Ultimo Aggiornamento: 6 Gennaio 2004

1: Anaesthesia. 2003 Dec;58(12):1250-1; author reply 1251.

Comment on:
Anaesthesia. 2003 Jul;58(7):725-6.Ethical considerations in obtaining consent under anaesthesia.

Ranganathan M, Raghuraman G.

Publication Types:
Comment
LetterPMID: 14705715 [PubMed - indexed for MEDLINE]

2: Anaesthesia. 2003 Dec;58(12):1248; author reply 1249.

Comment on:
Anaesthesia. 2003 Aug;58(8):745-8.Pulmonary mechanics and volatile anaesthesia.

Demeere JL.

Publication Types:
Comment
LetterPMID: 14705712 [PubMed - indexed for MEDLINE]

3: Anaesthesia. 2003 Dec;58(12):1246.

Ionised magnesium concentrations in non-neurosurgical patients undergoing spinal
anaesthesia.

Sasaki R, Hirota K, Yamazaki M.

Publication Types:
LetterPMID: 14705709 [PubMed - indexed for MEDLINE]

4: Anaesthesia. 2003 Dec;58(12):1235-6.

Comment on:
Anaesthesia. 2003 Sep;58(9):911-2.Academic anaesthesia.

Langton JA.

Publication Types:
Comment
LetterPMID: 14705691 [PubMed - indexed for MEDLINE]

5: Anaesthesia. 2003 Dec;58(12):1235.

Comment on:
Anaesthesia. 2003 Aug;58(8):760-74.Consent for anaesthesia.

Macdonald R.

Publication Types:
Comment
LetterPMID: 14705690 [PubMed - indexed for MEDLINE]

6: Anaesthesia. 2003 Dec;58(12):1210-9.

Anaesthesia for lung volume reduction surgery.

Hillier J, Gillbe C.

Department of Anaesthesia and Critical Care Medicine, Royal Brompton Hospital,
Sydney Street, London SW3 6NP, UK.

Lung volume reduction surgery is a surgical treatment for severe emphysema that
is increasing in popularity. The aim is to reverse the hyperexpansion of the
lungs that leads to expiratory airflow limitation, compromises the diaphragm and
chest wall mechanics, and tamponades the right ventricle. Optimal patient
selection has not yet been established, but it has become clear that those
patients with the most severe disease have an unacceptably high surgical
mortality. The anaesthetic management of patients undergoing lung volume
reduction surgery requires a good understanding of both the pathophysiology of
the disease and the surgical procedure. It is important for the anaesthetist and
the surgeon to work closely, supported by a large multidisciplinary team.
Excellent analgesia is essential to a successful outcome; whether this is best
provided by thoracic epidural is as yet unclear.

Publication Types:
Review
Review, TutorialPMID: 14705686 [PubMed - indexed for MEDLINE]

7: Anaesthesia. 2003 Dec;58(12):1200-3.

Regional anaesthesia.

Wildsmith JA.

University Department of Anaesthesia, Ninewells Hospital and Medical School,
Dundee, UK. j.a.w.wildsmith@dundee.ac.uk

Publication Types:
Review
Review, TutorialPMID: 14705684 [PubMed - indexed for MEDLINE]

8: Anaesthesia. 2003 Dec;58(12):1194-6.

Paediatric anaesthesia: past, present and future.

Bingham B.

Great Ormond Street Hospital for Children NHS Trust, London, UK.
bingham@doctors.org.uk

Publication Types:
Review
Review, TutorialPMID: 14705682 [PubMed - indexed for MEDLINE]

9: Anaesthesia. 2003 Dec;58(12):1189-93.

Orthopaedic anaesthesia.

Connolly D.

Musgrave Park Hospital, Belfast, UK. denis.connolly@greenpark.n-i.nhs.uk

Publication Types:
Review
Review, TutorialPMID: 14705681 [PubMed - indexed for MEDLINE]

10: Anaesthesia. 2003 Dec;58(12):1186-9.

Obstetric anaesthesia and analgesia.

May A.

Leicester Royal Infirmary NHS Trust, UK. annemayfrca@aol.com

Publication Types:
Review
Review, TutorialPMID: 14705680 [PubMed - indexed for MEDLINE]

11: Anaesthesia. 2003 Dec;58(12):1183-6.

Drugs in anaesthesia.

Sneyd R.

