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Anaesthesia 2002 Nov;57(11):1146-7
Specialist Registrar and Consultant, Department of Anaesthesia, Ninewells Hospital, Dundee, DD1 9SY, UK.
[Medline record in process]
PMID: 12392477, UI: 22280194
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Anaesthesia 2002 Nov;57(11):1142-1143
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PMID: 12392470
Anaesthesia 2002 Nov;57(11):1137-1138
PMID: 12392463
Anaesthesia 2002 Nov;57(11):1136
PMID: 12392461
Anaesthesia 2002 Nov;57(11):1135-1136
PMID: 12392460
Anaesthesia 2002 Nov;57(11):1083-9
Professor of Anaesthesia, University of New South Wales, St George Hospital, Kogarah, NSW 2217, Australia Anaesthetic Registrar, Department of Anaesthesia and Pain Management, Royal North Shore Hospital, St Leonards, NSW 2065, Australia.
An increasing number of people in the western world are using traditional Chinese herbal medicines. There are concerns that these Chinese medicines may contain potentially toxic ingredients and contaminants such as heavy metals. Undeclared conventional western drugs such as the non-steroidal anti-inflammatory and antihistamine drugs, steroids and oral hypoglycaemic agents are frequently added to Chinese herbal medicines. The constituents of the herbal products can cause adverse effects. The anaesthetist should be aware of the potential adverse effects of the herbal products, their contaminants and also of undeclared additives. The potential for drug interactions, coagulopathy and organ dysfunction caused by traditional Chinese herbal medicines has important anaesthetic implications.
PMID: 12392455, UI: 22280172
Anaesthesia 2002 Nov;57(11):1060-6
Specialist Anaesthetist, Department of Anaesthesiology and Perioperative Medicine, North Shore Hospital, Auckland, New Zealand National AIMS Co-ordinator, Australian Patient Safety Foundation, Adelaide, Australia.
Four hundred and nineteen incidents that occurred in the recovery room were extracted from the Anaesthetic Incident Monitoring Study database, representing 5% of the total database of 8372 reports. Incidents were reported mainly in daylight hours, with over 50% occurring in ASA 1-2 patients. The most common presenting problems related to respiratory/airway issues (183; 43%), cardiovascular problems (99; 24%) and drug errors (44; 11%). One hundred and twenty-two events (29%) led to a major physiological disturbance and required management in the High Dependency Unit or Intensive Care Unit. Contributing factors cited included error of judgement (77; 18%), communication failure (57; 14%) and inadequate pre-operative preparation (29; 7%), whilst factors minimising the incident included previous experience (97; 23%), detection by monitoring (72; 17%) and skilled assistance (54; 13%). Staffing and infrastructure of the recovery room needs to be supported, with ongoing education and quality assurance programmes developed to ensure that such events can be reduced in the future.
PMID: 12392453, UI: 22280170
Anaesthesist 2002 Oct;51(10):800-804
Klinik fur Anaesthesiologie und Intensivmedizin, Universitatskliniken des Saarlandes, Homburg/Saar.
