Anaesthesia 2002 Dec;57(12):1242
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PMID: 12437757
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Anaesthesia 2002 Dec;57(12):1236-1237
PMID: 12437751
Anaesthesia 2002 Dec;57(12):1235
PMID: 12437746
Anaesthesia 2002 Dec;57(12):1234-1235
PMID: 12437745
Anaesthesia 2002 Dec;57(12):1232-1233
PMID: 12437742
Anaesthesia 2002 Dec;57(12):1229-1230
PMID: 12437738
Anaesthesia 2002 Dec;57(12):1224-1226
PMID: 12437731
Anaesthesia 2002 Dec;57(12):1218-1219
PMID: 12437720
Anaesthesia 2002 Dec;57(12):1217
PMID: 12437718
Anaesthesia 2002 Dec;57(12):1216-1217
PMID: 12437716
Anaesthesia 2002 Dec;57(12):1215-1216
PMID: 12437715
Anaesthesia 2002 Dec;57(12):1214
PMID: 12437713
Anaesthesia 2002 Dec;57(12):1213-1214
PMID: 12437712
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Anaesthesia 2002 Dec;57(12):1190-4
[Medline record in process]
A patient in a permanent vegetative state required general anaesthesia for dental surgery. Because of the uncertainties involved in the appropriate monitoring and assessment of the conscious level of patients in a permanent vegetative state, it was decided to use the bispectral index to help guide the anaesthetic depth during surgery. We found that the bispectral index profile during anaesthesia and surgery was similar to that of a normal subject. The findings raise the possibility that patients in permanent vegetative states might sense noxious stimuli at a cortical level.
PMID: 12437711, UI: 22324995
Anaesthesia 2002 Dec;57(12):1174-82
We believe that one of the most influential developments for the practice of anaesthesia in this decade will be the introduction of a national (or possibly international) standard XML Schema for computerised anaesthetic records, and that such development should be actively promoted by appropriate professional groups. We discuss the implications of such a schema, and make suggestions regarding its requirements. We also report on one approach to the development of an XML Schema for anaesthetic records (provisionally named SnowSchema in honour of Dr John Snow), and compare the current version with the suggested requirements.
PMID: 12437708, UI: 22324992
Anaesthesia 2002 Dec;57(12):1164-7
This study compares spinal anaesthesia for inguinal herniotomy in preterm infants in the lateral or sitting position. Thirty patients were randomly divided into two equal groups. One hour before spinal anaesthesia, a eutetic mixture of local anaesthetic cream was applied to the lower lumbar spine. Sedation with nitrous oxide 50% in oxygen was given to all patients before and during induction of spinal anaesthesia, and throughout surgery. Lumbar punctures were performed at the L4-5 interspace using a 2.5 cm 22 G needle. Isobaric bupivacaine 0.5% with epinephrine 1 : 200 000 at a bupivacaine dose of 1 mg.kg-1 was injected in the lateral or sitting position. Measurements included heart rate, blood pressure, oxygen saturation, maximum sensory block height and duration of motor block and analgesia. There were no statistically significant differences between the groups in any measured parameters. Median [range] maximum block height was T5[T4-T7] in the lateral group and T5[T4-T5] in the sitting group. The median [range] duration of motor blockade was 67 [50-85] min in the lateral group and 63 [50-80] min in the sitting group. Our results indicate that in preterm infants sedated with nitrous oxide, spinal anaesthesia for inguinal herniotomy performed with isobaric bupivacaine 0.5% at a dose 1.0 mg.kg-1 in the lateral or sitting position is equally effective and is associated with minimal side effects.
PMID: 12437706, UI: 22324990
Anaesthesia 2002 Dec;57(12):1159-63
In most acupuncture studies it is difficult or even impossible to conduct a truly double-blind trial. However, this is possible when treatments are carried out on anaesthetised patients. Because acupuncture provides analgesia, we tested the hypothesis that needle stimulation of a combination of four ear acupoints would significantly reduce anaesthetic requirement. Ten healthy volunteers were anaesthetised with desflurane and randomly assigned to no treatment or acupuncture; the alternative treatment was given on a subsequent study day. Auricular acupuncture was performed with needles placed at the Shen Men, Thalamus, Tranquiliser and Master Cerebral Points on the right ear. Anaesthetic requirement, determined by the Dixon up-and-down method, was defined by the average desflurane concentration that prevented purposeful movement of the extremities in response to noxious electrical stimulation. Volunteers required a greater desflurane concentration to prevent movement on the control than on the acupuncture day: 4.9 (0.7; SD) vs. 4.4 (0.8) vol. %, p = 0.003. Acupuncture thus reduced anaesthetic requirement by 8.5 (7)%.
PMID: 12437705, UI: 22324989
Anaesthesia 2002 Dec;57(12):1155-8
Where practicable, exposure to a hazardous substance should be eliminated or adequately controlled. A postal questionnaire survey was sent to 10% of consultants from the Association of Anaesthetists of Great Britain and Ireland, to identify the level of use of nitrous oxide in current anaesthetic practice and identify any change of practice over the last 5 years. Details of anaesthetic practice were requested in three areas: nitrous oxide usage, availability of medical air on anaesthetic machines and the use of total intravenous anaesthesia. Replies were received from 320 consultants (75%). Of these, 49% felt that, over the last 5 years, their use of nitrous oxide had decreased. Twenty per cent of anaesthetists felt that there should be some restriction in availability of nitrous oxide. Where medical air was available, 32% felt that they would use it frequently. A total of 263 (83%) stated that they use total intravenous anaesthesia to some extent. The results showed that, although 49% of consultant anaesthetists had reduced their use of nitrous oxide, this was due to medical considerations rather than concerns over health and pollution issues arising from the use of nitrous oxide.
