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Items 1 - 29 of 29 |
One page. |
One-lung ventilation using the ProSeal laryngeal mask airway.
Ozaki M, Murashima K, Fukutome T.
Publication Types:
PMID: 15200557 [PubMed - indexed for MEDLINE]
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Thoracic paravertebral block for breast surgery.
Stamatiou G, Athanasiou E, Simeoforidou M, Bakos P, Michaloudis D.
Publication Types:
PMID: 15200553 [PubMed - indexed for MEDLINE]
Comment on:
Less caps, less connecting and instant monitoring.
Gulati MS.
Publication Types:
PMID: 15200549 [PubMed - indexed for MEDLINE]
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Filters and small infants.
Moores A, Bell GT.
Publication Types:
PMID: 15200548 [PubMed - indexed for MEDLINE]
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Difficult Airway Society guidelines for management of the unanticipated difficult intubation.
Henderson JJ, Popat MT, Latto IP, Pearce AC; Difficult Airway Society.
Anaesthetic Department, Gartnavel General Hospital, 1053 Great Western Road, Glasgow G12 0YN, UK. john.henderson@dial.pipex.com
Problems with tracheal intubation are infrequent but are the most common cause of anaesthetic death or brain damage. The clinical situation is not always managed well. The Difficult Airway Society (DAS) has developed guidelines for management of the unanticipated difficult tracheal intubation in the non-obstetric adult patient without upper airway obstruction. These guidelines have been developed by consensus and are based on evidence and experience. We have produced flow-charts for three scenarios: routine induction; rapid sequence induction; and failed intubation, increasing hypoxaemia and difficult ventilation in the paralysed, anaesthetised patient. The flow-charts are simple, clear and definitive. They can be fully implemented only when the necessary equipment and training are available. The guidelines received overwhelming support from the membership of the DAS. Disclaimer: It is not intended that these guidelines should constitute a minimum standard of practice, nor are they to be regarded as a substitute for good clinical judgement.
Publication Types:
- Guideline
- Practice Guideline
PMID: 15200543 [PubMed - indexed for MEDLINE]
Comment on:
Development of a difficulty score for spinal anaesthesia.
Notcutt W.
Publication Types:
PMID: 15304414 [PubMed - indexed for MEDLINE]
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Editorial I: Fifty years after--reflections on 'The elimination of rebreathing in various semi-closed anaesthetic systems'.
Mapleson WW.
Publication Types:
- Editorial
- Historical Article
PMID: 15304408 [PubMed - indexed for MEDLINE]
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Contamination of anaesthetic gases with nitric oxide and its influence on oxygenation: study in patients undergoing open heart surgery.
Hess W, Kannmacher J, Kruse J.
Department of Anaesthesiology and Operative Intensive Care, AK St Georg Hospital, Lohmuehlenstrasse 5, 20099 Hamburg, Germany.
BACKGROUND: Nitric oxide is important in vasomotor regulation. Contamination of anaesthetic gases with nitric oxide could affect gas exchange. METHODS: We measured oxygenation and nitric oxide concentrations in the inspiratory and expiratory limb of the ventilator circuit in patients about to have cardiac surgery. Measurements were made before surgery when the circulation and respiratory conditions were stable. FIO2 was set at 0.35. The breathing circuit was supplied with a fresh gas flow greater than the minute volume so that exhaled gas was not re-used. Three gas mixtures were given in sequence to each patient: oxygen and compressed air (AIRc), oxygen and nitrous oxide, and oxygen and synthetic air (AIRs) that was free from nitric oxide. All patients were given AIRs as the second gas and the other two gas mixtures (AIRc and nitrous oxide) were given randomly as the first and third gases. RESULTS: During ventilation with oxygen-AIRc, the median nitric oxide concentration was 5.6 ppb, during ventilation with oxygen-nitrous oxide it was 5.0 ppb and using oxygen-AIRs it was 1.5 ppb. When AIRc and nitrous oxide were used, PaO2 was greater and venous admixture was less than when AIRs was used. The different gas mixtures did not affect pulmonary vascular pressures or cardiac ouput. CONCLUSIONS: Compressed air and nitrous oxide contain very low concentrations of nitric oxide (<10 ppb). This can affect pulmonary oxygen transfer during anaesthesia.
PMID: 15298879 [PubMed - as supplied by publisher]
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Comparative effectiveness and safety of physician and nurse anaesthetists: a narrative systematic review.
Smith AF, Kane M, Milne R.
Department of Anaesthesia, Royal Lancaster Infirmary, Lancaster, UK.