OBJECITVE. As indicated by the manufacturer the EEG monitor Narcotrend trade mark (MonitorTechnik, Bad Bramstedt) can be used to analyse EEG effects of volatile anaesthetics, however, published data are missing. This study evaluated the emergence from a desflurane/remifentanil anaesthetic and was designed to investigate the relationship between Narcotrend stages (version 2.0 AF) and end-tidal desflurane concentrations and to identify the pattern of changes of the Narcotrend stages during recovery. METHODS. Adult patients scheduled for orthopaedic surgery were premedicated with 0.15 mg/kg diazepam orally in the evening and on the morning before surgery. Narcotrend EEG electrodes were positioned on the patient's forehead as recommended by the manufacturer. For induction of anaesthesia, remifentanil was infused at 0.4 &mgr;g/kg/min and propofol 2 mg/kg was given for hypnosis. After neuromuscular blockade and orotracheal intubation, remifentanil was reduced to 0.2 &mgr;g/kg/min, and desflurane in O(2)/air was added according to clinical needs. After termination of surgery, administration of anaesthetics was discontinued and simultaneously, the fresh gas flow was increased to 10 l/min of O(2) while the respirator pattern was left unchanged. Narcotrend stages and end-tidal desflurane concentrations were recorded as data pairs at intervals of 1 min during emergence from anaesthesia; data evaluation included the last 7 min before extubation. RESULTS. A total of 50 patients (mean age +/-SD 44.4+/-13.0 years) were studied and 400 data pairs were obtained. A decreasing depth of anaesthesia as indicated by the Narcotrend was associated with significantly lower end-tidal desflurane concentrations: for E (general anaesthesia with deep hypnosis) 3.6+/-1.0 vol%, for D (general anaesthesia) 1.7+/-0.8 vol%, for C (light anaesthesia) 0.7+/-0.3 vol% and for A and B (awake or sedated) 0.5 vol%. A reduction of end-tidal desflurane concentrations was accompanied by a shift of Narcotrend stages from C/D/E to A/B/C. CONCLUSION. During emergence from desflurane/remifentanil anaesthesia, a reduction of end-tidal desflurane concentrations was detected by the EEG monitor Narcotrend and classified as a typical change of distribution of Narcotrend stages.
PMID: 12395170
Anaesthesist 2002 Jun;51(6):493-512
Klinik fur Anaesthesiologie der Universitat Heidelberg.
PMID: 12391537, UI: 22277801
Anaesthesist 2002 Jun;51(6):475-81
Universitatsklinik fur Anasthesiologie und Intensivtherapie, Philipps-Universitat Marburg.
AIM OF THE STUDY. Postoperative nausea and vomiting (PONV) are among the most frequent complications after general anaesthesia. Avoiding these symptoms is of utmost importance for most patients; PONV is not only a major source of discomfort for patients but also a cause of additional costs for the patients and the health care provider. The economical impact of PONV will become even more important in the near future because the number of surgical procedures performed on an ambulatory basis is increasing. The following article gives a short overview of the terminology and measures used in pharmacoeconomical studies concerning PONV. Furthermore the economical aspects of a low-flow anaesthesia supplemented with the 5-HT(3)-antagonist tropisetron compared with a total intravenous anaesthesia (TIVA) using propofol are described. METHODS. For this comparison a decision analysis was performed using data of a randomised control trial on 150 female patients undergoing major gynaecological surgery. The patients were randomised to receive a total intravenous anaesthesia with propofol-alfentanil or a balanced anaesthesia with desfluran (fresh gas flow 1 l.min(-1)) supplemented by 2 mg tropisetron at the end of surgery. RESULTS. Indirect costs associated with anaesthesia using desflurane-tropisetron (4.94 Euro) are not different from that of propofol-TIVA (4.81 Euro) because of a similar incidence of PONV in the PACU. Furthermore, the total cost for 100 min general anaesthesia is higher in the desflurane-tropisetron group (30.94 Euro) compared with the TIVA group (24.55 Euro) due to the decreasing acquisition costs of propofol in the last 2 years. CONCLUSION. Total intravenous anaesthesia with propofol is more cost-efficient than balanced anaesthesia with desflurane and additional tropisetron as a prophylactic antiemetic.
PMID: 12391535, UI: 22277799
Anaesthesist 2002 Jun;51(6):457-62
Klinik fur Anasthesiologie, Intensiv- und Schmerztherapie, BG Kliniken Bergmannsheil, Ruhr-Universitat Bochum.
