Text Version
Entrez PubMed
Overview
Help |
FAQ
Tutorial
New/Noteworthy
E-Utilities
PubMed Services
Journals Database
MeSH Database
Single Citation Matcher
Batch Citation Matcher
Clinical Queries
LinkOut
Cubby
Related Resources
Order Documents
NLM Gateway
TOXNET
Consumer Health
Clinical Alerts
ClinicalTrials.gov
PubMed Central
Privacy Policy
|
|
Comment on:
Plasma concentrations of epinephrine need to be monitored in study of incidence of hypotensive/bradycardic events.
Souron V.
Publication Types:
PMID: 14742415 [PubMed - indexed for MEDLINE]
Comment on:
Other potential solutions to facilitate thoracoabdominal aortic aneurysm repair when uncontrolled hemorrhage develops at the subclavian clamp site.
Janelle GM, Klodell CT, Martin TD.
Publication Types:
PMID: 14742414 [PubMed - indexed for MEDLINE]
-
Uncoiling of Arrow Flextip plus epidural catheter reinforcing wire during catheter removal: an unusual complication.
Bastien JL, McCarroll MG, Everett LL.
Publication Types:
PMID: 14742413 [PubMed - indexed for MEDLINE]
Comment in:
Bilateral total knee replacement with tourniquets in a homozygous sickle cell patient.
Abdulla Al-Ghamdi A.
King Fahd Hospital of the University, Al-Khobar, King Faisal University, Saudi Arabia. mohsenkfu@hotmail.com
A 27-yr-old male patient, with homozygous sickle cell disease was scheduled for bilateral total knee replacement under tourniquet. The use of tourniquet in sickle cell patients is not without hazard. After preoperative exchange transfusion, total knee replacement was performed. The patient tolerated the procedure well. Patients with sickle cell disease should not be denied the benefit of a tourniquet if hematological correction has been undertaken. IMPLICATIONS: The use of a tourniquet in patients with sickle cell is controversial. The author describes a case of bilateral total knee replacement performed using a tourniquet in a patient with sickle cell disease.
Publication Types:
PMID: 14742403 [PubMed - indexed for MEDLINE]
-
Grand mal convulsion after an accidental intravenous injection of ropivacaine.
Dernedde M, Furlan D, Verbesselt R, Gepts E, Boogaerts JG.
Department of Anesthesiology, University Hospital Center, Charleroi, Belgium. mira.dernedde@chu-chareroi.be
A 36-yr old, ASA physical status I patient scheduled for hip arthroplasty under regional anesthesia received at the end of surgery an i.v. injection of approximately 200 mL of a 0.15% ropivacaine solution (300 mg = 4.6 mg/kg) in approximately 5 min. The bag prepared for postoperative epidural infusion was accidentally connected to a peripheral i.v. line. The patient developed grand mal convulsions, hypotension, and respiratory arrest. No arrhythmias were observed. Twenty minutes after the event, the arterial plasma concentration of ropivacaine was 3.10 microg/mL. Using a pharmacokinetic model, the peak plasma concentration at the time of the accidental administration was estimated at 17.04 microg/mL. The patient recovered uneventfully. IMPLICATIONS: An accidental i.v. injection of approximately 300 mg of ropivacaine was followed by seizures without any arrhythmia. The patient recovered uneventfully.
Publication Types:
PMID: 14742398 [PubMed - indexed for MEDLINE]
-
Bilateral brachial plexus block.
Franco CD, Salahuddin Z, Rafizad A.
Department of Anesthesiology and Pain Management, John H. Stroger, Jr. Hospital of Cook County, Chicago, Illinois 60612, USA. carlofr@aol.com
Bilateral regional anesthesia techniques in general and bilateral brachial plexus blocks in particular are rarely performed because they have few clinical indications. We present the case of a patient who presented to the operating room for bilateral upper extremity procedures where we thought regional anesthesia was appropriate. The anesthesia management is discussed as well as potential problems and complications. IMPLICATIONS: Reports on bilateral regional blocks are extremely rare in the literature. Whereas they have the potential for more complications than a single technique, they can be very useful in specific clinical situations.
Publication Types:
PMID: 14742397 [PubMed - indexed for MEDLINE]
-
The presence of working memory without explicit recall in a critically ill patient.
Ozcan MS, Gravenstein D.
