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Comment on:
Sub-Tenon techniques should be one option among many.
Gayer S, Cass GD.
Publication Types:
PMID: 14695749 [PubMed - indexed for MEDLINE]
Comment on:
Combined infraclavicular plexus block with suprascapular nerve block for humeral head surgery in a patient with respiratory failure: is an alternative approach really the best option for the lungs?
Blumenthal S, Nadig M, Borgeat A.
Publication Types:
PMID: 14695745 [PubMed - indexed for MEDLINE]
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Effects of perioperative oral amantadine on postoperative pain and morphine consumption in patients after radical prostatectomy: results of a preliminary study.
Snijdelaar DG, Koren G, Katz J.
Acute Pain Research Unit, Department of Anesthesia and Pain Management, Toronto General Hospital, Ontario, Canada. d.snijdelaar@anes.umcn.nl
BACKGROUND: Amantadine is known to be a noncompetitive N-methyl-D-aspartate receptor antagonist and may be useful in preventing postoperative central sensitization, acute opioid tolerance, and opioid-induced hyperalgesia, thereby decreasing pain and analgesic requirements. The aim of this pilot study was to evaluate the effects of perioperative oral amantadine on postoperative pain and analgesic consumption. METHODS: Twenty-four patients scheduled to undergo radical prostatectomy were given oral amantadine before and after surgery in a randomized, double-blind, placebo-controlled manner. After surgery, patients received intravenous patient-controlled analgesia with morphine for 48 h. Wound pain intensity, sensitivity to mechanical pressure around the surgical wound, and incidence of bladder spasm pain were assessed. Blood samples were drawn for analysis of amantadine, morphine, and the morphine metabolites. Adverse effects and patient satisfaction were assessed. RESULTS: The cumulative morphine consumption was significantly lower in the amantadine group at all time points (except at 48 h), amounting to a 32% reduction over the 48-h period. Forty-eight hours after surgery, visual analog pain scores to pressure applied near the wound were significantly lower in the amantadine group than in the placebo group. In addition, the number of patients reporting bladder spasm pain was significantly lower in the amantadine group. Plasma concentration of morphine-3-glucuronide was significantly lower at the end of surgery in the amantadine group. Pharmacokinetic analyses showed that the plasma clearance of morphine at 22-24 h after surgery was also significantly lower in the amantadine group. CONCLUSION: The results suggest that perioperative oral amantadine reduces postoperative opioid consumption by pharmacokinetic mechanisms, although additional pharmacodynamic interactions may also be involved.
Publication Types:
- Clinical Trial
- Randomized Controlled Trial
PMID: 14695734 [PubMed - indexed for MEDLINE]
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Hyperoxic ventilation reduces 6-hour mortality at the critical hemoglobin concentration.
Meier J, Kemming GI, Kisch-Wedel H, Wolkhammer S, Habler OP.
Department of Anesthesiology, J. W. Goethe-University, Frankfurt, Germany. meier@em.uni-frankfurt.de
BACKGROUND: Acute normovolemic hemodilution reduces the circulating erythrocyte mass and, thus, the hemoglobin concentration. After extreme acute normovolemic hemodilution to the critical hemoglobin concentration (Hbcrit), oxygen demand of the tissues is no longer met by oxygen supply, and death occurs with increasing oxygen debt. The aim of the current study was to investigate whether ventilation with 100% oxygen (fraction of inspired oxygen [FiO2] = 1.0; hyperoxic ventilation) initiated at Hbcrit could restore adequate tissue oxygenation and prevent death. METHODS: Fourteen anesthetized pigs ventilated with room air (FiO2 = 0.21) were hemodiluted by exchange of whole blood for 6% hydroxyethyl starch (200,000:0.5) until the individual Hbcrit was reached. Hbcrit was defined as the onset of oxygen supply dependency of oxygen consumption and was identified with indirect calorimetry. For the next 6 h, animals were either ventilated with an FiO2 of 0.21 (n = 7) or an FiO2 of 1.0 (n = 7). RESULTS: All animals in the 0.21 FiO2 group died within the first 3 h at Hbcrit (i.e., 6-h mortality 100%). Death was preceded by an increase of serum concentrations of lactate and catecholamines. In contrast to that, six of the seven animals of the 1.0 FiO2 group survived the complete 6-h observation period without lactacidosis and increased serum catecholamines (i.e., 6-h mortality 14%; FiO2 0.21 vs. FiO2 1.0, P < or = 0.05). After 6 h at Hbcrit, the FiO2 was reduced from 1.0 to 0.21, and five of the six animals died within the next 3 h. CONCLUSION: In anesthetized pigs submitted to lethal anemia, hyperoxic ventilation enabled survival for 6 h without signs of circulatory failure.
