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Items 1 - 27 of 27 |
One page. |
Comment on:
Professional conflicts in anaesthesia in the United States.
Ouellette SM.
Publication Types:
PMID: 15549993 [PubMed - indexed for MEDLINE]
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Anaesthetic and intensive care management of a patient with Ehlers-Danlos type IV syndrome after laparotomy.
Solan K, Davies P.
Department of Anaesthesia, Guy's Hospital, St Thomas' Street, London, SE1 9RT, UK. handkhastings@aol.com
A 31-year-old woman with Ehlers-Danlos type IV syndrome developed multiple intensive care related complications following laparotomy for perforated bowel. Complications are more likely to occur with the Ehlers-Danlos syndrome.
Publication Types:
PMID: 15549985 [PubMed - indexed for MEDLINE]
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Use of alpha-agonists for management of anaphylaxis occurring under anaesthesia: case studies and review.
Heytman M, Rainbird A.
Department of Anaesthesia, The Townsville Hospital, Douglas, QLD 4814, Australia.
Anaphylaxis is an uncommon but serious complication of anaesthesia. Most current guidelines for the management of anaphylaxis list only epinephrine as a vasopressor to use in the event of cardiovascular collapse. We present two cases of anaphylaxis under anaesthesia where return of spontaneous circulation was refractory to epinephrine, but occurred following the administration of the alpha-agonist metaraminol. Potential advantages and disadvantages of using epinephrine in this setting, the role of alpha-agonists and some potential mechanisms accounting for their role in successful management are reviewed.
Publication Types:
PMID: 15549981 [PubMed - indexed for MEDLINE]
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Cardiovascular effects of xenon and nitrous oxide in patients during fentanyl-midazolam anaesthesia.
Goto T, Hanne P, Ishiguro Y, Ichinose F, Niimi Y, Morita S.
Teikyo University, Ichihara Hospital, 3426-3 Anesaki, Ichihara-shi, Chiba-ken, 299-0111, Japan. takigoto@med.teikyo-u.ac.jp
Xenon anaesthesia appears to have minimal haemodynamic effects. The purpose of this randomised prospective study was to compare the cardiovascular effects of xenon and nitrous oxide in patients with known ischaemic heart disease. In 20 patients who were due to undergo coronary artery bypass graft surgery, 30 min following induction of anaesthesia with fentanyl 30 microg x kg(-1) and midazolam 0.1 mg x kg(-1) but prior to the start of surgery, xenon or nitrous oxide 60% was administered for 15 min. The results showed that xenon caused a minimal decrease in the mean arterial pressure (from 81 (7) to 75 (8) mmHg, mean (SD)), but did not affect the systolic function of the left ventricle, as demonstrated by unchanged left ventricular stroke work index (LVSWI) and the fractional area change of the left ventricle (FAC) derived from transoesophageal echocardiography (TOE). However, in contrast, nitrous oxide was found to decrease the mean arterial pressure (from 81 (8) to 69 (7) mmHg), the LVSWI, and the FAC. The cardiac index, central venous and pulmonary artery occlusion pressures, systemic and pulmonary vascular resistances, and the TOE-derived E/A ratio through the mitral valve were unchanged by xenon or nitrous oxide. We conclude that xenon provides improved haemodynamic stability compared with nitrous oxide, conserving the left ventricular systolic function.
Publication Types:
- Clinical Trial
- Randomized Controlled Trial
PMID: 15549976 [PubMed - indexed for MEDLINE]
[Total intravenous anesthesia with propofol and remifentanilResults of a multicenter study of 6,161 patients.]
[Article in German]
Schmidt J, Hering W, Albrecht S.
Klinik fur Anasthesiologie, Friedrich-Alexander-Universitat, Erlangen-Nurnberg.
INTRODUCTION. The aim of this study was to investigate efficacy and tolerability of propofol, remifentanil and cisatracurium or mivacurium in routine anesthetic practice. PATIENTS AND METHODS. A total of 6,161 patients scheduled for abdominal or orthopedic surgery were included in this open multicenter phase IV study. Perioperative hemodynamics as well as induction, recovery and discharge times, anesthetics, frequency of PONV and side-effects were studied. RESULTS. Quality of induction and maintenance of anesthesia were evaluated by anesthesiologists to be good or very good in 88%. 86% of the patients assessed anesthesia as good or very good. Adverse events were reported for 28 patients (0.45%), with hypotension and bradycardia being most frequent. Recovery was evaluated by anesthesiologists to be good or very good in 88%, surgeons and nursing staff assessed the TIVA as good or very good in 90%. Most frequent postoperative complaints were pain (16.7%), nausea (6.1%), shivering (3.1%) and vomiting (0.7%). CONCLUSIONS. The study showed that total intravenous anesthesia using propofol, remifentanil and cisatracurium or mivacurium is safe, tolerable and effective and has a high degree of acceptance.
