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A case of an anaphylactic reaction to an old substance--patent blue--for a new indication.
Bouman EA, Songun I, Marcus MA.
Publication Types:
PMID: 15315629 [PubMed - indexed for MEDLINE]
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Analgesic effects of preincisional administration of dextromethorphan and tenoxicam following laparoscopic cholecystectomy.
Yeh CC, Wu CT, Lee MS, Yu JC, Yang CP, Lu CH, Wong CS.
Department of Anesthesiology, Tri-Service General Hospital, Taipei, Taiwan.
BACKGROUND: Pre-incisional treatment with either N-methyl-D-aspartate (NMDA) receptor antagonists or non-steroidal anti-inflammatory drugs (NSAIDs) improves postoperative pain relief. This study examines the effect on postlaparoscopic cholecystectomy (LC) pain of a combination of dextromethorphan (DM), a NMDA-receptor antagonist, and tenoxicam, a NSAID, given preoperatively. METHODS: Eighty-eight ASA I or II patients scheduled for LC were entered into a randomized, double-blind study and randomly allocated to one of four groups. Controls received 20 mg (4 ml) of chlorpheniramine maleate (CPM) IM and 4 ml of normal saline (N/S) IV. Group DM received 40 mg of DM (containing 20 mg of CPM) IM and 4 ml of N/S IV. Group T were given CPM 20 mg IM, and tenoxicam 40 mg (4 ml) IV. Group DM + T were given DM 40 mg (containing 20 mg of CPM) IM, and tenoxicam 40 mg IV. All treatments were given 30 min before skin incision. Analgesic effects were evaluated by Visual Analog Scale (VAS) pain scores at rest and during coughing, at 1, 2, 4, 12, 24 and 48 h after surgery. The time to the first request for meperidine for pain relief, and total meperidine consumption, were recorded for 48 h after surgery. RESULTS: Compared to controls, patients given DM and DM + T first requested meperidine significantly later, had lower meperidine consumption, made fewer requests for meperidine, and had lower pain scores. There were significant differences between the DM + T and T groups at 2 and 4 h in both resting and incident VAS pain scores, the incidence of meperidine requests and the time to first meperidine injection. There were significant differences between groups DM and T at 1 h for resting pain and at 2 and 4 h for incident pain. Except for a significant difference in the incident pain score 1 h after surgery, there were no other differences in pain scores between the DM and DM + T groups. Neither synergistic nor antagonistic interaction was observed between DM and tenoxicam. CONCLUSIONS: The results suggest that pretreatment with DM, but not tenoxicam, provides significant pre-emptive analgesia for postoperative pain management in patients after LC surgery. Combining DM and tenoxicam also gives good pain relief.
Publication Types:
- Clinical Trial
- Randomized Controlled Trial
PMID: 15315625 [PubMed - indexed for MEDLINE]
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Changes in visual and auditory response time during conscious sedation with propofol.
Kim KM, Jeon WJ, Lee DH, Kang WC, Kim JH, Noh GJ.
Department of Anesthesiology and Pain Medicine, Sanggye Paik Hospital, College of Medicine, Inje University, Seoul, Republic of Korea.
BACKGROUND: Using a push-button device, we investigated whether visual or auditory response time would increase with increasing sedation, and assessed the responsiveness score of the Observer's Assessment of Alertness/Sedation (OAA/S) scale at the point of first loss of response to visual or auditory stimulation. METHODS: In experiment 1 we applied visual and auditory stimulation to 19 patients as the propofol target plasma concentration (CPT) was increased to determine whether the visual or auditory response would be lost first. Thirty patients were each then infused with propofol, starting at a CPT of 0.3 microg ml(-1) and increasing by increments of 0.2 microg ml(-1), during which visual (experiment 2) or auditory (experiment 3) stimulation was applied when the effect-site concentration (CE) of propofol reached CPT. Visual response time (VRT), auditory response time (ART), CE and total amounts of propofol, and OAA/S score at the first loss of visual/auditory response were measured. RESULTS: Visual response disappeared earlier than auditory response in 84.2% of the patients. Visual response time and ART were linearly prolonged as the CE of propofol increased. The CE and total amounts of propofol at the first loss of visual response were 1.2 +/- 0.4 microg ml(-1) and 57.9 +/- 16.7 mg, compared with 1.4 +/- 0.5 microg ml(-1) and 71.6 +/- 26.1 mg, respectively, at the first loss of auditory response. The median (range) OAA/S scores at the first loss of visual and auditory response were 4 (3-4) and 3 (2-4), respectively. CONCLUSION: VRT and ART were linearly prolonged with increasing sedation. Visual response may be useful in monitoring conscious sedation.
Publication Types:
PMID: 15315623 [PubMed - indexed for MEDLINE]
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Residents lack knowledge and practical skills in handling the difficult airway.
Rosenstock C, Ostergaard D, Kristensen MS, Lippert A, Ruhnau B, Rasmussen LS.
Academic Department of Anaesthesia, Department of Anaesthesia and Intensive Care, Copenhagen University Hospital, Rigshospitalet, Denmark. rosenstock@rh.dk
BACKGROUND: Full-scale simulators have been developed in anaesthesia. We aimed at assessing Danish anaesthesia residents' knowledge and management of a standardized difficult airway situation in an advanced airway simulator. The reliability of the assessment was also determined. METHODS: Thirty-six residents answered a questionnaire testing their knowledge on difficult airway management and practice patterns. Secondly, all residents attempted management of a standardized 'cannot ventilate, cannot intubate' airway scenario. Three observers independently assessed a video recording of the performance. RESULTS: Only 17% of the residents passed the written test. Ninety-seven per cent stated that they had difficulties recalling the American Society of Anesthesiologists'(ASA) difficult airway algorithm and 53% did not know how to oxygenate through the cricothyroid membrane. Seventeen per cent had previously been involved in emergency situations with severe complications due to insufficient airway management. In the scenario 75% of the residents established ventilation using a laryngeal mask airway. After establishing ventilation, 26% would continue with surgery without a definitive airway, despite the risk of aspiration. Analysis of the interobserver agreement showed good (Kappa = 0.63) to excellent (Kappa = 0.78) consistency for objective parameters in the scoring scheme. Inter-observer reliability was satisfactory (R = 0.43) for trained Crisis Resource Management evaluators. CONCLUSIONS: Theoretical and practical education in difficult airway management needs to be improved among Danish anaesthesia residents. Simulator assessment should only be performed using well-defined objective parameters and trained assessors.
PMID: 15315620 [PubMed - indexed for MEDLINE]
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Effect of cardiopulmonary bypass on pulmonary clearance of adrenomedullin in humans.