PMID: 14695726 [PubMed - indexed for MEDLINE]
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Gum elastic bougie-guided insertion of the ProSeal laryngeal mask airway is superior to the digital and introducer tool techniques.
Brimacombe J, Keller C, Judd DV.
Department of Anaesthesia and Intensive Care, Cairns Base Hospital, and James Cook University, Cairns, Australia. jbrimaco@bigpond.net.au
BACKGROUND: The authors compare three techniques for insertion of the ProSeal laryngeal mask airway. METHODS: Two hundred forty healthy patients aged 18-80 yr were randomly allocated for ProSeal laryngeal mask airway insertion using the digital, introducer tool (IT), or gum elastic bougie (GEB)-guided techniques. The digital and IT techniques were performed according to the manufacturer's instructions. The GEB-guided technique involved priming the drain tube with the GEB, placing the GEB in the esophagus under direct vision, and inserting the ProSeal laryngeal mask airway using the digital technique with the GEB as a guide. Failed insertion was defined by any of the following criteria: (1) failed pharyngeal placement; (2) malposition (air leaks, negative tap test results, or failed gastric tube insertion if pharyngeal placement was successful); and (3) ineffective ventilation (maximum expired tidal volume < 8 ml/kg or end-tidal carbon dioxide > 45 mmHg if correctly positioned). Any visible or occult blood was noted. Sore throat, dysphonia, and dysphagia were assessed 18-24 h postoperatively. RESULTS: Insertion was more frequently successful with the GEB-guided technique at the first attempt (GEB, 100%; digital, 88%; IT, 84%; both P < 0.001), but success after three attempts was similar (GEB, 100%; digital, 99%; IT, 98%). The time taken to successful placement was similar among groups at the first attempt but was shorter for the GEB-technique after three attempts (GEB, 25 +/- 14 s; digital, 33 +/- 19 s; IT, 37 +/- 25 s; both: P < 0.003). There were no differences in the frequency of visible blood, but occult blood occurred less frequently with the GEB-guided technique (GEB, 12%; digital, 29%; IT, 31%; both: P < 0.02) but was similar among techniques if insertion was successful at the first attempt. There were no differences in postoperative airway morbidity. CONCLUSION The GEB-guided insertion technique is more frequently successful than the digital or IT techniques. The authors suggest that the GEB-guided technique may be a useful backup technique for when the digital and IT techniques fail.
Publication Types:
- Clinical Trial
- Randomized Controlled Trial
PMID: 14695720 [PubMed - indexed for MEDLINE]
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[Monitoring curarization in anesthesia and resuscitation]
[Article in French]
Lagneau F, Plaud B, Marty J.
PMID: 14733204 [PubMed - indexed for MEDLINE]
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An assessment of the management of patients on warfarin by general dental practitioners in South West Wales.
Muthukrishnan A, Bishop K.
