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Items 1 - 12 of 12 |
One page. |
Double-blind comparison of intrapleural saline and 0.25% bupivacaine for ipsilateral shoulder pain after thoracotomy in patients receiving thoracic epidural analgesia.
Pennefather SH, Akrofi ME, Kendall JB, Russell GN, Scawn ND.
Department of Anaesthesia, Cardiothoracic Centre, Thomas Drive, Liverpool L14 3PE, UK.
BACKGROUND: The aim of this prospective double-blind randomized placebo-controlled study was to investigate the effect of intrapleural bupivacaine on ipsilateral post-thoracotomy shoulder pain in patients receiving thoracic epidural analgesia. METHODS: Of the 68 patients recruited to the study, 41(60%) developed ipsilateral shoulder pain within 2 h of surgery. These patients were randomly assigned to receive either 40 ml of intrapleural bupivacaine 0.25% with epinephrine 1:200 000 or 40 ml of intrapleural saline. The study solution was injected into the tube of a basal drain that had been clamped distal to the site of administration. Shoulder pain at rest and on coughing was assessed using a visual analogue scale (VAS) and an observer verbal rating score (OVRS) immediately before and 30 min, 1 h, 2 h, 3 h and 4 h after intrapleural bupivacaine/saline. The total volume of epidural solution administered was recorded. RESULTS: Thirty-nine patients completed the study and were included in the analysis. There were no significant differences in baseline characteristics between the two groups. There were no significant differences between groups for VAS or OVRS pain scores at rest or with cough at any of the six assessment times. The total volumes of epidural solution administered to the bupivacaine and saline groups were 56 ml and 48 ml, respectively. This difference was not significant. CONCLUSION: Intrapleural administration of 40 ml of bupivacaine 0.25% does not provide effective pain relief for ipsilateral post-thoracotomy shoulder pain.
PMID: 15567813 [PubMed - as supplied by publisher]
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Influence of working conditions on job satisfaction in anaesthetists.
Kinzl JF, Knotzer H, Traweger C, Lederer W, Heidegger T, Benzer A.
Department of Psychiatry, Division of Psychosomatic Medicine, Innsbruck Medical University, A-6020 Innsbruck, Austria.
BACKGROUND: We studied job satisfaction, physical health, emotional well-being and working conditions in 125 Austrian and Swiss anaesthetists. METHODS: Responses to self-reporting questionnaires were evaluated. Dependent variables included job satisfaction, emotional well-being and physical health. Independent variables included age, sex, marital status, position and working conditions as assessed by the Instrument for Stress-related Job Analysis. RESULTS: Control over work shows a strong effect on job satisfaction in anaesthetists, for example influence on handling tasks (P=0.001), time control (P=0.002) and participation (P=0.001), whereas task demands and task-related problems did not have any effect. Anaesthetists in leading positions and specialists reported lower job satisfaction (P=0.012) than did anaesthetists in non-leading positions. Job satisfaction was associated with better physical health (P=0.001) and better emotional well-being (P=0.005). CONCLUSIONS: Our results suggest that a high level of job satisfaction in anaesthetists correlates with interesting work demands and the opportunity to contribute skills and ideas. To improve job satisfaction, more attention should be paid to improving working conditions, including control over decision-making, and allowing anaesthetists to have more influence on their own work pace and work schedule.
PMID: 15567811 [PubMed - as supplied by publisher]
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Double-blind randomized controlled trial to determine extent of amnesia with midazolam given immediately before general anaesthesia.
Bulach R, Myles PS, Russnak M.
Department of Anaesthesia and Pain Management, Alfred Hospital, Commercial Road, Melbourne, Victoria 3004, Australia.