PMID: 15565387 [PubMed - as supplied by publisher]
Hypertensive crisis in a patient undergoing percutaneous radiofrequency ablation of an adrenal mass under general anesthesia.
Chini EN, Brown MJ, Farrell MA, Charboneau JW.
Department of Anesthesiology, Mayo Clinic, 200 First St. S.W., Rochester, MN 55905, USA. Chini.eduardo@mayo.edu
Radiofrequency ablation (RFA) is an effective therapeutic intervention for a variety of neoplastic lesions. Many of these procedures are conducted with patients under general anesthesia. Although RFA is associated with infrequent complications, it is not without risk. Injury to adjacent normal structures is a major concern during RFA of cancerous lesions. Unintended injury to normal adrenal tissue during RFA of adrenal tumors can lead to hypertensive crisis, a potentially catastrophic complication. Hemodynamic consequences of RFA of primary or metastatic adrenal masses have not been reported. We report a case of hypertensive crisis (249/140 mm Hg), tachycardia, and ventricular arrhythmia in an 82-yr-old woman undergoing RFA of renal cell carcinoma metastatic to the adrenal gland. Anesthesiologists should be aware of this potentially catastrophic complication. Direct-acting vasodilators and short-acting beta(1)-adrenergic antagonists should be immediately available, and intraarterial blood pressure monitoring should be seriously considered when providing care for patients undergoing RFA of an adrenal mass.
Publication Types:
PMID: 15562089 [PubMed - indexed for MEDLINE]
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Single-injection paravertebral block before general anesthesia enhances analgesia after breast cancer surgery with and without associated lymph node biopsy.
Kairaluoma PM, Bachmann MS, Korpinen AK, Rosenberg PH, Pere PJ.
Department of Anesthesia and Intensive Care Medicine, Helsinki University Hospital, PO Box 580, Helsinki, FIN-00029 HUS, Finland. pekka.kairaluoma@hus.fi
Paravertebral block (PVB) seems to decrease postoperative pain and postoperative nausea and vomiting (PONV) after breast surgery, but the studies have not been placebo controlled. We studied 60 patients scheduled for breast cancer surgery randomly given single-injection PVB at T3 with bupivacaine 5 mg/mL (1.5 mg/kg) or saline before general anesthesia. The patient and attending investigators were blinded; the PVB or the sham block was performed behind a curtain by an anesthesiologist not involved in the study. The patients given PVB with bupivacaine needed 40% less IV opioid medication (primary outcome variable) in the postanesthesia care unit, had a longer latency to the first opioid dose, and had less pain at rest after 24 h than the control patients (P < 0.01). They also had less PONV in the postanesthesia care unit (P < 0.05), were less sedated until 90 min (P < 0.05), and performed better in the digit symbol substitution test at 90 min and the ocular coordination test 60-120 min after surgery (P < 0.05). The average peak bupivacaine plasma concentration was 750 ng/mL. One patient had bilateral convulsions immediately after bupivacaine injection. We conclude that PVB before general anesthesia for breast cancer surgery reduced postoperative pain, opioid consumption, and occurrence of PONV and improved recovery from anesthesia.
Publication Types:
- Clinical Trial
- Randomized Controlled Trial
PMID: 15562083 [PubMed - indexed for MEDLINE]
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Cervical epidural anesthesia for combined neck and upper extremity procedure: a pilot study.
Michalek P, David I, Adamec M, Janousek L.
