, Kendall J B

Department of Anaesthesia, Royal Liverpool University Hospital, UK.

[Medline record in process]

The Montgomery T-tube is a device used as a combined tracheal stent and an airway after laryngotracheal surgery. The device is used mostly in specialist centres for head and neck surgery, and therefore, many anaesthetists may be unfamiliar with its use. The Montgomery T-tube presents the anaesthetist with challenges both during its surgical insertion when acute loss of the airway might occur and also during induction of anaesthesia in patients who have such a tube in situ. Anaesthetists who are unfamiliar with the tube may have to resort to ingenious ways of coping with the problems of a shared airway with a T-tube, which does not have a suitable adaptor for a standard catheter mount, as well as controlling and maintaining ventilation through the device. Safe management of such patients requires careful planning. We describe the anaesthetic management of two cases to illustrate the problems associated with Montgomery tubes.

PMID: 11878535, UI: 21867311

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Br J Anaesth 2001 Nov;87(5):781-3

Long-term consequences of repeated pentobarbital anaesthesia on choice reaction time performance in ageing rats.

Blokland A, Honig W, Jolles J

Faculty of Psychology, Maastricht Brain & Behaviour Institute, Maastricht University, The Netherlands.

[Medline record in process]

Recent studies have suggested that anaesthesia may be a factor in cognitive decline with age. We examined the effect of repeated (eight times) anaesthesia with pentobarbital on reaction time performance in rats in a longitudinal study. Treated rats had faster response times and made more premature responses than the control rats when they were older than 21 months. The results suggest that repeated anaesthesia during the lifespan can lead to an increase in impulsivity, as assessed by a choice reaction time test, during the later stages of life in the rat. These findings support the theory that repeated anaesthesia is a biological factor that affects cognitive ageing.

PMID: 11878533, UI: 21867309

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Br J Anaesth 2001 Nov;87(5):772-4

Randomized controlled study of colloid preload before spinal anaesthesia for caesarean section.

Ngan Kee W D, Khaw K S, Lee B B, Ng F F, Wong M M

Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin.

[Medline record in process]

We randomized women having elective Caesarean section to receive either no preload (control group, n=33) or 4% gelatin solution (Gelofusine) 15 ml kg(-1) (colloid group, n=35) i.v. before spinal anaesthesia. Intravenous metaraminol was titrated at 0.25-0.75 mg min(-1) to maintain systolic arterial pressure (SAP) in the target range 90-100% of baseline after the spinal injection. The control group required more vasopressor in the first 10 min [median 1.7 (range 0-2.9) mg vs 1.4 (0-2.8), P=0.02] at a greater maximum infusion rate [0.5 (0-0.75) vs 0.25 (0-0.5) mg min(-1), P=0.0005] and had a lower minimum SAP [90 (51-109) vs 101 (75-127) mm Hg, P=0.006] than the colloid group. Nausea was less frequent in the colloid group (6 vs 24%) but neonatal outcome was similar in the two groups. Colloid preload improved haemodynamic stability but did not affect neonatal outcome when arterial pressure was maintained with an infusion of metaraminol during spinal anaesthesia for Caesarean section.

PMID: 11878530, UI: 21867306

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Br J Anaesth 2001 Nov;87(5):748-54

Inhalation anaesthetics increase heart rate by decreasing cardiac vagal activity in dogs.

Picker O, Scheeren T W, Arndt J O

Department of Anaesthesiology, Heinrich-Heine-University, Dusseldorf, Germany.