Kamei M, Hayashi Y, Kikumoto K, Kawai Y, Kangawa K, Kuro M, Minaminoals N.
Department of Anesthesiology, National Cardiovascular Center, Suita, Osaka, Japan.
BACKGROUND: Adrenomedullin is a potent vasodilatory peptide and its plasma concentration increases after cardiopulmonary bypass. We analyzed the contribution of the lung to the disposition of adrenomedullin before and after cardiopulmonary bypass in humans. METHODS: Thirty-five patients undergoing cardiac surgery with cardiopulmonary bypass were studied. Bloods were sampled from the pulmonary artery and left atrium at the following times: prior to systemic heparinization, during pulmonary reperfusion and after cardiopulmonary bypass. Plasma concentrations of total and mature adrenomedullin were measured using an immunoradiometric assay kit specific for human adrenomedullin. Intermediate adrenomedullin was calculated as the difference between total adrenomedullin and mature adrenomedullin. RESULTS: Before cardiopulmonary bypass, mature and intermediate adrenomedullin concentrations were reduced by the pulmonary circulation by approximately 30% and 20%, respectively. However, these effects were not observed during pulmonary reperfusion. Mature, but not intermediate, adrenomedullin was reduced after cardiopulmonary bypass. Furthermore, pulmonary clearance quantity of mature adrenomedullin was significantly enhanced after cardiopulmonary bypass. CONCLUSION: These results indicate that cardiopulmonary bypass temporally impairs the pulmonary clearance of mature and intermediate adrenomedullin, but clearance of mature, not intermediate adrenomedullin is enhanced after cardiopulmonary bypass.
Publication Types:
PMID: 15315615 [PubMed - indexed for MEDLINE]
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Estimation of myocardial performance in CABG patients.
Poelaert J, Heerman J, Schupfer G, Moerman A, Reyntjens K, Roosens C.
Department of ICU, Cardiac Anaesthesia and Postoperative Cardiac Surgical ICU, Ghent University Hospital, Belgium.
Myocardial performance index (MPI) permits a relative easy estimation of global left ventricular (LV) systolic and diastolic function. It was shown that MPI inversely correlated strongly with the maximum derivative of LV pressure with respect to time (+dP/dtmax). The current study evaluated the change of MPI during and immediately after coronary artery bypass surgery (CABG) surgery and analyzed the relationship between MPI and hydraulic energy (exemplified by preload adjusted maximal power-PAMP) during that same period. The study was conducted in 45 patients undergoing CABG. After induction of anaesthesia, 10 min after revascularization and 2 h postoperatively, haemodynamics were assessed. Preload was characterized by LV end-diastolic area indexed for BSA (LVEDAI); afterload was estimated by arterial elastance (Ea) and indexed systemic vascular resistance (SVRI). Global myocardial performance was indicated in terms of MPI and contractility was achieved by PAMP. Myocardial performance index increased postoperatively (0.44 +/- 0.13, 0.37 +/- 0.17 and 0.50 +/- 0.16, respectively; P < 0.001). Preload adjusted maximal power did not alter significantly (1.90 +/- 1.24, 2.02 +/- 1.34 and 2.12 +/- 1.00 W cm(-2)*10(4), respectively). Left ventricular enddiastolic area indexed did not change. Arterial elastance augmented to 0.76 +/- 0.39, 0.80 +/- 0.40 and 1.01 +/- 0.43 mmHg ml(-1), respectively; P < 0.001. Systemic vascular resistance did not change. A relationship was found between 1-MPI/LVEDAI2 and PAMP (R2 = 0.50). This study shows that in the setting of CABG surgery, MPI appears to be a good measure of global LV function.
Publication Types:
PMID: 15315614 [PubMed - indexed for MEDLINE]
Comment on:
Ventriculo-arterial coupling and remifentanil: importance of the dosage.
Guarracino F, Cariello C, Danella A, Doroni L, Lapolla F, Stefani M.
Publication Types:
PMID: 15196119 [PubMed - indexed for MEDLINE]
Comment on:
Catheter-related epidural abscesses--reevaluating a true sterile technique.
Cohen S, Samet R.
Publication Types:
PMID: 15196118 [PubMed - indexed for MEDLINE]
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Blood pressure and central neuraxial blockades.
Dahlgren N.
Publication Types:
PMID: 15196116 [PubMed - indexed for MEDLINE]
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Acute airway obstruction in an infant with Pierre Robin syndrome after palatoplasty.
Dell'Oste C, Savron F, Pelizzo G, Sarti A.
Department of Anesthesia and Intensive Care, IRCCS Instituto per l'Infanzia Burlo Garofolo, Triest, Italy. sarti@burlo.trieste.it
This report describes a complication of post-operative oedema of the palate, tongue and pharynx after a Perko-revised cleft palate repair, which resulted in a life-threatening airway obstruction in an infant with Pierre Robin syndrome. Although infants experiencing airway problems after Wardill-Kilner, von Langenbeck and Furlow palatoplasty have been described, airway complications in a group of Perko-revised repair children have not been previously reported. We speculate that this complication, which occurred in the absence of a history of previous airway problems, is due to prolonged operating time and excessive pressure exerted on the base of the tongue by the Kilner-Doughty retractor. Acknowledgments of this risk permits to identify those patients prior to surgery so that they can be managed appropriately. Copyright 2004 Acta Anaesthesiologica Scandinavica
Publication Types:
PMID: 15196114 [PubMed - indexed for MEDLINE]
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Problems in anaesthesia: paediatric anaesthesia.
Courtman SP.
Consultant Paediatric Anaesthetist Derriford Hospital Plymouth.
PMID: 15601302 [PubMed - in process]
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Anaesthetic and Obstetric Management of High-Risk Pregnancy, 3rd edn.
Cowlishaw P.
Plymouth, UK.
PMID: 15601301 [PubMed - in process]
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A response to 'Conversion reaction following anaesthesia', Haden RA, Anaesthesia 2004; 59: 728-9.
Perkins V, Tallach R.
Dumfries and Galloway Royal Infirmary Dumfries DG1 4AP, UK E-mail: v.perkins@dgri.scot.nhs.uk.
PMID: 15601299 [PubMed - in process]
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A response to 'Emergency cricothyrotomy: a randomised crossover trial comparing the wire-guided and catheter-over-needle techniques', Fikkers BG, van Vugt S, van der Hoeven JG, van den Hoogen FJA, Marres HAM, Anaesthesia 2004; 59: 1008-11.
Hodgson R.
Nelson R Mandela School of Medicine Congella Durban 4012, South Africa E-mail: iti20178@mweb.co.za.
