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Anesth Analg 2002 Sep;95(3):786-7
Center for Evidence Based Practice, Syracuse, NY.
[Medline record in process]
PMID: 12198084, UI: 22186471
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Anesth Analg 2002 Sep;95(3):770-6
Department of Anaesthesia and Intensive Care, Cairns Base Hospital, The Esplanade, Cairns, Australia.
We compared the laryngeal mask airway ProSeal(TM) (PLMA(TM)) and the laryngeal tube airway (LTA), two new extraglottic airway devices, with respect to: 1) insertion success rates and times, 2) efficacy of seal, 3) ventilatory variables during pressure-controlled ventilation, 4) tidal volume in different head/neck positions, and 5) airway interventional requirements. One-hundred-twenty paralyzed anesthetized ASA physical status I and II adult patients were randomly allocated to the PLMA(TM) or LTA for airway management. A standardized anesthesia protocol was followed by two anesthesiologists experienced with both devices. The criteria for an effective airway included a minimal expired tidal volume of 6 mL/kg during pressure-controlled ventilation at 17 cm H(2)O with no oropharyngeal leak or gastric insufflation. First attempt success rates at achieving an effective airway were similar (PLMA(TM): 85%; LTA: 87%), but after 3 attempts, success was more frequent for the PLMA(TM) (100% versus 92%, P = 0.02). Effective airway time was similar. Oropharyngeal leak pressure was larger for PLMA(TM) at 50% maximal recommended cuff volume (29 +/- 7 versus 21 +/- 6 cm H(2)O, P < 0.0001), but was similar at the maximal recommended cuff volume (33 +/- 7 versus 31 +/- 8 cm H(2)O). Tidal volumes (614 +/- 173 versus 456 +/- 207 mL, P < 0.0001) were larger and ETCO(2) (33 +/- 9 versus 40 +/- 11 mm Hg, P = 0.0001) lower for the PLMA(TM). The number of airway interventions was significantly less frequent for the PLMA(TM). Airway obstruction was more common with the LTA. When comparing mean tidal volumes in different head/neck positions, the quality of airway was unchanged in 56 of 60 patients (93%) with the PLMA(TM) and 42 of 55 (76%) with the LTA (P = 0.01). The PLMA(TM) offers advantages over the LTA in most technical aspects of airway management in paralyzed patients undergoing pressure-controlled ventilation. IMPLICATIONS: The laryngeal mask airway ProSeal(TM) offers advantages over the laryngeal tube airway in most technical aspects of airway management in paralyzed patients undergoing pressure-controlled ventilation.
PMID: 12198070, UI: 22186457
Anesth Analg 2002 Sep;95(3):751-6
Department of Anesthesiology, Sapporo Medical University, School of Medicine, Sapporo, Japan.
In a double-blinded, placebo-controlled, randomized study, we evaluated the effect of prophylactic IM phenylephrine at doses of 1.5 and 3 mg on hyperbaric tetracaine spinal anesthesia-induced hypotension in 90 normotensive and hypertensive patients aged >65 yr undergoing surgery for hip fracture. Thirty normotensive patients received 1.5 or 3 mg of phenylephrine IM (N/P-1.5 and N/P-3.0 groups; n = 15 in each), whereas controls received saline (N/C group; n = 15), and 45 hypertensive patients were treated in a similar manner (H/P-1.5, H/P-3.0, and H/C groups; n = 15 in each). All groups had a peak sensory block height of T9, with a range of T8 to T10. The incidence of hypotension (>25% decrease in mean arterial blood pressure [MAP] from baseline) was significantly lower in the patients who received phenylephrine 1.5 or 3 mg than in the controls, both in the normotensive and hypertensive groups (P < 0.01). The N/P-3.0 and N/P-1.5 groups and the H/P-3.0 group had significantly lower percentage reductions in MAP (P < 0.05) and required significantly smaller doses of rescue IV ephedrine (P < 0.05) than did the N/C group or the H/C group. The H/P-1.5 group also required significantly less rescue IV ephedrine (P < 0.05), although it was not sufficient to significantly attenuate the percentage decrease in MAP compared with that in the H/C group. Bradycardia (heart rate <50 bpm) as an adverse effect after IM administration of phenylephrine was not observed in any of the groups. Hypertension (MAP >20% increase from baseline) after medication occurred in the N/P-3.0 and H/P-3.0 groups, but not in the N/P-1.5 and H/P-1.5 groups. We conclude that prophylactic IM injection of 1.5 mg of phenylephrine is a safe (defined as the inhibition of bradycardia and hypertension) and effective means of reducing the incidence of hypotension associated with spinal anesthesia in normotensive and hypertensive elderly patients. IMPLICATIONS: We evaluated the efficacy and safety of small-dose IM phenylephrine for prophylaxis against spinal anesthesia-induced hypotension in normotensive and hypertensive elderly patients. Phenylephrine 1.5 mg IM was effective for reducing the incidence of hypotension and avoided adverse effects.
PMID: 12198065, UI: 22186452
Anesth Analg 2002 Sep;95(3):746-50
Department of Anesthesiology, University of Louvain, St. Luc Hospital, Brussels, Belgium.
In this study we evaluated the analgesic efficacy of combined deep and superficial cervical plexus block in patients undergoing thyroidectomy under general anesthesia. For this purpose, 39 patients undergoing elective thyroid surgery were randomized to receive a bilateral combined deep and superficial cervical block (14 mL per side) with saline (Group 1; n = 13), ropivacaine 0.5% (Group 2; n = 13), or ropivacaine 0.5% plus clonidine 7.5 micro g/mL (Group 3; n = 13). Deep cervical plexus block was performed with a single injection (8 mL) at the C3 level. Superficial cervical plexus block consisted of a subcutaneous injection (6 mL) behind the lateral border of the sternocleidomastoid muscle. During surgery, the number of additional alfentanil boluses was significantly reduced in Groups 2 and 3 compared with Group 1 (1.3 +/- 1.0 and 1.1 +/- 1.0 vs 2.6 +/- 1.0; P < 0.05). After surgery, the opioid and non-opioid analgesic requirements were also significantly reduced in Groups 2 and 3 (P < 0.05) during the first 24 h. Except for one patient in Group 3, who experienced transient anesthesia of the brachial plexus, no side effect was noted in any group. We conclude that combined deep and superficial cervical plexus block is an effective technique to alleviate pain during and immediately after thyroidectomy. IMPLICATIONS: Combined deep and superficial cervical plexus block is an effective technique to reduce opioid requirements during and after thyroid surgery.
PMID: 12198064, UI: 22186451
Anesth Analg 2002 Sep;95(3):728-34
Division d'Anesthesiologie, Departement d'Anesthesiologie, Pharmacologie et Soins Intensifs de Chirurgie (APSIC), and Clinique d'Obstetrique, Departement de Gynecologie et Obstetrique, Hopitaux Universitaires de Geneve (HUG), Geneve, Suisse.
