Ultimo Aggiornamento: 6 Gennaio 2004

1: Anaesth Intensive Care. 2003 Aug;31(4):355-6.

Changing the guard.

Baker B.

Publication Types:
EditorialPMID: 12973956 [PubMed - indexed for MEDLINE]

2: Anaesthesia. 2004 Jan;59(1):100-102.

Abstracts from the Society of Intravenous Anaesthesia (UK)'s Annual Scientific
Meeting in Glasgow, 30-31 May 2003.

[No authors listed]

PMID: 14687122 [PubMed - as supplied by publisher]

3: Anaesthesia. 2004 Jan;59(1):94.

Peripartum anaesthetic management of a parturient with spinal cord injury and
autonomic hyperreflexia.

Ribes Pastor MP, Vanarase M.

Stoke Mandeville Hospital, Aylesbury HP21 8AL, UKE-mail: pura.ribes@smh.nhs.uk

PMID: 14687113 [PubMed - in process]

4: Anaesthesia. 2004 Jan;59(1):92-3.

Images in clinical anaesthesia: extrathoracic post-traumatic lung herniation.

Bui PK, Kuczkowski KM.

UCSD Medical Center, San Diego, CA 92103-8770, USAE-mail: kkuczkowski@ucsd.edu

PMID: 14687109 [PubMed - in process]

5: Anaesthesia. 2004 Jan;59(1):44-51.

Anaesthetic management in facial bipartition surgery: The experience of one
centre.

Mallory S, Yap LH, Jones BM, Bingham R.

Consultant Paediatric Anaesthetist, Department of Anaesthesia Fellow in
Craniofacial Surgery Consultant in Plastic and Reconstructive Surgery,
Department of Craniofacial Surgery, Great Ormond Street Hospital, London WC1,
UK.

Facial bipartition is amongst the most radical craniofacial surgery undertaken
but is performed rarely. There is little published information on its
anaesthetic management. We undertook a retrospective case-note review of 22
consecutive patients undergoing bipartition surgery by the same surgical team in
one centre in the period 1993-2001. There were incomplete data for two cases and
these were therefore excluded. Patients were aged 2 months to 19 years.
Conditions treated were facial cleft (n = 5), frontonasal dysplasia (n = 7) and
facial dysostosis (n = 8).Intra-operative complications included major
haemorrhage (n = 4), bradycardia (n = 3) and unintentional tracheal extubation
(n = 1). There were no peri-operative deaths. All patients required
intra-operative blood transfusion and 15% of them had a postoperative
haemoglobin concentration > 115% of their pre-operative value. In this series,
four patients required postoperative lung ventilation for a median duration of 3
days. Infants < 14 months old were significantly more likely to receive a
massive blood transfusion (p = 0.0002), to have an excessively high
postoperative haematocrit (p = 0.008) and to require postoperative lung
ventilation (p = 0.0002) compared with older patients. We conclude that patients
in this age group have a significantly increased risk of postoperative
complications.

PMID: 14687098 [PubMed - in process]

6: Anaesthesia. 2004 Jan;59(1):10-14.

The effect of nitrous oxide on cerebral blood flow velocity in children
anaesthetised with sevoflurane.

Rowney DA, Fairgrieve R, Bissonnette B.

Consultant in Paediatric Anaesthesia, Royal Hospital for Sick Children, Sciennes
Road, Edinburgh EH9 1LF, UK Consultant in Paediatric Anaesthesia, Department of
Anaesthesia, Royal Hospital for Sick Children, Glasgow, UK Professor of
Anaesthesia & University of Toronto, The Hospital for Sick Children, Toronto,
Canada.

To determine the effects of nitrous oxide on middle cerebral artery blood flow
velocity (CBFV) during sevoflurane anaesthesia in children, CBFV was measured
using transcranial Doppler sonography in 16 ASA I or II children. Anaesthesia
consisted of 1.0 MAC sevoflurane in 30% oxygen with intermittent positive
pressure ventilation maintaining FEco2 at 38 mmHg (5.0 kPa) and a caudal
epidural block using 0.25% bupivacaine 1.0 ml.kg-1. The remainder of the
inspired gas was varied in one of two sequences either air/nitrous oxide/air or
nitrous oxide/air/nitrous oxide. The results showed that CBFV decreased when
nitrous oxide was replaced by air (p = 0.03) and returned to its initial value
when nitrous oxide was reintroduced. CBFV increased when air was replaced by
nitrous oxide (p = 0.04) and returned to its initial value when air was
reintroduced. Mean heart rate and blood pressure remained constant. We conclude
that nitrous oxide increases cerebral blood flow velocity in healthy children
anaesthetised with 1.0 MAC sevoflurane.

PMID: 14687092 [PubMed - as supplied by publisher]

7: Anesth Analg. 2004 Jan;98(1):260-3, table of contents.

Mechanical versus manual ventilation via a face mask during the induction of
anesthesia: a prospective, randomized, crossover study.

von Goedecke A, Voelckel WG, Wenzel V, Hormann C, Wagner-Berger HG, Dorges V,
Lindner KH, Keller C.

Department of Anesthesiology and Critical Care Medicine,
Leopold-Franzens-University, Anichstrasse 35, 6020 Innsbruck, Austria.
achim.von-goedecke@uibk.ac.at

One approach to make ventilation safer in an unprotected airway has been to
limit tidal volumes; another one might be to limit peak airway pressure,
although it is unknown whether adequate tidal volumes can be delivered.
Accordingly, the purpose of this study was to evaluate the quality of automatic
pressure-controlled ventilation versus manual circle system face-mask
ventilation regarding ventilatory variables in an unprotected airway. We studied
41 adults (ASA status I-II) in a prospective, randomized, crossover design with
both devices during the induction of anesthesia. Respiratory variables were
measured with a pulmonary monitor (CP-100). Pressure-controlled mask ventilation
versus circle system ventilation resulted in lower (mean +/- SD) peak airway
pressures (10.6 +/- 1.5 cm H(2)O versus 14.4 +/- 2.4 cm H(2)O; P < 0.001), delta
airway pressures (8.5 +/- 1.5 cm H(2)O versus 11.9 +/- 2.3 cm H(2)O; P < 0.001),
expiratory tidal volume (650 +/- 100 mL versus 680 +/- 100 mL; P = 0.001),
minute ventilation (10.4 +/- 1.8 L/min versus 11.6 +/- 1.8 L/min; P < 0.001),
and peak inspiratory flow rates (0.81 +/- 0.06 L/s versus 1.06 +/- 0.26 L/s; P <
0.001) but higher inspiratory time fraction (48% +/- 0.8% versus 33% +/- 7.7%; P
< 0.001) and end-tidal carbon dioxide (34 +/- 3 mm Hg versus 33 +/- 4 mm Hg; not
significant). We conclude that in this model of apneic patients with an
unprotected airway, pressure-controlled ventilation resulted in reduced
inspiratory peak flow rates and peak airway pressures when compared with circle
system ventilation, thus providing an additional patient safety effect during
mask ventilation. IMPLICATIONS: In this model of apneic patients with an
unprotected airway, pressure-controlled ventilation resulted in reduced
inspiratory peak flow rates and lower peak airway pressures when compared with
circle system ventilation, thus providing an additional patient safety effect
during face-mask ventilation.