The purpose of the study was to investigate the effect of intraoperative hyperventilation on postoperative cognitive functions. METHODS. A total of 120 patients (60 older and 60 younger than 65 years old) were allocated randomly to group I "hyperventilation" (p(et)CO(2)=30 mmHg) or group II "normoventilation" (p(et)CO(2)=45 mmHg). Before the operation and on days 1, 3 and 6 after the operation, a battery of neuropsychological tests was performed (concentration endurance test d2, number connection test, digit symbol test). A decline of 20% in at least one test was regarded as postoperative cognitive deficit (POCD). Anaesthesia was maintained with isoflurane in nitrous oxide/oxygen supplemented with fentanyl. RESULTS. In all patients pooled, POCD was present in 26 patients (22%). In patients older than 65 years, POCD was present in 3 cases after hyperventilation and 13 cases after normoventilation ( p<0.01). In younger subjects, 5 cases of POCD were diagnosed in each ventilation group. Furthermore, POCD was more severely pronounced in older patients after normoventilation. CONCLUSION. In older patients, POCD occurred more frequently after intraoperative normoventilation. We assume that a reduced amount of noxious substances reach the brain after hyperventilation, because hyperventilation reduces the cerebral blood flow.
PMID: 12391531, UI: 22277795
Anaesthesist 2002 Jun;51(6):448-56
Anasthesieabteilung, Universitats-Kinderklinik, Zurich.
Former preterm infants with postconceptual age <50-60 weeks are at risk of postoperative apnea and bradycardia when operated under general anaesthesia. In addition, after general anaesthesia with endotracheal intubation preterm infants, who had suffered from severe respiratory distress syndrome, often require prolonged postoperative mechanical ventilation. Pure regional anaesthetic techniques can avoid most of these postoperative respiratory complications. Spinal anaesthesia has been used extensively so far. Recently, pure caudal anaesthesia for this indication has become a promising alternative. If a pure regional anaesthesia technique is not indicated or feasable, the combination of light inhalational anaesthesia with a caudal block seems appropriate. Overnight cardiorespiratory monitoring is mandatory in these patients regardless of the anaesthetic technique used.
PMID: 12391530, UI: 22277794
Anaesthesist 2002 Aug;51(8):668-78
We have developed a modern strategy for the anaesthetic management of the pediatric airway using anaesthetic drugs such as sevoflurane, propofol, mivacurium and remifentanil, together with new techniques including the laryngeal mask. This strategy provides optimal conditions for the examiner and maximum safety for the pediatric patient. The endoscopic investigation of pediatric airways has become important for the diagnosis and treatment of many pediatric diseases, and is often performed with the support of a pediatric anaesthetist. Important indications include acute and chronic stridor, chronic obstructive airway disease, mucoviscidosis and foreign body aspiration. The best and safest techniques are outlined depending on the clinical situation, and the most frequent complications are discussed, e.g. hypoxaemia, respiratory arrest, laryngospasm, bronchial obstruction, pneumothorax and overdosing of local anaesthetic agents.
PMID: 12391527, UI: 22277809
Br J Anaesth 2002 Nov;89(5):788-91
Nuffield Department of Anaesthetics and Department of Cardiology, Oxford Radcliffe Hospitals Trust, Oxford, OX3 9DU, UK.
The successful administration of a combined general and epidural anaesthetic to a patient with Brugada syndrome is reported. A review of the literature is presented. Br J Anaesth 2002; 89: 788-91
PMID: 12393785, UI: 22280486
Br J Anaesth 2002 Nov;89(5):786-7
Department of Anaesthesia, Royal United Hospital, Combe Park, Bath BA1 2NG, UK.
We report the anaesthetic management of an adult with Rubenstein-Taybi syndrome. This rare congenital syndrome is characterized by severe learning difficulties, cardiac abnormalities, gastrooesophageal reflux, and cranio-facial abnormalities with the likelihood of difficult intubation. A ProSeal laryngeal mask airway was used to ventilate the patient for eye surgery. Br J Anaesth 2002; 89: 786-7
PMID: 12393784, UI: 22280485
Br J Anaesth 2002 Nov;89(5):772-4
Department of Anaesthesia, Ysbyty Gwynedd, Bangor LL57 2PW, UK.
