Ultimo Aggiornamento: 6 Gennaio 2004

1: Acta Anaesthesiol Scand. 2003 Sep;47(8):993-1000.

Patient-controlled regional analgesia (PCRA) with ropivacaine after arthroscopic
subacromial decompression.

Axelsson K, Nordenson U, Johanzon E, Rawal N, Ekback G, Lidegran G, Gupta A.

Departments of Anaesthesiology and Intensive Care, University Hospital, Orebro,
Sweden. kjell.axelsson@orebroll.se

BACKGROUND: The aim of the study was to evaluate postoperative analgesia and
safety of wound instillation of ropivacaine either by a single dose or a
patient-controlled regional anaesthesia (PCRA) technique. METHODS: In 40
patients undergoing arthroscopic subacromial decompression the surgeon placed a
catheter into the subacromial space at the end of the operation. In Phase I (10
patients), ropivacaine 250 mg was injected twice within 1 h. In Phase II, 30
patients were randomised into three groups: group prilocaine-ropivacaine (PR) =
20 ml of 1% prilocaine-epinephrine injected preoperatively into the subacromial
bursa + 20 ml of 0.5% ropivacaine infused in the catheter postoperatively; group
saline-ropivacaine (SR) = saline-epinephrine (20 ml) preoperatively + 0.5%
ropivacaine as in group PR; group saline-saline (SS) = saline-epinephrine (20
ml) preoperatively + saline postoperatively. The PCRA pump was filled with local
anaesthetic or saline to allow boluses of 10-ml each, maximum one bolus/h, via
the catheter. Pain relief, side-effects and venous plasma concentration of
ropivacaine were evaluated during a 24-h-test period. RESULTS: The free plasma
concentration of ropivacaine was 0.12 + 0.041 mg l-1 in Phase I. No adverse
effects were seen. In Phase II pain at rest and on movement was lower in group
PR than in group SS during the first 30 min postoperatively (P < 0.05). Group PR
had the lowest morphine consumption (P < 0.05). Five to seven boluses were
administered via the PCRA-pump, and 20 min after administration of the study
solution, pain was lower in groups PR and SR compared with group SS (P < 0.001).
CONCLUSIONS: Preoperative intrabursal prilocaine with epinephrine +
postoperative subacromial administration of ropivacaine by PCRA-technique
provided the most effective analgesia with no major side-effects. The free
plasma concentrations of ropivacaine were far below toxic concentrations.

Publication Types:
Clinical Trial
Randomized Controlled TrialPMID: 12904192 [PubMed - indexed for MEDLINE]

2: Anaesthesia. 2004 Feb;59(2):205-208.

Abstracts from the British Ophthalmic Anaesthesia Society Annual Conference in
Chester, 26-27 June 2003.

[No authors listed]

PMID: 14725555 [PubMed - as supplied by publisher]

3: Anaesthesia. 2004 Feb;59(2):204.

A response to 'Bougie trauma - it is still possible', Prabhu A, Pradham P,
Sanaka R and Bilolikar A, Anaesthesia 2003; 58: 811-12.

Armstrong P, Sellers WF.

Stoke Mandeville Hospital, Aylesbury, UK E-mail: wfssellers@hotmail.com

PMID: 14725554 [PubMed - in process]

4: Anaesthesia. 2004 Feb;59(2):204.

A response to 'Patient safety', Levison A, Anaesthesia 2003; 58: 1236, and
'Sleep deprivation and performance', Price S R, Anaesthesia 2003; 58: 1238-9.

Arnstein F.

Western General Hospital, Edinburgh, UK E-mail: arnie.arnstein@luht.scot.nhs.uk

PMID: 14725553 [PubMed - in process]

5: Anaesthesia. 2004 Feb;59(2):203-4.

A response to 'Consent and anaesthetic risk', Jenkins K and Baker A B,
Anaesthesia 2003; 58: 962-84.

Crowe S.

Our Lady's Hospital for Sick Children, Dublin, Ireland E-mail:
suzbar@gofree.indigo.ie

PMID: 14725552 [PubMed - in process]

6: Anaesthesia. 2004 Feb;59(2):203.

A response to a response to 'Pharmacokinetics of sevoflurane uptake into the
brain and body', Lu C C, Tsai C S, Ho S T, Chen W Y, Wong C S, Wang J J, Hu O Yp
and Lin C Y, Anaesthesia 2003; 58: 951-56.

Ho ST.

National Defense Medical Center, Taipei, Taiwan E-mail: painlab@ndmctsgh.edu.tw

PMID: 14725551 [PubMed - in process]

7: Anaesthesia. 2004 Feb;59(2):202-3.

A response to 'Avoiding adverse outcomes when faced with "difficulty with
ventilation"', Bell D, Anaesthesia 2003; 58: 945-948.

Lake A.

Glan Clwyd Hospital, Rhyl, UK E-mail: apjlake@aol.com

PMID: 14725550 [PubMed - in process]

8: Anaesthesia. 2004 Feb;59(2):202.

A response to 'Whose distress is it anyway? "fetal distress" and the 30-minute
rule', Yentis S M, Anaesthesia 2003; 58: 732-34.

George A.

Mid Cheshire Hospital Trust, Crewe, UK E-mail: a.george2@btinternet.com

PMID: 14725549 [PubMed - in process]

9: Anaesthesia. 2004 Feb;59(2):201.

A response to 'The use of remifentanil for intubation in paediatric patients
during sevoflurane anaesthesia guided by Bispectral Index (BIS) monitoring',
Weber F, Fussel U, Gruber M and Hobbhahn J, Anaesthesia 2003; 58: 746-55.

George A.

Mid Cheshire Hospital Trust, Crewe, UK E-mail: a.george2@btinternet.com

PMID: 14725548 [PubMed - in process]

10: Anaesthesia. 2004 Feb;59(2):201.

A response to 'Pharmacokinetics of sevoflurane uptake into the brain and body',
Lu C C, Tsai C S, Ho S T, Chen W Y, Wong C S, Wang J J, Hu O Yp and Lin C Y,
Anaesthesia 2003; 58: 951-56.

Dorrington K.

University of Oxford, Oxford, UK E-mail: keith.dorrington@physiol.ox.ac.uk

PMID: 14725547 [PubMed - in process]

11: Anaesthesia. 2004 Feb;59(2):201-2.

A response to a response to 'The use of remifentanil for intubation in
paediatric patients during sevoflurane anaesthesia guided by Bispectral Index
(BIS) monitoring', Weber F, Fussel U, Gruber M and Hobbhahn J, Anaesthesia 2003;
58: 746-55.

Weber F.

University Hospital Regensburg, Regensburg, Germany E-mail:
frank.weber@klinik.uni-regensburg.de

PMID: 14725546 [PubMed - in process]

12: Anaesthesia. 2004 Feb;59(2):200-1.

In response to 'Difficult airway alert', Dunstan C R and Caesar H, Anaesthesia
2003; 58: 918-19.

Ball DR, Jefferson P.

Dumfries and Galloway Royal Infirmary, Dumfries, UK E-mail:
d.ball@dgri.scot.nhs.uk

PMID: 14725545 [PubMed - in process]

13: Anaesthesia. 2004 Feb;59(2):200.

A response to 'Sudden deaths during hip hemi-arthroplasty', Parry G, Anaesthesia
2003; 58: 922-23.

Werner L.

Klinikum Garmisch-Partenkirchen, Garmisch-Partenkirchen, Germany E-mail:
werner.leidinger@klinikum-gap.de

PMID: 14725544 [PubMed - in process]

14: Anaesthesia. 2004 Feb;59(2):198-9.

Anaesthesia for quinsy.

Baines D.

The Children's Hospital,Westmead, NSW 2154, AustraliaE-mail: DavidB@chw.edu.au

PMID: 14725540 [PubMed - in process]

15: Anaesthesia. 2004 Feb;59(2):195.

Inducing anaesthesia in the operating theatre.

Evans P.

Newcastle General Hospital, Newcastle upon Tyne NE4 6BE, UKE-mail:
prevans@doctors.org.uk

PMID: 14725532 [PubMed - in process]

16: Anaesthesia. 2004 Feb;59(2):166-72.

Improving anaesthetists' communication skills.

Harms C, Young JR, Amsler F, Zettler C, Scheidegger D, Kindler CH.

Staff Anaesthetist Consultant Psychologist Resident Professor and Chairman,
Department of Anaesthesia, University Clinics Basel Biostatistician, Basel
Institute of Clinical Epidemiology, University Clinics Basel, Kantonsspital,
CH-4031 Basel, Switzerland.