PMID: 14693633 [PubMed - in process]

8: Anesth Analg. 2004 Jan;98(1):240-1, table of contents.

Risperidone and exaggerated hypotension during a spinal anesthetic.

Williams JH, Hepner DL.

Department of Anesthesia and Critical Care, Massachusetts General Hospital,
Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA.

Antipsychotic medications are often continued through pregnancy and may have
important anesthetic interactions. For example, risperidone is an antipsychotic
medication with therapeutic effects mediated by dopaminergic and serotonergic
antagonism. However, it also possesses potent alpha-1 adrenergic antagonism.
Here we report a case of a parturient with bipolar disease, controlled with
lithium and risperidone, undergoing a spinal anesthetic for a cesarean delivery.
The parturient developed exaggerated hypotension, refractory to conventional
treatment with ephedrine and IV fluids, that eventually responded to large doses
of phenylephrine. Risperidone alpha-antagonism should be a consideration for any
patient receiving this medication during neuraxial anesthesia. Treatment of
significant and refractory hypotension with an alpha-1 agonist such as
phenylephrine may be warranted. IMPLICATIONS: Parturients receiving neuraxial
blocks may be taking antipsychotic medications. Although the therapeutic effects
of antipsychotic medications are mediated by dopaminergic and serotonergic
antagonism, many possess alpha-adrenergic antagonist properties. We report a
case of exaggerated hypotension during a spinal anesthetic for cesarean delivery
that may have been a result of the alpha-adrenergic antagonism of risperidone.

PMID: 14693627 [PubMed - in process]

9: Anesth Analg. 2004 Jan;98(1):235-9, table of contents.

A comparison of duration of analgesia of intrathecal 2.5 mg of bupivacaine,
ropivacaine, and levobupivacaine in combined spinal epidural analgesia for
patients in labor.

Lim Y, Ocampo CE, Sia AT.

Department of Anesthesia, KK Women's and Children's Hospital, 100 Bukit Timah
Road, Singapore 229899, Republic of Singapore.

We assessed the duration of labor analgesia rendered by intrathecal (IT) local
anesthetics as the sole drugs. In this randomized, controlled, and
double-blinded study, labor analgesia was induced using combined spinal-epidural
technique in 60 ASA physical status I nulliparous parturients with IT
bupivacaine 2.5 mg (group B), ropivacaine 2.5 mg (group R), or levobupivacaine
2.5 mg (group L). Pain scores (0-100 visual analog scale) and blood pressure
were recorded pre-block and for the first 30 min post-block. The degree of motor
block and the highest sensory block were also monitored. The duration of
analgesia (our primary outcome) was the longest in group B but was similar
between groups R and L (mean +/- SE, 76.3 +/- 5.9 min versus 52.6 +/- 4.0 min
and 51.5 +/- 3.4 min, respectively, P < 0.05). Group B had the most frequent
incidence of lower limb motor block but there was no difference between groups R
and L (5 of 20 parturients versus 2 of 20 and 0 of 20, respectively, P < 0.05).
The profile of the other side effects was indistinguishable between the groups.
With the current regimen, IT bupivacaine produced the longest duration of labor
analgesia. IMPLICATIONS: Intrathecal 2.5 mg bupivacaine significantly prolongs
the duration of analgesia in laboring patients compared with ropivacaine or
levobupivacaine. This suggests that, at clinically relevant doses, bupivacaine
may have greater potency.

PMID: 14693626 [PubMed - in process]

10: Anesth Analg. 2004 Jan;98(1):230-4, table of contents.

Intrathecal meperidine decreases shivering during cesarean delivery under spinal
anesthesia.

Roy JD, Girard M, Drolet P.

Departement d'Anesthesiologie, Hopital Maisonneuve-Rosemont, Universite de
Montreal, 5415 Boul l'Assomption, Montreal, Quebec, Canada H1T 2M4.

Shivering associated with spinal anesthesia is uncomfortable and may interfere
with monitoring. We performed this prospective, double-blinded, and randomized
study to determine whether intrathecal meperidine (0.2 mg/kg) decreases the
incidence and intensity of shivering after spinal anesthesia for cesarean
delivery. Forty parturients scheduled for nonemergent cesarean delivery were
enrolled in two groups. Spinal anesthesia consisted of hyperbaric bupivacaine
(0.75%; 10.5 mg), morphine 0.15 mg, and, in the experimental group, meperidine
(0.2 mg/kg) or, in the control group, normal saline. Data collection, including
sensory block level, blood pressure, core temperature, and shivering intensity,
was performed every minute for 10 min, every 3 min for 33 min, and then every 5
min until the sensory level receded to L4. Time to highest sensory level,
maximum number of blocked segments, sensory and motor blockade regression, and
systolic blood pressure showed no difference between groups. The incidence of
shivering was less (P < 0.02) in the meperidine group, as was its intensity (P <
0.003). Intrathecal meperidine (0.2 mg/kg) is effective in reducing the
incidence and intensity of shivering associated with spinal anesthesia for
cesarean delivery. IMPLICATIONS: Previous studies have suggested that IV
meperidine is helpful for treating intraoperative shivering. This study was
undertaken to evaluate spinal meperidine and found that it decreases the
incidence and intensity of shivering associated with spinal anesthesia for
cesarean delivery.

PMID: 14693625 [PubMed - in process]

11: Anesth Analg. 2004 Jan;98(1):224-9.

The effects of prolonged ambulation on labor with epidural analgesia.

Frenea S, Chirossel C, Rodriguez R, Baguet JP, Racinet C, Payen JF.

Department of Anesthesiology, Albert Michallon Hospital, BP 217, 38043 Grenoble,
France.