Department of Anesthesiology, University of Florida College of Medicine, Gainesville, Florida 32610-0254, USA. Ozcanms@anest1.anest.ufl.edu
We describe an intubated patient sedated with propofol who interacted with caregivers, demonstrating intact "working memory." When neuromuscular blockade and bispectral index (BIS) monitoring were instituted, a greatly reduced amount of sedative achieved BIS values less than 60. Neither the sedation that allowed working memory nor the lighter sedation that produced BIS values less than 60 resulted in recall. This experience suggests that working memory demonstrated when BIS values are less than 60 is unlikely to lead to recall. IMPLICATIONS: The presence of intact working memory during sedation is a poor predictor of explicit recall when bispectral index values are maintained less than 60.
Publication Types:
PMID: 14742389 [PubMed - indexed for MEDLINE]
-
Epidural levobupivacaine 0.1% or ropivacaine 0.1% combined with morphine provides comparable analgesia after abdominal surgery.
Senard M, Kaba A, Jacquemin MJ, Maquoi LM, Geortay MP, Honore PD, Lamy ML, Joris JL.
Department of Anesthesia and Intensive Care Medicine, CHU de Liege, Belgium.
Ropivacaine appears attractive for epidural analgesia because it produces less motor block than racemic bupivacaine. The potential benefits of levobupivacaine with regard to motor blockade require further investigations. In this study, we compared the efficacy, dose requirements, side effects, and motor block observed with epidural levobupivacaine and ropivacaine when given in combination with small-dose morphine for 60 h after major abdominal surgery. Postoperatively, 50 patients were randomly allocated, in a double-blinded manner, to patient-controlled epidural analgesia with the same settings and without basal infusion, using 0.1% levobupivacaine or 0.1% ropivacaine. Both were combined with an epidural infusion of 0.1 mg/h morphine. Pain scores, side effects, motor block, and local anesthetic consumption were measured for 60 h. Pain scores measured on a 100-mm visual analog scale were approximately 20 mm at rest and 40 mm during mobilization in both groups. Bromage scores were 1 for all patients after the fourth postoperative hour. Consumption of levobupivacaine and ropivacaine were similar: 344 +/- 178 mg levobupivacaine versus 347 +/- 199 mg ropivacaine 48 h postoperatively. On postoperative day 2, 19 patients in the ropivacaine group versus 12 in the levobupivacaine group were able to ambulate (P < 0.05). No difference was noted concerning incidence of side effects. We conclude that when used as patient-controlled epidural analgesia and combined with small-dose epidural morphine, 0.1% levobupivacaine and 0.1% ropivacaine produce comparable postoperative analgesia with a similar incidence of side effects. IMPLICATIONS: Small concentrations (0.1%) of epidural levobupivacaine and ropivacaine combined with morphine (0.1 mg/h) produce comparable analgesia and have similar side effects for similar dose requirements.
Publication Types:
- Clinical Trial
- Randomized Controlled Trial
PMID: 14742376 [PubMed - indexed for MEDLINE]
-
Heat and moisture exchange devices: are they doing what they are supposed to do?
Lemmens HJ, Brock-Utne JG.
Department of Anesthesia, Stanford University School of Medicine, Stanford, California 94305-5640, USA. hlemmens@stanford.edu
Heat and moisture exchangers (HMEs) are used to provide humidification and warming of the inspiratory gases during general anesthesia. The performance specifications provided by manufacturers of HMEs are based on in vitro measurements of moisture output using the International Standards Organization (ISO) 9360 method. We studied the in vivo performance of three different HMEs with similar ISO specifications in a randomized crossover fashion in patients under general anesthesia. The effect of each HME on temperature, convective heat loss, evaporative heat loss, total heat loss, relative humidity, and absolute humidity of inspiratory gases was determined. Although all HMEs in general improved baseline variables, we found significant differences in performance for the different HMEs. In only one type did the moisture output correspond with ISO specifications. We conclude that the in vivo performance of HMEs may not correspond with manufacturer's specifications. IMPLICATIONS: There is considerable variability in the in vivo performance of heat and moisture exchangers that have similar manufacturer specifications. These specifications, based on the International Standards Organization 9360 standard, which is measured in vitro, cannot be used to predict clinical performance.