The attitude, behaviour and communication skills of specialised doctors are
increasingly recognised as important and they have been identified as training
requirements. We designed a programme to teach communication skills to doctors
in a University Department of Anaesthesia and evaluated its effect on patient
outcomes such as satisfaction and anxiety. The 20 h programme was based on
videotaped reviews of actual pre-operative visits and role-playing. Effects on
patient satisfaction and pre-operative anxiety were assessed using a patient
questionnaire. In addition, all participating anaesthetists assessed the
training. We provide evidence that the training increased patient satisfaction
with the pre-operative anaesthetic visit. Training also decreased anxiety
associated with specific aspects of anaesthesia and surgery, but the effect was
rather small given the intense programme. The anaesthetists agreed that their
interpersonal skills increased and they felt better prepared to understand
patients' anxieties. Communication skills training can increase patient
satisfaction and decrease specific anxieties. The authors conclude that in order
to better demonstrate the efficacy of such a training programme, the particular
communication skills of anaesthetists rather than indirect patient outcome
parameters should be measured.

PMID: 14725519 [PubMed - in process]

17: Anaesthesia. 2004 Feb;59(2):122-6.

The influence of esmolol on the dose of propofol required for induction of
anaesthesia.

Wilson ES, McKinlay S, Crawford JM, Robb HM.

Specialist Registrar, Anaesthetics Consultant Anaesthetist, Department of
Anaesthesia, Gartnavel General Hospital, 30 Shelley Court, Glasgow G11 7NT, UK
Consultant Anaesthetist, Department of Anaesthesia, Falkirk and District Royal
Infirmary, Falkirk, UK.

Cardiac output may be an important determinant of the induction dose of
intravenous anaesthetic. Esmolol is known to reduce cardiac output, and we
examined its effect on the propofol dose required for induction of anaesthesia.
The size of the effect seen with esmolol was compared with midazolam
co-induction. Sixty patients were randomly allocated to placebo (saline),
esmolol (1mg.kg-1 bolus, followed by an infusion at 250 micro g.kg-1min-1) or
midazolam (0.04 mg.kg-1) groups. Induction of anaesthesia commenced 3 min
following the administration of the study drug, using a Diprifusor set to
achieve plasma propofol concentrations of 10 micro g.ml-1 at 5 min. The primary
end point used was the propofol dose per kg at loss of response to command. The
mean (SD) propofol dose for each group was 2.38 (0.48) mg.kg-1 for placebo, 1.79
(0.36) mg.kg-1 for esmolol and 1.34 (0.35) mg.kg-1 for midazolam (all means
significantly different; p < 0.0005). We found that predosing with esmolol
reduces the propofol requirements for induction of anaesthesia by 25%.

PMID: 14725513 [PubMed - in process]

18: Anaesthesia. 2004 Feb;59(2):105-7.

Checking anaesthetic equipment and the Expert Group on Blocked Anaesthetic
Tubing (EGBAT).

Carter JA.

Chairman, Safety Committee AAGBI, Bristol, UK E-mail:
john.carter@north-bristol.swest.nhs.uk

PMID: 14725510 [PubMed - in process]

19: Anesth Analg. 2004 Jan;98(1):273.

Thoracic epidural catheter placement in infants via the caudal approach under
electrocardiographic guidance: simplification of the original technique.

Tsui BC.

Publication Types:
LetterPMID: 14693645 [PubMed - indexed for MEDLINE]

20: Anesth Analg. 2004 Jan;98(1):267-8.

The cost comparison of infraclavicular brachial plexus block by nerve stimulator
and ultrasound guidance.

Sandhu NS, Sidhu DS, Capan LM.

Publication Types:
LetterPMID: 14693638 [PubMed - indexed for MEDLINE]

21: Anesth Analg. 2004 Jan;98(1):257-9, table of contents.

Administration of 100% oxygen before removal of the laryngeal mask airway does
not affect postanesthetic arterial partial pressure of oxygen.

Renner M, Hohlrieder M, Wolk T, Puhringer F, Kleinsasser AT, Keller C, Benzer A.

Department of Anesthesiology and Critical Care Medicine, Klinikum am
Steinenberg, Reutlingen, Germany.

Breathing 100% oxygen at the end of general anesthesia has been shown to worsen
postoperative pulmonary gas exchange when an endotracheal tube is used. Counter
measures, such as high positive end-expiratory pressure or the vital-capacity
maneuver, may limit this effect. Such strategies, however, may be impracticable,
or even contraindicated, when the laryngeal mask airway (LMA) is used. Because
of the vast differences in design between the LMA and endotracheal tube, we
examined postanesthetic blood gas tensions in patients after emergence from
anesthesia breathing oxygen via LMA. Sixty-four ASA physical status I-II
patients undergoing general anesthesia for 60 min with LMA were randomly
assigned to receive either 100% or 30% oxygen during emergence from anesthesia
and removal of LMA. Postoperative blood gas measurements were taken at 30 and 60
min after removal of the LMA. At either measurement, patients treated with 100%
oxygen essentially had the same arterial partial pressure of oxygen (60-min
measurement: 83 +/- 8 versus 85 +/- 7 mm Hg [mean +/- SD], P = 0.14) as those
treated with 30% oxygen. We conclude that breathing 100% oxygen at the end of
general anesthesia does not worsen postoperative pulmonary gas exchange when an
LMA is used. IMPLICATIONS: The endotracheal tube and laryngeal mask airway are
substantially different artificial airways used to ventilate the lungs of
anesthetized patients. Breathing 100% oxygen before removing the endotracheal
tube results in lung function defects. This study shows that oxygen breathing
before removing the laryngeal mask airway has no effect on pulmonary function.

Publication Types:
Clinical Trial
Randomized Controlled TrialPMID: 14693632 [PubMed - indexed for MEDLINE]

22: Anesth Analg. 2004 Jan;98(1):252-6, table of contents.

A novel infraclavicular brachial plexus block: the lateral and sagittal
technique, developed by magnetic resonance imaging studies.

Klaastad O, Smith HJ, Smedby O, Winther-Larssen EH, Brodal P, Breivik H, Fosse
ET.

Department of Anesthesiology, Rikshospitalet University Hospital,
Sognsvannsveien 20, NO-0027 Oslo, Norway. oivindkl@klinmed.uio.no

A new infraclavicular brachial plexus block method has the patient supine with
an adducted arm. The target is any of the three cords behind the pectoralis
minor muscle. The point of needle insertion is the intersection between the
clavicle and the coracoid process. The needle is advanced 0 degrees -30 degrees
posterior, always strictly in the sagittal plane next to the coracoid process
while abutting the antero-inferior edge of the clavicle. We tested the new
method using magnetic resonance imaging (MRI) in 20 adult volunteers, without
inserting a needle. Combining 2 simulated needle directions by 15 degrees
posterior and 0 degrees in the images of the volunteers, at least one cord in 19
of 20 volunteers was contacted. This occurred within a needle depth of 6.5 cm.
In the sagittal plane of the method the shortest depth to the pleura among all
volunteers was 7.5 cm. The MRI study indicates that the new infraclavicular
technique may be efficient in reaching a cord of the brachial plexus, often not
demanding more than two needle directions. The risk of pneumothorax should be
minimal because the needle is inserted no deeper than 6.5 cm. However, this
needs to be confirmed by a clinical study. IMPLICATIONS: A new infraclavicular
brachial plexus block method was investigated using magnetic resonance imaging
without inserting needles in the volunteers. The study suggests two needle
directions for performance of the block and that the risk of lung injury should
be minimal. Expectations need to be confirmed by a clinical study.

Publication Types:
Clinical TrialPMID: 14693630 [PubMed - indexed for MEDLINE]

23: Anesth Analg. 2004 Jan;98(1):248-51, table of contents.

Quantitative and selective evaluation of differential sensory nerve block after
transdermal lidocaine.

Sakai T, Tomiyasu S, Yamada H, Ono T, Sumikawa K.

Department of Anesthesiology, Nagasaki University School of Medicine, 1-7-1
Sakamoto, Nagasaki-City, Nagasaki 852-8501, Japan. tscat@fb3.so-net.ne.jp

We evaluated the effect of transdermal lidocaine on differential sensory nerve
block in 15 healthy volunteers. Lidocaine 10% gel was applied topically to a
forearm and covered with a plastic film. Three types of sensory nerve fibers
(Abeta, Adelta, and C fibers) were evaluated with a series of 2000-, 250-, and
5-Hz stimuli using current perception threshold (CPT) testing. Sensations of
touch, pinprick, cold, and warmth were also measured. These measurements were
made before the topical lidocaine (baseline), 60 min after the draping (T0), and
at 1-h intervals until 5 h after T0 (T1 to T5). A significant increase in CPT
compared with baseline was observed until T2 at 5 Hz and T4 at 250 Hz, whereas
the increase in CPT at 2000 Hz continued throughout the study period. All
subjects experienced the disappearance of pinprick and cold sensations, whereas
touch and warmth sensations were detectable during the study period. We conclude
that when lidocaine is applied transdermally, the sensitivity of nerves to local
anesthetics is proportional to the axon diameters. However, pinprick and cold
sensation are affected more strongly than other sensations at receptor sites.
IMPLICATIONS: We evaluated the effect of transdermal lidocaine on differential
sensory nerve block in healthy volunteers. Our results show that the sensitivity
of nerves to local anesthetics is proportional to the axon diameter.

