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Items 1 - 35 of 35 |
One page. |
Intravenous anaesthesia combined with peribulbar block in a child with suspected Duchenne muscular dystrophy.
Rajmala X, Savita S, Kirti K, Nandini X.
PMID: 15504199 [PubMed - in process]
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Rocuronium attenuates oculocardiac reflex during squint surgery in children anesthetized with halothane and nitrous oxide.
Karanovic N, Jukic M, Carev M, Kardum G, Dogas Z.
Department of Anesthesiology and Intensive Care, University Hospital Split, Split, Croatia.
Background: The oculocardiac reflex (OCR) may be activated during squint surgery. The aim of this study was to test whether rocuronium 0.4 mg kg(-1) could reduce the frequency of OCR, and also whether a single dose of succinylcholine 1 mg kg(-1) could affect the frequency of OCR during anesthesia with halothane in a nitrous oxide/oxygen mixture. Methods: A total of 161 ASA I children, 3-10 years old, undergoing elective surgery of the medial rectus muscle (MRM) were randomly assigned to three groups. Group R (n = 51), received 0.4 mg kg(-1) of rocuronium intravenously before endotracheal intubation. Group S (n = 58) received 1 mg kg(-1) of succinylcholine. Group C (controls, n = 52) received no relaxant. Oculocardiac reflex was defined as a reduction in heart rate (HR) >= 15% and/or the appearance of any other arrhythmias, during manipulation of the MRM. Analysis of variance (anova), chi-squared, Kruskal-Wallis, and Student's t-tests were used for statistical analysis; P< 0.05 was considered statistically significant. Results: In group R, OCR occurred in 15/51 (29%) of children, in group S in 31/58 (53%), and in group C in 23/52 (44%) (chi(2) = 6.46, P = 0.049). In group R, the incidence of arrhythmias such as nodal rhythms, supraventricular and ventricular premature beats was 6%, compared with 22% in group S and 19% in group C (chi(2) = 6.01, P = 0.040). However, there was no reduction in the occurrence of bradycardia (chi(2) = 0.16, P = 0.924)., Conclusion: Rocuronium reduced the frequency of OCR, mainly by reducing the incidence of supraventricular and ventricular premature beats.
PMID: 15504192 [PubMed - in process]
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Similar excitation after sevoflurane anaesthesia in young children given rectal morphine or midazolam as premedication.
Malmgren W, Akeson J.
Department of Anaesthesia and Intensive Care, Lund University, Malmo University Hospital, Malmo, Sweden.
Background: Sevoflurane is a rapid-acting volatile anaesthetic agent frequently used in paediatric anaesthesia despite transient postoperative symptoms of cerebral excitation, particularly in preschool children. This randomised and investigator-blinded study was designed to evaluate whether premedication with an opioid might reduce non-divertible postoperative excitation more than premedication with a benzodiazepine in preschool children anaesthetized with sevoflurane. Methods: Ninety-two healthy two to six year-old children scheduled for nasal adenoidectomy were randomised to be given rectal atropine 0.02 mg kg(-1) together with either morphine 0.15 mg kg(-1) or midazolam 0.30 mg kg(-1) approximately 30 min before induction and maintenance of sevoflurane anaesthesia. The patient groups were compared pre- and postoperatively by repeated clinical assessments of cerebral excitation according to a modified Objective Pain Discomfort Scale, OPDS. Results: There were no statistically significant postoperative differences in incidence, extent or duration of excitation between children given morphine or midazolam for premedication, whereas morphine was associated with more preoperative excitation than was midazolam. The study groups did not differ significantly with respect to age, weight, duration of surgery and anaesthesia, and time from tracheal extubation to arrival in and discharge from the postoperative ward. Conclusion: In this study morphine for premedication in young children anaesthetized with sevoflurane was associated with similar postoperative and higher preoperative OPDS scores compared with midazolam. These findings indicate that substitution of morphine for midazolam is no useful way of reducing clinical excitation after sevoflurane anaesthesia.
PMID: 15504188 [PubMed - in process]
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Effects of subanaesthetic and anaesthetic doses of sevoflurane on regional cerebral blood flow in healthy volunteers. A positron emission tomographic study.
