Ultimo Aggiornamento: Febbraio 2004

1: Acta Anaesthesiol Scand. 2003 Aug;47(7):910-1.

Is the analgesic effect of systemic lidocaine mediated through opioid receptors?

Cohen SP, Mao J.

Publication Types:
Case Reports
LetterPMID: 12859317 [PubMed - indexed for MEDLINE]

2: Acta Anaesthesiol Scand. 2003 Aug;47(7):904-6.

Cardiac arrest after interscalene brachial plexus block with ropivacaine and
lidocaine.

Reinikainen M, Hedman A, Pelkonen O, Ruokonen E.

Department of Anaesthesiology, Kuopio University Hospital, Kuopio, Finland.
matti.reinikainen@kuh.fi

Serious adverse reactions to ropivacaine and lidocaine are rare. In this report,
we describe a case of sudden cardiac arrest after an interscalene brachial
plexus block with a mixture of 150 mg of ropivacaine and 360 mg of lidocaine in
a previously healthy, 34-year-old, 97-kg man. Severe hypotension occurred after
successful resuscitation, necessitating an infusion of epinephrine. The patient
developed pulmonary oedema, and was mechanically ventilated for 22 h. He
eventually made a good recovery. We conclude that although ropivacaine and
lidocaine are often considered relatively safe local anesthetics, serious
cardiovascular complications can occur after the use of these drugs.

Publication Types:
Case ReportsPMID: 12859315 [PubMed - indexed for MEDLINE]

3: Acta Anaesthesiol Scand. 2003 Aug;47(7):828-32.

Use of the laryngeal tube in 100 patients.

Asai T, Shingu K, Cook T.

Department of Anesthesiology, Kansai Medical University, Moriguchi City, Osaka,
Japan. asait@takii.kmu.ac.jp

BACKGROUND: The laryngeal tube has a potential role during anaesthesia, but
there have been only a few studies assessing its efficacy during the entire
course of anaesthesia, and all previous studies used prototypes. We studied 100
patients to assess the efficacy of a new laryngeal tube during the entire course
of anaesthesia. METHODS: After induction of anaesthesia, the laryngeal tube was
inserted (up to two times) and adequacy of ventilation was assessed. The airway
pressure at which gas leaked around the device was measured. The device was used
during anaesthesia, while ventilation was controlled. The device was removed
after the patient had opened the mouth to verbal command. Any complications
during and after anaesthesia were recorded. RESULTS: Ventilation was possible at
the first attempt in 90 patients, at the second attempt in another seven
patients, and adequate ventilation failed after two attempts in three patients.
Median (interquartile range) leak pressure was 28 (22-30) cmH2O. In all 97
patients, the laryngeal tube was used until the end of surgery. However, in two
of the 97 patients the airway was partially obstructed during anaesthesia and it
was necessary to reposition the device. The laryngeal tube was tolerated well
during emergence from anaesthesia. No hypoxia, regurgitation, vomiting or
laryngospasm occurred in any patient. On removal of the laryngeal tube, no blood
was detected on the device and no apparent ischaemic changes to the tongue were
observed in any patient. Post-operatively, six patients complained of a mild
sore throat, and no patient complained of difficulty in swallowing or numbness
of the oropharynx. CONCLUSION: The laryngeal tube can be useful for maintaining
a patent airway during anaesthesia.

PMID: 12859303 [PubMed - indexed for MEDLINE]

4: Anaesthesia. 2003 Dec;58(12):1251.

Whoosh test 2 and confirmation of lumbar epidural space.

Khan RM, Chabra J, Alam MT, Ashraf M, Jain D.

Publication Types:
LetterPMID: 14705716 [PubMed - indexed for MEDLINE]

5: Anaesthesia. 2003 Dec;58(12):1240; discussion 1241.

A hidden safety feature in the event of oxygen failure.

Hearn CM, Chandradeva K.

Publication Types:
LetterPMID: 14705699 [PubMed - indexed for MEDLINE]

6: Anaesthesia. 2003 Dec;58(12):1240.

Comment on:
Anaesthesia. 2003 Aug;58(8):816.Six Smiths and safety.

Hudsmith JG.

Publication Types:
Comment
LetterPMID: 14705697 [PubMed - indexed for MEDLINE]

7: Anaesthesia. 2003 Dec;58(12):1239-40.

Faulty unidirectional expiratory valve as a cause of rebreathing.

Yew WS, Hwang NC.

Publication Types:
Case Reports
LetterPMID: 14705696 [PubMed - indexed for MEDLINE]

8: Anaesthesia. 2003 Dec;58(12):1236.

Comment on:
Anaesthesia. 2003 Sep;58(9):833-4.Patient safety.

Levison A.

Publication Types:
Comment
LetterPMID: 14705692 [PubMed - indexed for MEDLINE]

9: Anaesthesia. 2003 Dec;58(12):1224-8.

A comparison of deep vs. awake removal of the laryngeal mask airway in
paediatric dental daycase surgery. A randomised controlled trial.

Dolling S, Anders NR, Rolfe SE.

SpR Anaesthesia, Manchester Royal Infirmary, Manchester M13 9WL, UK.
sdolling@hotmail.com

Dental anaesthesia provides a potential conflict between anaesthetist and
surgeon because of the shared airway. The laryngeal mask airway (LMA) has helped
to improve airway control for these procedures, but there is little evidence for
best practice on the timing of their removal after airway surgery in the
paediatric population. We compared 'awake' and 'deep' removal of the LMA in 196
patients aged from 2 to 15 years in a randomised, controlled study. We found
that average peripheral oxygen saturation (SpO2) was lower in the deep group and
this was statistically significant (96.2% vs. 94.9%, p = 0.04). It was also
found that the deep group had a higher incidence of patients with SpO2 < 95% (p
= 0.003) and of patients who coughed (p = 0.003). We conclude that the LMA
should be taken out awake in these patients.

Publication Types:
Clinical Trial
Randomized Controlled TrialPMID: 14705688 [PubMed - indexed for MEDLINE]

10: Anaesthesia. 2003 Dec;58(12):1220-4.

The road to success: a review of 1000 axillary brachial plexus blocks.

Perris TM, Watt JM.

Department of Anaesthesia, Worcestershire Royal Hospital, Charles Hastings Way,
Worcester WR5 1DD, UK. tom_perris@hotmail.com

The authors present their experience of > 1000 axillary brachial plexus blocks
performed over 13 years (1990-2002). Using a technique that involves the
location of individual nerves with a nerve stimulator, the overall success rate
was 97.9%, ranging from 89.7% in 1990 to 98.4% in 1998. There have been no
failures, defined as the need for conversion to general anaesthesia, in the last
500 blocks. Supplementary nerve blocks at the elbow were performed in 22.2% of
patients. The first author, trained and supervised by the second author,
achieved similar success rates in half the time taken by the second author. The
authors conclude that technique and experience are the keys to success, but that
high success rates can be achieved in a short time if anaesthetists are trained
by experts in regional anaesthesia.

PMID: 14705687 [PubMed - indexed for MEDLINE]

11: Anaesthesia. 2003 Dec;58(12):1162-5.

