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Anaesthesia 2002 Sep;57(9):943
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PMID: 12240620, UI: 22224968
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Anaesthesia 2002 Sep;57(9):931-2
PMID: 12240612, UI: 22224960
Anaesthesia 2002 Sep;57(9):928
PMID: 12240608, UI: 22224956
Anaesthesia 2002 Aug;57(8):836-7
PMID: 12182152, UI: 22168611
Anaesthesia 2002 Aug;57(8):805-11
Addenbrooke's NHS Trust, Cambridge, UK. cjccheng@yahoo.co.uk
Patients undergoing procedures under general anaesthesia as day cases are routinely given a set of instructions regarding activities to avoid in the first 24 h after discharge. Day surgery units generally specify the need for a responsible carer from time of discharge for a period of 24 h. This study looks at the compliance of 240 patients with postoperative instructions. Of the patients studied, 4.1% drove, 1.7% made important decisions, 3.3% drank alcohol, 0.8% took sedatives and 10% cooked, ironed or looked after children. All patients were discharged into the care of a responsible adult. However, 13.3% failed to have a carer with them for 24 h and 1.3% spent the night alone at home. Of our cohort, 25% were unable to comply with the postoperative instructions in full. The majority of non-compliance occurred on the day following surgery, suggesting that patients may feel that the advice is excessively cautious.
PMID: 12133095, UI: 22128343
Anaesthesia 2002 Aug;57(8):768-72
Departm,ent of Anaesthesiology and Pain Therapy, Bosch Medicentrum, 5200 ME's-Hertogenbosch, The Netherlands. t.lechner@compaqnet.nl
Fifty patients scheduled for surgery under lumbar epidural anaesthesia were included in a study to evaluate the possibility of localising the epidural space solely by means of an acoustic signal. With an experimental set-up, the pressure generated during the epidural puncture procedure was translated into a corresponding acoustic signal. One anaesthetist held the epidural needle with both hands and detected the epidural space by means of this acoustic signal. At the same time, a second anaesthetist applied the loss of resistance technique and functioned as control. In all patients the epidural space was located with the acoustic signal. This was confirmed by conventional loss of resistance in 49 (98%) of the patients; in one patient (2%) it was not. We conclude that it is possible to locate the epidural space using an acoustic signal alone.
PMID: 12133089, UI: 22128337
Anaesthesist 2002 Sep;51(9):754-9
Department of Anesthesiology, University of Florida.
[Medline record in process]
The specialty of anesthesiology has made extraordinary advances in anesthesia safety. Yet, anesthetic mortality and morbidity continue to be far from tolerable. Efforts to enhance safety in anesthesia must include adherence to explicit and implicit safety standards, must make use of equipment that offers modern safety features, must seek to detect and correct developing safety threats as early as possible and must have a structured system to analyze problems and to institute remedies to prevent their recurrence.
PMID: 12232648, UI: 22217081
Anaesthesist 2002 Sep;51(9):704-15
Klinik fur Anaesthesie und Allgemeine Intensivmedizin, Leopold-Franzens-Universitat Innsbruck.
Correct indications are essential to perform surgical procedures. However, appropriate timing to achieve minimal rates of complications even in high-risk patients or major surgery is at the top of the priority list. Perioperative responsibility is divided between anaesthesiologists and surgeons. While the surgeon is accountable for the surgical procedure, the anaesthesiologist is responsible for preoperative risk evaluation, perioperative management, and maintenance of vital organ functions. Both of these medical specialities must weigh the urgency of the procedure against patient-associated risk factors. Goals are optimal patient safety, efficient preoperative evaluation and subsequent optimisation to reduce the burden for the health care systems. For most patients without underlying diseases, a thorough history and physical examination is sufficient. In teaching hospitals, some laboratory results for screening of organ function are advisable. Patients can be stratified on clinical grounds into low-, medium-, and high-risk categories. Use of these categories, along with consideration of the type and urgency of surgery, allows for a reasonable approach to preoperative testing. Testing directed towards assessment of organ system functional reserve and identification of organs at risk rather than the diagnosis of a specific disease, is the primary goal of preoperative evaluation prior to surgery. These results are essential to prepare an effective anaesthetic plan. Along with increased patient comfort, the number of preoperative hospital days can be reduced by outpatient preoperative evaluation clinics.
