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Unusual complication during knee arthroscopy.
Tommaso OD, Nistico A, Vitullo A.
Publication Types:
PMID: 14984540 [PubMed - indexed for MEDLINE]
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Check the capnograph.
Gauthama P, Morris E.
Publication Types:
PMID: 14984538 [PubMed - indexed for MEDLINE]
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The effect of gas flow on the filtration performance of breathing system filters.
Wilkes AR.
Department of Anaesthetics and Intensive Care Medicine, University of Wales College of Medicine, Heath Park, Cardiff CF14 4XN, UK. wilkes@cf.ac.uk
When tested according to the European standard, the performance of breathing system filters is determined at a flow of 15 or 30 l.min-1 for filters intended for use with paediatric or adult patients, respectively. However, higher flows of gas may pass through a filter in some circumstances. The penetration of sodium chloride particles through seven different breathing system filters (three pleated hydrophobic and four electrostatic) was measured at five different flows ranging from 15 to 75 l.min-1. Penetration varied from 0.004% to 24.4% for the various filters at the different flows. Penetration increased by between 2 and 40 times for the different filters as the flow increased by a factor of five but this did not markedly alter the rank order of the filters in terms of performance. Testing to the standard provides a useful indication of relative performance at any flow.
PMID: 14984527 [PubMed - indexed for MEDLINE]
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The moisture-conserving performance of breathing system filters during the first three minutes of simulated use.
Wilkes AR.
Department of Anaesthetics and Intensive Care Medicine, University of Wales College of Medicine, Heath Park, Cardiff CF14 4XN, UK. wilkes@cf.ac.uk
Breathing system filters are recommended for use during anaesthesia to protect the patient from inhaling gas-borne particles. Filters placed at the patient connection port of the breathing system can also humidify the inspired gases. The end-inspired moisture content was measured when using five different filters with two different ventilatory test conditions on a patient model during a typical pre-oxygenation period of 3 min. The moisture content of the end-inspired air at the end of the 3-min period varied from 6.4 to 27.8 and from 4.4 to 25.9 g.m-3 for tidal volumes of 0.5 and 1.0 l, respectively (p < 0.0001 for all pairwise comparisons of the five filters and for the two tidal volumes). Those breathing system filters that have at least an adequate level of performance (at least 20 g.m-3) will generally achieve this level within the 3-min pre-oxygenation period.
PMID: 14984525 [PubMed - indexed for MEDLINE]
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Thrombocytopenia in the parturient.
Kam PC, Thompson SA, Liew AC.
Department of Anaesthesia, University of NSW at St. George Hospital, Kogarah, NSW 2217, Australia. p.kam@unsw.edu.au
Thrombocytopenia in pregnant women can be associated with substantial maternal and neonatal morbidity. It may result from a range of conditions and early implementation of some specific treatment may improve both maternal and neonatal outcome. In this review we discuss the clinical features of the more common causes of thrombocytopenia associated with pregnancy, and provide an overview of the anaesthetic considerations.
Publication Types:
PMID: 14984524 [PubMed - indexed for MEDLINE]
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Measuring tracheal airway pressures during transtracheal jet ventilation: an observational study.
Patel C, Diba A.
Department of Anaesthesia, Queen Victoria Hospital, East Grinstead, RH19 3DZ, UK.
Tracheal airway pressures were measured via a transduced fibrescope during transtracheal jet ventilation in 10 patients. Ravussin transtracheal jet ventilation catheters were inserted under local anaesthesia. Following induction of general anaesthesia, tracheal airway pressures were measured at three anatomical levels during fibreoptic intubation. Overall pressure changes during transtracheal jet ventilation were small with the maximal pressure increase (13 mmHg) measured at the carina.
PMID: 14984522 [PubMed - indexed for MEDLINE]
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Subcutaneous tissue oxygen tension after coronary revascularisation with and without cardiopulmonary bypass.
Cody C, Buggy DJ, Marsh B, Moriarity DC.
University Department of Anaesthesia and Intensive Care Medicine, Mater Misericordiae University Hospital, Dublin 7, Ireland.
