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Comment on:
Remifentanil and propofol during ophthalmic block.
Zeyneloglu P, Donmez A.
Publication Types:
PMID: 14719439 [PubMed - indexed for MEDLINE]
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Whitacre needle insertion technique.
Duffy BL.
Publication Types:
PMID: 14719436 [PubMed - indexed for MEDLINE]
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Combination of adenosine with prilocaine and lignocaine for brachial plexus block does not prolong postoperative analgesia.
Apan A, Basar H, Ozcan S, Buyukkocak U.
Department of Anaesthesiology, Faculty of Medicine, Kirikkale University, Kirikkale, Turkey.
Adenosine analogues have been used by subarachnoid injection for the treatment of inflammatory and neuropathic pain. There is no data on the use of adenosine in peripheral nerve blocks. The aim of the present study was to determine the analgesic efficacy of adenosine in combination with a local anaesthetic solution for brachial plexus (BP) block. With local ethics committee approval, 50 consenting adult patients undergoing upper limb surgery were enrolled in this double-blind, prospective, randomized study. Patients with a history of bronchospastic disease were excluded. Patients were instructed not to take theophylline-containing drugs and beverages for at least one day before surgery or on the first postoperative day. A supraclavicular BP block was performed by injecting a mixture totalling 35 ml made up of prilocaine 1% 10 ml and lignocaine 2% 20 ml with adrenaline 1:200,000, and adenosine 10 mg in 5 ml saline (Group 1) or 5 ml saline (Group 2) as a placebo control group. Postoperative analgesia was assessed by time to first rescue analgesia, analgesic consumption in the first 24 hours, and VAS at rest at 4, 8, 12, 16, 20 and 24 hours. Side-effects were also noted. Vital signs were stable in both groups throughout the operation. There were no significant differences between the groups in onset of motor and sensory block. Time to first pain sensation from block was not significantly longer in the adenosine group (379 +/- 336 min) compared with controls (304 +/- 249 min, mean +/- SD, P = 0.14). Time to first analgesic requirements and analgesic consumption in the first 24 hours were also similar in both study groups. In the present study, the addition of adenosine to local anaesthetic in brachial plexus block did not significantly extend the duration of analgesia.
Publication Types:
- Clinical Trial
- Randomized Controlled Trial
PMID: 14719426 [PubMed - indexed for MEDLINE]
[A cerebral watershed infarction after general anaesthesia in a patient with increased anti-cardiolipin antibody level]
[Article in German]
Verbrugge SJ, Klimek M, Klein J.
Afdeling Anesthesiologie, Erasmus MC, Rotterdam, serge.verbrugge@12move.nl
During the first generalised epileptic attack, a patient suffered a humerus fracture which necessitated an operation. This patient also had a history of spontaneous lung emboli and an elevated anti-cardiolipin plasma level for which coumarin was prescribed but was stopped preoperatively. After induction of general anaesthesia for a total shoulder arthroplasty, the patient became hypotensive and the bispectral index recorded perioperatively dropped to 0. Postoperatively, the patient developed signs of a unilateral borderzone cerebral infarct in the area of the medial cerebral artery. The possible pathomechanisms involved are discussed. In cases of known cerebral pathology intraoperative hypotension should be avoided by at all costs. Patients with increased anti-cardiolipin antibody levels and who suffer from epileptic attacks have an increased risk of thromboembolic events.
PMID: 15088096 [PubMed - in process]
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[Perioperative use of medical hypnosisTherapy options for anaesthetists and surgeons]
[Article in German]
Hermes D, Trubger D, Hakim SG, Sieg P.
Klinik fur Kiefer- und Gesichtschirurgie, Universitatsklinikum Schleswig-Holstein/Campus Lubeck, hermesddd@aol.com
BACKGROUND. Surgical treatment of patients under local anaesthesia is quite commonly restricted by limited compliance from the patient. An alternative to treatment under pharmacological sedation or general anaesthesia could be the application of medical hypnosis. With this method, both suggestive and autosuggestive procedures are used for anxiolysis, relaxation, sedation and analgesia of the patient. PATIENTS AND METHODS. During a 1-year period of first clinical application, a total of 207 surgical procedures on a non-selected collective of 174 patients were carried out under combined local anaesthesia and medical hypnosis. RESULTS. Medical hypnosis proved to be a standardisable and reliable method by which remarkable improvements in treatment conditions for both patient and surgeons were achievable. CONCLUSION. Medical hypnosis is not considered to be a substitute for conscious sedation or general anaesthesia but a therapeutic option equally interesting for anaesthesists and surgeons.
PMID: 15088095 [PubMed - in process]
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["Alternative" effects of local anesthetic agents]
[Article in German]
Pecher S, Bottiger BW, Graf B, Hollmann MW.
Universitatsklinik fur Anaesthesiologie, Universitat Heidelberg.
The following article summarizes different aspects of local anesthetic effects that cannot be explained purely by a sodium channel blockade. Particularly remarkable is hereby their antiinflammatory activity, e.g. the inhibition of pathological changes such as excessive stimulation of the inflammatory system, without compromising the host defense system. In contrast to other immunosuppresive drugs commonly used for treating such conditions, local anesthetics look promising for the future as a new therapeutic option. Besides general anesthetic activity, local anesthetics exert cerebroprotective effects and are furthermore, in consideration of their cardiovascular stability, of interest during neuroanesthetic procedures. In addition, local anesthetics are known for their potency to minimize bronchial hyperreactivity, although details of the underlying mechanisms are not yet elucidated. These effects of local anesthetics may represent interesting prospects for which their relevance has to be determined.
PMID: 15088094 [PubMed - in process]
Abstracts of the Society of Cardiovascular Anesthesiologists 26th Annual Meeting and Workshops. Honolulu, Hawaii, April 24-28, 2004.
[No authors listed]
Publication Types:
PMID: 15085850 [PubMed - indexed for MEDLINE]
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Comparison of the effect of orally versus submucosally administered meperidine on the behavior of pediatric dental patients: a retrospective study.
Song YU, Webb MD.
Pediatric Dentistry, Baylor College of Dentistry, The Texas A&M University System Health Science Center, Dallas, Texas 75246, USA.
