Ultimo Aggiornamento: 31 Dicembre 2002

26 citations found

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Acta Anaesthesiol Scand 2002 Jan;46(1):30-6

The influence of anaesthesia and surgery on the circadian rhythm of melatonin.

Karkela J, Vakkuri O, Kaukinen S, Huang WQ, Pasanen M

Department of Anaesthesia and Intensive Care, Tampere University Hospital, Tampere, Department of Physiology, University of Oulu, Oulu, and UKK Institute for Health Promotion Research, Tampere, Finland.

[Medline record in process]

BACKGROUND: Operations are typically associated with sleep and other circadian rhythm disturbances. The present study was set up to evaluate the influence of spinal and general anaesthesia associated with knee surgery on the circadian rhythm of melatonin, which has sleep inducing properties. Previously this context has been studied only in some invasive operations and it might be that general anaesthesia induces more disturbances on circadian rhythm of melatonin than operations done with patients awake. METHODS: The circadian secretion pattern of melatonin was monitored during the pre- and postoperative evenings, nights and mornings to clarify possible anaesthesia/surgery-induced changes in the nocturnal secretion of melatonin and in the phase of the melatonin rhythm. The study included 20 patients scheduled for minor orthopaedic operations. The patients were randomised to receive either spinal or general anaesthesia. Melatonin was measured from evening and morning saliva samples radioimmunologically. The nocturnal urine before and after surgery was radioimmunologically examined for 6-hydroxymelatonin sulphate. RESULTS: Melatonin secretion evaluated from the saliva samples was significantly diminished during the first postoperative evening as compared with that during the preoperative evening (P<0.001). There was also a significant decline of 26% (P<0.05) in postoperative 6-hydroxymelatonin sulphate excretion. There was no significant difference in melatonin secretion between the spinal and general anaesthesia groups. CONCLUSION: Our findings suggest that anaesthesia in conjunction with surgery acutely disturbed the normal circadian rhythm of melatonin by delaying the onset of nocturnal melatonin secretion.

PMID: 11903069, UI: 21900151

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Acta Anaesthesiol Scand 2002 Jan;46(1):24-9

Effects of nicorandil on myocardial function and metabolism in the post-ischaemic reperfused heart with or without inhalation anaesthetics.

Furuya A, Kashimoto S, Kumazawa T

Department of Anaesthesiology, Yamanashi Medical University, Yamanashi, Japan.

[Medline record in process]

BACKGROUND: Nicorandil, which is an ATP-sensitive K channel opener, has been reported to protect the ischaemic myocardium. However, its interaction with inhalation anaesthetics on the ischaemic myocardium has not been well elucidated. So, we have investigated whether isoflurane or sevoflurane modify the effects of nicorandil on cardiac function and metabolism in the rat heart-lung preparation. METHODS: Animals were allocated to 4 groups as follows: Control group, no drug; Nic group, nicorandil; Nic+Iso group, nicorandil and isoflurane; Nic+Sev group, nicorandil and sevoflurane. Seven minutes after the start of perfusion, nicorandil was administered and 10 min after the start of perfusion, the heart was rendered globally ischaemic for 10 min, and then the heart was reperfused for 10 min. RESULTS: LVdP/dt max in the Nic group was higher than those in the other groups. Right atrial pressure in the Nic+Iso and Nic+Sev groups was significantly higher than in the Control and Nic groups. Myocardial ATP in the Nic group was higher than in the other groups. DHBA levels in the perfusate in the Nic and Nic+Iso groups were lower than those in the Control and Nic+Sev groups, but those in the Nic+Sev group were higher than those in the other groups. CONCLUSIONS: Nicorandil improved post-ischaemic cardiac function and preserved high-energy phosphates. However, these beneficial effects of nicorandil were abolished by the combination with isoflurane or sevoflurane. In addition, sevoflurane increased hydroxyl radical formation in the post-ischaemic reperfused heart.