Publication Types:
Clinical TrialPMID: 14693629 [PubMed - indexed for MEDLINE]

24: Anesth Analg. 2004 Jan;98(1):242-7, table of contents.

The effects of three different approaches on the onset time of sciatic nerve
blocks with 0.75% ropivacaine.

Taboada M, Alvarez J, Cortes J, Rodriguez J, Rabanal S, Gude F, Atanassoff A,
Atanassoff PG.

Department of Anesthesiology and. Clinical Epidemiology Unit, Hospital Clinico
Universitario de Santiago, Travesia de Choupana s/n, 15706 Santiago de
Compostela, Spain. manutabo@mixmail.com

We studied three different injection techniques of sciatic nerve block in terms
of block onset time and efficacy with 0.75% ropivacaine. A total of 75 patients
undergoing foot surgery were randomly allocated to receive sciatic nerve
blockade by means of the classic posterior approach (group classic; n = 25), a
modified subgluteus posterior approach (group subgluteus; n = 25), or a lateral
popliteal approach (group popliteal; n = 25). All blocks were performed with the
use of a nerve stimulator (stimulation frequency, 2 Hz; intensity, 2-0.5 mA) and
30 mL of 0.75% ropivacaine. Onset of nerve block was defined as complete loss of
pinprick sensation in the sciatic nerve distribution with concomitant inability
to perform plantar or dorsal flexion of the foot. In the three groups, an
appropriate sciatic stimulation was elicited at <0.5 mA. The failure rate was
similar in the three groups (group popliteal: 4% versus group classic: 4% versus
group subgluteus: 8%). The onset of nerve block was slower in group popliteal
(25 +/- 5 min) compared with group classic (16 +/- 4 min) and group subgluteus
(17 +/- 4 min; P < 0.001). There was no significant difference in the onset of
nerve block between group classic and group subgluteus. No differences in the
degree of pain measured at the first postoperative administration of pain
medication were observed among the three groups. We conclude that the three
approaches resulted in clinically acceptable anesthesia in the distribution of
the sciatic nerve. The subgluteus and classic posterior approaches generated a
significantly faster onset of anesthesia than the lateral popliteal approach.
IMPLICATIONS: Comparing three different approaches to the sciatic nerve with
0.75% ropivacaine, the classic and subgluteal approaches exhibited a faster
onset time of sensory and motor blockade than the lateral popliteal approach.

Publication Types:
Clinical Trial
Randomized Controlled TrialPMID: 14693628 [PubMed - indexed for MEDLINE]

25: Anesth Analg. 2004 Jan;98(1):193-200, table of contents.

Postanesthesia care unit recovery times and neuromuscular blocking drugs: a
prospective study of orthopedic surgical patients randomized to receive
pancuronium or rocuronium.

Murphy GS, Szokol JW, Franklin M, Marymont JH, Avram MJ, Vender JS.

Department of Anesthesiology, Evanston Northwestern Healthcare, Northwestern
University Feinberg School of Medicine, 2650 Ridge Avenue, Evanston, IL 60201,
USA. dgmurphy@core.com

In this study, we examined the effect of choice of neuromuscular blocking drug
(NMBD) (pancuronium versus rocuronium) on postoperative recovery times and
associated adverse outcomes in patients undergoing orthopedic surgical
procedures. Seventy patients were randomly allocated to a pancuronium or
rocuronium group. On arrival to the postanesthesia care unit (PACU) and again 30
min later, train-of-four ratios were quantified by using acceleromyography.
Immediately after acceleromyographic measurements, patients were assessed for
signs and symptoms of residual paresis. During the PACU admission, episodes of
hypoxemia, nausea, and vomiting were recorded. The time required for patients to
meet discharge criteria and the time of actual PACU discharge were noted. Forty
percent of patients in the pancuronium group had train-of-four ratios <0.7 on
arrival to the PACU, compared with only 5.9% of subjects in the rocuronium group
(P < 0.001). Patients in the pancuronium group were more likely to experience
symptoms of muscle weakness (blurry vision and generalized weakness; P < 0.001)
and hypoxemia (10 patients in the rocuronium group versus 21 patients in the
pancuronium group; P = 0.015) during the PACU admission. Significant delays in
meeting PACU discharge criteria (50 min [45-60 min] versus 30 min [25-40 min])
and achieving actual discharge (70 min [60-90 min] versus 57.5 min [45-61 min])
were observed when the pancuronium group was compared with the rocuronium group
(P < 0.001). In conclusion, our study indicates that PACU recovery times may be
prolonged when long-acting NMBDs are used in surgical patients. IMPLICATIONS:
Clinical recovery may be delayed in surgical patients administered long-acting
neuromuscular blocking drugs. During the postanesthesia care unit admission,
patients randomized to receive pancuronium (versus rocuronium) were more likely
to exhibit symptoms of muscle weakness, develop hypoxemia, and require more time
to meet discharge criteria.

Publication Types:
Clinical Trial
Randomized Controlled TrialPMID: 14693617 [PubMed - indexed for MEDLINE]

26: Anesth Analg. 2004 Jan;98(1):148-52, table of contents.

Antinociceptive and neurotoxicologic screening of chronic intrathecal
administration of ketorolac tromethamine in the rat.

Korkmaz HA, Maltepe F, Erbayraktar S, Yilmaz O, Guray M, Canda MS, Gunerli A,
Gokmen N.

Department of Anesthesiology and Reanimation, Dokuz Eylul University, School of
Medicine, 35340 Inciralti, Izmir, Turkey.

Many drugs are tested intrathecally to investigate alternatives to opioids. We
aimed to explore the analgesic and possible neurotoxic effects of chronic
intrathecally-administered ketorolac tromethamine in rats. Catheters were placed
via atlantoaxial interval in 28 Wistar rats under anesthesia of
intraperitoneally-injected thiopental 30 mg/kg. Rats were randomized into 4
groups and administered 4 repeated intrathecal doses of therapy with 5-day
intervals. The control group received 10 microL of saline, and the other groups
received 50, 150, and 400 microg of ketorolac tromethamine respectively. The
formalin test, behavioral test, and histopathological examination of four
different spinal cord levels were performed. Neither behavioral testing nor
histopathological examination revealed abnormalities that would suggest
neurotoxicity. Formalin tests showed that both phase I and phase II responses of
ketorolac tromethamine groups were significantly less than those of the control
group. Although phase I responses did not differ during comparisons among
ketorolac tromethamine-administered groups, phase II responses decreased
significantly in groups that received 150 and 400 microg of ketorolac
tromethamine. Intrathecally administered ketorolac tromethamine reduced
nociceptive responses and exhibited no untoward neurological effect even at
large doses. However, its intrathecal use as a safe alternative drug for chronic
pain remains to be investigated in other species. IMPLICATIONS: The present
study is unique because it has demonstrated that chronic intrathecal
administration of ketorolac tromethamine in rats, even at considerably large
doses, showed a potent analgesic effect during the formalin test without
exhibiting any neurotoxic side effect.

PMID: 14693610 [PubMed - indexed for MEDLINE]

27: Anesth Analg. 2004 Jan;98(1):107-10, table of contents.

Pharmacodynamic interactions between cisatracurium and rocuronium.

Breslin DS, Jiao K, Habib AS, Schultz J, Gan TJ.

Department of Anesthesiology, Duke University Medical Center, Durham, NC 27710,
USA.

The onset and duration of maintenance doses of neuromuscular blocking drugs may
be influenced by the original neuromuscular blocking drug used. We assessed the
effect of the interaction between steroidal and benzo-isoquinolinium compounds
on the clinical duration of maintenance doses of cisatracurium. Sixty adult
patients undergoing anesthesia with isoflurane, nitrous oxide, and oxygen were
randomized to receive the following: Group I = rocuronium 0.6 mg/kg followed by
cisatracurium 0.03 mg/kg when the first twitch in the train-of-four (TOF)
recovered to 25%, Group II = cisatracurium 0.15 mg/kg followed by cisatracurium
0.03 mg/kg, and Group III = rocuronium 0.6 mg/kg followed by rocuronium 0.15
mg/kg. Neuromuscular blockade was monitored using acceleromyography (TOF-Guard,
Boxtel, The Netherlands). The clinical duration (mean +/- SD) of the first 2
maintenance doses was 41 +/- 10, 31 +/- 7++, and 25 +/- 8++ min, and 39 +/- 11,
30 +/- 6+, 29 +/- 9* min in Groups I-III, respectively (*P < 0.05, +P < 0.01,
++P < 0.001; Group I versus II and III). Thus, the clinical duration of the
first two maintenance doses of cisatracurium was prolonged when administered
after rocuronium. IMPLICATIONS: We assessed the clinical effect of administering
cisatracurium after an intubating dose of rocuronium in 60 patients undergoing
isoflurane/nitrous oxide and oxygen anesthesia. The clinical duration of the
first two maintenance doses of cisatracurium administered after rocuronium was
significantly prolonged. This supports the contention that combinations of
structurally dissimilar neuromuscular blocking drugs result in a synergistic
effect.