Advances in neuroanaesthesia.

Hirsch N.

The National Hospital for Neurology and Neurosurgery, London, UK.
hirsch@btinternet.com

Publication Types:
Review
Review, TutorialPMID: 14705675 [PubMed - indexed for MEDLINE]

12: Anaesthesia. 2004 Jan;59(1):98; author reply 98.

Comment on:
Anaesthesia. 2003 Jul;58(7):713; discussion 713.Confusion relating to drug syringe labels.

Loader J.

Publication Types:
Case Reports
Comment
LetterPMID: 14687120 [PubMed - indexed for MEDLINE]

13: Anaesthesia. 2004 Jan;59(1):94-5.

Caesarean section in a parturient with type III spinal muscular atrophy and
pre-eclampsia.

Kitson R, Williams V, Howell C.

Publication Types:
Case Reports
LetterPMID: 14687114 [PubMed - indexed for MEDLINE]

14: Anesth Analg. 2004 Feb;98(2):558.

Pyloric stenosis, hyperkalemia, and anesthesia practice.

McCloskey JJ, Tobin JR.

Department of Anesthesiology, AI DuPont Hospital for Children, Wilmington, DE.
Department of Anesthesiology, Wake Forest University School of Medicine,
Winston-Salem, NC. Baystate Medical Center, Tufts University School of Medicine,
Boston, MA.

PMID: 14742418 [PubMed - in process]

15: Anesth Analg. 2004 Feb;98(2):557-558.

Local Anesthetic Switching for Intrathecal Tachyphylaxis in Cancer Patients with
Pain.

Yang CP, Yeh CC, Wong CS, Wu CT.

Division of Anesthesiology, Armed Forces Taoyuan General Hospital, Department of
Anesthesiology, Tri-Service General Hospital, National Defense Medical Center,
Taipei, Taiwan. Department of Anesthesiology, Tri-Service General Hospital,
National Defense Medical Center, Taipei, Taiwan. Anesthesia and Intensive Care
Unit and Pain Relief and Palliative Care Unit, La Maddalena, Cancer Center,
Palermo, Italy.

PMID: 14742416 [PubMed - as supplied by publisher]

16: Anesth Analg. 2004 Feb;98(2):548-9.

A suspected case of delayed onset malignant hyperthermia with desflurane
anesthesia.

Papadimos TJ, Almasri M, Padgett JC, Rush JE.

Department of Anesthesiology, Medical College of Ohio, St. Luke's Hospital Heart
Center, Maumee.

Desflurane has been identified as a weak triggering anesthetic of malignant
hyperthermia that, in the absence of succinylcholine, may produce a delayed
onset of symptoms. The prolonged interval after exposure may occur more than 6 h
after the induction of anesthesia. The unintended underdosing of this patient
with dantrolene and the prompt reversal of symptoms may be an attribute of the
genetic expression of a weak triggering volatile anesthetic such as desflurane.
IMPLICATIONS: There are multiple genetic variations for malignant hyperthermia
(MH) at the ryanodine receptor. Desflurane, as a sole trigger of MH, is weak,
and on two occasions in the literature (including this case), less than optimal
doses of dantrolene were given with a good result. There may be possible to
engineer the risk of MH out of an anesthetic once the genetics of the ryanodine
receptor are better understood.

PMID: 14742405 [PubMed - in process]

17: Anesth Analg. 2004 Feb;98(2):527-32.

The effect of music on the neurohormonal stress response to surgery under
general anesthesia.

Migneault B, Girard F, Albert C, Chouinard P, Boudreault D, Provencher D,
Todorov A, Ruel M, Girard DC.

Departments of Anesthesiology, Biochemistry, and. Gynecology, Centre Hospitalier
de l'Universite de Montreal, Hopital Notre-Dame, Montreal, Canada. Department of
Psychiatry, Washington University Medical Center, St. Louis, Missouri.

Several pharmacological interventions reduce perioperative stress hormone
release during surgery under general anesthesia. Listening to music and
therapeutic suggestions were also studied, but mostly in awake patients, and
these have a positive effect on postoperative recovery and the need for
analgesia. In this study, we evaluated the effect of listening to music under
general anesthesia on the neurohormonal response to surgical stress as measured
by epinephrine, norepinephrine, cortisol, and adrenocorticotropic hormone (ACTH)
blood levels. Thirty female patients scheduled for abdominal gynecological
procedures were enrolled and randomly divided into two groups: group NM (no
music) and group M (music). In group M, music was played from after the
induction of anesthesia until the end of surgery. In the NM group, the patients
wore the headphones but no music was played. We established three sample times
for hormonal dosage during the procedure and one in the recovery room.
Hemodynamic data were recorded at all times, and postoperative consumption of
morphine in the first 24 h was noted. There was no group difference at any
sample time or in the postoperative period in terms of mean arterial blood
pressure, heart rate, isoflurane end-tidal concentration, time of the day at
which the surgery was performed, bispectral index (BIS) value, doses of
fentanyl, or consumption of postoperative morphine. There was no difference
between the two groups with regard to plasmatic levels of norepinephrine,
epinephrine, cortisol, or ACTH at any sample time, although the blood level of
these hormones significantly increased in each group with surgical stimulation.
In conclusion, we could not demonstrate a significant effect of intraoperative
music on surgical stress when used under general anesthesia. IMPLICATIONS:
Listening to music under general anesthesia did not reduce perioperative stress
hormone release or opioid consumption in patients undergoing gynecological
surgery.

PMID: 14742400 [PubMed - in process]

18: Anesth Analg. 2004 Feb;98(2):512-517.

Spinal Anesthesia Performance Conditions and Side Effects Are Comparable Between
the Newly Designed Ballpen and the Sprotte Needle: Results of a Prospective
Comparative Randomized Multicenter Study.

Standl T, Stanek A, Burmeister MA, Gruschow S, Wahlen B, Muller K, Biscoping J,
Adams HA.

Department of Anesthesiology, University Hospital Eppendorf, Hamburg. Department
of Anesthesiology, University Hospital, Mainz. Department of Anesthesiology,
University Hospital Hannover-Oststadt. Department of Anesthesiology, St.
Vincentius Hospital, Karlsruhe, Germany.

In this study, we examined the characteristics of a newly designed spinal needle
(Ballpen [B]) with a pencil-like tip formed by a stylet that is withdrawn after
penetration of the dura. The main goal was to examine whether the use of the B
needle could reduce performance time by improved puncture conditions in
comparison with the Sprotte (S) needle. Seven-hundred patients at 4 hospitals
received single-dose spinal anesthesia with a 25-gauge B or S needle and 0.5%
bupivacaine. The performance time of spinal anesthesia was defined as the time
between insertion of the introducer needle and the first identification of
cerebrospinal fluid in the hub of the spinal needle. Failed spinals were
assessed when patients required general anesthesia. On postoperative Day 2-4,
all patients were visited and interviewed. Groups did not differ with respect to
demographics, puncture site, and dose of bupivacaine. Performance time was 98
+/- 145 s in Group B and 103 +/- 159 s in Group S (P = 0.68). The failure rate
in Groups B and S was 3.8% and 3.9%, respectively, and the incidence of
postdural puncture headache was 1.8% and 0.9% (P = 0.50), respectively. We
conclude that there was no difference in technical variables or outcome between
the B and S needles. IMPLICATIONS: This multicenter study examined
characteristics of the newly designed Ballpen needle with the Sprotte needle in
700 patients undergoing lower abdominal or extremity surgery in single-dose
spinal anesthesia. Technical variables and side effects were comparable between
both noncutting spinal needles.

