Anaesthesia 2003 Feb;58(2):185
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PMID: 12562417
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Anaesthesia 2003 Feb;58(2):125-30
Associate Professor, Assistant Professor, Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong, China.
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We have investigated the factors predicting umbilical arterial pH (UA pH) and standard base excess (UA BE) in 337 consecutive elective Caesarean sections performed under spinal anaesthesia. Multiple linear regression analysis was performed with UA pH and UA BE as the dependent factors. We found that the significant factors predicting UA pH were: use of ephedrine, uterine incision-to-delivery time, maximum decrease in systolic arterial pressure and the interaction between ephedrine use and duration of hypotension (adjusted R2 = 0.39, F15,321 = 15.4, p < 0.0001). The significant factors predicting UA BE were: use of ephedrine and the interaction between ephedrine use and duration of hypotension (adjusted R2 = 0.52, F15,321 = 25.0, p < 0.0001). We conclude that, in order to minimise the risk of fetal acidosis, ephedrine should not be used before delivery, uterine incision-to-delivery time should be as short as possible, and alpha-agonists such as metaraminol or phenylephrine should be used to minimise both the magnitude and duration of hypotension.
PMID: 12562407, UI: 22450031
Anaesthesia 2003 Feb;58(2):117-24
University Department of Anaesthesia, Gartnavel General Hospital, 30 Shelley Court, Glasgow G12 OYN, UK.
Nurses assess patients pre-operatively using screening questionnaires and locally-developed protocols. Our objectives were to determine which questions might identify patients who should be seen by an anaesthetist before the day of surgery. A review of the literature and a preliminary questionnaire to establish questions to be tested was followed by a modified, two-round Delphi questionnaire to determine the level of agreement by anaesthetists. There was agreement for referring patients who gave a positive response to questions that query: restricted exercise tolerance; previous anaesthetic problems; family history of anaesthetic problem; pathology affecting neck movement; angina; arrhythmia; heart failure; asthma; epilepsy; insulin-dependent diabetes mellitus; liver disease and unspecified kidney disease. There was equivocal agreement on questions that report a myocardial infarction over one year ago, cerebrovascular accident, non insulin-dependent diabetes mellitus and thyroid disease. Nurses should use these criteria during pre-operative assessment to decide the timing of evaluation by an anaesthetist.
PMID: 12562406, UI: 22450030
Anaesthesist 2002 Oct;51(10):866-7
Publication Types:
PMID: 12555772, UI: 22443028
Br J Anaesth 2003 Jan;90(1):108-9
PMID: 12488397, UI: 22375937
Br J Anaesth 2003 Jan;90(1):107-8; author reply 108
PMID: 12488395, UI: 22375935
Br J Anaesth 2003 Jan;90(1):94-6
Department of Anaesthesia, Joondalup Health Campus, Perth, Western Australia, Australia. dralanmillard@hotmail.com
An 18-yr-old man with insulin-dependent diabetes developed severe subglottic stenosis after a very brief period of intubation. Emergency tracheostomy was complicated by the development of bilateral pneumothoraces. This case highlights the importance of making an early diagnosis to minimize the risk of complications and examines postintubation subglottic stenosis in the context of poorly controlled insulin-dependent diabetes mellitus.
PMID: 12488388, UI: 22375928
Br J Anaesth 2003 Jan;90(1):86-7
Southmead Hospital, North Bristol NHS Trust, Southmead Road, Westbury-on-Trym, Bristol BS10 5NB, UK.
BACKGROUND: Lateral maternal tilt reduces aortocaval compression and the consequent cardiovascular instability. METHODS: We measured the angle of table tilt used by 16 anaesthetists during uncomplicated, elective Caesarean section. After initiating anaesthesia, they were asked to position the patient and estimate the angle of tilt, which was then measured. RESULTS: Almost every anaesthetist positioned the patient less than 15 degrees because they overestimated the angle of tilt. When questioned on their knowledge of the current advice for lateral tilt, 11 of the 16 anaesthetists were aware of the 15 degrees recommendation. CONCLUSION: Estimation of the angle of table tilt is unreliable.
PMID: 12488385, UI: 22375925
Br J Anaesth 2003 Jan;90(1):62-5
Nuffield Department of Anaesthetics, John Radcliffe Hospital, Headley Way, Headington, Oxford OX3 9DU, UK. caroline.rob@virgin.net
BACKGROUND: Caudal analgesia is widely used in paediatric anaesthetic practice. In adults, the 'whoosh' test has been recommended as a guide to successful needle insertion, but it has not been extensively studied in paediatric patients. We have investigated a modification of the 'whoosh' test, which we have christened the 'swoosh' test. It avoids the injection of air by performing auscultation during injection of the local anaesthetic solution. We have compared it with clinical judgement of correct placement. METHODS: We studied 113 children undergoing elective surgery. During insertion of the caudal block, a stethoscope was placed over the lower lumbar spine and the presence or absence of an audible 'swoosh' noted. The operator's clinical impression of successful insertion was also recorded. RESULTS: The overall success rate of caudal anaesthesia was 95.6%. Of the 108 patients with a successful block, 98 had a positive 'swoosh' test. There were no false positive results. Calculations show the 'swoosh' test to have a sensitivity of 91%, a specificity of 100% and a positive predictive value of 100%. CONCLUSIONS: The 'swoosh' test is a simple and accurate test to confirm successful caudal insertion in children, and is especially useful as a teaching aid for anaesthetists new to the technique.
