Br J Anaesth 2003 Mar;90(3):410-423
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PMID: 12594168
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Br J Anaesth 2003 Mar;90(3):402-4
Birmingham, AL, USA Izumo City, Japan.
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PMID: 12594166, UI: 22482080
Br J Anaesth 2003 Mar;90(3):402
Stanford, CA, USA Plymouth, UK.
PMID: 12594165, UI: 22482079
Br J Anaesth 2003 Mar;90(3):401-2
Nottingham, UK Durham, NC, USA.
PMID: 12594164, UI: 22482078
Br J Anaesth 2003 Mar;90(3):399-400
Manchester, UK Bath, UK.
PMID: 12594162, UI: 22482076
Br J Anaesth 2003 Mar;90(3):382-5
Department of Anesthesiology, Graduate School of Medicine, Chiba University 1-8-1 Inohana, Chuo-ku, Chiba 260-8670, Japan.
Airway management during awake craniotomy is a crucial part of the anaesthetic technique, but it remains the subject of debate. We report two cases of anaesthesia for awake craniotomy using non-invasive positive pressure ventilation; biphasic positive airway pressure or proportional assist ventilation was employed. Both ventilatory techniques provided adequate lung ventilation, smooth transition between anaesthesia and arousal, and patient comfort. Br J Anaesth 2003; 90: 382-5
PMID: 12594155, UI: 22482069
Br J Anaesth 2003 Mar;90(3):367-74
Department of Cardiothoracic Anaesthesia, Freeman Hospital, Newcastle upon Tyne NE7 7DN, UK E-mail: i.d.conacher@btinternet.com
In the last decade, stents suitable for the management of tracheobronchial stenoses and obstruction have evolved from bulky prostheses requiring tracheal resection to small devices that are self-expanding and can be inserted using fibreoptic techniques. The experience base for this review is more than 100 patients between 1989 and 2001 who have been anaesthetized for stent insertion. Early cases required rigid bronchoscopy for the routine of insertion. Anaesthetic techniques have evolved from those that were designed and developed for laser surgery in the central airways. The advent of modern devices now extends the variety of anaesthetic management techniques that can be used. But the original one, based on the requirement for use of a rigid bronchoscope, is best for dealing with complications and extracting problem stents. The most frequent complication of the processes of stent insertion has been respiratory failure because of carbon dioxide retention, consequent on obstruction with secretions in the area of the carina. The nature of central airway problems suggests that anaesthesia induction, management and teaching should not be founded on the conventional model-base of upper airway obstruction. Br J Anaesth 2003; 90: 367-74
PMID: 12594151, UI: 22482065
Br J Anaesth 2003 Mar;90(3):349-366
Cardiac Unit, Royal Liverpool Children's Hospital, Eaton Road, Liverpool L12 2AP, UK.
Br J Anaesth 2003; 90: 349-66
PMID: 12594150
Br J Anaesth 2003 Mar;90(3):333-337
Department of Work Psychology, Bat B-32 FAPSE, University of Liege, B-4000 Liege, Belgium. Department of Anaesthesia and Intensive Care Medicine, Cliniques Universitaires St Luc, Av. Hippocrate, B-1200 Bruxelles, Belgium. Department of Anaesthesia and Intensive Care Medicine, Bat B-35, University Hospital of Liege, B-4000 Liege, Belgium.
BACKGROUND: Formal studies on stress in anaesthetists have usually measured stress through mental or physiological indicators. When using this approach, one must be careful not to confuse the effects of stress or outcome variables and the sources of stress or antecedent variables. To date, it seems from the literature that there is no clear evidence of a common pattern of physiological effects of stress for all the sources of stress. Furthermore, work characteristics such as job satisfaction, job control and job support may moderate the effects of stress. METHODS: We measured the effects of stress together with the sources of stress and job characteristics, using self-reported questionnaires rather than physiological indicators in order to better diagnose stress in anaesthetists. RESULTS: The mean stress level in anaesthetists was 50.6 which is no higher than we found in other working populations. The three main sources of stress reported were a lack of control over time management, work planning and risks. Anaesthetists reported high empowerment, high work commitment, high job challenge and high satisfaction. However, 40.4% of the group were suffering from high emotional exhaustion (burnout); the highest rate was in young trainees under 30 years of age. CONCLUSIONS: Remedial actions are discussed at the end of the paper. Br J Anaesth 2003; 90: 333-7
PMID: 12594147
Br J Anaesth 2003 Mar;90(3):320-2
Department of Anesthesiology and Department of Plastic and Reconstructive Surgery, Zonguldak Karaelmas University, School of Medicine, Kozlu/Zonguldak, Turkey.