Publication Types:
- Clinical Trial
- Randomized Controlled Trial
PMID: 14742374 [PubMed - indexed for MEDLINE]
-
Severe hypotension in the prone position in a child with neurofibromatosis, scoliosis and pectus excavatum presenting for posterior spinal fusion.
Alexianu D, Skolnick ET, Pinto AC, Ohkawa S, Roye DP Jr, Solowiejczyk DE, Hyman JE, Sun LS.
Department of Anesthesiology, Columbia University College of Physicians & Surgeons and The Children's Hospital of the New York-Presbyterian, New York, New York 10032, USA.
A 34-mo-old boy with neurofibromatosis, scoliosis, and pectus excavatum developed severe hypotension when positioned prone. A magnetic resonance image study revealed neurofibromas encircling the great vessels. During the next anesthetic the patient was placed in the prone position on transverse bolsters and hypotension ensued again. A transesophageal echocardiogram (TEE) revealed compression of the right ventricle by the sternum. When the child was turned supine, the blood pressure returned to baseline. The patient was returned to the prone position, this time with bolsters placed longitudinally, without problem. This case supports a cardiac evaluation, possible intraoperative TEE, and avoidance of sternal pressure in patients with chest wall deformities requiring prone positioning. IMPLICATIONS: A child with neurofibromatosis, scoliosis, and a chest wall deformity presenting for spinal fusion developed severe hypotension while prone. This was due to compression of the heart by the sternum, not compression of the great vessels by neurofibromas. Sternal pressure in prone patients with chest wall deformities should be avoided. Unique management included the use of transesophageal echocardiography to determine the cause of the hypotension.
Publication Types:
PMID: 14742365 [PubMed - indexed for MEDLINE]
-
Does a preemptive block of the great auricular nerve improve postoperative analgesia in children undergoing tympanomastoid surgery?
Suresh S, Barcelona SL, Young NM, Heffner CL, Cote CJ.
Northwestern University Feinberg School of Medicine, and Department of Pediatric Anesthesiology, Children's Memorial Hospital, Chicago, Illinois, 60614, USA. ssuresh@northwestern.edu
We performed a double-blinded randomized controlled trial to evaluate the efficacy of preemptive analgesia in children undergoing tympanomastoid surgery. Children were divided into two groups: group block-block (BB) received a preemptive great auricular nerve block (GAN-block) with 0.25% bupivacaine with 1:200,000 epinephrine before incision followed by a second GAN-block with 0.25% bupivacaine with 1:200,000 epinephrine 1 h before the end of the procedure. Group sham block-block (SB-B) received a preemptive GAN-block with normal saline before surgical incision followed by a GAN-block with 0.25% bupivacaine with 1:200000 epinephrine 1 h before the completion of the procedure. All patients were evaluated for pain with the objective pain score (OPS) by a blinded observer. There was no difference in pain rescue requirements in the postanesthesia care unit (BB versus SB-B, 1 of 20 versus 3 of 20, P= 0.60) or in the short-stay unit (BB versus SB-B, 5 of 20 versus 11 of 20, P = 0.107) or for the entire hospital stay (P = 0.20). There was no significant difference between groups in the time to first rescue pain medication (BB versus SB-B, 226 +/- 71 min versus 201 +/- 94 min). There was no significant difference between groups regarding vomiting in the postoperative period (P = 0.52). We conclude that a preoperative GAN-block does not offer significant advantages for postoperative pain relief in children undergoing tympanomastoid surgery. IMPLICATIONS: This double-blinded randomized controlled trial compared the efficacy of preemptive analgesia with a peripheral nerve block of the great auricular nerve for decreasing postoperative pain in children undergoing tympanomastoid surgery. Preemptive analgesia did not improve the quality or duration of postoperative analgesia in our cohort.
Publication Types:
- Clinical Trial
- Randomized Controlled Trial
PMID: 14742364 [PubMed - indexed for MEDLINE]
-
The incidence of laryngospasm with a "no touch" extubation technique after tonsillectomy and adenoidectomy.
Tsui BC, Wagner A, Cave D, Elliott C, El-Hakim H, Malherbe S.