BACKGROUND: Despite widespread debate on the merits of different models of anaesthesia care delivery, there are few published data on the relative safety and effectiveness of different anaesthesia providers. Method. We conducted a systematic search for, and critical appraisal of, primary research comparing safety and effectiveness of different anaesthetic providers. RESULTS: Our search of Medline, EMBASE, CINAHL, and HMIC for material published between 1990 and April 2003 yielded four articles of relevance to the question. The studies used a variety of methodologies and all had potential confounding factors limiting the validity of the results. CONCLUSIONS: In view of the paucity of high-level primary evidence in this area, it is not possible to draw a conclusion regarding differences in patient safety as a function of provider type. There are difficulties in classifying events as 'anaesthesia-related', and also in the variable definitions of 'supervision' and 'anaesthesia care team'. We suggest that existing attempts to show differences in outcome might usefully be complemented by studies examining measures of anaesthetic process.
PMID: 15298878 [PubMed - in process]
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Heart failure.
Magner JJ, Royston D.
Department of Anaesthesia and Intensive Care Medicine, Royal Brompton and Harefield NHS Trust, Harefield Hospital, Harefield, Middlesex, UB9 6JH, UK.
Publication Types:
PMID: 15145822 [PubMed - indexed for MEDLINE]
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Sympatho-modulatory therapies in perioperative medicine.
Zaugg M, Schulz C, Wacker J, Schaub MC.
Institute of Anaesthesiology, University Hospital Zurich, Switzerland. michael.zaugg@usz.ch
Publication Types:
PMID: 15145819 [PubMed - indexed for MEDLINE]
Use of the OxyArm in a patient suffering from trigeminal neuralgia.
Noguchi T, Shiga Y, Koga K.
Publication Types:
PMID: 14766709 [PubMed - indexed for MEDLINE]
Comment on:
What do we do with a disconnected epidural catheter?--A response.
Cohen S, Sakr A, Sakr E.
Publication Types:
PMID: 14766708 [PubMed - indexed for MEDLINE]
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The infraclavicular block is a useful technique for emergency upper extremity analgesia.
Fuzier R, Fuzier V, Albert N, Decramer I, Samii K, Olivier M.
Publication Types:
PMID: 14766707 [PubMed - indexed for MEDLINE]
Comment on:
Intrathecal morphine vs psoas compartment block for hip surgery.
Paterson K, Kuehne J.
Publication Types:
PMID: 14766706 [PubMed - indexed for MEDLINE]
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Incident with a Baxter AS40A syringe pump: vigilance is warranted.
Christodoulou C.
Publication Types:
PMID: 14766699 [PubMed - indexed for MEDLINE]
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The Callander laryngoscope blade modification is associated with a decreased risk of dental contact.
Lee J, Choi JH, Lee YK, Kim ES, Kwon OK, Hastings RH.
Department of Anesthesiology, School of Medicine, The Catholic University of Korea, Seoul, Korea.
PURPOSE: Dental damage may occur with laryngoscopy. The purpose of this study was twofold: to determine whether preoperative examination could predict the risk of contacting the teeth with the laryngoscope and to evaluate the effectiveness of a modified Macintosh blade on reducing dental contact. METHODS: Four hundred and eighty-three patients scheduled for elective surgery requiring general anesthesia with endotracheal tube placement were studied prospectively. Features that might predict difficult intubation were assessed preoperatively. Laryngoscopy was performed twice on each patient, once with a regular Macintosh 3 blade and once with a blade in which the flange was partially removed (Callander modification). The distance between the flange of the blade and the upper incisors at glottic exposure was measured. We calculated correlations between individual airway characteristics and the chance of hitting the upper teeth with the regular Macintosh 3 blade and compared the frequencies of contacting the teeth between the two blades. RESULTS: The chance of hitting the upper teeth when using the regular Macintosh 3 blade increased significantly with non-parametric scores for Mallampati classification, mandibular subluxation, head and neck movement, interincisor gap, and condition of the upper teeth. (P < 0.01) The frequency of direct contact varied significantly between the two blades: 20.3% vs 4.1% for Macintosh 3 and modified blades, respectively (P < 0.05). Laryngeal views were improved with the modified blade. CONCLUSION: Airway characteristics correlate with the risk of hitting the upper teeth during laryngoscopy. The modified Macintosh blade reduces the risk of contacting the teeth.
Publication Types:
PMID: 14766698 [PubMed - indexed for MEDLINE]
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The distance from the skin to the subarachnoid space can be predicted in premature and former-premature infants.