Ambulation during labor is becoming more popular, although its impact on the
progress of labor and on pain intensity remains unclear. We wondered whether
prolonged ambulation with epidural analgesia had a possible effect on duration
of labor and pain. In this prospective, randomized trial, 61 parturients with
uncomplicated term pregnancies were allocated to be recumbent (n = 31) or to
ambulate (n = 30). Epidural analgesia was provided with intermittent
administrations of 0.08% bupivacaine-epinephrine plus 1 microg/mL of sufentanil.
Of the 30 women assigned to the ambulatory group, 25 actually walked. Their
ambulating time was 64 +/- 34 min (mean +/- SD), i.e., 29% +/- 16% of the first
stage. There were no differences between the two groups in the length of labor
and in pain visual analog scale scores. However, the ambulatory group received
smaller doses of bupivacaine (6.4 +/- 2.2 mg/h versus 8.4 +/- 3.6 mg/h; P =
0.01) and of oxytocin (6.0 +/- 3.7 mUI/min versus 10.2 +/- 8.8 mUI/min; P <
0.05). A greater ability to void was also found in the ambulatory group (P <
0.01). Although the duration of labor and pain relief was unchanged, these
findings support that ambulation during labor may be advantageous. IMPLICATIONS:
This study compared the duration of labor and pain relief between parturients
receiving epidural analgesia who were ambulated or were recumbent. Whereas
walking had no impact on either duration of labor or pain relief, it was
associated with a reduction in both bupivacaine and oxytocin requirements.

PMID: 14693624 [PubMed - in process]

12: Anesth Analg. 2004 Jan;98(1):141-7, table of contents.

Acupuncture decreases somatosensory evoked potential amplitudes to noxious
stimuli in anesthetized volunteers.

Meissner W, Weiss T, Trippe RH, Hecht H, Krapp C, Miltner WH.

Department of Anesthesiology and Intensive Care, Friedrich-Schiller-University
Jena, 07740 Jena, Germany. meissner@med.uni-jena.de

The effect of acupuncture on pain perception is controversial. Because late
amplitudes of somatosensory evoked potentials (SEPs) to noxious stimuli are
thought to correlate with the subjective experience of pain intensity, we
designed this study to detect changes of these SEPs before and after acupuncture
in a double-blinded fashion. Sixteen volunteers were anesthetized by propofol
and exposed to painful electric stimuli to the right forefinger. Then, blinded
to the research team, the acupuncture group (n = 8) was treated with electric
needle acupuncture over 15 min at analgesic points of the leg, whereas the sham
group (n = 8) received no treatment. Thereafter, nociceptive stimulation was
repeated. SEPs were recorded during each noxious stimulation from the vertex Cz,
and latencies and amplitudes of the N150 and P260 components were analyzed by
analysis of variance. P260 amplitudes decreased from 4.40 +/- 2.76 microV (mean
+/- SD) before treatment to 1.67 +/- 1.21 microV after treatment (P < 0.05),
whereas amplitudes of the sham group remained unchanged (2.64 +/- 0.94 microV
before versus 2.54 +/- 1.54 microV after treatment). In conclusion, this
double-blinded study demonstrated that electric needle acupuncture, as compared
with sham treatment, significantly decreased the magnitudes of late SEP
amplitudes with electrical noxious stimulation in anesthetized subjects,
suggesting a specific analgesic effect of acupuncture. IMPLICATIONS: This
double-blinded study demonstrates that electric needle acupuncture, as compared
with sham treatment, significantly decreases the magnitudes of late
somatosensory evoked potential amplitudes with electrical noxious stimulation in
anesthetized subjects, suggesting a specific analgesic effect of acupuncture.

PMID: 14693608 [PubMed - in process]

13: Anesth Analg. 2004 Jan;98(1):132-4, table of contents.

Correlation of bispectral index and Guedel's stages of ether anesthesia.

Bhargava AK, Setlur R, Sreevastava D.

Department of Anesthesiology and Critical Care, Armed Forces Medical College,
Pune 411040, India. colakbamc@yahoo.com

Bispectral index (BIS) analysis is a method of electroencephalograph (EEG)
analysis based on the interfrequency phase relationships of the EEG, designed to
quantify anesthetic hypnosis. The BIS was created after concurrent collection of
EEG and clinical data from a large number of patients anesthetized with various
drugs over a prolonged period and then performing a Fourier analysis followed by
a bispectral calculation. The clinical stages of anesthetic depth are very well
demonstrated in etherized patients. In this study, we studied the BIS changes
during various stages of ether anesthesia and quantified the hypnotic depth
during the surgical stage of ether anesthesia. The values for BIS under various
stages and planes of ether anesthesia were recorded in 21 patients listed for
short surgical procedures. During diethyl ether anesthesia, BIS initially
increased and subsequently decreased. During surgical anesthesia, a BIS value of
30 was observed. IMPLICATIONS: For the first time, bispectral index (BIS) has
been studied in patients being anesthetized solely with ether. Ether both causes
an increase and decrease in BIS during induction and emergence. The index
observed during the surgical stage of ether anesthesia is probably the correct
value for the depth of hypnosis because no other volatile anesthetic can produce
the true anesthetic state when used alone. This value could be taken as the
value to be attained when balanced anesthesia is being practiced.

PMID: 14693605 [PubMed - in process]

14: Anesth Analg. 2004 Jan;98(1):128-31, table of contents.

Assessing propofol induction of anesthesia dose using bispectral index analysis.

Gurses E, Sungurtekin H, Tomatir E, Dogan H.

Department of Anesthesiology, Pamukkale University School of Medicine, Zambak
Sok No: 8, 20045 Yenisehir Denizli, Turkey. elgurses@pamukkale.edu.tr

In this study we sought to determine the propofol requirement and hemodynamic
effects as guided by bispectral index (BIS) analysis during induction of
anesthesia. Sixty patients were enrolled in this study. Propofol, 2 mg/kg, was
given to Group I for induction. Propofol was administered for induction until
loss of response to verbal commands and until BIS values were around 50 to
Groups II and III. After induction, the smallest BIS value was different in
Group I. Decreases in total propofol dose were 36% and 43% in Groups II and III
respectively as compared with Group I. The dose of propofol assessed by BIS
analysis results in an important reduction of propofol requirement without side
effects. IMPLICATIONS: Hypotension during induction of anesthesia with propofol
is common. This study has shown that propofol requirement assessed by bispectral
index analysis during anesthesia induction may decrease the dose and side
effects and provide for satisfactory depth of anesthesia.

PMID: 14693603 [PubMed - in process]

15: Anesth Analg. 2004 Jan;98(1):123-7, table of contents.

Alaris AEP monitor's "Click Detection" does not help to detect inadvertent
disconnection of headphones during anesthesia.

Schmidt GN, Bischoff P, Standl T, Gerhardt A, Lankenau G, Schulte em Esch J.