Department of Cardiovascular Anesthesia and Intensive Care, Na Homolce Hospital, Roentgenova 2, Prague 5, 15021 Czech Republic. pafkam@seznam.cz
In a prospective pilot study, we evaluated the possibility of performing a total parathyroidectomy with parathyroid gland implantation into the forearm (a combined neck and upper extremity procedure) under cervical epidural anesthesia (CEA) at C6-7 level using ropivacaine. The indication for CEA was the patient's choice or a previous procedure on the neck with unilateral vocal cord paralysis. Anesthesia was induced by 10 mL of 0.75% ropivacaine plus 10 mug of sufentanil in 2 mL. Block onset time, success rate, analgesia, sensory block extent, changes in respiratory and hemodynamic variables, complications, and length of hospital stay were assessed. All 15 procedures were successfully performed under CEA. Sensory block was registered in the range C2-T10, with a lower median of T3. The upper margin of sensory block was C2 in all patients. Of the respiratory variables, the only significant decrease was observed in forced vital capacity; none of the patients developed clinically significant respiratory insufficiency. We conclude that combined procedures involving the neck and upper limbs can be performed using CEA with ropivacaine. CEA allows verbal communication with patients and early detection of vocal cord paralysis.
PMID: 15562082 [PubMed - indexed for MEDLINE]
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Determining minimum alveolar anesthetic concentration of halothane in rats: the effect of incremental change in halothane concentration and number of crossovers.
Leon A, Mayzler O, Benifla M, Semionov M, Fuxman Y, Eilig I, Passuga V, Doitchinova MK, Gurevich B, Artru AA, Shapira Y.
Department of Anesthesiology, 356540, University of Washington School of Medicine, Seattle, WA 98195-6540, USA.
Computer simulations for the technique of estimating minimum alveolar anesthetic concentration (MAC) in patients (quantal design) suggest that incremental concentration changes and the number of crossovers affect MAC. We hypothesized that these variables may also apply to estimating MAC in rats (bracketing design). This study tested that hypothesis and also examined whether these variables might mask differences in MAC between groups in which MAC might be expected to differ (pregnant [P] versus nonpregnant [NP]). There were 2 cohorts (n = 27 and n = 30 rats). Each cohort included NP females, females in early P, and females in late P. MAC was tested by using an incremental concentration change of 0.20% and one within-subject crossover in the first cohort and by using an increment size of 0.10% and four crossovers in the second cohort. MAC was statistically significantly increased in the three groups in the second cohort (NP, 1.16 +/- 0.12; early P, 1.14 +/- 0.10; late P, 1.07 +/- 0.10; mean +/- sd) compared with values in the three comparable groups in the first cohort (NP, 0.95 +/- 0.06; early P, 1.01 +/- 0.09; late P, 0.93 +/- 0.13). Values did not differ among groups within each cohort. Post hoc simulations indicated that up to 36% of the difference between cohorts was due to increment size, with the balance due to experimental factors. Our findings confirmed the hypothesis that increment size affects estimates of MAC when a bracketing design is used.
PMID: 15562080 [PubMed - indexed for MEDLINE]
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Using heart rate variability to stratify risk of obstetric patients undergoing spinal anesthesia.
Chamchad D, Arkoosh VA, Horrow JC, Buxbaum JL, Izrailtyan I, Nakhamchik L, Hoyer D, Kresh JY.
Department of Anesthesiology, Drexel University College of Medicine, Philadelphia, Pennsylvania 19102-1192, USA.
In this study, we evaluated whether point correlation dimension (PD2), a measure of heart rate variability, can predict hypotension accompanying spinal anesthesia for cesarean delivery. After the administration of spinal anesthesia with bupivacaine, hypotension was defined as systolic blood pressure </=75% of baseline within 20 min of intrathecal injection. Using the median prespinal PD2 (3.90) to form 2 groups, LO and HI, all 11 hypotensive patients were in the LO group, and all 11 patients without hypotension were in the HI group. Baseline heart rate in the LO group was 95 bpm (10.2 sd), versus 81 bpm (9.6 sd) in the HI group. PD2 shows promise as a predictor of hypotension in pregnant women receiving spinal anesthesia.
Publication Types:
PMID: 15562079 [PubMed - indexed for MEDLINE]
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Anesthesiologists, general surgeons, and tobacco interventions in the perioperative period.
Warner DO, Sarr MG, Offord KP, Dale LC.