PMID: 15601298 [PubMed - in process]
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A response to 'Clearing the cervical spine in unconscious adult trauma patients: A survey of practice in specialist centres in the UK', Jones PS, Wadley J, Healy M, Anaesthesia 2004; 59: 1095-9.
Sundaram R, Koteeswaren S.
Victoria Infirmary Glasgow G42 9TY, UK E-mail: adha@hotmail.com.
PMID: 15601297 [PubMed - in process]
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A response to 'Accidental tenfold overdose of propofol in a 6-month old infant undergoing elective craniosynostosis repair', Patermann B, Buzello S, Duck M, Paul M, Kampe S, Anaesthesia 2004; 59: 912-4.
Crawford D.
Newcastle General Hospital Newcastle upon Tyne NE46 BE, UK E-mail: david.crawford@nuth.northy.nhs.uk.
PMID: 15601296 [PubMed - in process]
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A response to 'Alveolar and plasma concentrations of interleukin and vascular endothelial growth factor following oesophagectomy', Cree RTJ, Warnell I, Staunton M, Shaw I, Bullock R, Griffin SM, Baudouin, Anaesthesia 2004; 59: 867-71.
Medford AR.
Southmead Hospital Westbury-on-Trym Bristol BS10 5NB, UK E-mail: andrew.medford@bris.ac.uk.
PMID: 15601295 [PubMed - in process]
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A live 'foreign body' in an anaesthetic circuit.
Razvi SA.
Royal Devon and Exeter Foundation NHS Trust, Exeter, UK E-mail: Dr_sarazvi@yahoo.com.
PMID: 15601292 [PubMed - in process]
-
Horner's syndrome after general anaesthesia.
Atkinson D, McCluskey A, Richardson AM.
Stepping Hill Hospital Stockport SK2 7JE, UK E-mail: amccluskey@mcmail.com.
PMID: 15601289 [PubMed - in process]
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Effects of the EWTD on anaesthetic training in the UK.
Tomlinson A.
University Hospital of North Staffordshire, Stoke-on-Trent ST4 6QG, UK E-mail: andy.tomlinson@doctors.org.uk.
PMID: 15601283 [PubMed - in process]
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Spinal anaesthesia despite combined clopidogrel and aspirin therapy in a patient awaiting lung transplantation: effects of platelet transfusion on clotting tests.
Herbstreit F, Peters J.
Resident in Anaesthesiology, Klinik fur Anasthesiologie und Intensivmedizin, Universitatsklimikum Essen, Hufelandstrasse 55, 45122 Essen, Germany.
Summary The risk of central neuraxial blockade in patients treated with newer antiplatelet drugs is unclear. We report the case of a woman awaiting lung transplantation who presented for emergency groin surgery. She had recently undergone a coronary artery stent implantation and was treated with both clopidogrel and aspirin. Despite this dual antiplatelet therapy, uneventful spinal anaesthesia was administered following platelet transfusion. While thromboelastography was of no help in assessing the degree of anticoagulation, the effects of platelet transfusion were reflected by adenosine diphosphate and epinephrine aggregometry. Thus, in selected patients, platelet transfusion may be appropriate to enable central neuraxial blockade when deemed necessary.
PMID: 15601279 [PubMed - in process]
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A quantitative analysis of anaesthetist-patient communication during the pre-operative visit.
Kindler CH, Szirt L, Sommer D, Hausler R, Langewitz W.
Staff Anaesthetist, Department of Anaesthesia, University Hospital Basel, CH-4031 Basel, Switzerland.
Summary Previous communication research in general medical practice has shown that effective communication enhances patient compliance, satisfaction and medical outcome. It is expected that communication is equally important in anaesthesia, since patients often suffer from anxiety and lack of knowledge about anaesthetic procedures. However, little is known about the nature of communication during routine anaesthetic visits. The present study of 57 authentic anaesthetic visits provides the first results on the structure and content of communication in the pre-operative setting using the Roter Interaction Analysis System (RIAS). Patient-centred communication behaviours of anaesthetists and the extent of patient involvement were particularly investigated. From the 57 pre-operative visits, 18 267 utterances were coded. The mean (SD) [range] duration of the visit was 16.1 (7.8) [3.7-42.7] min. Anaesthetists provided 169 (68) and patients 153 (82) utterances per visit (53.5% vs. 46.5%). Physician and patient gender had no impact on the distribution of utterances and the duration of the visit. Conversation mainly focussed on biomedical issues with little psychosocial discussion (< 0.1% of all anaesthetist utterances). However, anaesthetists quite frequently used emotional comments toward patients (7%) and involved them in the conversation. The use of facilitators, open questions and emotional statements by the anaesthetist correlated with high patient involvement. The amount of patient participation in anaesthetic decisions was assessed with the Observing Patient Involvement Scale (OPTION). Compared with general practitioners, anaesthetists offered more opportunities to discuss treatment options (mean (SD) OPTION score 26.8 (16.8) vs. 16.8 (7.7)).
PMID: 15601273 [PubMed - in process]
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Randomised trial of intravenous infusion of ephedrine or mephentermine for management of hypotension during spinal anaesthesia for Caesarean section.
Kansal A, Mohta M, Sethi AK, Tyagi A, Kumar P.
Postgraduate student, Department of Anaesthesiology and Critical care, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi 110096, India.
Summary This study compared the effects of intravenous infusions of ephedrine and mephentermine for maintenance of maternal arterial pressure and neonatal outcome in pregnant women receiving subarachnoid block for lower segment Caesarean section. Sixty patients who developed hypotension following subarachnoid block for Caesarean section were randomly divided into two groups of 30 each to receive an intravenous infusion of ephedrine or mephentermine. Hypotension was defined as a decrease in systolic blood pressure of >/= 20% from the baseline value or an absolute value of <100 mmHg, whichever was higher. The vasopressor infusion was titrated to maintain systolic blood pressure between 'hypotension' and baseline values. Baseline haemodynamic parameters, haemodynamic changes subsequent to the start of vasopressor infusion, duration of hypotension and amount of vasopressor required were statistically similar for both groups. Neonatal APGAR scores and acid-base profiles were also comparable. To conclude, mephentermine can be used as safely and effectively as ephedrine for the management of hypotension during spinal anaesthesia in patients undergoing elective Caesarean section.
PMID: 15601269 [PubMed - in process]
Comment on:
Chloroform, vitamin B12, and the tragic lives of Robert M. Glover and Horace Wells.
Alston TA.
Publication Types:
- Biography
- Comment
- Historical Article
- Letter
Personal Name as Subject:
PMID: 15479340 [PubMed - indexed for MEDLINE]
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Comparison of surgical site and patient's history with a simplified risk score for the prediction of postoperative nausea and vomiting.