Department of Anesthesiology, University Hospital Eppendorf, Martinistrasse 52,
20246 Hamburg, Germany. guschmid@uke.uni-hamburg.de

Auditory evoked potentials (AEP) can be suppressed by anesthetics dose
dependently, but may fail to be registered because of the absence of adequate
auditory stimuli. The Alaris AEP monitor includes the "Click Detection" (CD)
(generating the message "NO AEP" or "LOW AEP") to detect the loss of auditory
stimuli. We investigated the accuracy of the CD in 17 patients awake (AWAKE) and
during anesthesia (ANESTHESIA) with accurately placed headphones (HP) and after
disconnected HP (No HP) over 5 min each, respectively. Alaris AEP ARX index, CD,
and Bispectral Index were recorded each minute. Changes were evaluated with the
Friedman and Wilcoxon test. Sensitivity (SEN) and specificity (SPE) and receiver
operating characteristic curve were analyzed for the accuracy of the CD. During
AWAKE after disconnection of the HP, Alaris AEP ARX index decreased
significantly (P < 0.05). The CD was able to detect No HP after 2 min with a SEN
of 88% and a SPE of 97%. During ANESTHESIA, no changes were found after HP
disconnection. CD detected No HP with a SEN of 100% and a SPE of 20%. The CD of
the Alaris AEP monitor is not able to detect unnoticed disconnection of HP
during ANESTHESIA. IMPLICATIONS: Signal transmission of auditory evoked
potentials can be suppressed by anesthetics, but also by disconnection of
headphones. In the present study, we demonstrate that even the Alaris AEP
monitor with the very new feature "Click Detection" was not able to detect the
loss of headphones during general anesthesia with propofol and remifentanil.

PMID: 14693602 [PubMed - in process]

16: Anesth Analg. 2004 Jan;98(1):64-7, table of contents.

Levobupivacaine for pediatric spinal anesthesia.

Kokki H, Ylonen P, Heikkinen M, Reinikainen M.

Department of Anesthesiology and Intensive Care, Kuopio University Hospital, PO
Box 1777, FIN-70211 Kuopio, Finland. hannu.kokki@kuh.fi

In this clinical trial we evaluated the clinical effects of levobupivacaine in
spinal anesthesia in children. An open, noncomparative study was performed on 40
children, aged 1-14 yr, undergoing elective lower abdominal or lower limb
surgery. A plain solution of S(-)-bupivacaine 5 mg/mL at a mean dose of 0.3
mg/kg body weight (range, 0.2-0.5 mg/kg body weight) was administered via the
L3-4 or L4-5 interspace with the patient in the lateral decubitus position.
After injection, the patients were placed supine. The spread and duration of
sensory analgesia and the degree of motor block were recorded. Satisfactory
surgical anesthesia was achieved in 39 of the 40 children. One child received
supplemental anesthesia. The mean highest level of sensory block was T4 (range,
T2 to L1), and the mean time to the regression of sensory block to T10 was 90
min (range, 43-185 min). A complete motor block was achieved in 36 children.
These results are similar to those obtained with racemic bupivacaine in
subarachnoid anesthesia in children. IMPLICATIONS: This noncomparative,
descriptive study showed that levobupivacaine, the S(-)-enantiomer of
bupivacaine, has equivalent clinical efficacy in spinal anesthesia in children
to that of racemic bupivacaine.

PMID: 14693586 [PubMed - in process]

17: Anesth Analg. 2004 Jan;98(1):60-3, table of contents.

Single-dose dexmedetomidine reduces agitation after sevoflurane anesthesia in
children.

Ibacache ME, Munoz HR, Brandes V, Morales AL.

Departamento de Anestesiologia, Escuela de Medicina, Pontificia Universidad
Catolica de Chile, PO Box 114-D, Marcoleta 367, Santiago, Chile.
mibacach@med.puc.cl

Emergence agitation is a common side effect of sevoflurane anesthesia in
children. Dexmedetomidine, because of its sedative and analgesic properties,
might be useful for the management of this adverse effect. We studied the effect
of dexmedetomidine on recovery characteristics in 90 children aged 1 to 10 yr
scheduled to undergo superficial lower abdominal and genital surgery. After
inhaled induction with sevoflurane, patients were randomly assigned to receive
saline (Group 1, n = 30), dexmedetomidine 0.15 micro g/kg (Group 2, n = 30), or
dexmedetomidine 0.30 micro g/kg (Group 3, n = 30). After a laryngeal mask airway
insertion a caudal block was performed in all patients. Maintenance of
anesthesia was with 1% end-tidal sevoflurane and 50% nitrous oxide and
spontaneous ventilation. Intraoperative hemodynamic and respiratory variables
were recorded every 5 min. At the end of anesthesia time to eyes opening (TEO)
and characteristics of emergence were recorded. General and intraoperative
variables were similar in the 3 groups. The TEO was 7.5 +/- 5.0 min in Group 1,
8.2 +/- 5.0 min in Group 2, and 9.8 +/- 4.0 min in Group 3 (NS). The incidence
(95% confidence interval) of agitation was 37% (20%-54%) in Group 1, 17%
(4%-30%) in Group 2, and 10% (0%-21%) in Group 3 (P < 0.05). Paired comparisons
showed a significant difference for Group 1 versus Group 3 (P < 0.05, 95%
confidence interval of the difference: 7%-47%). The time to discharge from the
postanesthesia care unit was similar for the 3 groups. We conclude that a dose
of dexmedetomidine 0.3 micro g/kg administered after induction of anesthesia
reduces the postsevoflurane agitation in children and with no adverse effects.
IMPLICATIONS: In children undergoing surgery using sevoflurane anesthesia,
dexmedetomidine 0.3 micro g/kg administered in 10 min after induction reduced
the incidence of emergence agitation from 37% in the control group to 10%. No
adverse effects attributable to dexmedetomidine were observed.

PMID: 14693585 [PubMed - in process]

18: Anesth Analg. 2004 Jan;98(1):56-9, table of contents.

Clonidine prolongs spinal anesthesia in newborns: a prospective dose-ranging
study.

Rochette A, Raux O, Troncin R, Dadure C, Verdier R, Capdevila X.

Department of Anesthesia and Intensive Care "A", Hopital Lapeyronie, CHU de
Montpellier, 371 Avenue du doyen G. Giraud, 34295 Montpellier Cedex 5, France.
a-rochette@chu-montpellier.fr

Spinal anesthesia may reduce the incidence of morbidity that follows general
anesthesia in neonates and in former preterm infants. However, bupivacaine alone
provides a block too short for complete surgery in up to 40% of the patients.
Clonidine lengthens spinal anesthesia in adults and caudal block in children
without significant side effects. We conducted a controlled, prospective,
dose-ranging study of clonidine in spinal anesthesia in 75 neonates, including
50% of former preterm infants, undergoing elective inguinal herniorrhaphy.
Patients were given a spinal anesthetic with either 0.5% plain isobaric
bupivacaine (1 mg/kg), or bupivacaine plus 0.25, 0.5, 1, or 2 micro g/kg
clonidine. Mean arterial blood pressure, heart rate, SpO(2), sensory block
extension and duration were the main data recorded. Mean arterial blood
pressure, heart rate, SpO(2), and block extension were similar in the five
groups. Duration of spinal block increased from 67 (58-82) min in the control
group up to 111 (93-125) min in the group receiving 1 micro g/kg clonidine (P <
0.003). Transient hypotension occurred more often (P < 0.05), and caffeine was
given more often, when 2 micro g/kg clonidine was given. We conclude that 1
micro g/kg clonidine provides a significant improvement in spinal anesthesia
duration in newborns without significant side effects. IMPLICATIONS: Spinal
anesthesia is suitable but often too short for complete surgery in newborns.
This controlled, randomized, prospective, dose-ranging study was conducted in 75
neonates to test the hypothesis that clonidine could significantly lengthen
bupivacaine spinal block. Clonidine 1 micro g/kg, added to spinal isobaric
bupivacaine, doubles the duration of the block without significant deleterious
hemodynamic or respiratory side effects.

