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Anaesthesist 2002 Jun;51(6):485-8
Hachenburg, Germany.
Publication Types:
PMID: 12391536, UI: 22277800
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Anaesthesist 2002 Jun;51(6):470-4
Klinik fur Anasthesiologie der Ludwig-Maximilians-Universitat Munchen, Germany.
A giant hemangioma of the tongue was resected in a 16-year-old otherwise healthy young man (ASA I). Despite a total blood loss of 4,300 ml, corresponding to 105% of the patients intravascular blood volume, no allogeneic red blood cells had to be transfused intraoperatively. Besides minimization of intraoperative blood loss with preoperative alcohol injections into the tumor, ligation of large tumor-perfusing arteries, application of fibrin glue, skillful surgical technique, positioning of the surgical field above the level of the heart, controlled hypotension and maintenance of normothermia, acute normovolemic hemodilution (augmented by preoperative administration of recombinant human erythropoetin - rhEpo) and autotransfusion of lost blood were used for recovery of autologous blood. Under the protection of hyperoxia, a decrease of the hemoglobin (Hb) concentration to 4.2 g/dl was bridged by extreme normovolemic hemodilution. No signs of immanent or manifest tissue hypoxia were encountered. Retransfusion of autologous red blood cells was only started when surgical control of bleeding was achieved. Additionally a total of 4 units of fresh frozen plasma were infused for stabilization of plasma coagulation.After a 9-hour surgical duration, the patient was transferred to the intensive care unit, normotensive (with low-dose infusion of norepinephrin) and normothermic with a Hb concentration of 5.6 g/dl. In the face of an increasing lactacidosis 2 units of packed red blood cells were transfused on post surgical day 1.
PMID: 12391534, UI: 22277798
Anaesthesist 2002 Jun;51(6):467-9
Institut fur Anasthesiologie und Reanimation, Universitatsklinikum Umberto, Rom, Italien. p.orfei@mclink.it
This case report describes the perforation of a laryngeal mask during central venous cannulation of the internal jugular vein in a 2000 g, formerly preterm infant. The procedure was undertaken with the patient under general anaesthesia with a laryngeal mask and spontaneous breathing. As a result of the infant's clinical status, multiple needle insertions were required to obtain venous access. The needle was inadvertently advanced to the retropharynx and perforated the air-filled part of the laryngeal mask. Ventilation parameters remained stable. The laryngeal mask causes anatomical alterations of cervical structures in the newborn and therefore its use for the airway management during jugular vein cannulation appears to be limited.
PMID: 12391533, UI: 22277797
Anaesthesist 2002 Jun;51(6):463-6
Universitatsklinik fur Anasthesiologie und Intensivtherapie, Philipps-Universitat Marburg, Germany. eberhart@mailer.uni-marburg.de
BACKGROUND: In 1999 Myles and co-workers presented their quality of recovery score (QoR score) as a tool to evaluate postoperative recovery and to measure patient satisfaction. It was developed according to predefined psychological standards and its reliability and validity had been proven in large clinical trials. The aim of this study was to evaluate a German version of the QoR in a heterogeneous group of surgical patients. METHODS: A total of 577 unselected patients completed a modified questionnaire. The response rate and time spent on completing the test were recorded. A stepwise multivariate regression analysis identified factors with significant impact on the QoR score. Other analyses were performed descriptively. RESULTS: Of the patients 83% completed the questionnaire in a median time of 9 h after surgery without assistance. For 75% of these it took 2 min or less. The median QoR score was 15 (10(th)/90(th) percentile: 11/18). Cronbach's p (=0.63) and mean corrected item correlation (=0.32) were used as measures of internal reliability. Factors with impact on the QoR score were: period of time after surgery when performing the test, severity of surgery, sex, general vs local anaesthesia, duration of anaesthesia, and age. CONCLUSIONS: The German translation of the QoR score is easily applicable to a heterogeneous surgical population and thus can be used as a valuable measure of quality of anaesthesia care and patient satisfaction.
PMID: 12391532, UI: 22277796
Can J Anaesth 2003 Jan;50(1):93
Toronto, Ontario.
[Medline record in process]
PMID: 12514161, UI: 22401569
Can J Anaesth 2003 Jan;50(1):86-91
Department of Anesthesiology and Neurosurgery Nara Medical University Japan.
