Ultimo Aggiornamento: 6 Gennaio 2004

1: Acta Anaesthesiol Scand. 2003 Oct;47(9):1091-5.

Continuous epidural or intercostal analgesia following thoracotomy: a
prospective randomized double-blind clinical trial.

Debreceni G, Molnar Z, Szelig L, Molnar TF.

Department of Anaesthesiology and Intensive Therapy, University of Pecs,
Hungary. drdebrecenig@hotmail.com

BACKGROUND: Pain following thoracotomy is frequently associated with clinically
important abnormalities of pulmonary function. The aim of the current study was
to compare the efficacy of continuous thoracic epidural analgesia (EDA) to
continuous intercostal (IC) block for postoperative pain and pulmonary function
in a prospective, randomized, double-blinded clinical trial. METHODS: Fifty
patients undergoing lung lobectomy for malignancies were randomized into two
groups (25/group). Respiratory function (forced vital capacity, forced
expiratory volume per 1 s/forced vital capacity, maximum midexpiratory flow
rate, peak expiratory flow rate) were evaluated preoperatively, within 4 h after
the operation and on the first postoperative day. Visual analog scale (VAS:
0-10) scores were evaluated four-hourly for 20 h. RESULTS: The VAS scores were
significantly lower in the EDA versus IC group at the 4th, 8th, and 12th h of
observation (mean +/- SD) 5.5 +/- 2.9 vs. 7.3 +/- 2.2 P = 0.04; 4.1 +/- 2.1 vs.
5.1 +/- 2.9 P = 0.02; 3.6 +/- 1.9 vs. 5.2 +/- 2.4 P = 0.01, respectively.
Respiratory function parameters deteriorated significantly in both groups (P <
0.001) with no significant difference between the groups. Only one major adverse
effect was detected: one patient suffered from rib osteomyelitis after
intercostal cannulation and healed following surgical repair. CONCLUSIONS: The
results of the present study show that following thoracotomy in the early
postoperative period continuous EDA is a better pain relieving method than
continuous IC block, as indicated by the VAS scores.

Publication Types:
Clinical Trial
Randomized Controlled TrialPMID: 12969101 [PubMed - indexed for MEDLINE]

2: Acta Anaesthesiol Scand. 2003 Oct;47(9):1064-6.

Seizure duration with remifentanil/methohexital vs. methohexital alone in
middle-aged patients undergoing electroconvulsive therapy.

Smith DL, Angst MS, Brock-Utne JG, DeBattista C.

Department of Psychiatry and Behavioral Sciences, Stanford University School of
Medicine, Stanford, CA 94305, USA.

BACKGROUND: The object of this study was to test whether substituting part of
the methohexital dose with the short-acting opioid remifentanil would prolong
seizure duration in middle-aged patients while providing a similar depth of
anesthesia as with methohexital alone. This has been reported for the combined
use of methohexital and remifentanil in elderly patients, but has not been
investigated in middle-aged patients likely to require a higher total dose of
methohexital for inducing anesthesia. METHOD: Seven patients (42+/-10 years;
mean +/-SD) receiving electroconvulsive therapy (ECT) were anesthetized with
methohexital (1.25 mg kg-1) or with methohexital (0.625 mg kg-1) plus
remifentanil (1 micro g kg-1) in this randomized, double blind, crossover study.
Additional methohexital was given as needed until loss of eyelash reflex was
observed. Suxamethonium (1 mg kg-1) was used for muscular paralysis. RESULTS:
Motor and EEG seizure durations were significantly longer after induction with
methohexital plus remifentanil (45+/-14 and 58+/-15 s) than with methohexital
alone (31+/-11 and 42+/-18 s). A methohexital dose of 1.2+/-0.3 and 1.9+/-0.3 mg
was necessary to achieve loss of eyelash reflex if methohexital was used with
and without remifentanil. Peak heart rate after ECT was significantly higher if
remifentanil was coadministered with methohexital (148+/-12 vs. 126+/-24 b.p.m).
CONCLUSION: Substituting part of the methohexital dose with remifentanil is a
useful anesthetic technique to prolong seizure duration in middle-aged patients
requiring a 1.5-fold higher induction dose of methohexital than elderly
patients, the only population studied to date for the combined use of
methohexital and remifentanil in ECT.