Shenkman Z, Rathaus V, Jedeikin R, Konen O, Hoppenstein D, Snyder M, Freud E.
Department of Anesthesia and Critical Care Medicine, Meir Hospital, Kfar Saba, Israel. shlomsh1@netvision.net.il
PURPOSE: Spinal anesthesia can be technically challenging in young infants. We studied whether the distance between the skin and the lumbar subarachnoid space in premature and former-premature young infants could be predicted prior to lumbar puncture. METHODS: The distance from skin entry point to tip of the spinal needle was measured using a caliper after lumbar spinal anesthesia at the L4-5 interspace. This distance was correlated to the patient's weight, postconceptual age and lumbar ultrasonographic measurement of the skin-to-subarachnoid space and predictive statistical models were sought. RESULTS: Thirty-five premature or former-premature infants were studied. Three models were examined: all three independent variables, weight and postconceptual age only, and weight only. The model selected contained the weight and postconceptual age, because it had the highest value for adjusted R squared, as well as the lowest value for the mean squared error. Adding the ultrasonic measurement to the model worsened the results. The statistical model that described the depth of the subarachnoid space at the L4-5 level was Y = 13.19 + 0.0026 x W - 0.12 x PCA, where Y is the distance (mm) from the skin to the subarachnoid space, W is the patient's weight (g) and PCA is the postconceptual age (weeks). Adjusted R squared was 0.72, mean square error was 2.63 and P < 10(-9). CONCLUSION: The distance between the skin and the subarachnoid space at the level of L4-5 interspace can be predicted using a statistical model based on the infant's weight and postconceptual age. Spinal ultrasound has no value in L4-5 subarachnoid space depth prediction.
Publication Types:
PMID: 14766693 [PubMed - indexed for MEDLINE]
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Amniotic fluid embolism with second trimester pregnancy termination: a case report.
Ray BK, Vallejo MC, Creinin MD, Shannon KT, Mandell GL, Kaul B, Ramanathan S.
Department of Anesthesiology, Magee Womens Hospital, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania 15213, USA.
PURPOSE: Describe the diagnosis, clinical features, pathophysiology, treatment and anesthetic management of amniotic fluid embolism (AFE) in a patient undergoing second trimester pregnancy termination. CLINICAL FEATURES: A 30-yr-old gravida 2, para 1, woman was admitted for a dilatation and evacuation procedure for underlying intra-uterine fetal demise in her second trimester of pregnancy. Hypotension, shock, respiratory arrest, pulseless electrical activity, hemorrhage, disseminated intravascular coagulopathy, requiring cardiopulmonary resuscitation and blood transfusion complicated her intraoperative care. AFE was considered the most likely cause of this intraoperative event. CONCLUSIONS: It is now recognized that the pathophysiological features of AFE are similar to a type-1 hypersensitivity reaction ranging from mild systemic reaction to anaphylaxis and shock. AFE has a high maternal and fetal morbidity and mortality rate, requiring prompt recognition and treatment. In patients with cardiovascular instability, the treatment of AFE is similar to anaphylaxis requiring aggressive fluid hydration, cardiopulmonary resuscitation, administration of blood products and the use of vasopressors.
Publication Types:
PMID: 14766690 [PubMed - indexed for MEDLINE]
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Clear hydro-gel, compared to ointment, provides improved eye comfort after brief surgery.
Smolle M, Keller C, Pinggera G, Deibl M, Rieder J, Lirk P.
Department of Anesthesiology and Critical Care Medicine, University of Innsbruck, Innsbruck, Austria.
PURPOSE: Anesthesia impairs lid closure and decreases tear secretion and stability. Protection may, in principle, be conveyed by manual eye closure, taping the eyelids closed, and by instillation of protective substances into the conjunctival sac. Both hydro-gels and ointments are used in clinical practice. It was the objective of the present study to compare a transparent clear ocular hydro-gel (Vidisic) and a commonly used dexpanthenol and vitamin A (Oleovit) based ointment as examples of these classes of ocular lubricants in their capability to provide perioperative eye comfort. Furthermore, their bacteriostatic properties were assessed in vitro. METHODS: Ninety-two consecutive patients undergoing total iv general anesthesia were randomly allocated to receive either ocular dexpanthenol ointment or a clear hydro-gel after induction of anesthesia. Subjects were assessed one hour following termination of anesthesia. RESULTS: Main findings were an increased incidence of foreign body sensation, adherent eyelashes and disturbance elicited by blurred vision in the ointment group as compared to clear hydro-gel (P < 0.001). Bacterial growth was significantly attenuated by the ocular hydro-gel as compared to ointment. DISCUSSION: Clear ocular hydro-gel offers improved patient comfort and decreased ocular inflammation as compared to conventional eye ointments. In addition, it decreases bacterial growth. Therefore, the use of clear ocular hydro-gel for perioperative ocular comfort is suggested.