Department of Anesthesiology, Mayo Clinic, 200 First St. S.W., Rochester, MN 55905, USA. warner.david@mayo.edu
Surgery presents an opportunity for interventions in cigarette smokers that will facilitate abstinence from tobacco. However, little attention has been paid to the role of anesthesiologists and surgeons in addressing tobacco use. To determine the practices and attitudes of these physicians regarding this issue, we sent a postal mail survey to a national random sampling of anesthesiologists and general surgeons engaged in active practice within the United States (1000 in each group). Response rates were 33% and 31% for anesthesiologists and surgeons, respectively. More than 90% of both groups almost always ask their patients about tobacco use, and almost all respondents believed that surgical patients should maintain abstinence after surgery. Most believed that it was their responsibility to advise their patients to quit smoking, but only 30% of anesthesiologists and 58% of surgeons routinely do so. Nonetheless, approximately 70% of both groups would be willing to spend an extra 5 min before surgery to help their patients quit. Barriers to intervention included a lack of training regarding intervention techniques, a perceived lack of effective interventions, and insufficient time to intervene. Intervention opportunities are not exploited consistently in the surgical population; educational efforts directed at physicians in surgical specialties are indicated.
PMID: 15562069 [PubMed - indexed for MEDLINE]
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The use of high-fidelity human patient simulation and the introduction of new anesthesia delivery systems.
Dalley P, Robinson B, Weller J, Caldwell C.
National Patient Simulation Training Centre, Wellington Hospital, Private Bag 7902, Wellington South, New Zealand.
New anesthesia delivery systems are becoming increasingly complex. Although equipment is involved in a large proportion of intraoperative anesthesia problems (most also involving human error), the current methods of introducing new equipment into clinical practice have not been well studied. We designed a randomized, controlled, prospective study to investigate an alternative method of introducing new anesthesia equipment. Fifteen anesthesiology trainees were randomized to either the standard introduction to a Drager Fabius GS anesthesia delivery machine plus simulated clinical use of the new machine in a high-fidelity human patient simulator (HPS) (Group 1) or to the standard introduction alone (Group 2). We used a questionnaire to seek their opinion on the new equipment, and responses showed that both groups were comparable in their reported confidence to use the new equipment safely. All trainees were then tested in two simulated anesthetic crises with the new machine. Performance was analyzed in terms of time to resolve the emergency, by using analysis of videos by an independent rater. Group 1 resolved both crises significantly faster. HPS allowed us to detect design features that were common sources of error.
Publication Types:
- Clinical Trial
- Randomized Controlled Trial
PMID: 15562063 [PubMed - indexed for MEDLINE]
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Potent activation of the human tandem pore domain K channel TRESK with clinical concentrations of volatile anesthetics.
Liu C, Au JD, Zou HL, Cotten JF, Yost CS.
Department of Anesthesia and Perioperative Care, 513 Parnassus Ave., Room S-261, Box 0542, San Francisco, CA 94143, USA.
The tandem pore domain K channel family mediates background K currents present in excitable cells. Currents passed by certain members of the family are enhanced by volatile anesthetics, thus suggesting a novel mechanism of anesthesia. The newest member of the family, termed TRESK (TWIK [tandem pore domain weak inward rectifying channel]-related spinal cord K channel), has not been studied for anesthetic sensitivity. We isolated the coding sequence for TRESK from human spinal cord RNA and functionally expressed it in Xenopus oocytes and transfected COS-7 cells. With both whole-cell voltage-clamp and patch-clamp recording, TRESK currents increased up to three-fold by clinical concentrations of isoflurane, halothane, sevoflurane, and desflurane. Nonanesthetics (nonimmobilizers) had no effect on TRESK. Various IV anesthetics, including etomidate, thiopental, and propofol, have a minimal effect on TRESK currents. Amide and ester local anesthetics inhibit TRESK in a concentration-dependent manner but at concentrations generally larger than those that inhibit other tandem pore domain K channels. We also determined that TRESK is found not only in spinal cord, but also in human brain RNA. These results identify TRESK as a target of volatile anesthetics and suggest a role for this background K channel in mediating the effects of inhaled anesthetics in the central nervous system.
PMID: 15562060 [PubMed - indexed for MEDLINE]
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A comparison of selective spinal anesthesia with hyperbaric bupivacaine and general anesthesia with desflurane for outpatient knee arthroscopy.
Korhonen AM, Valanne JV, Jokela RM, Ravaska P, Korttila KT.