PURPOSE: To investigate whether motor evoked potentials (MEP) to transcranial electrical stimulation under constant blood propofol concentration are affected by the arousing effect of surgical noxious stimuli. METHODS: Twenty patients who underwent elective spinal surgery were studied. Patients were anesthetized with 50% nitrous oxide in oxygen, fentanyl, and propofol to maintain the bispectral index (BIS) score around 50. MEP in response to a multipulse transcranial electrical stimulation at stimulus sites of C3-C4 were recorded over the right abductor pollicis brevis muscle. Changes of peak-to-peak amplitude and onset latency of MEP, BIS score before and after surgical stimuli were evaluated. Propofol plasma concentration was measured at the same time points. RESULTS: Both MEP amplitude and latency did not change significantly after surgical stimuli although BIS increased significantly (48 +/- 6 to 58 +/- 5; P < 0.05). Plasma propofol concentration was maintained at the same level between the two measurement points (3.3 +/- 0.7 to 3.3 +/- 0.7 micro g*mL(-1)). There was no relation between BIS change and changes of MEP amplitude and latency, and propofol plasma concentration. CONCLUSION: MEP to the transcranial electrical stimulation under a constant and clinically appropriate blood propofol concentration are not affected by surgical noxious stimuli.
PMID: 12514158, UI: 22401566
Can J Anaesth 2003 Jan;50(1):67-70
Department of Anesthesia, McGill University, Montreal, Quebec, Canada.
PURPOSE: To assess the dose-dependent effect of low concentrations of isoflurane on respiratory mechanics in normal subjects. METHODS: We studied 12 non-premedicated ASA I patients scheduled for lower abdominal or extremity surgery. After thiopental 5-7 mg*kg(-1) iv and succinylcholine 1 mg*kg(-1) iv, the trachea was intubated and an esophageal balloon was placed optimally by the occlusion test. After introduction of N(2)O and muscle paralysis with vecuronium, we studied 0, 0.6, 0.9 and 1.2% isoflurane. We recorded flow (F), airway opening and esophageal pressures. Signals were amplified, filtered, sampled at 100 Hz, and then fed in a 12-bit analogue-digital converter in a personal computer. Data were collected and analyzed using LABDAT and ANADAT software. Signals were acquired for 60-90 sec during mechanical ventilation (10 mL*kg(-1), 10 breaths*min(-1), I:E ratio 1:2). We estimated respiratory system (RS), lung (L) and chest wall (W) dynamic elastance (E) and resistance (R) by P(t) = EV(T)(t) + RF(t) + K, where t is time, V(T) tidal volume from integration of F, and K an estimation of end-expiratory pressure. ANOVA was used for comparing the basal state with the three concentrations. RESULTS: E and R were statistically lower at 0.6, 0.9 and 1.2% compared to basal values for RS, L and W. Concentrations equal to or higher than 0.6% did not further change respiratory mechanics, except for E(L1.2) compared to E(L0.6,) 12.37 +/- 5.72 and 13.52 +/- 5.64 cm H(2)O.L(-1), respectively. CONCLUSION: Isoflurane concentrations between 0.6-1.2% are not associated to a dose-dependent effect on respiratory mechanics.
PMID: 12514154, UI: 22401562
Can J Anaesth 2003 Jan;50(1):32-5
Departement d'anesthesiologie, Universite de Montreal, Montreal, Quebec, Canada.
PURPOSE: To present and discuss a case of opioid-induced rigidity with low-dose fentanyl during recovery from anesthesia. Clinical features: A 41-yr-old woman underwent laparotomy for total abdominal hysterectomy and bilateral salpingo- oophorectomy under general anesthesia. She received a total of 500 micro g of fentanyl by iv intermittent boluses during the three-hour anesthetic. During emergence from anesthesia, while intubated, the patient presented with rigidity. No changes in ventilatory parameters were measured during the episode. The only notable predisposing factor was treatment with venlafexine, an antidepressant that modifies serotonin and norepinephrine levels. She was successfully treated with iv naloxone 20 micro g. The rest of the postoperative period was uneventful. CONCLUSION: We observed an atypical case of opioid-induced rigidity in contrast to the classical syndrome, which presents at induction with high-dose opioids. This syndrome has many clinical presentations with neurologic and ventilatory signs of varying intensity. Early recognition of the syndrome and adequate treatment is crucial. If treated adequately, opioid-induced rigidity is self-limited with few complications.
PMID: 12514147, UI: 22401555
Can J Anaesth 2003 Jan;50(1):26-31
Department of Anesthesiology Dokkyo University School of Medicine Mibu Tochigi Japan.