PMID: 11903068, UI: 21900150

Anesth Analg 2002 Feb;94(2 Suppl):S1-378

Abstracts of the International Anesthesia Research Society 76th Clinical and Scientific Congress. San Diego, California, USA. March 16-20, 2002.

Publication Types:

• Congresses
• Overall

PMID: 11902161, UI: 21898831

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Anesth Analg 2002 Mar;94(3):764

Epidural catheter placement using electrical stimulation test.

Marchant W

Publication Types:

• Letter

PMID: 11867417, UI: 21855832

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Anesth Analg 2002 Mar;94(3):764-5

Intrapleural--another approach to sensory phrenic nerve block.

Cole AF

Publication Types:

• Letter

PMID: 11867416, UI: 21855831

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Anesth Analg 2002 Mar;94(3):762-3

Gastroesophageal reflux and aspiration of gastric contents.

Brock-Utne JG

Publication Types:

• Letter

PMID: 11867413, UI: 21855828

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Anesth Analg 2002 Mar;94(3):711-6; table of contents

The antinociceptive and histologic effect of sciatic nerve blocks with 5% butamben suspension in rats.

McCarthy RJ, Kerns JM, Nath HA, Shulman M, Ivankovich AD

Departments of Anesthesiology and Anatomy, Rush Medical College at Rush-Presbyterian-St. Luke's Medical Center, Chicago, Illinois 60611, USA. r-mccarthy@northwestern.edu

Butamben, a lipophilic local anesthetic of the ester class, produces a differential nerve block of long duration. Epidural and peripheral nerve blocks with butamben, formulated as a 5%--10% suspension, result in prolonged analgesia without significant motor blockade. We evaluated the effect of butamben sciatic nerve block on antinociception using the rat paw formalin test, as well as withdrawal latencies to thermal stimulation, and assessed histologic changes in the nerve. After right sciatic nerve block with butamben 5% or saline, responses to intradermal injection of 5% formalin were recorded in randomly selected groups of 6 animals each on days 1, 2, 5, 10, 21, and 28. In an additional group of 8 thermal challenges to both hind paws were recorded at 1, 2, 5, 7, 10, 14, 17, 21, and 28 days after right sciatic butamben 5% blocks. Butamben injection decreased the formalin-induced flinches on days 2, 5, 10, 21 and 28 and decreased thermal challenges on days 1 through 17. Histologic changes were minimal. This study demonstrates a prolonged antinociceptive effect from butamben nerve block to both formalin-induced nociception and heat hyperalgesia, without an effect on gross motor function or histologic morphology. IMPLICATIONS: Butamben 5% nerve blocks produced a prolonged antinociceptive effect to formalin-induced nociception and heat hyperalgesia, without significant motor effect or evidence of substantial histologic changes.

PMID: 11867403, UI: 21855818

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Anesth Analg 2002 Mar;94(3):706-10; table of contents

Ultrasound guidance for the psoas compartment block: an imaging study.

Kirchmair L, Entner T, Kapral S, Mitterschiffthaler G

Institute of Anatomy and Histology and Department of Neurology, Leopold-Franzens-University of Innsbruck, Innsbruck, Austria. lukas.kirchmair@chello.at

We conducted this study to develop an ultrasound-guided approach to the psoas compartment and to assess its feasibility and accuracy by means of computed tomography (CT). Two examiners performed ultrasound-guided approaches at three levels (L2-3, L3-4, and L4-5) on 10 embalmed cadavers, which were seated prone. After each needle had been advanced into the psoas compartment under ultrasound guidance, the positions of their tips were computed by using two coordinates (A and B). Subsequently, axial transverse CT scans were made to verify the ultrasound measurements by using the same coordinates. In total, 48 approaches were performed (Examiner 1, n = 20; Examiner 2, n = 28). CT revealed that 47 of 48 ultrasound-guided approaches were performed exactly. In 1 of 48 approaches (L3-4), the tip of the needle was located posterior to the psoas muscle. The median differences between ultrasound and CT coordinates were 0.3 plus minus 0.3 cm for A and 0.2 plus minus 0.3 for B. Kendall's coefficient of concordance was 0.9 (P < 0.001) between ultrasound and CT measurements for both coordinates. These results indicate that ultrasound enables exact needle placement, as proved by CT. We conclude that ultrasound guidance might be a useful adjunct to increase the safety and efficacy of the psoas compartment block at these levels. IMPLICATIONS: We developed an ultrasound-guided approach to the psoas compartment at the levels L2-3, L3-4, and L4-5. Feasibility and accuracy were tested on embalmed cadavers and verified by means of computed tomography. Ultrasound guidance proved to be feasible and accurate for the performance of psoas compartment blocks.