Schlunzen L, Vafaee MS, Cold GE, Rasmussen M, Nielsen JF, Gjedde A.
Department of Neuroanaesthesiology, Aarhus University Hospital, Aarhus, Denmark.
Background: We tested the hypothesis that escalating drug concentrations of sevoflurane are associated with a significant decline of cerebral blood flow in regions subserving conscious brain activity, including specifically the thalamus. Methods: Nine healthy human volunteers received three escalating doses using 0.4%, 0.7% and 2.0% end-tidal sevoflurane inhalation. During baseline and each of the three levels of anaesthesia one PET scan was performed after injection of . Cardiovascular and respiratory parameters were monitored and electroencephalography and bispectral index (BIS) were registered. Results: Sevoflurane decreased the BIS values dose-dependently. No significant change in global cerebral blood flow (CBF) was observed. Increased regional CBF (rCBF) in the anterior cingulate (17-21%) and decreased rCBF in the cerebellum (18-35%) were identified at all three levels of sedation compared to baseline. Comparison between adjacent levels sevoflurane initially (0 vs. 0.2 MAC) decreased rCBF significantly in the inferior temporal cortex and the lingual gyrus. At the next level (0.2 MAC vs. 0.4 MAC) rCBF was increased in the middle temporal cortex and in the lingual gyrus, and decreased in the thalamus. At the last level (0.4 MAC vs. 1 MAC) the rCBF was increased in the insula and decreased in the posterior cingulate, the lingual gyrus, precuneus and in the frontal cortex. Conclusion: At sevoflurane concentrations at 0.7% and 2.0% a significant decrease in relative rCBF was detected in the thalamus. Interestingly, some of the most profound changes in rCBF were observed in structures related to pain processing (anterior cingulate and insula).
PMID: 15504187 [PubMed - in process]
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Pitfalls and challenges when assessing the depth of hypnosis during general anaesthesia by clinical signs and electronic indices.
Jensen EW, Litvan H, Struys M, Vazquez PM.
Department of Cardiac Anaesthesia, Hospital Santa Creu i Sant Pau, Barcelona, Spain, and Consultant, Research Section, Danmeter A/S.
The objective of this article was to review the present methods used for validating the depth of hypnosis. We introduce three concepts, the real depth of hypnosis (DH(real)), the observed depth of hypnosis (DH(obs)), and the electronic indices of depth of hypnosis (DH(el-ind)). The DH(real) is the real state of hypnosis that the patient has in a given moment during the general anaesthesia. The DH(obs) is the subjective assessment of the anaesthesiologist based on clinical signs. The DH(el-ind) is any estimation of the depth of hypnosis given by an electronic device. The three entities DH(real), DH(obs) and DH(el-ind) should in the ideal situation be identical. However, this is rarely the case. The correlation between the DH(obs) and the DH(el-ind) can be affected by a number of factors such as the stimuli used for the assessment of the level of consciousness or the administration of analgesic agents or neuro muscular blocking agents. Opioids, for example, can block the response to tactile and noxious stimuli, and even the response to verbal command could vanish, hence deeming the patient in a lower depth of hypnosis than the real patient state. The DH(el-ind) can be disturbed by the presence of facial muscular activity. In conclusion, although several monitors and clinical scoring scales are available to assess the depth of hypnosis during general anaesthesia, care should be taken when interpreting their results.
PMID: 15504186 [PubMed - in process]
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Low-dose bupivacaine with sufentanil prevents hypotension after spinal anesthesia for hip repair in elderly patients.
Olofsson C, Nygards EB, Bjersten AB, Hessling A.
Department of Anesthesiology and Intensive Care, Karolinska Hospital, Stockholm, Sweden.