The purpose of this study was to compare the effect of oral versus submucosal meperidine on the behavior of pediatric dental patients. Twenty charts (10 in each group) were retrospectively reviewed. The groups were matched for age and weight. Presedation and postsedation behavior was rated. No difference was found in the increase in cooperation between the oral and the submucosal meperidine groups. While no difference was found between the 2 groups, a larger prospective study is needed to confirm these findings.
PMID: 14558588 [PubMed - indexed for MEDLINE]
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A comparison of injection pain and postoperative pain of two intraosseous anesthetic techniques.
Gallatin J, Nusstein J, Reader A, Beck M, Weaver J.
The Ohio State University, Columbus, Ohio 43210, USA.
The purpose of this prospective, randomized, blinded study was to compare injection pain and postoperative pain of an apical primary X-Tip intraosseous technique to a coronal primary Stabident intraosseous technique in mandibular first molars. Using a repeated-measures design, 41 subjects randomly received 2 primary intraosseous injections at 2 separate appointments. Using a site distal to the mandibular first molar for both injections, the subjects received 1.8 mL of 2% lidocaine with 1: 100,000 epinephrine administered with the X-Tip system using an apical location in alveolar mucosa or 1.8 mL of 2% lidocaine with 1: 100,000 epinephrine administered with the Stabident system using a coronal location in attached gingiva. The pain of infiltration, perforation, needle insertion, solution deposition, mock or actual guide sleeve removal and postoperative pain were recorded on a Heft-Parker visual analogue scale (VAS) scale for the 2 intraosseous systems. The results demonstrated that the apical primary X-Tip intraosseous technique was not statistically different (P > .05) from the coronal primary Stabident technique regarding pain ratings of infiltration, perforation, needle insertion, solution deposition, mock or actual guide sleeve removal and postoperative pain (at the time subjective anesthesia wore off). However, on postoperative days 1 through 3, significantly (P < .05) more males experienced postoperative pain with the X-Tip system than with the Stabident system.
Publication Types:
- Clinical Trial
- Randomized Controlled Trial
PMID: 14558586 [PubMed - indexed for MEDLINE]
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Parental evaluation of quality of life measures following pediatric dental treatment using general anesthesia.
White H, Lee JY, Vann WF Jr.
University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599-7450, USA.
The purpose of this study was to examine (a) parental satisfaction with the dental care their child received under general anesthesia, and (b) perception of the impact of this care on physical and social quality of life. The sample included 45 children (median age 50 months, 26 boys and 19 girls). Data were collected using a 1-page survey instrument completed by the parent at the first follow-up appointment. Dichotomous dependent variables were developed to measure parental satisfaction, dental outcome, and social impact of treatment. There was an overwhelmingly positive impression with dental outcomes (pain relief and improved masticatory efficiency). Parental perceptions in the social dimension were also positive. Parents reported more smiling, improved school performance, and increased social interaction. Relative to overall health, the majority of parents reported an improvement. Logit regression analysis revealed that absence of pain (P < .05) and increased social interaction (P < .01) had a significant impact on parents' perception of overall health. Our findings indicate that dental care under general anesthesia for preschool children has a high degree of acceptance by parents and is perceived to have a positive social impact on their child.
PMID: 14558585 [PubMed - indexed for MEDLINE]
Sevoflurane or Desflurane Anesthesia plus Postoperative Propofol Sedation Attenuates Myocardial Injury after Coronary Surgery in Elderly High-risk Patients: In Reply.
De Hert SG, Van Der Linden PJ.
* University Hospital Antwerp, Belgium. stefan.dehert@ua.ac.be
PMID: 15087656 [PubMed - as supplied by publisher]
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Sevoflurane or desflurane anesthesia plus postoperative propofol sedation attenuates myocardial injury after coronary surgery in elderly high-risk patients.
Xia Z, Luo T.
Publication Types:
PMID: 15087655 [PubMed - in process]
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An unusual cause of airway obstruction during general anesthesia with a laryngeal mask airway.
Bernards CM.
Department of Anesthesiology, University of Washington, Seattle, Washington 98195, USA. chrisb@u,.washignton.edu
PMID: 15087642 [PubMed - in process]
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The birth of opioid anesthesia.
Raja SN, Lowenstein E.
Harvard Medical School, and Department of Anesthesia and Critical Care, Massachusetts General Hospital, Boston, 02114-2696, USA. elowenstein1@partners.org
PMID: 15087641 [PubMed - in process]
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A historical perspective on use of the laryngoscope as a tool in anesthesiology.
Burkle CM, Zepeda FA, Bacon DR, Rose SH.
Department of Anesthesiology, Mayo Clinic College of Medicine, Rochester, Minnesota 55905, USA. burkle.christopher@mayo.edu
PMID: 15087639 [PubMed - in process]
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Influence of sensory and proprioceptive impairment on the development of phantom limb syndrome during regional anesthesia.
Paqueron X, Leguen M, Gentili ME, Riou B, Coriat P, Willer JC.
Department of Anesthesiology, Centre Hospitalier Universitaire Pitie-Salpetriere, Paris, France. xavier.paqueron@psl.ap-hop-paris.fr
BACKGROUND: The relation between impairment of sensorimotor function and occurrence of phantom limb syndrome (PLS) during regional anesthesia has not been described. This study assessed the temporal relation between PLS and the progression of sensorimotor impairment during placement of a brachial plexus nerve block. METHODS: Fifty-two patients had their arm randomly placed either alongside their body (group A) or in 90 degrees abduction (group B) immediately after brachial plexus nerve block placement. Responses to pin prick, cold, heat, touch, proprioception, and voluntary movement were assessed every 5 min for 60 min. Meanwhile, patients described their perceptions of the size, shape, and position of their anesthetized limb. RESULTS: Phantom limb syndrome occurred 19 +/- 9 min after nerve block placement. Proprioception was impaired and abolished after 22 +/- 9 and 43 +/- 17 min, respectively (P < 0.05 vs. PLS onset). When PLS occurred, responses to pin prick, cold, heat, and proprioception were abolished in 96, 94, 87, and 4% of patients, respectively. Patients were more likely to feel their anesthetized limb in adduction and in abduction in groups A and B (P < 0.05 vs. group A), respectively. After PLS had become motionless, two stereotyped positions were identified: arm adduction, elbow flexion, hand over the abdomen (68% of group A patients) and arm abduction, elbow flexion, hand held close to the homolateral ear (48% of group B patients). CONCLUSIONS: This study provides a better understanding of the determinants of PLS by showing that the final position of PLS is related both to the abolition of proprioception and the initial position of the anesthetized limb.