Morriston Hospital, Swansea SA6 6NL. akhila.muthukrishnan@swansea-tr.nhs.uk
For anticoagulation therapy, warfarin is used to reduce the risk of thrombo-embolic events in patients with mechanical prosthetic heart valves, certain cardiovascular conditions, deep vein thrombosis (DVT) and hypercoagulable states.(1). The International Normalised Ratio (INR) is used as a measure of anticoagulation and is expressed as a ratio of the patient's prothrombin time (PT) to control prothrombin time. In a person with a normal PT, the INR is approximately 1. The therapeutic range is the value of INR or degree of anticoagulation required to prevent the development of serious thrombo-embolism and is normally maintained between 2.0 and 4.5. It is important to recognize that the INR is only valid for patients on well controlled anticoagulant therapy, ie where the level of anticoagulation is reasonably stable over a moderate length of time.(2).
PMID: 14631427 [PubMed - indexed for MEDLINE]
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Epidural levobupivacaine, ropivacaine and bupivacaine in combination with sufentanil in early labour: a randomized trial.
Camorcia M, Capogna G.
Citta di Roma Hospital, Department of Anaesthesia, Rome, Italy. michela_camorcia@yahoo.it
BACKGROUND AND OBJECTIVE: To evaluate the efficacy, delay and duration of analgesia of three equianalgesic epidural doses of levobupivacaine, ropivacaine and bupivacaine during the first stage of labour. METHODS: One hundred and twenty-nine healthy primigravida in spontaneous labour who requested epidural analgesia were enrolled in a randomized observer-blinded study. Parturients were allocated to receive epidural levobupivacaine 0.0625%, ropivacaine 0.1% or bupivacaine 0.06259%. Sufentanil 10 microg was added to all solutions; the total volume of epidural solution was 20 mL. Pain was measured using a 100 mm visual analogue pain scale immediately before the epidural block, and at 5, 10, 15, 20 and 30 min thereafter. Motor block was evaluated using a modified Bromage scoring system. The adequacy of motor function for ambulation was also evaluated. Delay of analgesia was the time interval between the injection of the solution and the first painless contraction. Duration of analgesia was the time from the first painless contraction to the parturients' requests for further analgesia. RESULTS: Twelve parturients failed to complete the study. Eleven parturients had inadequate analgesia (four in Group Levobupivacaine, four in Group Ropivacaine and three in Group Bupivacaine; P > 0.05). Data was analysed from 34 parturients in Group Levobupivacaine, from 37 in Group Ropivacaine and from 35 in Group Bupivacaine. There were no differences in the delay of analgesia or in the number of parturients who were able to walk unaided. Levobupivacaine and ropivacaine produced more prolonged analgesia than bupivacaine (114 and 119 min, respectively, versus 89 min; P < 0.01). CONCLUSIONS: During early labour, equipotent low concentrations of levobupivacaine, ropivacaine and bupivacaine, all with the addition of sufentanil 10 microg, produced similar pain relief and motor block, but levobupivacaine and ropivacaine produced a longer lasting analgesia. About 10% of parturients had inadequate analgesia with a single bolus of the tested solutions.
Publication Types:
- Clinical Trial
- Randomized Controlled Trial
PMID: 12932065 [PubMed - indexed for MEDLINE]
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Sufentanil added to hyperbaric bupivacaine for subarachnoid block in Caesarean section.
Braga Ade F, Braga FS, Poterio GM, Pereira RI, Reis E, Cremonesi E.