BACKGROUND: Anterograde, but not retrograde, amnesia has been demonstrated following midazolam administration. However, there have been no studies investigating whether or not immediate retrograde amnesia can be produced with midazolam. METHODS: After ethics committee approval and consent, 40 adult patients undergoing surgery and general anaesthesia were randomly allocated to one of four groups: midazolam 2 mg, midazolam 5 mg, midazolam 10 mg or control (normal saline). Measurements were made from 12 min prior to induction of anaesthesia, and the study drug was administered 8 min prior to induction of anaesthesia. Midazolam effects were measured using visual recognition of posters, recall of specific events, bispectral index (BIS) and sedation visual analogue score. RESULTS: Recognition and recall rates were similar between groups up until the time of study drug administration, with no evidence of retrograde amnesia (all P>0.3). There was a dose-dependent deterioration in visual recall (P=0.002), event recollection (P<0.001), BIS (P<0.001) and sedation score (P<0.001) following i.v. midazolam when compared with control. CONCLUSIONS: We found no evidence that i.v. midazolam 2-10 mg produces immediate retrograde amnesia. Midazolam causes anterograde amnesia in a dose-responsive manner.
PMID: 15567810 [PubMed - as supplied by publisher]
Images in Anesthesia: Accidental knot formation of a pulmonary artery catheter.
Matsuda T, Inoue S, Keiichi S, Furuya H.
PMID: 15574552 [PubMed - in process]
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Spinal anesthesia for Cesarean section in a parturient with long QT syndrome: [La rachianesthesie pour une cesarienne chez une parturiente qui presente un syndrome du QT long].
Al-Refai A, Gunka V, Douglas J.
Department of Anesthesia, BC Women's Hospital, 4500 Oak Street, Vancouver, BC V6H 3N1, Canada. vgunka@cw.bc.ca.
PURPOSE: To report the first use of spinal anesthesia for Cesarean section (CS) in a parturient with a long QT syndrome (LQTS) and an automatic implantable cardiac defibrillator (AICD). Although both general and epidural anesthesia have been described for CS in patients with LQTS, there are no previous case reports on the use of spinal anesthesia. The clinical features, diagnosis, treatment and anesthetic management of LQTS are discussed. CLINICAL FEATURES: A 31-yr-old woman, gravida 2 para 1 known to have LQTS and an AICD, presented in labour at 35 weeks gestation, three weeks before her scheduled CS. Her previous delivery by CS under spinal anesthesia at our institution was uneventful. On this occasion, we elected to administer spinal anesthesia because she was asymptomatic (no arrhythmia or cardiac arrest) for the last few years, was hemodynamically stable, and had received uneventful spinal anesthesia before. CONCLUSION: Spinal anesthesia was used safely for CS in this parturient with LQTS.
PMID: 15574549 [PubMed - as supplied by publisher]
CME in cardiothoracic and vascular anesthesia.
[No authors listed]
PMID: 15578494 [PubMed - as supplied by publisher]
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Time to tracheal extubation after coronary artery surgery with isoflurane, sevoflurane, or target-controlled propofol anesthesia: a prospective, randomized, controlled trial.
Parker FC, Story DA, Poustie S, Liu G, McNicol L.
Department of Anaesthesia, Austin Health, Heidelberg, Victoria, Australia.
OBJECTIVES: To determine if anesthesia with sevoflurane or target-controlled propofol reduced the time to tracheal extubation after coronary artery bypass graft surgery compared with isoflurane anesthesia. DESIGN: A 3-arm (isoflurane, sevoflurane, or propofol), randomized, controlled trial with patients and intensive care staff blinded to the drug allocation. SETTING: A single, tertiary referral hospital affiliated with the University of Melbourne. PARTICIPANTS: Three hundred sixty elective coronary artery surgery patients. INTERVENTIONS: Patients received either isoflurane (control group, 0.5%-2% end-tidal concentration), sevoflurane (1%-4% end-tidal concentration), or target-controlled infusion of propofol (1-8 microg/mL plasma target concentration) as part of a balanced, standardized anesthetic technique including 15 microg/kg of fentanyl. MEASUREMENTS AND MAIN RESULTS: The primary outcome was time to tracheal extubation. The median time to tracheal extubation for the propofol group was 10.25 hours (interquartile range [IQR] 8.08-12.75), the sevoflurane group 9.17 hours (IQR 6.25-11.25), and the isoflurane group 7.67 hours (IQR 6.25-9.42). Intraoperatively, the propofol group required less vasopressor (p = 0.002) and more vasodilator therapy (nitroglycerin p = 0.01, nitroprusside p = 0.002). There was no difference among the groups in time to intensive care unit discharge. CONCLUSIONS: The median time to tracheal extubation was significantly longer for the target-controlled propofol group. A significantly greater number in this group required the use of a vasodilator to control intraoperative hypertension.