PMID: 15087637 [PubMed - in process]
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Possible mechanism of irreversible nerve injury caused by local anesthetics: detergent properties of local anesthetics and membrane disruption.
Kitagawa N, Oda M, Totoki T.
Department of Anesthesiology, Saga Medical School, Nabeshima, Saga, Japan. kitagawa@mail.anes.saga-med.ac.jp
BACKGROUND: Irreversible nerve injury may result from neural membrane lysis due to the detergent properties of local anesthetics. This study aimed to investigate whether local anesthetics display the same properties as detergents and whether they disrupt the model membrane at high concentrations. METHODS: Concentrations at which dodecyltrimethylammonium chloride and four local anesthetic (dibucaine, tetracaine, lidocaine, and procaine) molecules exhibit self-aggregation in aqueous solutions were measured using an anesthetic cation-sensitive electrode. Light-scattering measurements in a model membrane solution were also performed at increasing drug concentrations. The concentration at which drugs caused membrane disruption was determined as the point at which scattering intensity decreased. Osmotic pressures of anesthetic agents at these concentrations were also determined. RESULTS: Concentrations of dodecyltrimethylammonium chloride, dibucaine, tetracaine, lidocaine, and procaine at which aggregation occurred were 0.15, 0.6, 1.1, 5.3, and 7.6%, respectively. Drug concentrations causing membrane disruption were 0.09% (dodecyltrimethylammonium chloride), 0.5% (dibucaine), 1.0% (tetracaine), 5.0% (lidocaine), 10.2% (procaine), and 20% (glucose), and osmotic pressures at these concentrations were 278, 293, 329, 581, 728, and 1,868 mOsm/kg H2O, respectively. CONCLUSIONS: These results show that all four local anesthetics form molecular aggregations in the same manner as dodecyltrimethylammonium chloride, a common surfactant. At osmotic pressures insufficient to affect the membrane, local anesthetics caused membrane disruption at the same concentrations at which molecular aggregation occurred. This shows that disruption of the model membrane results from the detergent nature of local anesthetics. Nerve membrane solubilization by highly concentrated local anesthetics may cause irreversible neural injury.
PMID: 15087634 [PubMed - in process]
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Intrathecal anesthesia and recovery from radical prostatectomy: a prospective, randomized, controlled trial.
Brown DR, Hofer RE, Patterson DE, Fronapfel PJ, Maxson PM, Narr BJ, Eisenach JH, Blute ML, Schroeder DR, Warner DO.
Department of Anesthesiology, Mayo Clinic, Rochester, Minnesota 55905, USA. brown.daniel@mayo.edu
BACKGROUND: Previous studies suggest that intraoperative anesthetic care may influence postoperative pain and recovery from surgery. The authors tested the hypothesis that the addition of intrathecal analgesia to general anesthesia would improve long-term functional status and decrease pain in patients undergoing radical retropubic prostatectomy. METHODS: One hundred patients received either general anesthesia supplemented with intravenous fentanyl or general anesthesia preceded by intrathecal administration of bupivacaine (15 mg), clonidine (75 microg), and morphine (0.2 mg). Patients and providers were masked to treatment assignment. All patients received multimodal pain management postoperatively. Primary outcomes included pain and functional status over the first 12 postoperative weeks. RESULTS: Patients receiving intrathecal analgesia required more intravenous fluids and vasopressors intraoperatively. Pain was well controlled throughout the study (mean numerical pain scores < 3 in both groups at all times studied). Intrathecal analgesia decreased pain and supplemental intravenous morphine use over the first postoperative day but increased the frequency of pruritus. Pain and functional status after discharge from the hospital did not differ between groups. Intrathecal analgesia significantly decreased the duration of hospital stay (from 2.8 +/- 2.0 to 2.1 +/- 0.5 days; P < 0.01) as a result of five patients in the control group who stayed in the hospital more than 3 days. CONCLUSIONS: The benefits of improved immediate analgesia and decreased morphine requirements resulting from intrathecal analgesia must be weighed against factors such as pruritus, increased intraoperative requirement for fluids and vasopressors, and resources needed to implement this modality. Further studies are needed to determine the significance of the decrease in duration of hospital stay.
PMID: 15087629 [PubMed - in process]
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Can ropivacaine and levobupivacaine be used as test doses during regional anesthesia?
Owen MD, Gautier P, Hood DD.
Department of Anesthesiology, Wake Forest University School of Medicine, Winston-Salem, North Carolina 27157-1009, USA. mowen@wfubmc.edu
BACKGROUND: Lower systemic toxicity reported with ropivacaine and levobupivacaine may produce less reliable recognition of inadvertent intravenous injection during regional anesthesia. This study was undertaken to determine whether ropivacaine and levobupivacaine are suitable for use as intravenous test doses by evaluating central nervous system (CNS) symptoms after intravenous bolus injection. METHODS: Institutional approval and informed consent were granted for the study. One hundred twenty patients scheduled to undergo elective surgery were randomly assigned to receive 5 ml intravenous saline, 100 mg lidocaine, 25 mg ropivacaine, or 25 mg levobupivacaine before anesthesia. Patients reported CNS symptoms after injection and were monitored for hemodynamic change. RESULTS: Intravenous ropivacaine or levobupivacaine produced CNS symptoms in only 52% and 57% of patients, respectively, compared with 87% of patients after lidocaine (P < 0.02). Despite preparatory instruction, many patients receiving ropivacaine or levobupivacaine did not spontaneously volunteer symptoms because they were subtle and admitted symptoms only after in-depth questioning by the investigator. CONCLUSIONS: Plain ropivacaine and levobupivacaine (25 mg) solutions are unsuitable for use as intravenous test doses during regional anesthesia because CNS symptoms are insufficient. When using ropivacaine or levobupivacaine for regional anesthesia, for test dose purposes, the authors recommend the addition of epinephrine to the local anesthetic solution or the use of a separate agent with more predictable CNS characteristics.