PMID: 11867402, UI: 21855817

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Anesth Analg 2002 Mar;94(3):680-5; table of contents

Spinal ropivacaine for cesarean delivery: a comparison of hyperbaric and plain solutions.

Khaw KS, Ngan Kee WD, Wong M, Ng F, Lee A

Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Shatin, Hong Kong, China. KimKhaw@cuhk.edu.hk

We compared, in this prospective, randomized, double-blinded study, the characteristics of spinal anesthesia with plain and hyperbaric ropivacaine for elective cesarean delivery. We hypothesized that the addition of glucose would change the onset, offset, and extent of motor and sensory block from intrathecal ropivacaine. Forty ASA physical status I--II women were given 25 mg of either ropivacaine (n = 20) or ropivacaine in 8.3% glucose (n = 20) intrathecally, via a combined spinal/epidural technique in the right lateral position. Sensory changes to ice and pinprick and motor block (Bromage score) were recorded at 2.5-min intervals. Adequate anesthesia for surgery was achieved in all patients in the Hyperbaric group, whereas in the Plain group, five (25%) patients required epidural top-up because of insufficient rostral spread (P < 0.05). With hyperbaric ropivacaine, we found the following: higher cephalic spread (median [range] maximum block height to pinprick, T1 [T4 to C2] versus T3 [T11 to C3], P < 0.001); lower coefficient of variation of maximum block height (17.7% vs 21.9%); faster onset to T4 dermatome (mean [SD] 7.7 [4.9] vs 16.4 [14.1] min, P = 0.015); and faster recovery to L1 (189.0 [29.6] vs 215.5 [27.0] min, P = 0.01). The onset of complete motor block (9.9 [5.3] vs 13.8 [5.4] min, P = 0.027) and complete recovery (144.8 [28.4] vs 218.5 [56.8] min, P < 0.001) was also faster. No neurologic symptoms were found at 24 h. IMPLICATIONS: We compared hyperbaric and plain ropivacaine for combined spinal/epidural analgesia in the lateral position in patients undergoing elective cesarean delivery. Hyperbaric ropivacaine produced more rapid block with faster recovery and less requirement for epidural supplementation compared with plain ropivacaine.

Publication Types:

• Clinical trial
• Randomized controlled trial

PMID: 11867397, UI: 21855812

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Anesth Analg 2002 Mar;94(3):674-9; table of contents

The primary action of epidural fentanyl after cesarean delivery is via a spinal mechanism.

Cohen S, Pantuck CB, Amar D, Burley E, Pantuck EJ

Department of Anesthesiology, UMDNJ-Robert Wood Johnson Medical School, New Brunswick, New Jersey 08903, USA. cohensh@umdnj.edu