BACKGROUND: There is little advice on the posture to be used when intubating the trachea. Does the stance used depend on experience? METHODS: Twenty-six subjects with varying experience of intubation were photographed during laryngoscopy of an intubation training mannequin. Posture was measured from the photographs and the data were analysed with the Mann-Whitney U-test. RESULTS: The less experienced group had shallower lines of sight, levered more, and stood with their face closer to the mannequin (P=0.037, 0.018 and 0.06 respectively). CONCLUSIONS: Novice anaesthetists should be given explicit instructions on correct trolley height and should be taught to intubate with a straight back. Br J Anaesth 2002; 89: 772-4
PMID: 12393780, UI: 22280481
Br J Anaesth 2002 Nov;89(5):707-10
Hope Hospital, Stott Lane, Salford, UK.
BACKGROUND: A variety of techniques and drugs, many unlicensed, is used in paediatric regional anaesthesia. This study is the first to survey paediatric anaesthetists about the techniques and drugs used in paediatric regional anaesthesia. The aim is to provide a record and benchmark of UK practice. METHODS: A postal questionnaire was sent to all members of the Association of Paediatric Anaesthetists residing in the UK. Information was requested on the type of hospital worked in, years of practice, paediatric anaesthesia workload, regional anaesthesia techniques used, and drugs used in regional anaesthesia. RESULTS: A total of 220 responses from 264 questionnaires (83.3%) were received. Of these respondents, 155 (70%) practised paediatric anaesthesia as more than 50% of their workload, and 10 had retired or returned blank forms. Two hundred and two of 210 (96%) use caudal anaesthesia and 151 (72%) use caudal, epidural and peripheral block. One hundred and ninety-two of 210 (91%) have no lower age limit for using caudal anaesthesia. One hundred and twenty-three of 210 anaesthetists (58%) used adjuvants with local anaesthetics in caudal block, the most common being fentanyl [44/210 (21%)], clonidine [55/210 (26%)], diamorphine [27/210 (13%)] and ketamine [67/210 (32%)]. Those working in specialist centres or teaching hospitals or who had a greater paediatric anaesthesia workload were more likely to use a greater variety of regional anaesthesia techniques. CONCLUSIONS: Caudal anaesthesia is widely used for patients of all ages by almost all practitioners. Most anaesthetists at all hospital types and experience levels use adjuvants with local anaesthetics when performing caudal anaesthesia. Those with more experience in paediatric anaesthesia and those in specialist centres commonly use other neuraxial and peripheral block techniques. Br J Anaesth 2002; 89: 707-10
PMID: 12393767, UI: 22280468
Br J Anaesth 2002 Nov;89(5):702-6
Department of Anaesthetics and Intensive Care Medicine, The Queen's University of Belfast, Whitla Medical Building, 97 Lisburn Road, Belfast BT9 7BL, UK.
BACKGROUND: Ropivacaine provides effective spinal anaesthesia for total hip arthroplasty. This study was designed to compare the efficacy and safety of plain ropivacaine with plain bupivacaine for spinal anaesthesia in patients undergoing total hip arthroplasty. METHODS: Sixty-six patients, ASA I or II, were randomized to receive an intrathecal injection of one of two local anaesthetic solutions. Group R (n=32) received 3.5 ml of ropivacaine 5 mg ml(-1) (17.5 mg). Group B (n=34) received 3.5 ml of bupivacaine 5 mg ml(-1) (17.5 mg). The onset and duration 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. RESULTS: 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 2-5 min) in Group R and 2 min in Group B (range 2-9 min). The median duration of sensory block at the T10 dermatome was 3.0 h (range 1.5-4.6 h) in Group R and 3.5 h (2.7-5.2 h) in Group B (P<0.0001). The median duration of complete motor block (modified Bromage Scale 3) was significantly shorter in the ropivacaine group compared with the bupivacaine group (2.1 vs 3.9 h, P<0.001). CONCLUSIONS: Intrathecal administration of either 17.5 mg plain ropivacaine or 17.5 mg plain bupivacaine was well tolerated and an adequate block for total hip arthroplasty was achieved in all patients. A more rapid postoperative recovery of sensory and motor function was seen in Group R compared with Group B. Br J Anaesth 2002; 89: 702-6
PMID: 12393766, UI: 22280467
Br J Anaesth 2002 Nov;89(5):693-6
Department of Anaesthesiology, Hotel Dieu, C.H.U. Nantes, France. Societe d'Etude des Risques Toxiques, Nantes, France.
