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Anaesthetic considerations in Kartagener's syndrome - a case report.
Mathew PJ, Sadera GS, Sharafuddin S, Pandit B.
Department of Anaesthesiology and Critical Care, All India Institute of Medical Sciences (AIIMS), New Delhi, India.
Kartagener's syndrome is a rare disorder characterized by the triad of situs inversus, including dextrocardia, bronchiectasis and paranasal sinusitis. We report the anaesthetic management of a patient with Kartagener's syndrome and postrenal transplant immunosuppression, presenting for repair of uterovaginal prolapse. Combined spinal epidural anaesthesia was administered to this patient. The anaesthetic considerations of this rare disorder and the relative advantages of the regional technique over general anaesthesia in this situation are discussed.
PMID: 15025618 [PubMed - in process]
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Spinal anesthesia for arthroscopic knee surgery.
Gurkan Y, Canatay H, Ozdamar D, Solak M, Toker K.
Department of Anesthesiology and Reanimation, Kocaeli University School of Medicine, Kocaeli, Turkey.
Background and objective: The purpose of the study was to compare the effects of adding 50 micro g of morphine, 25 micro g of fentanyl or saline to 6 mg of hyperbaric bupivacaine on postoperative analgesia and time to urination in patients undergoing arthroscopic knee surgery under spinal anesthesia. Methods: The study was designed in a prospective, randomized, double-blinded and placebo-controlled manner. Sixty ASA I-II patients were randomized into the following three groups: Group BM: 6 mg of bupivacaine and 50 micro g of morphine, Group BF: 6 mg of bupivacaine and 25 micro g of fentanyl, and Group BS: 6 mg of bupivacaine and saline. Selective spinal anesthesia was performed in a lateral decubitus position, with the operative knee dependent for 10 min. Results: In all groups satisfactory anesthesia was provided during the operation. There was a statistically significant difference between all the groups in times to voiding [Group BM 422 +/- 161 min; Group BF 244 +/- 163 min; Group BS 183 +/- 54 min (mean +/- SD)]. The incidence of pruritus was significantly greater in Group BM (80%) and BF (65%) in comparison with Group BS (no pruritus) (P < 0.05). The incidence of nausea was significantly increased in Group BM (35%) in comparison with Group BF (10%) and Group BS (P < 0.05). Analgesic consumption was significantly greater in Group BS in comparison with Groups BM and BF (P < 0.01). Conclusions: We conclude that during spinal anesthesia even mini-dose intrathecal morphine is not acceptable for outpatient surgery due to side-effects, especially severely prolonged time to urination.
PMID: 15025617 [PubMed - in process]
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Analgesia and discharge following preincisional ilioinguinal and iliohypogastric nerve block combined with general or spinal anaesthesia for inguinal herniorrhaphy.
Toivonen J, Permi J, Rosenberg PH.
Department of Anaesthesiology, South Carelian Centre Hospital, Lappeenranta, Finland.
Background: Preincisional ilioinguinal and iliohypogastric nerve block (IINB) reduces postoperative analgesics after inguinal herniorrhaphy. The effect of an IINB on postoperative pain and discharge profile was therefore studied in day-surgery patients undergoing inguinal herniorrhaphy with general or spinal anaesthesia. Methods: Seventy ASA I-II adult patients scheduled for inguinal herniorrhaphy received an IINB before the surgical incision with 15 ml of 0.5% bupivacaine. In a randomized fashion half of them received general anaesthesia with spontaneous breathing via a laryngeal mask (GA-group) and the other half received spinal anaesthesia with 5 mg of bupivacaine diluted with sterile water to 2.5-ml volume (SPIN-group). In the postanaesthesia care unit (PACU), pain was assessed on a scale from 0 to 10 (VAS) and ketorolac 30 mg i.v. (VAS < 5), or fentanyl 0.05 mg i.v. (VAS >/= 5) was administered as scheduled. In the day surgery unit and at home the analgesic was a tablet of ibuprofen 200 mg + codeine 30 mg (VAS >/= 3). Results: Patients in the SPIN-group reported lower postoperative pain scores at 30, 60 min (P < 0.0001) and 120 min (P < 0.05) after surgery, and longer time to first analgesic use (P < 0.0001). Patients in the GA-group had a shorter time to discharge without voiding (P < 0.001) and with voiding (P < 0.05). After discharge, there were no significant differences between the groups regarding pain scores at rest and at walking, or the doses of analgesic. Adverse events were rare in both groups. Conclusion: Only a relatively short immediate analgesic benefit could be demonstrated by a combination of IINB with spinal anaesthesia compared with IINB combined with general anaesthesia. The use of general anaesthesia facilitated an earlier postoperative discharge than spinal anaesthesia.