[Medline record in process]

Inhalation anaesthetics decrease heart rate in isolated hearts but mostly increase heart rate in the intact organism, although most inhibit sympathetic drive. Differences in the degree of increase in heart rate between agents may be related to differences in their vagolytic action. To test this hypothesis, we studied the effects of halothane (H), isoflurane (I), enflurane (E), sevoflurane (S) and desflurane (D) [1-3 MAC (minimum alveolar concentration)] on heart rate and heart rate variability (HRV) as a measure of cardiac vagal activity in seven dogs. HRV was analysed in the time domain as the standard deviation of the RR interval (SDNN) and in the frequency domain as power in the high-frequency (HF, 0.15-0.5 Hz) and low-frequency (LF, 0.04-0.15 Hz) ranges. Heart rate increased with anaesthetic concentration and there were corresponding decreases in SDNN, HF power and LF power. Heart rate increased most with D (+40 beats min(-1)), least with H (+8 beats min(-1)) and to an intermediate extent with S, I and E. SDNN and HF power, as measures of vagal activity, changed in the opposite direction and decreased in the same order as heart rate increased. However, SDNN and HF power correlated significantly with heart rate [r=-0.81 (0.04) and -0.81 (0.03) respectively] and were independent of the anaesthetic and its concentration (P<0.05). Consistent with our hypothesis, these results suggest that differences between agents in the degree of increase in heart rate are explained by differences in their vagolytic action.

PMID: 11878527, UI: 21867303

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Br J Anaesth 2001 Nov;87(5):738-42

Spinal anaesthesia with 0.5% hyperbaric bupivacaine in elderly patients: effects of duration spent in the sitting position.

Veering B T, Immink-Speet T T, Burm A G, Stienstra R, van Kleef J W

Department of Anaesthesiology, Leiden University Medical Center, The Netherlands.

[Medline record in process]

Sixty patients, aged 65-84 yr, undergoing minor urological surgery under spinal anaesthesia remained sitting for 2 (group 1, n = 15), 5 (group 2, n = 15), 10 (group 3, n = 15), or 20 (group 4, n = 15) min after completion of the subarachnoid administration of 3 ml of a 0.5% hyperbaric bupivacaine solution. They were then placed in the supine position. Analgesia levels were assessed bilaterally using pinprick. Motor block was scored using a 12-point scale. Systolic and diastolic arterial pressures and heart rate were also recorded. Twenty minutes after the injection the upper analgesia levels were lower (P<0.05) in group 4 (median T9.0) than in the groups 1-3 (medians T6.6-T8.5). The highest obtained levels (medians T5.7-T8.0) did not differ between the groups, but occurred later (P<0.05) in group 4 (median 35 min) than in groups 1-3 (medians 19-24 min). There were no significant differences in the maximum degree of motor block or haemodynamic changes between the four study groups.

PMID: 11878525, UI: 21867301

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Br J Anaesth 2001 Nov;87(5):706-10

Effects of minor surgery and endotracheal intubation on postoperative breathing patterns in patients anaesthetized with isoflurane or sevoflurane.

Tanaka A, Isono S, Sato J, Nishino T

Department of Anaesthesiology, Chiba University School of Medicine, Japan.

[Medline record in process]

We studied the effects of minor surgery and endotracheal intubation on postoperative breathing patterns. We measured breathing patterns and laryngeal resistance during the periods immediately before intubation (preoperative) and immediately after extubation following minor surgery (postoperative) in eight patients anaesthetized with sevoflurane and eight patients anaesthetized with isoflurane, breathing spontaneously through a laryngeal mask airway at a constant end-tidal anaesthetic concentration (1.0 MAC). In both sevoflurane-anaesthetized and isoflurane-anaesthetized patients, expiratory time was reduced and inspiratory and expiratory laryngeal resistance increased after surgery. In sevoflurane-anaesthetized patients, occlusion pressure (P0.1) increased without changes in inspiratory time (T(I)). Occlusion pressure did not change and T(I) was greater in isoflurane-anaesthetized patients after surgery. Minor surgery may have a small but significant influence on breathing and increased laryngeal resistance following endotracheal intubation may modulate these changes. The difference in breathing pattern between sevoflurane and isoflurane may be a result of different responses of the central nervous system to different anaesthetics in the presence of increased laryngeal resistance.

PMID: 11878520, UI: 21867296

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J Neurosurg 2002 Mar;96(3):571-9

Total intravenous anesthesia for intraoperative monitoring of the motor pathways: an integral view combining clinical and experimental data.