BACKGROUND: Defluorination of sevoflurane is catalysed by the hepatic enzyme cytochrome P450 2E1 (CYP2E1). Data about the ontogenesis (developmental variations in activity) of this enzyme suggest a low metabolism of sevoflurane during the first months of life. METHODS: To test this hypothesis, 45 children less than 48 months of age undergoing sevoflurane anaesthesia were enrolled in a prospective open clinical trial. The 24 h urine fluoride excretion was measured in five groups of children (A, <4 months; B, 4 to <8 months; C, 8-12 months; D, >12-24 months; and E, >24-48 months old). An index of sevoflurane metabolism (ISM) was calculated as the ratio of fluoride excretion, cumulative expiratory sevoflurane concentrations measured every minute during anaesthesia, and body surface area. ISM values were median (IQ 25-75%). RESULTS: ISM was lower in group A (n=9, 18.9 (11.2-29.5) than group C (n=11, 44.2 (37.5-53.5), P<0.05), group D (n=7, 52.6 (45.8-68.4), P<0.01) and group E (n=9, 53.6 (50.7-85), P<0.001). Median ISM expressed as a function of median age, exponentially increased with a rapid increase during the first months of life, followed by a slower increase after 10 months of age. CONCLUSION: These results suggest that, in children less than 48 months, sevoflurane metabolism parallels postnatal development of CYP2E1. Br J Anaesth 2002; 89: 693-6
PMID: 12393764, UI: 22280465
Br J Anaesth 2002 Oct;89(4):658-9
Milwaukee, WI, USA.
PMID: 12393375, UI: 22280457
Br J Anaesth 2002 Oct;89(4):655-7
Celal Bayar University, School of Medicine, Department of Anaesthesiology and Reanimation, Manisa, Turkey.
There are few reports of management of severe bradycardia with temporary cardiac pacing. We describe a 65-yr-old female patient who developed bradycardia and hypotension on two occasions during general anaesthesia for laryngoscopy. The first episode was treated with atropine, ephedrine, and colloid infusion and the second with a temporary pacemaker and ephedrine. Br J Anaesth 2002; 89: 655-7
PMID: 12393374, UI: 22280456
Br J Anaesth 2002 Oct;89(4):635-7
Academic Unit of Anaesthesia and Intensive Care, Institute of Medical Sciences, University of Aberdeen, Aberdeen AB25 2ZD, UK.
BACKGROUND: Cyclic GMP (cGMP) has been implicated in modulating the effects of general anaesthesia. Changes in cGMP in humans undergoing anaesthesia have not been reported previously. METHODS: In this pilot study we measured cGMP in the saliva of six healthy volunteers and eight patients undergoing general anaesthesia for minor gynaecological procedures. Samples were obtained using a commercially available sampling device and cGMP was determined with an enzyme immunoassay and results expressed as a cGMP per mg protein. RESULTS: There was no statistically significant variation in salivary cGMP either day-to-day or between time points in healthy volunteers. Analysis of variance of salivary cGMP of patients undergoing general anaesthesia showed that cGMP increased significantly intraoperatively and returned to preoperative levels after surgery (P=0.03). CONCLUSIONS: This is the first time that real time in vivo changes in salivary cGMP levels during general anaesthesia in humans have been demonstrated and may allow an alternative technique for measuring depth of anaesthesia in the future. Br J Anaesth 2002; 89: 635-7
PMID: 12393367, UI: 22280449
Br J Anaesth 2002 Oct;89(4):599-604
Faculte de Medecine, Universite-Montpellier I, Montpellier, France. INSERM U 469, Montpellier, France.