Plymouth Hospitals NHS Trust, Derriford, UK. robert.sneyd@pms.ac.uk

Publication Types:
Review
Review, TutorialPMID: 14705679 [PubMed - indexed for MEDLINE]

12: Anaesthesia. 2003 Dec;58(12):1171-7.

Cardiac anaesthesia: the last 10 years.

Feneck RO.

St Thomas Hospital, London, UK. rob_feneck@msn.com

Publication Types:
Review
Review, TutorialPMID: 14705677 [PubMed - indexed for MEDLINE]

13: Ann Fr Anesth Reanim. 2003 Nov;22(9):840-2.

[The relation between the patient and medical anesthesiologist]

[Article in French]

Albaladejo P, Beloeil H, Gentili M, Marty J.

Service d'anesthesie-reanimation, CHU de Beaujon, 92110 Clichy, France.
pierre.albaladejo@bjn.ap-hop-paris.fr

Publication Types:
Review
Review, TutorialPMID: 14612176 [PubMed - indexed for MEDLINE]

14: Ann Fr Anesth Reanim. 2003 Nov;22(9):778-86.

[Factors associated with laparoscopic approach for cholecystectomy,
appendicectomy and inguinal herniorraphy in France]

[Article in French]

Lienhart A, Pequignot F, Auroy Y, Benhamou D, Clergue F, Laxenaire MC, Jougla E.

Service d'anesthesie-reanimation, centre hospitalier universitaire
Saint-Antoine, 184, rue du Faubourg-Saint-Antoine, 75012 Paris, France.
andre.lienhart@sat.ap-hop-paris.fr

OBJECTIVE: To determine on a national level the factors associated with the use
of laparoscopy for digestive surgery. STUDY DESIGN: Nation wide study using a
large representative sample (3 days of anaesthesia in France). METHODS:
Univariate followed by multivariate analyses of data gathered in 1996 during the
survey led by the French Society of Anaesthesia and Intensive care ("SFAR")
including 2847 surgical procedures for cholecystectomy, appendicectomy or
inguinal herniorraphy. RESULTS: Independent factors associated with the use of
laparoscopy were: for cholecystectomy: age (less frequent when > or =71 years:
adjusted Odds ratio [AOR] 0.4), sex (more frequent in female: AOR 1.7), ASA
physical status (less frequent when > or =3: AOR 0.5), private hospital (AOR
2.0), procedure scheduled at least the night before (AOR 2.1), and use of closed
circuit general anaesthesia (AOR 1.6); for appendectomy: age >15 years (AOR
1.9-2.2), female (AOR 2.1), private hospital (AOR 2.7), scheduled procedure (AOR
2.1), prolonged procedure (AOR 8.4), endotracheal intubation (AOR 16.7), and
closed circuit (AOR 2.7); for inguinal herniorraphy: ASA physical status (less
frequent when > or =3: AOR 0.4), private hospital (AOR 3.4), prolonged procedure
(AOR 5.6), and endotracheal intubation (AOR 21.6). Association with a closed
circuit was confirmed for general anaesthesia using a volatile agent (AOR 1.5).
Overall, ambulatory surgery was rarely performed and used only for open
procedures. Regional anaesthesia was used only for inguinal open herniorraphy.
CONCLUSION: These data obtained from a large national survey confirmed the
higher frequency of laparoscopy in middle aged patients, female (except for
inguinal herniorraphy), without important comorbidity, in private hospitals.
Laparoscopy was associated with prolonged procedures and with a change in the
anaesthetic technique for appendicectomy and inguinal herniorraphy: tracheal
intubation was almost constantly used. Whatever the procedure, closed circuit
anaesthesia was more frequently used when surgery was performed under
laparoscopy, reflecting newer equipment of the hospital, private or public.

PMID: 14612165 [PubMed - indexed for MEDLINE]

15: Br J Anaesth. 2003 Dec;91(6):916-7.

Anatomical variations of the phrenic nerve and its clinical implication for
supraclavicular block.

Bigeleisen PE.

Department of Anesthesiology, Box 604, University of Rochester School of
Medicine and Dentistry,Strong Memorial Hospital, 601 Elmwood Avenue, Rochester,
NY 14642, USA. Paul_Bigeleisen@urmc.rochester.edu

This paper reports a case of simultaneous diaphragmatic and brachial plexus
stimulation followed by a successful nerve block using the supraclavicular
approach. An explanation for the qualitative differences in phrenic nerve block
between interscalene and supraclavicular block is postulated, based on known
anatomical variations.