Publication Types:
Clinical Trial
Randomized Controlled TrialPMID: 12969096 [PubMed - indexed for MEDLINE]

3: Anaesth Intensive Care. 2003 Dec;31(6):667-71.

A patient with congenital complete heart block undergoing multiple exposures to
general anaesthesia.

Mohan VK, Naik AK, Bharti N, Shende D.

Department of Anaesthesiology and Intensive Care, All India Institute of Medical
Sciences, New Delhi-110029, India.

We present a patient with congenital complete heart block who underwent multiple
anaesthetic exposures for eye examination and bilateral cataract surgery. The
diagnosis was made during the first general anaesthetic. Various complications
encountered during the multiple exposures are discussed.

PMID: 14719430 [PubMed - in process]

4: Anaesth Intensive Care. 2003 Dec;31(6):637-41.

Levobupivacaine versus racemic bupivacaine in spinal anaesthesia for urological
surgery.

Lee YY, Muchhal K, Chan CK.

Department of Anaesthesiology and Operating Theatre Services, Kwong Wah
Hospital, Hong Kong, S.A.R.

Racemic bupivacaine is the most common local anaesthetic used intrathecally.
This prospective, randomized, double-blind study compared the clinical efficacy
and motor block of 0.5% levobupivacaine with 0.5% racemic bupivacaine in spinal
anaesthesia for urological surgery. The surgery required an upper level of
sensory block of at least the tenth thoracic dermatome. Fifty patients were
recruited (levobupivacaine group n = 24; bupivacaine group n = 26). Spinal
anaesthesia was achieved with 2.6 ml of study solution injected in the
subarachnoid space at the lumbar 3/4 interspace. One patient from the
levobupivacaine group was excluded due to technical failure. There were no
significant differences between the two groups in the quality of sensory and
motor block or in haemodynamic change. Anaesthesia was adequate and patient
satisfaction good in all cases. We conclude that 0.5% levobupivacaine can be
used as an alternative to 0.5% racemic bupivacaine in spinal anaesthesia for
surgery when a sensory block to at least T10 is required.

PMID: 14719424 [PubMed - in process]

5: Anaesth Intensive Care. 2003 Dec;31(6):619-28.

Anaesthesia and isolated systolic hypertension--pathophysiology and anaesthesia
risk.

Wongprasartsuk P, Sear JW.

Nuffield Department of Anaesthetics, John Radcliffe Hospital, Oxford, United
Kingdom.

This review examines the pathophysiology of isolated systolic hypertension,
changing medical perspectives on this condition as a cardiovascular risk factor
in the community and evolving evidence of it being an independent risk factor
for perioperative morbidity and mortality. Hypertension is regarded as an added
risk in anaesthesia. Continuation of antihypertensive medication through the
perioperative period is an established principle. Studies supporting this
practice have demonstrated greater perioperative haemodynamic stability in
association with general anaesthesia and surgery in patients with treated
hypertension compared to untreated hypertension. Therapy has historically
focused on control of diastolic blood pressure, rather than systolic blood
pressure. Recent clinical trial data and data from large observational studies
show a closer association of systolic hypertension with both coronary heart
disease and stroke compared with diastolic hypertension. This has led to
recommendations for aggressive treatment of isolated systolic hypertension,
especially in patients over 65 years old. The association between decreased
compliance of the central systemic arteries and isolated systolic hypertension
is well understood. The fact that this same pathology, lack of compliance of
central arteries, can cause a decrease in diastolic blood pressure is not so
well recognised. This means that, in patients with isolated systolic
hypertension, decreasing diastolic blood pressure can be associated with
worsening arterial disease and that systolic minus diastolic blood pressure may
give a better indication of the problem. Anaesthetic assessment and technique
should be studied and potentially revised in the light of these changes in
perspective on isolated systolic hypertension.