Background: Hip fracture is common in the geriatric population. Patients in this group are often at high risk for perioperative complications from concurrent diseases. Conventional spinal anesthesia can be associated with hypotension but has a better postoperative outcome compared to general anesthesia. We judged that a reduced dose of bupivacaine in combination with sufentanil could give reliable blocks with minimal hypotension. Methods: Fifty elderly patients were randomized into two groups. The study group received spinal anesthesia as a combination of hyperbaric bupivacaine 7.5 mg and sufentanil 5 microg while the control group received hyperbaric bupivacaine 15 mg. The hemodynamic stability of the patients and the quality of the blocks were compared. Results: All patients had adequate duration of reliable blocks. More control group patients than study group patients required ephedrine due to hypotension. Conclusion: A reduced dose of hyperbaric bupivacaine (7.5 mg) in combination with sufentanil (5 microg) provides reliable spinal anesthesia for the repair of hip fracture in aged patients with few events of hypotension and little need for vasopressor support of blood pressure.
PMID: 15504182 [PubMed - in process]
Is a double-injection technique superior to a single injection in posterior subgluteal sciatic nerve block?
Taboada M, Alvarez J, Cortes J, Rodriguez J, Atanassoff PG.
Department of Anesthesiology, Hospital Clinico Universitario de Santiago, Santiago de Compostela, Spain. manutabo@mixmail.com
BACKGROUND and objectives: Currently, no information is available on the effects of a double-injection technique on onset time and efficacy following subgluteal sciatic nerve blockade. We hypothesized that the success rate and time to onset of subgluteal nerve block following a double-injection technique would be superior to that after a single injection. METHODS: Fifty ASA I or II patients undergoing foot or ankle surgery randomly received a single or double injection subgluteal sciatic nerve block. Group S (n=25) received a single injection of 30 ml of 0.75% ropivacaine to the sciatic nerve. In Group D (n = 25), 15 ml of the same solution was injected to each sciatic nerve component. Completion of sensory and motor blockade, and patient acceptance, was evaluated by a blinded anesthesiologist. RESULTS: Complete sensory and motor blockade of the foot was achieved faster with the double injection (7.4 [5.9-8.8] min and 12.3 [10.4-14.2] min, respectively) than with the single-injection technique (12.5 [10.7-14.3] min and 18.8 [16.7-21.0] min, respectively) (P<0.001 and P<0.001, respectively). Success rate and acceptance were similar in both groups. Severe or moderate discomfort during the procedure was less frequent after a single injection (P = 0.013). CONCLUSIONS: Both the single- and double-injection technique for subgluteal sciatic nerve blockade resulted in acceptable anesthesia in most patients. The double injection generated a faster onset of anesthesia than the single injection. However, the double-injection technique caused more patient discomfort during establishment of the nerve block.
Publication Types:
- Clinical Trial
- Randomized Controlled Trial
PMID: 15242434 [PubMed - indexed for MEDLINE]
Study regarding anesthesia outcomes cites outdated studies * response.
Weis M, Abenstein JP, Long KH, McGlinch BP, Dietz NM.
PMID: 15502074 [PubMed - in process]
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The Laryngeal Mask Airway UniqueTM versus the Soft SealTM Laryngeal Mask: A Randomized, Crossover Study in Paralyzed, Anesthetized Patients.
Brimacombe J, von Goedecke A, Keller C, Brimacombe L, Brimacombe M.
Department of Anesthesia and Intensive Care, Cairns Base Hospital, The Esplanade, Cairns 4870, Australia. jbrimaco@bigpond.net.au.
We tested the hypothesis that ease of insertion, oropharyngeal leak pressure, fiberoptic position, ease of ventilation, and mucosal trauma are different for the Soft Sealtrade mark laryngeal mask airway (SSLM) and the laryngeal mask airway Uniquetrade mark (LMA-U). Ninety paralyzed, anesthetized adult patients (ASA I-II; 18-80 yr old) were studied. Both devices were inserted into each patient in random order. Oropharyngeal leak pressure and fiberoptic position were determined during cuff inflation from 0-40 mL in 10-mL increments and at an intracuff pressure of 60 cm H(2)O. Ease of ventilation was determined by controlling ventilation for 10 min at 8 and 12-mL/kg tidal volume and recording hemoglobin oxygen saturation, end-tidal CO(2), leak fraction, peak airway pressure, and the presence or absence of gastric insufflation. Mucosal trauma was determined by examining the first randomized device for the presence of visible and occult blood. Insertion time was shorter (P = 0.0001) and fewer attempts were required (P = 0.005) for the LMA-U. There were no failed uses of either device. Oropharyngeal leak pressures were similar, but fiberoptic position was superior with the LMA-U (P </= 0.0003). There were no differences in hemoglobin oxygen saturation, end-tidal CO(2), leak fraction, or peak airway pressure at either tidal volume. Gastric insufflation was not detected in either group at either tidal volume. The frequency of visible (P = 0.009) and occult blood (P = 0.0001) was less with the LMA-U. We conclude that the LMA-U is superior to the SSLM in terms of ease of insertion, fiberoptic position, and mucosal trauma, but similar in terms of oropharyngeal leak pressure and ease of ventilation.