PMID: 15025612 [PubMed - in process]
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Practices of anaesthesiologists with regard to withholding and withdrawal of life support from the critically ill in Turkey.
IyilikCi L, Erbayraktar S, Gokmen N, Ellidokuz H, Kara HC, Gunerli A.
Department of Anaesthesiology, School of Medicine, Dokuz Eylul University, Izmir, Turkey.
Background: To determine practices of Turkish anaesthesiologists with regard to withholding and withdrawal of life support from the critically ill. Methods: An anonymous questionnaire consisting of 18 questions was mailed to 439 members of the Turkish Society of Anaesthesiology and Reanimation. Results: Three hundred and 69 questionnaires were returned (84% response). Over 90% of the respondents indicated that they were Muslim. We found that 66% of respondents had initiated written or oral do-not-resuscitate orders, most frequently after discussion with colleagues (82%). Conclusions: While a number of similarities were found between Turkish anaesthesiologists and those from other countries, some specific differences could be identified, particularly related to consensus decision-making and sharing information with other providers and the value of Ethics Committees in the decision-making process.
PMID: 15025608 [PubMed - in process]
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Convulsions on anaesthetic induction with sevoflurane in young children.
Akeson J, Didriksson I.
Department of Anaesthesia and Intensive Care, Lund University, Malmo University Hospital, Malmo, Sweden.
Increased worldwide use for paediatric anaesthesia of the volatile anaesthetic agent sevoflurane has mainly resulted from its low blood-gas partition coefficient and low airway irritability, providing smooth conditions for rapid induction of anaesthesia. Nevertheless, there are several clinical and experimental reports suggesting a correlation between exposure to sevoflurane and generalized clonic or tonic seizure activity. We report two clinical episodes of convulsions associated with the induction of sevoflurane anaesthesia in young children. Case 1: during induction of anaesthesia with sevoflurane by facemask in a 3-year-old healthy boy, there were symmetrical clonic seizure-like movements of the upper extremities for 60 s. Case 2: on re-induction of anaesthesia with sevoflurane because of profuse bleeding following nasal adenoidectomy in a 4-year-old healthy girl with a family history of epilepsy, there were symmetrical tonic and clonic seizure-like movements for 30-40 s in the upper and lower extremities. Both episodes ceased spontaneously. Although no EEG was recorded, it cannot be excluded that both episodes resulted from seizure activity within the CNS. Based on our observations and reports by others we suggest that, until further notice, sevoflurane should be avoided or at least used cautiously in patients where clinical epileptic activity has been verified or is strongly suspected.
PMID: 15025599 [PubMed - in process]
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Anaesthesia and intensive care a-z. An encyclopaedia of principles and practice.
O'Regan M.
PMID: 15023134 [PubMed - in process]
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Reluctance of anaesthetists to perform awake intubation.
Allan AG.
University of Michigan, Ann Arbor, Michigan 48109-0048, USA.
PMID: 15023129 [PubMed - in process]
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Mentor system for anaesthesia trainees.
Gould G.
St Thomas' Hospital, London SE1 7EH, UK.
PMID: 15023127 [PubMed - in process]
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Ethics of training in regional anaesthesia.
Bartley C, Shelton JM.
Queen Elizabeth Hospital, Gateshead NE9 6SX, UK.
PMID: 15023116 [PubMed - in process]
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The effect of epidural analgesia in labour on maternal respiratory function*.
Von Ungern-Sternberg BS, Regli A, Bucher E, Reber A, Schneider MC.
Senior Registrar, Department of Anaesthesia, University of Basel/Kantonsspital, CH 4031, Basel, Switzerland.