PMID: 15087628 [PubMed - in process]
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Hemorrhage during isoflurane-nitrous oxide anesthesia: effects of endothelin-A or angiotensin II receptor blockade or both.
Hohne C, Vogler P, Frerking I, Francis RC, Swenson ER, Kaczmarczyk G, Boemke W.
Clinic of Anesthesiology and Intensive Care Medicine, Campus Virchow-Klinikum, Charite, Humboldt-University of Berlin, Germany. claudia.hoehne@charite.de
BACKGROUND: The objective of this study was to determine whether endothelin-A receptor blockade (ETAB) impairs hemodynamic and hormonal regulation compared with controls and angiotensin II receptor blockade (AT1B) during hypotensive hemorrhage in dogs under isoflurane-nitrous oxide anesthesia. METHODS: Six dogs were studied in four protocols: (1) control experiments (controls); (2) ETA blockade using ABT-627 (ETAB); (3) AT1 blockade using losartan (AT1B); and (4) combined AT1B and ETAB (AT1B + ETAB). After a 30-min awake period, isoflurane-nitrous oxide anesthesia was established (1.3 minimum anesthetic concentration). After 60 min of anesthesia, 20 ml blood/kg body weight was withdrawn within 5 min, and the dogs were observed for another hour. Thereafter, the blood was retransfused, and the dogs were observed for a final hour. RESULTS: Anesthesia: Cardiac output decreased in all protocols, whereas mean arterial pressure decreased more in AT1B and AT1B + ETAB than in controls and ETAB. Hemorrhage: After 60 min, cardiac output had decreased less in controls than in all other protocols. Mean arterial pressure decreased more during ETAB than in controls, but most severely during AT1B and AT1B + ETAB. Angiotensin II increased further only in controls and ETAB, whereas vasopressin and catecholamines increased similarly in all protocols. Retransfusion: Mean arterial pressure remained below controls in all protocols but was lowest when the AT1 receptor was blocked. Cardiac output fully recovered in all but the ETAB protocol. CONCLUSIONS: ETAB impairs long-term hemodynamic regulation after hemorrhage and retransfusion during anesthesia despite an activation of vasoconstrictive hormones. This suggests that endothelins have a role in long-term cardiovascular regulation. AT1B impairs both short- and long-term blood pressure regulation during anesthesia and after hemorrhage.
PMID: 15087624 [PubMed - in process]
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Time-dependent inhibition of G protein-coupled receptor signaling by local anesthetics.
Hollmann MW, Herroeder S, Kurz KS, Hoenemann CW, Struemper D, Hahnenkamp K, Durieux ME.
Department of Anesthesiology and Intensive Care Medicine, University Hospital Heidelberg, Germany.
BACKGROUND: Several beneficial effects of local anesthetics (LAs) were shown to be due to inhibition of G protein-coupled receptor signaling. Differences in exposure time might explain discrepancies in concentrations of LAs required to achieve these protective effects in vivo and in vitro (approximately 100-fold higher). Using Xenopus oocytes and human neutrophils, the authors studied time-dependent effects of LAs on G protein-coupled receptor signaling and characterized possible mechanisms and sites of action. METHODS: Measurement of agonist-induced Ca2+-activated Cl currents, using a two-electrode voltage clamp technique, and determination of superoxide anion production by cytochrome c assay were used to assess the effects of LAs on G protein-coupled receptor signaling in oocytes and primed and activated human neutrophils, respectively. Antisense knockdown of G alpha q protein and inhibition of various proteins within the signaling pathway served for defining mechanisms and sites of action more specifically. RESULTS: LAs attenuated G protein-coupled receptor signaling in both models in a time-dependent and reversible manner (lidocaine reduced lysophosphatidic acid signaling to 19 +/- 3% after 48 h and 25 +/- 2% after 6 h of control response in oocytes and human neutrophils, respectively). Whereas no effect was observed after extracellularly applied or intracellularly injected QX314, a lidocaine analog, using G alpha q-depleted oocytes, time-dependent inhibition also occurred after intracellular injection of QX314 into undepleted oocytes. Inhibition of phosphatases or protein kinases and agonist-independent G-protein stimulation, using guanosine 5'-O-3-thiotriphosphate or aluminum fluoride, did not affect time-dependent inhibition by LAs. CONCLUSION: Inhibition of G protein-coupled receptor signaling by LAs was found to be time dependent and reversible. Critically requiring G alpha q-protein function, this effect is located downstream of guanosine diphosphate-guanosine triphosphate exchange and is not dependent on increased guanosine triphosphatase activity, phosphatases, or protein kinases.
PMID: 15087620 [PubMed - in process]
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Electroencephalographic bicoherence is sensitive to noxious stimuli during isoflurane or sevoflurane anesthesia.
Hagihira S, Takashina M, Mori T, Ueyama H, Mashimo T.
Department of Anesthesiology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan. hagihara@masui.med.osaka-u.ac.jp
BACKGROUND: The authors previously reported changes in electroencephalographic bicoherence during isoflurane anesthesia combined with epidural anesthesia. Here, they examined the influence of noxious stimuli on electroencephalographic bicoherence as well as on the Bispectral Index (BIS) and the 95% spectral edge frequency (SEF95). METHODS: The authors enrolled 48 elective abdominal surgery patients (aged 22-77 years; American Society of Anesthesiologists physical status I or II). Raw electroencephalographic signals as well as BIS and SEF95 were recorded on a computer using a BIS monitor (A-1050) and Bispectrum Analyzer (BSA) for BIS (the authors' original software). Using BSA for BIS, the authors evaluated the two peak heights of electroencephalographic bicoherence. Anesthesia was induced with 3 mg/kg thiopental and was maintained with, in air-oxygen, 1.0% isoflurane or 1.5% sevoflurane. After confirming the steady state, the authors recorded baseline values. In experiment 1, they administered 3 microg/kg fentanyl 5 min after incision and investigated the changes in electroencephalographic derivatives at 5 and 10 min after incision. In experiment 2, they administered a similar dose of fentanyl 5 min before incision and investigated the changes in electroencephalographic derivatives immediately before and 5 min after incision. RESULTS: In experiment 1, after incision, both peak heights of electroencephalographic bicoherence significantly decreased but returned to control values after fentanyl administration. By contrast, after incision, BIS and SEF95 showed individual variability. In experiment 2, although fentanyl itself did not affect all electroencephalographic derivatives before incision, the variables remained unchanged after incision. CONCLUSION: Noxious stimuli decreased the peak heights of electroencephalographic bicoherence, an effect that was counteracted by fentanyl analgesia.