Apfel CC, Kranke P, Eberhart LH.
Department of Anaesthesiology and Perioperative Medicine, University of Louisville, Louisville, KY 40202, USA. christian.apfel@louisville.edu
Although site of surgery and previous occurrence of postoperative nausea and vomiting are often used to decide whether prophylactic anti-emetic drugs are indicated, the value of these predictors is unclear. We compared these two risk factors against a simplified four-factor risk score. We analysed data from 1566 adult inpatients who received balanced anaesthesia without prophylactic anti-emetics. Sensitivity, specificity, predictive value and area under the receiver operating characteristic curve were used to quantify predictive properties. Nausea and vomiting occurred in 600 (38.3%) patients within 24 h. Sensitivity and specificity were, respectively, 47% and 59% for surgical site; 47% and 70% for history of postoperative nausea and vomiting; and 58% and 70% for risk score with three or more factors. The area under the curve for surgical site was 0.53 (95% CI 0.50-0.56); that for patient's history was 0.58 (95% CI 0.56-0.61) while for risk score it was 0.68 (95% CI 0.66-0.71; P < 0.001). Prediction using surgical site or patient's history alone was poor while the simplified risk score provided clinically useful sensitivity and specificity.
PMID: 15479315 [PubMed - indexed for MEDLINE]
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Effect of head posture on tracheal tube position in children.
Olufolabi AJ, Charlton GA, Spargo PM.
Duke University Medical Centre, Erwin road, Durham, NC 27710, USA. olufo001@mc.duke.edu
Changes in the tracheal tube tip to carina distance were measured by radiographic screening following various head postures in 45 children undergoing cardiac catheterisation under general anaesthesia who were intubated via nasal and oral routes. Extension of the head moved the tracheal tube away from the carina and flexion moved it towards the carina in both routes. Endobronchial intubation was noted during neck flexion in a significant proportion of children intubated orally but none occurred during nasal intubation. Extension produced greater upward movement of the tracheal tube tip in the oral route than the nasal route. In contrast, flexion produced greater downward movement in the nasal route in some patients. The direction of movement with lateral rotation and use of a shoulder roll was inconsistent.
PMID: 15479313 [PubMed - indexed for MEDLINE]
[Quality assurance of haemotherapy in anaesthesia Auswertung eines 3-jahrigen Erfahrungszeitraums.]
[Article in German]
von Heymann C, Pruss A, Foer A, Volk T, Braun J, Rohrs A, Kiesewetter H, Spies C.
Klinik fur Anasthesiologie und operative Intensivmedizin, Charite-Universitatsmedizin Berlin, Campus Charite Mitte, .
BACKGROUND: The measures for quality assurance in haemotherapy developed at the Charite Campus Mitte according to the transfusion law of 1998 are introduced and discussed.METHODS: In a 3-year study period the submission of transfusion documentation and the expiry of blood products were compared to the year 2001. The potentials for improvement for 2001-2003 were compared based on evaluation of the self-inspection documentation of the transfusion clinics.RESULTS: The submission rate for the transfusion documentation increased from 90% in 2001 to 98.3% in 2002 and 2003. The expiry of blood products decreased from 5.1% in 2001 to 1.7% in 2003 resulting in a cost reduction from 140,000 Euro to 50,000 Euro. Continuous need for improvement was found for the prescribed annual further education of staff on quality management.CONCLUSIONS: The self-inspection procedure in transfusion clinics still revealed potential for improvement, although documentation of transfusions were improved and the expiry of blood products and the resulting costs were substantially reduced.
PMID: 15599688 [PubMed - as supplied by publisher]
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[Implementation of an internal transfer pricing system for anaesthesia services.]
[Article in German]
Raetzell M, Reissmann H, Steinfath M, Schuster M, Schmidt C, Scholz J, Bauer M.
Klinik fur Anasthesiologie und Operative Intensivmedizin, Universitatsklinikum Schleswig-Hostein, Campus Kiel, matzell@anaesthesie.uni-kiel.de.
Internal transfer pricing system (ITPS) of anaesthesia services is established to guarantee a close connection of delivered service and the budget of the department of anaesthesia. In most cases a time-based system is used with the pricing unit being calculated as the quotient from the enumerator "costs" divided by the denominator "anaesthesia time in minutes". The implementation of a transfer pricing system requires the identification of all relevant costs caused by the department of anaesthesia and a cost centre structure is needed which allocates all costs correctly according to their cause. The regulations regarding cost calculations as defined by the German DRG System should be considered. To generate valid data not only the necessary technical infrastructure is needed, but also detailed training of the staff and plausibility checks are needed to ensure correct and complete data. Subsequent agreements with the hospital administration are necessary in order to adjust the system if extrinsic cost increases occur. This paper gives a step-by-step guidance for the successful implementation of an internal transfer pricing system based on anaesthesia time.
PMID: 15597163 [PubMed - as supplied by publisher]
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[In vitro effects of anaesthetic agents on the blood-brain barrier.]
[Article in German]
Fischer S, Renz D, Kleinstuck J, Schaper W, Karliczek GF.
Abteilung fur Anasthesiologie und Intensivmedizin, Kerckhoff-Klinik GmbH, Bad Nauheim, s.fischer@kerckhoff.mpg.de.
BACKGROUND. The blood-brain barrier (BBB) forms a selective barrier between blood and brain and regulates the passage of most molecules. Pathological conditions such as ischemia lead to breakdown of the BBB. Vascular endothelial growth factor (VEGF) has been shown to be responsible for hypoxia-induced hyperpermeability of the BBB in vivo as well as in vitro. To eliminate factors which alter the permeability of the BBB in vivo, an in vitro model was used to test the effects of intravenous and volatile anesthetics on the permeability and on VEGF expression during normoxia and hypoxia. METHODS. The in vitro model of the BBB consisted of primary cultures of porcine brain microvascular endothelial cells (BMEC). The permeability was measured by the paracellular passage of [3H]inulin across the BMEC monolayer and the expression of VEGF was determined by northern blot analysis. RESULTS. All intravenous and volatile anesthetics tested (etomidate, ketamine, fentanyl, propofol, midazolam, sodium-gamma-hydroxybutyrate as well as halothane, enflurane, isoflurane, sevoflurane, desflurane) did not alter the permeability of the BBB or the expression of VEGF in vitro. Hypoxia (2 vol%) increased the permeability and the VEGF expression significantly which was not altered in the presence of the anesthetics. CONCLUSION. The in vitro model represents a suitable model of the BBB to investigate direct effects of anesthetics on functions of the BBB independent of hemodynamic factors.