Summary Lumbar epidural analgesia during labour has gained widespread acceptance. The impact of epidural analgesia based on mixtures of low-dose local anaesthetic solutions and lipophilic opioids on most clinically relevant obstetric outcomes is minimal. Since the pregnant state per se is associated with important alterations in respiration, we assessed whether a subtle degree of motor blockade brought about by epidural analgesia might compromise respiratory function as assessed by spirometry. Sixty consenting parturients receiving epidural analgesia were consecutively included in this prospective study. We performed spirometry during the antepartum visit and in labour after effective epidural analgesia was established; at both assessments the women were pain-free. Values were within normal ranges but increased significantly after effective epidural analgesia; median (IQR [range]) increase for vital capacity 7.4 (3.0-13 [-12-27])% (p < 0.001); forced vital capacity 4.4 (1.7-9.8 [-13-26])% (p < 0.001); forced expiratory volume in 1 s 5.5 (1.7-8.6 [-14-28])% (p < 0.001); and peak expiratory flow rate 2.3 (-1.6-5.8 [-18-16])% (p = 0.01)). We conclude that epidural analgesia for labour significantly improved respiratory function.
PMID: 15023105 [PubMed - in process]
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[OR-manager: surgeon or anesthesiologist? An interdisciplinary study]
[Article in German]
Gebhard E, Hartwig E, Isenmann R, Triebsch K, Gerstner H, Bailer M, Brinkmann A.
Abteilung Unfallchirugie, Hand- and Wiederherstellungschirurgie, Linikum der Universitat, Ulm
Publication Types:
PMID: 15015505 [PubMed - indexed for MEDLINE]
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[Aortocaval compression syndrome]
[Article in German]
Kiefer RT, Ploppa A, Dieterich HJ.
Abteilung fur Anasthesiologie und Intensivmedizin, Universitatsklinikum Tubingen. thomas.kiefer@uni-tuebingen.de
Aortocaval compression syndrome (supine hypotensive syndrome) represents a common complication mainly of late pregnancy, although the syndrome has been described to occur as early as 16 weeks of gestation. The nature and severity of symptoms range from unspecific complaints to severe maternal hypotension, loss of consciousness, cardiovascular collapse, and consecutive fetal depression. Predominantly, the syndrome is provoked by placing the parturient supine. Since supine positioning is required for diverse diagnostic and therapeutic procedures in obstetrics, these involve increased risk of aortocaval compression. For the anesthetist, cesarean section is most relevant, because of the coincidence of several risk factors. The following article begins by reviewing the pathophysiology of the syndrome, known risk factors and anesthesiological procedures that predispose to the syndrome. The second part is concerned with prophylactic measures and therapeutic options, together with the discussion of a clinically practicable algorithm.
Publication Types:
PMID: 14992095 [PubMed - indexed for MEDLINE]
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[Artificial neural networks. Theory and applications in anesthesia, intensive care and emergency medicine]
[Article in German]
Traeger M, Eberhart A, Geldner G, Morin AM, Putzke C, Wulf H, Eberhart LH.
Klinik fur Innere Medizin, Kreiskrankenhaus Gunzburg.
Artificial neural networks (ANN) are constructed to simulate processes of the central nervous system of higher creatures. An ANN consists of a set of processing units (nodes) which simulate neurons and are interconnected via a set of "weights" (analogous to synaptic connections in the nervous system) in a way which allows signals to travel through the network in parallel. The nodes (neurons) are simple computing elements. They accumulate input from other neurons by means of a weighted sum. If a certain threshold is reached the neuron sends information to all other connected neurons otherwise it remains quiescent. One major difference compared with traditional statistical or rule-based systems is the learning aptitude of an ANN. At the very beginning of a training process an ANN contains no explicit information. Then a large number of cases with a known outcome are presented to the system and the weights of the inter-neuronal connections are changed by a training algorithm designed to minimise the total error of the system. A trained network has extracted rules that are represented by the matrix of the weights between the neurons. This feature is called generalisation and allows the ANN to predict cases that have never been presented to the system before. Artificial neural networks have shown to be useful predicting various events. Especially complex, non-linear, and time depending relationships can be modelled and forecasted. Furthermore an ANN can be used when the influencing variables on a certain event are not exactly known as it is the case in financial or weather forecasts. This article aims to give a short overview on the function of ANN and their previous use and possible future applications in anaesthesia, intensive care, and emergency medicine.
Publication Types:
PMID: 14992094 [PubMed - indexed for MEDLINE]
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[Ambulatory and day surgery]
[Article in German]
Schafer MK, Wittenmeier E.