Publication Types:
Clinical Trial
Randomized Controlled TrialPMID: 14693597 [PubMed - indexed for MEDLINE]

28: Anesth Analg. 2004 Jan;98(1):95-101, table of contents.

Spinal 2-chloroprocaine: the effect of added dextrose.

Warren DT, Kopacz DJ.

Department of Anesthesiology, Virginia Mason Medical Center, 1100 Ninth Avenue,
B2-AN, Seattle, WA 98111, USA.

Spinal 2-chloroprocaine is being investigated as an alternative short-acting
spinal anesthetic to replace lidocaine for outpatient surgery. Adding dextrose
increases the baricity of solutions and alters the characteristics of spinal
anesthesia. In this study, we compared 2-chloroprocaine spinal anesthesia
performed with or without the addition of dextrose (1.1%). Eight volunteers
underwent 2 spinal anesthetics, receiving 40 mg 2-chloroprocaine (2 mL, 2%) with
0.25 mL saline with one and 0.25 mL 10% dextrose with the other in a
double-blinded, randomized, balanced crossover manner. Pinprick anesthesia,
tolerance to transcutaneous electrical stimulation, and tourniquet, motor
strength measurements, and time to ambulation and void were assessed. Postvoid
residual bladder volume was measured via ultrasound. Spinal anesthesia was
successful in all subjects and regressed within 110 (80-110) min. There was no
significant difference in peak height T4 (T7-C6), time to achieve peak block
height (14 +/- 6 min), time for 2-segment regression (44 +/- 9 min), regression
to L1 (66 +/- 12 min), tolerance of tourniquet (43 +/- 9 min), or return of
motor function (81 +/- 14 min). Mean postvoid residual volume was larger with
dextrose (74 +/- 67 mL versus 16 +/- 35 mL; P = 0.02). No subject reported signs
of transient neurologic symptoms (TNS). In conclusion, spinal 2-chloroprocaine
provides adequate potency with reliable regression, seemingly without TNS.
Adding dextrose does not significantly alter spinal block characteristics but
increases residual bladder dysfunction. Therefore, the addition of glucose to
2-chloroprocaine for spinal anesthesia is not necessary. IMPLICATIONS: Spinal
chloroprocaine provides adequate potency with reliable regression, seemingly
without concerns of transient neurologic symptoms, and hence an appealing
profile for outpatient surgery. The addition of dextrose does not alter peak
block height or tolerance of thigh tourniquet, and increases the degree of
residual bladder dysfunction.

Publication Types:
Clinical Trial
Randomized Controlled TrialPMID: 14693594 [PubMed - indexed for MEDLINE]

29: Anesth Analg. 2004 Jan;98(1):89-94, table of contents.

Spinal 2-chloroprocaine: the effect of added fentanyl.

Vath JS, Kopacz DJ.

Department of Anesthesiology, Virginia Mason Medical Center, 1100 Ninth Avenue,
B2-AN, Seattle, WA 98111, USA.

Chloroprocaine is being investigated as a possible replacement for spinal
lidocaine. Adding fentanyl to lidocaine increases the quality of spinal
anesthesia without prolongation of block. We report the characteristics of
2-chloroprocaine (2-CP) spinal anesthesia with or without fentanyl in 8
volunteers receiving 40 mg 2-CP with saline or 20 micro g fentanyl in a
double-blinded, randomized, crossover manner. Spinal anesthesia was successful
for all subjects with complete block regression, ambulation, and void by 110
min. Itching occurred in all subjects receiving fentanyl, though medication was
not required. No subject reported signs of transient neurological symptoms. Peak
block with fentanyl averaged T5 (T3-7) and without fentanyl T9 (L1-T4) (P =
0.005). Regression to L1 was 78 +/- 7 min with fentanyl and 53 +/- 19 min
without fentanyl (P = 0.02). Tourniquet was tolerated for 51 +/- 8 min with
fentanyl and for 34 +/- 14 min without fentanyl (P = 0.02). Complete regression
of block occurred at 104 +/- 7 min with fentanyl and by 95 +/- 9 min without
fentanyl (P = 0.02). We conclude that 2-CP spinal anesthesia provides rapid
onset and adequate potency, giving it a positive profile for ambulatory surgery.
The addition of fentanyl lengthens regression to L1 and tourniquet tolerance
while minimally lengthening block duration. IMPLICATIONS: Spinal
2-chloroprocaine (40 mg) provides rapid onset and reliable blockade without
signs of transient neurological symptoms, giving it a positive profile for
ambulatory surgical settings. The addition of fentanyl appears to lengthen the
regression to L1 dermatome and tourniquet time while minimally lengthening
duration of block.

Publication Types:
Clinical Trial
Randomized Controlled TrialPMID: 14693593 [PubMed - indexed for MEDLINE]

30: Anesth Analg. 2004 Jan;98(1):81-8, table of contents.

Spinal 2-chloroprocaine: a dose-ranging study and the effect of added
epinephrine.

Smith KN, Kopacz DJ, McDonald SB.

Department of Anesthesiology, Virginia Mason Medical Center, 1100 Ninth Avenue,
B2-AN, Seattle, WA 98111, USA.

With the availability of preservative- and antioxidant-free 2-chloroprocaine
(2-CP), there may be an acceptable short-acting alternative to lidocaine for
spinal anesthesia. We examined the safety, dose-response characteristics, and
effects of epinephrine with spinal 2-CP. Six volunteers per group were
randomized to receive 30, 45, or 60 mg of spinal 2-CP with and without
epinephrine. Intensity and duration of sensory and motor blockade were assessed.
When 11 of the 18 volunteers complained of vague, nonspecific flu-like symptoms,
breaking of the blind revealed that all spinal anesthetics associated with the
flu-like symptoms contained epinephrine. There were no complaints of flu-like
symptoms in the volunteers who received 2-CP without epinephrine. No further
spinal anesthetics containing epinephrine were administered, resulting in 29
anesthetics (11 with epinephrine, 18 without epinephrine.) Plain 2-CP
demonstrated a dose-dependent increase in peak block height and duration of
effect at all variables except time to 2-segment regression and time to
regression to T10. Time to complete sensory regression with plain 2-CP was 98
+/- 20, 116 +/- 15, and 132 +/- 23 min, respectively. 2-CP with epinephrine
produced times to complete sensory regression of 153 +/- 25, 162 +/- 33, and 148
+/- 29 min, respectively. Preservative and antioxidant free 2-CP can be used
effectively for spinal anesthesia in doses of 30-60 mg. Epinephrine is not
recommended as an adjunct because of the frequent incidence of side effects.
IMPLICATIONS: Hyperbaric spinal 2-chloroprocaine is effective and has an
anesthetic profile appropriate for use in the surgical outpatient over the dose
range of 30-60 mg without signs of transient neurologic symptoms. The addition
of epinephrine is not recommended because of the frequent incidence of side
effects.

Publication Types:
Clinical Trial
Randomized Controlled TrialPMID: 14693591 [PubMed - indexed for MEDLINE]

31: Anesth Analg. 2004 Jan;98(1):75-80, table of contents.

Spinal 2-chloroprocaine: a comparison with lidocaine in volunteers.

Kouri ME, Kopacz DJ.

Department of Anesthesiology, Virginia Mason Medical Center, 1100 Ninth Avenue,
B2-AN, Seattle, WA 98111, USA.

Subarachnoid lidocaine has been the anesthetic of choice for outpatient spinal
anesthesia. However, its use is associated with transient neurologic symptoms
(TNS). Preservative-free formulations of 2-chloroprocaine are now available and
may compare favorably with lidocaine for spinal anesthesia. In this
double-blinded, randomized, crossover study, we compared spinal chloroprocaine
and lidocaine in 8 volunteers, each receiving 2 spinal anesthetics: 1 with 40 mg
2% lidocaine and the other with 40 mg 2% preservative-free 2-chloroprocaine.
Pinprick anesthesia, tolerance to transcutaneous electrical stimulation and
thigh tourniquet, motor strength, and a simulated discharge pathway were
assessed. Chloroprocaine produced anesthetic efficacy similar to lidocaine,
including peak block height (T8 [T5-11] versus T8 [T6-12], P = 0.8183) and
tourniquet tolerance (46 +/- 6 min versus 38 +/- 24 min, P = 0.4897).
Chloroprocaine anesthesia resulted in faster resolution of sensory (103 +/- 13
min versus 126 +/- 16 min, P = 0.0045) and more rapid attainment of simulated
discharge criteria (104 +/- 12 min versus 134 +/- 14 min, P = 0.0007). Lidocaine
was associated with mild to moderate TNS in 7 of 8 subjects; no subject
complained of TNS with chloroprocaine (P = 0.0004). We conclude that the
anesthetic profile of chloroprocaine compares favorably with lidocaine. Reliable
sensory and motor blockade with predictable duration and minimal side effects
make chloroprocaine an attractive choice for outpatient spinal anesthesia.
IMPLICATIONS: The spinal anesthetic profile of chloroprocaine (40 mg) compares
favorably with the same dose of spinal lidocaine. Reliable sensory and motor
blockade with predictable duration and minimal side effects and without signs of
transient neurological symptoms make chloroprocaine an attractive choice for
outpatient spinal anesthesia.