PMID: 15578473 [PubMed - in process]
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Difficult intubation in pediatric cardiac anesthesia.
Akpek EA, Mutlu H, Kayhan Z.
Department of Anesthesiology, Bakent University, Ankara, Turkey. elifakpek@baskent-ank.edu.tr
OBJECTIVE: The aim of this study was to investigate cases of difficult intubation in pediatric cardiac surgical patients and to evaluate the importance of associated congenital abnormalities. DESIGN: Retrospective analysis. SETTING: Departments of Anesthesiology and Pediatric Cardiovascular Surgery of a tertiary university hospital. PARTICIPANTS: All children undergoing congenital heart surgery. INTERVENTIONS: Patients who had difficult intubations according to their anesthetic charts were further evaluated from hospital files for demographic characteristics, associated congenital abnormalities, and perioperative airway and/or respiratory complications. MEASUREMENTS AND MAIN RESULTS: A total of 1,278 pediatric patients with congenital heart disease were operated on from January 1999 to July 2002. Difficult intubation was encountered in 16 cases (1.25%). Two of these were newborns, 11 were infants, and 3 were in the pediatric age group. Anterior larynx was the most common reason for difficult intubation (7 cases, 43.7%). There were associated syndromes and/or other congenital abnormalities in 8 children (50%). CONCLUSION: The likelihood of difficult intubation during pediatric cardiac surgery, especially in cases with other congenital pathologies should be kept in mind, and the anesthetic approach must be planned accordingly.
PMID: 15578472 [PubMed - in process]
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Importance of anesthesia for the genesis of neurogenic pulmonary edema in spinal cord injury.
Leal Filho MB, Morandin RC, de Almeida AR, Cambiucci EC, Borges G, Gontijo JA, Metze K.
Curso de Posgraduacao em Ciencias Medicas, Faculdade de Ciencias Medicas, Universidade Estadual de Campinas, PO Box 6111, 13084-971 Campinas, SP, Brazil.
There are reports describing both provocation and inhibition of neurogenic pulmonary edema by anesthetic drugs. Therefore, we compared the effect of two types of anesthesia on the formation of neurogenic pulmonary edema in rats with balloon-induced acute spinal cord injury. Animals with sham procedure (group 1) were anesthesized by intraperitoneal sodium pentobarbital. In the experimental groups, rats were submitted to acute spinal cord lesion by insufflations of a balloon in the epidural space at T8 for 1 min (group 3 under i.p. sodium pentobarbital and group 2 under i.p. xylazine-ketamine anesthesia). In rats with pentobarbital anesthesia, systolic blood pressure doubled the baseline value during compression, whereas this effect was less pronounced in the ketamine-xylazine group. The pulmonary index (100 x wet lung weight/body weight) was 0.395 (+/-0.018) in sham-operated rats, rose to 0.499 (+/-0.060) in group 2, and was maximum under pentobarbital anesthesia (0.639+/-0.14; p=0.0018). Histologic examination of the spinal cord showed parenchymal ruptures and acute hemorrhage. Comparison of the pulmonary index with histologic slides of lung parenchyma revealed that relevant intra-alveolar edema occurred only for index values above 0.55. On electron microscopy, endothelial alterations, and damage of the alveolar lining cells were found. Our study indicates that neurogenic pulmonary edema caused by spinal cord injury is less pronounced in rats under xylazine-ketamine anesthesia, when compared with pentobarbital.
PMID: 15567574 [PubMed - in process]
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Augmented breath phase volume and timing relationships in the anesthetized rat.
Golder FJ, Davenport PW, Johnson RD, Reier PJ, Bolser DC.