PMID: 15597157 [PubMed - in process]
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[Therapeutic hypothermia after traumatic brain injury or subarachnoid hemorrhageCurrent practices of German anaesthesia departments in intensive care.]
[Article in German]
Himmelseher S, Werner C.
Klinik fur Anaesthesiologie, Klinikum rechts der Isar, Technische Universitat Munchen, Munchen, s.himmelseher@lrz.tu-muenchen.de.
BACKGROUND. We aimed to explore current practices in use of therapeutic hypothermia after traumatic brain injury (TBI) or subarachnoid hemorrhage (SAH) in intensive care of adults. METHODS. Questionnaires were sent to anaesthesia department chairs in German hospitals with neurosurgical care in January 2004 with a survey focussing on cooling procedures, temperature measurement, depth and duration of hypothermia, and rewarming after therapy. RESULTS. 99 (67%) questionnaires on TBI and 95 (64%) on SAH could be analysed. Hypothermia was used in 39% after TBI and 18% after SAH. Its aims were neuroprotection in approximately 45% and control of refractory intracranial hypertension in approximately 50%. However, in most cases (69% TBI, 59% SAH) hypothermia was used in less than a quarter of patients treated. A criterion for hypothermia was severe disease in approximately 40% and refractory intracranial hypertension in approximately 50%. Temperatures were targeted to 36-34 degrees C in 77% after TBI and 88% after SAH. In more than 80%, bladder temperatures were measured. For induction of hypothermia, surface cooling was applied in approximately 90%. The duration of hypothermia was 24-48 h in 62% after TBI and 29% after SAH. Cooling was orientated at the intracranial pressure (ICP) in 31% after TBI and 47% after SAH, and was used for more than 48 h in approximately 25%. After hypothermia was stopped, a rewarming rate of 0.5 degrees C/h was applied in 38% after TBI and 53% after SAH. In approximately 35%, rewarming was orientated at the ICP, and in 33% after TBI and 24% after SAH, it was performed over 24 h. After SAH, spontaneous rewarming was used in 24%. CONCLUSION. Therapeutic hypothermia is used in 39% after TBI and 18% after SAH in the intensive care of German anaesthesia departments. There is no standard in management, and there is wide variation in practices of duration of cooling and rewarming. For patients' benefit, evidence-based recommendations on therapeutic hypothermia should be published by the appropriate medical societies in the German language.
PMID: 15597156 [PubMed - in process]
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[Propofol infusion syndrome]
[Article in German]
Motsch J, Roggenbach J.
Klinik fur Anasthesiologie, Universitatsklinikum Heidelberg. johann.motsch@med.uni-heidelberg.de
Propofol infusion syndrome has not only been observed in patients undergoing long-term sedation with propofol, but also during propofol anesthesia lasting 5 h. It has been assumed that the pathophysiologic cause is propofol's impairment of oxidation of fatty acid chains and inhibition of oxidative phosphorylation in the mitochondria, leading to lactate acidosis and muscular necrosis. It has been postulated that propofol might act as a trigger substrate in the presence of priming factors. Severe diseases in which the patient has been exposed to high catecholamine and cortisol levels have been identified as trigger substrates. Once the development of propofol infusion syndrome is suspected, propofol infusion has to be stopped immediately and specific therapeutic measures initiated, including cardiocirculatory stabilization and correction of metabolic acidosis. To increase elimination of propofol and its potential toxic metabolites, hemodialysis or hemofiltration are recommended. Due to its possible fatal side effects, the use of propofol for long-term sedation in critically ill patients should be reconsidered. In cases of unexplained lactate acidosis occurring during continuous propofol infusion, propofol infusion syndrome must be taken into consideration.
Publication Types:
PMID: 15448937 [PubMed - indexed for MEDLINE]
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[Accuracy of target-controlled infusion (TCI) with 2 different propofol formulations]
[Article in German]
Ihmsen H, Jeleazcov C, Schuttler J, Schwilden H, Bremer F.
Klinik fur Anasthesiologie, Friedrich-Alexander-Universitat, Erlangen-Nurnberg. Harald.Ihmsen@kfa.imed.uni-erlangen.de
BACKGROUND: Target-controlled infusion (TCI) of propofol was initially realized as a device for prefilled syringes (Diprifusor). New TCI systems can be used with any propofol formulation. We compared two different propofol formulations with respect to accuracy of TCI and pharmacokinetics. MATERIALS AND METHODS: A total of 10 volunteers received Diprivan 1% and Propofol 1% MCT Fresenius as TCI using the pharmacokinetic model of the Diprifusor. The prediction error was determined from measured arterial concentrations. A three-compartment model was fitted to the concentration data. RESULTS: The median prediction error and the median absolute prediction error were -1.4% and 23.3% for Diprivan, and -5.9% and 17.8% for Propofol Fresenius. The drugs did not differ in pharmacokinetics but showed a smaller central volume of distribution than used for infusion control. CONCLUSIONS: The pharmacokinetic model of Diprifusor can also be used for TCI of Propofol Fresenius. The large volume of distribution in this model may cause an overshoot in concentration.
PMID: 15372176 [PubMed - indexed for MEDLINE]
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[Those said to be dead live longer...]
[Article in German]
Conzen P.
Klinik fur Anaesthesiologie, Klinikum Innenstadt, Munchen. Peter.Conzen@med.uni-muenchen.de
Publication Types:
PMID: 15338040 [PubMed - indexed for MEDLINE]
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[Does fentanyl or midazolam improve patient's comfort and cooperation when given for regional catheter placement? A randomized, controlled and double-blind trial]
[Article in German]
Morin AM, Vasters FG, Wulf H, Geldner G, Kratz C, Hedderich U, Kussin A, Eisenhardt G, Eberhart LH.
Klinik fur Anasthesie und Intensivtherapie, Klinikum der Philipps-Universitat Marburg. a.morin@web.de
BACKGROUND: The procedure of placing a catheter for continuous regional anaesthesia is often associated with fear and pain in the patient. Thus, we evaluated the use of midazolam and fentanyl to improve patient's comfort and cooperation. METHODS: After an oral dose of 20 mg clorazepate, 174 patients receiving peripheral nerve catheters for regional anaesthesia where randomized into 3 groups to receive either intravenous placebo, 3 mg midazolam or 0.1 mg fentanyl immediately before catheter placement in a double-blind manner. Stepwise regression analysis was used to identify factors associated with patient's assessment of subjective discomfort (measured using a VAS 0-10) during the procedure. Amnesia was evaluated 24 h later. The anaesthetist rated patient's cooperation during catheter placement. RESULTS: Female sex and longer duration of catheter placement had significant negative impact on patient's comfort, whereas fentanyl showed an improvement. Age, body mass index, midazolam and the type of catheter had no influence. The following day 27% of the midazolam group, 6% of the placebo group and 9% of the fentanyl patients did not remember catheter placement. Patient's cooperation was poor in 26% of the midazolam patients but only in 9% of the placebo and 3% of the patients receiving fentanyl. Of the placebo patients 18.4% had to be supplemented with fentanyl because they found the procedure of catheter placement unbearable. No side effects occurred in either group. CONCLUSION: As patient's comfort and cooperation were significantly improved by fentanyl, we recommend fentanyl to facilitate catheter placement for regional anaesthesia.