Publication Types:
Clinical Trial
Randomized Controlled TrialPMID: 14693590 [PubMed - indexed for MEDLINE]

32: Anesth Analg. 2004 Jan;98(1):70-4, table of contents.

Spinal chloroprocaine solutions: density at 37 degrees C and pH titration.

Na KB, Kopacz DJ.

Department of Anesthesiology, Virginia Mason Medical Center, 1100 Ninth Avenue,
B2-AN, Seattle, WA 98111, USA.

The density and pH of a local anesthetic are important characteristics in its
use as an intrathecal drug. Preservative- and antioxidant-free formulations of
chloroprocaine are available and are being investigated for short-duration
spinal anesthesia. In this study, we evaluated the pH and density (to 5
significant digits in g/mL, at 37.0 degrees C) of these new chloroprocaine
formulations. In addition to plain 2% and 3% chloroprocaine and 2% lidocaine,
mixed solutions of 2% chloroprocaine with epinephrine or with bicarbonate were
evaluated. Density was also measured after water dilution and after increasing
amounts of added dextrose. Chloroprocaine, 2% or 3%, is hyperbaric relative to
cerebrospinal fluid (CSF) before any addition of dextrose (density 1.00123 g/mL
and 1.00257 g/mL, respectively). When diluted with water, all the solutions are
hypobaric relative to CSF (density <1.00028 g/mL). Plain 2% lidocaine is the
only dextrose-free solution measured to be hypobaric (density 1.00004 g/mL).
Bisulfite-free 2-chloroprocaine remains very acidic (pH <4.0), but the pH can be
increased to more than 7.0 with a small amount of bicarbonate (0.25-0.33 mL/10
mL). The increased density of plain chloroprocaine makes it a useful hyperbaric
spinal drug without the addition of dextrose. IMPLICATIONS: Dextrose-free
2-chloroprocaine is hyperbaric relative to cerebrospinal fluid at 37 degrees C,
and therefore can be used for spinal anesthesia without dextrose. Bisulfite-free
2-chloroprocaine remains very acidic (pH <4.0). The pH can be increased to more
than 7.0 with a small amount of bicarbonate (0.25-0.33 mL/10 mL).

PMID: 14693589 [PubMed - indexed for MEDLINE]

33: Anesth Analg. 2004 Jan;98(1):68-9, table of contents.

Pyloromyotomy in a patient with paramyotonia congenita.

Ay B, Gercek A, Dogan VI, Kiyan G, Gogus YF.

Department of Anesthesiology and Reanimation, Marmara University Medical School,
Istanbul, Turkey.

A 2-mo-old infant with paramyotonia congenita was scheduled for pyloromyotomy
and repair of inguinal hernia. Diagnosis of paramyotonia congenita was done with
positive family history, myotonia at eyelids, provocation by cold, and
electromyogram analysis. Anesthesia was induced via face mask with sevoflurane
at 4 minimum alveolar anesthetic concentration in oxygen. Tracheal intubation
was attempted without a neuromuscular relaxant. Anesthesia was maintained with
sevoflurane at 0.5 minimum alveolar anesthetic concentration in oxygen and
remifentanil infusion at a rate of 0.2 micro g. kg(-1). min(-1). After
discontinuation of sevoflurane and remifentanil, the patient was awake and had
full recovery of muscle activity. IMPLICATIONS: The literature concerning
general anesthesia in paramyotonic patients is limited. We report a case of
paramyotonia congenita in a 2-mo-old male infant undergoing surgery for pyloric
stenosis and inguinal hernia after an uneventful anesthesia.

Publication Types:
Case ReportsPMID: 14693588 [PubMed - indexed for MEDLINE]

34: Anesth Analg. 2004 Jan;98(1):11-9, table of contents.

A-type and B-type natriuretic peptides in cardiac surgical procedures.

Berendes E, Schmidt C, Van Aken H, Hartlage MG, Rothenburger M, Wirtz S, Scheld
HH, Brodner G, Walter M.

Klinik und Poliklinik fur Anasthesiologie und Operative Intensivmedizin,
University of Munster, Albert-Schweitzer-Strasse 33, 48149 Munster, Germany.
berenel@uni-muenster.de

This study was performed to determine the secretion pattern and prognostic value
of A-type (ANP) and B-type (BNP) natriuretic peptide in patients undergoing
cardiac surgical procedures. We measured ANP and BNP in patients undergoing
coronary artery bypass grafting (CABG) with (n = 28) or without (n = 32)
ventricular dysfunction and in patients undergoing mitral (n = 21) or aortic (n
= 24) valve replacement, respectively. Postoperative mortality was recorded up
to 730 days after operation. ANP, but not BNP, concentrations were closely
associated with volume reloading of the heart after aortic cross-clamp in all
patients. The secretion pattern of BNP during surgery was much less uniform.
BNP, but not ANP, concentrations correlated with aortic cross-clamp time (r(2) =
0.32; P = 0.006) and postoperative troponin I concentrations (r(2) = 0.22; P =
0.0009) in bypass patients, and preoperative BNP increases were associated with
a more frequent postoperative (2-yr) mortality in these patients. Markedly
increased preoperative BNP concentrations in mitral (3-fold) and aortic
(14-fold) valve disease patients did not further increase during cardiopulmonary
surgery. The data suggest that ANP is primarily influenced by intravascular
volume reloading of the heart after cross-clamp, whereas the secretion of BNP is
related to other factors, such as duration of ischemia and long-term left
ventricular pressure and/or excessive intravascular volume. BNP, but not ANP,
was shown to be a mortality risk predictor in patients undergoing CABG.
IMPLICATIONS: A-type natriuretic peptide is primarily influenced by volume
reloading of the heart after cross-clamp, whereas the secretion of B-type
natriuretic peptide (BNP) is related to the duration of ischemia and long-term
left ventricular pressure and/or volume overload. Preoperative BNP, but not
postoperative BNP, concentrations predict long-term outcome after coronary
artery bypass grafting.

Publication Types:
Clinical TrialPMID: 14693575 [PubMed - indexed for MEDLINE]

35: Anesthesiology. 2004 Feb;100(2):460-1.

Delayed Postoperative Arousal following Remifentanil-based Anesthesia in a
Myasthenic Patient Undergoing Thymectomy.

Baraka AS, Haroun-Bizri ST, Gerges FJ.

American University of Beirut, Beirut, Lebanon.abaraka@aub.edu.lb

Publication Types:
LetterPMID: 14739835 [PubMed - in process]

36: Anesthesiology. 2004 Feb;100(2):428-33.

Consciousness unbound: toward a paradigm of general anesthesia.

Mashour GA.

Clinical Fellow in Anaesthesia, Harvard Medical School, and Resident Physician,
Department of Anesthesia and Critical Care, Massachusetts General Hospital.

PMID: 14739820 [PubMed - in process]

37: Anesthesiology. 2004 Feb;100(2):413-27.

Chronobiology and anesthesia.

Chassard D, Bruguerolle B.

Professor of Anesthesiology and Chairman, Department of Anesthesiology,
Hotel-Dieu Hospital. dagger Professor of Pharmacology and Chairman, Department
of Pharmacology, University of Aix Marseille II, Marseille, France.

PMID: 14739819 [PubMed - in process]

38: Anesthesiology. 2004 Feb;100(2):395-402.

Infraclavicular Perineural Local Anesthetic Infusion: A Comparison of Three
Dosing Regimens for Postoperative Analgesia.

Ilfeld BM, Morey TE, Enneking FK.

Assistant Professor of Anesthesiology, dagger Associate Professor of
Anesthesiology, Department of Anesthesiology, double dagger Professor of
Anesthesiology and Orthopaedics and Rehabilitation, Departments of
Anesthesiology and Orthopaedics and Rehabilitation.

SUMMARY: BACKGROUND In this randomized, double-blind study, the authors
investigated the efficacy of continuous and patient-controlled ropivacaine
infusions via an infraclavicular perineural catheter in ambulatory patients
undergoing moderately painful orthopedic surgery at or distal to the
elbow.METHODS Preoperatively, patients (n = 30) received an infraclavicular
perineural catheter and nerve block. Postoperatively, patients were discharged
home with both oral analgesics and a portable infusion pump delivering 0.2%
ropivacaine (500-ml reservoir) in one of three dosing regimens: the basal group
(12 ml/h basal, 0.05-ml patient-controlled bolus dose), the basal-bolus group (8
ml/h basal, 4 ml bolus), or the bolus group (0.3 ml/h basal, 9.9 ml bolus).
Investigators and patients were blinded to random group assignment.RESULTS The
basal group (n = 10) required more oral analgesics than the basal-bolus group (P
= 0.002) and had a shorter median infusion duration than the other two groups (P
< 0.001 for both). The bolus group had the longest median infusion duration (P <
0.001 for both) but experienced an increase in breakthrough pain incidence (P =
0.004) and intensity (P = 0.04 vs. basal-bolus group) as well as sleep
disturbances (P < 0.001 for both) compared with the other groups. Overall
satisfaction was greatest in the basal-bolus group (9.7 +/- 0.5 vs. 7.9 +/- 1.7
and 8.1 +/- 1.5; P < 0.05 for both).CONCLUSIONS After moderately painful
orthopedic surgery at or distal to the elbow, 0.2% ropivacaine delivered as a
continuous infusion combined with patient-controlled bolus doses via an
infraclavicular perineural catheter optimizes analgesia while minimizing oral
analgesic use compared with basal- or bolus-only dosing regimens.