Klinik fur Anasthesiologie, Klinikum der Johannes Gutenberg-Universitat, Mainz. schaefer@anaesthesie.klinik.uni-mainz.de
Ambulatory surgical care is intended to save healthcare expenditure from the economical viewpoint. From the patients point of view significant advantages as well as specific disadvantages of ambulatory surgery are known. The increase in the volume and complexity of procedures provided in an ambulatory setting are driven by improvements in anesthesia and surgical technique as well as by changes in financing and reimbursement. Therefore careful quality control and scientific evidence for the safety of increasingly used complex surgical procedures for higher risk patients is essential. Reducing the surgical trauma by minimally invasive surgical techniques and very good controllability by modern anesthesia concepts is making the management of the postoperative period crucial for successful ambulatory surgery. Most of the complications and common problems during the postoperative period, such as pain, nausea and vomiting, are not specific for ambulatory surgery, but management places an increasing burden of responsibility not only on general and specialised physicians, but also on other health professionals, patients, and family members.
Publication Types:
PMID: 14992093 [PubMed - indexed for MEDLINE]
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[Secondary cranial extension after spinal anesthesia with isobaric 0.5% bupivacaine following postural change]
[Article in German]
Vicent O, Litz RJ, Hubler M, Koch T.
Klinik fur Anasthesiologie und Intensivmedizin, Universitatsklinikum Carl-Gustav-Carus, TU Dresden. vicentoli@web.de
Inadvertent cranial extension of sympathetic and sensory block following posture change during spinal anaesthesia has been reported for isobaric as well as for hyperbaric local anaesthetics. We present the case of a patient who underwent surgical repair of a refracture of the tibia under spinal anaesthesia with 17.5 mg of isobaric 0.5% bupivacaine. The maximum level of sensory block (MLSB) reached T8 after 15 min. Following posture change into a 15 degrees anti-Trendelenburg position 35 min after lumbar puncture, the MLSB increased cranially for 10 segments and reached the C6 level after 10 min of anti-Trendelenburg position. The patient suffered from severe bradycardia and arterial hypotension which were treated with 6% hydroxyethyl starch, atropine and Akrinor. In addition, the patient developed respiratory insufficiency and was therefore intubated and the lungs were mechanically ventilated. The operation was performed uneventfully with the patient under general anaesthesia. At the end of surgery the trachea was extubated, and the patient was awake with stable hemodynamics, sufficient spontaneous ventilation and free of pain. MLSB reached the second lumbar dermatome. This case shows that after assumed fixation of the local anaesthetic an inadvertent extension of the MLSB following posture change is possible. Close surveillance is recommended for patients with central neuraxial blocks until the block is in complete remission. The mechanisms for inadvertent high extension of the MLSB following posture change are discussed.
Publication Types:
PMID: 14992091 [PubMed - indexed for MEDLINE]
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[Dissociative stupor as a postoperative consequence of general anesthesia]
[Article in German]
Haller M, Kiefer K, Vogt H.
Abteilung fur Anasthesie und Operative Intensivmedizin, Klinikum Kempten-Oberallgau gGmbH. mathias.haller@klinikum-kempten.de
A 31-year-old woman failed to awaken after an uneventful general anesthesia (propofol, alfentanil and 65% N2O in oxygen) for laparoscopic resection of an ovarian cyst. After the operation she was extubated and vital signs were stable. However, the patient remained unresponsive even to painful stimuli for about 2 h. Just before we performed a computed tomogram of the brain to exclude a cerebral lesion we noticed that she blinked. We hypothesized that unconsciousness was due to a dissociative stupor. After administration of sublingual lorazepam the patient woke up promptly and was alert and normal for the rest of the hospital stay. In conclusion, after exclusion of a pharmacological or organic cause for postoperative unconsciousness, dissociative stupor may be a reason for apparent coma after general anesthesia.
Publication Types:
PMID: 14992090 [PubMed - indexed for MEDLINE]
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[Cataract surgery in a patient with severe obstructive sleep apnea syndrome]
[Article in German]
Reber A, Ursprung T.
