Text Version
Entrez PubMed
Overview
Help |
FAQ
Tutorial
New/Noteworthy
E-Utilities
PubMed Services
Journals Database
MeSH Database
Single Citation Matcher
Batch Citation Matcher
Clinical Queries
LinkOut
Cubby
Related Resources
Order Documents
NLM Gateway
TOXNET
Consumer Health
Clinical Alerts
ClinicalTrials.gov
PubMed Central
Privacy Policy
|
|
-
Are we going to talk with our anaesthesia monitors in the future?
Schmitz A, Weiss M.
Publication Types:
PMID: 14995952 [PubMed - in process]
-
Hepatopulmonary syndrome: a concern for the anesthetist? Pre-operative evaluation of hypoxemic patients with liver disease.
Mazzeo AT, Lucanto T, Santamaria LB.
Department of Neuroscience, Psychiatric and Anesthesiological Sciences, Section of Anesthesiology and Intensive Care, University Hospital Policlinico G. Martino, Via Consolare Valeria, 98121 Messina, Italy. annateresamazzeo@virgilio.it
Liver cirrhosis and other chronic hepatic diseases are followed in a subset of affected patients by gas exchange abnormalities resulting from a syndrome called hepatopulmonary syndrome (HPS). The structural basis of this clinical entity is an alteration of pulmonary vasculature resulting in abnormal vasodilatation and mismatching of ventilation and perfusion of the lung. Dilatation of the capillary bed near the gas exchange area is the most important factor implicated; it precludes O2 molecules diffusing to the centrum of the dilated vessels to oxygenate venous blood. Contrast (microbubbles) echocardiography and lung perfusion scan are, respectively, the screening tests with the highest sensitivity and specificity for HPS diagnosis. Because of the high morbidity and mortality of HPS, clinicians have been trying to understand the pathophysiology of pulmonary vasodilatation in the hope that the process can be reversed pharmacologically or surgically. An imbalance between production and clearance of vasoactive circulating substances has been implicated in the pathogenesis of HPS with glucagon and nitric oxide among the principal responsible factors. To date various molecules have been implicated for therapy but without definitive positive results. Liver transplantation remains the only real therapy for HPS, and resolution of gas exchange defects outlines the possible functional reversible nature of vascular abnormalities of this syndrome. The need to perform surgery under general anesthesia for hepatic and extrahepatic procedures in patients with HPS is followed by an increased peri-operative risk. The authors emphasize the role of pre-operative clinical evaluation for proper patient management during the peri-operative period.
PMID: 14995940 [PubMed - in process]
-
Pre-anesthetic maternal separation increases pups' locomotor behavior during emergence from anesthesia in rats.
Arai YC, Ueda W, Al-Chaer ED.
Department of Internal Medicine and Anatomy, University of Texas Medical Branch, Galveston, TX, USA. arainon@med.kochi-ms.ac.jp
BACKGROUND: Problematic behavior at emergence from anesthesia in children, partly linked with maternal separation, is a major problem in pediatric anesthesia. In humans, as well as in many other mammalian species, such separation causes psychological and behavioral changes. This study was to investigate whether or not pre-anesthetic maternal separation has a similar effect on rat pups. METHODS: This study was conducted on 66 3-week-old Sprague-Dawley male rats. The rats were divided into two groups; pups housed with a dam (n = 33) and those housed without (n = 33). Pups were anesthetized with 1.2% halothane for 30 min. Afterwards we recorded their locomotor behavior at emergence from general anesthesia using a video tracking system. RESULTS: Pre-anesthetic maternal separation significantly increased the maximum velocity and the distance traveled by pups at the emergence. CONCLUSION: Pre-anesthetic maternal separation influenced pups' locomotive behavior at emergence.
PMID: 14995939 [PubMed - in process]
-
Effect of desflurane/remifentanil anaesthesia on glucose metabolism during surgery: a comparison with desflurane/epidural anaesthesia.
Schricker T, Galeone M, Wykes L, Carli F.