PMID: 14739817 [PubMed - as supplied by publisher]

39: Anesthesiology. 2004 Feb;100(2):370-374.

Ophthalmic Regional Anesthesia: Medial Canthus Episcleral (Sub-Tenon) Single
Injection Block.

Nouvellon E, L'Hermite J, Chaumeron A, Mahamat A, Mainemer M, Charavel P, Mahiou
P, Dupeyron G, Bassoul B, Dareau S, Eledjam JJ, Ripart J.

Federation des Departement Anesthesie Douleur et Urgences Reanimation, CHU
Nimes. dagger Laboratoire d' epidemiologie et de Biostatistiques, Institut
Universitaire de Recherche Clinique Montpellier, Montpellier, France, and
Departement Informatique Medicale, CHU Nimes. double dagger Clinique les Cedres,
Grenoble, France. section sign Service d' Ophtalmologie, CHU Nimes. parallel
Clinique Beau Soleil, Montpellier, France. # Departement d'Anesthesie, Soins
Intensifs et Unite de Transplantation, CHU Montpellier, Montpellier, France.

SUMMARY: BACKGROUND The purpose of this study was to evaluate the efficacy and
safety of episcleral single-injection anesthesia in a large number of
patients.METHODS Over a period of 5 yr, in four institutions, anesthesiologists
involved in this prospective study completed a standardized form to evaluate
single-injection medial canthus high-volume episcleral anesthesia. The success
rate of the block was rated according to an akinesia score. The study parameters
included demographic data, surgical procedure, and anesthetic management. All
patients were followed up at least until postoperative day 1, and all
complications, pain, and discomfort were noted. Statistical analysis was done to
assess the risk factors for complications.RESULTS A total of 2,031 patients were
included in the study. The most frequent surgical procedures performed were
phacoemulsification and posterior chamber artificial lens implantation (91.0%).
A total of 66 complications (3.3%) occurred in 60 patients. One patient had a
retrobulbar hemorrhage, and 59 had one or two more minor incidents or
pain/discomfort with the procedure. The complications consisted of
subconjunctival hematoma (1.3%), ocular hypertonia (0.4%), and chemosis (0.30%).
Statistical analysis revealed that inexperience in the technique represented a
risk factor for complications.CONCLUSIONS This is the first survey of a large
experience in episcleral single-injection anesthesia, a form of anesthesia that
does not preclude sharp-needle complications and does require training. Only one
complication occurred among 2,031 patients; however, a larger number of patients
is needed to definitively evaluate the safety of episcleral single-injection
anesthesia.

PMID: 14739813 [PubMed - as supplied by publisher]

40: Anesthesiology. 2004 Feb;100(2):309-14.

Long-term Impairment of Acquisition of a Spatial Memory Task following
Isoflurane-Nitrous Oxide Anesthesia in Rats.

Culley DJ, Baxter MG, Yukhananov R, Crosby G.

Instructor, double dagger Associate Professor, Department of Anesthesia, Harvard
Medical School, Brigham & Women's Hospital. dagger Assistant Professor,
Department of Psychology, Harvard University.

SUMMARY: BACKGROUND The authors demonstrated previously that isoflurane-nitrous
oxide anesthesia attenuates performance improvement on an already-learned
spatial memory task and that the effect persists for weeks. This experiment was
designed to test the hypothesis that learning of new information is particularly
susceptible to prolonged disruption after general anesthesia.METHODS Six- (n =
5) and 20- (n = 5) month-old male Fischer 344 rats were anesthetized for 2 h
with 1.2% isoflurane, 70% nitrous oxide, and 30% oxygen. Age-matched control
rats received 30% oxygen and 70% nitrogen (n = 5 per group). Rats breathed
spontaneously, and anesthetic and oxygen concentrations were measured. Spatial
learning was assessed daily for 21 days on a 12-arm radial maze (RAM) beginning
48 h after anesthesia. In a post hoc experiment to examine locomotion, swim
speed was assessed in a separate group of identically treated rats (n = 3 per
group) for 4 days beginning 48 h after anesthesia.RESULTS Aged rats were slower
to complete the maze, made fewer correct choices before first error, and made
more errors at baseline than young rats (P < 0.05). Anesthesia worsened maze
performance in both age groups, as evidenced by increased time to complete the
maze and a decreased number of correct choices before first error (P < 0.05),
but there were no statistically significant differences in total number of
errors. Interestingly, there were no age-by-anesthesia interactions. Aged rats
swam slower than adult rats (P < 0.001), but there were no differences between
the control and anesthesia groups.CONCLUSIONS Isoflurane-nitrous oxide
anesthesia is associated with a persistent deficit in RAM performance that is
not explained by impaired locomotion. This impairment occurs in adult and aged
rats, indicating that it is not an age-specific phenomenon. Thus, RAM
performance is altered after general anesthesia for longer than predicted by the
pharmacology of the drugs used, which, by inference, suggests a long-term
deficit in learning/memory.

PMID: 14739805 [PubMed - in process]

41: Anesthesiology. 2004 Feb;100(2):302-308.

Alterations in Rat Brain Proteins after Desflurane Anesthesia.

Futterer CD, Maurer MH, Schmitt A, Feldmann RE Jr, Kuschinsky W, Waschke KF.

Research Fellow, double dagger Candidate of Medicine, parallel Professor of
Anesthesiology, Department of Anesthesiology and Critical Care Medicine, Faculty
of Clinical Medicine Mannheim. dagger Research Fellow, section sign Professor of
Physiology and Chair, Department of Physiology and Pathophysiology, University
of Heidelberg.

SUMMARY: BACKGROUND Volatile anesthetics disappear from an organism after the
end of anesthesia. Whether changes of protein expression persist in the brain
for a longer period is not known. This study investigates the question of
whether the expression of proteins is altered in the rat brain after the end of
desflurane anesthesia.METHODS Three groups (n = 12 each) of rats were
anesthetized with 5.7% desflurane in air for 3 h. Brains were removed directly
after anesthesia, 24 h after anesthesia, or 72 h after anesthesia. Two
additional groups (n = 12 each) served as naive conscious controls, in which the
brains were removed without previous anesthesia 3 or 72 h after the start of the
experiment. Cytosolic proteins were isolated. A proteome-wide study was
performed, based on two-dimensional gel electrophoresis and mass
spectrometry.RESULTS Compared with conscious controls, significant (P < 0.05)
increase/decrease was found: 3 h of anesthesia, 5/2 proteins; 24 h after
anesthesia, 13/1 proteins; 72 h after anesthesia, 6/4 proteins. The overall
changes in protein expression as quantified by the induction factor ranged from
-1.67 (decrease to 60%) to 1.79 (increase by 79%) compared with the controls
(100%). Some of these regulated proteins play a role in vesicle transport and
metabolism.CONCLUSION Desflurane anesthesia produces changes in cytosolic
protein expression up to 72 h after anesthesia in the rat brain, indicating yet
unknown persisting effects.

PMID: 14739804 [PubMed - as supplied by publisher]

42: Anesthesiology. 2004 Feb;100(2):292-301.

An Investigation to Dissociate the Analgesic and Anesthetic Properties of
Ketamine Using Functional Magnetic Resonance Imaging.

Rogers R, Wise RG, Painter DJ, Longe SE, Tracey I.

Consultant Anaesthetist, Nuffield Department of Anesthetics, University of
Oxford, John Radcliffe Hospital. dagger Postdoctoral Research Fellow, Centre for
Functional Magnetic Resonance Imaging of the Brain, Department of Clinical
Neurology, University of Oxford, John Radcliffe Hospital; and Department Human
Anatomy and Genetics, University of Oxford. double dagger Anaesthetic Research
Fellow, Nuffield Department of Anesthetics, University of Oxford, John Radcliffe
Hospital; and Department of Human Anatomy and Genetics, University of Oxford.
section sign Research Assistant, Centre for Functional Magnetic Resonance
Imaging of the Brain, Department of Clinical Neurology, University of Oxford,
John Radcliffe Hospital. parallel University Lecturer, Head Pain Group, Centre
for Functional Magnetic Resonance Imaging of the Brain, Department of Clinical
Neurology, University of Oxford, John Radcliffe Hospital; and Department Human
Anatomy and Genetics, University of Oxford.