PMID: 14719422 [PubMed - in process]

6: Anaesth Intensive Care. 2003 Dec;31(6):611.

Local anaesthesia--the early evolution of spinal needles.

Ball C, Westhorpe R.

PMID: 14719421 [PubMed - in process]

7: Br J Anaesth. 2004 Feb;92(2):301P-316P.

Proceedings of the Anaesthetic Research Society Meeting: University of
Manchester, November 20-21, 2003.

[No authors listed]

PMID: 14722195 [PubMed - as supplied by publisher]

8: Br J Anaesth. 2004 Feb;92(2):295-6.

Combined spinal epidural anaesthesia is better than spinal or epidural alone.

Lee JS, Ranasinghe JS, Steadman J.

Los Angeles, USA Miami, USA.

PMID: 14722190 [PubMed - in process]

9: Br J Anaesth. 2004 Feb;92(2):275-7.

Animal dependence of inhaled anaesthetic requirements in cats( dagger ).

Barter LS, Ilkiw JE, Steffey EP, Pypendop BH, Imai A.

Department of Surgical and Radiological Sciences, School of Veterinary Medicine,
University of California, Davis, USA Present address: B32-322-26-6 B Heiwa-Machi
Kanazawa, Ishikawa 921-8105, Japan.

BACKGROUND: The minimum alveolar concentration (MAC) of an inhaled anaesthetic
describes its potency as a general anaesthetic. Individuals vary in their
sensitivity to anaesthetics and we sought to determine whether an individual
animal's sensitivity to inhaled anaesthetics would be maintained across
different agents. METHODS: Six female mongrel cats, age 2 yr (range 1.8-2.3) and
mean weight 3.5 (SD 0.3) kg, were studied on three separate occasions over a
12-month period to determine the MAC of isoflurane, sevoflurane and desflurane.
Induction of anaesthesia in a chamber was followed by orotracheal intubation and
maintenance of anaesthesia with the inhaled agent in oxygen delivered via a
non-rebreathing circuit. MAC was determined in triplicate using standard
tail-clamp technique. RESULTS: Mean MAC values for isoflurane, sevoflurane and
desflurane were 1.90 (SD 0.18), 3.41 (0.65) and 10.27 (1.06)%, respectively.
Body temperature, systolic pressure and Sp(O(2)) recorded at the time of MAC
determinations for isoflurane, sevoflurane and desflurane were 38.3 (0.3), 38.6
(0.1) and 38.3 (0.3) degrees C; 71.2 (8.3), 74.6 (15.9) and 88.0 (12.0) mmHg;
99.2 (1.1), 99.1 (1.3) and 99.4 (0.8)%, respectively. Both the anaesthetic agent
and the individual cat had significant effects on MAC. Correlation coefficients
for comparisons between desflurane and isoflurane, desflurane and sevoflurane,
and sevoflurane and isoflurane were 0.90, 0.89 and 0.97, respectively.
CONCLUSIONS: These findings show that an individual has a consistent degree of
sensitivity to a variety of inhaled anaesthetics, suggesting a genetic basis for
sensitivity to inhaled anaesthetic effects. Br J Anaesth 2004; 92: 275-7

PMID: 14722183 [PubMed - in process]

10: Br J Anaesth. 2004 Feb;92(2):254-260.

Effects of volatile anaesthetic agents on enhanced airway tone in sensitized
guinea pigs.

Schutz N, Petak F, Barazzone-Argiroffo C, Fontao F, Habre W.

Division of Anaesthesiological Investigations and Department of Pathology and
Paediatrics, University of Geneva, Switzerland. Department of Medical
Informatics and Engineering, University of Szeged, Hungary. Paediatric
Anaesthesia Unit, Geneva Children's Hospital, 6, rue Willy Donze, CH-1205
Geneva, Switzerland.