PMID: 14742396 [PubMed - as supplied by publisher]

19: Anesth Analg. 2004 Feb;98(2):503-511.

Human Immunodeficiency Virus: Anesthetic and Obstetric Considerations.

Evron S, Glezerman M, Harow E, Sadan O, Ezri T.

Obstetric Anesthesia Unit, the. Department of Obstetrics and Gynecology, the.
Ambulatory Surgical Unit, Delivery Ward, ||Department of Anesthesia, The Edith
Wolfson Medical Center, Holon (Israel), Sackler School of Medicine, Tel Aviv
University, Tel Aviv, Israel.

The pandemic of acquired immune deficiency syndrome (AIDS) is on the threshold
of its third decade of existence. The World Health Organization-United Nations
statistics show that human immunodeficiency virus (HIV)/AIDS pandemia is set to
get much worse. Women of reproductive age are the fastest growing population
with HIV. Common signs and symptoms have become more moderate or subclinical,
and new clinical presentations have emerged. It is quite apparent that
HIV-disease affects multiple organ systems. Advances have been made in
elucidating the pathogenesis of HIV. In addition, the molecular technique of
viral load determination and the CD + 4 T-lymphocyte count enable evaluation of
the disease, its prognosis, and its response to therapy. There is limited
specific information concerning the overall risk of anesthesia and surgery of
HIV/AIDS patients. However, as far as can be determined, surgical interventions
do not increase the postoperative risk for complications or death and should
therefore not be withheld. There is also little evidence to suggest that HIV or
antiretroviral drugs increase the rate of pregnancy complications or that
pregnancy may alter the course of HIV infection. General anesthesia is
considered safe, but drug interactions and their impact on various organ systems
should be considered preoperatively. Regional anesthesia is often the technique
of choice. Yet, one must take into consideration the presence of neuropathies,
local infection, or blood clotting abnormalities. It should be emphasized that
all practicing anesthesiologists should be familiar with the disease and should
use prenatal anesthesia consultations and a team approach to assure optimal
treatment for HIV patients.

PMID: 14742395 [PubMed - as supplied by publisher]

20: Anesth Analg. 2004 Feb;98(2):491-6.

Sensorimotor anesthesia and hypotension after subarachnoid block: combined
spinal-epidural versus single-shot spinal technique.

Goy RW, Sia AT.

Department of Anesthesia, KK Women's and Children's Hospital, Singapore.

The extent of the intrathecal compartment depends on the balance between
cerebrospinal fluid and subatmospheric epidural pressure. Epidural insertion
disrupts this relationship, and the full impact of loss-of-resistance on the
qualities of subarachnoid block is unknown. In this study we sought to determine
if subarachnoid block, induced by combined spinal-epidural (CSE) using
loss-of-resistance to air could render higher sensory anesthesia than
single-shot spinal (SSS) when an identical mass of intrathecal anesthetic was
injected. Sixty patients, scheduled for minor gynecological procedures, were
randomly allocated into three groups all receiving 10 mg of 0.5% hyperbaric
bupivacaine. In the SSS group, intrathecal administration was through a 27-gauge
Whitacre spinal needle inserted at the L3-4 level. For the CSE group, the
epidural space was identified with an 18-gauge Tuohy needle using
loss-of-resistance to 4 mL of air. After intrathecal administration, a 20-gauge
catheter was left in the epidural space. No further drug or saline was
administered through the catheter. The procedure was repeated in group CSE
((no-catheter)) except without insertion of a catheter. Sensorimotor anesthesia
was assessed at regular 2.5-min intervals until T10 was reached. In all aspects,
there was no difference between CSE and CSE ((no-catheter)). Peak sensory level
in SSS was lower than CSE and CSE ((no-catheter)) (median T5 [max T3-min T6]
versus (T3 [T1-4] and (T3 [T2-5]) (P < 0.01). During the first 10 min postblock,
dermatomal thoracic block was the lowest in SSS (P < 0.05). Time for regression
of sensory level to T10 was also shortest in SSS. Hypotension, ephedrine use and
period of motor recovery were more pronounced in CSE and CSE ((no-catheter)). We
conclude that subarachnoid block induced by CSE produces greater sensorimotor
anesthesia and prolonged recovery compared with SSS. There is also a more
frequent incidence of hypotension and vasoconstrictor use despite using
identical doses and baricity of local anesthetic. IMPLICATIONS: This study
confirms that induction of subarachnoid block by a combined-spinal epidural
technique produces a greater sensorimotor anesthesia and results in prolonged
recovery when compared with a single-shot spinal technique. There is a more
frequent incidence of hypotension and vasoconstrictor administration despite
identical doses of intrathecally administered local anesthetic.

PMID: 14742393 [PubMed - in process]

21: Anesth Analg. 2004 Feb;98(2):483-90.

A dose-response meta-analysis of prophylactic intravenous ephedrine for the
prevention of hypotension during spinal anesthesia for elective cesarean
delivery.

Lee A, Ngan Kee WD, Gin T.

Department of Anaesthesia and Intensive Care, The Chinese University of Hong
Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong, China.

We systematically reviewed available studies to determine the dose-response
characteristics of prophylactic IV ephedrine for the prevention of hypotension
during spinal anesthesia for cesarean delivery. We searched for randomized
controlled trials (RCTs) or cohort studies-obtained through MEDLINE, EMBASE, the
Cochrane Central Register of Controlled Trials, and reference lists of published
articles-in which two or more different doses of prophylactic IV ephedrine were
used to prevent hypotension during spinal anesthesia for cesarean delivery. Four
RCTs and one cohort study were found (total n = 390). There was a significant
dose-response relationship in the RCTs pooled for hypotension (slope = -0.0128;
95% confidence interval [CI], -0.0213 to -0.0044), hypertension (slope = 0.0563;
95% CI, 0.0235 to 0.0892), and umbilical arterial pH (slope = -0.03; 95% CI,
-0.05 to 0.00). The efficacy of ephedrine for preventing hypotension was small.
At 14 mg, the number-needed-to-treat was only 7.6 (95% CI, 4.8-21.1), and this
was the same as the number-needed-to-harm (7.6; 95% CI, 3.7-23.4). At larger
doses, the likelihood of causing hypertension was actually more than that of
preventing hypotension, and there was also a minor decrease in umbilical
arterial pH. IMPLICATIONS: The authors performed a systematic review of
dose-response studies of IV bolus ephedrine for preventing hypotension during
spinal anesthesia for cesarean delivery. Prophylactic ephedrine cannot be
recommended. The efficacy is poor at smaller doses, whereas at larger doses, the
likelihood of causing hypertension is actually more than that of preventing
hypotension.