Department of Anaesthesia, McGill University Health Centre, Royal Victoria Hospital, 687 Pine Avenue West, Rm. S5.05, Montreal, Quebec, Canada H3A 1A1. thomas.schricker@mcgill.ca
BACKGROUND: The aim of this study was to investigate the effect of general anaesthesia combined with remifentanil or epidural blockade on glucose metabolism during surgery. METHODS: We randomly assigned patients undergoing elective colorectal surgery to receive either desflurane anaesthesia supplemented with intravenous remifentanil (n = 7) or desflurane anaesthesia supplemented with epidural bupivacaine (n = 7). Plasma concentrations of glucose, lactate, free fatty acids (FFA), insulin, glucagon and cortisol were measured before and after 2 h of surgery. Pre- and intraoperative whole body glucose production and glucose clearance, an indicator of glucose uptake, were determined by an isotope dilution technique using [6,6-2H2]glucose. RESULTS: In both groups intraoperative glucose production ( P< 0.05) and uptake ( P< 0.05) decreased. Plasma glucose concentrations ( P< 0.05) increased during surgery but did not exceed the normal range (remifentanil group: 5.7 +/- 0.7 mmol l-1, epidural group: 5.8 +/- 0.4 mmol l-1). The plasma concentrations of lactate, FFA, insulin and glucagon remained unchanged during the operation. The plasma cortisol concentration in both groups increased intraoperatively (P< 0.05). CONCLUSION: Both desflurane/remifentanil and desflurane/epidural anaesthesia decrease the intraoperative rate of whole body glucose production, thereby attenuating the hyperglycaemic response to colorectal surgery.
PMID: 14995938 [PubMed - in process]
-
Recovery characteristics and post-operative delirium after long-duration laparoscope-assisted surgery in elderly patients: propofol-based vs. sevoflurane-based anesthesia.
Nishikawa K, Nakayama M, Omote K, Namiki A.
Department of Anesthesia, Muroran City General Hospital, Yamate-chou 3-8-1, Muroran, Hokkaido 051-8512, Japan. nkouki@sapmed.ac.jp
BACKGROUND: Post-operative mental dysfunction may be an important problem in elderly patients. This study was designed to compare the effects of propofol and sevoflurane anesthesia on recovery characteristics and the incidence of post-operative delirium (POD) in long-duration laparoscopic surgery for elderly patients. METHODS: Fifty ASA physical status I-II patients over the age of 65 scheduled for laparoscopic surgery lasting 3 h or more randomly received propofol (group P, n = 25) or sevoflurane (group S, n = 25) for both induction and maintenance of general anesthesia. Both groups were combined with continuous perioperative epidural analgesia. The level of primary anesthetics was adjusted to maintain changes in mean arterial pressure within 20% of the pre-anesthetic values. The emergence times from anesthesia (eye opening, extubation, response to command, and orientation) were recorded, and the occurrence of POD was assessed by the delirium rating scale (DRS) during the first 3 days after surgery. All patients received oxygen and continuous epidural analgesia postoperatively. RESULTS: Immediate emergence, i.e. eye opening and extubation was significantly faster after sevoflurane (P < 0.05). There was no significant difference between the incidences of POD in the two groups during the first 3 days after surgery. The scores for DRS on day 2 and 3 after surgery, however, were significantly higher in group P than in group S (P < 0.01). CONCLUSION: Sevoflurane may be preferable to propofol for general anesthesia in combination with epidural analgesia with respect to less effect on mental function during the early postoperative period for long-duration laparoscopic surgery in elderly patients.
PMID: 14995937 [PubMed - in process]
-
Time-frequency balanced spectral entropy as a measure of anesthetic drug effect in central nervous system during sevoflurane, propofol, and thiopental anesthesia.
Vakkuri A, Yli-Hankala A, Talja P, Mustola S, Tolvanen-Laakso H, Sampson T, Viertio-Oja H.