To determine the effects of clonidine with ropivacaine during epidural labor analgesia, we studied 66 nulliparous women in early active labor. Women were randomized to receive ropivacaine 0.1% 8 mL plus 75 micro g of clonidine (Group 1), ropivacaine 0.2% 8 mL plus 0.5 mL of NaCl 0.9% (Group 2), or ropivacaine 0.2% 8 mL plus 75 micro g of clonidine (Group 3) 5 min after a bupivacaine 7.5 mg with epinephrine 15 micro g test dose. Upon request, additional analgesia with ropivacaine 0.1% 8 mL followed by ropivacaine 0.2% 8 mL/h was administered. With clonidine, duration of analgesia was increased (132 +/- 48 min [Group 1] and 154 +/- 42 min [Group 3] versus 91 +/- 44 min [Group 2]; P < 0.05), and total ropivacaine dose over the first 4 h was significantly reduced (40.5 +/- 15 mg [Group 1] and 47.0 +/- 16 mg [Group 3] versus 72.5 +/- 18 mg [Group 2]; P < 0.01). The incidence of more profound motor block was more frequent in Group 2 (P < 0.05). Although there was a trend for more women receiving clonidine to require ephedrine for treatment of hypotension, this did not seem to have an impact on fetal outcome or incidence of cesarean deliveries for nonreassuring fetal heart rate tracings. This study demonstrates the dose-sparing effect of clonidine when added to ropivacaine. IMPLICATIONS: The effect of adding 75 micro g of clonidine to ropivacaine for epidural labor analgesia was studied. Clonidine increased analgesia duration and produced dose sparing compared with ropivacaine alone. Despite a tendency for hypotension in women receiving clonidine, there was no apparent effect on delivery mode or neonatal outcome.
PMID: 12198061, UI: 22186448
Anesth Analg 2002 Sep;95(3):656-60
Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, and Department of Anesthesiology, Children's Hospital, Harvard Medical School, Boston, Massachusetts.
Numerous studies have suggested that chronic exposure to trace levels of anesthetic gas is harmful to operating room (OR) personnel. In the delivery of pediatric general anesthesia, an uncuffed endotracheal tube (ETT) is normally used which can result in considerable volatile anesthetic and nitrous oxide contamination of the OR. In this report, we present a method to reduce exposure to these anesthetic gases by means of an anesthetic scavenging hood (ASH). The ASH was used on six pediatric patients undergoing general endotracheal anesthesia via an uncuffed ETT. Measurements of all ambient gas levels were made 6 in. horizontally from the patient's ear and 6 in. from the table surface. The application of the vacuum source to the ASH resulted in a very significant (P < 0.01, paired t-test) decrease in levels of ambient anesthetic gas, with no measurable change in ventilatory variables or changes in body temperature (P > 0.05, paired t-test). Discontinuation of the vacuum force to the ASH resulted in a marked increase in ambient levels of anesthetic gas. We conclude that the ASH is extremely effective in reducing waste anesthetic gas associated with anesthesia administered via an uncuffed ETT. The ASH may be a valuable and cost-effective addition in the OR for both reducing ambient anesthetic waste gas levels and conserving patient heat. IMPLICATIONS: Chronic exposure to trace levels of anesthetic gas is harmful to operating room personnel, especially in the delivery of pediatric general anesthesia via an uncuffed endotracheal tube. The anesthetic scavenging hood is a cost-effective and efficient method to reduce these waste anesthetic gases, and it offers patient heat conservation.
PMID: 12198055, UI: 22186442
Anesth Analg 2002 Sep;95(3):609-14
Department of Anesthesia and Perioperative Care, University of California, San Francisco.
IMPLICATIONS: The two experimental designs (quantal and bracketing) used for population minimum alveolar anesthetic concentration studies give equivalent results. An expression relating variability in terms of Hill coefficients and SD is presented. Evolutionary implications of low population variability in anesthetic phenotypes is discussed.
PMID: 12198046, UI: 22186433
Anesth Analg 2002 Sep;95(3):597-605
Departments of Anesthesia and Surgery, Institut Gustave Roussy, Villejuif, France.
Hypnotics and opioids interact synergistically to block responses to surgery and different dose combinations may be used to provide adequate anesthesia. In this study, we sought to determine the optimal concentrations of propofol and sufentanil, given by target-controlled infusions, to ensure hemodynamic stability, adequate hypnosis (assessed by electroencephalogram bispectral index(TM)), and fast recovery for a moderately painful operation. Forty-five patients, ASA physical status I or II, undergoing thyroidectomy, were randomly assigned to a sufentanil target concentration (STC) that was maintained throughout surgery (0.1, 0.2, or 0.3 ng/mL). The propofol target concentration was adjusted to keep mean arterial blood pressure within 30% of a reference value, and bispectral index(TM) between 40 and 60. Adequate anesthesia was obtained in all groups. Hypertension and clinically dangerous movements were more frequent with the small STC, and hypotension requiring treatment was more frequent with the large STC. Propofol target concentration during surgery decreased significantly with increasing STC (median at thyroid removal 5.0, 4.0, and 2.5 micro g/mL, respectively) as well as the propofol consumption (740, 668, 474 mg/h). The 0.3 ng/mL STC significantly delayed the return of spontaneous breathing. IMPLICATIONS: Given as a target-controlled infusion for thyroid surgery, sufentanil 0.3 ng/mL for intubation and 0.2 ng/mL during surgery, combined with propofol 4 micro g/mL (corresponding to a maintenance infusion rate of approximately 7-10 mg. kg(-1). h(-1)), is recommended to ensure both optimal intraoperative stability and fast recovery.
PMID: 12198044, UI: 22186431
Anesth Analg 2002 Sep;95(3):578-82
Departments of Anesthesiology and Pharmacology, University of Pittsburgh, Pennsylvania.