BACKGROUND: Recent studies have shown that a local anaesthetic action of tramadol 5% was able to induce a sensory block to pinprick, touch, and cold similar to that of lidocaine 1%. The aim of this study was to compare the local anaesthetic effects of tramadol hydrochloride with prilocaine. METHODS: Sixty ASA I or II patients, undergoing excision of the cutaneous lesions under local anaesthesia, were included in the study. Patients were randomly assigned to receive either 1 ml of tramadol 5% (Group T, n=30) or 1 ml of prilocaine 2% (Group P, n=30) intradermally, in a double-blinded fashion. The degree of the burning sensation and pain at the injection site was documented. Sensory block was assessed 1 min after injection. The patient was asked to report the degree of sensation and to grade touch and pinprick sensation. Two minutes after drug administration, incision was performed and intensity of pain, felt by the patient was evaluated on a four-point scale (0-3). Any local adverse effects were recorded. RESULTS: There was no difference in the quality of block between the two groups. Side effects were noted in both groups with a significant increase in the incidence of local reaction (rash) in Group T (seven patients) when compared with Group P (one patient) (P<0.05). Seven patients in Group T vs four patients in Group P complained of burning at the injection site (P>0.05). CONCLUSIONS: Intradermal tramadol 5% can provide a local anaesthesia similar to the prilocaine but the incidence of local adverse effects is higher. Br J Anaesth 2003; 90: 320-2
PMID: 12594144, UI: 22482058
Br J Anaesth 2003 Mar;90(3):309-13
Department of Anaesthesia, University Hospital Antwerp, Wilrijkstraat 10, B-2650 Edegem, Belgium.
BACKGROUND: Micturition problems after spinal anaesthesia may delay hospital discharge. The use of lidocaine has raised concerns because of the occurrence of transient neurological symptoms (TNS). This randomized double-blind study was designed to compare the newer local anaesthetics with lidocaine regarding block characteristics, micturition problems, and discharge times in day-case spinals for arthroscopy. METHODS: Ninety patients received either isobaric lidocaine 60 mg, ropivacaine 15 mg, or levobupivacaine 10 mg intrathecally. Urinary bladder volumes were measured by ultrasound imaging at regular time intervals until a post-voiding residual volume (PVRV) less than 100 ml was obtained. Micturition problems were classified in five groups ranging from no problems to those requiring catheterization. RESULTS: Times to regain a Bromage-1 and -0 motor block were similar in the three groups but sensory block regression to L2 occurred at 145 (30) min in the lidocaine group, 25-30 min (P<0.05) faster than the other groups. Lidocaine allowed voiding after 245 (65) min and hospital discharge 265 (70) min after spinal injection, 40 min faster than in the two other groups. The incidence or degree of micturition problems were not different between after discharge, three patients (10%) receiving lidocaine complained of symptoms compatible with TNS. CONCLUSIONS: Our study suggested that the three local anaesthetics behave similar regarding quality of anaesthesia and motor block but voiding and discharge occurred significantly earlier with lidocaine although the 40 min difference was not impressive considering a spinal discharge time interval of 4-5 h. Br J Anaesth 2003; 90: 309-13
PMID: 12594142, UI: 22482056
Br J Anaesth 2003 Mar;90(3):304-8
University Department of Anaesthesia, Ninewells Hospital and Medical School, Dundee DD1 9SY, UK. Present address: Department of Anaesthetics, St John's Hospital, Livingston, West Lothian, UK.