We tested the hypotheses that the primary mechanism of action of epidural fentanyl after cesarean delivery is spinal and that very small dose epidural bupivacaine with epinephrine enhances this effect. After elective cesarean delivery, 100 parturients were randomized in a double-blinded design to four groups. Group I and II patients received a continuous 12 mL/h epidural infusion of bupivacaine 0.015% with epinephrine 1 microg/mL for 48 h and Groups III and IV received a 12 mL/h saline epidural infusion instead. Fentanyl 20 microg/mL was administered via a patient-controlled analgesia device either into the epidural infusion (Groups I and IV) or IV (Groups II and III). When compared to patients receiving epidural fentanyl, those receiving IV fentanyl required larger mean infused and total dose of fentanyl (P < 0.0001), reported more pain (P < 0.001), and had a more frequent incidence of excessive sedation (P < 0.01), nausea (P < 0.01), and vomiting (P < 0.01). Plasma concentrations of fentanyl were larger for Group II and III than for Groups I and IV (P < 0.001) at 24 and 48 h. Our results support the hypothesis that the primary mechanism of analgesia of epidural fentanyl after cesarean delivery is spinal. Our data also show that the total required dose of epidural, but not IV, fentanyl is reduced by very small dose epidural bupivacaine and epinephrine (Group I versus Group IV, P < 0.02 and Group II vs Group III, not significant). IMPLICATIONS: Fentanyl administered epidurally to parturients after cesarean delivery has a primarily spinal mechanism of action and this effect is enhanced by very small dose epidural bupivacaine and epinephrine.

PMID: 11867396, UI: 21855811

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Anesth Analg 2002 Mar;94(3):560-4; table of contents

Fast-track eligibility of geriatric patients undergoing short urologic surgery procedures.

Fredman B, Sheffer O, Zohar E, Paruta I, Richter S, Jedeikin R, White PF

Departments of Anesthesiology and Intensive Care and Urology, Meir Hospital, Kfar Saba, Israel. bdfgls@netvision.net.il

Our primary objective was to assess the feasibility of geriatric patients (>65 yr) bypassing the postanesthesia care unit (PACU) after ambulatory surgery. A secondary objective was to compare recovery profiles when using three different maintenance anesthetics. Ninety ASA physical status I--III consenting outpatients (>65 yr) undergoing short urologic procedures were randomly assigned to one of three anesthetic treatment groups. After a standardized induction with fentanyl and propofol, anesthesia was maintained with propofol (75-150 microg center dot kg(-1) center dot min(-1) IV), isoflurane (0.7%-1.2% end tidal), or desflurane (3%-6% end tidal), in combination with nitrous oxide 70% in oxygen. In all three groups, the primary anesthetic was titrated to maintain an electroencephalographic-bispectral index value of 60-65. Recovery times, postanesthesia recovery scores, and therapeutic interventions in the PACU were recorded. Although emergence times were similar in the three groups, the time to achieve a fast-track discharge score of 14 was significantly shorter in patients receiving desflurane compared with propofol and isoflurane (22 +/- 23 vs 33 +/- 25 and 44 +/- 36 min, respectively). On arrival in the PACU, a significantly larger percentage of patients receiving desflurane were judged to be fast-track eligible compared with those receiving either isoflurane and propofol (73% vs 43% and 44%, respectively). The number of therapeutic interventions in the PACU was also significantly larger in the Isoflurane group when compared with the Propofol and Desflurane groups (21 vs 11 and 7, respectively). In conclusion, use of desflurane for maintenance of anesthesia should facilitate PACU bypass ("fast-tracking") of geriatric patients undergoing short urologic procedures. IMPLICATIONS: Geriatric outpatients undergoing brief urologic procedures more rapidly achieve fast-tracking discharge criteria after desflurane (versus isoflurane and propofol) anesthesia. Use of isoflurane was also associated with an increased need for nursing interventions in the early recovery period compared with desflurane and propofol.

Publication Types:

• Clinical trial
• Randomized controlled trial

PMID: 11867375, UI: 21855790

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Br Dent J 2001 Dec 22;191(12):686-8

Referrals to a secondary care dental clinic for anxious adult patients: implications for treatment.