We used two mouse lines with glycine receptor mutations to determine whether glycine receptors might play an important role in anesthetic responses in vivo. Spastic (spA) mutants were slightly more sensitive (P = 0.02) to enflurane in the loss-of-righting reflex assay (50% effective concentration [EC(50)] = 1.17 +/- 0.06 atm for controls versus 0.97 +/- 0.06 atm for spA) but were also substantially more resistant (P = 0.01) to enflurane in the tail clamp assay (EC(50) = 1.96 +/- 0.10 atm for controls versus 2.58 +/- 0.25 atm for spA). spA mice were also more sensitive to halothane (P < 0.001) in the loss-of-righting reflex assay (EC(50) = 0.81 +/- 0.03 atm for controls versus 0.57 +/- 0.04 atm for spA), but the responses of mutant and control mice to tail clamp in the presence of halothane were similar. Spasmodic control and mutant mice did not differ in their responses to the two drugs. Sleep time was substantially longer in both mutant mouse lines after injection of three hypnotics (midazolam, pentobarbital, and ethanol). Our results suggest a complex involvement of glycinergic pathways in mediating anesthetic responses. Greater sensitivity to the hypnotic effect of enflurane, halothane, midazolam, pentobarbital, and ethanol in mutant mice with diminished glycinergic capacity suggests that glycinergic activity is inversely related to hypnosis, whereas resistance to enflurane in the tail clamp assay suggests that glycinergic activity potentiates the minimum alveolar anesthetic concentration response. Halothane seems to share some, but not all, of enflurane's mechanisms, indicating that not all volatile anesthetics modulate glycinergic pathways equally. IMPLICATIONS: We tested two mouse lines with glycine receptor mutations to determine whether glycine receptors might play an important role in anesthetic responses in vivo. Both sensitivity and resistance to common anesthetics were observed in mutant mice, depending on the behavioral end-point evaluated.
PMID: 12198041, UI: 22186428
Anesth Analg 2002 Sep;95(3):573-7
Departments of Anesthesia, Harvard Medical School.
The nonhalogenated anesthetic alkanes, cyclopropane and butane, do not enhance gamma-aminobutyric acid-elicited GABAergic currents, suggesting that these agents produce anesthesia via interactions with other molecular targets. Perhalogenated nonimmobilizing alkanes, such as 1,2-dichlorohexafluorocyclobutane and 2,3-dichlorooctafluorobutane, also fail to enhance GABAergic currents, but display specific behavioral effects that are distinct from those of structurally similar anesthetics. At concentrations predicted to be anesthetic, 1,2-dichlorohexafluorocyclobutane and 2,3-dichlorooctafluorobutane produce amnesia but fail to produce immobility. Neuronal nicotinic acetylcholine (nACh) receptors are sensitive to many anesthetics and are thought to have an important role in learning and memory. We postulated that neuronal nACh receptors might mediate the common amnestic action of nonhalogenated and perhalogenated alkanes. To test the hypothesis that neuronal nACh receptors have a role in mediating the behavioral effects of general anesthetics and nonimmobilizers, we quantified the inhibitory potencies of nonhalogenated anesthetic alkanes and perhalogenated nonimmobilizing alkanes on currents mediated by alpha(4)beta(2) neuronal nACh receptors. Our studies reveal that anesthetics and nonimmobilizers significantly inhibit alpha(4)beta(2) neuronal nACh receptors at concentrations that suppress learning and with potencies that correlate with their hydrophobicities. These results support the hypothesis that alpha(4)beta(2) neuronal nACh receptors mediate the amnestic actions of alkanes but not their immobilizing actions. IMPLICATIONS: The results of this study suggest that the immobilizing actions of general anesthetics do not result from the inhibition of alpha(4beta2) neuronal nicotinic acetylcholine receptors. However, the inhibition of neuronal nicotinic acetylcholine receptors may account for the amnestic activities of general anesthetics and nonimmobilizers.
PMID: 12198040, UI: 22186427
Anesth Analg 2002 Sep;95(3):555-7
Department of Anaesthesia, Royal Infirmary of Edinburgh, Scotland.
IMPLICATIONS:A patient with catecholaminergic polymorphic ventricular tachycardia required anesthesia for implantation of a defibrillator. The diagnostic criteria, treatment, and anesthetic considerations for this rare, familial dysrhythmia are described.
PMID: 12198034, UI: 22186421
Anesth Analg 2002 Sep;95(3):509-11
Waggoner Center for Alcohol and Addiction Research, University of Texas at Austin, Austin, Texas.
PMID: 12198026, UI: 22186413
Anesthesiology 2002 Jun;96(6):1533-4; discussion 1534-5
Publication Types:
PMID: 12170080, UI: 22159364
Anesthesiology 2002 Jun;96(6):1530; discussion 1530-1
PMID: 12170077, UI: 22159361
Anesthesiology 2002 Jun;96(6):1435-42
Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston, Massachusetts 02115, USA. gerner@zeus.bwh.harvard.edu
BACKGROUND: The antidepressant amitriptyline is commonly used orally for the treatment of chronic pain, particularly neuropathic pain, which is thought to be caused by high-frequency ectopic discharge. Among its many properties, amitriptyline is a potent Na(+) channel blocker in vitro, has local anesthetic properties in vivo, and confers additional blockade at high stimulus-discharge rates (use-dependent blockade). As with other drug modifications, adding a phenylethyl group to obtain a permanently charged quaternary ammonium derivative may improve these advantageous properties. METHODS: The electrophysiologic properties of N-phenylethyl amitriptyline were assessed in cultured neuronal GH(3) cells with the whole cell mode of the patch clamp technique, and the therapeutic range and toxicity were evaluated in the rat sciatic nerve model. RESULTS: In vitro, N-phenylethyl amitriptyline at 10 microm elicits a greater block of Na(+) channels than amitriptyline (resting block of approximately 90% vs. approximately 15%). This derivative also retains the attribute of amitriptyline in evoking high-degree use-dependent blockade during repetitive pulses. In vivo, duration to full recovery of nociception in the sciatic nerve model was 1,932 +/- 72 min for N-phenylethyl amitriptyline at 2.5 mm (n = 7) versus 72 +/- 3 min for lidocaine at 37 mm (n = 4; mean +/- SEM). However, there was evidence of neurotoxicity at 5 mm. CONCLUSION: N-phenylethyl amitriptyline appears to have a narrow therapeutic range but is much more potent than lidocaine, providing a block duration several times longer than any clinically used local anesthetic. Further work in animal models of neuropathic pain will assess the potential use of this drug.
PMID: 12170057, UI: 22159341
Anesthesiology 2002 Jun;96(6):1310-4
Department of Anesthesiology, Leiden University Medical Center, Leiden, The Netherlands.
BACKGROUND: Extension of sensory blockade after an epidural top-up in combined spinal epidural (CSE) anesthesia is partly attributed to compression of the dural sac by the injected volume. This study investigated whether a volume effect plays a significant role when administering an epidural top-up after an initial epidural loading dose and assessed the predictive value of different factors with respect to the increase in sensory blockade. METHODS: After an epidural loading dose of 75 mg ropivacaine, 0.75%, 30 patients were randomly assigned to one of three groups. After the maximum level of sensory blockade (MLSB) had been established, patients received either an epidural top-up with 10 ml ropivacaine, 0.75% (group 1, n = 10) or saline (group 2, n = 10), or no epidural top-up (group 3, n = 10). Subsequently, sensory blockade was assessed at 5-min intervals for a further 30 min by a blinded observer. RESULTS: The MLSB increased significantly in the patients receiving an epidural top-up with ropivacaine but not in the patients receiving normal saline. Sensory block extension was inversely related to the number of segments blocked at the time of the epidural top-up, and female gender was associated with a smaller increase in MLSB. CONCLUSIONS: When using epidural ropivacaine, the extension of sensory blockade after administering an epidural top-up is caused by a local anesthetic effect and not by a volume effect. Under the conditions of this study, predictors of the increase in sensory blockade are the presence of ropivacaine in the top-up injectate, the number of segments blocked at the time of epidural top-up, and gender.