PMID: 14693584 [PubMed - in process]

19: Anesth Analg. 2004 Jan;98(1):40-5, table of contents.

Orthostatic hypotension occurs frequently in the first hour after anesthesia.

Cowie DA, Shoemaker JK, Gelb AW.

Department of Anesthesia and Perioperative Medicine, London Health Sciences
Centre, The University of Western Ontario, 339 Windermere Road, London, Ontario
N6A 5A5, Canada.

Symptoms of orthostatic intolerance are common after general anesthesia and are
associated with an increased risk of postoperative morbidity. The contribution
of orthostatic hypotension (OH) has not been well defined. We conducted a
head-up tilt test on patients after general anesthesia for minor surgery to
assess the incidence of and risk factors for OH after general anesthesia.
One-hundred-four patients were enrolled and were prospectively divided into four
groups: older female, older male, young female, and young male. The incidence of
OH was 76.0%, 72.0%, 45.5%, and 62.5% respectively and was associated with
increasing age (P < 0.05) and posttest dizziness (P < 0.05). Body mass index,
preoperative blood pressure, ASA class, anesthetic duration, IV fluid
administration, and use of analgesics and antiemetics in the postanesthetic care
unit were not different in subjects who demonstrated OH compared with those with
a normotensive response. Subjects with OH after general anesthesia did not
increase their heart rate and diastolic blood pressure with a head-up tilt which
may have been caused by persistent effects of anesthetics on reflex
cardiovascular control and/or bedrest-induced dysregulation of reflex
cardiovascular control. We conclude that OH is common after general anesthesia
for minor surgery and may be the major cause of postoperative orthostatic
intolerance. IMPLICATIONS: Orthostatic hypotension, a failure to maintain blood
pressure on assuming an upright posture, is common after general anesthesia for
minor surgery and may be the major cause of postoperative orthostatic
intolerance.

PMID: 14693580 [PubMed - in process]

20: Anesthesiology. 2004 Jan;100(1):197.

Topical anesthesia is the technique of choice for routine cataract surgery.

Sosis MB, Guise PA.

Publication Types:
LetterPMID: 14695750 [PubMed - in process]

21: Anesthesiology. 2004 Jan;100(1):191-3.

Mechanisms of Hypotension and Bradycardia during Regional Anesthesia in the
Sitting Position.

Liguori GA, Kahn RL, Gordon MA, Urban MK, Campagna JA, Carter C.

Hospital for Special Surgery, Weill Medical College of Cornell University, New
York, New York. lliguorig@hss.edu

Publication Types:
LetterPMID: 14695746 [PubMed - in process]

22: Anesthesiology. 2004 Jan;100(1):183-5.

Anesthesia management of orthotopic liver transplantation in a patient with
mustard repair of transposition of great arteries and superior vena caval
obstruction.

Boucek C, Krishnamurthy M D P, Marsh JW, Lee J.

Associate Professor of Clinical Anesthesiology, dagger Assistant Professor of
Anesthesiology, double dagger Department of Surgery, and section sign Department
of Cardiology.

PMID: 14695743 [PubMed - in process]

23: Anesthesiology. 2004 Jan;100(1):176-7.

Concerning neurologic sequelae of spinal anesthesia.

Vandam LD.

Retired, Department of Anesthesiology, Perioperative and Pain Management,
Brigham and Women's Hospital.

SUMMARY: Long-term follow-up of patients who received 10,098 spinal anesthetics:
Failure to discover major neurological sequelae. By Robert D. Dripps and Leroy
D. Vandam. JAMA 1954; 156:1486-91.The goal of this study was to determine the
incidence and severity of neurologic complications after spinal anesthesia and
to examine the factors contributing to these complications. Early and late
effects of 10,098 spinal anesthetics were analyzed in 8,460 patients treated at
the Hospital of the University of Pennsylvania between 1948 and 1951. The
comparison groups were comprised of 1,000 patients undergoing similar procedures
under general anesthesia and 75 patients who received spinal anesthesia after
general anesthesia. Follow-up data on 8,987 spinal anesthetics were obtained 6
months after surgery via mailed questionnaire or by physical
examination.Patients of both sexes, ranging in age from 10 to 89 yr, were
included. Exclusion criteria for spinal anesthesia were reports of a previous
unsatisfactory spinal anesthetic, neurologic disease, backache, frequent
headaches, difficulty with the legs, or infections of the back. Lumbar puncture
was performed with needles ranging from 16- to 24-gauge. Spinal anesthetic
preparations used included tetracaine, procaine, dibucaine, piridocaine, and
pyrrolocaine with or without epinephrine and dextrose. Patients were examined
postoperatively to discover neurologic disease. Follow-up questions determined
whether patients would choose a spinal anesthetic again, if they experienced any
untoward effects, and their current condition. When possible, additional
information was obtained from patients with suspicious symptoms. Only one case
of incapacitating neurologic disease was observed in the 6-month follow-up
examinations after the spinal anesthetic. The patient had an asymptomatic
meningioma of the spinal cord. No patients developed cauda equina syndrome,
transverse myelitis, or meningeal or epidural sepsis. The primary minor
neurologic sequela was headache (9% in male patients and 15% in female
patients). Transient minor sequelae included backache, pain and numbness in the
extremity, and an occasional weakness in the leg. Neurologic complications are
uncommon after spinal anesthesia with careful patient selection, meticulous
technique, and use of safe concentrations of spinal anesthetic mixtures.

PMID: 14695740 [PubMed - in process]

24: Anesthesiology. 2004 Jan;100(1):106-114.

Influence of Lumbosacral Cerebrospinal Fluid Density, Velocity, and Volume on
Extent and Duration of Plain Bupivacaine Spinal Anesthesia.

Higuchi H, Hirata JI, Adachi Y, Kazama T.

Chief Anesthesiologist, Department of Anesthesia, Self Defense Force Hanshin
Hospital. dagger Chief Radiologist, Department of Radiology, Kyorin Hospital.
double dagger Research Assistant, section sign Professor and Chairman,
Department of Anesthesiology, National Defense Medical College.