BACKGROUND: Hyperbaric solutions of ropivacaine have been used successfully to provide spinal anaesthesia. This study was designed to compare the clinical efficacy of hyperbaric ropivacaine with that of the commercially available hyperbaric preparation of bupivacaine. METHODS: Forty ASA grade I-II patients undergoing lower-abdominal, perineal or lower-limb surgery under spinal anaesthesia were recruited and randomized to receive ropivacaine 5 mg ml(-1) (with glucose 50 mg ml(-1)), 3 ml or bupivacaine 5 mg ml(-1) (with glucose 80 mg ml(-1)), 3 ml. The level and duration of sensory block, intensity and duration of motor block, and time to mobilize and micturate were recorded. Patients were interviewed at 24 h and at 1 week to identify any residual problems. RESULTS: All blocks were adequate for the proposed surgery, but there were significant differences between the two groups in mean time to onset of sensory block at T10 (ropivacaine 5 min; bupivacaine 2 min; P<0.005), median maximum extent (ropivacaine T7; bupivacaine T5; P<0.005) and mean duration of sensory block at T10 (ropivacaine 56.5 min; bupivacaine 118 min; P=0.001). Patients receiving ropivacaine mobilized sooner (ropivacaine mean 253.5 min; bupivacaine 331 min; P=0.002) and passed urine sooner (ropivacaine mean 276 min; bupivacaine 340.5 min; P=0.01) than those receiving bupivacaine. More patients in the bupivacaine group required treatment for hypotension (>30% decrease in systolic pressure; P=0.001). CONCLUSIONS: Ropivacaine 15 mg in glucose 50 mg ml(-1) provides reliable spinal anaesthesia of shorter duration and with less hypotension than bupivacaine. The recovery profile for ropivacaine may be of interest given that more surgery is being performed in the day-case setting. Br J Anaesth 2003; 90: 304-8
PMID: 12594141, UI: 22482055
Br J Anaesth 2003 Mar;90(3):281-90
Department of Anaesthesiology, University-Hospital Dusseldorf, Moorenstrasse 5, D-40225 Dusseldorf, Germany. Department of Anaesthesiology, Merheim Hospital, D-51109 Cologne, Germany.
BACKGROUND: Oxygen consumption (V(.)>O(2)) is rarely measured during anaesthesia, probably because of technical difficulties. Theoretically, oxygen delivery into a closed anaesthesia circuit (V(.)>O(2)-PF; PhysioFlex(TM) Draeger Medical Company, Germany) should measure V(.)>O(2). We aimed to measure V(.)>O(2)-PF in vitro and in vivo. METHODS: Three sets of experiments were performed. V(.)>O(2)-PF was assessed with five values of V(.)>O(2) (0-300 ml min(-1)) simulated by a calibrated lung model (V(.)>O(2)-Model) at five values of FI(O(2)) (0.25-0.85). The time taken for V(.)>O(2)-PF to respond to changes in V(.)>O(2)-Model gave a measure of dynamic performance. In six healthy anaesthetized dogs we compared V(.)>O(2)-PF with V(.)>O(2) measured by the Fick method (V(.)>O(2)-Fick) during ventilation with nine values of FI(O(2)) (0.21-1.00). V(.)>O(2)-PF and V(.)>O(2)-Fick were also compared in three dogs when V(.)>O(2) was changed pharmacologically [102 (SD 14), 121 (17) and 200 (57) ml min(-1)]. In patients during surgery, we measured V(.)>O(2)-PF and V(.)>O(2)-Fick simultaneously after induction of anaesthesia (n=21) and during surgery (n=17) (FI(O(2)) 0.3-0.5). RESULTS: Compared with V(.)>O(2)-Model, V(.)>O(2)-PF values varied from time to time so that averaging over 10 min is recommended. Furthermore, at an FI(O(2)) >0.8, V(.)>O(2)-PF always overestimated V(.)>O(2). With FI(O(2)) <0.8, averaged V(.)>O(2)-PF corresponded to V(.)>O(2)-Model and adapted rapidly to changes. Averaged V(.)>O(2)-PF also corresponded to V(.)>O(2)-Fick in dogs at FI(O(2)) <0.8. V(.)>O(2) measured by the two methods gave similar results when V(.)>O(2 )was changed pharmacologically. In contrast, V(.)>O(2)-PF systematically overestimated V(.)>O(2)-Fick in patients by 52 (SD 40) ml min(-1 )and this bias increased with smaller arteriovenous differences in oxygen content. CONCLUSION: V(.)>O(2)-PF measures V(.)>O(2) adequately within specific conditions. Br J Anaesth 2003; 90: 281-90
PMID: 12594137, UI: 22482051
Eur J Anaesthesiol 2002 Nov;19(11):846-8
Publication Types:
PMID: 12442943, UI: 22330107
Eur J Anaesthesiol 2002 Nov;19(11):844-5
PMID: 12442941, UI: 22330105
Eur J Anaesthesiol 2002 Nov;19(11):839-40
PMID: 12442938, UI: 22330102
Eur J Anaesthesiol 2002 Nov;19(11):834-6
PMID: 12442936, UI: 22330100
Eur J Anaesthesiol 2002 Nov;19(11):829-31
St Maartenskliniek, Department of Anaesthesiology, Nijmegen, The Netherlands. r.slappendel@maartenskliniek.nl
BACKGROUND AND OBJECTIVE: To determine whether prior exposure of non-steroidal anti-inflammatory drugs increases perioperative blood loss associated with major orthopaedic surgery. METHODS: Fifty patients scheduled for total hip replacement were allocated to two groups (double blind, randomized manner). All patients were pretreated for 2 weeks before surgery: Group 1 with placebo drug, Group 2 with ibuprofen. All patients were injected intrathecally with bupivacaine 20mg plus morphine 0.1 mg, in a total volume of 4 mL, to provide surgical anaesthesia. RESULTS: The presence of severe adverse effects caused eight patients in the ibuprofen group and six in the placebo group to terminate their participation in the trial. The perioperative blood loss increased by 45% in the ibuprofen group compared with placebo. The total (+/-SD) blood loss in the ibuprofen group was 1161 (+/-472) mL versus 796 (+/-337) mL in the placebo group. CONCLUSIONS: Pretreatment with ibuprofen before elective total hip surgery increases the perioperative blood loss significantly. Early discontinuation of non-selective non-steroidal anti-inflammatory drugs is advised.