PMID: 12170041, UI: 22159325
Anesthesiology 2002 Jun;96(6):1297-304
Department of Anesthesiology and Orthopedics and Rehabilitation, University of Florida College of Medicine, Gainesville, Florida 32610, USA.
BACKGROUND: This randomized, double-blinded, placebo-controlled study investigated the efficacy of patient-controlled regional analgesia using an infraclavicular brachial plexus perineural catheter and a portable infusion pump for outpatients undergoing moderately painful, upper extremity orthopedic surgery. METHODS: Preoperatively, patients (n = 30) received an infraclavicular nerve block and perineural catheter. Postoperatively, patients were discharged home with oral narcotics and a portable infusion pump delivering study solution (0.2% ropivacaine or 0.9% saline) via the catheter for 3 days. Investigators and patients were blinded to random group assignment. Daily end points included pain scores at rest and with limb movement, narcotic use and side effects, sleep quality, patient satisfaction, and symptoms of catheter- or local anesthetic-related complications. RESULTS: Ropivacaine (n = 15) infusion significantly reduced pain compared with saline (n = 15) infusion (P < 0.001). For example, the average pain with movement (scale, 0-10) on postoperative day 1 was 6.1 +/- 2.3 for the saline group versus 2.5 +/- 1.6 for the ropivacaine group (P < 0.001). Oral narcotic use and related side effects were significantly decreased in the ropivacaine group. For example, on postoperative day 1, mean tablet consumption was 5.5 +/- 2.4 and 1.7 +/- 1.6 for the saline and ropivacaine groups, respectively (P < 0.001). Sleep disturbance scores were 10-fold greater for saline administration than for ropivacaine infusion (P < 0.001). Overall satisfaction was significantly greater in the ropivacaine group. No catheter- or local anesthetic-related complications occurred. CONCLUSION: After moderately painful orthopedic surgery of the upper extremity, ropivacaine infusion using a portable, mechanical pump and an infraclavicular brachial plexus perineural catheter at home decreased pain, sleep disturbances, narcotic use and related side effects, and improved overall satisfaction.
PMID: 12170039, UI: 22159323
Anesthesiology 2002 Jun;96(6):1290-6
Department of Anesthesiology and Intensive Care, Orebro Medical Center Hospital, Orebro, Sweden. n.rawal@orebroll.se
BACKGROUND: The aim of this randomized, double-blinded study was to compare the analgesic efficacy of bupivacaine versus ropivacaine brachial plexus analgesia after ambulatory hand surgery. An additional aim was to study the feasibility and safety of patient-controlled regional analgesia (PCRA) outside the hospital. METHODS: Sixty patients scheduled for ambulatory hand surgery underwent surgery with axillary plexus blockade. After surgery, the plexus catheter was connected to an elastomeric, disposable "homepump," containing 100 ml of either 0.125% bupivacaine or 0.125% ropivacaine. When patients experienced pain, they self-administered 10 ml of the study drug. Analgesic efficacy of PCRA was evaluated by self-assessment of pain intensity by visual analog scale (VAS) and verbal scale. Patients recorded adverse effects, technical problems, use of rescue analgesic tablets, and overall satisfaction. A follow-up telephone call was made the day after surgery. RESULTS: Visual analog scale scores decreased after each treatment in both groups, but there were no significant differences between the two drugs. One patient in each group took rescue dextropropoxyphene tablets. In both groups, 87% patients expressed their desire to have the same treatment again. On the day of surgery, significantly more patients were satisfied with ropivacaine PCRA. None of the patients had any signs or symptoms of local anesthetic toxicity or catheter infection. CONCLUSIONS: This double-blinded study has demonstrated the feasibility of self-administration of local anesthetic to manage postoperative pain outside the hospital. Ropivacaine and bupivacaine provided effective analgesia, and patient satisfaction with PCRA was high. Patient selection, follow-up telephone call, and 24-h access to anesthesiology services are prerequisites for PCRA at home.
PMID: 12170038, UI: 22159322
Anesthesiology 2002 Jun;96(6):1283-5
PMID: 12170035, UI: 22159319
Ann Fr Anesth Reanim 2002 Jun;21(6):f93-6
Service d'anesthesie-reanimation chirurgicale, CHU, hopital Central, CO no. 34, 54035 Nancy, France.
PMID: 12134607, UI: 22130666
Ann Fr Anesth Reanim 2002 Jun;21(6):542-3
PMID: 12134604, UI: 22130663
Ann Fr Anesth Reanim 2002 Jun;21(6):517-20
Service d'anesthesie-reanimation chirurgicale, Hotel-Dieu, 44093 Nantes, France. thierry.lepoivre@free.fr
A caesarean section was indicated in a 29-year-old parturient affected by a muscular deficit in myophosphorylase responsible for a type V glycogen storage disease (McArdle disease). This metabolic myopathy had been diagnosed two years previously, whereas the patient already suffered from a hereditary form of dilated cardiomyopathy. The muscular disease was invalidating on the functional level with exercise intolerance. The cardiopathy was little symptomatic but the dysfunction of the left ventricle worsened during the pregnancy with an ejection fraction calculated to 43%. In this case, we report the realization of a general anaesthesia in a patient who had epidural anaesthesia for a previous caesarean section.
PMID: 12134596, UI: 22130655
Ann Fr Anesth Reanim 2002 Jun;21(6):464-70
Departement d'anesthesie-reanimation III, hopital Pellegrin-Tondu, 5, place Amelie Raba-Leon, 33076 Bordeaux, France. secretariat.ballanger@bu-u-bordeaux2.fr
OBJECTIVE: To investigate the effects of coeliosurgery by catecholamine assays and the use of urapidil in the management of phaeochromocytoma. STUDY DESIGN: Prospective cohort study. PATIENTS: Nine consecutive patients from April 1997 to April 2001. METHODS: Urapidil (250 mg.j-1) was administered by continuous intravenous infusion three days before surgery and continued throughout anaesthesia. Plasma catecholamine concentrations were measured before surgery, after induction of anaesthesia, during insufflation, after adrenalectomy and in the recovery room. Haemodynamic disorders were treated by nicardipine +/- esmolol bolus doses. RESULTS: Creation of pneumoperitoneum and adrenal gland manipulations resulted in significant catecholamine releases associated with hypertension in five and eight patients respectively. Preventive urapidil use enabled easy control of blood pressure variations by additive antihypertensive drugs. CONCLUSION: Perioperative alpha 1 blockade by urapidil enables an effective and easy control of acute preoperative haemodynamic changes.