HUCH, Department of Anaesthesia and Intensive Care Med, Meilahti Hospital, PO. Box 340, FIN-00029 HUS, Finland. anna-maija.korhonen@hus.fi
In this randomized and controlled trial, 64 adult ambulatory knee arthroscopy patients received either selective spinal anesthesia (SSA) with 4 mg of hyperbaric bupivacaine or general anesthesia (GA) with desflurane. We conducted the study to determine whether SSA with small-dose bupivacaine provides equal fast-tracking possibilities, a shorter stay in the postanesthesia care unit, and earlier discharge home compared with GA with desflurane. Patients with a high risk for postoperative nausea and vomiting received prophylaxis in the GA group. No difference was seen in the fast-tracking possibilities or time in the postanesthesia care unit between the groups. Home readiness was achieved after 114 (31-174) and 129 (28-245) min (NS) in the SSA and GA groups, respectively. In the hospital, the pain scores were significantly (P < 0.001) lower in the SSA group compared with the GA group and the need for postoperative opioids was significantly (P = 0.008) larger after GA. The incidence of postoperative nausea and vomiting was 0% versus 19% in the SSA and GA groups (P = 0.024), respectively. We conclude that for outpatients undergoing knee arthroscopy, SSA with hyperbaric bupivacaine provides equal recovery times with less frequent side effects compared with GA with desflurane.
Publication Types:
- Clinical Trial
- Randomized Controlled Trial
PMID: 15562051 [PubMed - indexed for MEDLINE]
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Anesthetic concerns for robot-assisted laparoscopy in an infant.
Mariano ER, Furukawa L, Woo RK, Albanese CT, Brock-Utne JG.
Department of Anesthesia, Stanford University Medical Center, 300 Pasteur Dr. H3580, Stanford, CA 94305, USA. ermariano@hotmail.com
A 2-mo-old infant with biliary atresia was scheduled for laparoscopic Kasai with robot assistance. Before surgery, a practice trial maneuvering the cumbersome robotic equipment was performed to ensure rapid access to the patient in case of emergency. IV access, tracheal intubation, and arterial line placement followed inhaled anesthesia induction with sevoflurane. Robotic setup took 53 min and severely limited patient access. No adverse events occurred during the procedure requiring the removal of the robotic equipment, and the patient was discharged after a stable postoperative recovery. Advance preparation is required to maximize patient safety during robotic surgery.
Publication Types:
PMID: 15562050 [PubMed - indexed for MEDLINE]
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The effects of chin lift and jaw thrust while in the lateral position on stridor score in anesthetized children with adenotonsillar hypertrophy.
Arai YC, Fukunaga K, Hirota S, Fujimoto S.
Department of Anesthesiology, Kochi Medical School, Oko-Cho, Nankoku, Kochi, 783-8505, Japan. arainon@med.kochi-ms.ac.jp
Obstruction of the upper airway is a major challenge for anesthesiologists administering general anesthesia in spontaneously breathing patients, especially in pediatric anesthesia with adenotonsillar hypertrophy. Lateral positioning is a simple treatment for obstructive sleep apnea and also decreases collapsibility of the pharynx in anesthetized adults with obstructive sleep apnea. In this study, we examined the effects of body position shifting and common airway maneuvers, such as chin lift and jaw thrust, on airway patency (stridor score) in anesthetized children scheduled for adenotonsillectomy. Thirty children aged 1-10 yr were anesthetized with sevoflurane. During spontaneous breathing of 5% sevoflurane, stridor score was recorded. After baseline recording, chin lift and jaw thrust were performed on patients in both the supine and the lateral decubitus positions. Chin lift and jaw thrust improved the stridor score. Furthermore, lateral positioning dramatically enhanced the effects of these airway maneuvers on airway patency. Jaw thrust combined with lateral positioning provided easy airway management for the anesthesiologists. We conclude that lateral positioning combined with airway maneuvers significantly improved airway patency compared with the airway maneuvers alone for patients in the supine position.
Publication Types:
PMID: 15562046 [PubMed - indexed for MEDLINE]
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Bronchoscopic lung volume reduction in patients with severe emphysema: anesthetic management.
Hillier JE, Toma TP, Gillbe CE.