State University of Campinas, Department of Anaesthesia, School of Medical Sciences, Campinas, Sao Paolo, Brazil. danest@fcm.unicamp.br
BACKGROUND AND OBJECTIVE: Subarachnoid block is a widely used technique for Caesarean section. Its quality can be improved by adding opioids to the local anaesthetics. We studied the quality of the block and its maternal-fetal repercussions when different doses of sufentanil were combined with hyperbaric bupivacaine using the intrathecal route in pregnant women undergoing Caesarean section. METHODS: This was a prospective, randomized, double-blind, controlled trial with 80 pregnant women, ASA I-II, who were scheduled for elective Caesarean section under subarachnoid block. Patients were distributed into four groups according to the dose of sufentanil used: no sufentanil (Group 1, control) or 2.5, or 5.0 or 7.5 microg sufentanil (Groups 2-4, respectively). In every group, the local anaesthetic used was hyperbaric bupivacaine 0.5% (12.5 mg) and the total volume of the solution 4 mL. The onset time of the block, maximum level of sensory block, motor block level, duration of analgesia, maternal side-effects and maternal-fetal cardiovascular repercussions were evaluated. RESULTS: Onset of the block was significantly shorter in the groups receiving opioids compared with the control group. Analgesia was significantly prolonged in Groups 3 and 4. The occurrence of pruritus and somnolence was significantly higher in the group receiving sufentanil 7.5 microg than in other groups. With the exception of pruritus, no differences were observed between groups with respect to cardiovascular or other maternal effects. CONCLUSIONS: The addition of sufentanil 5.0 and 7.5 microg to hyperbaric bupivacaine provided adequate anaesthesia for Caesarean section and good postoperative analgesia. Pruritus was the most common side-effect and had a significantly higher incidence when a dose of sufentanil 7.5 microg was used.
Publication Types:
- Clinical Trial
- Randomized Controlled Trial
PMID: 12932064 [PubMed - indexed for MEDLINE]
Intravenous self-administration of abused solvents and anesthetics in mice.
Blokhina EA, Dravolina OA, Bespalov AY, Balster RL, Zvartau EE.
Department of Psychopharmacology, Institute of Pharmacology, Pavlov Medical University, 6/8 Leo Tolstoy Street, St. Petersburg 197089, Russia.
Volatile organic solvents, fuels and anesthetics are subject to abuse. The aim of the present study was to evaluate i.v. self-administration of several of these chemicals in drug- and experiment-naive mice using a commercially available vehicle, intralipid. Two strains of mice (DBA/2 and Swiss) were allowed to self-administer toluene (0.0017-0.17 micromol/infusion), 1,1,1-trichloroethane (0.006-0.19 micromol/infusion), ethanol (0.32-1.6 micromol/infusion), cyclohexane (0.0017-0.052 micromol/infusion), propofol (0.01-0.53 micromol/infusion) and flurothyl (0.00042-0.072 micromol/infusion) or their vehicles during 30-min tests. During the test, each nose-poke of the master mouse resulted in a 1.88-microl i.v. infusion to the master mouse and a yoked control mouse. When the delivery line was loaded with a reinforcing drug solution, the number of nose-pokes of the master mice significantly exceeded that for yoked control mice. In the present experiments, significant differences in rates of nose-poking were observed between mice receiving response-contingent and response-noncontingent deliveries of ethanol and toluene in both strains of mice and of 1,1,1-trichloroethane in Swiss mice. These data suggest that the reinforcing effects of abused inhalants can be studied using i.v. self-administration procedures.
PMID: 14757143 [PubMed - in process]
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Management of the obese patient undergoing office-based oral and maxillofacial surgery procedures.
Chacon GE, Viehweg TL, Ganzberg SI.
Department of Oral and Maxillofacial Surgery, College of Dentistry, Columbus, Ohio, USA. chacon.4@osu.edu
PMID: 14699555 [PubMed - indexed for MEDLINE]
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Patient-controlled sedation with propofol in minor oral surgery.
Rodrigo C, Irwin MG, Yan BS, Wong MH.
Department of Anaesthesiology, University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong, People's Republic of China. rodrigo@hkusua.hku.hk
PURPOSE: We sought to evaluate the benefits of patient-controlled sedation with propofol for minor oral surgery. PATIENTS AND METHODS: After instructions were given on how to use the technique, 28 male and 24 female patients sedated themselves during minor oral surgery with titrating 18-mg bolus doses of propofol with a lockout period of 1 minute. RESULTS: Surgery lasted from 5 to 29 minutes; 28 patients were moderately and 17 were deeply sedated. Seven patients were oversedated. All of those who were oversedated responded to commands within 1 minute of being unresponsive and continued to obtain increments of propofol. Vital signs were stable in all patients even during oversedation. Eighteen patients were talkative, and 17 complained of pain along the vein. Operating conditions were good in 38, fair in 12, and poor in 2. The majority, 48 patients, were relaxed, and 47 were willing to undergo the sedation technique again. Ten had total, 22 had partial, and 20 had no amnesia. CONCLUSIONS: Relaxed patients, good operating conditions, and quick recovery of oversedated patients without unstable vital signs provide evidence that propofol has favorable pharmacokinetic and pharmacodynamic properties for patient-controlled sedation. This study also highlights the importance of close monitoring of patients during patient-controlled sedation.