PMID: 12232641, UI: 22217074
Anesth Analg 2002 Sep;95(3):785
PMID: 12198081, UI: 22186468
Anesth Analg 2002 Sep;95(3):784; discussion 784
PMID: 12198080, UI: 22186467
Anesth Analg 2002 Sep;95(3):780; discussion 780
PMID: 12198073, UI: 22186460
Anesth Analg 2002 Sep;95(3):780; discussion 780-1
PMID: 12198072, UI: 22186459
Anesth Analg 2002 Sep;95(3):762-3, table of contents
Department of Anesthesiology, Virginia Mason Medical Center, 1100 Ninth Avenue, Seattle, WA 98111, USA. anemfm@vmmc.org
IMPLICATIONS: Unsolicited paresthesias may occur when a nerve stimulator is used and may indicate valid proximity to the nerve. This phenomenon suggests that nerve stimulator use does not protect against unplanned direct contact with peripheral nerves during performance of a nerve block on an obtunded patient.
PMID: 12198068, UI: 22186455
Anesth Analg 2002 Sep;95(3):760-1, table of contents
Departments of Anaesthesia and Pain Management, Sir Charles Gairdner Hospital, Hospital Avenue, Nedlands, Perth, Western Australia 6009, Australia.
IMPLICATIONS: We report a previously undescribed complication of peripheral nerve catheter placement. The catheter was sheared when its stylet was removed with the placement needle still in the tissues. The lost distal fragment was identified with computed tomography scanning.
PMID: 12198067, UI: 22186454
Anesth Analg 2002 Sep;95(3):757-9, table of contents
Department of Anesthesiology, Virginia Mason Medical Center, 900 Seneca Street, Seattle, WA 98111, USA.
IMPLICATIONS: The occurrence of transient neurologic symptoms after hypobaric lidocaine spinal anesthesia has not been reported, and may suggest sciatic stretch with neural ischemia rather than maldistribution as the cause of this syndrome.
PMID: 12198066, UI: 22186453
Anesth Analg 2002 Sep;95(3):650-5, table of contents
Department of Anesthesiology and General Intensive Care (B), University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria. erich.knolle@univie.ac.at
In this study we sought to determine whether an absorbent in which little carbon monoxide (CO) forms has a correspondingly small capacity to absorb carbon dioxide (CO(2)). Completely dried samples (600 g) of Baralyme (A), Dragersorb 800 (B), Dragersorb 800 Plus (C), Intersorb (D), Spherasorb (E), LoFloSorb (F), Superia (G), and Amsorb (H) were exposed to a flow of 0.5% (A-H; n = 4-5) and 4% isoflurane (F-H; n = 3) in pure oxygen at 5 L/min for 60 min. Downstream CO concentration, temperature, and isoflurane concentration were recorded every 60 s to calculate CO formation and isoflurane loss. The CO(2) absorption capacity of each brand was determined by passing 5.1% CO(2) in oxygen (flow, 250 mL/min) through untreated samples (30 g; n = 5) until the outlet CO(2) concentration reached 0.5%. CO formation was largest in absorbents containing potassium hydroxide (A and B) and negligible in absorbents not containing any alkali hydroxide (F-H). The outlet temperature correlated with CO formation, but the isoflurane loss did not. The duration of CO(2) absorption also did not correlate with CO formation. We conclude that absorbents that allow only very little CO formation are not necessarily poor CO(2) absorbents. IMPLICATIONS: In an in vitro study, carbon dioxide (CO(2)) absorption capacity and possible carbon monoxide (CO) formation were tested in different absorbent brands. Absorbents with very small CO formation are not necessarily poor CO(2) absorbents.