Department of Anesthesia, Surgical Hospital, Helsinki University Hospital, Kasarmikatu 11-13, PO Box 263, 00029 HUS, Helsinki, Finland. anne.vakkuri@hus.fi
BACKGROUND: Time-frequency balanced spectral entropy of electroencephalogram (EEG) and frontal electromyogram (FEMG) is a novel measure of hypnosis during anesthesia. Two Entropy parameters are described: Response entropy (RE) is calculated from EEG and FEMG; and State Entropy (SE) is calculated mainly from EEG. This study was performed to validate their performance during transition from consciousness to unconsciousness under different anesthetic agents. METHODS: Response entropy, SE [S/5 Entropy Module, M-ENTROPY (later in text: Entropy), Datex-Ohmeda Division, Instrumentarium Corp., Helsinki, Finland] and BIS (BIS XP, A-2000, Aspect Medical Systems, Newton, MA) data were collected from 70 patients; 30 anesthetized with propofol 2 mg kg-1, 20 with sevoflurane inhalation, and 20 with thiopental 5 mg kg-1. Loss and regaining of consciousness (LOC, ROC) was tested every 10 s, and sensitivity, specificity, and prediction probability (Pk) were calculated. Behavior of the indices was studied. RESULTS: Sensitivity, specificity, and Pk values for consciousness were high and similar for all indices. During regaining of consciousness after propofol bolus, RE, SE, and BIS values recovered by 81 +/- 22%, 75 +/- 26%, and 59 +/- 18% (mean +/- SD), respectively, from the minimum relative to their baseline. After thiopental bolus, RE, SE, and BIS values recovered by 86+/-21%, 88 +/- 13%, and 63 +/- 14%, respectively. The relative rise was higher in RE and SE compared with BIS (P < 0.01). During deep levels of hypnosis, RE and SE decreased monotonously as a function of burst suppression ratio, while BIS showed biphasic behavior. On average, RE indicated emergence from anesthesia 11 s earlier than SE, and 12.4 s earlier than BIS. CONCLUSIONS: All indices, RE, SE, and BIS, distinguished excellently between conscious and unconscious states during propofol, sevoflurane, and thiopental anesthesia. During burst suppression, Entropy parameters RE and SE, but not BIS, behave monotonously. During regaining of consciousness after a thiopental or propofol bolus, RE and SE values recovered significantly closer to their baseline values than did BIS. Response entropy indicates emergence from anesthesia earlier than SE or BIS.
PMID: 14995935 [PubMed - in process]
[Perioperative use of medical hypnosisTherapy options for anaesthetists and surgeons]
[Article in German]
Hermes D, Trubger D, Hakim SG, Sieg P.
Klinik fur Kiefer- und Gesichtschirurgie, Universitatsklinikum Schleswig-Holstein/Campus Lubeck.
BACKGROUND. Surgical treatment of patients under local anaesthesia is quite commonly restricted by limited compliance from the patient. An alternative to treatment under pharmacological sedation or general anaesthesia could be the application of medical hypnosis. With this method, both suggestive and autosuggestive procedures are used for anxiolysis, relaxation, sedation and analgesia of the patient. PATIENTS AND METHODS. During a 1-year period of first clinical application, a total of 207 surgical procedures on a non-selected collective of 174 patients were carried out under combined local anaesthesia and medical hypnosis. RESULTS. Medical hypnosis proved to be a standardisable and reliable method by which remarkable improvements in treatment conditions for both patient and surgeons were achievable. CONCLUSION. Medical hypnosis is not considered to be a substitute for conscious sedation or general anaesthesia but a therapeutic option equally interesting for anaesthesists and surgeons.
PMID: 14999398 [PubMed - as supplied by publisher]
-
Trauma in pregnancyPerioperative anesthetic considerations for the head-injured pregnant trauma victim.
Kuczkowski KM.
Departments of Anesthesiology and Reproductive Medicine, University of California, San Diego, California, USA, kkuczkowski@ucsd.edu
PMID: 14991198 [PubMed - in process]
|