PMID: 12442934, UI: 22330098
Eur J Anaesthesiol 2002 Nov;19(11):819-22
G. Gennimatas University Hospital, Department of Anesthesiology, Thessaloniki, Greece.
BACKGROUND AND OBJECTIVE: The aim was to determine if the intravenous administration of sufentanil or clonidine before the induction of anaesthesia could obtund the increase of intraocular pressure associated with rapid-sequence induction. METHODS: Thirty-two ASA I-II patients with no history of eye illness scheduled for elective non-ophthalmic surgery were randomly assigned to receive either sufentanil 0.05 microg kg(-1) i.v. (Group A, n = 15) or clonidine 2 microg kg(-1) i.v. (Group B, n = 17) prior to induction. General anaesthesia was induced with thiopental (5 mg kg(-1)) followed by succinylcholine 1 mg kg(-1) to facilitate tracheal intubation. The general anaesthetic technique was standardized in both groups. Intraocular pressure was measured using the Schioetz tonometer just before the succinylcholine administration (t0), just before tracheal intubation (t1) and immediately after intubation (t2). Mean arterial pressure and heart rate were recorded at the same time intervals. RESULTS: Intraocular pressures were similar in both groups at t0, but the sufentanil group had significantly lower values compared with the clonidine group just before (t1) and immediately after tracheal intubation (t2). CONCLUSIONS: Sufentanil is effective in blunting the increase in intraocular pressure caused by rapid-sequence induction with succinylcholine, while clonidine did not seem to have any effect in intraocular pressures just before (t1) and just after (t2) intubation.
PMID: 12442932, UI: 22330096
Eur J Anaesthesiol 2002 Nov;19(11):796-802
Universitatsklinikum Munster, Klinik and Poliklinik fur Anasthesiologie und operative Intensivmedizin, Germany.
BACKGROUND AND OBJECTIVE: Myocardial ischaemia and infarction are major complications immediately after coronary artery bypass grafting. They may be due to incomplete surgical revascularization, perioperative anaesthetic management or vasospasm of arterial grafts, e.g. the internal mammary artery. Infusions of nifedipine or milrinone have been advocated to prevent spasm of the mammary artery. The study compared the incidence of myocardial ischaemia after continuous infusion of either nifedipine (0.2 microg kg(-1) min(-1)) or milrinone (0.375 microg kg(-1) min(-1)) in patients with compromised left ventricular function scheduled for elective coronary artery bypass graft. METHODS: After Institutional Review Board approval, this double-blinded randomized clinical study enrolled 30 adult patients with compromised left ventricular function (ejection fraction < 0.4) scheduled for elective coronary artery bypass grafting after written informed consent had been obtained. Ischaemia was detected by Holter electrocardiographic monitoring. The incidence of myocardial cell death was monitored by serial determinations of the creatine kinase-MB (CK-MB) and troponin-I. RESULTS: New ST elevation > or = 0.2 mV or new ST depression < or = 0.1 mV occurred in five of 15 patients in the milrinone group (33.3%) and in 13 of 15 patients (86.6%) in the nifedipine group (P < 0.05). There were increases in CK-MB and troponin-I in both groups. Twenty-four hours postoperatively, CK-MB (P = 0.003) and troponin-I (P = 0.001) were significantly higher in the nifedipine group. CONCLUSIONS: Perioperative continuous infusion of milrinone, compared with nifedipine, results in a significantly lower incidence of myocardial ischaemia and myocardial cell damage after elective coronary artery bypass grafting.
PMID: 12442928, UI: 22330092