Klinik fur Anasthesiologie und Intensivmedizin, Spital Zollikerberg, Zollikerberg. Adrian.Reber@spitalzollikerberg.ch
This case report describes airway management during cataract surgery for a patient with known severe obstructive sleep apnea syndrome. Surgery could not be performed using a pure local anesthetic procedure because of the psychological history of the patient. In consideration of the severity of the patient's sleep apnea syndrome, we chose an anesthetic procedure that would compromise the upper airway as little as possible. For respiratory strategy, the patient's own nasal CPAP (continuous positive airway pressure) equipment was used. Anesthesia was maintained with continuous infusion of propofol and remifentanil while the patient was breathing spontaneously. The patient was transferred to the recovery room where nasal CPAP was continued for 1 h until the patient was returned to the ward.
Publication Types:
PMID: 14992089 [PubMed - indexed for MEDLINE]
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[Methemoglobinemia due to prilocaine after plexus anesthesia. Reduction by prophylactic administration of ascorbic acid?]
[Article in German]
Kortgen A, Janneck U, Vetsch A, Bauer M.
Klinik fur Anaesthesiologie und Intensivmedizin, Universitatskliniken des Saarlandes, Homburg/Saar. aiakor@uniklinik-saarland.de
OBJECTIVE: This study investigated in vivo and in vitro kinetics of o-toluidine-induced methemoglobinemia and the influence of ascorbic acid on resulting methemoglobin concentrations. o-Toluidine is a metabolite of prilocaline and ascorbic acid is recommended for treatment of methemoglobinemia as an alternative to methylene blue. METHODS: We measured the formation of methemoglobin in vitro in a whole blood culture system of 8 healthy individuals 30, 60, and 360 min after the addition of different concentrations of o-toluidine (0.5, 5, 50 micrograms/ml) with and without addition of ascorbic acid (0.5 and 5 mg/ml). In a prospective randomized clinical study, a total of 72 patients of ASA risk I-III were investigated. The 3 groups of 24 patients received either an axillary, an infraclavicular vertical brachial plexus, or a combined femoral and ischiadic blockade. In each plexus anesthesia group, 12 patients were given 2,000 mg ascorbic acid intravenously before applying the local anesthetics. For surgery of the upper limb the patients received 40 ml 1% prilocaine and 10 ml 0.5% bupivacaine, for surgery of the lower limb they received 60 ml 1% prilocaine and 0.25 mg adrenaline. Blood samples for measurement of methemoglobin concentrations were taken before and 30, 60, 120, 180 and 360 min after the injection of the regional anesthetic. A p < 0.05 was considered to be significant. RESULTS: There was a dose-dependent increase of methemoglobin due to addition of o-toluidine after 360 min in vitro. The application of 0.5 mg/ml ascorbic acid to the whole blood samples with 0.5 and 5 micrograms/ml o-toluidine resulted in a further increase of methemoglobin formation whereas there was no difference in the samples with 50 micrograms/ml. The higher concentration of 5 mg/ml ascorbic acid attenuated the methemoglobin formation only with 50 micrograms/ml o-toluidine. No effect was observed with lower concentrations of o-toluidine. In the in vivo study plexus anesthesia with prilocaine resulted in an increase of the methemoglobin concentration with a maximum after 120-180 min. The highest measured methemoglobin concentration found was 11.3%. The methemoglobin concentration already showed a decrease 360 min after the application of the regional anesthetic 2,000 mg ascorbic acid given intravenously before plexus anesthesia was not able to influence the resulting methemoglobin concentrations. CONCLUSIONS: In vitro high concentrations of ascorbic acid are able to reduce the resulting methemoglobin concentration 360 min after addition of 50 micrograms/ml o-toluidine. The application of 2,000 mg ascorbic acid i.v. before plexus anesthesia with prilocaine does not reduce the concentration of methemoglobin.
Publication Types:
- Clinical Trial
- Randomized Controlled Trial
PMID: 14992088 [PubMed - indexed for MEDLINE]
[Seizure-like movements following sevoflurane induction in paediatric anaesthesia]
[Article in French]
Zeidan A, Maaliki H, Hajjar W.
Departement d'anesthesie, Sahel General hospital, universite libanaise, Airport avenue, Ghobeiry, PO Box 99/25, Beirut, Lebanon.
Publication Types:
PMID: 15030868 [PubMed - as supplied by publisher]
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[Uncommon cause of respiratory distress in the post-anaesthesia care unit]
[Article in French]
Lalot M, Veyckemans F, Ketelslegers E, Roelants F.
Service d'anesthesiologie, cliniques universitaires Saint-Luc, Bruxelles, Belgique.