McGoldrick P, Levitt J, de Jongh A, Mason A, Evans D

University of Dundee Dental School. p.m.mcgoldrick@dundee.ac.uk

OBJECTIVES: This study aimed to determine the methods suggested by general dental practitioners for management of patients with dental anxiety whom they refer to a dental hospital setting, the treatment modalities eventually used with such patients and the relationship between patients previous sedation experience and the current referral. METHODS: Consecutive referral letters (n = 125) for management of patients with dental anxiety over a 16 month period were analysed for content, including reason for referral and suggested treatment modalities. Patient records were also examined for previous sedation experience. RESULTS: From 115 referrals eligible for analysis, the dentists requested management of anxiety using pharmacological methods in 113 referrals with only two referrals mentioning psychologically-based treatments. In secondary care, 29% of the adult referrals opted for dental treatment using psychological techniques alone. CONCLUSIONS: In spite of the efficacy of psychological treatments for dental anxiety, primary and secondary care dentists appear not to be suggesting or promoting their use for patients with dental anxiety. Further research into the availablility of, and barriers to accessing the full range of services for those with dental anxiety, including patient perspectives, needs to be undertaken.

PMID: 11792115, UI: 21649612

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Br J Anaesth 2001 Nov;87(5):806

Perioperative bradycardia.

Wildsmith J A

Publication Types:

• Letter

PMID: 11878545, UI: 21867321

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Br J Anaesth 2001 Nov;87(5):803-4

Is it safe to artificially ventilate a paralysed patient through a laryngeal mask?

MacKillop A

Publication Types:

• Letter

PMID: 11878542, UI: 21867318

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Br J Anaesth 2001 Nov;87(5):784-7

Grand mal convulsion and plasma concentrations after intravascular injection of ropivacaine for axillary brachial plexus blockade.

Muller M, Litz R J, Huler M, Albrecht D M

Department of Anaesthesiology and Intensive Care Medicine, Carl Gustav Carus University Hospital, Dresden, Germany.

We report a patient to whom ropivacaine 1.1 mg kg(-1) was administered for brachial plexus blockade and who developed grand mal convulsions because of inadvertent i.v. injection. No symptoms of cardiovascular toxicity occurred. Venous blood samples were taken 15, 45, 75 and 155 min after the injection. The measured total plasma concentrations of ropivacaine were 3.3, 1.6, 1.2 and 1.0 mg litre(-1) respectively. Initial plasma concentration after the end of the injection period was estimated at 5.75 mg litre(-1) using a two-compartment pharmacokinetic model.

Publication Types:

• Review
• Review of reported cases

PMID: 11878534, UI: 21867310

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Br J Anaesth 2001 Nov;87(5):778-80

Effects of the auditory stimuli of an auditory evoked potential system on levels of consciousness, and on the bispectral index.

Absalom A R, Sutcliffe N, Kenny G N

University Department of Anaesthesia, Alexandra Parade, Glasgow Royal Infirmary, UK.

Investigators in the field of depth of anaesthesia monitoring sometimes measure the auditory evoked potential (AEP) and the Bispectral Index (BIS) concurrently. However, the auditory stimuli required to generate an AEP may increase the level of consciousness, and cause an increase in the BIS. They may also alter the BIS by producing phase-locked harmonics in the surface electroencephalogram. The aim of this study was to determine if AEP stimuli have clinically significant effects on levels of consciousness and BIS values during sedation and general anaesthesia. Ten healthy adult patients were studied by measuring and recording the BIS for 6 epochs of 5 min each. The first 3 epochs took place during steady-state sedation, during which time the Observer's Assessment of Awareness/Sedation (OAA/S) score was also measured. The second 3 epochs took place during steady-state anaesthesia. During alternate epochs, patients were subjected to the auditory stimuli generated by an AEP system. The auditory stimuli were not associated with a change in BIS values (during sedation and anaesthesia) or OAA/S scores (sedation).

PMID: 11878532, UI: 21867308

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Br J Anaesth 2001 Nov;87(5):743-7

Intrathecal ropivacaine for total hip arthroplasty: double-blind comparative study with isobaric 7.5 mg ml(-1) and 10 mg ml(-1) solutions.