BACKGROUND: Although volatile anaesthetics afford protection against
bronchospasm, their potential to reverse a sustained constriction of
hyperreactive airways has not been characterized. Accordingly, we investigated
the ability of halothane, isoflurane, sevoflurane and desflurane to reverse lung
constriction induced by prolonged stimulation of the muscarinic receptors in
guinea pigs sensitized to ovalbumin. METHODS: Pulmonary input impedance (ZL) was
measured using forced oscillations in five groups of ovalbumin-sensitized,
mechanically ventilated guinea pigs. ZL was measured under baseline conditions,
during steady-state bronchoconstriction induced by an i.v. infusion of
methacholine (MCh), and after administration of one of the volatile agents at 1
MAC after the induction of a steady-state bronchoconstriction. Airway resistance
(Raw), and parenchymal tissue resistive and elastic coefficients were extracted
from ZL by model fitting. RESULTS: All four volatile agents exhibited an initial
relaxation of the MCh-induced airway constriction followed by gradual increases
in Raw. The bronchodilatory effect of isoflurane was the most potent (-28.9 (SE
5.5)% at 2 min, P<0.05) and lasted longest (7 min); sevoflurane and halothane
had shorter and more moderate effects (-21.1 (3.9)%, P<0.05, and -6.1 (1.7)%,
P<0.05, respectively, at 1 min). Desflurane caused highly variable changes in
Raw, with a tendency to enhance airway tone. CONCLUSIONS: Volatile agents can
reverse sustained MCh-induced airway constriction only transiently in sensitized
guinea pigs. Isoflurane proved most beneficial in temporally improving lung
function in the presence of a severe constriction of allergic inflamed airways.
Desflurane displayed potential to induce further airway constriction. Br J
Anaesth 2004; 92: 254-60

PMID: 14722179 [PubMed - as supplied by publisher]

11: Br J Anaesth. 2004 Feb;92(2):231-4.

Articaine versus lidocaine plus bupivacaine for peribulbar anaesthesia in
cataract surgery.

Ozdemir M, Ozdemir G, Zencirci B, Oksuz H.

Department of Ophthalmology and Department of Anaesthesiology, Medical Faculty
of Kahramanmaras Sutcu Imam University, T-46050 Kahramanmaras, Turkey.

BACKGROUND: We compared the efficacy and safety of articaine 2% with a mixture
of lidocaine 2% and bupivacaine 0.5% without hyaluronidase for peribulbar
anaesthesia in cataract surgery. METHOD: In this double-blind randomized
clinical study, 58 cataract patients were allocated to receive either articaine
2% with epinephrine 1:200 000 or a mixture of equal parts of lidocaine 2% with
epinephrine 1.25:100 000 and bupivacaine 0.5%. Ocular and eyelid movement
scores, the number of supplementary injections, total volume of solution used
and pain and complications during injection and surgery were used as clinical
end-points. RESULTS: Articaine produced greater akinesia after 5 min (P=0.03).
Eighteen patients (60%) in the articaine group and 26 (93%) in the
lidocaine/bupivacaine group required a second injection (P=0.003). A third
injection was needed by two patients (7%) in the articaine group and 12 (43%) in
the lidocaine/bupivacaine group (P=0.001). The total mean volume of local
anaesthetic required to achieve akinesia was mean 9.4 (SD 1.7) ml in the
articaine group and 11.28 (1.86) ml in the lidocaine/bupivacaine group
(P<0.001). Median pain score was lower in the articaine group than in
lidocaine/bupivacaine group during injection (P=0.004) and surgery (P=0.014).
There was no difference between the groups for the incidence of complications.
CONCLUSION: Articaine 2% without hyaluronidase is more advantageous than a
mixture of lidocaine 2% and bupivacaine 0.5% without hyaluronidase for
peribulbar anaesthesia in cataract surgery. Br J Anaesth 2004; 92: 231-4

PMID: 14722174 [PubMed - in process]

12: Br J Anaesth. 2004 Feb;92(2):228-30.

Comparison of articaine and bupivacaine/lidocaine for sub-Tenon's anaesthesia in
cataract extraction.

Gouws P, Galloway P, Jacob J, English W, Allman KG.