PMID: 12198054, UI: 22186441
Anesth Analg 2002 Sep;95(3):627-34, table of contents
Department of Anesthesiology, University of Washington, 1959 NE Pacific, Seattle, WA 98195, USA. jpavlin@u.washington.edu
Pain complicates the recovery process after ambulatory surgery. We surveyed 175 ambulatory surgery patients to determine pain severity, analgesic use, relationship of pain to duration of recovery, and the relative importance of various factors to predicting these outcomes. Multivariate regression analysis was used to determine unique contributions of predictor variables to outcome. Surgical procedures included knee arthroscopy (n = 50), hernia surgery (n = 25), pelvic laparoscopy (n = 25), transvaginal uterine surgery (n = 25), surgery for breast disease (n = 25), and plastic surgery (n = 25). Maximum pain (on a scale of 0-10) varied from 2.3 +/- 0.5 to 5.1 +/- 0.5 (mean +/- SE), depending on surgical procedure; 24% of patients had pain scores of > or =7, and 24% were delayed in Phase 1 recovery by pain. Pain scores were lower if local anesthetic or ketorolac was administered intraoperatively (22% and 26% respectively). Fentanyl dose during recovery correlated with maximum pain scores; fentanyl dose was 42% less if ketorolac was administered intraoperatively. In females, the recovery fentanyl dose increased in proportion to the intraoperative fentanyl dose. The maximum pain score was predictive of total recovery time (135, 172, and 212 min of recovery for maximum pain scores of 0-3, 4-6, and 7-10, respectively; P < 0.001). We conclude that improvements in pain therapy are warranted to improve patient comfort and to expedite recovery. IMPLICATIONS: Moderate to severe pain is common after ambulatory surgery and is a frequent cause of delayed discharge. Postoperative pain, opioid-related side effects, and time to discharge were less when nonsteroidal antiinflammatory drugs or local anesthetics were used intraoperatively to prevent pain before patient awakening.
PMID: 12198050, UI: 22186437
Anesth Analg 2002 Sep;95(3):624-6, table of contents
Department of Anesthesiology, University of Washington and Children's Hospital/Regional Medical Center, Seattle, WA 98104, USA. kboddu@u.washington.edu
IMPLICATIONS: Transesophageal echocardiography may be useful in guiding detection and removal of thorax penetrating objects and for the monitoring of complications after removal of such objects.
PMID: 12198049, UI: 22186436
Anesth Analg 2002 Sep;95(3):561-3, table of contents
Department of Anesthesia, Chiba Hokusoh Hospital, Nippon Medical School, Kamagari 1715, Inba-mura, Inba-gun, Chiba 270-1694, USA. shiga/anesth@nms.ac.jp
IMPLICATIONS: Transesophageal echocardiography (TEE) has not been used during airway manipulation to assess the occasional occurrence of hemodynamic instability that occurs especially in cardiac patients. We describe a new technique using an endoscopy mask to perform TEE monitoring during airway manipulation with a large concentration of supplemented oxygen.
PMID: 12198036, UI: 22186423
Anesth Analg 2002 Sep;95(3):531-6, table of contents
Division of Anesthesiology, Soroka Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 84101, Israel.
Surgery is associated with activation of neutrophils and their influx into affected tissue. The pathogenic role of superoxide production generated by activated neutrophils has been documented repeatedly. Ketamine suppresses neutrophil oxygen radical production in vitro. In the present study, we compared the effect of adding small-dose ketamine to opioids during the induction of general anesthesia on superoxide production by neutrophils after coronary artery bypass grafting (CABG). Thirty-five patients undergoing elective CABG were randomized to one of two groups and prospectively studied in a double-blinded manner. The patients received either ketamine 0.25 mg/kg or a similar volume of saline in addition to large-dose fentanyl anesthesia. Blood samples were drawn before the operation, immediately after cardiopulmonary bypass, 24 and 48 postoperative h, and on postoperative Days 3-6. Functional capacity of neutrophils was assessed by superoxide generation after stimulation with phorbol 12-myristate 13-acetate, opsonized zymosan, or formyl-methionyl-leucyl-phenylalanine. The addition of small-dose ketamine to general anesthesia attenuates increased production of the superoxide anion (O2-) by neutrophils without chemical stimulation and after stimulation with phorbol 12-myristate 13-acetate, formyl-methionyl-leucyl-phenylalanine, and opsonized zymosan for 4-6 days after CABG. In addition, ketamine attenuated the percentage of neutrophils on postoperative Days 2-6. In the Control group, superoxide production significantly increased compared with the baseline value. By contrast, in the Ketamine group, this difference was not significant. IMPLICATIONS: In a randomized, double-blinded, prospective clinical study, we compared the effect of adding small-dose ketamine to opioids during general anesthesia on superoxide production and showed that ketamine suppressed the increase of superoxide anion production by neutrophils after coronary artery bypass grafting.