Directly measured subcutaneous tissue oxygen tension reflects the adequacy of regional tissue oxygenation and influences wound infection and healing. We tested the hypothesis that off-pump coronary artery bypass would increase subcutaneous tissue oxygen tension by minimizing cardiopulmonary bypass-induced systemic inflammation. Ten consecutive patients scheduled for off-pump coronary artery bypass were compared with 10 undergoing conventional cardiopulmonary bypass. All patients had a tissue oxygen sensor implanted longitudinally into the subcutaneous tissue of the leg in the saphenous vein harvest wound. Data were collected from closure of the saphenous vein wound for 20 h postoperatively. Although more off-pump patients had only one coronary artery grafted, postoperative subcutaneous tissue oxygen tension was significantly higher in off-pump patients throughout the 20-h study. Absolute mean (SD) differences ranged from 2.3 kPa in the first 2 h [14.4 (2.3) vs. 12.1 (2.4) kPa in off-pump and cardiopulmonary bypass, respectively, p = 0.04] to 4.6 kPa at 8-10 h [14.0 (3.5) vs. 9.3 (2.7) kPa, p = 0.007]. In contrast, there were no significant differences in arterial oxygen tension values over this period. Mean arterial pressure and haemoglobin were transiently higher in off-pump patients at 8 h only. We conclude that postoperative subcutaneous tissue oxygen tension was higher for 20 h after off-pump compared with conventional cardiopulmonary bypass.
PMID: 14984520 [PubMed - indexed for MEDLINE]
[Livid discoloration of the hand as complication during plexus anaesthesia]
[Article in German]
Varelmann D, Hostmann F, Stuber F, Schroeder S.
Klinik und Poliklinik fur Anasthesiologie und Spezielle Intensivmedizin, Rheinische Friedrich-Wilhelms-Universitat, Bonn.
During axillary brachial plexus block for hand surgery, the axillary artery was accidentally punctured. After skin disinfection of the operation site a livid discoloration of the hand appeared. The initial intention of stopping surgery and performing an angiography for clarification of the suspicion of a vessel lesion was dismissed after recording the pulse at the wrist and all fingertips employing a pulsoximeter. Further investigation showed that the livid discoloration of the hand was a product of the interaction of the octenidin solution used for pre-operative hand disinfection with the polyvidone-iodine solution used for surgical skin disinfection. This case report shows that interactions of topically administered pharmaceuticals have to be taken into consideration. Lack of knowledge might lead to unnecessary and unjustified diagnostic procedures which imply additional costs and dangers for the patient.
PMID: 15014896 [PubMed - as supplied by publisher]
Supplementary oxygen for elective Caesarean section under spinal anaesthesia: useful in prolonged uterine incision-to-delivery interval?{dagger}
Khaw KS, Ngan Kee WD, Lee A, Wang CC, Wong AS, Ng F, Rogers MS.
Department of Anaesthesia and Intensive Care and Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong, China.
BACKGROUND: The benefit of administering supplementary oxygen during elective Caesarean section under regional anaesthesia is controversial. It has been hypothesized that its use would improve fetal oxygenation in the event of a prolonged uterine incision-to-delivery (U-D) interval. Our aim was to test this hypothesis in a prospective, randomized, double-blinded, controlled study. METHODS: We allocated randomly 204 women having elective Caesarean section under spinal anaesthesia to breathe 21, 40 or 60% oxygen. We recorded the U-D interval, umbilical arterial (UA) and venous (UV) blood gases and oxygen content and Apgar scores. Subgroup analysis was performed according to whether the U-D interval was prolonged (>180 s) or not. RESULTS: The U-D interval was <180 s in 159 patients and >180 s in 45 patients. There were no differences in UV or UA blood gases, oxygen content or Apgar scores between cases with and without a prolonged U-D interval. In cases without a prolonged U-D interval, administering 60% oxygen increased UV Po(2) (mean 4.3 (sd 1.1) vs 3.7 (1.0) kPa, P=0.003) and oxygen content (14.4 (3.3) vs 12.9 (2.7) ml dl(-1), P=0.007) compared with air. In cases with a prolonged U-D interval, administering 60% oxygen increased UV Po(2) (4.6 (0.6) vs 3.9 (0.8) kPa, P=0.019) compared with air but there was no difference in UV oxygen content. There was no increase in the UV Po(2) or oxygen content when 40% oxygen was administered compared with air. CONCLUSIONS: Supplementary oxygen did not increase fetal oxygenation in cases where the U-D interval was prolonged. Our data do not support the routine administration of supplementary oxygen during elective Caesarean section for this purpose.