West of England Eye Unit and Department of Anaesthesia, Royal Devon and Exeter
Hospital, Barrack Road, Exeter EX2 5DW, UK.

BACKGROUND: Articaine is the most widely used local anaesthetic for dental
anaesthesia in Germany, Italy and The Netherlands and has recently been
introduced and licensed for dental use in the UK. We have previously shown
articaine to be superior to a standard mixture of bupivacaine 0.5%/lidocaine 2%
for peribulbar anaesthesia. Sub-Tenon's anaesthesia arguably provides a safer
method of anaesthetic delivery for cataract surgery. A blunt cannula is used in
this technique, thus greatly reducing the risk of globe perforation, intrathecal
injection and sight-threatening periocular haemorrhage. METHODS: We compared
articaine and bupivacaine/lidocaine for sub-Tenon's anaesthesia in cataract
surgery. RESULTS: Sub-Tenon's anaesthesia using articaine 2% resulted in a more
rapid onset of motor block compared with a bupivacaine/lidocaine (P=0.0076).
Ocular movement scores were significantly lower from 2 min after injection until
the end of surgery (P=0.031 ANOVA). CONCLUSION: Articaine 2% is safe and
effective for sub-Tenon's anaesthesia and is a suitable alternative to the
traditional bupivacaine 0.5%/lidocaine 2% mixture. Br J Anaesth 2004; 92: 228-30

PMID: 14722173 [PubMed - in process]

13: Br J Anaesth. 2004 Feb;92(2):171-7.

Unconscious learning during surgery with propofol anaesthesia( dagger ).

Deeprose C, Andrade J, Varma S, Edwards N.

Department of Psychology, University of Sheffield, Western Bank, Sheffield S10
2TP, UK. Sunderland Royal Hospital, Sunderland, UK. Northern General Hospital,
Sheffield, UK.

BACKGROUND: Learning during anaesthesia has been demonstrated, but little is
known about the circumstances under which it may occur. This study investigated
the hypothesis that learning during anaesthesia occurs during, but not before,
surgical stimulation. METHODS: Words were played through headphones to 64
day-surgery patients during propofol anaesthesia. Fourteen words were played
repeatedly (15 times) for 1 min each either before (n=32) or during (n=32)
surgical stimulation. The depth of anaesthesia was estimated using the
bispectral index(TM) (BIS(TM)). Heart rate, ventilatory frequency, mean arterial
pressure, end-tidal carbon dioxide concentration, and infusion rate of propofol
were recorded at 1 min intervals during word presentation. On recovery, memory
was assessed using an auditory word stem completion test and word recognition
test. RESULTS: The mean BIS(TM), arterial pressure, end-tidal carbon dioxide and
heart rate during word presentation did not differ between the groups. The
infusion rate of propofol and the ventilatory frequency were significantly
greater in the during-surgical stimulation group. There was no evidence for
explicit recall or recognition, nor of awareness during anaesthesia (median
mean-BIS(TM)=38 in the before-surgical stimulation group and 42 in the
during-surgical stimulation group). Only patients who were played words during
surgical stimulation showed significant implicit memory on recovery (mean
score=0.08, P<0.02) However, their scores were not significantly higher than
those of the before-surgical stimulation group (mean score=0.01). CONCLUSIONS:
Learning during anaesthesia seems more likely to occur during rather than before
surgical stimulation at comparable anaesthetic depth. We hypothesize that
surgical stimulation facilitates learning during anaesthesia, independently of
its effects on anaesthetic depth. Br J Anaesth 2004; 92: 171-7

PMID: 14722165 [PubMed - in process]

14: Br J Anaesth. 2004 Feb;92(2):167-70.

Entropy of EEG during anaesthetic induction: a comparative study with propofol
or nitrous oxide as sole agent( dagger ).

Anderson RE, Jakobsson JG.

Department of Cardiothoracic Anaesthetics and Intensive Care, Karolinska
Hospital, Stockholm, Sweden. Department of Anaesthesiology, Sabbatsberg
Hospital, S-113 24 Stockholm, Sweden.