PMID: 14742392 [PubMed - in process]

22: Anesth Analg. 2004 Feb;98(2):471-6.

Intravenous administration of flurbiprofen does not affect cerebral blood flow
velocity and cerebral oxygenation under isoflurane and propofol anesthesia.

Yoshitani K, Kawaguchi M, Tatsumi K, Sasaoka N, Kurumatani N, Furuya H.

Departments of Anesthesiology and. Hygiene, Nara Medical University, Nara,
Japan, and the. Department of Anesthesia, Seikeikai Hospital, Osaka, Japan.

Flurbiprofen, a nonsteroidal antiinflammatory drug (NSAID), has been used to
treat rheumatic and osteoarthritic pain and to reduce postoperative pain.
Although other NSAIDs, such as indomethacin, reduce cerebral blood flow (CBF),
the effect of flurbiprofen on CBF is unknown. In the present study, we
investigated the effects of flurbiprofen on cerebral blood flow velocity (CBFV)
and cerebral oxygenation under isoflurane or propofol anesthesia. Forty-eight
patients undergoing orthopedic or abdominal surgery were enrolled. Patients were
randomly allocated to receive either propofol (target control infusion: target
site effect concentration 3 micro g/mL) or isoflurane (1 MAC) for maintenance of
anesthesia. In each group (n = 12), 1 mg/kg of flurbiprofen (PROP-F and ISO-F
groups) or 0.1 mL/kg saline (PROP-S and ISO-S groups) was administered IV for 5
min. During and after the administration of flurbiprofen or saline, cerebral
oxygenation variables (tissue oxygen index [TOI], total hemoglobin change
[DeltacHb], oxygenated hemoglobin changes [DeltaO(2)Hb], and deoxygenated
hemoglobin changes [DeltaHHb]), and middle cerebral artery flow velocity (Vmca)
were measured using a cerebral oximeter (NIRO 300) and transcranial Doppler,
respectively, from 5 min before study drug administration to 60 min
postadministration. Before the administration of flurbiprofen, control values of
TOI in the ISO-S and ISO-F groups were significantly higher than those in the
PROP-S and PROP-F groups, respectively (ISO-S versus PROP-S, 67% +/- 4% versus
60% +/- 7%; IOS-F versus PROP-F, 69% +/- 4% versus 63% +/- 8%; P < 0.05).
However, values of TOI, DeltacHb, DeltaO(2)Hb, DeltaHHb, and Vmca did not change
significantly during and after the administration of flurbiprofen under propofol
or isoflurane anesthesia, and these values were similar to those during and
after the administration of saline in the same anesthesia group. These data
indicate that flurbiprofen does not affect CBFV and cerebral oxygenation under
propofol or isoflurane anesthesia. IMPLICATIONS: Indomethacin, a nonsteroidal
antiinflammatory drug (NSAID), has been demonstrated to reduce cerebral blood
flow (CBF). The CBF effects of flurbiprofen, another NSAID, are unknown. We
investigated cerebral blood flow velocity (CBFV) and cerebral oxygenation during
and after the administration of flurbiprofen under isoflurane and propofol
anesthesia. We found that flurbiprofen had no effect on CBFV and cerebral
oxygenation.

PMID: 14742390 [PubMed - in process]

23: Anesth Analg. 2004 Feb;98(2):443-51.

Citation classics in anesthetic journals.

Baltussen A, Kindler CH.

Department of Anesthesia, University Clinics Basel, Kantonsspital, CH-4031
Basel, Switzerland.

The number of citations an article receives after its publication reflects its
recognition in the scientific community. In the present study, therefore, we
identified and examined the characteristics of the top 100 most frequently cited
articles published in anesthetic journals. These articles were identified using
the database of the Science Citation Index Expanded (SCI-EXPANDED, 1945 to
present) and the Web of SCIENCE(R). The most-cited article received 707
citations and the least cited article received 197 citations, with a mean of 283
citations per article. These citation classics were published between 1954 and
1997 in 5 high-impact anesthetic journals, led by Anesthesiology (73 articles)
followed by Anesthesia & Analgesia (10), British Journal of Anesthesia (10),
Anesthesia (6), and Acta Anaesthesiologica Scandinavica (2). Seventy-eight
articles were original publications, 22 were review articles, and one was an
editorial. They originated from nine countries, with the United States
contributing 70 articles. Within the United States, California leads the list of
citation classics with 25 articles. Twenty-nine persons authored two or more of
the top-cited articles. The main topics covered by the top-cited articles are
pharmacology, volatile anesthetics, circulation, regional anesthesia, and lung
physiology. This analysis of citation rates allows for the recognition of
seminal advances in anesthesia and gives a historic perspective on the
scientific progress of this specialty. IMPLICATIONS: We performed a citation
analysis to identify important contributions and contributors to the anesthetic
literature. These classic articles have influenced many people and have brought
to our attention the many important advances in anesthesia made during the last
50 yr.

PMID: 14742385 [PubMed - in process]

24: Anesth Analg. 2004 Feb;98(2):437-42.

Resident training level and quality of anesthesia care in a university hospital.

Posner KL, Freund PR.

Departments of Anesthesiology and. Anthropology, University of Washington.
Anesthesia Clinical Services, University of Washington Medical Center, Seattle.

In this study, we analyzed the relationship between resident training and
patient safety in anesthesia. A retrospective quality improvement database
review was used to calculate the relative risk of any quality problem and
specific types of quality problems (injury, escalation of care, or operational
inefficiency) between anesthesia teams with CA1, CA2, and CA3 residents. It was
expected that teams with less experienced residents (CA1) would have more
frequent quality problems than teams with more experienced residents (CA2 and
CA3 teams). Data showed that risk of injury did not differ between CA1, CA2, and
CA3 teams. CA2 teams had higher rates of critical incidents and escalation of
care than CA1 and CA3 teams and higher rates of operational inefficiency than
CA3 teams. The CA2 yr is when residents move into specialty training, requiring
more advanced skills and a larger knowledge base. Their higher relative risk for
critical incidents, escalation of care, and operational inefficiencies may
reflect lack of experience, uncertainty, and less skill mastery compared with
CA3 residents. The higher inefficiency and escalation of care rates associated
with CA2 teams may translate into larger costs for the institution.
IMPLICATIONS: Appropriate supervision of anesthesia residents helps to ensure
patient safety. Anesthesia management problems are most common during the CA2 yr
and result in higher costs for the institution.

PMID: 14742384 [PubMed - in process]

25: Anesth Analg. 2004 Feb;98(2):434-6.

Reversal of an unintentional spinal anesthetic by cerebrospinal lavage.

Tsui BC, Malherbe S, Koller J, Aronyk K.

Departments of Anesthesiology and Pain Medicine and. Neurosurgery, University of
Alberta, Edmonton, Alberta, Canada.