PMID: 15013959 [PubMed - as supplied by publisher]
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Editorial III: Tissue oxygen tension (PTO2) in anaesthesia and perioperative medicine.
Ragheb J, Buggy DJ.
PMID: 15013958 [PubMed - in process]
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Editorial I: Spinal anaesthesia for Caesarean delivery: keep the pressure up and don't spare the vasoconstrictors.
Riley ET.
PMID: 15013956 [PubMed - in process]
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Influence of volatile anaesthetics on hypercapnoeic ventilatory responses in mice with blunted respiratory drive{dagger}
Groeben H, Meier S, Tankersley CG, Mitzner W, Brown RH.
Department of Environmental Health Sciences/Division of Physiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA; University of Essen, Essen, Germany; Department of Anesthesiology and Critical Care Medicine, University of Essen, Hufelandstrasse 55, 45122 Essen, Germany.
BACKGROUND: Subanaesthetic concentrations of volatile anaesthetics significantly affect the respiratory response to hypoxia and hypercapnoeia. Individuals with an inherited blunted respiratory drive are more affected than normal individuals. To test the hypothesis that subjects with blunted hypercapnoeic respiratory drive are diversely affected by different anaesthetics, we studied the effects of three volatile anaesthetics on the control of breathing in C3H/HeJ (C3) mice, characterized by a blunted hypercapnoeic respiratory response. METHODS: Using whole body plethysmography, we assessed respiratory rate (RR) and pressure amplitude in 11 male C3 mice at rest, during anaesthesia with isoflurane, sevoflurane or desflurane, and during recovery. To test respiratory drive, mice were exposed to 8% carbon dioxide. Data were analysed by two-way-analysis of variance with post hoc tests and Bonferroni correction. RESULTS: RR was unaffected during sevoflurane anaesthesia up to 1.0 MAC. Likewise, sevoflurane at 1.5 MAC affected RR less than either isoflurane (P=0.0014) or desflurane (P=0.0048). The increased RR to a carbon dioxide challenge was blocked by all three anaesthetics even at the lowest concentration, and remained depressed during recovery (P<0.0001). Tidal volume was unaffected by all three anaesthetics. CONCLUSIONS: In C3 mice, spontaneous ventilation was less affected during sevoflurane compared with either isoflurane or desflurane anaesthesia. However, the RR response to hypercapnoeia was abolished at 0.5 MAC for all the anaesthetic agents and remained depressed even at the end of recovery. Our data suggest that different volatile anaesthetics have varying effects on the control of breathing frequency but all block the respiratory response to carbon dioxide. Therefore, a genetic predisposition to a blunted carbon dioxide response represents a susceptibility factor that interacts with hypercapnoeic hypoventilation during maintenance of anaesthesia and in the emergence from anaesthesia, regardless of the agent used.
PMID: 15003977 [PubMed - as supplied by publisher]
Ultrasound imaging in pediatric regional anesthesia.
Rapp HJ, Grau T.
Heidelberg, Germany.
PMID: 15010416 [PubMed - in process]
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Images in Anesthesia: Temporary atrial pacing via a triple lumen central venous catheter.
Iida Y, Akita M, Nukariya M.
Chiba, Japan. Saitama, Japan.
PMID: 15010406 [PubMed - in process]
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Witnessed asystole during spinal anesthesia treated with atropine and ondansetron: a case report: [Asystolie pendant la rachianesthesie traitee avec de l'atropine et de l'ondansetron : une etude de cas].
Martinek RM.
Department of Anesthesia, Brantford General Hospital, Brantford, Ontario, Canada.