PMID: 12437704, UI: 22324988
Anesthesiology 2002 Nov;97(5):7A
Publication Types:
PMID: 12436967, UI: 22322579
Eur J Anaesthesiol 2002 Nov;19(11):848-50
PMID: 12442944, UI: 22330108
Eur J Anaesthesiol 2002 Nov;19(11):845-6
PMID: 12442942, UI: 22330106
Eur J Anaesthesiol 2002 Nov;19(11):842-4
PMID: 12442940, UI: 22330104
Eur J Anaesthesiol 2002 Nov;19(11):836-8
PMID: 12442937, UI: 22330101
Eur J Anaesthesiol 2002 Nov;19(11):808-11
Sapporo Medical University School of Medicine, Department of Anesthesiology, Japan. mnakaya@sapmed.ac.jp
BACKGROUND AND OBJECTIVE: The effects of altering the concentration of a local anaesthetic on the development of epidural anaesthesia in pregnant females are unclear. We compared the anaesthetic effects of a constant dose of two different concentrations of epidural lidocaine for Caesarean section. METHODS: After Institutional Review Board approval and informed consent, patients undergoing elective Caesarean section were randomized to receive either lidocaine 1% 30 mL (+epinephrine 5 microg mL(-1)) or lidocaine 2% 15 mL (+epinephrine 5 microg mL(-1)) (n = 20 each) for epidural anaesthesia at the L1-L2 interspace. The spread of the sensory block to pinprick and the degree of motor block (modified Bromage scale) were measured at 5, 10, 15, 20 and 30 min after injection. RESULTS: No significant differences in the progression of analgesia and motor block were observed at any time between 1 and 2% lidocaine. The maximum cephalad spread was observed 30 min after injection; the median was at T4 (range T3-T5) and at T4 (range T3-T6) for lidocaine 1 and 2%, respectively. CONCLUSIONS: The same doses but different volumes of lidocaine 1 and 2% produced comparable anaesthetic effects in pregnant females. The effects of epidural anaesthesia depend primarily on the total dose of the local anaesthetic.
PMID: 12442930, UI: 22330094
Eur J Anaesthesiol 2002 Nov;19(11):789-95
University of Basel, Department of Anaesthesia, Switzerland.
BACKGROUND AND OBJECTIVE: Doppler echocardiography of diastolic transmitral flow velocity is more sensitive for the detection of myocardial ischaemia in awake patients than echocardiographic analysis of systolic wall motion. However, its diagnostic value in anaesthetized patients is unknown. METHODS: Doppler indices of diastolic transmitral flow velocity previously found to be highly sensitive for detecting ischaemia in awake patients were studied in 72 anaesthetized patients with documented coronary artery disease undergoing dobutamine stress echocardiography. These Doppler indices were compared with standard echocardiographic and electrocardiographic criteria for ischaemia. RESULTS: Sixty-five patients showed evidence of ischaemia by standard echocardiographic and/or electrocardiographic criteria, and seven patients did not. Regardless of evidence of ischaemia by standard criteria, the Doppler indices changed similarly in both groups. Accordingly, only a minority of anaesthetized patients displayed the changes in Doppler indices of diastolic transmitral flow previously suggested to be sensitive for detecting ischaemia. CONCLUSIONS: The results do not confirm the diagnostic value of Doppler echocardiography of diastolic transmitral flow velocity for detecting ischaemia in anaesthetized patients undergoing dobutamine stress echocardiography during positive-pressure ventilation of the lungs.
PMID: 12442927, UI: 22330091
Eur J Anaesthesiol 2002 Nov;19(11):780-8
claude.lentschener@cch.ap-hop-paris.fr
Improvement in surgical techniques, technology and perioperative assessment has dramatically simplified the anaesthetic care for elective liver resection. Patients with a non-tumorous healthy liver should only need the usual preoperative assessment. Patients with pre-existing parenchymal liver disease should be specifically assessed for gas exchange impairment, alcoholic or nutritional-associated cardiomyopathy, infection, cirrhosis decompensation, acute alcoholic hepatitis, and kidney impairment. The type of anaesthetic management does not influence the intra- and postoperative courses. Intermittent clamping of the portal vascular triad is better tolerated than prolonged continuous periods of ischaemia--especially in patients with abnormal liver parenchyma. Intraoperative antibiotic prophylaxis must be administered to prevent translocation of intestinal enterobacteria to the systemic circulation in patients with both healthy and diseased livers. Blood-salvage techniques have limited indications in liver resection. Systematic invasive haemodynamic monitoring is no longer warranted. An arterial cannula should only be considered in procedures of long duration and in selected situations likely to cause anticipated circulatory impairment: total liver vascular occlusion, repeat surgery, combined organ resection, and surgery conducted on tumours >10 cm in size or in connection with the vena cava. In a recent large series of liver resections, 60% of patients did not need a blood transfusion, only 2% of transfused patients received >10 units of blood and cirrhosis was not predictive of increased intraoperative bleeding. Postoperative ascites, which always develops at the expense of circulating fluid, is a frequent occurrence in patients with healthy or diseased livers. Intra- and postoperative fluid limitation does not prevent postoperative ascites. Volume expansion, diuretics and vasopressor therapy should be initiated early to prevent kidney failure.
PMID: 12442926, UI: 22330090