BACKGROUND: Renin-angiotensin system antagonists, either angiotensin-converting enzyme (ACE) inhibitors or angiotensin II receptor (AT(1)) antagonists, may interfere with regulation of arterial pressure during anaesthesia. This study aimed to compare the haemodynamic profile of anaesthetized pigs, which were subjected to haemorrhage in the presence of the ACE inhibitor enalaprilat or the AT(1) antagonist valsartan. METHODS: Thirty-six pigs were assigned randomly to placebo, enalaprilat or valsartan groups. After a 30-min period of stabilization following anaesthesia and injection of the study drug, the animals were bled in two equal steps of 20% of their estimated blood volume (20% BV and 40% BV). RESULTS: After bleeding of 20% BV, the mean arterial pressure (MAP) decreased significantly but similarly in each group (20-25%) but the placebo and the enalaprilat groups had a significant decrease in cardiac index (CI, 22% and 16%, respectively) without significant change in systemic vascular resistance (SVR). Conversely, in the valsartan group, SVR decreased significantly (23%, P<0.02 vs other groups) without significant change in CI (-4%). After bleeding of 40% BV, the CI decreased significantly compared with 20% BV in the three groups (19% in the placebo and enalaprilat groups, 14% in the valsartan group) but the MAP decreased significantly in the enalaprilat group only (23%). The SVR increased significantly in the placebo group (P<0.01 vs each of the other groups), but there were no differences in the change in SVR between the other groups. CONCLUSION: Blockade of the renin-angiotensin system by either enalaprilat or valsartan leads to a similar decrease in arterial pressure during anaesthesia and haemorrhage but the haemodynamic profiles are quite different. Br J Anaesth 2002; 89: 599-604
PMID: 12393362, UI: 22280444
Br J Anaesth 2002 Oct;89(4):594-8
Department of Anaesthesiology and Intensive Care, Faculty of Medicine, University of Istanbul, Istanbul, Turkey.
BACKGROUND: The present randomized, placebo-controlled, double-blind study was designed to assess the effect of peroperatively administered i.v. magnesium sulphate on anaesthetic and analgesic requirements during total i.v. anaesthesia. METHODS: Eighty-one patients (36 women, 45 men) undergoing elective spinal surgery were included in one of two parallel groups. The magnesium group received magnesium sulphate 30 mg kg(-1) as a bolus before induction of anaesthesia and 10 mg kg(-1) h(-1) by continuous i.v. infusion during the operation period. The same volume of isotonic solution was administered to the control group. Anaesthesia was maintained with propofol (administered according to the bispectral index) and remifentanil (adjusted according to heart rate and arterial blood pressure) infusions. RESULTS: A significant reduction in hourly propofol consumption was observed with magnesium administration. For example, the mean infusion rate of propofol in the second hour of the operation was 7.09 mg kg(-1) h(-1) in the control group vs 4.35 mg kg(-1) h(-1) in the magnesium group (P<0.001). The magnesium group required significantly less remifentanil (P<0.001) and vecuronium (P<0.001). No side-effects were observed with magnesium administration. CONCLUSION: The administration of magnesium led to a significant reduction in the requirements for anaesthetic drugs during total i.v. anaesthesia with propofol, remifentanil and vecuronium. Br J Anaesth 2002; 89: 594-8
PMID: 12393361, UI: 22280443
Br J Anaesth 2002 Oct;89(4):586-93
Department of Anaesthetics, Norfolk and Norwich University Hospital NHS Trust, Colney Lane, Norwich NR4 7UZ, UK.
BACKGROUND: We describe a practical method of training anaesthetists in the technique of awake fibreoptic intubation. This is performed on a training course using the delegates as subjects. METHODS: The first 15 subjects underwent cardiovascular monitoring during airway fibreoptic endoscopy performed by other course members. They were subsequently interrogated by use of a questionnaire. RESULTS: Evidence from questionnaires suggests this method of instruction is acceptable in this self-selected group of individuals. Gagging was the commonest unpleasant side-effect of airway endoscopy, although only one delegate rated this as uncomfortable. Fifty-four per cent of subjects found the procedure slightly painful; 46% reported no pain at all. Overall, the procedure was rated as acceptable by 85% of subjects and enjoyable by 15% of subjects. No delegate found endoscopy or intubation distressing. Cardiovascular monitoring revealed pulse rate and arterial pressure changes of less than 25% of baseline values. Paraesthesia developed in one individual and nasal bleeding in two cases, neither of which was clinically significant and did not interfere with endoscopy. CONCLUSIONS: The use of course delegates as subjects for training was acceptable to anaesthetists and is associated with a low level of discomfort and morbidity. Br J Anaesth 2002; 89: 586-93
PMID: 12393360, UI: 22280442
Br J Anaesth 2002 Oct;89(4):556-61
Department of Anaesthesia and Intensive Care, Department of Paediatrics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong, China.