Department of Anesthesia, Harefield Hospital, Hill End Road, Harefield Middlesex, UB9 6JH England. thehilliers@clara.co.uk
Bronchoscopic lung volume reduction is a novel approach to the treatment of severe emphysema. Its objective is to achieve the same improvements in lung function and exercise tolerance as lung volume reduction surgery while avoiding the surgical morbidity and mortality. We describe the anesthetic experience in a series of seven patients who underwent a total of eight procedures (one patient underwent a second procedure on the contralateral side). The technique used was one of total IV anesthesia using remifentanil and propofol, with a ventilatory strategy aimed at avoiding gas trapping and dynamic hyperinflation. To achieve this pressure, limited ventilation with a prolonged expiratory phase was provided by a Draeger Evita 2 ventilator. This technique resulted in intraoperative hypercapnia (Paco(2) 6.75 kPa) compared with baseline values (median Paco(2) 5.1 kPa; P < 0.05), but 2 h postoperatively the arterial partial pressure of CO(2) was returning to baseline (median Paco(2) 5.6 kPa; P < 0.01 compared with intraoperative data). There were no deaths or admissions to the intensive care unit after the procedure. One patient developed a pneumothorax that required drainage, three patients had acute exacerbations of chronic obstructive pulmonary disease, and one patient developed a cough that resolved spontaneously. Total hospital stay did not exceed 5 days for any of these patients.
PMID: 15562041 [PubMed - indexed for MEDLINE]
Regimens for patient-controlled epidural analgesia during labor.
Paech M.
Publication Types:
PMID: 15564970 [PubMed - in process]
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Regimens for Patient-controlled Epidural Analgesia during Labor.
Boselli E, Chassard D.
* Hotel-Dieu Hospital, Lyon, France. dominique.chassard@chu-lyon.fr.
PMID: 15564969 [PubMed - in process]
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Transient profound neurologic deficit associated with thoracic epidural analgesia in an elderly patient.
Jacob AK, Borowiec JC, Long TR, Brown MJ, Rydberg CH, Wass CT.
Department of Anesthesiology, Mayo Clinic and Mayo Foundation, Rochester, Minnesota, USA.
PMID: 15564958 [PubMed - in process]
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Spinal epidural hematoma after spinal anesthesia in a patient treated with clopidogrel and enoxaparin.
Litz RJ, Gottschlich B, Stehr SN.
Department of Anesthesiology and Critical Care Medicine, University Hospital Dresden, Technical University Dresden, Germany. rainer.litz@mailbox.tu-dresden.de
PMID: 15564957 [PubMed - in process]
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Effect of different cost drivers on cost per anesthesia minute in different anesthesia subspecialties.
Schuster M, Standl T, Wagner JA, Berger J, Reimann H, Am Esch JS.
Department of Anesthesiology, University Hospital Hamburg-Eppendorf, Hamburg, Germany. m.shuster@uke.uni-hamburg.de
BACKGROUND: Little is known about differences in costs to provide anesthesia care for different surgical subspecialties and which factors influence the subspecialty-specific costs. METHODS: In this retrospective study, the authors determined main cost components (preoperative visit, intraoperative personnel costs, material and pharmaceutical costs, and others) for 10,843 consecutive anesthesia cases from a 6-month period in the 10 largest anesthesia subspecialties in their university hospital: ophthalmology; general surgery; obstetrics and gynecology; ear, nose, and throat surgery; oral and facial surgery; neurosurgery; orthopedics; cardiovascular surgery; traumatology; and urology. Using regression analysis, the effect of five presumed cost drivers (anesthesia duration, emergency status, American Society of Anesthesiologists physical status of III or higher, patient age younger 6 yr, and placement of invasive monitoring) on subspecialty-specific costs per anesthesia minute were analyzed. RESULTS: Both personnel costs for anesthesiologists and total costs calculated per anesthesia minute were inversely correlated with the duration of anesthesia (adjusted R2 = 0.75 and 0.69, respectively), i.e., they were higher for subspecialties with short cases and lower for subspecialties with longer cases. The multiple regression model showed that differences in anesthesia duration alone accounted for the majority of the cost differences, whereas the other presumed cost drivers added only little to explain subspecialty-specific cost differences. CONCLUSIONS: Different anesthesia subspecialties show significant and financially important differences regarding their specific costs. Personnel costs and total costs are highest for subspecialties with the shortest cases. Other analyzed cost drivers had little effect on subspecialty-specific costs. In the light of these cost differences, a detailed cost analysis seems necessary before the profitability of an anesthesia subspecialty can be assessed.
PMID: 15564953 [PubMed - in process]
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Differential protective effects of volatile anesthetics against renal ischemia-reperfusion injury in vivo.
Lee HT, Ota-Setlik A, Fu Y, Nasr SH, Emala CW.