PMID: 12134591, UI: 22130650
Ann Fr Anesth Reanim 2002 Jun;21(6):456-7
PMID: 12134589, UI: 22130648
Ann Fr Anesth Reanim 2002 Jun;21(6):455
PMID: 12134588, UI: 22130647
Ann Fr Anesth Reanim 2002 Jun;21(6):453-4
PMID: 12134587, UI: 22130646
Other Formats: Links:
BMJ 2002 Aug 10;325(7359):339
PMID: 12173621, UI: 22161466
Br Dent J 2002 Jul 27;193(2):64
PMID: 12199126, UI: 22188012
Can J Anaesth 2002 Aug;49(7):760
Tel Aviv, Israel. Pittsburgh, Pennsylvania.
PMID: 12193505, UI: 22181044
Can J Anaesth 2002 Aug;49(7):759-60
Dallas, Texas. Toronto, Ontario.
PMID: 12193504, UI: 22181043
Can J Anaesth 2002 Aug;49(7):718-23
Department of Anesthesia, University of Cattolica del Sacro Cuore di Roma, Policlinico Universitario "A. Gemelli", Rome, Italy.
PURPOSE: Several experimental and clinical studies have demonstrated a direct bronchoconstrictor effect of opioids on smooth bronchial musculature following iv administration. The aim of this study was to evaluate the effects of alfentanil on respiratory system mechanics in a group of ASA I patients ventilated mechanically during general anesthesia. Clinical features: Twenty consecutive ASA I patients (ten men and ten women) scheduled for general surgery interventions were studied (mean age 45.4 +/- 9.9 yr, mean weight 61.9 +/- 6.7 kg). Exclusion criteria were a history of chronic obstructive pulmonary disease, asthma or other pulmonary disease, atopy, wheezes, smoking and age below 18 yr. Subjects were randomly divided in two groups: Group A, receiving alfentanil at a 15 micro g*kg(-1) dose and Group B receiving alfentanil at a 30 micro g*kg(-1) dose. Respiratory mechanic variables were acquired at baseline (T0) and after three, ten and 15 min (T1, T2 and T3, respectively). We compared the basal values to the values measured at each time interval; basal values, prior to drug administration, served as control for each patient. P values < 0.05 were considered statistically significant. RESULTS: We did not observe significant differences in respiratory mechanic variables after the administration of alfentanil, 15 and 30 micro g*kg(-1). More specifically, respiratory system compliance and the different subcomponents of respiratory system resistances (i.e., maximum, minimum and delta resistance of respiratory system) were within normal limits and did not vary after alfentanil administration. CONCLUSION: No respiratory adverse effect was reported after alfentanil iv administration.
PMID: 12193492, UI: 22181031
Can J Anaesth 2002 Aug;49(7):701-5
Department of Anesthesiology, Magee-Womens Hospital, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
PURPOSE: This study compares plasma lidocaine concentrations in 16-sets of twin neonates to 16-singleton neonates all of whom were delivered by Cesarean section under lumbar epidural anesthesia (LEA). METHODS: Lidocaine 1.5% with epinephrine 5 micro g*mL(-1) was used for activation of LEA. Upon delivery plasma lidocaine concentrations were measured from the maternal vein (MV), neonatal umbilical vein (UV) and umbilical artery (UA) using TDx fluorescence polarization immunoassay. RESULTS: MV lidocaine concentrations were similar in both twin and singleton mothers. Both mean lidocaine UV and UA levels were 35% higher in twin A (first-delivered) compared to the singleton neonate, (P < 0.01, t test). Similarly, twin B mean UV and UA lidocaine levels were 35% and 53% higher than the singleton value (P < 0.01). Mean UV and UA lidocaine fetal/maternal ratios in both twins were at least 18% higher than the singleton value (P < 0.05). CONCLUSION: Even though there were no differences in neonatal outcome, a potential does exist for high plasma lidocaine concentrations in twin fetuses, suggesting that the total maternal dose of lidocaine must be regulated carefully.
PMID: 12193489, UI: 22181028
Can J Anaesth 2002 Aug;49(7):678-81
Departments of Anesthesiology, and Surgery A, Rabin Medical Center, Beilinson Campus, Petach Tikva, Israel.
PURPOSE: To present a case of spinal anesthesia in a patient suffering from carcinoid syndrome undergoing an inguinal hernia repair. In the past, regional anesthesia was considered unacceptable in these patients because of the possibility of intraoperative hypotension, hypertension, or bronchospasm. Recently, however, the preoperative use of octreotide, the synthetic analogue of the naturally occurring hormone somastatin, has been found to prevent these complications. Nevertheless, it remains unclear whether the use of this drug in patients with carcinoid syndrome allows the possibility of regional anesthesia. Clinical findings: We report the uneventful use of spinal anesthesia in a patient suffering from carcinoid syndrome treated with long-acting octreotide. With careful attention to volume status of the patient and low volume of local anesthetics (10 mg hyperbaric bupivacaine 0.5%) supplemented with intrathecal narcotics (fentanyl 20 micro g), we were able to prevent any episodes of intraoperative hypotension in this patient. Octreotide was available in the operating theatre in case of an emergency. One of the original aspects of this case report is that the patient received long-acting octreotide (once a month administration) instead of the usual daily dose. In addition this is one of the few reports of spinal anesthesia administered to a patient with carcinoid syndrome. CONCLUSION: Preoperative octreotide may result in more favourable conditions for regional anesthesia in patients with carcinoid syndrome. However, further studies will be required to confirm the favourable outcome observed in this patient.
PMID: 12193484, UI: 22181023
Can J Anaesth 2002 Aug;49(7):671-7
Departments of Anesthesia, University of Manitoba, University of Toronto, and McGill University.
PURPOSE: To examine the supply of physician anesthesia providers necessary to accommodate the previously described clinical and non-clinical service volume needs throughout Canada METHODS: The Canadian Medical Association (CMA) physician database provided baseline specialist anesthesiologists numbers and ages as of January 1, 2000. The Royal College of Physician and Surgeons of Canada (RCPSC) provided annual anesthesia certificant numbers for the period 1971-2000. Combining these data with the separately reported estimates of anesthesia provider needs for the years 1999 and 2016, the matching of anesthesia provider supply and demand during the period 2000-2016 was examined. RESULTS: The CMA database included 2,287 anesthesiologists in Canada on January 1, 2000. The needs assessment (clinical and non-clinical) identified the requirement for 2,495 full time equivalent (FTE) anesthesiologists in 1999 and 3,265 in 2016 (31% increase). Taking into account the ages of current anesthesiologists, the increased future requirements and the current rate of graduation from RCPSC-approved training programs in Canada a deficit of at least 656 FTEs is identified for the period 2000-2016 (average 41 per year). CONCLUSIONS: Canada has a current shortage of anesthesiologists. Based on the assessment of future needs in Quebec and extrapolated to all provinces, this shortage will worsen, unless Canadian training programs are expanded or other steps are taken to augment the numbers of anesthesia practitioners. Ongoing studies in each province are required to validate and update these conclusions.