Publication Types:
Case ReportsPMID: 14633767 [PubMed - indexed for MEDLINE]

16: Br J Anaesth. 2003 Dec;91(6):905-8.

Quality of perioperative AEP--variability of expert ratings.

Schneider G, Nahm W, Kochs EF, Bischoff P, Kalkman CJ, Kuppe H, Thornton C.

Department of Anaesthesiology, Technische Universitat Munchen, Klinikum rechts
der Isar, Ismaningerstr 22, D-81675 Munich, Germany.
gerhard.schneider@lrz.tum.de

BACKGROUND: Previous studies suggest that auditory evoked potentials (AEP) may
be used to monitor anaesthetic depth. However, during surgery and anaesthesia,
the quality of AEP recordings may be reduced by artefacts. This can affect the
interpretation of the data and complicate the use of the method. We assessed
differences in expert ratings of the signal quality of perioperatively recorded
AEPs. METHODS: Signal quality of 180 randomly selected AEP, recorded
perioperatively during a European multicentre study, was rated independently by
five experts as 'invalid' (0), 'poor' (1), or 'good' (2). Average (n=5) quality
rating was calculated for each signal. Differences between quality ratings of
the five experts were calculated for each AEP: inter-rater variability (IRV) was
calculated as the difference between the worst and best classification of a
signal. RESULTS: Average signal quality of 57% of the AEPs was rated as
'invalid', 39% as 'poor', and only 4% as 'good'. IRV was 0 in only 6%, 1 in 62%,
and 2 in 32% of the AEP, that is in 32% one expert said signal quality was good,
whereas a different expert thought the identical signal was invalid.
CONCLUSIONS: There is poor agreement between experts regarding the signal
quality of perioperatively recorded AEPs and, as a consequence, results obtained
by one expert may not easily be reproduced by a different expert. This limits
the use of visual AEP analysis to indicate anaesthetic depth and may affect the
comparability of AEP studies, where waveforms were analysed by different
experts. An objective automated method for AEP analysis could solve this
problem.

Publication Types:
Multicenter StudyPMID: 14633763 [PubMed - indexed for MEDLINE]

17: Br J Anaesth. 2003 Dec;91(6):850-6.

Randomized, controlled, cross-over clinical trial comparing intravenous
midazolam sedation with nitrous oxide sedation in children undergoing dental
extractions.

Wilson KE, Girdler NM, Welbury RR.

Department of Sedation, Newcastle Dental School and Hospital, Framlington Place,
Newcastle-upon-Tyne NE2 4BW, UK. katherine.wilson@newcastle.ac.uk

BACKGROUND: The use of benzodiazepines for paediatric dental sedation has
received limited attention with regard to research into clinical effectiveness.
A study was therefore designed to investigate the use of midazolam, for i.v.
sedation in paediatric dental patients. METHOD: The aim of the study was to
assess the effectiveness of i.v. midazolam in a randomized, controlled,
cross-over trial. Children aged 12-16 yr (ASA I and II), requiring two
appointments for equivalent but contralateral dental extractions for orthodontic
purposes, were recruited. Conscious sedation with either i.v. midazolam titrated
at 0.5 mg x min(-1), to a maximum of 5 mg, or nitrous oxide/oxygen titrated to
30%/70% inhalation sedation was used at the first visit, the alternative being
used at the second visit. Vital signs including blood pressure, arterial oxygen
saturation and ventilatory frequency, as well as sedation levels and behavioural
scores, were recorded every 2 min. RESULTS: Forty patients, mean age 13.2 yr
(range 12-16 yr), participated in the trial. A mean dose of midazolam 2.8 mg was
administered in the test group. The median time to the maximum level of sedation
was 8 min for midazolam compared with 6 min for nitrous oxide (P<0.001). Vital
signs for both treatments were comparable and within acceptable clinical limits
and communication with the patient was maintained at all times. The median
(range) lowest arterial oxygen saturation level recorded for midazolam was 97
(91-99)% compared with 97 (92-100)% for nitrous oxide. The mean (range) recovery
time for midazolam was 51.6 (39-65) min and 23.3 (20-34) min for nitrous oxide
(P<0.0001). Fifty-one per cent said they preferred i.v. midazolam, 38% preferred
nitrous oxide, and 11% had no preference. CONCLUSION: I.V. midazolam sedation
(0.5 mg x min(-1) to a maximum of 5 mg) appears to be as effective as nitrous
oxide sedation in 12-16-yr-old healthy paediatric dental patients.