Publication Types:
- Clinical Trial
- Randomized Controlled Trial
PMID: 15316642 [PubMed - indexed for MEDLINE]
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[Premedication visits. Economizing at the cost of the patient?]
[Article in German]
Kratz CD, Christ M, Maisch B, Kerwat KM, Olt C, Zielke A, Hellinger A, Wulf H, Geldner G.
Klinik fur Anasthesie und Intensivmedizin, Klinikum der Philipps-Universitat Marburg.
The older the patient, the higher the risk of perioperative cardiac complications. Therefore, patients at risk have to be identified and the appropriate diagnostic or therapeutic measures initiated. The most important factor in this context is whether a planned surgery can be postponed. Several strategies have been developed (e.g. Goldman index, Eagle criteria) and the American Heart Association (AHA/ACC) has produced guidelines concerning perioperative diagnosis and therapy of cardiac risk patients. The common goal of these strategies is always the risk classification of the patient by combining the operative risk and the risk factors of the patient. The further procedure (diagnostic or therapeutic measures) is based on the risk classification. If further invasive therapy proves to be necessary, the determining factor is the period of time for which the operation can be delayed. This appears to be about 3 months but if this is not possible the outcome could be improved with a beta-blocker therapy in advance. A working group from the university hospital in Marburg has developed a strategy for risk classification and further diagnostic and therapeutic measures as outlined in this article.
Publication Types:
PMID: 15221120 [PubMed - indexed for MEDLINE]
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[Anesthesia and intensive care medicine--status report. XIIIth International Symposium on Anesthesia in Heidelberg, March 19-21, 2004]
[Article in German]
Bopp C, Plachky J, Hofer S, Graf BM, Weigand MA.
Klinik fur Anasthesiologie, Universitatsklinikum Heidelberg. Christian.Bopp@med.uni-heidelberg.de
Publication Types:
PMID: 15221113 [PubMed - indexed for MEDLINE]
Comment on:
Fluid leak from epidural puncture site: a diagnostic dilemma.
Bansal S.
Publication Types:
- Case Reports
- Comment
- Letter
PMID: 15502073 [PubMed - indexed for MEDLINE]
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Awake intubation is indicated in pregnant women with difficult airways.
Goldszmidt E, Brimacombe J, Keller C.
Publication Types:
PMID: 15502072 [PubMed - indexed for MEDLINE]
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Polypoid hyperplasia of the larynx misdiagnosed as a malpositioned laryngeal mask airway.
d'Hulst D, Butterworth J, Dale S, Oaks T, Matthews B.
Department of Anesthesiology, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157-1009, USA.
Polypoid hyperplasia of the vocal cords, associated with smoking, reflux, and vocal cord abuse, results in inflammation and edema. This condition can produce partial airway obstruction during positive pressure ventilation.
Publication Types:
PMID: 15502067 [PubMed - indexed for MEDLINE]
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Adding a selective obturator nerve block to the parasacral sciatic nerve block: an evaluation.
Jochum D, Iohom G, Choquet O, Macalou D, Ouologuem S, Meuret P, Kayembe F, Heck M, Mertes PM, Bouaziz H.
Department of Anesthesiology and Intensive Care Medicine, Private Hospital Group of Center Alsace, Alsace, France.
Our aim was to objectively evaluate the efficacy of obturator nerve anesthesia after a parasacral block. Patients scheduled for knee surgery had a baseline adductor strength evaluation. After a parasacral block with 30 mL 0.75% ropivacaine, sensory deficit in the sciatic distribution (temperature discrimination) and adductor strength were assessed at 5-min intervals. Patients with an incomplete sensory block (defined as a temperature discrimination score of less than 2 in the 3 cutaneous distributions of the sciatic nerve tested) 30 min after the parasacral block were excluded from the study. Subsequently, a selective obturator block was performed with 7 mL 0.75% ropivacaine and adductor strength was reassessed at 5 min intervals for 15 min. Finally, a femoral block was performed using 10 mL 0.75% ropivacaine. Patient discomfort level during each block was assessed using a visual analog scale (VAS). Thirty-one patients completed the study. Five patients were excluded as a result of inadequate sensory block in the sciatic distribution 30 min after the parasacral block (success rate of 89%). Thirty min after the parasacral block, adductor strength decreased by 11.3% +/- 7% compared with baseline (85 +/- 24 versus 97 +/- 28 mm Hg, P = 0.002). Fifteen min after the obturator nerve block, adductor muscle strength decreased by an additional 69% +/- 7% (16.6 +/- 15 versus 85 +/- 24 mm Hg, P < 0.0001). VAS scores were similar for all blocks (26 +/- 19, 28 +/- 24, and 27 +/- 19 mm for parasacral, obturator, and femoral respectively). Four parasacral blocks were simulated in 2 fresh cadavers using 30 mL of colored latex solution. The spread of the die in relation to the obturator nerve was assessed. Injection of 30 mL colored latex into cadavers resulted in spread of the injectate restricted to the sacral plexus. These findings demonstrate the unreliability of parasacral block to achieve anesthesia of the obturator nerve. A selective obturator block should be considered in the clinical setting when this is desirable.
PMID: 15502062 [PubMed - indexed for MEDLINE]
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A single injection ultrasound-assisted femoral nerve block provides side effect-sparing analgesia when compared with intrathecal morphine in patients undergoing total knee arthroplasty.
Sites BD, Beach M, Gallagher JD, Jarrett RA, Sparks MB, Lundberg CJ.