PMID: 12193483, UI: 22181022
Can J Anaesth 2002 Aug;49(7):663-70
Departments of Anaesthesia, University of Toronto, University of Manitoba, and McGill University.
PURPOSE: A human resource planning model for anesthesiology is described. METHODS: The model uses 'per capita' expenditure for anesthesiologists in Quebec, as a measure of clinical services provided to different age/gender groups. The future demand for anesthesia services is calculated as the product of 'per capita' expenditure and the population projections to a future date. Future demand was converted into full-time equivalent (FTE) providers required, by dividing by the annual 'units of service' optimally delivered by one FTE anesthesiologist. The pattern of age/gender (demographic) consumption of anesthesia services in Quebec was compared with data from Ontario to validate its use in a planning model. The model was then applied to all provinces and territories. RESULTS: The 'per capita' expenditures on anesthesia services in Quebec and Ontario showed a regular pattern. Using the model, the estimated 1999 demand for FTE anesthesiologists to provide clinical services in Quebec is 546 and 669 for 2016. When non-clinical demands were included, we estimated that Quebec's total demand will increase to approximately 730 FTEs in 2016. Similar estimates are made for all provinces. The population increase anticipated is 17.9% but the increase in FTE demand in Canada is 30.9%. CONCLUSION: The model showed that the cause of the increased FTE demand for anesthesiologists is a combination of increased population and its demographic composition. The relative impact of each of these factors varies in different provinces. Effective specialty-specific planning models can be designed but they need ongoing committed resources and personnel for their usefulness to be maximized.
PMID: 12193482, UI: 22181021
Can J Anaesth 2002 Aug;49(7):659-62
Department of Anesthesia, Sunnybrook & Women's College Health Sciences Centre, and The Centre for Research in Education, University of Toronto, Toronto, Ontario, Canada.
PURPOSE: To gather information regarding the global use of simulation technology in education, evaluation and research in anesthesia. METHODS: The WorldWide Web was searched and located sites with simulation centres (n = 158) were mailed a 67-item questionnaire requesting information regarding demographics, personnel, education use and research involvement. Comments were solicited. Medical school data only are reported in this article. RESULTS: Two web sites were used to generate the list of simulation centres. Sixty responses were received (38%), with 41 emanating from medical schools. Seventy-seven percent of centres were involved in undergraduate education and 85% in postgraduate education. Few centres were involved in evaluation and/or competency assessments. Sixty-one percent of centres indicated ongoing research with a further 25% interested in international collaboration. University or university departmental-based funding largely supported simulation technology used in medical schools. The lack of financial and human resources was the single most common problem identified by respondents. CONCLUSIONS: From the survey responses received, opportunities for the simulator to be used for the assessment of performance appear to be under-utilized. This may be due to the lack of research in this area, lack of standardized, valid and reliable tests and the fact that most centres have only recently acquired this technology. Further research supporting the use of the simulator in education and evaluation is required.
PMID: 12193481, UI: 22181020
Can J Anaesth 2002 Aug;49(7):655-8
Edmonton, Alberta. Toronto, Ontario.
PMID: 12193480, UI: 22181019
Can J Anaesth 2002 Aug;49(7):650-4
Department of Continuing Medical Education and Professional Development, Vancouver Island Health Authority, Royal Jubilee Hospital, Victoria, British Columbia, Canada.
PMID: 12193479, UI: 22181018
Can J Anaesth 2002 Aug;49(7):647-9
Department of Anesthesia, Hopital Maisonneuve-Rosemont, Montreal, Quebec, Canada.
PMID: 12193478, UI: 22181017
Eur J Anaesthesiol 2002 Aug;19(8):604-8
Cork University Hospital, Departments of Anaesthesia and Intensive Care Medicine.
BACKGROUND AND OBJECTIVE: Volatile anaesthetic agents are known to influence neutrophil function. The aim was to determine the effect of chronic occupational exposure to volatile anaesthetic agents on the rate of neutrophil apoptosis among anaesthetists. To test this hypothesis, we compared the rate of neutrophil apoptosis in anaesthetists who had been chronically exposed to volatile anaesthetic agents with that in unexposed volunteers. METHODS: Venous blood (20 mL) was withdrawn from 24 ASA I-II volunteers, from which neutrophils were isolated, and maintained in culture. At 1, 12 and 24 h in culture, the percentage of neutrophil apoptosis was assessed by dual staining with annexin V-FITC and propidium iodide. RESULTS: At 1 h (but not at 12 and 24 h) in culture, the rate of neutrophil apoptosis was significantly less in the anaesthetists--13.8 (12.9%) versus 34.4 (12.1%) (P = 0.001). CONCLUSIONS: Chronic occupational exposure to volatile anaesthetic agents may inhibit neutrophil apoptosis. This may have implications for anaesthetists and similarly exposed healthcare workers in terms of the adequacy of their inflammatory response.
PMID: 12200952, UI: 22189791
Eur J Anaesthesiol 2002 Aug;19(8):600-3
Self Defense Force Hanshin Hospital, Department of Anaesthesia, 4-1-50 Kushiro, Kawanishi, Hyogo 666-0024, Japan. higu-chi@ka2.so-net.ne.jp
BACKGROUND AND OBJECTIVE: Although the MACtetanus (minimum alveolar concentration that prevents movement in response to electrical tetanus stimulation in 50% of patients) of isoflurane decreases during anaesthesia and surgery, it is not known whether this occurs to the same extent with other inhalational anaesthetics. We determined the MACtetanus of sevoflurane before and after surgery. METHODS: Eleven patients who underwent arthroscopy of the shoulder underwent inhalational induction of anaesthesia with sevoflurane and tracheal intubation by succinylcholine. MACtetanus was determined in each patient by testing the response to a 10 s, 50 Hz, 80 mA transcutaneous tetanic electrical stimulus to the ulnar nerve at varying concentrations of sevoflurane. The end-tidal concentration of sevoflurane was kept constant for 15 min before each stimulus and the concentration of sevoflurane varied in increments of 0.1% until a sequence of three alternate responses (move, not move, move) or (not move, move, not move) was obtained. After arthroscopy of the shoulder, individual MACtetanus were measured as described above. RESULTS: The mean MACtetanus decreased from 2.22 +/- 0.29% before arthroscopy to 1.82 +/- 0.26% after arthroscopy (P < 0.01). CONCLUSIONS: It is concluded that the MACtetanus of sevoflurane decreases during anaesthesia and surgery.