BACKGROUND: The search continues for an anaesthetic monitor that can define the
level of anaesthesia in an individual patient irrespective of anaesthetic
agent(s) used. Studies of available monitors based on bispectral analysis or
evoked auditory potentials show the complexity of the problem. We assessed a new
monitor, based on the entropy of the EEG, during induction of anaesthesia with
either propofol or nitrous oxide. METHODS: In an open, randomized study (two
groups; n=10) of day surgical patients, we induced loss of response with
incremental boluses of propofol. The other group was given propofol 30 mg and
then increasing concentrations of nitrous oxide until loss of response. We
measured entropy with the M-Entropy Module S/5(TM) (Datex-Ohmeda) using forehead
electrodes and recorded response entropy (RE; including frontal electromyogram)
and state entropy (SE; only the cortical EEG). Values are median (range).
RESULTS: Baseline values were RE 98 (96-100), SE 89 (87-91) and RE 98 (96-99),
SE 89 (87-91) for the propofol and nitrous oxide patients, respectively. During
propofol induction, both entropy indices decreased with increasing sedation,
with RE 40 (23-76) and SE 34 (17-70) at loss of response. Neither RE nor SE
decreased during nitrous oxide inhalation, and at loss of response using nitrous
oxide, RE and SE were unchanged at 98 (96-100) and 88 (85-91) respectively.
CONCLUSIONS: The entropy monitor of anaesthetic depth shows a successive
decrease with propofol but loss of consciousness with nitrous oxide is not
associated with change in entropy indices. Br J Anaesth 2004; 92: 167-70

PMID: 14722164 [PubMed - in process]

15: JAMA. 2004 Jan 7;291(1):79-87.

Surgical site infection and the routine use of perioperative hyperoxia in a
general surgical population: a randomized controlled trial.

Pryor KO, Fahey TJ 3rd, Lien CA, Goldstein PA.

Department of Anesthesiology, Weill Medical College of Cornell University, New
York, NY 10021, USA. kopryor@yahoo.com

CONTEXT: Surgical site infection (SSI) in the general surgical population is a
significant public health issue. The use of a high fractional inspired
concentration of oxygen (FIO2) during the perioperative period has been reported
to be of benefit in selected patients, but its role as a routine intervention
has not been investigated. OBJECTIVE: To determine whether the routine use of
high FIO2 during the perioperative period alters the incidence of SSI in a
general surgical population. DESIGN, SETTING, AND PATIENTS: Double-blind,
randomized controlled trial conducted between September 2001 and May 2003 at a
large university hospital in metropolitan New York City of 165 patients
undergoing major intra-abdominal surgical procedures under general anesthesia.
INTERVENTIONS: Patients were randomly assigned to receive either 80% oxygen
(FIO2 of 0.80) or 35% oxygen (FIO2 of 0.35) during surgery and for the first 2
hours after surgery. MAIN OUTCOME MEASURES: Presence of clinically significant
SSI in the first 14 days after surgery, as determined by clinical assessment, a
management change, and at least 3 prospectively defined objective criteria.
RESULTS: The study groups were closely matched in a large number of clinical
variables. The overall incidence of SSI was 18.1%. In an intention-to-treat
analysis, the incidence of infection was significantly higher in the group
receiving FIO2 of 0.80 than in the group with FIO2 of 0.35 (25.0% vs 11.3%; P
=.02). FIO2 remained a significant predictor of SSI (P =.03) in multivariate
regression analysis. Patients who developed SSI had a significantly longer
length of hospitalization after surgery (mean [SD], 13.3 [9.9] vs 6.0 [4.2]
days; P<.001). CONCLUSIONS: The routine use of high perioperative FIO2 in a
general surgical population does not reduce the overall incidence of SSI and may
have predominantly deleterious effects. General surgical patients should
continue to receive oxygen with cardiorespiratory physiology as the principal
determinant.

Publication Types:
Clinical Trial
Randomized Controlled TrialPMID: 14709579 [PubMed - indexed for MEDLINE]