SUMMARY: BACKGROUND The current study was designed to investigate the influence
of lumbosacral cerebrospinal fluid (CSF) density, velocity, and volume on the
extent and duration of plain bupivacaine spinal anesthesia.METHODS Forty-one
patients scheduled to undergo orthopedic surgery with spinal block were
enrolled. Lumbosacral CSF volumes were calculated from low thoracic, lumbar, and
sacral axial magnetic resonance images. CSF velocity at the L3-L4 level was
derived from phase-contrast magnetic resonance images. Spinal anesthesia was
performed in the lateral decubitus position. CSF (2 ml) was sampled to measure
CSF density before injection of 3 ml plain bupivacaine (0.5%). Statistical
correlation coefficients (rho) between CSF characteristics and measurements of
spinal anesthesia were assessed by Spearman rank correlation. In addition,
stepwise multiple linear regression models were used to select important
predictors of measures of spinal anesthesia.RESULTS There was a significant
correlation between CSF density and peak sensory block level (rho = 0.33, P =
0.034). Lumbosacral CSF volume inversely correlated with peak sensory block
level (rho = -0.65, P < 0.0001) and positively correlated with onset time of
complete motor block (rho = 0.42, P = 0.008). CSF volume also inversely
correlated with time required for regression of the sensory block to L1 (rho =
-0.35, P = 0.026) and L2 (rho = -0.33, P = 0.039). There was a significant
inverse correlation between peak diastolic CSF velocity and duration of motor
blockade (rho = -0.44, P = 0.005). Multiple regression analysis revealed that
weight and CSF volume significantly contributed to the peak sensory block level
(R2 = 0.46).CONCLUSIONS These findings indicate that CSF density and volume
influence the spread of spinal anesthesia with plain bupivacaine and that CSF
volume also influences the duration of spinal anesthesia. CSF velocity might
also influence the duration of plain bupivacaine spinal anesthesia.

PMID: 14695731 [PubMed - as supplied by publisher]

25: Anesthesiology. 2004 Jan;100(1):98-105.

Chronic Pain Management: American Society of Anesthesiologists Closed Claims
Project.

Fitzgibbon DR, Posner KL, Domino KB, Caplan RA, Lee LA, Cheney FW.

Associate Professor, section sign Clinical Professor, parallel Assistant
Professor, # Professor and Chair, Department of Anesthesiology; dagger Research
Associate Professor, Departments of Anesthesiology and Anthropology (adjunct),
double dagger Professor, Departments of Anesthesiology and Neurological Surgery
(adjunct).

SUMMARY: BACKGROUND The practice of chronic pain management has grown steadily
in recent years. The purpose of this study was to identify and describe issues
and trends in liability related to chronic pain management by
anesthesiologists.METHODS Data from 5,475 claims in the American Society of
Anesthesiologists Closed Claims Project database between 1970 and 1999 were
reviewed to compare liability related to chronic pain management with that
related to surgical and obstetric (surgical/obstetric) anesthesia. Acute pain
management claims were excluded from analysis. Outcomes and liability
characteristics between 284 pain management claims and 5,125 surgical/obstetric
claims were compared.RESULTS Claims related to chronic pain management increased
over time (P < 0.01) and accounted for 10% of all claims in the 1990s.
Compensatory payment amounts were lower in chronic pain management claims than
in surgical/obstetric anesthesia claims from 1970 to 1989 (P < 0.05), but during
the 1990s, there was no difference in size of payments. Nerve injury and
pneumothorax were the most common outcomes in invasive pain management claims.
Epidural steroid injections accounted for 40% of all chronic pain management
claims. Serious injuries, involving brain damage or death, occurred with
epidural steroid injections with local anesthetics and/or opioids and with
maintenance of implantable devices.CONCLUSIONS Frequency and payments of claims
associated with chronic pain management by anesthesiologists increased in the
1990s. Brain damage and death were associated with epidural steroid injection
only when opioids or local anesthetics were included. Anesthesiologists involved
in home care of patients with implanted devices such as morphine pumps and
epidural injections or patient-controlled analgesia should be aware of potential
complications that may have severe outcomes.

PMID: 14695730 [PubMed - as supplied by publisher]

26: Anesthesiology. 2004 Jan;100(1):59-69.

Differential Activation of Mitogen-activated Protein Kinases in Ischemic and
Anesthetic Preconditioning.

Da Silva R, Grampp T, Pasch T, Schaub MC, Zaugg M.

Ph.D. Student, dagger Laboratory Technician, section sign Professor of
Pharmacology, Institute of Pharmacology and Toxicology, University of Zurich.
double dagger Professor and Chairman, Institute of Anesthesiology, University
Hospital Zurich. parallel Director, Cardiovascular Anesthesia Laboratory,
Institute of Anesthesiology, University Hospital Zurich, and Institute of
Pharmacology and Toxicology, University of Zurich.

SUMMARY: BACKGROUND Accumulating evidence pinpoints to the pivotal role of
mitogen-activated protein kinases (MAPKs) in the signal transduction underlying
cardiac preconditioning.METHODS PD98059, an inhibitor of extracellular
signal-regulated protein kinase (MEK-ERK1/2), and SB203580, an inhibitor of p38
MAPK, were used to evaluate the role of MAPKs with respect to postischemic
functional recovery in isolated perfused rat hearts subjected to ischemic
preconditioning (IPC) and anesthetic preconditioning (APC). Western blot
analyses were used to determine the degree of ERK1/2 and p38 MAPK activation
after the application of the preconditioning stimulus and after
ischemia-reperfusion. Immunohistochemical staining served to visualize
subcellular localization of activated MAPKs.RESULTS PD98059 and SB203580
abolished postischemic functional recovery in IPC but not in APC. IPC but not
APC markedly activated ERK1/2 and p38 MAPK, which were abrogated by
coadministration of the specific blockers. Conversely, IPC and APC enhanced
ERK1/2 activity after ischemia-reperfusion as compared to nonpreconditioned
hearts, and IPC in addition enhanced p38 MAPK activity. Coadministration of
PD98059 and SB203580 during IPC but not during APC inhibited postischemically
enhanced MAPK activities. Moreover, chelerythrine and 5-hydroxydecanoate,
effective blockers of IPC and APC, annihilated IPC- and APC-induced enhanced
postischemic responses of MAPKs. Finally, administration of PD98059 during
ischemia-reperfusion diminished the protective effects of IPC and APC.
Immunohistochemistry revealed increased ERK1/2 activity primarily in
intercalated discs and nuclei and increased p38 MAPK activity in the sarcolemma
and nuclei of IPC-treated hearts.CONCLUSIONS Although MAPKs may orchestrate
cardioprotection as triggers and mediators in IPC, they are devoid of
triggering, but they may have mediator effects in APC.