PURPOSE: To present a case of asystole during spinal anesthesia that responded to atropine and ondansetron and to discuss the possible pathophysiology with special emphasis on the Bezold-Jarisch reflex and the role of 5-HT(3) receptors in mediating bradycardia and sympathoinhibition. Clinical features: A 50-yr-old, 97-kg, healthy male presented for elective left high tibial osteotomy. Spinal anesthesia was induced uneventfully at L3-4 with 11.25 mg of hyperbaric 0.75% bupivacaine and morphine 0.25 mg. Thirteen minutes after induction, the incision site was infiltrated with 20 mL of 0.5% bupivacaine with epinephrine 5 micro g*mL(-1) for intraoperative hemostasis, resulting in an increase in heart rate from 74 to 90 beats*min(-1). Three minutes after infiltration of the incision site, the patient's heart rate dropped to 48 beats*min(-1), accompanied by a blood pressure of 107/51 mmHg, SpO(2) 97%, and a sinus bradycardia on the electrocardiogram. The electrocardiographic complexes suddenly disappeared with loss of the pulse oximeter waveform. Pre-drawn atropine 0.6 mg iv and ondansetron 4 mg iv were administered within seven seconds of the event. After an asystolic period of 30 to 40 sec, but before chest compressions were initiated, vital signs returned to normal with no other sequelae. CONCLUSION: Exogenous epinephrine may have triggered the Bezold-Jarisch reflex and subsequent asystole. It is postulated that the combination of atropine and ondansetron may have played a key role in resuscitation by blocking the serotonergic and cholinergic receptors in the afferent and efferent limbs of this vagally-mediated reflex.
PMID: 15010403 [PubMed - in process]
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Anesthesiology, the birth of pharmacogenetics and Werner Kalow/L'anesthesiologie, la naissance de la pharmacogenetique et Werner Kalow.
Viby-Mogensen J.
Department of Anaesthesia and Intensive Care, Copenhagen University Hospital, Copenhagen, Denmark.
PMID: 15010397 [PubMed - in process]
Comment in:
Analgesic effects of intrathecal neostigmine in perianal surgery.
Yegin A, Yilmaz M, Karsli B, Erman M.
Akdeniz University Faculty of Medicine, Department of Anaesthesiology, Antalya, Turkey. ayegin@ixir.com
BACKGROUND AND OBJECTIVE: In recent human and animal studies, intrathecal administration of various doses of neostigmine produces analgesia without neurotoxicity. The aim was to examine the effects of intrathecal neostigmine and bupivacaine in patients undergoing perianal surgery under spinal anaesthesia. METHODS: The patients were randomly allocated into three groups of 15: Group 1 (controls) received hyperbaric bupivacaine 10 mg + dextrose 5%, 1 mL, to a total volume of 3 mL; Group 2 received hyperbaric bupivacaine 10 mg + neostigmine 25 microg in dextrose 5%, 1 mL, to a total volume of 3 mL; and Group 3 received hyperbaric bupivacaine 10 mg + neostigmine 50 microg in dextrose 5%, 1 mL, to a total volume of 3 mL. RESULTS: The onset of sensory block was significantly earlier for Group 2 and 3 patients compared with Group 1 patients (P < 0.05). The full time to recovery of motor block and sensory block was significantly longer in Group 3 compared with Group 1 (P < 0.05). In Group 3, the average time until the first dose of tramadol was longer than Group 1 (P < 0.05). The incidence rate of nausea and vomiting was significantly higher in Groups 2 and 3 than in Group 1 (P < 0.05). CONCLUSIONS: The use of intrathecal neostigmine as an analgesic drug in perianal surgery is unsatisfactory because of prolonged motor blockade and nausea.
Publication Types:
- Clinical Trial
- Randomized Controlled Trial
PMID: 12790214 [PubMed - indexed for MEDLINE]
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Effect of sevoflurane on the ex vivo secretion of TNF-alpha during and after coronary artery bypass surgery.
El Azab SR, Rosseel PM, De Lange JJ, Groeneveld AB, Van Strik R, Van Wijk EM, Scheffer GJ.