In this case report, we describe the use of cerebrospinal fluid lavage as a
successful treatment of an inadvertent intrathecally placed epidural catheter in
a 14-yr-old girl who underwent a combination of epidural anesthesia and general
anesthesia for orthopedic surgery. In this case, a large amount of local
anesthetic was injected (the total possible intrathecal injection was 200 mg of
lidocaine and 61 mg of bupivacaine), resulting in apnea and fixed dilated pupils
in the patient at the end of surgery. Twenty milliliters of cerebrospinal fluid
was replaced with 10 mL of normal saline and 10 mL of lactated Ringer's solution
from the "epidural" catheter. Spontaneous respiration returned 5 min later, and
the patient was tracheally extubated after 30 min. No signs of neurological
deficit or postdural puncture headache were noted after surgery. IMPLICATIONS:
Cerebrospinal lavage may be a helpful adjunct to the conventional supportive
management of patients in the event of an inadvertent total spinal.

PMID: 14742383 [PubMed - in process]

26: Anesth Analg. 2004 Feb;98(2):386-8.

Case report of remote anesthetic monitoring using telemedicine.

Cone SW, Gehr L, Hummel R, Rafiq A, Doarn CR, Merrell RC.

Medical Informatics and Technology Applications Consortium (MITAC), Department
of Surgery, Virginia Commonwealth University, Richmond, Virginia.

We report a case supporting the use of telecommunications technology from a
remote location to monitor anesthetic events. Vital signs, data, and video were
transmitted from surgery conducted in the remote Amazonian rainforests of
Ecuador to Richmond, VA. This application of telemedicine technologies makes
available expert advice from remote locations during surgical procedures.
IMPLICATIONS: This study validates the use of telecommunications technology from
a remote location to monitor an anesthetic event. This type of work makes expert
advice available during surgical procedures.

PMID: 14742375 [PubMed - in process]

27: Anesth Analg. 2004 Feb;98(2):371-6.

Rapid Onset of Cutaneous Anesthesia with EMLA Cream After Pretreatment with a
New Ultrasound-Emitting Device.

Katz NP, Shapiro DE, Herrmann TE, Kost J, Custer LM.

Pain Trials Center, Brigham & Women's Hospital, Boston, Massachusetts.

In this randomized, double-blinded, placebo-controlled, crossover trial of 42
human subjects, we examined the speed of onset of cutaneous anesthesia by
eutectic mixture of local anesthetics (EMLA) cream after brief (approximately
10-s) pretreatment of the underlying skin with low-frequency (55 kHz)
ultrasound. Four treatments were compared: ultrasound pretreatment followed by
application of 1 g EMLA or placebo cream for 5 min, 10 min, 15 min, and 60 min
without ultrasound pretreatment as positive control. Pain was tested by pricks
with a 20 g needle. Pain scores and patient preference for EMLA or placebo cream
were measured at each time point. Based on both pain scores and patient
preference, cutaneous anesthesia was achieved in the EMLA groups as compared
with placebo at all time points. After ultrasound pretreatment and then 5, 10,
or 15 min after EMLA cream application, pain scores and overall preference were
statistically indistinguishable from EMLA cream application for 60 min (without
ultrasound pretreatment). There were no significant adverse effects.
Low-frequency ultrasound pretreatment appears to be safe and effective in
producing rapid onset of EMLA cream in this model, with results as early as 5
min. IMPLICATIONS: A prospective, randomized, double-blinded, placebo-controlled
clinical trial demonstrated rapid onset of cutaneous anesthesia by pretreatment
of the skin with ultrasound before application of EMLA cream.

PMID: 14742372 [PubMed - in process]

28: Anesth Analg. 2004 Feb;98(2):346-52.

Isoflurane Facilitates Hiccup-Like Reflex Through Gamma Aminobutyric Acid
(GABA)(A)- and Suppresses Through GABA(B)-Receptors in
Pentobarbital-Anesthetized Cats.

Oshima T, Dohi S.

Department of Anesthesiology and Critical Care Medicine, Gifu University School
of Medicine, Gifu-City, Japan.

The mechanism by which volatile anesthetics exert inconsistent effects on
hiccups is unknown. We elicited a hiccup-like reflex by mechanical stimulation
of the dorsal epipharynx in mechanically ventilated cats. The magnitude of the
hiccup-like reflex was measured as the peak negative esophageal pressure (nPes)
generated against an occluded airway. First, we examined the effects of
different end-expiratory concentrations of isoflurane on nPes. Second, we
determined the effects of 1.0 minimum alveolar anesthetic concentration of
isoflurane on nPes after a peripherally restricted gamma aminobutyric acid
(GABA)(A)-receptor antagonist, bicuculline methiodide (BM), a GABA(B)-receptor
antagonist, CGP 35348, a peripherally restricted GABA(B)-receptor antagonist,
CGP 54626, or saline had been administered IV. Third, BM, CGP 35348, or
artificial cerebrospinal fluid was administered intracisternally before 1.0
minimum alveolar anesthetic concentration of isoflurane exposure. During
isoflurane anesthesia, nPes was inversely proportional to the end-expiratory
isoflurane concentration. The rank order of nPes values obtained after IV drug
pretreatment and isoflurane exposure was BM < saline < CGP54626 < CGP35348.
After intracisternal drug pretreatment and isoflurane administration, the order
of nPes was BM < artificial cerebrospinal fluid < CGP35348. Isoflurane modulates
the hiccup-like reflex in opposite directions through both central and
peripheral GABA(A) and GABA(B) receptors, with the net effect being a
dose-dependent suppression. IMPLICATIONS: Isoflurane facilitated the hiccup-like
reflex through activation of central and peripheral gamma aminobutyric acid
(GABA)(A) receptors but suppressed it via activation of central and peripheral
GABA(B) receptors. The net result was that the hiccup-like reflex was inhibited
in proportion to the alveolar isoflurane concentration.

PMID: 14742368 [PubMed - in process]

29: Anesth Analg. 2004 Feb;98(2):321-6.

The effect of caudal analgesia on emergence agitation in children after
sevoflurane versus halothane anesthesia.

Weldon BC, Bell M, Craddock T.

Departments of Anesthesiology and Pediatrics, University of Florida College of
Medicine, Gainesville, Florida. Department of Pediatric Surgery, St. John's
Mercy Medical Center, St. Louis, Missouri.

Sevoflurane anesthesia in young children has been associated with an increased
incidence of emergence agitation compared with halothane. Postoperative pain may
be an etiologic factor. We designed a study to compare the incidence of
emergence agitation after halothane and sevoflurane anesthesia in children whose
pain was managed with caudal analgesia. Eighty children undergoing inguinal
hernia repair between the ages of 12 mo and 6 yr were randomly assigned to
receive either halothane or sevoflurane anesthesia. Baseline preoperative
anxiety was assessed with the Yale Preoperative Anxiety Scale. The children were
sedated with oral midazolam, underwent a mask induction, and had a caudal block
placed for postoperative analgesia. After surgery, the children's behavior was
assessed with a four-point agitation scale. At 5 min after arrival in the
postanesthesia care unit (PACU), sevoflurane was associated with a greater
incidence of emergence agitation than halothane (26% vs 6%; P < 0.05), but not
during the remainder of the PACU stay. Higher levels of preoperative anxiety
were associated with difficult mask induction, agitation on admission to the
PACU, and more severe agitation episodes. Emergence agitation appears to be an
early and transient phenomenon after sevoflurane anesthesia in children with
effective postoperative analgesia. IMPLICATIONS: Effective postoperative
analgesia may reduce the incidence of emergence agitation reported with
sevoflurane anesthesia. The Yale Preoperative Anxiety Scale appears to be
helpful in identifying young children who are at risk for developing emergence
agitation.