McNamee D A, Parks L, McClelland A M, Scott S, Milligan K R, Ahlen K, Gustafsson U

Department of Anaesthetics and Intensive Care Medicine, The Queen's University of Belfast, UK.

This study was designed to evaluate the efficacy and safety of two concentrations of intrathecal ropivacaine, 7.5 and 10 mg ml(-1), in patients undergoing total hip arthroplasty. One hundred and four patients, ASA I-III, were randomized to receive an intrathecal injection of one of two concentrations of isobaric ropivacaine. Group 1 (n=51) received 2.5 ml of 7.5 mg ml(-1) ropivacaine (18.75 mg). Group 2 (n=53) received 2.5 ml of 10 mg ml(-1) ropivacaine (25 mg). The onset and offset of sensory block at dermatome level T10, maximum upper and lower spread of sensory block and the onset, intensity and duration of motor block were recorded, as were safety data. Onset of motor and sensory block was rapid with no significant differences between the two groups. The median time of onset of sensory block at the T10 dermatome was 2 min (range 1-25 min) in Group 1 and 2 min (range 1-21 min) in Group 2. The median duration of sensory block at the T10 dermatome was 3.0 h (range 0.5-4.2 h) in Group 1 and 3.4 h (1.1-5.9 h) in Group 2 (P=0.002). The median duration of complete motor block was significantly prolonged (P<0.05) in Group 2 compared with Group 1 (1.9 vs 1.2 h, respectively). Anaesthetic conditions were excellent in all but one patient. Intrathecal ropivacaine, in doses of 18.75 and 25 mg, was well tolerated and provided effective anaesthesia for total hip arthroplasty.

Publication Types:

• Clinical trial
• Randomized controlled trial

PMID: 11878526, UI: 21867302

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Br J Anaesth 2001 Nov;87(5):718-26

Comparative efficacy and safety of remifentanil and fentanyl in 'fast track' coronary artery bypass graft surgery: a randomized, double-blind study.

Mollhoff T, Herregods L, Moerman A, Blake D, MacAdams C, Demeyere R, Kirno K, Dybvik T, Shaikh S

Westfalische Wilhelms-Universitat, Munster, Germany.

This multi-centre, parallel group, randomized, double-blind study compared the efficacy and safety of high-dose remifentanil administered by continuous infusion with an intermittent bolus fentanyl regimen, when given in combination with propofol for general anaesthesia in 321 patients undergoing elective coronary artery bypass graft surgery. A significantly lower proportion of the patients who received remifentanil had responses to maximal sternal spread (the primary efficacy endpoint) compared with those who received fentanyl (11% vs 52%; P<0.001). More patients who received remifentanil responded to tracheal intubation compared with those who received fentanyl (24% vs 9%; P<0.001). However, fewer patients who received remifentanil responded to sternal skin incision (11% vs 36%; P<0.001) and sternotomy (14% vs 60%; P <0.001). Median time to extubation was longer in the subjects who received remifentanil than for those who received fentanyl (5.1 vs 4.2 h; P=0.006). There were no statistically significant differences between the two groups in the times for transfer from intensive care unit or hospital discharge but time to extubation was significantly longer in the remifentanil group. Overall, the incidence of adverse events was similar but greater in the remifentanil group with respect to shivering (P<0.049) and hypertension (P<0.001). Significantly more drug-related adverse events were reported in the remifentanil group (P=0.016). There were no drug-related adverse cardiac outcomes and no deaths from cardiac causes before hospital discharge in either treatment group.

Publication Types:

• Clinical trial
• Multicenter study
• Randomized controlled trial

PMID: 11878522, UI: 21867298

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Br J Anaesth 2001 Nov;87(5):711-7

Use of multi-plane transoesophageal echocardiography in visualization of the main hepatic veins and acquisition of Doppler sonography curves. Comparison with the transabdominal approach.