PMID: 12198030, UI: 22186417
Br J Anaesth 2002 Jul;89(1):1-183
PMID: 12227306, UI: 22214431
Br J Anaesth 2002 Jul;89(1):188; discussion 188
PMID: 12173236, UI: 22163579
Br J Pharmacol 2002 Apr;135(8):2011-9
Centre for Gastroenterological Research, Department of Pathophysiology, University of Leuven, B-3000 Leuven, Belgium. inge.depoortere@med.kuleuven.ac.be
1. Inflammation may affect subpopulations of neurons of the myenteric plexus. 2. In the present study the effect of trinitrobenzene sulphonic acid (TNBS) induced colitis on nitrergic, purinergic and adrenergic inhibitory neurotransmission was studied as well as the consequences of the related changes on the response of 5-HT agonists using these neurotransmitters to mediate their effect. 3. Strips from normal and colitis rabbits (135 mg kg(-1) TNBS) were subjected to electrical field stimulation (EFS, 0.3 ms, 6V, 0.5 - 32 Hz, 10 s train). The response was measured isometrically in the absence or presence of L-NAME, suramin, guanethidine, the 5-HT agonists (5-HT(1/5A/7): 5-carboxamidotryptamine (5-CT), 5-HT(2): alpha-methyl-5-HT, 5-HT(3): 2-methyl-5-HT, 5-HT(4): 5-methoxytryptamine (5-MeOT)) or a combination. 4. In normal strips L-NAME (1 - 32 Hz), suramin (0.5 - 2, 8 Hz) and guanethidine (4, 16, 32 Hz) increased the response to EFS. This effect was abolished in inflamed strips and was accompanied by a decrease in nNOS expression. 5. In normal strips all 5-HT agonists induced pronounced (5-CT, alpha-methyl-5-HT) or small (2-methyl-5-HT, 5-MeOT) inhibitory neural responses. In inflamed strips this was reversed to cholinergic excitatory responses. 6. The effect of inflammation on the 5-HT(4) response was mimicked by preincubation of normal strips with L-NAME or suramin. Accordingly, in inflamed strips L-NAME or suramin did not affect the excitatory effects of 5-MeOT. 7. TNBS-colitis abolishes nitrergic, purinergic and adrenergic neurotransmission. This reverses serotonergic inhibition into excitation.
PMID: 11959805, UI: 21956214
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Lancet 2002 Aug 17;360(9332):568-9; discussion 569
PMID: 12241679, UI: 22227057
Lancet 2002 Aug 17;360(9332):568; discussion 569
PMID: 12241678, UI: 22227056
PMID: 12241677, UI: 22227055
Neurosci Lett 2002 Sep 20;330(2):204
Department of Physiology, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, 216-8511, Kawasaki, Japan
To determine whether long-term depression (LTD) affects cortical gamma-band local field potential (40-100 Hz), we conducted a LTD induction experiment in the hippocampus-prefrontal cortex (PFC) pathway of an anesthetized rat. The LTD induction increased the spontaneous level of PFC gamma-band power of 70-100 Hz, which was not affected after the long-term potentiation (LTP) induction in our previous experiment. In addition, the LTD induction increased the evoked PFC gamma-band power at 900 ms after hippocampal test stimulation; this latency appeared to differ from that (500-700 ms) observed in our previous LTP experiment. The results indicate that the PFC field potential increases its gamma-band power following both LTP and LTD in the hippocampus-PFC pathway, which is involved in working memory. Particularly, the sustained increase by LTD may reflect a representation of working memory.
PMID: 12231447, UI: 22218510
Neurosci Lett 2002 Sep 20;330(2):179
National Institute for Health and Medical Research (INSERM), U 420, Faculte de Medecine, Vandoeuvre-les-Nancy, France
The influence of trigeminal afferences on postural stabilization was tested. Twenty-seven subjects were recruited to evaluate the impact of trigeminal disturbance on orthostatic postural control before and after unilateral truncular anaesthesia of the mandibular nerve. Balance control quality was assessed using static posturography by means of statokinesigrams and lateral deviation. Postural control monitored by measuring the area covered by the centre of foot pressure decreases after anaesthesia in the eyes open condition. Postural deviation in the eyes closed condition was observed after anaesthesia in the controlateral side of anaesthesia. These data document the effects of trigeminal afferences on postural stabilization.
PMID: 12231441, UI: 22218504
Neurosci Lett 2002 Jul 12;327(1):5-8
University Hospital, Chung-Shan Medical University, No. 110 Chang-Kuo North Road, the first Section, Taichung 10018, Taiwan.