We report a case of respiratory distress in the post anesthesia care unit following general anaesthesia for a dilatation and curettage related to miscarriage in a 32-year-old woman. The preoperative physical examination showed no abnormalities except for the presence of dry cough during the preceding two or three days. A few minutes after her arrival in the PACU, the patient developed hyperthermia till 40.6 degrees C, cough, polypnea and oxygen desaturation (SpO(2): 82% on FiO(2): 40%). A thoraco-abdominal angioscanner showed pulmonary basal condensations and a thrombosis of the right ovarian vein. The patient had to be transferred to the intensive care unit where she remained intubated and ventilated during 13 days because of a Haemophilus influenzae pneumonia.
PMID: 15030862 [PubMed - as supplied by publisher]
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[Assessment of teaching methods of anaesthesiology and intensive care medicine in France: opinions of teacher and residents]
[Article in French]
Malinovsky JM, Gardenal O, Barrier JH.
Service d'anesthesie-reanimation, hopital Maison-Blanche, 51092 Reims, France.
Objective. - The objective of this study was to provide informations about French practice of anaesthesiology and intensive care graduation. Study design. - Prospective study. Material et methods. - Surveys relative to evaluation tools were sent to professors, and students in anaesthesiology and intensive care in France. Result. - About 95% of French students in anaesthesiology and intensive care want to be evaluated all over their cursus, by using "Carnet de stage", tutor-student agreement or written examinations. Pedagogical evaluation is hardly wished by students and professors despite that "Carnet de stage" and written examinations are frequently used before professional certification. In order to improve the professional competence, the patronage and use of simulator are frequently quoted by professors. Conclusion. - Despite the fact that "Carnet de stage" and written examinations are frequently used, pedagogic dimension of evaluation need to be improved.
PMID: 15030861 [PubMed - as supplied by publisher]
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[A famous trio of anaesthetists, yesterday in Paris: Ernest Kern, Jean Lassner and Guy Vourc'h]
[Article in French]
Otteni JC.
Publication Types:
PMID: 15017993 [PubMed - in process]
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Appropriate consent and referral for general anaesthesia - a survey in the Paediatric Day Care Unit, Barnsley DGH NHS Trust, South Yorkshire.
Patel AM.
1Specialist Registrar in Orthodontics, Orthodontic Department, Birmingham Dental Hospital, St. Chad's Queensway, Birmingham B4 6NN.
Background In November 1998 the General Dental Council introduced guidelines for dental practitioners when referring a patient for general anaesthesia (GA). The practitioner is required to explain the risks associated with GA and the alternatives, give a detailed medical history and a clear justification for providing GA in the letter of referral.Method A survey was administered on 202 parents or guardians, which aimed to investigate whether they felt that their dental practitioners had advised them of any risks of GA prior to referral. A record was also made if any reasons were given for the provision of GA in the letter of referral.Results The majority of the parents or guardians (66%) felt that they were not informed of any of the risks of GA and 25% felt that they were. From the letters of referral, 37% contained a reason for GA and 63% did not give any reason or justification for GA.Conclusion There is evidence that referring practitioners do not adequately explain the risks of the anaesthetic to parents or guardians of children undergoing GA. There is also a lack of clear justification in the letters of referral for providing GA.Practice implication It is essential that the alternatives and the risks of GA are discussed and if GA is still required, a clear justification should be contained in the letter of referral as part of informed consent. More importantly the referring practitioner should keep a contemporaneous record of this, preferably with a signature from the parent or guardian on agreement of referral.
PMID: 15017416 [PubMed - in process]
Comment on:
A commentary on the legal issues.
Morris CD.
Hempsons Solicitors, Hempsons House, 40 Villiers Street, London WC2N 6NJ. cdnm@hempsons.co.uk
Publication Types:
PMID: 14963432 [PubMed - indexed for MEDLINE]
Comment on:
A UK perspective.
Manley MC.
Canterbury Health Centre, Dental Department, 26 Old Dover Rd, Canterbury CT1 3JH. gmanley@marshalney.freeserve.co.uk
Publication Types:
PMID: 14963431 [PubMed - indexed for MEDLINE]
Comment on:
Perspectives.
Grace M.
Publication Types:
PMID: 14963414 [PubMed - indexed for MEDLINE]
Non-pharmacological approaches to decrease surgical blood loss.
Ozier Y, Lentschener C.