BACKGROUND: The optimal inspired oxygen fraction FI(O(2)) for fetal oxygenation during general anaesthesia for Caesarean section is not known. METHODS: We randomized patients having elective Caesarean section to receive one of the following: FI(O(2)) 0.3, FI(N(2))(O) 0.7 and end-tidal sevoflurane 0.6% (Group 30, n=20); FI(O(2)) 0.5, FI(N(2))(O) 0.5 and end-tidal sevoflurane 1.0% (Group 50, n=20), or FI(O(2)) 1.0 and end-tidal sevoflurane 2.0% (Group 100, n=20) until delivery. Neonatal outcome was compared biochemically and clinically. RESULTS: At delivery, for umbilical venous blood, mean PO(2) was greater in Group 100 (7.6 (SD 3.7) kPa) compared with both Group 30 (4.0 (1.1) kPa, P<0.0001) and Group 50 (4.7 (0.9) kPa, P=0.002) and oxygen content was greater in Group 100 (17.2 (1.6) ml dl(-1)) compared with both Group 30 (12.8 (3.6) ml dl(-1), P=0.0001) and Group 50 (13.8 (2.6) ml dl(-1), P=0.0001). For umbilical arterial blood, PO(2) was greater in Group 100 (3.2 (0.4) kPa) compared with Group 30 (2.4 (0.7) kPa, P=0.003), and in Group 50 (2.9 (0.8) kPa) compared with Group 30 (2.4 (0.7) kPa, P=0.04); oxygen content was greater in Group 100 (10.8 (3.5) ml dl(-1)) than in Group 30 (7.0 (3.0) ml dl(-1), P<0.01). Apgar scores, neonatal neurologic and adaptive capacity scores, and maternal arterial plasma concentrations of epinephrine and norepinephrine before induction and at delivery were similar among groups. No patient reported intraoperative awareness. CONCLUSIONS: Use of FI(O(2)) 1.0 during general anaesthesia for elective Caesarean section increased fetal oxygenation. Br J Anaesth 2002; 89: 556-61
PMID: 12393355, UI: 22280437
Br J Anaesth 2002 Oct;89(4):551-5
Department of Anaesthesia, Beaumont Hospital, Dublin 9, Ireland.
BACKGROUND: A practical and reliable monitor of depth of anaesthesia would be a major advance on current clinical practice. None of the present monitors is both simple to use and accurate. Ocular microtremor (OMT) is a physiological tremor that is suppressed by propofol in a dose-dependent manner. We studied OMT during propofol induction and nitrous oxide- oxygen-sevoflurane maintenance of anaesthesia in 30 patients, and compared OMT with the bispectral index (BIS) as a predictor of response to verbal command. METHODS: OMT was measured using the closed-eye piezoelectric strain-gauge technique. OMT and BIS were measured at specific times during the anaesthetic, including at loss of consciousness, at end-tidal sevoflurane 1 and 2%, and at emergence. RESULTS: OMT decreased significantly after induction, did not decrease as end-tidal sevoflurane was increased from 1 to 2%, and increased at emergence in all patients. By logistic regression, OMT was more sensitive and specific than BIS in distinguishing the awake from the anaesthetized state (OMT, 84.9 and 93.1% respectively; BIS, 75.7 and 69.0%). CONCLUSIONS: OMT is suppressed by sevoflurane and accurately predicts response to verbal command. OMT may be a useful monitor of depth of hypnosis. Br J Anaesth 2002; 89; 551-5
PMID: 12393354, UI: 22280436
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