Department of Anesthesiology, College of Physicians and Surgeons of Columbia University, New York, New York, USA. tl128@columbia.edu
BACKGROUND: Volatile anesthetics protect against cardiac ischemia-reperfusion injury via adenosine triphosphate-dependent potassium channel activation. The authors questioned whether volatile anesthetics can also protect against renal ischemia-reperfusion injury and, if so, whether cellular adenosine triphosphate-dependent potassium channels, antiinflammatory effects of volatile anesthetics, or both are involved. METHODS: Rats were anesthetized with equipotent doses of volatile anesthetics (desflurane, halothane, isoflurane, or sevoflurane) or injectable anesthetics (pentobarbital or ketamine) and subjected to 45 min of renal ischemia and 3 h of reperfusion during anesthesia. RESULTS: Rats treated with volatile anesthetics had lower plasma creatinine and reduced renal necrosis 24-72 h after injury compared with rats anesthetized with pentobarbital or ketamine. Twenty-four hours after injury, sevoflurane-, isoflurane-, or halothane-treated rats had creatinine (+/- SD) of 2.3 +/- 0.7 mg/dl (n = 12), 1.8 +/- 0.5 mg/dl (n = 6), and 2.4 +/- 1.2 mg/dl (n = 6), respectively, compared with rats treated with pentobarbital (5.8 +/- 1.2 mg/dl, n = 9) or ketamine (4.6 +/- 1.2 mg/dl, n = 8). Among the volatile anesthetics, desflurane demonstrated the least reduction in plasma creatinine after 24 h (4.1 +/- 0.8 mg/dl, n = 12). Renal cortices from volatile anesthetic-treated rats demonstrated reduced expression of intercellular adhesion molecule 1 protein and messenger RNA as well as messenger RNAs encoding proinflammatory cytokines and chemokines. Volatile anesthetic treatment reduced renal cortex myeloperoxidase activity and reduced nuclear translocation of proinflammatory nuclear factor kappaB. Adenosine triphosphate-dependent potassium channels are not involved in sevoflurane-mediated renal protection because glibenclamide did not block renal protection (creatinine: 2.4 +/- 0.4 mg/dl, n = 3). CONCLUSION: Some volatile anesthetics confer profound protection against renal ischemia-reperfusion injury compared with pentobarbital or ketamine anesthesia by attenuating inflammation. These findings may have significant clinical implications for anesthesiologists regarding the choice of volatile anesthetic agents in patients subjected to perioperative renal ischemia.
PMID: 15564938 [PubMed - in process]
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Comparative evaluation of the Datex-Ohmeda S/5 Entropy Module and the Bispectral Index monitor during propofol-remifentanil anesthesia.
Schmidt GN, Bischoff P, Standl T, Hellstern A, Teuber O, Schulte Esch J.
Department of Anesthesiology, University Hospital Hamburg-Eppendorf, Hamburg, Germany. guschmid@uke.uni-hamburg.de
BACKGROUND: Different analytical concepts were introduced to quantify the changes of the electroencephalogram. The Datex-Ohmeda S/5 Entropy Module (Datex-Ohmeda Division, Instrumentarium Corp., Helsinki, Finland) was the first commercial monitor based on the entropy generating two indices, the state entropy (SE) and the response entropy (RE). The aim of the current study was to compare the accuracy of SE and RE with the Bispectral Index(R) monitor (BIS(R); Aspect Medical Systems, Newton, MA) during propofol-remifentanil anesthesia. METHODS: The authors investigated 20 female patients during minor gynecologic surgery. SE, RE, BIS, mean arterial blood pressure, heart rate, and sedation level were recorded every 20 s during stepwise increase (target-controlled infusion, 0.5 microg/ml) of propofol until the patients lost response. Five minutes after loss of response, remifentanil infusion (0.4 microg . kg(-1) . min(-1)) was started. Spearman correlation coefficient and prediction probability were calculated for sedation levels with SE, RE, BIS, mean arterial blood pressure, and heart rate. The ability of the investigated parameters to distinguish between the anesthesia steps awake versus loss of response, awake versus anesthesia, anesthesia versus first reaction, and anesthesia versus extubation was analyzed with the prediction probability. RESULTS: SE correlates best with sedation levels, but no significant differences of the prediction probability values among SE, RE, and BIS were found. The prediction probability for all investigated steps of anesthesia did not show significant differences among SE, RE, and BIS. SE, RE, and BIS were superior to mean arterial blood pressure and heart rate. CONCLUSION: SE, RE, and BIS revealed similar information about the level of sedation and allowed the authors to distinguish between different steps of anesthesia. Both monitors provided useful additional information for the anesthesiologist.