Department of Anesthesiology and Orthopedic Surgery, Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH 03756, USA. brian.sites@hitchcock.org
Postoperative pain after total knee arthroplasty (TKA) is severe, and achieving adequate analgesia remains a clinical challenge. We tested the hypothesis that, in patients having unilateral TKA under intrathecal (IT) anesthesia, the addition of a femoral nerve block would provide superior analgesia when compared with IT morphine and demonstrate fewer adverse side effects. In a single-blinded and controlled trial, 41 ASA I-III patients undergoing unilateral TKA were randomized into 2 groups. Both groups received 15 mg of IT hyperbaric bupivacaine for the surgical anesthetic. Group ITM received 250 microg of IT morphine and group FNB received an ultrasound-assisted femoral nerve block with 40 mL of 0.5% ropivacaine, 5 microg/mL of epinephrine, and 75 microg of clonidine. At 1, 2, 4, 6, 12, and 24 h postoperatively, we measured visual analog scales for pain, cumulative IV morphine consumption, hemodynamics, and side effects. There were no statistically significant differences in morphine consumption, pain at rest, or pain with movement. However, group FNB had fewer perioperative side effects including nausea, vomiting, and pruritus (P < 0.05 for each event). This corresponded to a decrease in patient satisfaction in group ITM, in which 20% of the patients rated their experience as "unsatisfactory" (P < 0.05). We conclude that, in comparison with IT morphine, a single injection femoral nerve block provides equivalent analgesia but with a significant reduction in side effects for patients having TKA under bupivacaine intrathecal anesthesia.
Publication Types:
- Clinical Trial
- Randomized Controlled Trial
PMID: 15502061 [PubMed - indexed for MEDLINE]
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Preincisional intravenous pentoxifylline attenuating perioperative cytokine response, reducing morphine consumption, and improving recovery of bowel function in patients undergoing colorectal cancer surgery.
Lu CH, Chao PC, Borel CO, Yang CP, Yeh CC, Wong CS, Wu CT.
Department of Anesthesiology, Tri-Service General Hospital and National Defense Medical Center, National Defense University, #325 Section 2 Chenggung Road, Neihu 114, Taipei, Taiwan, Republic of China.
Cytokine release during surgery can produce a long-lasting hyperalgesia. Thus, preoperatively-administered cytokine inhibitors might reduce the production of cytokines, decreasing central nervous system sensitization and improving the quality of postoperative pain relief. We investigated the hypothesis that preincisional IV pentoxifylline (PTX) treatment could attenuate the release of proinflammatory (tumor necrosis factor, interleukin (IL)-1beta, IL-6, and IL-8) and antiinflammatory (IL-1 receptor antagonist) cytokines in patients who underwent elective colorectal cancer surgery. Forty patients were randomly assigned to 1 of 2 groups of 20 each: the PTX group received a PTX 5 mg/kg IV infusion before the induction of anesthesia, whereas the control group received an equal volume of normal saline. Venous blood samples were obtained at frequent intervals. After surgery, all patients received patient-controlled analgesia (PCA) morphine for postoperative pain relief. Patients in the PTX group exhibited longer PCA trigger times, less morphine consumption, and a faster return of bowel function compared with patients in the control group. Moreover, the plasma levels of IL-6, IL-8, and IL-1 receptor antagonist were less in the treatment group, and there was no significant difference in wound infections, tumor recurrence, or metastatic rates between groups during a 2-yr follow-up.
Publication Types:
- Clinical Trial
- Randomized Controlled Trial
PMID: 15502050 [PubMed - indexed for MEDLINE]
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Is the patient state analyzer with the PSArray2 a cost-effective alternative to the bispectral index monitor during the perioperative period?
White PF, Tang J, Ma H, Wender RH, Sloninsky A, Kariger R.
Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center at Dallas, 5323 Harry Hines Blvd., F2.208, Dallas, TX 75390-9068, USA. paul.white@utsouthwestern.edu
New disposable electrodes, the PSArray and XP sensor, have been developed for the patient state analyzer (PSA) and the bispectral index (BIS) monitors, respectively. We designed this clinical study to compare the sensitivity and specificity of the patient state index (PSI) with the BIS during the perioperative period when the new electrode sensors were used. Twenty-two consenting patients scheduled for elective laparoscopic procedures were enrolled in this prospective study. The elapsed time to apply electrodes and obtain a baseline index value was recorded, as were the comparative PSI and BIS values at specific time intervals during the induction, maintenance, and emergence periods in patients who were administered a standardized general anesthetic. In addition, the changes in these indices were recorded after a bolus dose of propofol (20 mg IV) or a 2% increase or decrease in the inspired concentration of desflurane during the maintenance period. The total elapsed time to obtain an index value was similar with both devices (66 +/- 32 s versus 72 +/- 41 s for the PSA and BIS, respectively). By using logistic regression models, both the BIS and PSI were found to be equally effective as predictors of unconsciousness (i.e., failure to respond to verbal stimuli). The PSI also correlated with the BIS during both the induction of (R = 0.85) and the emergence from (R = 0.74) general anesthesia. The area under the receiver operating characteristic curve for detection of consciousness also indicated a similar performance with the PSI (0.98 +/- 0.05) and the BIS (0.97 +/- 0.05). During the maintenance period, the PSI values tended to be lower than the BIS value; however, the responses to changes in propofol and desflurane were similar. Finally, the PSI (versus BIS) values showed less interference from the electrocautery unit during the operation (31% versus 73%, respectively). Although the list price of the PSArray(2) disposable electrode strip (USD $24.95) was higher than that of the BIS XP sensor (USD $17.50), the average sale price (USD $14.95) was identical for both electrode systems. Therefore, we conclude that the PSA monitor with the PSArray(2) is a cost-effective alternative to the BIS monitor with the XP sensor for evaluating consciousness during the induction of and emergence from general anesthesia, as well as for titrating propofol and desflurane during the maintenance period.
Publication Types:
PMID: 15502043 [PubMed - indexed for MEDLINE]
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Sevoflurane and propofol increase 11C-flumazenil binding to gamma-aminobutyric acidA receptors in humans.
Salmi E, Kaisti KK, Metsahonkala L, Oikonen V, Aalto S, Nagren K, Hinkka S, Hietala J, Korpi ER, Scheinin H.