The neural mechanism underlying the effect of electroacupuncture (Ea) on arterial blood pressure (BP) and renal nerve activity (RNA) in the intact state and during acute hemorrhage was investigated in anesthetized rats. Two acupoints, Hoku (Li-4, at the junction of the first and the second metacarpal bone) and Tsusanli (St-36, at the lateral upper tibia bone), were tested using Ea of two different frequencies (2 and 20 Hz). In the intact state, Ea at Hoku elicited an elevation of BP in parallel with RNA, while Ea found no response with identical parameters at Tsusanli. The pattern of the pressor response caused by a low frequency Ea (2 Hz) at Hoku was different than a high frequency one (20 Hz), i.e. a tonic effect was elicited with 2 Hz, while a phasic one was induced with 20 Hz. In mild hemorrhage conditions (10% of BP decrease), similar pressor effects, as in intact rats, were also elicited by Ea. However, in severe hemorrhage conditions (20 and 30% BP decrease), Ea induced a pressor effect on RNA and an attenuated effect on BP. BP and RNA showed a significant correlation in intact and mild hemorrhage conditions, but not in severe hemorrhage conditions. All the results suggested that Ea at Hoku with appropriate stimulation parameters can increase and maintain BP in normal and hemorrhage conditions, and such a therapeutic technique has potential in clinical practice.
PMID: 12098487, UI: 22093388
Pediatr Dent 2002 May-Jun;24(3):221-6
Department of Dental Anesthesiology, The Ohio State University and Columbus Children 's Hospital, USA.
PURPOSE: This preliminary investigation evaluated the associations among multiple factors designed to measure depth of sedation, such as changes in the patient's electroencephalogram (EEG) via a bispectral analysis (BIS), other physiological variables, observed behaviors and clinical assessment of sedation levels consistent with the American Academy of Pediatric Dentistry (AAPD) sedation guidelines. METHODS: Thirty-four healthy pediatric patients between three to six years of age were enrolled in this institutionally approved study. All children required dental restorations and were uncooperative. The children received a routine oral sedation regimen used in our clinic consisting of chloral hydrate, meperidine, and hydroxyzine that varied in dose for each child. Intraoperatively, nitrous oxide/oxygen was also administered. Physiological variables including oxygen saturation, blood pressure and heart rate were recorded in compliance with AAPD sedation guidelines. The behavior and levels of sedation consistent with AAPD guidelines were also recorded. The BIS monitor was used to obtain EEG information. RESULTS: Useful data were recorded from 21 patients. The mean age and weight of the children were 46.1 +/- 10 months and 16.1 +/- 5 kgs, respectively. The results show a significant association between observed patient behavior and the AAPD levels of sedation (chi2 = 105.1, df = 6, P< 0.0001), between levels of sedation and behavior as a function of 12 time-oriented periods during treatment, (chi2=41.90, df=22, P<0.005 and chi2=48.0, df=33, P=0.04, respectively) and between BIS readings as a function of both level of sedation and behavior (chi2=105.1, df=6, P<0.001 and chi2=28.5, df = 18, P< 0.05, respectively). CONCLUSIONS: There appears to be a significant association between observed patient behaviors during sedation and levels of sedation as measured by BIS and AAPD sedation guidelines. The study also showed that, under treatment conditions used in this study, BIS does not appear to be a more valid means of monitoring sedation depth than the current commonly accepted methods.
PMID: 12064495, UI: 22059129
Pediatr Dent 2002 May-Jun;24(3):207-11
Department of Pediatric Dentistry, New Jersey Dental School, Newark, USA.
PURPOSE: This study investigated the relationship between oral conscious sedation and subsequent behavior in the dental setting. METHODS: The sample consisted of 38 children between the ages of 39 to 71 months (mean=50 months) who had been treated with oral sedation 2 to 34 months(mean=13 months) previously, and a control group of 38 children, matched by age (mean=51 months) and gender, who had received dental treatment without conscious sedation or general anesthesia one week to 3 years previously. Subjects were matched by age and gender. All children received a standard recall examination and a prophylaxis, during which behavior and anxiety were measured. Independent variables included age at the time of sedation, present age, gender, time elapsed since sedation, effectiveness of sedation, parental scores on Corah's Dental Anxiety Scale and parent's answers to a questionnaire. The dependent variables were child behavior (rated with the 4-point Frankl scale) and self-reported anxiety ratings. RESULTS: Both groups had mean behavior ratings of positive or very positive (experimental group mean=3.13; control group mean=3.34). There were no statistically significant differences between the groups and there was little correlation of independent and dependent variables. CONCLUSIONS: There is no relationship between oral conscious sedation and the future behavior of children in the dental setting.
PMID: 12064492, UI: 22059126
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