Department of Anesthesiology and Pain Medicine, University of Alberta Hospitals, Edmonton, Canada. btsui@ualberta.ca
In this case series, we evaluated the incidence of laryngospasm using a clearly defined awake tracheal extubation technique in 20 children undergoing elective tonsillectomy with or without adenoidectomy. This technique required patients to be turned to the recovery position at the end of the procedure before discontinuing the volatile anesthetics. No further stimulation, besides continuous oximetry monitoring, was allowed until the patients spontaneously woke up ("no touch" technique). The incidence of laryngospasm, oxygen saturation, and coughing was recorded. No cases of laryngospasm, oxygen desaturation, or severe coughing occurred in our patient population. IMPLICATIONS: This study re-emphasizes the importance of a sound anesthetic technique in tracheally extubating pediatric patients.
Publication Types:
PMID: 14742363 [PubMed - indexed for MEDLINE]
-
Octreotide-induced bradycardia and heart block during surgical resection of a carcinoid tumor.
Dilger JA, Rho EH, Que FG, Sprung J.
Department of Anesthesiology, Mayo Clinic, Rochester, Minnesota 55905, USA.
Octreotide may be a life-saving treatment in the case of an acute carcinoid crisis, but when given as an i.v. bolus in larger doses, it may cause significant effects on the cardiac conduction system. We describe cardiac conduction impairment observed during octreotide administration in a patient undergoing carcinoid tumor surgery. In this patient, i.v. boluses of 100 microg of octreotide resulted in symptomatic bradycardia, Mobitz type II atrioventricular block, and complete heart block. Perioperative physicians especially need to be aware of these potential effects because they may be more likely to occur during surgery because of the larger doses and boluses that are used to treat acute symptoms secondary to tumor manipulation. IMPLICATIONS: In some susceptible patients, i.v. bolus administration of octreotide may cause significant bradycardia and cardiac conduction defects. Therefore, when octreotide is administered as a bolus, it may be advisable to give it slowly while monitoring the electrocardiogram.
Publication Types:
PMID: 14742361 [PubMed - indexed for MEDLINE]
-
A randomized controlled trial of the Arctic Sun Temperature Management System versus conventional methods for preventing hypothermia during off-pump cardiac surgery.
Grocott HP, Mathew JP, Carver EH, Phillips-Bute B, Landolfo KP, Newman MF; Duke Heart Center Neurologic Outcome Research Group.
Department of Anesthesiology and Surgery, Duke University Medical Center, Durham, North Carolina.
In this trial we compared the hypothermia avoidance abilities of the Arctic Sun Temperature Management System (a servo-regulated system that circulates temperature-controlled water through unique energy transfer pads adherent to the patient's body) with conventional temperature control methods. Patients undergoing off-pump coronary artery bypass (OPCAB) surgery were randomized to either the Arctic Sun System alone (AS group) or conventional methods (control group; increased room temperature, heated IV fluids, convective forced air warming system) for the prevention of hypothermia (defined by a temperature <36 degrees C). The AS group had nasopharyngeal temperature servo-regulated to a target of 36.8 degrees C. Temperature was recorded throughout the operative period and comparisons were made between groups for both the time and area under the curve (AUC) for a temperature <36 degrees C (AUC<36 degrees C). Twenty-nine patients (AS group = 14, control group = 15) were studied. The AS group had significantly less hypothermia than the control group, both for duration of time <36 degrees C (2.5 [0-22] min, median [interquartile range] AS group versus 118 [49-192] min, control group; P = 0.0008) as well as for AUC<36 degrees C (0.3 [0-2.2] degrees C x min, AS group versus 17.1 [3.6-173.4] degrees C x min, control group; P = 0.002). The Arctic Sun Temperature Management System significantly reduced intraoperative hypothermia during OPCAB surgery. Importantly, this was achieved in the absence of any other temperature modulating techniques, including the use of IV fluid warming or increases in the ambient operating room temperature. IMPLICATIONS: The Arctic Sun Temperature Management System was more effective than conventional methods in preventing hypothermia during off-pump coronary artery bypass graft surgery.
Publication Types:
- Clinical Trial
- Randomized Controlled Trial
PMID: 14742358 [PubMed - indexed for MEDLINE]
Comment on:
Sickle cell disease: dogma, science, and clinical care.
Tobin JR, Butterworth J.
Publication Types:
PMID: 14742355 [PubMed - indexed for MEDLINE]
Desflurane might not be the optimal volatile anaesthetic in morbidly obese patients.
Hemmerling TM, Olivier JF, De Baerdemaeker L.
Montreal, Canada Gent, Belgium.