Turku PET Centre, Turku University Hospital, PO Box 52, FIN-20521 Turku, Finland. elina.salmi@utu.fi
Based on in vitro studies and animal data, most anesthetics are supposed to act via gamma-aminobutyric acid type A (GABA(A)) receptors. However, this fundamental characteristic has not been extensively investigated in humans. We studied (11)C-flumazenil binding to GABA(A) receptors during sevoflurane and propofol anesthesia in the living human brain using positron emission tomography (PET). Fourteen healthy male subjects underwent 2 60-min dynamic PET studies with (11)C-labeled flumazenil, awake and during anesthesia. Anesthesia was maintained with 2% end-tidal sevoflurane (n = 7) or propofol at a target plasma concentration of 9.0 +/- 3.0 (mean +/- sd) microg/mL (n = 7). The depth of anesthesia was measured with bispectral index (BIS). Values of regional distribution volumes (DV) of (11)C-flumazenil were calculated in several brain areas using metabolite-corrected arterial plasma curves and a two-compartment model. Separate voxel-based statistical analysis using parametric DV images was performed for detailed visualization. The average BIS index was 35 +/- 6 in the sevoflurane group and 28 +/- 8 in the propofol group (P = 0.02). Sevoflurane increased the DV of (11)C-flumazenil significantly (P < 0.05) in all brain areas studied except the pons and the white matter. In the propofol group the increases were significant (P < 0.05) in the caudatus, putamen, cerebellum, thalamus and the frontal, temporal, and parietal cortices. Furthermore, the DV increases in the frontal, occipital, parietal, and temporal cortical areas and in the putamen were statistically significantly larger in the sevoflurane than in the propofol group. Our findings support the involvement of GABA(A) receptors in the mechanism of action of both anesthetics in humans.
PMID: 15502041 [PubMed - indexed for MEDLINE]
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Xenon does not prolong neuromuscular block of rocuronium.
Kunitz O, Baumert JH, Hecker K, Beeker T, Coburn M, Zuhlsdorff A, Rossaint R.
Department of Anesthesiology, University Hospital of the RWTH Aachen, Pauwelsstrasse 30, D-52074 Aachen, Germany. okunitz@ukaachen.de
With the exception of xenon, the interaction between muscle relaxants and inhaled anesthetics is known. We therefore compared the pharmacodynamics of rocuronium during xenon anesthesia versus a total IV anesthesia with propofol. Anesthesia was induced with propofol and remifentanil in both the xenon and propofol groups (each n = 20). The xenon group received xenon via face mask until an end-expiratory concentration of 60% was maintained for 1 min. Meanwhile, the acceleromyograph (TOF-Watch SX(R)) was calibrated and a frequent train-of-four stimulation of the musculus adductor pollicis was started. After stabilization of the signal for 5 min, a single bolus of 0.6 mg/kg rocuronium was injected. Anesthesia was maintained with xenon and remifentanil (xenon group) or with propofol and remifentanil (propofol group). There were no significant differences between the groups concerning the onset time (xenon group 125 +/- 33 and propofol group 144 +/- 43 s), duration (xenon group 33.2 +/- 10.8 and propofol group 32.6 +/- 8.4 min), recovery index (xenon group 9.4 +/- 6.6 and propofol group 8.4 +/- 5.3 min), and clinical recovery (xenon group 18.0 +/- 10.2 and propofol group 17.1 +/- 8.5 min). We conclude that the neuromuscular blocking effects of rocuronium are not different when given during propofol versus xenon anesthesia.
Publication Types:
- Clinical Trial
- Randomized Controlled Trial
PMID: 15502037 [PubMed - indexed for MEDLINE]
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Suspected central anticholinergic syndrome in a 6-week-old infant.
Kulka PJ, Toker H, Heim J, Joist A, Jakschik J.
Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, Prosper-Hospital, Muhlenstrasse 27, D-45659 Recklinghausen, Germany. peter.kulka@prosper-hospital.de
A 6-wk-old male infant became unresponsive after an uneventful general anesthetic for hernia repair. His symptoms were consistent with central anticholinergic syndrome. He appeared to awaken after treatment with IV physostigmine in a dose of 0.04 mg/kg. Because of the recurrence of sedation, a second physostigmine infusion was administered, which again led to transient arousal. Finally, the patient awoke spontaneously after 24 h and recovered uneventfully.
Publication Types:
PMID: 15502033 [PubMed - indexed for MEDLINE]
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Review of pediatric sedation.
Cravero JP, Blike GT.
Department of Anesthesiology, Dartmouth Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH 03756, USA. Joseph.Cravero@Hitchcock.org
Sedating children for diagnostic and therapeutic procedures remains an area of rapid change and considerable controversy. Exploration of this topic is made difficult by the fact that the reports of techniques and outcomes for pediatric sedation appear in a wide range of subspecialty publications and rarely undergo comprehensive examination. In this review article, we will touch on many aspects of the topic of pediatric sedation from the perspective of the anesthesiologist. We begin with a review of the historical role of anesthesiologists in the development of the current standards for pediatric sedation. We also examine the current status of pediatric sedation as reflected in published studies and reports. A specific review of the issues surrounding safety of sedation services is included. Current trends in sedation practice, including the expanding role of potent sedative hypnotic drugs outside the field of anesthesiology, are noted. Finally, we suggest future areas for research and clinical improvement for sedation providers.
Publication Types:
PMID: 15502031 [PubMed - indexed for MEDLINE]
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Is muscle relaxant necessary for cardiac surgery?
Gueret G, Rossignol B, Kiss G, Wargnier JP, Miossec A, Spielman S, Arvieux CC.
Departement d'Anesthesie Reanimation, CHU la Cavale Blanche, 29609 Brest, France. gildas.gueret@chu-brest.fr
The need for continuous and complete paralysis during the entire cardiac surgery has not yet been investigated and is still controversial. In a series of 87 patients undergoing cardiac surgery with normothermic cardiopulmonary bypass, we studied the delay of recovery, incidence of residual paralysis, unwanted patient movement, and difficult surgical conditions after a single dose of atracurium (0.5 mg/kg) or cisatracurium (0.15 mg/kg). Anesthesia was induced with etomidate and remifentanil followed by tracheal intubation. The delay to obtain a train-of-four ratio of >0.9 was longer with cisatracurium than with atracurium (86 +/- 18 versus 97 +/- 19 min). However, at the end of surgery, this ratio was >0.9 for all patients. The presence of unwanted patient movement, diaphragmatic contractions, and difficult surgical conditions were observed. Delay of extubation of the trachea was similar in both groups. We conclude that there is no need for continuous neuromuscular blockade during cardiac surgery. A single dose of either atracurium or cisatracurium is sufficient to provide efficient paralysis from the start of induction leading to quicker recovery from paralysis in fast-track cardiac surgery.
Publication Types:
- Clinical Trial
- Randomized Controlled Trial
PMID: 15502026 [PubMed - indexed for MEDLINE]
A modified rapid sequence induction using the ProSeal laryngeal mask airway and an Eschmann tracheal tube introducer or gum elastic bougie.
Brimacombe J, Keller C.
Publication Types:
PMID: 15505481 [PubMed - indexed for MEDLINE]
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Movement of the Cauda Equina during the lateral decubitus position with fully flexed leg.
Takiguchi T, Yamaguchi S, Hashizume Y, Kitajima T.
Publication Types:
PMID: 15505480 [PubMed - indexed for MEDLINE]
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