PMID: 15564934 [PubMed - in process]
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This month in anesthesiology.
Henkel G.
PMID: 15564928 [PubMed - in process]
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Effects of SEA0400, a novel inhibitor of the Na+/Ca2+ exchanger, on myocardial stunning in anesthetized dogs.
Takahashi T, Takahashi K, Onishi M, Suzuki T, Tanaka Y, Ota T, Yoshida S, Nakaike S, Matsuda T, Baba A.
Medicinal Research Laboratories, Taisho Pharmaceutical Co., Ltd., 1-403 Yoshino-cho, Kita-ku, Saitama-shi, Saitama 331-9530, Japan. teisuke.takahashi@po.rd.taisho.co.jp
Activation of the Na+/Ca2+ exchanger may contribute to Ca2+ overload during reperfusion after transient ischemia. We examined the effects of 2-[4-[(2,5-difluorophenyl) methoxy]phenoxy]-5-ethoxyaniline (SEA0400), a selective inhibitor of Na+/Ca2+ exchange, on a canine model of ischemia/reperfusion injury (myocardial stunning). Myocardial stunning was induced by a 15-min occlusion of the left anterior descending coronary artery followed by a 4-h reperfusion in anesthetized open-chest dogs. Reperfusion gradually restored myocardial percent segment shortening but remained depressed during a 4-h reperfusion period. A bolus intravenous injection of SEA0400 (0.3 or 1.0 mg/kg), given 1 min before reperfusion, improved significantly the recovery of percent segment shortening in the ischemic/reperfused myocardium. SEA0400 did not affect the hemodynamics and electrocardiogram parameters. In addition, SEA0400 did not affect reperfusion-induced change in coronary blood flow. These results suggest that the Na+/Ca2+ exchanger is involved in the stunned myocardium of dogs after reperfusion, and that SEA0400 has a protective effect against myocardial stunning in dogs.
PMID: 15556149 [PubMed - in process]
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Facilitated assessment of unconsciousness from morphologic changes in the bilateral posterior tibial nerve cortical somatosensory evoked potential under total intravenous propofol anesthesia during spine surgery.
Schwartz DM, Sestokas AK.
Surgical Monitoring Associates, Inc., 25 Bala Avenue, Suite 105, Bala Cynwyd, PA 19004, USA. danielmschwartz@mac.com
OBJECTIVE: To describe a unique morphologic feature of the bilateral posterior tibial nerve cortical somatosensory evoked potential, the S-wave, which varies systematically with propofol infusion rate and which appears to be useful in guiding adequate propofol concentration levels during spine surgery. METHODS: Two illustrative cases were selected from a pool of 15,000 pediatric and adult patients (ages 8-85 years) who were undergoing corrective spine surgery in operating rooms of university and community hospitals. Anesthesia was maintained with a continuous intravenous infusion of propofol (125-225 microg/kg/min) along with intermittent boluses of narcotic and midazolam (1.0-2.0 mg) as needed. Characteristic metamorphosis of the bilateral posterior tibial nerve cortical somatosensory evoked potential, highlighted by the emergence of an additional middle-latency component labeled the S-wave, served as a neurophysiological marker of "light" propofol anesthesia prompting elevation of propofol infusion rate or bolus injection. RESULTS: The S-wave was routinely abolished with increased propofol infusion rate or bolus injection. In all instances increased propofol concentration levels produced a characteristic morphologic change in the posterior tibial nerve cortical somatosensory evoked potential consistent with a return to adequate anesthetic depth. Selected cases presented herein compare the S-wave technique to BIS and illustrate the usefulness of the S-wave in identifying inadequate depth of propofol anesthesia. CONCLUSIONS: The bilateral posterior tibial nerve cortical somatosensory evoked potential changes its morphology in predictable fashion with decreased depth of propofol anesthesia, allowing for anticipation of imminent anesthetic "lightening." It serves as a useful cross-check to Bispectral Index (BIS) or other "level of consciousness" EEG-based algorithms for monitoring depth of propofol anesthesia during prolonged corrective spine surgery.
PMID: 15562986 [PubMed - in process]
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