Publication Types:
- Clinical Trial
- Randomized Controlled Trial
PMID: 14766687 [PubMed - indexed for MEDLINE]
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Drinking 300 mL of clear fluid two hours before surgery has no effect on gastric fluid volume and pH in fasting and non-fasting obese patients.
Maltby JR, Pytka S, Watson NC, Cowan RA, Fick GH.
Department of Anesthesia, University of Calgary, Calgary, Alberta, Canada.
PURPOSE: To determine whether, in obese [body mass index (BMI) > 30 kg.m(2)] patients, oral intake of 300 mL clear liquid two hours before elective surgery affects the volume and pH of gastric contents at induction of anesthesia. METHODS: A single-blind, randomized study of 126 adult patients, age > or = 18 yr, ASA physical status I or II, BMI > 30 kg.m(2) who were scheduled for elective surgery under general anesthesia. Patients were excluded if they had diabetes mellitus, symptoms of gastroesophageal reflux, or had taken medication within 24 hr that affects gastric secretion, gastric fluid pH or gastric emptying. All patients fasted from midnight and were randomly assigned to fasting or fluid group. Two hours before their scheduled time of surgery, all patients drank 10 mL of water containing phenol red 50 mg. Those in the fluid group followed with 300 mL clear liquid of their choice. Immediately following induction of general anesthesia and tracheal intubation, gastric contents were aspirated through a multiorifice Salem sump tube. The fluid volume, pH and phenol red concentration were recorded. RESULTS: Median (range) values in fasting vs fluid groups were: gastric fluid volume 26 (3-107) mL vs 30 (3-187) mL, pH 1.78 (1.31-7.08) vs 1.77 (1.27-7.34) and phenol red retrieval 0.1 (0-30)% vs 0.2 (0-15)%. Differences between groups were not statistically significant. CONCLUSION: Obese patients without comorbid conditions should follow the same fasting guidelines as non-obese patients and be allowed to drink clear liquid until two hours before elective surgery, inasmuch as obesity per se is not considered a risk factor for pulmonary aspiration.
Publication Types:
- Clinical Trial
- Randomized Controlled Trial
PMID: 14766684 [PubMed - indexed for MEDLINE]
Pneumothorax after shoulder arthroscopy: Don't blame it on regional anesthesia.
Oldman M, Peng Pi P.
Publication Types:
PMID: 15305270 [PubMed - in process]
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We need to educate about perioperative pain control and not just regional anesthesia.
McCartney CJ.
Publication Types:
PMID: 15305269 [PubMed - in process]
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Continuous spinal anesthesia after unintentional dural puncture during attempted epidural anesthesia for mastectomy.
Ozturk E, Gokce M, Gunaydin B, Babacan A.
Publication Types:
PMID: 15305268 [PubMed - in process]
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Adding methylprednisolone to local anesthetic increases the duration of axillary block.
Stan T, Goodman EJ, Bravo-Fernandez C, Holbrook CR.
Publication Types:
PMID: 15305267 [PubMed - in process]
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Piriformis syndrome in a patient after cesarean section under spinal anesthesia.
Vallejo MC, Mariano DJ, Kaul B, Sah N, Ramanathan S.
Department of Anesthesiology, Magee-Womens Hospital, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA. vallejomc@anes.upmc.edu
OBJECTIVES: The diagnosis, pathogenesis, and treatment of piriformis syndrome as a cause of persistent buttock and hip pain after spinal anesthesia are presented in this case report. CASE REPORT: A 29-year-old woman presented 5 days after cesarean delivery with sudden onset of pain in the left buttock and left hip radiating to the posterior knee with fever. She was subsequently diagnosed with piriformis syndrome. CONCLUSIONS: Back pain with radiation into the buttocks after spinal anesthesia is frequently attributed to the spinal procedure itself. However, prolonged sitting and weight bearing in the upright position after cesarean delivery can cause sciatic nerve compression at the sacroiliac joint with concomitant irritation, inflammation, and spasm of the piriformis muscle. Piriformis syndrome is frequently underdiagnosed in the obstetric population. Because the diagnosis of piriformis syndrome is based mainly on clinical signs and symptoms, the clinician must have a high index of suspicion.