Amphia Hospital, Department of Anaesthesia and Intensive Care, Breda, The Netherlands.
BACKGROUND AND OBJECTIVE: Sevoflurane has been used for the induction and maintenance of anaesthesia during cardiac surgery owing to its favourable haemodynamic effects. It has been suggested that it offers protection against myocardial ischaemia-reperfusion injury. METHODS: We investigated the effect of sevoflurane on plasma concentrations of tumour necrosis factor-alpha (TNF-alpha) after ex vivo stimulation of whole-blood leukocytes by lipopolysaccharide from 20 patients undergoing coronary artery bypass surgery. The patients were randomized to two groups. Group 1 patients were induced and maintained with sevoflurane; those in Group 2 were anaesthetized with moderate doses of midazolam-sufentanil. Blood samples were drawn from the patients on seven occasions from before induction of anaesthesia until 24 h after skin closure. RESULTS: Plasma concentrations of TNF-alpha were lower in Group 1 than in Group 2 after cessation of cardiopulmonary bypass (median (interquartiles): 25 (21-30) versus 37 (28-79) pg mL(-1); P < 0.05) and 24h after skin closure (196 (100-355) versus 382 (233-718) pg mL(-1); P < 0.05). Postoperatively, two cases of myocardial infarction were recorded, one in each group. Six patients in Group 2 needed continued inotropic support after the first morning to maintain haemodynamic stability versus one patient in Group 1 (P < 0.05). The length of stay in the intensive care unit was significantly lower in Group 1 than in Group 2 (mean +/- SD: 25 +/- 16 versus 54 +/- 30 h; P < 0.05). CONCLUSIONS: Sevoflurane reduces production of TNF-alpha more than total intravenous anaesthesia with midazolam-sufentanil during cardiac surgery. This may reduce cardiac morbidity and the length of stay in the intensive care unit.
PMID: 12790209 [PubMed - indexed for MEDLINE]
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Modelling the pharmacodynamic interaction between remifentanil and propofol by EEG-controlled dosing.
Fechner J, Hering W, Ihmsen H, Palmaers T, Schuttler J, Albrecht S.
Friedrich-Alexander-Universitat Erlangen-Nurnberg, Department of Anaesthesiology, Erlangen, Germany. joerg.fechner@kfa.imed.uni-erlangen.de
BACKGROUND AND OBJECTIVE: Knowledge of the pharmacodynamic interaction between remifentanil and propofol is important to permit optimal dosage strategies. We studied this pharmacodynamic interaction using the median power frequency of the processed electroencephalogram as a control parameter for feedback-controlled dosing of propofol. METHODS: Twenty-one patients were given total intravenous anaesthesia with remifentanil and propofol. During three target-controlled infusion regimens, the target concentrations of remifentanil (5, 10, 15 ng mL(-1)) and propofol dosing were automatically adjusted to keep the median power frequency in the range 2 +/- 0.5 Hz. In each patient and during each remifentanil target concentration, four arterial propofol/remifentanil concentration pairs were measured. The type of interaction was tested using the relative distance from the line of additivity and the isobole was modelled using Bernstein splines. RESULTS: The results from 13 patients were used for data analysis. The measured remifentanil concentrations during the three targets were (mean +/- SD): 3.6 +/- 0.9, 8.1 +/- 2.5 and 12.4 +/- 2.8 ng mL(-1). The corresponding propofol concentrations were 2.64 +/- 0.86, 2.13 +/- 0.58 and 2.09 +/- 0.58 microg mL(-1). The data were best described with an additive type of interaction and the isobole was estimated using: ((c)Remifentanil/64.2 ng mL(-1)) + ((c)Propofol/2.61 microg mL(-1)) = 1. CONCLUSIONS: Within the studied concentration range, remifentanil and propofol showed an additive type of pharmacodynamic interaction on the electroencephalogram.
PMID: 12790208 [PubMed - indexed for MEDLINE]
Parenteral vs epidural analgesia for postoperative pain.
Jankowski CJ, Warner DO.
Publication Types:
PMID: 15010438 [PubMed - in process]
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