PMID: 14970143 [PubMed - in process]
-
Anaesthesia and pseudoseizures.
Allen G, Farling P, Ng L, Chambers N.
Belfast, UK.
PMID: 14970142 [PubMed - in process]
-
Topical anaesthesia in neonates, infants and children.
Lillieborg S, Otterbom I, Ahlen K, Long C.
Sodertalje, Sweden Belfast, UK.
PMID: 14970141 [PubMed - in process]
-
Off-pump coronary artery bypass surgery: physiology and anaesthetic management{dagger}
Chassot PG, Van Der Linden P, Zaugg M, Mueller XM, Spahn DR.
Departments of Anaesthesiology and Cardiovascular Surgery, University Hospital Lausanne (CHUV), CH-1011 Lausanne, Switzerland.
Increasing interest is being shown in beating heart (off-pump) coronary artery surgery (OPCAB) because, compared with operations performed with cardiopulmonary bypass, OPCAB surgery may be associated with decreased postoperative morbidity and reduced total costs. Its appears to produce better results than conventional surgery in high-risk patient populations, elderly patients, and those with compromised cardiac function or coagulation disorders. Recent improvements in the technique have resulted in the possibility of multiple-vessel grafting in all coronary territories, with a graft patency comparable with conventional surgery. During beating-heart surgery, anaesthetists face two problems: first, the maintenance of haemodynamic stability during heart enucleation necessary for accessing each coronary artery; and second, the management of intraoperative myocardial ischaemia when coronary flow must be interrupted during grafting. The anaesthetic technique is less important than adequate management of these two major constraints. However, experimental and recent clinical data suggest that volatile anaesthetics have a marked cardioprotective effect against ischaemia, and might be specifically indicated. OPCAB surgery requires team work between anaesthetists and surgeons, who must be aware of each other's constraints. Some surgical aspects of the operation are reviewed along with physiological and anaesthetic data.
PMID: 14970136 [PubMed - as supplied by publisher]
-
Editorial II: Anaesthesia for off-pump coronary artery surgery.
Kelleher A, Gothard J.
Department of Anaesthesia, The Royal Brompton Hospital, London SW3 6NP, UK. j.gothard@rbh.nthames.nhs.uk
PMID: 14970132 [PubMed - in process]
-
General anesthetic octanol and related compounds activate wild-type and delF508 cystic fibrosis chloride channels.
Marcet B, Becq F, Norez C, Delmas P, Verrier B.
Cystic fibrosis transmembrane conductance regulator (CFTR) Cl(-) channel is defective during cystic fibrosis (CF). Activators of the CFTR Cl(-) channel may be useful for therapy of CF. Here, we demonstrate that a range of general anesthetics like normal-alkanols (n-alkanols) and related compounds can stimulate the Cl(-) channel activity of wild-type CFTR and delF508-CFTR mutant. The effects of n-alkanols like octanol on CFTR activity were measured by iodide ((125)I) efflux and patch-clamp techniques on three distinct cellular models: (1) CFTR-expressing Chinese hamster ovary cells, (2) human airway Calu-3 epithelial cells and (3) human airway JME/CF15 epithelial cells which express the delF508-CFTR mutant. Our data show for the first time that n-alkanols activate both wild-type CFTR and delF508-CFTR mutant. Octanol stimulated (125)I efflux in a dose-dependent manner in CFTR-expressing cells (wild-type and delF508) but not in cell lines lacking CFTR. (125)I efflux and Cl(-) currents induced by octanol were blocked by glibenclamide but insensitive to 4,4'-diisothiocyanatostilbene-2,2'-disulfonic acid, as expected for a CFTR Cl(-) current. CFTR activation by octanol was neither due to cell-to-cell uncoupling properties of octanol nor to an intracellular cAMP increase. CFTR activation by octanol requires phosphorylation by protein kinase-A (PKA) since it was prevented by H-89, a PKA inhibitor. n-Alkanols chain length was an important determinant for channel activation, with rank order of potencies: 1-heptanol<1-octanol<2-octanol<1-decanol. Our findings may be of valuable interest for developing novel therapeutic strategies for CF.
PMID: 14967738 [PubMed - as supplied by publisher]
CME in cardiothoracic and vascular anesthesia.
[No authors listed]
PMID: 14973822 [PubMed - as supplied by publisher]
|