PMID: 15087616 [PubMed - in process]
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Does the use of electroencephalographic bispectral index or auditory evoked potential index monitoring facilitate recovery after desflurane anesthesia in the ambulatory setting?
White PF, Ma H, Tang J, Wender RH, Sloninsky A, Kariger R.
Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center at Dallas, Dallas, Texas 75390-9068, USA. paul.white@utsouthwestern.edu
BACKGROUND: Analogous to the Bispectral Index (BIS) monitor, the auditory evoked potential monitor provides an electroencephalographic-derived index (AAI), which is alleged to correlate with the central nervous system depressant effects of anesthetic drugs. This clinical study was designed to test the hypothesis that intraoperative cerebral monitoring guided by either the BIS or the AAI value would facilitate recovery from general anesthesia compared with standard clinical monitoring practices alone in the ambulatory setting. METHODS: Sixty consenting outpatients undergoing gynecologic laparoscopic surgery were randomly assigned to one of three study groups: (1) control (standard practice), (2) BIS guided, or (3) AAI guided. Anesthesia was induced with 1.5-2.5 mg/kg propofol and 1-1.5 microg/kg fentanyl given intravenously. Desflurane, 3%, in combination with 60% nitrous oxide in oxygen was administered for maintenance of general anesthesia. In the control group, the inspired desflurane concentration was varied based on standard clinical signs. In the BIS- and AAI-guided groups, the inspired desflurane concentrations were titrated to maintain BIS and AAI values in targeted ranges of 50-60 and 15-25, respectively. BIS and AAI values, hemodynamic variables, and the end-tidal desflurane concentration were recorded at 5-min intervals during the maintenance period. The emergence times and recovery times to achieve specific clinical endpoints were recorded at 1- to 10-min intervals. The White fast-track and modified Aldrete recovery scores were assessed on arrival in the PACU, and the quality of recovery score was evaluated at the time of discharge home. RESULTS: A positive correlation was found between the AAI and BIS values during the maintenance period. The average BIS and AAI values (mean +/- SD) during the maintenance period were significantly lower in the control group (BIS, 41 +/- 10; AAI, 11 +/- 6) compared with the BIS-guided (BIS, 57 +/- 14; AAI, +/- 11) and AAI-guided (BIS, 55 +/- 12; AAI, 20 +/- 10) groups. The end-tidal desflurane concentration was significantly reduced in the BIS-guided (2.7 +/- 0.9%) and AAI-guided (2.6 +/- 0.9%) groups compared with the control group (3.6 +/- 1.5%). The awakening (eye-opening) and discharge times were significantly shorter in the BIS-guided (7 +/- 3 and 132 +/- 39 min, respectively) and AAI-guided (6 +/- 2 and 128 +/- 39 min, respectively) groups compared with the control group (9 +/- 4 and 195 +/- 57 min, respectively). More importantly, the median [range] quality of recovery scores was significantly higher in the BIS-guided (18 [17-18]) and AAI-guided (18 [17-18]) groups when compared with the control group (16 [10-18]). CONCLUSION: Compared with standard anesthesia monitoring practice, adjunctive use of auditory evoked potential and BIS monitoring can improve titration of desflurane during general anesthesia, leading to an improved recovery profile after ambulatory surgery.
PMID: 15087615 [PubMed - in process]
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This Month in ANESTHESIOLOGY.
Henkel G.
PMID: 15087606 [PubMed - as supplied by publisher]
Comment on:
Inadvertence refers to a lack of attention.
Hardy JF.
Publication Types:
PMID: 15013966 [PubMed - indexed for MEDLINE]
Comment in:
Hypertension, hypertensive heart disease and perioperative cardiac risk.
Howell SJ, Sear JW, Foex P.
Academic Unit of Anaesthesia, University of Leeds, Leeds General Infirmary, Leeds LS1 3EX, UK. s.howell@leeds.ac.uk
The evidence for an association between hypertensive disease, elevated admission arterial pressure, and perioperative cardiac outcome is reviewed. A systematic review and meta-analysis of 30 observational studies demonstrated an odds ratio for the association between hypertensive disease and perioperative cardiac outcomes of 1.35 (1.17-1.56). This association is statistically but not clinically significant. There is little evidence for an association between admission arterial pressures of less than 180 mm Hg systolic or 110 mm Hg diastolic and perioperative complications. The position is less clear in patients with admission arterial pressures above this level. Such patients are more prone to perioperative ischaemia, arrhythmias, and cardiovascular lability, but there is no clear evidence that deferring anaesthesia and surgery in such patients reduces perioperative risk. We recommend that anaesthesia and surgery should not be cancelled on the grounds of elevated preoperative arterial pressure. The intraoperative arterial pressure should be maintained within 20% of the best estimate of preoperative arterial pressure, especially in patients with markedly elevated preoperative pressures. As a result, attention should be paid to the presence of target organ damage, such as coronary artery disease, and this should be taken into account in preoperative risk evaluation. The anaesthetist should be aware of the potential errors in arterial pressure measurements and the impact of white coat hypertension on them. A number of measurements of arterial pressure, obtained by competent staff (ideally nursing staff), may be required to obtain an estimate of the "true" preoperative arterial pressure.
Publication Types:
- Meta-Analysis
- Review
- Review, Academic
PMID: 15013960 [PubMed - indexed for MEDLINE]
Comment on:
Editorial II: Preoperative hypertension: remain wary? "Yes"--cancel surgery? "No".
Spahn DR, Priebe HJ.
Publication Types:
PMID: 15013957 [PubMed - indexed for MEDLINE]
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Rocuronium for muscle relaxation in two children with Friedreich's ataxia.
Schmitt HJ, Wick S, Munster T.