Scheufler KM, Zentner J

Department of Neurosurgery, University of Freiburg, Germany. scheufle@nz11.ukl.uni-freiburg.de

[Medline record in process]

OBJECT: Monitoring of descending corticospinal pathways by using motor evoked potentials (MEPs) has proven to be useful in preventing permanent neurological deficits during cranial and spinal procedures. Difficulties in interpretation of intraoperative changes in potentials may largely be attributed to the effects of anesthesia. Development of suitable intravenous anesthesia protocols specifically tailored for MEP monitoring, including plasma level target-controlled infusion (TCI), requires precise knowledge of the specific neurophysiological properties of the various agents. METHODS: The effects of alfentanil, sufentanil, fentanyl, remifentanil, thiopental, midazolam, etomidate, ketamine, and propofol on neurogenic and myogenic MEPs were evaluated in an integral study combining clinical data obtained in 40 patients and experimental investigations conducted in 140 animals. The dose-dependent modulation of MEPs after electrical and magnetoelectrical stimulation of the motor cortex was recorded from peripheral muscles and the spinal cord. The results were as follows: opioids, propofol, and thiopental suppressed myogenic, but not neurogenic MEPs in a dose-dependent fashion; remifentanil exerted the least suppressive effects. Etomidate and midazolam did not suppress myogenic MEP, even at plasma concentrations sufficient for anesthesia. Ketamine induced moderate reduction of compound muscle action potential amplitudes only at high doses. Remifentanil and propofol administered via TCI systems allowed recording of myogenic potentials within a defined target plasma concentration range. CONCLUSIONS: Development of standardized total intravenous anesthesia/TCI protocols by using anesthetic agents such as propofol, remifentanil, ketamine, and midazolam, which have favorable pharmacokinetic and neurophysiological properties, will enhance the quality of intraoperative MEPs and promote the use of MEP monitoring as a useful tool to reduce surgery-related morbidity.

PMID: 11883843, UI: 21880732

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Lancet 2002 Feb 16;359(9306):630

New law on male circumcision in Sweden.

Hofvander Y

Publication Types:

• Letter

PMID: 11867150, UI: 21856915

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Paediatr Anaesth 2002 Feb;12(2):193-5

Epidural analgesia for patients undergoing hepatic portoenterostomy (Kasai procedure).

Seefelder C, Lillehei CW

Department of Anesthesia Children's Hospital, Boston, MA, USA, Department of Surgery Children's Hospital, Boston, MA, USA.

[Medline record in process]

PMID: 11882238, UI: 21877533

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Paediatr Anaesth 2002 Feb;12(2):176-80

Anaesthesia for phaeochromocytoma removal in a 5-year-old boy.

Matsota P, Avgerinopoulou-Vlahou A, Velegrakis D

Department of Anaesthesiology, Children's Hospital, 'P & A Kyriakou', Athens, Greece.

[Medline record in process]

We describe the case of a 5-year-old boy with phaeochromocytoma of the left adrenal gland, treated surgically by removal of the tumour under general anaesthesia. Phaeochromocytoma is a particularly rare tumour in children and surgical excision is the definitive treatment. We discuss the clinical and laboratory characteristics of the case, the diagnostic approach, the preoperative and intraoperative management and the postoperative course.

PMID: 11882232, UI: 21877527

Paediatr Anaesth 2002 Feb;12(2):146-150

A comparison of prilocaine and lidocaine for intravenous regional anaesthesia for forearm fracture reduction in children.

Davidson AJ, Eyres RL, Cole WG

Department of Anaesthesia, Royal Children's Hospital, Parkville, Victoria, Australia, Division of Orthopaedics, The Hospital for Sick Children, Toronto, Ontario, Canada.