PMID: 12488381, UI: 22375921
Br J Anaesth 2003 Jan;90(1):32-8
Department of Anesthesiology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522, Japan.
BACKGROUND: Because the time available for cooling and rewarming during deliberate mild hypothermia is limited, studies of the rate of the cooling and rewarming are useful. The decrease in core hypothermia caused by heat redistribution depends on the anaesthetic agent used. We therefore investigated possible differences between sevoflurane and propofol on the decrease and recovery of core temperature during deliberate mild hypothermia for neurosurgery. METHODS: After institutional approval and informed consent, 26 patients were assigned randomly to maintenance of anaesthesia with propofol or sevoflurane. Patients in the propofol group (n=13) received propofol induction followed by a continuous infusion of propofol 3-5 mg kg(-1) h(-1). Patients in the sevoflurane group (n=13) received propofol induction followed by sevoflurane 1-2%. Nitrous oxide and fentanyl were also used for anaesthetic maintenance. After induction of anaesthesia, patients were cooled and tympanic membrane temperature was maintained at 34.5 degrees C. After surgery, patients were actively rewarmed. RESULTS: There was no difference in the rate of decrease and recovery of core temperature between the groups. There was also no difference in skin surface temperature gradient (forearm to fingertip), heart rate and mean arterial blood pressure between the groups. CONCLUSIONS: Sevoflurane-based anaesthesia did not affect cooling and rewarming for deliberate mild hypothermia compared with propofol-based anaesthesia.
PMID: 12488375, UI: 22375915
Can J Anaesth 2003 Jan;50(1):12-3
PMID: 12561800, UI: 22446042
Reg Anesth Pain Med 2003 Jan-Feb;28(1):58-63
Department of Anesthesiology, Mayo Clinic and Foundation, Rochester, Minnesota.
PMID: 12567346, UI: 22454806
Reg Anesth Pain Med 2003 Jan-Feb;28(1):33-6
Department of Anesthesiology, Hospital Clinico Universitario de Santiago, CHUS (J.R., J.A.), Santiago de Compostela, Spain; and the Department of Anesthesiology, Hospital de Conxo, CHUS (M.B.), Santiago de Compostela, Spain.
Background and Objectives: The distribution of local anesthetic after different approaches for brachial plexus anesthesia could be responsible for the varying rates of side effects, such as phrenic block, hoarseness, and Horner's syndrome associated with each approach. We compared the distribution of local anesthetic within the neurovascular space in infraclavicular block with that of interscalene and supraclavicular block. METHODS: In a prospective analysis using fluoroscopy, we studied the distribution of a solution of local anesthetic containing radiologic contrast medium in 18 patients. Six patients received an interscalene block, another 6 patients received a perpendicular supraclavicular block, and another 6 patients, a perpendicular coracoid block. RESULTS: Distribution of the anesthetic solution in the interscalene and supraclavicular groups extended to both supraclavicular and infraclavicular spaces in all patients. This distribution was significantly different (P <.05) compared with that of the infraclavicular group. In this group, the solution remained below the clavicle in every patient. CONCLUSIONS: Spread of the local anesthetic from the infraclavicular space after infraclavicular coracoid block appears to be limited to below the level of the clavicle. Conversely, local anesthetic solution passes below the clavicle in all patients given interscalene or supraclavicular blocks. Reg Anesth Pain Med 2003;28:33-36.
PMID: 12567341, UI: 22454801
Reg Anesth Pain Med 2003 Jan-Feb;28(1):3-11
Department of Anesthesiology, Wake Forest University School of Medicine, Winston-Salem, North Carolina.
With the development of the newer long-acting amide local anesthetics,ropivacaine and levobupivacaine, numerous animal studies of LA systemic toxicity have emerged. Because of the complex nature of the human response to LA intoxication, the task of designing and interpreting these animal studies of LA toxicity can be difficult. Accordingly, this report will review the selection of an animal model for the study of LA toxicity; examine the pertinent in vivo animal studies that compare the central nervous system toxicity, cardiovascular toxicity, and the ease of resuscitation of the single enantiomer local anesthetics to racemic bupivacaine; and extrapolate these findings to the clinical setting. Reg Anesth Pain Med 2003;28:3-11.
PMID: 12567336, UI: 22454796