PMID: 15502065 [PubMed - in process]
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Intraoperative Wake-Up Test and Postoperative Emergence in Patients Undergoing Spinal Surgery: A Comparison of Intravenous and Inhaled Anesthetic Techniques Using Short-Acting Anesthetics.
Grottke O, Dietrich PJ, Wiegels S, Wappler F.
Department of Anesthesiology, University Witten/Herdecke, Hospital Cologne-Merheim, Ostemerheimer Strassse 200, D-51109 Cologne, Germany. wapplerf@kliniken-koeln.de.
Surgical procedures on the vertebral column may result in spinal cord damage, leading to neurological deficits that demand immediate therapeutical intervention. We designed this study to determine which anesthetic regimen allows a rapid wake-up test during and after surgery to detect neurological deficits. Fifty-four patients were randomly allocated to the following groups: group PR (propofol/remifentanil): target-controlled infusion with propofol (plasma concentration, 2-4 μg/mL) and remifentanil 0.2-0.5 μg . kg(-1) . min(-1); group PS (propofol/sufentanil): propofol (2-4 μg/mL) and repetitive boluses of 0.1-0.2 μg/kg of sufentanil adjusted to patients requirements; and group DR (desflurane/remifentanil): desflurane/air 3.0-4.0 vol% combined with remifentanil 0.2-0.5 μg . kg(-1) . min(-1). Group PS required significantly longer times for the onset of breathing (8.9 +/- 1.6 min), elevation of the head (17.0 +/- 3.8 min), and motion of the feet (17.0 +/- 7.4 min) than group PR (6.9 +/- 2.6 min, 9.3 +/- 2.2 min, and 9.4 +/- 2.4 min, respectively) or group DR (5.4 +/- 0.8 min, 6.1 +/- 1.0 min, and 6.2 +/- 1.0 min, respectively). The anesthetic regimen with desflurane and remifentanil allowed faster awakening during and after surgery that permitted immediate neurological examination after spinal surgery compared with propofol/remifentanil.
PMID: 15502058 [PubMed - as supplied by publisher]
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Publications in anesthesia journals: quality and clinical relevance.
Lauritsen J, Moller AM.
Bakkedraget 18, 2. th, 3400 Hillerod, Denmark. jakobl@dadlnet.dk.
Clinicians performing evidence-based anesthesia rely on anesthesia journals for clinically relevant information. The objective of this study was to analyze the proportion of clinically relevant articles in five high impact anesthesia journals. We evaluated all articles published in Anesthesiology, Anesthesia & Analgesia, British Journal of Anesthesia, Anesthesia, and Acta Anaesthesiologica Scandinavica from January to June, 2000. Articles were assessed and classified according to type, outcome, and design; 1379 articles consisting of 5468 pages were evaluated and categorized. The most common types of article were animal and laboratory research (31.2%) and randomized clinical trial (20.4%). A clinically relevant article was defined as an article that used a statistically valid method and had a clinically relevant end-point. Altogether 18.6% of the pages had as their subject matter clinically relevant trials. We compared the Journal Impact Factor (a measure of the number of citations per article in a journal) and the proportion of clinically relevant pages and found that they were inversely proportional to each other.
PMID: 15502053 [PubMed - in process]
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The postoperative analgesic effect of tramadol when used as subcutaneous local anesthetic.
Altunkaya H, Ozer Y, Kargi E, Ozkocak I, Hosnuter M, Demirel CB, Babuccu O.
Ev-Ko Konutlari F-66 No: 8, 67600 Kozlu/Zonguldak, Turkey. haltunkaya@hotmail.com.