PURPOSE: To establish the appropriate inhalation induction technique using a high concentration of sevoflurane in the elderly. METHODS: Forty-five patients, aged 70-79-yr-old, were randomly divided into three groups: 1) Group I: anesthesia was induced with propofol 2 mg*kg(-1) and sevoflurane 2% (n = 15); 2) Group II: anesthesia was induced with a three- minute inhalation of sevoflurane 8%; 3) Group III: anesthesia was induced with inhalation of sevoflurane using a gradual reduction technique (8, 6, 4% for each minute). In Groups II and III, a modified vital capacity inhalation induction was performed. Mean arterial pressure (MAP), heart rate (HR) and oxygen saturation (SpO(2)) were measured continuously during induction. In addition, induction time and adverse events related to anesthetic induction were recorded. RESULTS: The induction time in Group I was significantly shorter than that in Groups II and III (P < 0.05). However, there was no difference in the induction time between Groups II and III. In Groups II and III, the majority of patients required additional breaths. In comparison with the other groups, stability of MAP was maintained in Group III. The variations of HR in all groups were small. During induction, no patient experienced a decrease in SpO(2) below 96%, except for two patients in Group I. Severe respiratory adverse events were not observed. Other adverse events were similar in all groups. CONCLUSIONS: Our results suggest that a high concentration sevoflurane induction using a gradual reduction technique may be an acceptable alternative to standard iv induction in elderly patients.
PMID: 12514146, UI: 22401554
Can J Anaesth 2003 Jan;50(1):11-3
Hamilton, Ontario. Geneva, Switzerland.
PMID: 12514143, UI: 22401551
Can J Anaesth 2002 Nov;49(9):990-2
Department of Anesthesiology, University of North Carolina Chapel Hill, North Carolina, USA. fspielman@aims.unc.edu
PURPOSE: To describe a complication of the disposable laryngeal mask airway (LMA). CLINICAL FEATURES: A 23-yr-old woman underwent a wide local excision of a chest wall melanoma and sentinel node biopsy under general anesthesia. During use of a single-use LMA-Unique(TM), the airway tube became completely separated from the distal mask (backplate). No sequelae resulted from failure of the airway apparatus. The LMA was examined by LMA North America, and the company stated "no definitive explanation can be made to explain the cause for separation of the airway from the backplate." CONCLUSION: Although the use of the LMA is associated with rare and minimal complications, each airway should be carefully inspected before its use for loss of integrity resulting from sterilization or for defects in manufacturing.
PMID: 12419731, UI: 22306829
Can J Anaesth 2002 Nov;49(9):951-3
Department of Anaesthesiology, Lady Hardinge Medical College and Associated Hospitals, New Delhi, India. rasvin666@rediffmail.com
PURPOSE: Mandibular nerve block allows surgery to be performed on the mandible. However, pain in the postoperative period needs to be treated with opioids or non-steroidal anti-inflammatory agents which have undesirable side effects. We examine the feasibility of continuous mandibular nerve block with 0.25% bupivacaine top-ups using a catheter for intraoperative and postoperative pain relief in two patients with a fracture of the mandible. METHODS: Using the lateral extraoral approach, the mandibular nerve was approached with an 18-gauge indwelling iv cannula in two patients undergoing repair of a fractured mandible under general anesthesia. After removing the needle, an 18-gauge epidural catheter was inserted into the cannula which was then removed. The catheter was tunnelled subcutaneously to emerge at the lateral aspect of the forehead. Two to 4 mL bupivacaine 0.25% were injected on a 12-hr basis and the catheter was kept in place for seven days. RESULTS: Both patients had excellent pain relief and no parenteral or oral analgesics were required throughout the postoperative period. No side effects were noted. CONCLUSIONS: Continuous mandibular nerve block with 2-4 mL 0.25% bupivacaine top-ups injected twice a day through a catheter provides excellent pain relief in patients with a fracture of the mandible. This method may have implications for the management of pain of other etiology in the mandibular region.