PMID: 14742362 [PubMed - in process]

30: Ann Fr Anesth Reanim. 2003 Dec;22(10):915-6.

Comment on:
Ann Fr Anesth Reanim. 2003 Jun;22(6):564-5.[Can we prove a septum existence of epidural space?]

[Article in French]

Al-Nasser B.

Publication Types:
Comment
LetterPMID: 14644379 [PubMed - indexed for MEDLINE]

31: Ann Fr Anesth Reanim. 2003 Dec;22(10):909-12.

[Continuous lumbar plexus block sets in France. Our experience]

[Article in French]

Lascurain P, Breining T, Labbani L, Le Gourrier L, Lupescu R, Gaertner E.

Service d'anesthesie-reanimation chirurgicale, hopital de Hautepierre, avenue
Moliere, 67098 Strasbourg, France.

The undeniable postoperative analgesia brought by the lumbar plexus block among
patients scheduled for major surgery of the hip or knee justifies, the setting
of a catheter to allow a continues analgesia more durable. Having drawn aside
the difficulties of the daily practice (in allusion to the number of blocks
carried out per day) and anatomical variations, the failure of the perineural
catheter setting is in direct relationship with the material used by the
anaesthesiologists for neurostimulation. The presentation of a case report
describes a failure of catheter introduction due to the canula in deep
continuous blocks, and the advantages and disadvantages of the various sets of
neurostimulation. The authors conclude that the sets with the "catheter through
the needle" are to be recommended, particularly the stimulating Tuohy needle.

Publication Types:
Case ReportsPMID: 14644376 [PubMed - indexed for MEDLINE]

32: Br J Anaesth. 2004 Jan 22 [Epub ahead of print]

Anaesthesia for carotid endarterectomy: comparison of hypnotic- and opioid-based
techniques{dagger}

Godet G, Reina M, Raux M, Amour J, De Castro V, Coriat P.

Department of Anesthesiology, Pitie-Salpetriere Hospital, 47 bd de l'Hopital,
F-75651 Paris Cedex 13, France.

BACKGROUND: Although the synergistic interaction between hypnotics and opioids
for total i.v. anaesthesia has been repeatedly demonstrated, questions about
different dose combinations of hypnotics and opioids remain. The optimal
combination would be based on maximal synergy, using the lowest dose of both
drugs and having the lowest incidence of side-effects. METHODS: The major goal
of this prospective randomized study was to compare two different dose
combinations of propofol and remifentanil (both administered by target
controlled infusion (TCI)) in respect of haemodynamics during surgery and
recovery, and the need for cardiovascular treatment in the recovery room. A
secondary goal was to compare pain scores (VAS) and morphine consumption in the
recovery room. Anaesthesia was induced in both groups using TCI propofol,
adjusted to obtain a bispectral index score (BIS) value between 40 and 60. TCI
for remifentanil commenced at an initial effect-site concentration of 0.5 ng
ml(-1), and was adjusted according to haemodynamics. Patients were divided into
one of two groups during anaesthesia: (i) Group H, hypnotic anaesthesia (n=23),
propofol effect-site concentration maintained at 2.4 micro g ml(-1); and (ii)
Group O, opioid anaesthesia (n=23), propofol effect-site concentration
maintained at 1.2 micro g ml(-1). In both groups, remifentanil effect-site
concentration was adjusted according to haemodynamics and changes in BIS value.
RESULTS: In Group O, more episodes of intraoperative hypotension (P<0.02) and
hypertension (P<0.01), and fewer episodes of tachycardia were observed. More
patients in Group O required nicardipine administration for postoperative
hypertension (8 patients in Group H vs 15 patients in Group O, P<0.04). During
recovery, morphine titration was necessary in approximately 50% of patients. No
significant difference between groups was observed concerning pain scores or
requirement for morphine titration. CONCLUSIONS: Maintenance of anaesthesia
predominantly with propofol and a low dose of remifentanil, both administered
using TCI, is associated with greater stability in perioperative haemodynamics
than anaesthesia predominantly with remifentanil alone. Postoperative pain was
identical in both groups of patients who underwent relatively short duration,
and relatively painless surgery.

PMID: 14742344 [PubMed - as supplied by publisher]

33: Br J Anaesth. 2004 Jan 22 [Epub ahead of print]

Use of epidural anaesthesia for surgery in a patient with Kennedy's disease.

Okamoto E, Nitahara K, Yasumoto M, Higa K.

Department of Anesthesiology, Fukuoka University School of Medicine, Fukuoka,
Japan.

Use of neuraxial block in a patient with motor neuron disease is controversial.
We describe the anaesthetic management by epidural anaesthesia of a patient with
Kennedy's disease, a rare lower motor neuron disease characterized by
progressive weakness and wasting of limbs and bulbar muscles. The perioperative
course was uneventful, and there was no exacerbation of neurologic signs or
symptoms. We suggest that a patient with Kennedy's disease may be successfully
managed by epidural anaesthesia for surgical internal urethrotomy.

PMID: 14742338 [PubMed - as supplied by publisher]

34: Br J Anaesth. 2004 Jan 22 [Epub ahead of print]

Cerebrospinal fluid-cutaneous fistula and pseudomonas meningitis complicating
thoracic epidural analgesia.

Abaza KT, Bogod DG.

Department of Anaesthesia, Nottingham City Hospital NHS, Hucknall Road,
Nottingham NG5 1PB, UK.

We report a case of delayed cerebrospinal fluid-cutaneous fistula that developed
in a patient following removal of a thoracic epidural catheter used for
perioperative analgesia. It was further complicated by the development of
bacterial meningitis. Predisposing factors and management of this rare
iatrogenic complication are discussed and the literature reviewed for similar
reports.

PMID: 14742337 [PubMed - as supplied by publisher]

35: Br J Anaesth. 2004 Jan 22 [Epub ahead of print]

Development of a difficulty score for spinal anaesthesia.

Atallah MM, Demian AD, Shorrab AA.

Department of Anaesthesia, Urology & Nephrology Center, Mansoura, Egypt.