Recently, it has been shown that tramadol was an effective local anesthetic in minor surgery. In this study, its efficacy for relieving postoperative pain was evaluated. Forty patients undergoing minor surgery (lipoma excision and scar revision) under local anesthesia were included. The patients were randomly allocated into two groups: In group T (n = 20), 2 mg/kg tramadol, and in group L (n = 20), 1 mg/kg lidocaine were given subcutaneously. In both groups, the injection volume was 5 mL containing 1/200,000 adrenalin. The degree of the erythema, burning sensation, and pain at the injection site were recorded. Incision response, which is a degree of the pain sensation during incision, was recorded and graded with the visual analog scale (VAS) 0-10. After incision, VAS values were recorded at 15-min intervals. When the VAS score of the pain during surgery exceeded 4, an additional 0.5 mg/kg of the study drug was injected and this dosage was added to the total amount. Patients were discharged on the same day. Subjects with VAS >/=4 were advised to take paracetamol as needed. No side effects were recorded in either group except for 1 patient complaining of nausea in group T at the 30th min of operation. After 24 h, patients were called and the time of first analgesic use and total analgesic dose taken during the postoperative period were recorded. During the 24 postoperative hours, 18 of 20 (90%) subjects did not need any type of analgesia in group T, whereas this number was 10 (50%) in group L (P < 0.05). The time span before taking first analgesic medication was longer (4.9 +/- 0.3 h) in group T than that of group L (4.4 +/- 0.7 h) (P < 0.05). We propose that tramadol can be used as an alternative drug to lidocaine for minor surgeries because of its ability to decrease the demand for postoperative analgesia.
PMID: 15502049 [PubMed - in process]
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The Inhibition of Aortic Smooth Muscle Cell Proliferation by the Intravenous Anesthetic Ketamine.
Shiga Y, Minami K, Segawa K, Uezono Y, Shiraishi M, Sata T, Yamamoto C, Sung-Teh K.
MD Assistant Department of Anesthesiology, University of Occupational and Environmental Health School of Medicine, 1-1 Iseigaoka, Yahatanishiku, Kitakyushu 807-8555, Japan. kminami@med.uoeh-u.ac.jp.
Smooth muscle cell (SMC) proliferation has been recognized as central to the pathology of both major forms of vascular disease, atherosclerosis and hypertension. Recently, we reported that ketamine inhibits rat mesangial cell proliferation, suggesting that ketamine inhibits cell growth. Although the IV anesthetic ketamine has been widely used clinically, the exact effects of ketamine on vascular SMC proliferation have not been studied. In this study, we investigated the effects of ketamine on vascular SMC proliferation. Ketamine inhibited [(3)H]thymidine incorporation and decreased the number of SMCs in a concentration-dependent manner (10-200 μM); neither propofol nor fentanyl inhibited [(3)H]thymidine incorporation into human aortic SMCs. The protein kinase C (PKC) inhibitor GF109203x abolished the ketamine-induced inhibition of [(3)H]thymidine incorporation into SMC, but the inhibition was not affected by either the protein kinase A inhibitor H-89 or the protein kinase G inhibitor KT5823. A histological analysis demonstrated the inhibitory effect of ketamine on the intimal thickening of the balloon-injured rat aorta. Based on these results, ketamine inhibits SMCs at clinical concentrations via the PKC pathway. Our results indicate that ketamine might prevent the proliferation of SMCs clinically.
PMID: 15502039 [PubMed - as supplied by publisher]
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Impaired Acquisition of Spatial Memory 2 Weeks After Isoflurane and Isoflurane-Nitrous Oxide Anesthesia in Aged Rats.
Culley DJ, Baxter MG, Crosby CA, Yukhananov R, Crosby G.
Department of Anesthesiology, Brigham & Women's Hospital, 75 Francis Street, Boston, MA. 02115. gcrosby@zeus.bwh.harvard.edu.