Publication Types:
Clinical Trial
Randomized Controlled TrialPMID: 14633757 [PubMed - indexed for MEDLINE]

18: Br J Anaesth. 2003 Dec;91(6):797-9.

Real-time breath monitoring of propofol and its volatile metabolites during
surgery using a novel mass spectrometric technique: a feasibility study.

Harrison GR, Critchley AD, Mayhew CA, Thompson JM.

Featherstone Department of Anaesthesia and Intensive Care, Queen Elizabeth
Hospital, University Hospital Birmingham NHS Trust, Birmingham B15 2TH, UK.

BACKGROUND: At present, there is no rapid method for determining the plasma
concentration of i.v. anaesthetics. A solution might be the measurement of the
anaesthetic concentration in expired breath and its relation to the plasma
concentration. We used chemical ionization methods to determine whether an i.v.
anaesthetic can be detected in the low concentrations (parts per billion by
volume) in the expired breath of an anaesthetized patient. METHOD: Chemical
ionization mass spectrometry can measure trace gases in air with high
sensitivity without interference from major gases. We carried out a feasibility
trial with a proton transfer reaction mass spectrometer (PTR-MS) to monitor the
i.v. anaesthetic agent propofol and two of its metabolites in exhaled gas from
an anaesthetic circuit. Exhaled gas was sampled via a 4 m long, unheated tube
connected to the PTR-MS. RESULTS: Propofol and its metabolites were monitored in
real time in the expired breath of patients undergoing surgery. CONCLUSION:
Routine measurement of i.v. agents, analogous to that for volatile anaesthetic
agents, may be possible.

PMID: 14633747 [PubMed - indexed for MEDLINE]

19: Br J Anaesth. 2003 Dec;91(6):793-6.

Increased carbon dioxide absorption during retroperitoneal laparoscopy.

Streich B, Decailliot F, Perney C, Duvaldestin P.

Department of Anesthesiology and Intensive Care Unit, Henri Mondor Hospital, 51
avenue Marechal de Lattre de Tassigny, 94010 Creteil, France.

BACKGROUND: Retroperitoneoscopy for renal surgery is now a common procedure. We
compared carbon dioxide absorption in patients undergoing retroperitoneoscopy
for adrenal or renal surgery with that of patients undergoing laparoscopic
cholecystectomy. METHODS: We measured carbon dioxide elimination with a
metabolic monitor in 30 anaesthetized patients with controlled ventilation,
undergoing retroperitoneoscopy (n=10), laparoscopy (n=10) or orthopaedic surgery
(n=10). RESULTS: Carbon dioxide production increased by 38, 46 and 63% at 30, 60
and 90 min after insufflation (P<0.01) in patients having retroperitoneoscopy.
Carbon dioxide production (mean (SD)) increased from 92 (21) to 150 (43) ml x
min(-1) m(-2) 60-90 min after insufflation and remained increased after the end
of insufflation. During laparoscopy, V(.)(CO(2)) increased less (by 15%) (P<0.05
compared with retroperitoneoscopy) and remained steady throughout the procedure.
CONCLUSION: Retroperitoneal carbon dioxide insufflation causes more carbon
dioxide absorption than intraperitoneal insufflation, and controlled ventilation
should be increased if hypercapnia should be avoided.

PMID: 14633746 [PubMed - indexed for MEDLINE]

20: Br J Anaesth. 2003 Dec;91(6):771-2.

Comment on:
Br J Anaesth. 2003 Dec;91(6):773-80.How low can we go?

Sneyd JR.

Publication Types:
Comment
EditorialPMID: 14633742 [PubMed - indexed for MEDLINE]

21: Can J Anaesth. 2004 Jan;51(1):92.

Epidural anesthesia in a patient with hyperkalemic periodic paralysis undergoing
orthopedic surgery.

Aouad R, Atanassoff PG.

New Haven, Connecticut.

PMID: 14709476 [PubMed - in process]

22: Can J Anaesth. 2004 Jan;51(1):41-4.

Brachial plexus anesthesia compared to general anesthesia when a block room is
available: [L'anesthesie du plexus brachial comparee a l'anesthesie generale
quand une salle de bloc est disponible].

Armstrong KP, Cherry RA.

Department of Anesthesia and Perioperative Medicine, University of Western
Ontario, London, Ontario, Canada.