BACKGROUND: Multiple attempts at spinal puncture may be hazardous. Accurate
preoperative prediction of difficulty adds to the delivery of high quality care.
This clinical trial was designed to: (i) determine the predictive performance of
difficulty variables; (ii) compare senior and junior anaesthetists; (iii)
develop a score to predict difficulty during the performance of spinal
anaesthesia. METHODS: A total of 300 patients subjected to urological procedures
and scheduled for spinal anaesthesia were independently assessed and stratified
according to the categories of the difficulty predictors of spinal anaesthesia
into one of nine grades (0-8) and randomized according to the experience of the
anaesthetist into two groups (group A, staff with more than 15 yrs' experience;
group B, resident with more than 6 months but less than 1 yr in training). The
number of attempts and levels, and success rate of the technique were the
outcome variables. Data were analysed by multivariate analysis and receiver
operating characteristic (ROC) curves. RESULTS: The bony landmarks of the back
and the radiological characteristics of the lumbar vertebrae were two
independent predictors of difficulty. Multivariate analysis indicated
differences between junior and senior staff but ROC curves indicated no
difference. Grade 4 was the difficulty score at or above which difficulty was
expected whether or not radiological characteristics of the vertebrae were
included. CONCLUSIONS: Spinal bony landmarks and radiological characteristics of
the lumbar vertebrae are independent predictors of difficulty during spinal
anaesthesia. There is no difference between senior and junior anaesthetists.
Grade 4 is the difficulty score at or above which difficulty is expected.

PMID: 14742333 [PubMed - as supplied by publisher]

36: Br J Anaesth. 2004 Jan 22 [Epub ahead of print]

Recording the middle latency response of the auditory evoked potential as a
measure of depth of anaesthesia. A technical note.

Bell SL, Smith DC, Allen R, Lutman ME.

Institute of Sound and Vibration Research, University of Southampton, Highfield,
Southampton SO17 1BJ, UK.

The middle latency response of the auditory evoked potential may be useful as an
indicator of the hypnotic state during anaesthesia. However, it is difficult to
record in some circumstances. This communication provides some suggestions and
guidance for those not familiar with the technique.

PMID: 14742332 [PubMed - as supplied by publisher]

37: Br J Anaesth. 2004 Jan 22 [Epub ahead of print]

Trainee anaesthetists understand their work in different ways: implications for
specialist education.

Larsson J, Holmstrom I, Lindberg E, Rosenqvist U.

Clinic of Anaesthesia and Intensive Care, Uppsala Academic Hospital, SE-751 85
Uppsala, Sweden; Department of Public Health and Caring Sciences, Health
Services Unit, University of Uppsala, Uppsala Science Park, SE-751 85 Uppsala,
Sweden.

BACKGROUND: Traditionally, programmes for specialist education in anaesthesia
and intensive care have been based on lists of attributes such as skills and
knowledge. However, modern research in the science of teaching has shown that
competence development is linked to changes in the way professionals understand
their work. The aim of this study was to define the different ways in which
trainee anaesthetists understand their work. METHODS: Nineteen Swedish trainee
anaesthetists were interviewed. The interviews sought the answers to three
open-ended questions. (i) When do you feel you have been successful in your
work? (ii) What is difficult or what hinders you in your work? (iii) What is the
core of your anaesthesia work? Transcripts of the interviews were analysed by a
phenomenographic approach, a research method aiming to determine the various
ways a group of people understand a phenomenon. RESULTS: Six ways of
understanding their work were defined: giving anaesthesia according to a
standard plan; taking responsibility for the patient's vital functions;
minimizing the patient's suffering and making them feel safe; giving service to
specialist doctors to facilitate their care of patients; organizing and leading
the operating theatre and team; and developing one's own competence, using the
experience gained from every new patient for learning. CONCLUSIONS: Trainee
anaesthetists understand their work in different ways. The trainee's
understanding affects both his/her way of performing work tasks and how he/she
develops new competences. A major task for teachers of anaesthesia is to create
learning situations whereby trainees can focus on new aspects of their
professional work and thus develop new ways of understanding it.

PMID: 14742329 [PubMed - as supplied by publisher]

38: Br J Anaesth. 2004 Jan 22 [Epub ahead of print]

Effect of three anaesthetic techniques on isometric skeletal muscle strength.

Ginz HF, Zorzato F, Iaizzo PA, Urwyler A.

Department of Anaesthesia, University of Basel/Kantonsspital, CH-4031, Basel,
Switzerland.

BACKGROUND: Our aim was to quantify human involuntary isometric skeletal muscle
strength during anaesthesia with propofol, sevoflurane, or spinal anaesthesia
using bupivacaine. METHODS: Thirty-three healthy patients undergoing anaesthesia
for elective lower limb surgery were investigated. Twenty-two patients received
a general anaesthetic with either propofol (n=12) or sevoflurane (n=10); for the
remaining 11 patients spinal anaesthesia with bupivacaine was used. We used a
non-invasive muscle force assessment system before and during anaesthesia to
determine the contractile properties of the ankle dorsiflexor muscles after
peroneal nerve stimulation (single, double, triple, and quadruple stimulation).
We measured peak torques; contraction times; peak rates of torque development
and decay; times to peak torque development and decay; half-relaxation times;
torque latencies. RESULTS: Males elicited greater peak torques than females,
medians 6.3 vs 4.4 Nm, respectively (P=0.0002, Mann-Whitney rank-sum test).
During sevoflurane and propofol anaesthesia, muscle strength did not differ from
pre-anaesthetic values. During spinal anaesthesia, torques were diminished for
single-pulse stimulation from 3.5 to 2.0 Nm (P=0.002, Wilcoxon signed rank
test), and for double-pulse from 7.6 to 5.6 Nm (P=0.02). Peak rates of torque
development decreased for single-pulse stimulation from 113 to 53 Nm s(-1) and
for double pulse from 195 to 105 Nm s(-1). Torque latencies were increased
during spinal anaesthesia. CONCLUSIONS: At clinically relevant concentrations,
propofol and sevoflurane did not influence involuntary isometric skeletal muscle
strength in adults, whereas spinal anaesthesia reduced strength by about 20%.
Muscle strength assessment using a device such as described here provided
reliable results and should be considered for use in other scientific
investigations to identify potential effects of anaesthetic agents.

PMID: 14742328 [PubMed - as supplied by publisher]

39: Br J Anaesth. 2004 Jan 22 [Epub ahead of print]

The Patient State Index as an indicator of the level of hypnosis under general
anaesthesia.

Prichep LS, Gugino LD, John ER, Chabot RJ, Howard B, Merkin H, Tom ML, Wolter S,
Rausch L, Kox WJ.

Brain Research Laboratories, New York University School of Medicine, New York,
NY, USA; Nathan S. Kline Institute for Psychiatric Research, Orangeburg, New
York, NY, USA.

BACKGROUND: This retrospective study describes the performance of the Patient
State Index (PSI), under standard clinical practice conditions. The PSI is
comprised of quantitative features of the EEG (QEEG) that display clear
differences between hypnotic states, but consistency across anaesthetic agents
within the state. METHODS: The PSI was constructed from a systematic
investigation of a database containing QEEG extracted from the analyses of
continuous 19 channel EEG recordings obtained in 176 surgical patients.
Induction was accomplished with etomidate, propofol, or thiopental. Anaesthesia
was maintained by isoflurane, desflurane, or sevoflurane, total i.v. anaesthesia
using propofol, or nitrous oxide/narcotics. It was hypothesized that a
multivariate algorithm based on such measures of brain state, would vary
significantly with changes in hypnotic state. RESULTS: Highly significant
differences were found between mean PSI values obtained during the different
anaesthetic states selected for study. The relationship between level of
awareness and PSI value at different stages of anaesthetic delivery was also
evaluated. Regression analysis for prediction of arousal level using PSI was
found to be highly significant for the combination of all anaesthetics, and for
the individual anaesthetics. CONCLUSIONS: The PSI, based upon derived features
of brain electrical activity in the anterior/posterior dimension, significantly
co-varies with changes in state under general anaesthesia and can significantly
predict the level of arousal in varying stages of anaesthetic delivery.