SUMMARY: BACKGROUND Anatomic sites within the brain, which activate in response
to noxious stimuli, can be identified with the use of functional magnetic
resonance imaging. The aim of this study was to determine whether the analgesic
effects of ketamine could be imaged.METHODS Ketamine was administered to eight
healthy volunteers with use of a target-controlled infusion to three predicted
plasma concentrations: 0 (saline), 50 (subanalgesic), and 200 ng/ml (analgesic,
subanesthetic). Volunteers received noxious thermal stimuli and auditory stimuli
and performed a motor task within a 3-T human brain imaging magnet. Activation
of brain regions in response to noxious and auditory stimuli and during the
motor task was compared with behavioral measures.RESULTS The analgesic
subanesthetic dose of ketamine significantly reduced the pain scores, and this
matched a decrease in activity within brain regions that activate in response to
noxious stimuli, in particular, the insular cortex and thalamus. A different
pattern of activation was observed in response to an auditory task. In
comparison, smaller behavioral and imaging changes were found for the motor
paradigm. The lower dose of ketamine gave similar but smaller nonsignificant
effects.CONCLUSION The analgesic effect can be measured within a more global
effect of ketamine as shown by auditory and motor tasks, and the analgesia
produced by ketamine occurs with a smaller degree of cortical processing in
pain-related regions.

PMID: 14739803 [PubMed - as supplied by publisher]

43: Anesthesiology. 2004 Feb;100(2):281-286.

Epidural Anesthesia, Hypotension, and Changes in Intravascular Volume.

Holte K, Foss NB, Svensen C, Lund C, Madsen JL, Kehlet H.

Research Fellow, # Professor of Surgery, Department of Surgical
Gastroenterology, dagger Research Fellow, section sign Associate Professor and
Division Chief, Department of Anesthesiology, parallel Assistant Professor,
Department of Clinical Physiology and Nuclear Medicine, Hvidovre University
Hospital. double dagger Associate Professor, Department of Anesthesiology,
University of Texas Medical Branch, Galveston, Texas.

SUMMARY: BACKGROUND The most common side effect of epidural or spinal anesthesia
is hypotension with functional hypovolemia prompting fluid infusions or
administration of vasopressors. Short-term studies (20 min) in patients
undergoing lumbar epidural anesthesia suggest that plasma volume may increase
when hypotension is present, which may have implications for the choice of
treatment of hypotension. However, no long-term information or measurements of
plasma volumes with or without hypotension after epidural anesthesia are
available.METHODS In 12 healthy volunteers, the authors assessed plasma
(125I-albumin) and erythrocyte (51Cr-EDTA) volumes before and 90 min after
administration of 10 ml bupivacaine, 0.5%, via a thoracic epidural catheter
(T7-T10). After 90 min (t = 90), subjects were randomized to administration of
fluid (7 ml/kg hydroxyethyl starch) or a vasopressor (0.2 mg/kg ephedrine), and
40 min later (t = 130), plasma and erythrocyte volumes were measured. At the
same time points, mean corpuscular volume and hematocrit were measured. Systolic
and diastolic blood pressure, heart rate, and hemoglobin were measured every 5
min throughout the study. Volume kinetic analysis was performed for the
volunteers receiving hydroxyethyl starch.RESULTS Plasma volume did not change
per se after thoracic epidural anesthesia despite a decrease in blood pressure.
Plasma volume increased with fluid administration but remained unchanged with
vasopressors despite that both treatments had similar hemodynamic effects.
Hemoglobin concentrations were not significantly altered by the epidural
blockade or ephedrine administration but decreased significantly after
hydroxyethyl starch administration. Volume kinetic analysis showed that the
infused fluid expanded a rather small volume, approximately 1.5 l. The
elimination constant was 56 ml/min.CONCLUSIONS Thoracic epidural anesthesia per
se does not lead to changes in blood volumes despite a reduction in blood
pressure. When fluid is infused, there is a dilution, and the fluid initially
seems to be located centrally. Because administration of hydroxyethyl starch and
ephedrine has similar hemodynamic effects, the latter may be preferred in
patients with cardiopulmonary diseases in which perioperative fluid overload is
undesirable.

PMID: 14739801 [PubMed - as supplied by publisher]

44: Anesthesiology. 2004 Feb;100(2):267-273.

Laryngeal Mask Airway Insertion by Anesthetists and Nonanesthetists Wearing
Unconventional Protective Gear: A Prospective, Randomized, Crossover Study in
Humans.

Flaishon R, Sotman A, Friedman A, Ben-Abraham R, Rudick V, Weinbroum AA.

Lecturer, Anesthesiology and Critical Care Department and Outpatient Surgery
Unit, dagger Resident, double dagger Staff Anesthesiologist, section sign
Lecturer, parallel Associate Professor, Anesthesiology and Critical Care
Department, # Senior Lecturer, Anesthesiology and Critical Care Department and
Post-Anesthesia Care Unit.

SUMMARY: BACKGROUND Mass casualty situations impose special difficulties in
airway management, even for experienced caregivers. The laryngeal mask airway is
part of the difficult airway algorithm. The authors evaluated the success rate
and the time to secure airways by mask by anesthetists, surgeons, and novices
when wearing either surgical attire or full antichemical protective gear that
included butyl rubber gloves and a filtering antigas mask.METHODS Twenty
anesthetists and 22 surgeons with 2-5 yr of residency inserted a laryngeal mask
airway in 84 anesthetized patients, and 6 novices repetitively inserted masks in
57 patients under both conditions in a prospective, randomized, crossover
manner. The duration of insertion was measured from the time the device was
first grasped until a normal capnography recording was obtained.RESULTS
Anesthetists needed 39 +/- 14 s to insert the masks when wearing surgical attire
and 40 +/- 12 s with protective gear. In contrast, surgery residents needed 64
+/- 40 and 102 +/- 40 s (P = 0.0001), respectively. Anesthetists inserted masks
in a single attempt, whereas the surgeons needed up to four attempts with no
hypoxia or failure associated. The initial attire-wearing novices' insertions
took as long as the surgeons'; three of them then reached the mean performance
time of the anesthetists after four (protective gear) and two (surgical attire)
trials, with only one occurrence of hypoxia and a failure rate similar to that
of the surgeons.CONCLUSIONS Anesthesia residents insert laryngeal mask airways
at a similar speed when wearing surgical attire or limiting antichemical
protective gear and two to three times faster than surgical residents or novices
wearing either outfit. Novices initially perform at the level of surgical
residents, but their learning curve was quick under both conditions.

PMID: 14739799 [PubMed - as supplied by publisher]

45: Anesthesiology. 2004 Feb;100(2):209-12.

Long-lasting Changes in Brain Protein Expression after Exposure to an
Anesthetic.

Hogan K.

Publication Types:
EditorialPMID: 14739789 [PubMed - in process]

46: Anesthesiology. 2004 Feb;100(2):5A-6A.

This Month in ANESTHESIOLOGY.

Henkel G.

Publication Types:
EditorialPMID: 14739787 [PubMed - in process]

47: Br Dent J. 2004 Jan 24;196(2):93-8.

A survey of the opinions of consultant anaesthetists in Scotland of sedation
carried out by dentists.

Shearer J, Wilson KE, Girdler NM.

1Staff Grade in Oral and Maxillofacial Surgery, Falkirk Royal Infirmary,
Falkirk.

Objectives To elicit the attitudes and opinions of consultant anaesthetists
working in Scotland, with regard to conscious sedation carried out by dental
practitioners.Method A questionnaire was designed to gauge opinion of consultant
anaesthetists in Scotland on the practice of conscious sedation by dentists. The
questionnaire was sent to 353 consultant anaesthetists working in 49 hospitals
within the 15 health boards in Scotland.Results Of the 366 questionnaires sent,
249 were returned of which 235 were valid. This gave a response rate of 64%. In
general, those questioned felt that the provision of sedation in a hospital
setting was more appropriate than in general dental practice. A majority (65%)
thought that it was unrealistic for anaesthetists to provide all sedation for
dental treatment, although many (58%) felt that anaesthetists should take more
responsibility in this area. Again, a majority (60%) agreed that dentists should
be trained to use sedation techniques for their patients but a significant
number (63%) disagreed with the practice of operator/sedationist.Conclusion It
is of concern to the dental profession that a significant number of
anaesthetists do not feel that it is appropriate for dentists to be
administering even the most simple methods of sedation. At present there are no
clear, recognised guidelines as to the level of formal training required for the
practice of conscious sedation by dentists. It is in the interests of the dental
profession and the public to ensure that those choosing to practice sedation do
so safely by following recognised guidelines in the training and practice of
sedation.

PMID: 14739967 [PubMed - in process]

48: Br Dent J. 2004 Jan 24;196(2):88.

What do anaesthetists think of sedation by GDPs?

Leitch J.