PURPOSE: Regional anesthesia is often felt to be beneficial to patient care but
detrimental to operating room (OR) efficiency. In this report we compare how a
block room (BR) affects OR time (ORT) utilization for brachial plexus anesthesia
(BPA) in a busy upper limb practice. We also compare how anesthetic technique,
BPA or general anesthesia (GA), impacts on the time to recovery and discharge in
patients having outpatient upper limb surgery. METHODS: With the Ethics
Committee's approval, a prospective study using hospital databases was
undertaken. All patients presenting for surgery on the upper limb between
November 1999 and April 2000 were eligible for analysis. A comparison was made
of the various time intervals that comprise a patient's hospital stay for either
GA or BPA. Demographic data (ASA, age, outpatient status), and location of BPA
were analyzed. RESULTS: Use of the BR for BPA significantly reduced the
pre-procedure anesthesia ORT when compared to BPA done in the OR (11.4 vs 32.9
min, P < 0.05; GA pre-procedure time was 17.8 min). In the ambulatory patient,
BPA alone reduced post procedure anesthesia ORT, postanesthetic care unit,
surgical day care unit, and total hospital times when compared to those
receiving GA. On average those receiving a BPA spent 1.5 hr less in hospital (P
< 0.01). Additionally, fewer admissions (2.4 vs 5.4%) occurred in the BPA group.
CONCLUSION: The use of a BR reduces the anesthesia ORT associated with BPA.
Secondly, BPA improves the recovery time phase of outpatients undergoing surgery
on the upper limb.

PMID: 14709459 [PubMed - in process]

23: Can J Anaesth. 2004 Jan;51(1):20-4.

Remifentanil provides better analgesia than alfentanil during breast biopsy
surgery under monitored anesthesia care: [Le remifentanil fournit une meilleure
analgesie que l'alfentanil pendant la biopsie mammaire realisee sous
surveillance anesthesique].

Dilger JA, Sprung J, Maurer W, Tetzlaff J.

Departments of Anesthesiology, Mayo Clinic, Rochester, Minnesota, and The
Cleveland Clinic Foundation, Cleveland, Ohio, USA.

PURPOSE: To compare the analgesic effects of remifentanil and alfentanil during
breast biopsy under monitored anesthesia care (MAC). METHODS: Sixty patients
received sedation with propofol (50 micro g*kg(-1)*min(-1)). After receiving a
loading dose of opioid (either remifentanil 0.5 micro g*kg(-1), or alfentanil
2.5 micro g*kg(-1)), an infusion was initiated (remifentanil 0.05 micro
g*kg(-1)*min(-1) or alfentanil 0.25 micro g*kg(-1)*min(-1)), and this was
supplemented with local anesthetic infiltration. The pain was evaluated with a
ten-point visual analogue scale (VAS) during local anesthetic infiltration and
deep tissue dissection. Inadequate analgesia, defined as VAS scores >/=="
BORDER="0"> 5, was treated first with boluses of opioid (remifentanil group 10
micro g or alfentanil group 50 micro g) and if inadequate after two treatments
with additional local anesthetic. Postoperative times were recorded including
the times until discharge criteria were achieved and patient's actual discharge.
RESULTS: The pain scores were similar between the two groups during the initial
injections of local anesthetic in the breast, however, patients in the
remifentanil group had lower mean pain scores during deep tissue dissection (2.3
vs 4.3, P < 0.01). Patients in the remifentanil group required fewer rescue
doses of opioid (1.9 vs 3.6, P < 0.03) and local anesthetic (5 vs 15, P <
0.006). The two study groups had comparable speed of recovery. CONCLUSION:
Remifentanil was a better opioid choice than alfentanil for breast biopsy under
MAC at the doses studied, but it did not increase the rapidity in which patients
recovered postoperatively.

PMID: 14709455 [PubMed - in process]

24: Can J Anaesth. 2004 Jan;51(1):1-5.

Regional anesthesia, block room and efficiency: putting things in
perspective/Anesthesie regionale, salle de bloc et efficacite : perspectives.

Drolet P, Girard M.

Department of Anesthesiology, Maisonneuve-Rosemont Hospital, Montreal, Quebec,
Canada.

PMID: 14709452 [PubMed - in process]

25: Can J Anaesth. 2003 Dec;50(10):1035-8.

Best evidence in anesthetic practice: prevention: magnesium sulfate reduces the
risk of eclampsia in women with pre-eclampsia.

Macarthur A.

PMID: 14708138 [PubMed - in process]