PMID: 12419723, UI: 22306821
Can J Anaesth 2002 Nov;49(9):927-31
First Department of Anesthesiology, Dokkyo University School of Medicine, Mibu, Tochigi, Japan. mio28@mug.biglobe.ne.jp
PURPOSE: To assess the effects of age on recovery of psychomotor function for propofol sedation during spinal anesthesia. METHODS: Propofol was continuously infused during surgery and spinal anesthesia in 15 elderly patients (65-85 yr-old) and 15 younger patients (20-50 yr-old). Infusion rates were adjusted to maintain an appropriate level of sedation using the bispectral index (range 60-70). The sedative infusion was discontinued at the end of surgery. The early recovery times from the end of propofol infusion to opening of eyes on command, sustaining a hand grip, and recall of name were noted. Psychomotor function, as measured by the Trieger's dot test, was evaluated before anesthesia and 30, 60, 90, 120 min after the end of propofol infusion. RESULTS: The duration of anesthesia was 142 +/- 55 min and 134 +/- 61 min in the elderly and younger patients, respectively. No differences were observed in early recovery times between elderly and younger patients (opened their eyes on command, 6.3 +/- 4.0 min and 5.2 +/- 2.6 min; sustained a hand grip, 7.2 +/- 3.9 min and 6.1 +/- 3.5 min and recalled their name, 8.0 +/- 4.5 min and 6.5 +/- 3.8 min, P > 0.05 ). The recovery of psychomotor function in the elderly took longer compared with the younger patients, and psychomotor function in the elderly recovered at 120 min after the end of propofol infusion. CONCLUSION: Early recovery times following propofol sedation is similar between elderly and younger patients, but recovery of psychomotor function in the elderly is delayed compared with younger patients.
PMID: 12419718, UI: 22306816
Can J Anaesth 2002 Nov;49(9):918-21
Du service d'anesthesie-reanimation Hopital Henri-Mondor, AP-HP et Universite Paris XII, Creteil, France.
OBJECTIVE: To compare bispectral index (BIS) values to hemodynamic variations, in order to evaluate adequacy of anesthesia during orotracheal intubation with muscle relaxants. METHODS: Forty-one patients ASA I-II, scheduled for elective peripheral surgery under general anesthesia with tracheal intubation were enrolled in the study. Fentanyl/thiopental followed by vecuronium were used for induction. Onset of relaxation was monitored at the orbicularis occuli (OO) muscle using train-of-four stimulation. Intubation was performed when no response at the OO was detected visually. Intubating conditions were noted. The "isolated forearm" technique was used to detect movement during laryngoscopy/intubation. BIS values, pulse rate (PR), and systolic pressure were recorded before induction, during laryngoscopy/intubation and 60 sec after intubation. RESULTS: Although intubating conditions were clinically adequate for all patients, ten out of 41 had movement of the isolated arm during laryngoscopy/intubation. BIS values were not significantly different for these patients: 67 (55-83) compared to those who had no movement: 60 (35-80), P = 0.6. During laryngoscopy, PR increased for all patients while systolic pressure increased significantly only in patients who moved: 125 (100-136) mmHg vs those who did not: 108 (67-140), P < 0.05. CONCLUSION: Systolic pressure elevations were associated with inadequate anesthesia as evaluated by the "isolated forearm" technique, during laryngoscopy/intubation. BIS values were not different between groups, suggesting that systolic blood pressure may be a better predictor of inadequate anesthesia under the circumstances described.
PMID: 12419716, UI: 22306814
Can J Anaesth 2002 Nov;49(9):913-7
Department of Anesthesia, Neuromuscular Research Group, Centre Hospitalier de l'Universite de Montreal (CHUM) and the Department of Anesthesiology, Universite de Montreal, Montreal, Quebec, Canada. thomashemmerling@hotmail.com
PURPOSE: Phonomyography (PMG) is a novel technique for measuring neuromuscular blockade (NMB). The effect of the duration of control stimulation on the onset and duration of blockade was investigated using PMG and acceleromyography (AMG). METHODS: After induction of anesthesia, a microphone was placed above the middle portion of the left eyebrow, and an acceleromyographic probe was placed above the middle portion of the right eyebrow. Twenty patients were randomized to receive bilateral, single-twitch, facial nerve stimulation (0.1 Hz, 20 mA) with three minutes (n = 10) or ten minutes (n = 10) of supramaximal stimulation before mivacurium 0.2 mg.kg(-1) was administered. Onset, maximum effect, and offset of NMB were measured. RESULTS: Using PMG, lag time, onset time, maximum effect, and time to reach 75% of control twitch height (mean +/- SD) were 36 +/- 27 sec, 136 +/- 35 sec, 89 +/- 10%, and 12.1 +/- 4.5 min, respectively, after three minutes of control stimulation and were 40 +/- 22 sec, 122 +/- 40 sec, 93 +/- 3%, and 12.4 +/- 4.9 min, after ten minutes. Using AMG, the values were 38 +/- 23 sec, 106 +/- 28 sec, 79 +/- 6%, and 14.3 +/- 5.9 min, respectively, after three minutes and were 34 +/- 22 sec, 106 +/- 28 sec, 76 +/- 10%, and 14.9 +/- 3.7 min, after ten minutes. Compared to PMG, AMG revealed significant bias for onset time (-30 sec), maximum effect (-16%) and time to reach 75% of control twitch height (1.5 min), with wide limits of agreement of 66 sec, 22%, and 5.6 min, respectively. CONCLUSION: The duration of control stimulation did not influence the time course of blockade measured by either method. Three minutes of supramaximal stimulation is sufficient to measure pharmacodynamic parameters. AMG measures a shorter onset and longer recovery time and reduced anesthesiology the maximum effect compared to PMG.