Department of Anaesthesia and Intensive Care, Groupe Hospitalier Cochin, Assistance Publique-Hopitaux de Paris et Universite Rene Descartes--Paris V, France. yves.ozier@cch.ap-hop-paris.fr
Publication Types:
PMID: 14629049 [PubMed - indexed for MEDLINE]
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Annual spring regional anesthesia meeting & workshops.
[No authors listed]
PMID: 15029559 [PubMed - as supplied by publisher]
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An unusual case of painful phantom-limb sensations during regional anesthesia.
Paqueron X, Lauwick S, Le Guen M, Coriat P.
OBJECTIVE: The objective of this article is to describe a late-onset phantom-limb pain during a continuous analgesic popliteal nerve block after foot surgery and its alleviation and recurrence when stopping and resuming the local anesthetic infusion.Case report A 29-year-old woman undergoing a left hallux valgus repair received a continuous popliteal sciatic nerve block for postoperative analgesia. Postoperatively, 6 hours after the commencement of a ropivacaine 0.2% infusion, she reported feelings of tingling, clenching pain, and missing-limb sensation below the ankle. The surgical site remained painless. Sensation elicited by touch and propioception were normally perceived. Only sensations for pinprick and heat were impaired. The ropivacaine infusion was stopped, followed 2.5 hours later by the complete regression of any abnormal sensation. Meanwhile, pain at the surgical site was scored at 50 mm on a 100-mm visual analogic scale. As the infusion of ropivacaine was resumed, the abnormal sensations reappeared. The catheter was removed, and abnormal sensations again disappeared. The patient was discharged from hospital without further complications. CONCLUSIONS: This observation suggests that phantom-limb pain can be of late-onset and might occur during a continuous infusion of low-concentration local anesthetic responsible only for an analgesic block, as shown by the fact that only thermal and pinprick sensations, known to depend on Adelta-fibers and C-fibers, were altered. Therefore, this case contradicts the usual belief that a profound block is necessary to elicit phantom-limb pain.
PMID: 15029554 [PubMed - in process]
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An announcement from the wood library-museum of anesthesiology.
[No authors listed]
PMID: 15029552 [PubMed - as supplied by publisher]
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Labat lecture 2004: Regional anesthesia risks-from Labat to tort reform.
Brown DL.
PMID: 15029547 [PubMed - in process]
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The public's fears about and perceptions of regional anesthesia.
Matthey PW, Finegan BA, Finucane BT.
Background and objectives The public is not well informed about matters relating to regional anesthesia. Previous studies concerning regional anesthesia have involved patients, surgeons, and anesthesiologists. This study is the first in-depth survey of the attitudes of the general public toward a number of commonly perceived fears about regional anesthesia. METHODS: A province-wide telephone survey was conducted in Alberta, Canada. The sample surveyed was representative of the adult population of the province and included an equal balance of urban and rural participants. General and regional anesthesia were defined, a scenario involving major knee surgery was described, and participants were asked to choose between regional and general anesthesia. Respondents were then questioned so their attitudes toward commonly perceived fears associated with regional anesthesia could be assessed. RESULTS: A total of 1,216 people were surveyed. A preference for regional or general anesthesia was not expressed in this scenario. Approximately 27% of respondents were very concerned about permanent paralysis, back injury, perioperative pain, seeing the surgical procedure, and the prospect of a needle in the back. Only 6% of individuals were concerned about headaches. CONCLUSIONS: The public's fears and conceptions about regional anesthesia are greatly distorted. The anesthesia community has not been successful in keeping the public informed about regional anesthesia. Future anesthesia-related educational programs should address the concerns of the public about anesthesia matters, particularly regional anesthesia.
PMID: 15029543 [PubMed - in process]
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The public's perception of regional anesthesia: Why don't they get "the point"?
Birnbach D.
PMID: 15029540 [PubMed - in process]
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Anticoagulation and neuraxial regional anesthesia: Perspectives.
Bergqvist D, Wu CL, Neal JM.
PMID: 15029537 [PubMed - in process]
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Regional anesthesia in the anticoagulated patient: Defining the risks.
Horlocker TT, Wedel DJ, Benzon H, Brown DL, Enneking KF, Heit JA, Mulroy MF, Rosenquist RW, Rowlingson J, Tryba M, Yuan CS.
PMID: 15029535 [PubMed - in process]
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