PMID: 14742326 [PubMed - as supplied by publisher]

40: Br J Anaesth. 2004 Jan;92(1):153-4.

Comment on:
Br J Anaesth. 2003 Feb;90(2):189-93.Diplopia after cataract surgery.

Rahman W, Gregson RM.

Publication Types:
Comment
LetterPMID: 14665574 [PubMed - indexed for MEDLINE]

41: Br J Anaesth. 2004 Jan;92(1):152; author reply 152.

Comment on:
Br J Anaesth. 2003 Apr;90(4):487-98.Preservative-free ketamine.

Huddy NC, Kiff K.

Publication Types:
Comment
LetterPMID: 14665573 [PubMed - indexed for MEDLINE]

42: Br J Anaesth. 2004 Jan;92(1):144-6.

Use of a ProSeal laryngeal mask airway for airway maintenance during emergency
Caesarean section after failed tracheal intubation.

Awan R, Nolan JP, Cook TM.

Royal United Hospital, Combe Park, Bath BA1 3NG, UK. timcook@ukgateway.net

We report the use of the ProSeal laryngeal mask airway to establish and maintain
the airway during emergency Caesarean section when tracheal intubation had
failed with conventional laryngoscopy and mask ventilation was difficult. The
ProSeal laryngeal mask allowed controlled ventilation without gas leak and
facilitated drainage of the stomach.

Publication Types:
Case ReportsPMID: 14665568 [PubMed - indexed for MEDLINE]

43: Br J Anaesth. 2004 Jan;92(1):140-3.

Supraventricular tachycardia in pregnancy.

Robins K, Lyons G.

Department of Obstetric Anaesthesia, St James' University Hospital, Beckett
Street, Leeds LS9 7TF, UK. kayrobins14@hotmail.com

We present four cases of supraventricular tachycardia in pregnancy of varied
aetiology. Risk factors for the development of supraventricular tachycardia and
options for obstetric anaesthetic management, during pregnancy, labour, and at
Caesarean section are discussed. We recommend the use of adenosine as first line
therapy.

Publication Types:
Case ReportsPMID: 14665567 [PubMed - indexed for MEDLINE]

44: Br J Anaesth. 2004 Jan;92(1):109-20.

Obstetric epidurals and chronic adhesive arachnoiditis.

Rice I, Wee MY, Thomson K.

Shackelton Department of Anaesthesia, Southampton General Hospital, Tremona
Road, Shirley, Southampton SO14 6YD, UK. isobelrice@yahoo.co.uk

It has been suggested that obstetric epidurals lead to chronic adhesive
arachnoiditis (CAA). CAA is a nebulous disease entity with much confusion over
its symptomatology. This review outlines the pathological, clinical, and
radiological features of the disease. The proposed diagnostic criteria for CAA
are: back pain that increases on exertion, with or without leg pain;
neurological abnormality on examination; and characteristic MRI findings. Using
these criteria, there is evidence to show that epidural or subarachnoid
placement of some contrast media, preservatives and possibly vasoconstrictors,
may lead to CAA. No evidence was found that the preservative-free, low
concentration bupivacaine with opioid mixtures or plain bupivacaine currently
used in labour lead to CAA.

Publication Types:
Review
Review LiteraturePMID: 14665562 [PubMed - indexed for MEDLINE]

45: Br J Anaesth. 2004 Jan;92(1):71-4.

Outcome of ASA III patients undergoing day case surgery.

Ansell GL, Montgomery JE.

Department of Anaesthesia, Torbay District General Hospital, Lawes Bridge,
Torquay TQ2 7AA, UK. gillyansell@hotmail.com

BACKGROUND: Day case surgery is becoming more acceptable, even for patients with
complex medical conditions. Current recommendations suggest that patients who
are graded as American Society of Anaesthesiologists physical status (ASA) III
may be suitable for this approach. There is only a small amount of published
data available to support this. We present a retrospective review of ASA III
patients who had undergone day surgical procedures in our unit. METHODS: We
carried out a retrospective case controlled review of 896 ASA III patients who
had undergone day case procedures between January 1998 and June 2002 using the
existing computerized patient information system. The system records admission
rates, unplanned contact with healthcare services and post-operative
complications in the first 24 h after discharge. RESULTS: We demonstrated no
significant differences in unplanned admission rates, unplanned contact with
health care services, or post-operative complications in the first 24 h after
discharge between ASA III and ASA I or II patients. CONCLUSION: With good
pre-assessment and adequate preparation ASA III patients can be treated safely
in the day surgery setting.

PMID: 14665556 [PubMed - indexed for MEDLINE]

46: Br J Anaesth. 2004 Jan;92(1):18-24.

Evoked EEG patterns during burst suppression with propofol.

Huotari AM, Koskinen M, Suominen K, Alahuhta S, Remes R, Hartikainen KM, Jantti
V.

Department of Anaesthesiology, and Department of Clinical Neurophysiology, Oulu
University Hospital, Oulu, Finland. ari-matti.huotari@nic.fi

BACKGROUND: During EEG suppression with isoflurane or sevoflurane anaesthesia,
median nerve stimulation causes cortical responses of two kinds: an N20 wave
with a latency of 20 ms and an EEG burst with a latency of 200 ms. We tested the
possibility that median nerve stimulation during EEG suppression with propofol
would cause an EEG response that was consistent enough to be of use for
neuromonitoring. METHODS: Eight patients were anaesthetized with propofol to
allow burst suppression. Electrical stimulation of the median nerve was applied
during general anaesthesia and the EEG was measured. RESULTS: The EEG response
to a painful stimulus had four successive components: (i) N20 and P22
potentials, reflecting activation of fast somatosensory pathways; (ii) a
high-amplitude negative wave, possibly reflecting activation of the
somatosensory cortex SII bilaterally; (iii) a burst (i.e. a negative slow wave
with superimposed 10 Hz activity, probably reflecting an arousal mechanism); and
(iv) a 13-15 Hz spindle, probably originating from the thalamus, similar to
sleep spindles. These could be seen separately and in different combinations.
Bursts and spindles during burst suppression were also seen without stimulation.
In deepening propofol anaesthesia, spindles were seen in the continuous EEG
before burst suppression was achieved. In deep anaesthesia, spindles were seen
when bursts had ceased, and painful stimuli evoked sharp waves without
subsequent bursts. CONCLUSION: In addition to SSEP (somatosensory evoked
potentials), three different evoked responses are noted that could be useful for
clinical monitoring.

PMID: 14665548 [PubMed - indexed for MEDLINE]