Meierhenric R, Gauss A, Georgieff M, Schutz W

Department of Anaesthesiology, University of Ulm, Germany.

The role of multi-plane transoesophageal echocardiography (TOE) in the visualization of the three main hepatic veins and acquisition of Doppler sonography curves has not been established. We have studied this diagnostic option of TOE in 34 patients during general anaesthesia. The findings were compared with the results of conventional transabdominal sonography (TAS). Using TOE, each of the three main hepatic veins could be visualized in all patients. In contrast, TAS allowed adequate two-dimensional visualization of the right, middle, and left hepatic vein in only 97%, 85%, and 61% of the patients, respectively. Adequate Doppler tracings of the right and middle hepatic vein could be obtained in 100% and 97% of the patients by TOE and in 91% and 50% of the patients by TAS. Doppler tracings of the left hepatic vein could only be acquired in 18% of the patients by TOE, but in 47% of the patients by TAS. As blood flow may be calculated from the diameter of the vessel, velocity time integral of the Doppler curve and heart rate, TOE may provide an interesting non-invasive tool to monitor blood flow in the right and middle hepatic vein.

Publication Types:

• Evaluation studies

PMID: 11878521, UI: 21867297

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Neurosci Lett 2002 Jan 25;318(2):85-8

Effect of electroacupuncture on the stress-induced changes in brain-derived neurotrophic factor expression in rat hippocampus.

Yun SJ, Park HJ, Yeom MJ, Hahm DH, Lee HJ, Lee EH

Graduate School of East-West Medical Science, Kyung Hee University, 1 Seochun, Yong-In 449-701, South Korea.

Stress induces neuronal atrophy and death especially in the hippocampus. Alterations in the expression of neurotrophic factors are implicated in stress-induced hippocampal degeneration. In the hippocampus, stress decreases brain-derived neurotrophic factor (BDNF) mRNA levels. In oriental medicine, acupuncture has long been employed as a treatment of numerous disorders. The objective of this study was to examine whether electroacupuncture (EA) stimulation can influence BDNF expression in the hippocampus of rats exposed to immobilization stress. Rats were immobilized in plastic bags, and then subjected to EA at ST36 Zusanli. After treatment, the animals were decapitated and the hippocampi were rapidly removed and processed for RNA isolation and reverse transcription. Real-time polymerase chain reaction analysis showed that EA stimulation significantly restored BDNF mRNA expression declined by immobilization stress. The results suggest that EA may relieve neuropathological effects of stress by modulating neurotrophic factor expression.

PMID: 11796192, UI: 21655591

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Paediatr Anaesth 2002 Mar;12(3):287

Does internal jugular vein cannulation in infants require a SMART needle rather than a smart anaesthetist?

Reich A, Booke M

Klinik und Poliklinik fr Ansthesiologie und Operative Intensivmedizin der Westflischen Wilhelms-Universitt Mnster, Germany.

[Medline record in process]

PMID: 11903947, UI: 21901924

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Paediatr Anaesth 2002 Mar;12(3):278-83

Anaesthetic management of a patient with microvillus inclusion disease for intestinal transplantation.

Goldman LJ, Santamaria ML, Gamez M

Department of Paediatric Anaesthesiology, La Paz Children's University Hospital, Madrid, Spain, Department of Paediatric Surgery, La Paz Children's University Hospital, Madrid, Spain.

[Medline record in process]

We report the anaesthetic management of a 3-year-old-child with microvillus inclusion disease undergoing isolated small bowel transplantation. He required long-term total parenteral nutrition which was complicated with numerous episodes of catheter related sepsis. This resulted in thrombosis of the major blood vessels which critically restricted vascular access available for intravenous nutrition, becoming a life-threatening condition for the patient. Haemodynamic, respiratory parameters and urinary output were well preserved throughout the procedure. Besides a transitory increase in potassium following graft revascularization, biochemical changes were small. Anaesthetic management included comprehensive preoperative assessment, central venous angiography to depict accessibility of central and peripheral veins, assurance of additional vascular access through the intraoperative catheterization of the left renal vein, perioperative epidural analgesia and preservation of splanchnic perfusion to ensure implant viability.