Aged rats are impaired on a spatial memory task for at least 24-48 h after isoflurane-nitrous oxide anesthesia. In this study, we tested how long the impairment lasts and investigated the role of nitrous oxide. Eighteen-month-old rats were randomized to anesthesia for 2 h with 1.2% isoflurane with or without 70% nitrous oxide or a control group (30% oxygen). Two weeks later, rats were tested daily for 14 days on a 12-arm radial maze. The number of correct choices to first error, total errors, and time to complete the maze were recorded. Rats anesthetized with 1.2% isoflurane with 70% nitrous oxide made fewer correct choices before first error (P </= 0.05). Trends toward similar results were noted for error rate and time to complete the maze, but these did not achieve statistical significance. Post hoc analysis comparing all anesthetized rats to controls demonstrated that anesthetized rats made fewer correct choices to first error (P </= 0.05) and took longer to complete the maze (P </= 0.05). There were no differences in total number of errors (P </= 0.06). Thus, spatial memory is impaired for 2 wk after general anesthesia in aged rats independent of whether nitrous oxide is used.
PMID: 15502036 [PubMed - as supplied by publisher]
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A prospective, randomized, double-blind comparison of unilateral spinal anesthesia with hyperbaric bupivacaine, ropivacaine, or levobupivacaine for inguinal herniorrhaphy.
Casati A, Moizo E, Marchetti C, Vinciguerra F.
Department of Anesthesiology, University of Parma, Azienda Ospedaliera di Parma, Via Gramsci 13-33100 Parma, Italy. acasati@ao.pr.it.
In 60 patients undergoing inguinal hernia repair, we compared the clinical profile of unilateral spinal anesthesia produced with either 8 mg of hyperbaric bupivacaine 0.5% (n = 20), 8 mg of hyperbaric levobupivacaine 0.5% (n = 20), or 12 mg of hyperbaric ropivacaine 0.5% (n = 20). The study drug was injected slowly through a 25-gauge Whitacre directional needle and patients maintained the lateral decubitus position for 15 min. The onset time and intraoperative efficacy were similar in the three groups. The maximal level of sensory block on the operative and nonoperative sides was T6 (T12-5) and L3 (/[no sensory level detectable]-T4) with bupivacaine, T8 (T12-5) and L3 (/-T3) with levobupivacaine, T5 (T10-2) and T11 (/-T3) with ropivacaine (P = 0.11, P = 0.23, respectively). Complete regression of spinal anesthesia occurred after 166 +/- 42 min with ropivacaine, 210 +/- 63 min with levobupivacaine, and 190 +/- 51 min with bupivacaine (P = 0.03 and P = 0.04, respectively); however, no differences were observed in time for home discharge (329 +/- 89 min with bupivacaine, 261 +/- 112 min with levobupivacaine, and 332 +/- 57 min with ropivacaine [P = 0.28]). We conclude that 8 mg of levobupivacaine or 12 mg of ropivacaine are acceptable alternatives to 8 mg of bupivacaine when limiting spinal block at the operative side for inguinal hernia repair.
PMID: 15502035 [PubMed - in process]
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The Pharmacokinetics of the Intravenous Formulation of Fentanyl Citrate Administered Orally in Children Undergoing General Anesthesia.
Wheeler M, Birmingham PK, Lugo RA, Heffner CL, Cote CJ.
Department of Pediatric Anesthesiology, #19, Children's Memorial Hospital, 2300 Children's Plaza, Chicago, IL 60614. mwheeler@northwestern.edu.
The bioavailability of oral transmucosal fentanyl citrate (OTFC) in children is similar to that of fentanyl solution administered orally to adults. We hypothesized that administering an oral fentanyl solution to children would result in similar fentanyl plasma concentrations and pharmacokinetic variables as administering comparable doses of OTFC. In this pilot study, 10 healthy children requiring postoperative analgesia were enrolled. Each received the undiluted IV fentanyl formulation orally (approximately 10-15 μg/kg; maximum, 400 μg). Venous blood samples were collected from 15 to 600 min after administration. Pharmacokinetic variables were determined using noncompartmental analysis and were compared with a previously studied population of children who received a similar dose of OTFC. Pharmacokinetic variables for the orally administered IV fentanyl formulation were as follows: time to reach peak concentration = 1.7 +/- 1.6 h, peak concentration = 1.83 +/- 1.19 ng/mL, half-life = 4.7 +/- 2.8 h, area under the plasma concentration time curve = 6.46 +/- 3.96 h . ng(-1) . mL(-1), apparent oral volume of distribution (V/F) = 17.5 +/- 7.2 L/kg, apparent oral clearance (CL/F) = 3.33 +/- 2.25 L . kg(-1) . h(-1). Although both OTFC and orally administered IV fentanyl resulted in similar pharmacokinetic variables and plasma concentrations for a given dose, there was marked interpatient variability, particularly in the early hours after oral administration of the IV formulation of fentanyl. This suggests that this method of administration be used with caution until further data are available.