PMID: 14695725 [PubMed - as supplied by publisher]

27: Anesthesiology. 2004 Jan;100(1):44-50.

Monitoring of Immobility to Noxious Stimulation during Sevoflurane Anesthesia
Using the Spinal H-reflex.

Rehberg B, Grunewald M, Baars J, Fuegener K, Urban BW, Kox WJ.

Privatdozent, dagger Medical Student, double dagger Resident, # Professor,
Department of Anesthesiology, Humboldt-University, Charite Campus Mitte.
parallel Professor, Department of Anesthesiology, University of Bonn, Bonn,
Germany.

SUMMARY: BACKGROUND The spinal H-reflex has been shown to correlate with
surgical immobility, i.e., the absence of motor responses to noxious
stimulation, during isoflurane anesthesia. Here, the authors established
individual concentration-response functions for H-reflex amplitude and tested
the predictive power of the H-reflex for movement responses during sevoflurane
anesthesia in comparison to electroencephalographic parameters. In addition,
they investigated the effect of noxious stimulation on the H-reflex
itself.METHODS The authors studied 12 female patients during sevoflurane
anesthesia before surgery. The sevoflurane concentration was increased, a
laryngeal mask was inserted, and then the sevoflurane concentration was
decreased until H-reflex amplitude (recorded over the soleus muscle) recovered.
Thereafter, the end-tidal sevoflurane concentration was kept at a constant value
close to the minimum alveolar concentration for suppression of movement
responses after tetanic stimulation (MACtetanus), determined by the Dixon
up-down method. Pharmacodynamic modeling of H-reflex amplitude and of the
Bispectral Index was performed, and predictive values for motor responses to
noxious electrical stimulation (50 Hz, 60 mA tetanus, volar forearm) were
compared using the prediction probability.RESULTS Concentration-dependent
depression of H-reflex amplitude by sevoflurane was well modeled (median r2 =
0.97) by a sigmoid function with a median EC50 of 1.5 vol% and a median slope
parameter of 3.7, much steeper than the slope for the Bispectral Index.
MACtetanus calculated by logistic regression was 1.6 vol%. H-reflex amplitude
predicted motor responses to noxious stimulation with a prediction probability
of 0.76, whereas the prediction probability for Bispectral Index and spectral
edge frequency (SEF95) were not different from chance alone. Noxious stimulation
was followed by a substantial increase of H-reflex amplitude for several
minutes, whereas the Bispectral Index and SEF95 exhibited no significant
changes.CONCLUSIONS Suppression of movement to noxious stimulation and
suppression of H-reflex amplitude by sevoflurane follow similar
concentration-response functions. Although this does not imply a causal
relation, it explains the high predictive value of H-reflex amplitude for motor
responses to noxious stimuli, even in a narrow concentration range around the
MACtetanus.

PMID: 14695723 [PubMed - in process]

28: Anesthesiology. 2004 Jan;100(1):5A-6A.

This Month in ANESTHESIOLOGY.

Henkel G.

Publication Types:
EditorialPMID: 14695717 [PubMed - in process]

29: Br Dent J. 2003 Sep 27;195(6):305-10.

General medicine and surgery for dental practitioners Part 9: haematology and
patients with bleeding problems.

Meechan JG, Greenwood M.

Department of Oral and Maxillofacial Surgery, The Dental School, Framlington
Place, Newcastle upon Tyne NE2 4BW.

Disorders of the blood can affect the management of dental patients. Particular
oral signs may be produced. In addition healing may be affected and the choice
of anaesthesia for operative procedures will be influenced. Similarly, patients
who have problems with haemostasis are a concern. Surgical procedures are
obvious problems. However, restorative dentistry is not trouble-free as patients
with bleeding problems may present difficulties regarding the choice of local
anaesthesia, as regional block techniques may be contraindicated in some
patients.

PMID: 14512990 [PubMed - indexed for MEDLINE]

30: Eur J Anaesthesiol. 2003 Dec;20(12):973-8.

Sub-Tenon's block reduces both intraoperative and postoperative analgesia
requirement in vitreo-retinal surgery under general anaesthesia.

Farmery AD, Shlugman D, Rahman R, Rosen P.

Oxford Eye Hospital, Department of Anaesthetics, Oxford, UK.
andrew.farmery@nda.ox.ac.uk

BACKGROUND AND OBJECTIVE: We compared the effects of sub-Tenon's local
anaesthetic block and placebo on peri-operative opioid requirement and
cardiovascular stability and on postoperative pain, nausea and vomiting in
patients undergoing vitreo-retinal surgery under general anaesthesia. METHODS:
We studied 43 patients undergoing vitreo-retinal surgery under general
anaesthesia in a randomized double blind study. Patients received a standard
general anaesthetic followed by a sub-Tenon's injection of 4-5 mL of either
bupivacaine 0.75% or saline. We recorded intraoperative invasive arterial
pressure, then the incidence and severity of pain and of nausea and vomiting,
for 24 h postoperatively. RESULTS: In the sub-Tenon's bupivacaine group, there
was a significant reduction in the perioperative opioid use and a reduction in
the frequency of bradycardia and hypertensive episodes, defined as a rise > 25%
of baseline for a duration of > 3 min. The sub-Tenon's bupivacaine group also
had significantly lower pain scores and nausea scores at 12 h, concomitant with
a lower consumption of analgesia and antiemetics. CONCLUSIONS: This local
anaesthetic technique is effective in vitreo-retinal surgery and can be safely
applied to this population of patients regardless of axial length.

PMID: 14690100 [PubMed - in process]

31: Eur J Anaesthesiol. 2003 Dec;20(12):967-72.

User acceptance of an anaesthesia information management system.

Quinzio L, Junger A, Gottwald B, Benson M, Hartmann B, Jost A, Banzhaf A,
Hempelmann G.

University Hospital Giessen, Department of Anaesthesiology, Intensive Care and
Pain Therapy, Germany.

BACKGROUND AND OBJECTIVE: This paper describes the user acceptance of an
anaesthesia information management system at the University Hospital in Giessen,
Germany, after 5 yr of routine use. METHODS: A questionnaire with 75 items was
distributed to all anaesthesiologists and anaesthetic nurses of the Department
of Anaesthesiology. The questions were answered anonymously on a five-point
Likert scale. RESULTS: The return rate was 60% (44 physicians and 24 nurses).
The results indicated that the system generally met user expectations. The
respondents thought that electronic record keeping improved the quality of their
work, and they did not want to switch back to paper records. Problems arose with
hardware placement and software features, e.g. coding tools for diagnoses and
type of surgery. The perceived quality of training strongly influenced user
acceptance. CONCLUSIONS: Despite the deficits revealed by the survey, the
respondents did not want to switch back to manual record keeping. A structured
user survey is a useful tool for the development, adaptation and implementation
of an anaesthesia information management system. A training strategy that takes
the needs of the users into account is recommended.