PMID: 12419715, UI: 22306813
Can J Anaesth 2002 Nov;49(9):907-12
Department of Anesthesiology, Centre Hospitalier de l'Universite de Montreal, Universite de Montreal, Montreal, Quebec, Canada.
PURPOSE: Volatile anesthetic agents potentiate neuromuscular blockade, but the magnitude of potentiation appears to be time dependent. The time course of this interaction was studied by measuring mivacurium infusion rates during sevoflurane, isoflurane and propofol anesthesia. METHODS: After informed consent, anesthesia was induced in 48 ASA physical status I-II adults with propofol, fentanyl and mivacurium 0.25 mg.kg(-1) and maintained with N(2)O (60%) and one of the three agents chosen at random: sevoflurane 1.9%; isoflurane 1.2%; or propofol 100-150 microgram.kg(-1).min(-1). Train-of-four stimulation was applied every 15 sec to the ulnar nerve. Neuromuscular blockade was monitored with accelerometry. At 5% recovery of the first twitch (T1), a mivacurium infusion was started and adjusted every five minutes to maintain 90-95% T1 depression. RESULTS: The time to 5% T1 recovery after the initial dose was similar in all groups (13-15 min). Fifteen minutes after the start of the infusion mivacurium requirements were greater (P < 0.05) in the propofol group (7.5 +/- 1.7 microgram.kg(-1).min(-1); mean +/- SD) than in either isoflurane (4.7 +/- 1.6 microgram.kg(-1).min(-1)) or sevoflurane (4.5 +/- 1.5 microgram.kg(-1).min(-1)) group. Then, the rate remained stable for propofol (6.2 +/- 1.4 microgram.kg(-1).min(-1) after 90 min of infusion) while it decreased with isoflurane to 2.9 +/- 1.6 microgram.kg(-1).min(-1) at 90 min (P < 0.05 vs propofol) and to 1.4 +/- 1.0 microgram.kg(-1).min(-1) in the sevoflurane group (P < 0.05 vs propofol and isoflurane). CONCLUSION: Sevoflurane and isoflurane do not prolong the effect of a bolus dose of mivacurium, but potentiation increases with time from 30-105 min of exposure. This interaction is greater with sevoflurane than isoflurane.
PMID: 12419714, UI: 22306812
Eur J Anaesthesiol 2002 May;19(5):384-6
PMID: 12095024, UI: 22089456
Eur J Anaesthesiol 2002 May;19(5):381
PMID: 12095021, UI: 22089453
Eur J Anaesthesiol 2002 May;19(5):376-80
Gazi University, Department of Anesthesiology, Faculty of Medicine, Ankara, Turkey. mahli@med.gazi.edu.tr
Stellate ganglion block is a selective sympathetic block that affects the ipsilateral head, neck, upper extremity and upper part of the thorax. Convulsions are a recognized complication of intra-arterial injection during stellate ganglion block. As central nervous system toxicity depends ultimately on the concentration of the local anaesthetics presented to the brain, the likely causative factors are discussed as well as the types of toxic symptoms and their onset times. The paper considers the aetiological factors of such convulsions resulting from stellate ganglion block in two patients.
PMID: 12095020, UI: 22089452
Eur J Anaesthesiol 2002 May;19(5):317-29
University College of Medical Sciences and Guru Teg Bahadur Hospital, Shahadra, Delhi, India. dr_ashatyagi@hotmail.com
Patients receiving anticoagulants offer a challenge to anaesthesiologists. The issue of spinal haematoma following central neuraxial block in such patients is a contentious issue. Although rare, with an estimated incidence of < 1:150,000 for epidural blocks and 1:220,000 for spinal anaesthetics in patients with normal coagulation status, this is an emergency situation with a potentially grave prognosis. The review presents cases of spinal haematomata that have occurred in the last 5 years, both spontaneously and after central neuraxial blockade. Of the 60 cases reported in the literature, 33% occurred following central neuraxial block and, of these, 55% were associated with concomitant use of anticoagulants. The pharmacology of the newer and older anticoagulants is also described. The variety of risk factors and diverse recommendations that have been described in these patients are reviewed.
PMID: 12095011, UI: 22089443