PMID: 12200951, UI: 22189790
Eur J Anaesthesiol 2002 Aug;19(8):594-9
Vita-Salute University of Milano, IRCCS H. San Raffaele Department of Anaesthesiology, Milano, Italy.
BACKGROUND AND OBJECTIVE: The aim of this prospective, randomized study was to compare the preparation and discharge times, the side-effects and patient satisfaction after gynaecological outpatient procedures performed using either spinal block or total intravenous anaesthesia with propofol and remifentanil. METHODS: With Ethics Committee approval and written informed consent, 40 healthy females scheduled for hysteroscopic ablation of endometrial neoplasm were randomly allocated to receive either a spinal block with bupivacaine 0.5% hyperbaric solution 10 mg (n = 20) or total intravenous anaesthesia with propofol and remifentanil (n = 20). Preparation and discharge times, as well as occurrence of untoward events and anaesthesia-related costs, were recorded. RESULTS: The median (range) preparation time was 7 (7-10) min with general anaesthesia, and 11 (7-21) min with spinal block (P = 0.00005). No differences in discharge time from the postanaesthesia care unit and incidence of hypotension or bradycardia, or both, were reported between the two groups. Hospital discharge times were 156 (101-345) min after general anaesthesia and 296 (195-720) min after spinal anaesthesia (P = 0.0005). Acceptance of the anaesthesia technique was better after general (100%) than after spinal anaesthesia (75%) (P = 0.04). No differences in total costs were reported between spinal block ([symbol: see text] 155 ([symbol: see text] 117-[symbol: see text] 224)) and propofol-remifentanil general anaesthesia ([symbol: see text] 143 ([symbol: see text] 124-[symbol: see text] 203) (P = 0.125)). CONCLUSIONS: Accurate titration of short-acting intravenous anaesthetic drugs such as propofol and remifentanil results in shorter preparation times and earlier home discharge after outpatient gynaecological procedures compared with spinal anaesthesia with hyperbaric bupivacaine 10 mg, with better patient acceptance and no increased costs.
PMID: 12200950, UI: 22189789
Eur J Anaesthesiol 2002 Aug;19(8):589-93
Hospital Universitari de Girona Dr. Josep Trueta, Department of Anesthesia, Av. de Franca s/n., E-17007 Girona, Catalonia, Spain. anestesia@htrueta.scs.es
BACKGROUND AND OBJECTIVE: The alpha 2-adrenoceptor agonist clonidine has potent central antinociceptive properties. The study was designed to investigate the effects of the combined subarachnoid administration of clonidine and prilocaine on spinal block and postoperative analgesia for the transurethral resection of tumours in the urinary bladder. METHODS: The controlled, prospective, double-blind study enrolled 40 patients scheduled for elective transurethral resection of bladder tumours under spinal anaesthesia with prilocaine. Patients were randomly assigned to receive an intrathecal injection of prilocaine 75 mg alone (control group) or in combination with clonidine 75 micrograms. We assessed haemodynamic changes (non-invasive arterial pressure, heart rate), pulse oximetry, the upper level of block, the onset and duration of sensory and motor block, postoperative analgesia and any adverse effects. RESULTS: There were no statistically significant differences in demographic data, heart rate, onset time or the levels of sensory or motor block. Analgesia lasted significantly longer in the clonidine group (498.4 +/- 226.9 versus 187.2 +/- 103.1 min; P < 0.05). The duration of motor block was longer in the clonidine group (165.5 +/- 30.6 min) than in the control group (139.7 +/- 40.4 min; P < 0.05) and the duration of sensory block was also longer in the clonidine group (157.3 +/- 24.5 min) than in the control group (137.2 +/- 31.2 min; P < 0.05). Fewer patients in the recovery room needed metamizol (dipyrone) in the clonidine group (5%) than in the control group (50%). Arterial pressure decreased significantly in the clonidine group 75-135 min after the block. CONCLUSIONS: The addition of clonidine 75 micrograms to prilocaine 75 mg for subarachnoid anaesthesia increased the duration of sensory and motor block and reduced the need for additional postoperative analgesics by providing excellent analgesia for about 8 h during recovery from transurethral resection of bladder tumours.
PMID: 12200949, UI: 22189788
Eur J Anaesthesiol 2002 Aug;19(8):580-4
Manchester Royal Infirmary, Department of Anaesthesia, Manchester, M13 9WL, UK. danielconway@netscapeonline.co.uk
BACKGROUND AND OBJECTIVE: Target-controlled infusions of anaesthetic agents have become increasingly available. They can involve the use of propofol in combination with an opioid or a benzodiazepine. The effect site concentration of propofol infusions has been advocated as a method of estimating drug distribution. We investigated the influence of co-induction with remifentanil and midazolam on effect site propofol requirements at induction of anaesthesia using target-controlled infusions. METHODS: Sixty-six consenting adult patients were randomly allocated to three treatment groups. Each group received induction of anaesthesia with a different total intravenous technique. One group was induced with target-controlled propofol alone; another received target-controlled propofol and target-controlled remifentanil (3 ng mL-1); and the last received midazolam (0.03 mg kg-1), target-controlled remifentanil (3 ng mL-1) and target-controlled propofol. Computer simulation was used to calculate effect site concentrations. We recorded propofol dose and effect site concentration at loss of verbal response. RESULTS: The effect site concentration (Ce50) of propofol alone was 2.19 micrograms mL-1. This was reduced to 1.55 micrograms mL-1 during co-induction with remifentanil and further reduced to 0.64 microgram mL-1 with midazolam premedication (P < 0.001; ANOVA). CONCLUSIONS: We conclude that co-induction with remifentanil alone or with midazolam can be used to reduce propofol doses at induction of anaesthesia using target-controlled infusions. We believe that using effect site concentration may prove a useful tool in routine clinical practice.
PMID: 12200947, UI: 22189786
Eur J Anaesthesiol 2002 Aug;19(8):560-3
University Hospital Zurich, Department of Medical Economics, Switzerland.
BACKGROUND AND OBJECTIVE: We investigated whether an increase in anaesthesia staffing to permit induction of anaesthesia before the previous case had ended ('overlapping') would increase overall efficiency in the operating room. Hitherto, the average duration of operating sessions was too long, thus impeding the timely commencement of physicians' ward duties. METHODS: The investigation was designed as a prospective, non-randomized, interrupted time-series analysis divided into three phases: (a) a baseline of 3.5 months, (b) a 2.5 month intervention phase, in which anaesthesia staffing was increased by one attending physician and one nurse, and (c) a further 2 months under baseline conditions. Data focussed on process management were collected from operating room staff, anaesthesia personnel and surgeons using a structured questionnaire collected daily during the entire study. RESULTS: Turnover time between consecutive operations decreased from 65 to 52 min per operation (95% CI: 9; 17; P = 0.0001). Operating room occupancy increased from 4:28 to 5:27 h day-1 (95% CI: 50; 68; P = 0.005). The surgeons began their work on the ward 35 min (95% CI: 30; 40) later than before the intervention and their overtime increased from 22:36 to 139:50 h. CONCLUSIONS: The time between surgical operations decreased significantly. Increased operating room efficiency owing to overlapping induction of anaesthesia allows more intense scheduling of operations. Thus, physicians and nurses can be released to spend more time with their patients in the ward. Improving the efficiency of the operating room alone is insufficient to improve human resource management at all levels of a surgical clinic.