[Record supplied by publisher]

Background: In this prospective blinded randomized study, we compared prilocaine and lidocaine for intravenous regional anaesthesia for forearm fracture reduction in children.Methods: Two hundred and seventy-nine children, aged 3--16 years, were enrolled and randomly assigned to receive 3 mgcenter dotkgminus sign1 of either prilocaine or lidocaine. The severity of fracture was classified according to the displacement of the radius (i.e., no radial fracture, angulated, partly displaced or completely displaced). Pain during the procedure was assessed as none, minimal, moderate or severe.Results: There was no significant difference between agents in the proportion of patients with a successful reduction (prilocaine 94%, lidocaine 92%). Compared with less severe fractures, successful reduction was less common in the completely displaced fractures (P < 0.001) but there was no significant difference in this category between anaesthetic agents (successful reduction: prilocaine, 84%; lidocaine, 78%). Analgesia was superior in the lidocaine group with more patients having no or minimal pain (prilocaine, 78%; lidocaine, 90%, P < 0.05).Conclusions: Both agents are effective for forearm fracture reduction in children with a high incidence of successful reductions, particularly in the minimally or nondisplaced fractures. Lidocaine provided superior analgesia.

PMID: 11882226

Paediatr Anaesth 2002 Feb;12(2):124-130

The introduction of a paediatric anaesthesia information leaflet: an audit of its impact on parental anxiety and satisfaction.

Bellew M, Atkinson KR, Dixon G, Yates A

Department of Clinical and Health Psychology, St James's University Hospital, Leeds, UK, Department of Clinical Effectiveness, St James's University Hospital, Leeds, UK, Division of Critical Care Services, St James's University Hospital, Leeds, UK, Department of Anaesthesia, St James's University Hospital, Leeds, UK.

[Record supplied by publisher]

Background: A paediatric anaesthesia information leaflet was produced to address preoperative parental anxiety and to facilitate informed parental consent.Methods: An audit was undertaken to assess the impact of introducing the leaflet. This addressed the information needs and expectations of parents of children undergoing anaesthesia, parental satisfaction with information provision and parental preoperative anxiety.Results: The audit revealed that parents expect to be provided with information, although not necessarily in written form. However, the majority who received the information leaflet concluded that verbal information alone would not have been sufficient. The information leaflet was found to be accessible, informative and useful and those who received it reported greater satisfaction with information provision than a control group. Many parents perceived that it resulted in lower levels of preoperative anxiety.Conclusions: A decision was therefore undertaken that routine use of the leaflet would continue on all of the paediatric surgical wards. However, the study also indicated that leaflets should not replace verbal communication with nursing and medical staff, who remain important sources of information.

PMID: 11882223

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Pediatr Dent 2002 Jan-Feb;24(1):69-71

Failure rates of restorative procedures following dental rehabilitation under general anesthesia.

Tate AR, Ng MW, Needleman HL, Acs G

George Washington University School of Medicine, Washington, DC, USA. atate@cnmc.org

[Medline record in process]

PURPOSE: The failure rates of restorative procedures for children undergoing dental rehabilitation under general anesthesia, performed by pediatric dental residents in advanced educational programs, were evaluated in order to determine treatment outcomes and best practices. METHODS: Retrospective review of 504 dental records of children receiving comprehensive dental treatment under general anesthesia at children's hospitals in Boston between 1990-1992 and in Washington, DC, between 1994-1998, were undertaken. Data regarding restoration outcomes were evaluated using chi square tests with correction for continuity. Only records of patients who returned for follow-up at least six months after their rehabilitations were evaluated. T-tests were performed on parametric data. RESULTS: Two-hundred and forty-one (48%) of the records were evaluated. Stainless steel crowns (SSCs) had significantly lower failure rates than amalgams (P<0.001, chi2=63). The highest failure rates were seen in composites (P<0.001, chi2=112) and composite strip crowns (P<0.001, chi2=121). CONCLUSIONS: SSCs are the most reliable restorations while composite restorations are the least durable. Failure of restorations appears to be related to follow-up length.

PMID: 11874065, UI: 21862760