PMID: 14699549 [PubMed - indexed for MEDLINE]
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Preoperative assessment.
Garcia-Miguel FJ, Serrano-Aguilar PG, Lopez-Bastida J.
Department of Anaesthesiology and Reanimation, Hospital General de Segovia, Segovia, Spain. fgarcia@hgse.sacyl.es
Although anaesthetic and surgical procedures should be individualised for every patient, in practice many preoperative protocols and routines are used generally. In this article, we aim to emphasise: why preoperative assessment is important; how it should be done, and by whom; what can be expected; and the importance of test selection based on patients' needs and on scientific evidence of effectiveness. We outline the roles of preoperative medical assessment in otherwise healthy patients. Clinical history, preoperative questionnaires, physical examination, routine tests, individual risk-assessment, and fasting policies are investigated by review of published work. Cost of routine preoperative assessment, the anaesthetist's legal responsibility, and patients'views in the preoperative process are also considered. A thorough clinical preoperative assessment of the patient is more important than routine preoperative tests, which should be requested only when justified by clinical indications. Moreover, this practice eliminates unnecessary cost without compromising the safety and quality of care. Education and training of medical doctors should be more scientifically guided, emphasising the relevance of effectiveness, and cost-effectiveness in clinical decision-making and complemented by audit.
Publication Types:
PMID: 14643127 [PubMed - indexed for MEDLINE]
Anesthetic effect of intrauterine lidocaine plus naproxen sodium in endometrial biopsy.
Dogan E, Celiloglu M, Sarihan E, Demir A.
Department of Obstetrics and Gynecology, Dokuz Eylul University Faculty of Medicine, 35340 Inciralti, Izmir, Turkey. erbil.dogan@deu.edu.tr
OBJECTIVE: To compare the efficacy of intrauterine lidocaine with oral naproxen sodium on pain perception of the patients during endometrial biopsy using the Pipelle instrument and to investigate their effects when used in combination. METHODS: One-hundred twenty women were randomly assigned to receive either 5 mL of intrauterine 2% lidocaine or saline and either 550 mg of naproxen sodium or a similar-appearing placebo tablet. Subsequently, each woman completed a 10-cm visual analog scale for subjective pain experience and a physician scored visible signs of the women's distress during the procedure using a 3-point observer scale. RESULTS: There was no statistically significant difference between the 4 groups in age, vaginal parity, history of chronic pelvic pain, menopausal status, tenaculum use, previous endometrial biopsy, or difficulty in passing the cervical os. The mean pain scores of the women in the naproxen only (5.8 +/- 2.2) and lidocaine only (5.9 +/- 2.2) groups were not significantly different compared with placebo group (7.1 +/- 2.0). However, the mean pain score in the lidocaine plus naproxen group (4.6 +/- 1.8) compared with the placebo group showed significant reduction in pain (P <.05). Pain rated by the physician was significantly lower in the lidocaine plus naproxen group compared with other groups, and a significant correlation was noted between the visual analog pain score and the patients' distress recorded by the physician (r =.791, P <.001). One patient in the naproxen-only group had vasovagal syncope after the procedure. CONCLUSION: Intrauterine lidocaine instillation significantly decreases pain associated with Pipelle endometrial biopsy when used in combination with oral naproxen sodium. LEVEL OF EVIDENCE: I
PMID: 14754707 [PubMed - in process]
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