PMID: 15502029 [PubMed - as supplied by publisher]
Society for obstetric anesthesia and perinatology. Ft. Myers, Florida. May 12-16, 2004.
Bucklin BA.
University of Colorado Health Sciences Center, Denver, Colorado. brenda.bucklin@uchsc.edu.
PMID: 15505485 [PubMed - in process]
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Weak intermolecular associations and anesthesia.
Sandorfy C.
Professor Emeritus, Departement de chimie, Universite de Montreal, Montreal, Quebec.
PMID: 15505460 [PubMed - in process]
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Introduction of Anesthesia Resident Trainees to the Operating Room Does Not Lead to Changes in Anesthesia-controlled Times for Efficiency Measures.
Eappen S, Flanagan H, Bhattacharyya N.
* Assistant Professor, Department of Anesthesiology, Perioperative and Pain Medicine, dagger Associate Professor, Department of Otology and Laryngology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.
BACKGROUND:: Operating room efficiency is an important concern in most hospitals today. Little work has been reported to evaluate the contribution of anesthesia residents to changes in anesthesia-controlled time-related efficiencies in the operating room. The goal of this study was to measure the impact of the initiation of new residents to the operating room on anesthesia-related time measures of operating room efficiency. METHODS:: Using the computerized operating room information systems, specific data regarding anesthesia-controlled times were extracted over three distinct 2-week periods over the course of 1 academic year. These included the first 2 weeks of July, when most of the operating rooms were staffed by attending physicians working alone; 2 weeks in September when new anesthesia residents were working in a 2:1 ratio with staff; and 2 weeks in May. The induction times, emergence times, and room turnover times were compared over these three periods for first-year anesthesia residents. Standard descriptive statistics were computed. Analysis of variance testing was then conducted comparing each of these time periods. Significance was set at P < 0.05. RESULTS:: A total of 3,004 surgical procedures were performed during the 2-week study periods in July, September, and May, respectively. For the July, September, and May groups, the mean anesthesia induction times were 17.3, 19.0, and 20.8 min (P = 0.047); the emergence times were 8.7, 9.7, and 10.0 min, (P = 0.024); and the corresponding mean room turnover times were 47.6, 48.5, and 48.6 min (P = 0.907), respectively. CONCLUSION:: Although statistically significant time differences were found, these data strongly suggest that the initiation of anesthesia trainees to the operating room has no clinically or economically meaningful adverse effect on the anesthesia-controlled time component of operating room efficiency.
PMID: 15505458 [PubMed - as supplied by publisher]
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Mitochondrial Injury and Caspase Activation by the Local Anesthetic Lidocaine.
Johnson ME, Uhl CB, Spittler KH, Wang H, Gores GJ.
* Assistant Professor, dagger Research Technician, section sign Research Fellow, Department of Anesthesiology, ||Professor, Center for Basic Research in Digestive Diseases, Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine. double dagger Clinical Director of Pain Management, Department of Anesthesiology, Eastern Maine Medical Center, Bangor, Maine.