Department of Anaesthesiology, Friedrich Alexander University Erlangen-Nuremberg, Krankenhausstrasse 12, D-91054 Erlangen, Germany. hubert.schmitt@kfa.imed.uni-erlangen.de
Friedreich's ataxia is a rare hereditary neurodegenerative disease caused by a defect in the gene that encodes a mitochondrial protein called frataxin. We report the use of rocuronium 0.6 mg kg(-1) in two adolescent girls with Friedreich's ataxia undergoing propofol-sufentanil-oxygen-air anaesthesia for spinal surgery. Neuromuscular transmission was monitored using acceleromyography, and onset and recovery times were recorded. The clinical duration of rocuronium was comparable to that of children without neuromuscular disease (25% recovery T(1)=44 and 24 min for patients 1 and 2 respectively).
Publication Types:
PMID: 14977802 [PubMed - indexed for MEDLINE]
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A fine balance--one-lung ventilation in a patient with Eisenmenger syndrome.
Heller AR, Litz RJ, Koch T.
Department of Anaesthesiology and Intensive Care Medicine, University Hospital Carl Gustav Carus, Harvard Medical International Associated Institution, Fetscherstrasse 74, D-01307 Dresden, Germany. axel.heller@mailbox.tu-dresden.de
A 38-yr-old woman with an atrial septum defect and Eisenmenger syndrome was scheduled for a lung biopsy via thoracoscopy during one-lung ventilation. Fluids were given to increase central venous pressure to 8 mm Hg, an epidural catheter was inserted at the sixth thoracic intervertebral space and ropivacaine 0.3%, 6 ml were given. Careful balance of systemic and pulmonary vascular resistance is crucial in Eisenmenger syndrome, so norepinephrine (0.14 mg kg(-1) min(-1)) was infused before general anaesthesia was started with fentanyl 4 mg kg(-1), ketamine 2 mg kg(-1), pancuronium 1 mg and succinylcholine 2 mg kg(-1). Anaesthesia was maintained with propofol 4-8 mg kg(-1) h(-1). To control pulmonary artery pressure, ventilation was performed with oxygen 100% and nitric oxide 20 ppm. Surgery and anaesthesia course were uneventful and the patient was extubated. However, pleural haemorrhage required treatment with blood components, re-intubation on the second postoperative day and removal of the haematoma by mini-thoracotomy. A step-by-step approach using a balanced combination of regional and general anaesthesia, controlled fluid administration, norepinephrine and inhaled nitric oxide preserved a stable circulation even during one-lung ventilation. The diagnostic value of lung biopsy must be weighed against the possibility of life-threatening haemorrhage.
Publication Types:
PMID: 14977800 [PubMed - indexed for MEDLINE]
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Glass recycling in the labour suite is environmentally sound and economical.
Gaiser RR, Cheek TG, Gutsche BB.
Department of Anesthesia, University of Pennsylvania Health System, 3400 Spruce Street, Philadelphia, PA 19104, USA. gaiserr@uphs.upenn.edu
BACKGROUND: Glass bottles are used for the storage of local anaesthetics in the US and are recyclable. Recycling would result in hospital solid waste reduction. METHODS: The members of the Department of Anaesthesia were surveyed to determine where these local anaesthetic bottles were disposed of. From November 2002 to April 2003, glass bottles used on the labour and delivery suite were saved for recycling. The number of bottles and the weight recycled were recorded. The number of procedures involving anaesthesia were also recorded during this time period. RESULTS: Residents dispose of the local anaesthetic bottle in the sharps container while consultants dispose of them in the trash (P<0.05). Both means of disposal are not recycled in the US. The average amount of glass recycled per month was 19.37 (3.15) kg. Our hospital pays $0.46/kg (0.26 UK pound/kg) for sharps disposal. By not disposing of the glass in the sharps container, the average savings per month was $8.95 (1.45) (5.15 UK pounds (0.84)). CONCLUSION: The recycling of glass is good for the environment through waste reduction and results in small savings to the hospital.
PMID: 14977799 [PubMed - indexed for MEDLINE]
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EEG-controlled closed-loop dosing of propofol in rats.
Tzabazis A, Ihmsen H, Schywalsky M, Schwilden H.
Klinik fur Anasthesiologie, Universitat Erlangen-Nurnberg, Krankenhausstrasse 12, D-91054 Erlangen, Germany.
BACKGROUND: Based on previous pharmacokinetic and pharmacodynamic studies, we have developed an EEG-controlled closed-loop system for the i.v. hypnotic agent propofol in rats. METHODS: Seven adult male Sprague-Dawley rats (weight 423-584 g) were included in the study. EEG was recorded with occipito-occipital needle electrodes and the EEG power spectrum was estimated. The median frequency (MEF) was extracted from the power spectrum and was modified MEF (mMEF) to account for the occurrence of spikes and burst suppression patterns in the EEG. Propofol infusion was controlled by a model-based adaptive control algorithm to maintain a set point of mMEF=3.0 (sd 0.5) Hz. The performance of the feedback system was characterized by the median performance error MDPE=median[(mMEF-set point)/set point] and the median absolute performance error (MDAPE). The effective therapeutic infusion (ETI) to maintain the set point was determined from the resulting infusion rates. RESULTS: In all rats a feedback period of 90 min could be performed. Mean MDPE was 1.2 (se 0.4)% and MDAPE was 13.9 (0.3)%. The ETI was 0.73 (sd 0.20) mg kg(-1) min(-1). Mean arterial pressure before propofol infusion was 148 (14) mm Hg, with the lowest value during closed-loop infusion being 110 (20) mm Hg. CONCLUSIONS: The feedback system presented here may be a useful tool not only for automatic drug control to maintain a defined hypnotic effect but may also be a powerful device in pharmacological studies such as the determination of dose requirements or the assessment of drug-drug interactions.
PMID: 14977798 [PubMed - indexed for MEDLINE]
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Prevalence of postoperative bladder distension and urinary retention detected by ultrasound measurement.
Lamonerie L, Marret E, Deleuze A, Lembert N, Dupont M, Bonnet F.
Service d'Anesthesie-Reanimation, Hopital Tenon, Assistance Publique Hopitaux de Paris, 4 rue de la Chine, 75970 Paris cedex 20, France.