PMID: 12200944, UI: 22189783
Eur J Anaesthesiol 2002 Aug;19(8):543-9
PMID: 12200942, UI: 22189781
Eur J Anaesthesiol 2002 Feb;19(2):155-6
PMID: 11999605, UI: 21994252
Eur J Anaesthesiol 2002 Feb;19(2):147-8
PMID: 11999600, UI: 21994247
Eur J Anaesthesiol 2002 Feb;19(2):141-4
Pulmonary alveolar proteinosis is often treated with bronchopulmonary lavage. Transoesophageal echocardiography has been used to detect lung atelectasis in critical situations. A 68-yr-old male with pulmonary alveolar proteinosis underwent bronchopulmonary lavage and was examined using transoesophageal echocardiography. His dependent left-lung area was observed through the descending aorta. Following saline infusion, no bright areas containing air were observed. The average area of the air-free region following instillation was 37.4 +/- 1.8 cm2, which decreased to 22.8 +/- 2.6 cm2 after drainage (P < 0.001). There was a significant relationship between the percentage venous admixture and air-free area during lavage (P < 0.05, r = -0.76). The image of the right lung was unclear. Transoesophageal echocardiography can yield useful information about the lung during bronchopulmonary lavage.
PMID: 11999598, UI: 21994245
Eur J Anaesthesiol 2002 Feb;19(2):109-14
Vita Salute University, Department of Anaesthesiology, IRCCS H. San Raffaele, Milano, Italy. casati.andrea@hsr.it
BACKGROUND AND OBJECTIVE: To evaluate preparation and discharge times as well as the anaesthesia-related costs of out-patient knee arthroscopy performed with a combined sciatic-femoral nerve block, or a propofol-remifentanil general anaesthetic. METHODS: With Ethics Committee approval and written informed consent, 40 healthy patients were pre-medicated with intravenous midazolam (0.05 mg kg(-1)) and ketoprofen (50 mg). They were then randomly allocated to receive either a combined sciatic-femoral nerve block with 25 mL mepivacaine 2% (15 mL for the femoral nerve, 10 mL for the sciatic nerve) (PNB group, n = 20), or a general anaesthetic with a continuous intravenous infusion of remifentanil (0.1-0.3 microgkg(-1) min(-1)) and propofol (target plasma concentration 2-4 microg mL(-1)) with a laryngeal mask airway (GA group, n = 20). RESULTS: The median (range) preparation time was 16 (10-28)min in the PNB group and 13 (8-22)min in the GA group (P = 0.015). Ten PNB patients were directly discharged to the day-surgery unit after the procedure as compared with one GA patient (P = 0.003). Discharge from the postanaesthesia care unit (PACU) required 5 (5-20) min in the PNB group and 23 (7-95) min in the GA group (P = 0.001). Home discharge criteria were fulfilled after 277 (150-485) min in the PNB group and 170 (100-400) min in the GA group (P = 0.005). Costs related to the time spent in the PACU were lower for the PNB group (1.10 euro, range Euro 0-22 euro) compared with the GA group (30 euro, range 0-176 euro) (P = 0.0005). There were no differences in total costs: PNB group 158 euro (range 105-194 euro) versus GA group 160 euro (range 101-238 euro) (P = 0.61). CONCLUSIONS: In patients undergoing out-patient knee arthroscopy, the length of stay in the PACU can be shorter after a sciatic-femoral nerve block with a small volume of mepivacaine 2% compared with a propofol-remifentanil anaesthetic, and there is an increased likelihood that they will bypass the first phase of the postoperative recovery.
PMID: 11999592, UI: 21994239
Eur J Anaesthesiol 2002 Feb;19(2):105-8
Centre Medico-Chirurgical, Department of Anaesthesia and Intensive Care, Saint Vincent-Volney, Rennes, Ireland. Marc.Gentili@wanadoo.fr
BACKGROUND AND OBJECTIVE: Patients' perception of limb position during regional anaesthesia is frequently incorrect. The incidence and nature of this phenomenon has not yet been completely described. The aim of this prospective study was to assess phantom sensation in patients undergoing a brachial plexus block. METHODS: Axillary block was performed in 81 patients with the aid of a peripheral nerve stimulator. Immediately after the block, patients were allocated randomly to two groups (Group 1, n = 40; Group 2, n = 41) to have the blocked limb placed either on their thorax or in abduction. Fifteen minutes later, when the block was complete, the position of the limb was changed, without the knowledge of the patient, to a new position of abduction and flexion of the forearm. Patients were questioned about the new limb position. Fifteen minutes later, the limb was then transiently shown to the patient and further placed 'blindly' to another position. Patients were once more questioned about this new position. RESULTS: Correct perception was more frequently observed in both groups following the first interview. Thirty-two and 34 patients gave at least one erroneous response about their limb position when it was initially placed on the thorax or in abduction respectively. Transient visualization of the limb position did not improve the rate of correct response. CONCLUSIONS: Patients' perception of the position of the limb after axillary block in the majority of instances was probably due to persisting sensory inputs from the shoulder joint, which is not involved in this block. This is in contrast to supraclavicular or interscalene blocks. A significant number of patients experienced phantom limb sensation. They reported an arm position in fact related to the position of their arm before the axillary block.
PMID: 11999591, UI: 21994238
Neurosci Lett 2002 Jun 21;326(1):17-20
Institute of Chinese Medical Science, China Medical College, Taichung City, Taiwan.
We found that electroacupuncture (EA) at the Zhongwan acupoint released beta-endorphin to induce an insulin-dependent hypoglycemia in rats. The present study investigated the source of beta-endorphin. EA at 2 Hz for 30 min in rats decreased plasma glucose that could be abolished by naloxone. A similar effect of EA was also observed in wild-type mice but disappeared in mu-opioid receptor knockout mice. Mediation of the mu(1)-opioid receptor is considered from the blockade of response to EA by naloxonazine in rats. Otherwise, adrenalectomy abolished not only the hypoglycemic response to EA in rat and mouse but also the increase of plasma beta-endorphin and insulin by EA in rats. In conclusion, the increase of plasma beta-endorphin by EA at 2 Hz is mainly from the adrenal gland.
PMID: 12052528, UI: 22048144
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