Department of Physiological Sciences, University of Florida, Gainesville, FL, USA. golderf@svm.vetmed.wisc.edu
Augmented breaths (ABs), or sighs, are airway protective reflexes and part of the normal repertoire of respiratory behaviors. ABs consist of two phases, where phase I volume and timing resembles preceding eupnic breaths, and phase II is an augmenting motor pattern and occurs at the end of phase I. Recent evidence suggest multiple respiratory motor patterns can occur following dynamic functional reconfiguration of one respiratory neural network. It follows that the response of the respiratory network to modulatory inputs also may undergo dynamic reconfiguration. We hypothesized that lung-volume related feedback during ABs would alter AB timing differentially during phase I and II. We measured phase I and II volumes and durations in urethane anesthetized rats with decreased lung volume secondary to three models of varying phrenic motor impairment (spinal injury alone, unilateral phrenicotomy, and combined injuries). AB phase I and II inspired volume were decreased after phrenic motor impairment (p<0.05). In contrast, only phase I duration following injury was altered compared to controls. Phase II duration remaining unchanged despite the greatest effect of injury on volume occurring during phase II. Thus, sigh volume-timing relationships differ between phases of an augmented breath suggesting that the response of the respiratory network to modulatory inputs has changed. These data support the hypothesis that multiple respiratory behaviors occur following dynamic reconfiguration of the respiratory neural network.
PMID: 15567559 [PubMed - in process]
The effect of ephedrine on intrapartum fetal heart rate after epidural analgesia.
Kreiser D, Katorza E, Seidman DS, Etchin A, Schiff E.
Department of Gynecology and Obstetrics and Anesthesia, Sheba Medical Center, Tel-Hashomer, Israel.
OBJECTIVE: Adverse fetal heart rate (FHR) changes occur frequently during the first 30 minutes after epidural analgesia. The aim of this study was to estimate whether intravenous administration of ephedrine during induction of epidural analgesia can reduce the frequency of adverse FHR changes. METHODS: We prospectively studied 145 term singleton deliveries where epidural analgesia was administered. The patients were randomly allocated before the administration of epidural analgesia to receive an intravenous infusion of 10 mg ephedrine, after epidural induction, followed by a continuous infusion for 60 minutes of 20 mg ephedrine (study group) or to receive no ephedrine (control group). The FHR tracing was evaluated for 20 minutes before and 40 minutes after initiating epidural analgesia. Demographic data and clinical and delivery outcome were assessed and compared between the 2 groups. RESULTS: Injection of ephedrine significantly reduced the rate of major FHR changes appearing 15-25 minutes after induction of epidural analgesia in the study group compared with the control group (2/72 compared with 11/73, respectively; P = .009). To avoid 1 case of adverse FHR changes, 6.8 women should be treated with ephedrine. Maternal and fetal characteristics and outcome and mode of delivery were similar in the 2 groups. Mean arterial pressure was significantly higher in the study group from the time of analgesia induction and during the subsequent 25 minutes. Maternal heart rate was transiently reduced in the study group only. CONCLUSION: Ephedrine administration during the time of epidural analgesia initiation can reduce the frequency of adverse FHR changes commonly observed immediately afterward.
PMID: 15572490 [PubMed - in process]
Do-not-resuscitate orders for pediatric patients who require anesthesia and surgery.
Fallat ME, Deshpande JK; American Academy of Pediatrics Section on Surgery, Section on Anesthesia and Pain Medicine, and Committee on Bioethics.
This clinical report addresses the topic of preexisting do-not-resuscitate (DNR) orders for children undergoing anesthesia and surgery. Pertinent issues addressed include the rights of children, surrogate decision-making, the process of informed consent, and the roles of surgeons and anesthesiologists. The reevaluation process of DNR orders called "required reconsideration" can be incorporated into the process of informed consent for surgery and anesthesia. Care should be taken to distinguish between goal-directed and procedure-directed approaches to DNR orders. By giving parents or other surrogates and clinicians the option of deciding from among full resuscitation, limitations based on procedures, or limitations based on goals, the child's needs are individualized and better served.
PMID: 15574636 [PubMed - in process]
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