PMID: 11903944, UI: 21901921

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Paediatr Anaesth 2002 Mar;12(3):272-7

Therapeutic applications of regional anaesthesia in paediatric-aged patients.

Tobias JD

Departments of Child Health and Anesthesiology, The University of Missouri, Columbia, Missouri, USA.

[Medline record in process]

PMID: 11903943, UI: 21901920

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Paediatr Anaesth 2002 Mar;12(3):261-6

A survey of parental satisfaction during parent present induction of anaesthesia for children undergoing cardiovascular surgery.

Odegard KC, Modest SA, Laussen PC

Department of Anesthesia, Children's Hospital, Boston and Harvard Medical School, Boston, MA, USA, Cardiovascular Nursing, Children's Hospital, Boston, MA, USA.

[Medline record in process]

Methods: To assess parental reaction and possible complications of parent present induction (PPI) for children undergoing cardiovascular surgery, the parents of 183 patients were provided with a questionnaire to complete after they had participated in PPI. Questions included: prior experience with PPI, which member of the staff initiated the plan for PPI, parental role in the process, how prepared parents felt, and overall satisfaction. Results: PPI was successfully performed in the 183 patients surveyed. No parent was asked to leave the operating room because of respiratory or haemodynamic complications; 77.6% of the parents had no prior experience with PPI; however, 91.8% were aware of their role in the operating room, 94.5% were aware how their child would be anaesthetized and 96.7% felt prepared for their role and believed that this was a positive experience for themselves and their child. Conclusions: This prospective survey demonstrated a high level of parental acceptance and satisfaction for PPI in children undergoing cardiovascular surgery, with a low incidence of untoward events, despite the underlying congenital heart disease. Further work is necessary to objectively characterize anxiety levels associated with induction of anaesthesia in this group of patients and parents.

PMID: 11903941, UI: 21901918

Paediatr Anaesth 2002 Mar;12(3):243-247

Management of general anaesthesia in infants and children with a history of idiopathic pulmonary haemorrhage.

Tripi PA, Thomas S, Dearborn DG

Department of Anesthesiology, University Hospitals of Cleveland, Cleveland, OH, USA, Rainbow Babies and Children's Hospital, Case Western Reserve University School of Medicine, Cleveland, OH, USA, Division of Paediatric Pulmonary Disease, Rainbow Babies and Children's Hospital, Case Western Reserve University School of Medicine, Cleveland, OH, USA.

[Record supplied by publisher]

Background: Idiopathic pulmonary haemorrhage in infants is a rare disorder that is endemic to metropolitan Cleveland, Ohio. Since 1993, 32 infants with this disorder were diagnosed and treated at our institution, one of them after developing pulmonary haemorrhage during induction of anaesthesia. Of this population, five patients have undergone a total of 10 general anaesthetics at some time after the initial diagnosis of pulmonary haemorrhage. Methods: We performed a retrospective chart review of these cases to identify whether any risk factors for anaesthesia-related morbidity were present, to review the anaesthetic technique and to identify morbidity related to residual underlying pulmonary disease. Results: No patients experienced any anaesthesia related complication nor any perioperative respiratory problem. Conclusions: These data may be useful to anaesthesiologists in other geographical locations since this disorder has been reported in other parts of the USA, and presumably may exist in other areas of the world.

PMID: 11903938

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Paediatr Anaesth 2002 Mar;12(3):205-19

Scaling for size: some implications for paediatric anaesthesia dosing.

Anderson BJ, Meakin GH

Departments of Anaesthesia and Intensive Care, Auckland Children's Hospital, Auckland, New Zealand, Department of Anaesthesia, Royal Manchester Children's Hospital, Pendlebury, Manchester, UK.

[Medline record in process]

PMID: 11903934, UI: 21901911