BACKGROUND: Postoperative bladder distension and urinary retention are commonly underestimated. Ultrasound enables accurate measurement of bladder volume and thus makes it possible to determine the prevalence of postoperative bladder distension. METHODS: Using ultrasound, we measured the volume of the bladder contents at the time of discharge from the recovery room in 177 adult patients who had undergone thoracic, vascular, abdominal, orthopaedic or ENT surgery. RESULTS: Forty-four per cent of the patients had a bladder volume >500 ml and 54% of the 44%, who had no symptoms of bladder distension, were unable to void spontaneously within 30 min. The risk factors for urinary retention were age >60 yr (odds ratio (OR) 2.11, 95% confidence interval (CI) 1.01-4.38), spinal anaesthesia (OR 3.97, 95% CI 1.32-11.89) and duration of surgery >120 min (OR 3.03, 95% CI 1.39-6.61). CONCLUSION: Before discharge from the recovery room it seems worthwhile to systematically check the bladder volume with a portable ultrasound device in patients with risk factors.
PMID: 14977795 [PubMed - indexed for MEDLINE]
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Volume kinetics of glucose 2.5% solution during laparoscopic cholecystectomy.
Sjostrand F, Hahn RG.
Department of Anaesthesia, Karolinska Institute, S-118 83 Stockholm, Sweden.
BACKGROUND: Analyses of the distribution and elimination of glucose 2.5% solutions can be used to suggest combinations of infusion rates and infusion times which yield a predetermined plasma glucose level and degree of plasma dilution during surgery. METHODS: Twelve patients aged between 27 and 51 (mean 40) underwent laparoscopic cholecystectomy. An i.v. infusion of 1.4 litres of glucose 2.5% over 60 min was started when surgery began. A volume kinetic model was fitted to measurements of the plasma glucose concentration and the degree of haemodilution. Nomograms were constructed based on the kinetic results. RESULTS: The volume of distribution for the glucose and infused fluid and the plasma insulin levels were similar to the ones recorded in previous volunteer studies, but 50-70% lower values were obtained for the clearance of glucose (mean 0.21 litres min(-1)), endogenous glucose production (1.1 mmol min(-1)) and the elimination rate constant for the infused fluid (median 37 ml min(-1)). Urinary excretion was markedly depressed and amounted to 9% of the infused fluid volume 4 h after starting surgery. To prevent hyperglycaemia, nomograms suggested that the infusion should be directed towards a "target" glucose concentration and then slowed down in a controlled way. At steady state, the infused fluid maintains a 3.5% plasma dilution for each mmol that plasma glucose remains above baseline. CONCLUSION: Metabolic changes warrant careful balancing of infusion rates of glucose 2.5% during laparoscopic cholecystectomy, which is facilitated by a nomogram. Volume expansion from the infused fluid volume should be recognized.
PMID: 14977794 [PubMed - indexed for MEDLINE]
Pharmacological studies of 8-OH-DPAT-induced pupillary dilation in anesthetized rats.
Yu Y, Ramage AG, Koss MC.
Department of Cell Biology, University of Oklahoma College of Medicine, Oklahoma City, OK 73190, USA.
Serotonin (5-HT)(1A) receptor agonists have been reported to produce mydriasis in mice, and miosis in rabbits and humans. However, the underlying mechanisms for this action are unclear. This study was undertaken in an attempt to explore the mechanism by which 5-HT(1A) receptors are involved in the modulation of pupillary size in pentobarbital-anesthetized rats. Intravenous administration of the 5-HT(1A) receptor agonist, (2R)-(+)-8-hydroxy-2-(di-n-propylamino)tetralin hydrobromide (8-OH-DPAT; 0.003-3 mg/kg), elicited dose-dependent pupillary dilation, which was not affected by section of the preganglionic cervical sympathetic nerve. 8-OH-DPAT-elicited mydriatic responses were attenuated by the selective 5-HT(1A) receptor antagonist, N-[2-[4-(2-methoxyphenyl)-1-piperazinyl]ethyl]-N-2-pyridinylcyclohexanecarboxamide maleate (WAY 100635; 0.3-1 mg/kg, i.v.), as well as by the selective alpha(2)-adrenoceptor antagonist, (8aR,12aS,13aS)-5,8,8a,9,10,11,12,12a,13,13a-dechydro-3-methoxy-12-(ethylsulfonyl)-6H-isoquino[2,1-g][1,6]naphthyridine hydrochloride (RS 79948; 0.3 mg/kg, i.v.), but not by the selective alpha(1)-adrenoceptor antagonist, prazosin (0.3 mg/kg, i.v.). Mydriatic responses elicited by the alpha(2)-adrenoceptor agonist, guanabenz (0.003-0.3 mg/kg, i.v.), were not antagonized by WAY 100635 (0.3-1 mg/kg, i.v.). To determine whether central nervous system (CNS) 5-HT(1A) receptors, like alpha(2)-adrenoceptors, are involved in reflex mydriasis, voltage response curves of pupillary dilation were constructed by stimulation of the sciatic nerve in anesthetized rats. WAY 100635 (1 mg/kg, i.v.) did not antagonize the evoked reflex mydriasis, which, however, was blocked by RS 79948 (0.3 mg/kg, i.v.). Taken together, these results suggest that 8-OH-DPAT produces pupillary dilation in anesthetized rats by stimulating CNS 5-HT(1A) receptors, which in turn trigger the release of norepinephrine, presumably from the locus coeruleus. The latter reduces parasympathetic neuronal tone to the iris sphincter muscle by stimulation of postsynaptic alpha(2)-adrenoceptors within the Edinger-Westphal nucleus. Unlike alpha(2)-adrenoceptors, 5-HT(1A) receptors in the CNS do not mediate reflex mydriasis evoked by sciatic nerve stimulation.
PMID: 15087245 [PubMed - in process]
Celioscopic surgery in infants and children: the anesthesiologist's point of view.
Veyckemans F.
Department of Anaesthesiology, Cliniques universitaires St Luc, Brussels, Belgium.
PMID: 15086857 [PubMed - in process]
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An update on the etiology and prevention of anesthesia-related cardiac arrest in children.
Mason LJ.
Professor of Anesthesiology and Pediatrics, Loma Linda University, Loma Linda, CA, USA.
PMID: 15086854 [PubMed - in process]
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Pediatric regional anesthesia update.
Bosenberg A.
Department of Anaesthesia, Faculty of Health Sciences, University Cape Town, Cape Town, South Africa.
PMID: 15086851 [PubMed - in process]
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Local anesthetics in infants and children: an update.
Berde C.