ObjectivesTo elicit the attitudes and opinions of consultant anaesthetists
working in Scotland, with regard to conscious sedation carried out by dental
practitioners.MethodA questionnaire was designed to gauge opinion of consultant
anaesthetists in Scotland on the practice of conscious sedation by dentists. The
questionnaire was sent to 353 consultant anaesthetists working in 49 hospitals
within the 15 health boards in Scotland.ResultsOf the 366 questionnaires sent,
249 were returned of which 235 were valid. This gave a response rate of 64%. In
general, those questioned felt that the provision of sedation in a hospital
setting was more appropriate than in general dental practice. A majority (65%)
thought that it was unrealistic for anaesthetists to provide all sedation for
dental treatment, although many (58%) felt that anaesthetists should take more
responsibility in this area. Again, a majority (60%) agreed that dentists should
be trained to use sedation techniques for their patients but a significant
number (63%) disagreed with the practice of operator/sedationist.ConclusionIt is
of concern to the dental profession that a significant number of anaesthetists
do not feel that it is appropriate for dentists to be administering even the
most simple methods of sedation. At present there are no clear, recognised
guidelines as to the level of formal training required for the practice of
conscious sedation by dentists. It is in the interests of the dental profession
and the public to ensure that those choosing to practice sedation do so safely
by following recognised guidelines in the training and practice of sedation.

PMID: 14739965 [PubMed - in process]

49: Br Dent J. 2004 Jan 24;196(2):79-81.

Necrotizing sialometaplasia: An unusual bilateral presentation associated with
antecedent anaesthesia and lack of response to intralesional steroids. Case
report and review of the literature.

Keogh PV, O'Regan E, Toner M, Flint S.

1Specialist Registrar in Oral Surgery, Department of Oral Surgery, Oral Medicine
and Oral Pathology, School of Dental Science, Trinity College Dublin, Ireland.

Necrotizing sialometaplasia is a self-limiting, variably ulcerated benign
process affecting minor salivary glands. Accurate histological diagnosis is
paramount, as it has been mistaken for malignancy, which has resulted in
excessively aggressive and unnecessary radical surgery. A unique case of
bilateral necrotizing sialometaplasia, presenting with anaesthesia of the
greater palatine nerves, is described. An attempt at active therapy with
intralesional steroids had no effect on the course of the condition.

PMID: 14739958 [PubMed - in process]

50: Neurosci Lett. 2003 Dec 15;353(1):37-40.

Increased corticortropin-releasing hormone release in ovariectomized rats'
paraventricular nucleus: effects of electroacupuncture.

Zhao H, Tian ZZ, Chen BY.

Department of Neurobiology, Shanghai Medical Center of Fudan University
(Formerly Shanghai Medical University), P.O. Box 291, 138 Yi-Xue-Yuan Road,
200032 Shanghai, China.

Utilizing push-pull perfusion, we examined secretary profiles of
corticotropin-releasing hormone (CRH) in the nucleus paraventricularis (PVN) of
freely moving intact (INT) and ovariectomized (OVX) rats, and in the meanwhile
the effects of electroacupuncture (EA) on the release patterns of CRH were
observed. The PVN was perfused with artificial cerebrospinal fluid between 08:00
and 12:00 h, and perfusates were collected every 10 min. The average CRH output
was significantly larger in OVX rats than that in INT and INT with EA (INT+EA)
groups. Interestingly enough, the CRH output showed a significant elevation in
OVX with EA (OVX+EA) group during the EA procedure and further increase
immediately after the EA. It is the first time to present the temporal profiles
of CRH secretion in the PVN of OVX and OVX+EA rats.

PMID: 14642432 [PubMed - indexed for MEDLINE]

51: Pediatr Dent. 2003 Nov-Dec;25(6):546-52.

Reasons for repeat dental treatment under general anesthesia for the healthy
child.

Sheller B, Williams BJ, Hays K, Mancl L.

Children's Hospital and Regional Medical Center, Seattle, Wash, USA.
b.sheller@seattlechildrens.org

PURPOSE: This study investigated reasons a healthy child may need repeat dental
treatment under general anesthesia (GA). METHODS: Experimental subjects were 23
healthy children who received dental treatment under GA twice; controls were 23
healthy children requiring a single dental treatment session under GA. Records
review determined demographics, intraoperative information, diagnosis, and
treatment provided. Parents of 11 subjects and 9 controls competed a
questionnaire and were interviewed. RESULTS: Many factors differed between
subject and control children. Common characteristics of children requiring
repeat care under GA (subjects) were: (1) 100% percent caries involvement of
maxillary central incisors at time of initial treatment; (2) majority of central
incisors were nonrestorable; (3) still using nursing bottle at the time of GA;
(4) child responsible for brushing own teeth; (5) poor cooperation in the
medical and dental setting; (6) difficult personality as described by parent;
(7) dysfunctional social situation; and (8) lack of follow-up dental care.
Stainless steel crowns were the most successful restoration placed. CONCLUSIONS:
A number of predictors were found to help identify high-risk children. Best
outcomes following dental rehabilitation under GA may result from aggressive
treatment of caries, active follow-up, and education of parents.

PMID: 14733468 [PubMed - in process]

52: Reg Anesth Pain Med. 2004 Jan-Feb;29(1):65-8.

Lower lobe collapse during continuous interscalene brachial plexus local
anesthesia at home.

Sardesai AM, Chakrabarti AJ, Denny NM.

OBJECTIVES: We report a case of pulmonary left lower lobe collapse following an
interscalene local anesthetic infusion administered at home. This case
highlights the need for patient education and postoperative communication.Case
report A 52-year-old male patient presented for a rotator cuff repair. He was a
chronic tobacco abuser with a history of occasional chest pain of unexplained
cause. An interscalene catheter was placed preoperatively and surgery was
performed under a combination of an interscalene block and a general anesthetic.
An infusion of 0.2% ropivacaine was started via the interscalene catheter
postoperatively and continued at home following his discharge from the hospital
on the third postoperative day. Within 24 hours of discharge, he was readmitted
to the hospital after complaining of chest pain and dyspnea. The patient was
seen in the emergency department by nonanesthesiologists who were not familiar
with the potential for interscalene blocks to cause diaphragmatic paresis.
CONCLUSIONS: Good communication must be maintained with the patient at all
times. Doctors from other specialties may be unaware of the potential
complications of an interscalene block.

PMID: 14727282 [PubMed - in process]

53: Reg Anesth Pain Med. 2004 Jan-Feb;29(1):58-9.

Regional anesthesia in a very low-birth-weight neonate for a neurosurgical
procedure.

Suresh S, Bellig G.

Background and objectives Peripheral nerve blocks can be successfully utilized
in infants for neurosurgical procedures. Our objective was utilizing a series of
peripheral nerve blocks for a neurosurgical procedure in a very low-birth-weight
neonate.Case report We report the use of supraorbital, great auricular, and
greater occipital nerve block in a very low-birth-weight neonate (700 g) who was
scheduled for a neurosurgical procedure. DISCUSSION: We were able to
successfully utilize peripheral nerve blocks and were able to blunt physiologic
responses to surgical stress without compromising hemodynamic stability using
high-dose opioids.

PMID: 14727280 [PubMed - in process]

54: Reg Anesth Pain Med. 2004 Jan-Feb;29(1):52-7.

Anesthesia and analgesia for colon surgery.

Liu SS.

PMID: 14727279 [PubMed - in process]

55: Reg Anesth Pain Med. 2004 Jan-Feb;29(1):17-22.

A low-dose bupivacaine: A comparison of hyperbaric and hypobaric solutions for
unilateral spinal anesthesia.

Kaya M, Oguz S, Aslan K, Kadiogullari N.

Background and objectives The injection of small doses of local anesthetic
solutions through pencil-point directional needles and maintaining the lateral
decubitus position for 15 to 30 minutes after the injection have been suggested
to facilitate the unilateral distribution of spinal anesthesia. We evaluated the
effects of hypobaric and hyperbaric bupivacaine in attempting to achieve
unilateral spinal anesthesia for patients undergoing lower limb orthopedic
surgery. METHODS: Fifty patients were randomly allocated into 2 groups to
receive either 1.5 mL hyperbaric bupivacaine 0.5% (7.5 mg; n = 25) or 4.2 mL
hypobaric bupivacaine 0.18% (7.5 mg; n = 25). Drugs were administered at the
L3-4 interspace with the patient in the lateral position. Patients remained in
this position for 15 minutes before turning supine for the operation. Spinal
block was assessed by pinprick and modified Bromage scale on both sides.
RESULTS: Unilateral spinal block was observed in 20 patients in the hyperbaric
group (80%) and in 19 patients in the hypobaric group (76%) while in the lateral
position. However, 15 minutes after patients were turned supine, unilateral
spinal anesthesia decreased to 68% of cases in the hyperbaric group and 24% of
cases in the hypobaric group (P <.05). The motor block was more intense during
the first 5 and 10 minutes (P <.05), but at the end of operation there was no
difference between the groups. The hemodynamic changes were similar between the
groups. CONCLUSION: As a result, unilateral spinal anesthesia with hyperbaric
and hypobaric bupivacaine provided a rapid motor and sensory recovery and good
hemodynamic stability, but more unilateral spinal block was achieved in patients
in the hyperbaric group when compared with patients in the hypobaric group.

PMID: 14727273 [PubMed - in process]