PMID: 15305258 [PubMed - in process]
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Cervical epidural analgesia via a thoracic approach using nerve stimulation guidance in an adult patient undergoing elbow surgery.
Tsui BC, Bateman K, Bouliane M, Finucane B.
Department of Anesthesiology and Pain Medicine, University of Alberta Hospitals, Edmonton, Alberta, Canada. btsui@ualberta.ca
OBJECTIVE: This case report describes the placement of a cervical epidural catheter via the thoracic approach, using nerve stimulation, in a patient undergoing elbow surgery. CASE REPORT: An epidural catheter was easily advanced to the C5 dermatome level from the T4-5 interspace, using nerve stimulation guidance. Successful perioperative analgesia was accomplished using an infusion of ropivacaine 0.2% with 0.05 mg/mL morphine at 4 mL/h. CONCLUSIONS: This case report suggests that electrical stimulation may allow one to accurately position epidural catheters in the central neuraxial space to provide reliable, effective analgesia of the upper extremity. This approach might be an alternative way to deliver cervical epidural analgesia for patients undergoing upper extremity surgery.
PMID: 15305256 [PubMed - in process]
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Local anesthetic myotoxicity.
Zink W, Graf BM.
Department of Anesthesiology, University of Heidelberg, Heidelberg, Germany.
Skeletal muscle toxicity is a rare and uncommon side effect of local anesthetic drugs. Intramuscular injections of these agents regularly result in reversible myonecrosis. The extent of muscle damage is dose dependent and worsens with serial or continuous administration. All local anesthetic agents that have been examined are myotoxic, whereby procaine produces the least and bupivacaine the most severe muscle injury.The histologic pattern and the time course of skeletal muscle injury appear rather uniform: hypercontracted myofibrils become evident directly after injection, followed by lytic degeneration of striated muscle sarcoplasmic reticulum, and by myocyte edema and necrosis over the next 1 to 2 days. Myoblasts, basal laminae, and connective tissue elements remain intact in most cases, which permits muscular regeneration within 3 to 4 weeks. Subcellular pathomechanisms of local anesthetic myotoxicity are still not understood in detail. Increased intracellular Ca2+ levels appear to be the most important element in myocyte injury; since denervation, inhibition of sarcolemmal Na+ channels, and direct toxic effects on myofibrils have been excluded as sites of action. In this respect, the quantitative impact of further mitochondria-mediated pathways--at least in bupivacaine toxicity--is still to be established. Although experimental myotoxic effects are impressively intense and reproducible, only a few case reports of myotoxic complications in patients after local anesthetic administrations have been published. In particular, the occurrence of clinically relevant myopathy and myonecrosis has been described after continuous peripheral blocks, infiltration of wound margins, trigger point injections, and peri- and retrobulbar blocks.
PMID: 15305253 [PubMed - in process]
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The effect of adjuvant epinephrine concentration on the vasoactivity of the local anesthetics bupivacaine and levobupivacaine in human skin.
Newton DJ, McLeod GA, Khan F, Belch JJ.
Vascular Diseases Research Unit, The Institute of Cardiovascular Research, Dundee, United Kingdom. d.j.newton@dundee.ac.uk
BACKGROUND AND OBJECTIVES: The recommended optimal concentration of adjuvant epinephrine for use with local infiltration anesthesia is usually 5 microg/mL. However, a lower dose might be as effective at prolonging the anesthetic effects, while limiting the risk of hazards associated with unintentional intravascular injection. The aim of our study was to determine the lowest effective vasoconstrictor concentration of epinephrine in human skin for a range of doses of bupivacaine and its less-vasodilatory S(-) isomer, levobupivacaine. METHODS: We injected combinations of 0.125%, 0.25%, and 0.75% bupivacaine and levobupivacaine with 1.25, 2.5, and 5 microg/mL epinephrine into the forearm skin of 10 healthy volunteers and measured the resulting blood flow changes over 1 hour using laser Doppler imaging. RESULTS: All 3 concentrations of epinephrine produced marked vasoconstriction, both alone and in combination with all 3 doses of the anesthetics ( P <.001 in all cases). There was almost no difference in effect between the 3 epinephrine concentrations. CONCLUSIONS: We conclude that 1.25 microg/mL epinephrine produces a comparable vasoconstrictor effect in human skin to that of higher concentrations when coinjected with clinical doses of bupivacaine and levobupivacaine and may be equally effective for infiltration anesthesia.
PMID: 15305248 [PubMed - in process]
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