Division of Pain Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Children's Hospital, Boston, and Harvard Medical School, Harvard, MA, USA.
PMID: 15086849 [PubMed - in process]
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Inhalational anesthetics.
Lerman J.
Women and Children's Hospital of Buffalo, Buffalo, NY, USA.
PMID: 15086847 [PubMed - in process]
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Congress impressions of a European participant of 9th Annual Meeting of the Japanese Society of Pediatric Anesthesiology, September 12-14, 2003 in Fukuoka, Kyushu, Japan.
Holzki J.
President of the FEAPA Children's Hospital Amsterdamer Str. 59 D-50735 Koln, Germany. Email: josef.holzki@arcor.de
PMID: 15078391 [PubMed - in process]
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Rabies vaccine and anaesthesia.
Celiker V, Basgul E, Peker L.
Publication Types:
PMID: 15078387 [PubMed - in process]
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Anaesthetic management of a patient with the intracardiac extension of Wilms' tumour.
Shiratori T, Fujisawa T, Ichino T, Mitono Y, Inokuti M, Ohata J.
Department of Anaesthesiology, Nagano Children's Hospital, 3100 Toyoshina, Toyoshina, Minamiazumi-gun, Nagano, Japan. tohru_shiratori@yahoo.co.jp
Summary Wilms' tumour (nephroblastoma) is known to invade the inferior vena cava and extend to the intracardiac chambers. We describe the treatment and surgical removal of the intracardiac extension of a Wilms' tumour using cardiopulmonary bypass in a 4-year-old girl. Techniques to avoid paradoxical embolism in the presence of a patent foramen ovale and to deal with excessive hepatic venous blood flow using the Pringle manoevre (hepatic inflour occlusion) are described. Good communication between anaesthesiologists, surgeons and perfusionists was indispensable. The anaesthesiologist is an important member of the team during performance of a complicated procedure.
PMID: 15078385 [PubMed - in process]
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Anaesthetic implications of LEOPARD syndrome.
Torres J, Russo P, Tobias JD.
The Department of Child Health, The Division of Pediatric Critical Care/Pediatric Anesthesiology, The University of Missouri, Columbia, MO 65212, USA.
LEOPARD syndrome is a neuroectodermal disorder presumed to result from an abnormality in neural crest cells. The acronym 'LEOPARD' is derived from the clinical features which include multiple lentigines, electrocardiographic abnormalities, ocular hypertelorism, pulmonary stenosis, abnormal genitalia, retarded growth, and deafness. Given the multisystem nature of the disease process, several issues may affect the perioperative care of these patients. Of primary importance are associated conditions of the cardiovascular system including congenital heart disease, conduction disturbances, and progressive hypertrophic obstructive cardiomyopathy. The authors present a 4-year old boy who presented for anaesthetic care for repair of a ventricular septal defect and pulmonary valvotomy for congenital pulmonary stenosis. The potential perioperative implications of LEOPARD syndrome are discussed.
PMID: 15078383 [PubMed - in process]
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The anaesthetic management of patients with congenital insensitivity to pain with anhidrosis.
Rozentsveig V, Katz A, Weksler N, Schwartz A, Schilly M, Klein M, Gurman GM.
Division of Anesthesiology and Critical Care Medicine, Soroka University Medical Center, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel.
BACKGROUND: Congenital insensitivity to pain with anhidrosis (CIPA, or hereditary sensory and autonomic neuropathy type IV) is a rare, autosomal recessive disease, related to a mutation in the TrkA gene, characterized by inability to sweat, insensitivity to pain and recurrent episodes of hyperpyrexia. There are two Bedouin tribes in Israel with different mutations of the TrkA gene: one in the southern region and the other in the northern region. The Soroka University Medical Center is the referral centre for the entire southern region of Israel. One in 4500 anaesthesia cases involves a patient with CIPA. METHODS: We reviewed 40 anaesthesia records of 20 patients with CIPA for anaesthetic technique and incidence of side-effects. RESULTS: Sixteen patients developed complications in the immediate perioperative period: mild hypothermia in one patient and cardiovascular events in 15 others with one case of cardiac arrest. These complications were unrelated to the anaesthetic drug administered. There were no events of hyperthermia or postoperative nausea. CONCLUSIONS: Cardiovascular complications following anaesthesia are common in patients with the southern Israel variant of CIPA. Hyperthermia, previously recognized as a major concern in patients with congenital insensitivity to pain with anhydrous, was not seen in our patients. We conclude that cardiovascular involvement is frequently encountered in CIPA patients following anaesthesia and is the major concern in their anaesthetic management.
PMID: 15078381 [PubMed - in process]
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Providing parents with information before anaesthesia: what do they really want to know?
Wisselo TL, Stuart C, Muris P.
Department of Anaesthesia, University Hospital Maastrichet, Maastricht, The Netherlands.
BACKGROUND: Videotapes presenting information concerning children's anaesthesia are often based on what the makers of the videotape believe the parents want to know rather than what parents actually want to know. They frequently do not take into account the parent's coping style. Two common parental coping styles are information-seeking (monitoring) and information-avoiding (blunting). METHODS: We wished to take parent needs into account when making our local videotape and accordingly constructed a questionnaire designed to elicit these needs. RESULTS: Of the parents questioned, 55% wanted more extensive preoperative information and 41% of parents wanted a videotape as part of this preparation. Information about premedication, induction of anaesthesia, side-effects of anaesthesia and postoperative pain management were sought by more than 70% of parents. Parents had concerns about induction of anaesthesia, emergence from anaesthesia and postoperative pain and nausea. When asked a question concerning preference about being present at the induction of anaesthesia, 90% of parents wanted to be present at the induction and 75% of parents thought that their child should receive a premedicant. The number of parents requesting to be present at the induction decreased to 72% after an explanation about the purpose and effects of premedication. There was no correlation between the coping style of the parent and the responses given to the questions. There was no correlation between the level of education and the coping style of the parent. CONCLUSIONS: The use of a questionnaire of parental attitudes towards information and anaesthesia provided a useful tool in the production of a video as part of our preoperative preparation. Our videotape has proved a success with staff and parents and children and enhances the quality of our service. Its popularity stems from the fact that it addresses what the parents want to know and also conveys what the staff of this hospital would like the parents to know.
PMID: 15078374 [PubMed - in process]
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