PMID: 14690099 [PubMed - in process]

32: J Cardiothorac Vasc Anesth. 2003 Dec;17(6):C3.

Academic anesthesiologist.

[No authors listed]

PMID: 14689436 [PubMed - as supplied by publisher]

33: J Cardiothorac Vasc Anesth. 2003 Dec;17(6):785-787.

CME in cardiothoracic and vascular anesthesia.

[No authors listed]

PMID: 14689431 [PubMed - as supplied by publisher]

34: J Cardiothorac Vasc Anesth. 2003 Dec;17(6):740-3.

Anesthetic management for a hypertensive patent ductus arteriosus (PDA) closure
in a patient with surgically uncorrectable long-segment right pulmonary artery
hypoplasia and a ventricular septal defect.

Neema PK, Unnikrishnan M, Sinha PK, Rathod RC.

PMID: 14689417 [PubMed - in process]

35: J Cardiothorac Vasc Anesth. 2003 Dec;17(6):691-3.

Propofol-ketamine mixture for anesthesia in pediatric patients undergoing
cardiac catheterization.

Kogan A, Efrat R, Katz J, Vidne BA.

OBJECTIVE: To evaluate the safety of a propofol-ketamine mixture to induce and
maintain anesthesia in spontaneously breathing pediatric patents during cardiac
catheterization. DESIGN: Prospective clinical study. SETTING: Departments of
Cardiothoracic Surgery, Anesthesiology, and Pediatric Anesthesiology in a
university hospital. PARTICIPANTS: Forty-five children aged 6 months to 16 years
with ASA grade II to III undergoing cardiac catheterization. INTERVENTIONS:
Continuous intravenous infusion of a mixture of propofol (4 mg/mL) and ketamine
(2 mg/mL) with spontaneous ventilation. The infusion rate was changed and
additional boluses of propofol or/and ketamine were given as needed.
Hemodynamic, respiratory, and other variables were recorded during the procedure
and recovery. RESULTS: Mean dose of ketamine was 26 +/- 8.3 microg/kg/min and of
propofol, 68.3 +/- 21.7 microg/kg/min. Changes in heart rate and mean arterial
pressure of more than 20% from baseline were observed in 4 and 5 patients,
respectively. A transient reduction in oxygen saturation because of
hypoventilation was observed in 3 patients and responded to oxygen
administration and manual assisted ventilation. No other complications were
observed. CONCLUSIONS: The propofol-ketamine mixture is a safe, practical
alternative for general anesthesia in pediatric patients undergoing cardiac
catheterization.

PMID: 14689406 [PubMed - in process]

36: J Cardiothorac Vasc Anesth. 2003 Dec;17(6):686-90.

Which anesthetic agent alters the hemodynamic status during pediatric
catheterization? comparison of propofol versus ketamine.

oKlu E, Bulutcu Fs F, Yalcin Y, Ozbek U, Cakali E, Bayindir O.

OBJECTIVE: To compare the effects of propofol and ketamine on systemic and
pulmonary circulations in pediatric patients scheduled for elective cardiac
catheterization. DESIGN: Prospective, randomized, and blinded. SETTING:
University hospital. PARTICIPANTS: Children (n = 41) undergoing cardiac
catheterization. INTERVENTIONS: All children were premedicated with oral
midazolam 60 minutes before the procedure. Patients were separated into 3 groups
according to shunts diagnosed by transthoracic echocardiography before the
catheterization procedure: patients without cardiac shunt (Group I, n = 11),
left-to-right shunt (Group II, n = 12), and right-to-left shunt (Group III, n =
18). A continuous infusion of propofol (100-200 microg/kg/min) or ketamine
(50-75 microg/kg/min) was randomly started in all groups to obtain immobility
during the procedure. Hemodynamic data, including systemic venous, pulmonary
artery and vein, aortic saturations and pressures, were recorded; Qp/Qs were
calculated. The same set of data was recorded before discontinuation of
infusions at the end of the procedure.Measurements and main results After the
propofol administration, in all 3 patient groups propofol infusion was
associated with significant decreases in systemic mean arterial pressure. In
groups with cardiac shunts (Group II and III), propofol infusion significantly
decreased systemic vascular resistance and increased systemic blood flow,
whereas pulmonary vascular resistance and pulmonary blood flow did not change
significantly. These changes resulted in decreased left-to-right shunting and
increased right-to-left shunting; the pulmonary-to-systemic flow ratio decreased
significantly. On the other hand, after ketamine infusion, systemic mean
arterial pressure increased significantly in all patient groups, but pulmonary
mean arterial pressure, systemic vascular resistance, and pulmonary vascular
resistance were unchanged. CONCLUSION: In children with cardiac shunting, the
principal hemodynamic effect of propofol is a decrease in systemic vascular
resistance. In children with intracardiac shunting, this results in an increase
in right-to-left shunting and a decrease in the ratio of pulmonary to systemic
blood flow, which may lead to arterial desaturation. Ketamine did not produce
these changes. The authors suggested that during cardiac catheterization in
children, both the anesthesiologists and cardiologists need to know that
anesthetic agents can significantly alter the hemodynamic status in children
with complex congenital heart defects and affect the results of hemodynamic
calculations that are important for decision-making and treatment of these
patients.

PMID: 14689405 [PubMed - in process]

37: J Cardiothorac Vasc Anesth. 2003 Dec;17(6):683-5.

An anesthesiologist for all pediatric cardiac catheterizations: Luxury or
necessity?

Andropoulos DB, Stayer SA.

PMID: 14689404 [PubMed - in process]

38: Obstet Gynecol. 2003 Nov;102(5 Pt 2):1191-4.

Arnold-Chiari malformation in a pregnant woman.

Sicuranza GB, Steinberg P, Figueroa R.

Department of Obstetrics and Gynecology, Winthrop-University Hospital, Mineola,
New York, USA.

BACKGROUND: The Arnold-Chiari malformation type I is characterized by the
prolapse of the cerebellar tonsils below the foramen magnum. There is a lack of
literature on the management of a pregnancy in a woman affected by an
Arnold-Chiari malformation. CASE: A young primipara with severe headaches
underwent an elective primary cesarean delivery under general anesthesia
successfully. Five years earlier, she had undergone neurosurgical resection for
filum terminale syndrome shortly after her first pregnancy (term vaginal
delivery) and decompression of a type I Arnold-Chiari malformation 4 months
later. CONCLUSION: Careful selection of anesthetic technique for the delivery of
a woman with an Arnold-Chiari malformation is of paramount importance.

Publication Types:
Case ReportsPMID: 14607053 [PubMed - indexed for MEDLINE]