BACKGROUND:: Lidocaine, a local anesthetic, can be neurotoxic. However, the cellular mechanisms of its neurotoxicity at concentrations encountered during spinal anesthesia remain unclear. METHODS:: The authors examined the mechanisms of lidocaine neurotoxicity in the ND7 cell line derived from rat dorsal root ganglion. Individual neurons were assayed by flow cytometry or microscopy using fluorescent probes of plasma membrane integrity, mitochondrial membrane potential, caspase activity, phospholipid membrane asymmetry, and mitochondrial cytochrome c release. RESULTS:: In the ND7 cell line, lidocaine at 185 mm x 10 min to 2.3 mm x 24 h caused necrosis or late apoptosis. Equimolar Tris buffer and equipotent tetrodotoxin controls were not toxic, indicating that neither osmotic nor Na-blocking effects explain lidocaine neurotoxicity. The earliest manifestation of lidocaine neurotoxicity was complete loss of mitochondrial membrane potential within 5 min after exposure to lidocaine at a concentration of 19 mm or greater. Consistent with these data, 37 mm lidocaine (1%) induced release of mitochondrial cytochrome c into the cytoplasm, as well as plasma membrane blebbing, loss of phosphatidylserine membrane asymmetry, and caspase activation, with release of mitochondrial cytochrome c to the cytoplasm within 2 h. Treatment with z-VAD-fmk, a specific inhibitor of caspases, prevented caspase activation and delayed but did not prevent neuronal death, but did not inhibit the other indicators of apoptosis. CONCLUSIONS:: Collectively, these data indicate that lidocaine neurotoxicity involves mitochondrial dysfunction with activation of apoptotic pathways.
PMID: 15505455 [PubMed - as supplied by publisher]
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Intravenous Emulsified Halogenated Anesthetics Produce Acute and Delayed Preconditioning against Myocardial Infarction in Rabbits.
Chiari PC, Pagel PS, Tanaka K, Krolikowski JG, Ludwig LM, Trillo RA Jr, Puri N, Kersten JR, Warltier DC.
* Research Fellow in Anesthesiology, double dagger Research Scientist in Anesthesiology, section sign Graduate Student, ** Professor of Anesthesiology and Pharmacology, Medical College of Wisconsin, Milwaukee, Wisconsin. dagger Professor and Director of Cardiac Anesthesia, Medical College of Wisconsin and Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, Wisconsin, and Professor of Biomedical Engineering, Marquette University, Milwaukee, Wisconsin. parallel Senior Director, Marketing, # Research Scientist, Baxter Healthcare Corporation, New Providence, New Jersey. daggerdagger Professor of Anesthesiology, Medicine (Division of Cardiovascular Diseases), and Pharmacology, Medical College of Wisconsin and Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, Wisconsin; Professor of Biomedical Engineering, Marquette University, Milwaukee, Wisconsin; and Senior Vice Chairman of Anesthesiology, Medical College of Wisconsin, Milwaukee, Wisconsin.
BACKGROUND:: Preconditioning against myocardial infarction by volatile anesthetics is well known. The authors tested the hypothesis that new emulsified formulations of halogenated anesthetics administered intravenously reduce myocardial infarct size when administered either 1 or 24 h before prolonged ischemia and reperfusion. METHODS:: Pentobarbital-anesthetized rabbits (n = 39) were instrumented for measurement of hemodynamics and randomly assigned to receive intravenous saline (control), lipid vehicle, or infusions (3.5 ml . kg . h for 30 min) of emulsified isoflurane (6.9%), enflurane (7.1%), or sevoflurane (7.5%). Infusions were discontinued 30 min before a 30-min coronary occlusion and 3 h of reperfusion. In three additional groups, conscious rabbits (n = 21) received saline, lipid vehicle, or emulsified sevoflurane (7.5%) infusions (3.5 ml . kg . h for 30 min) 24 h before ischemia and reperfusion. Infarct size was determined using triphenyltetrazolium staining. RESULTS:: Lipid vehicle produced transient increases in heart rate, whereas emulsified volatile anesthetics had no effect on hemodynamics before coronary occlusion. Lipid vehicle did not affect infarct size (38 +/- 2% of the area at risk; mean +/- SEM) as compared with saline control (41 +/- 4%). In contrast, emulsified isoflurane, enflurane, and sevoflurane reduced infarct size (20 +/- 3%, 20 +/- 3%, and 21 +/- 2% of the area at risk, respectively; P < 0.05). Administration of lipid vehicle or emulsified sevoflurane did not produce sedation or respiratory depression in conscious rabbits. Emulsified sevoflurane (18 +/- 2%) but not lipid vehicle (44 +/- 2%) reduced infarct size as compared with control in delayed preconditioning experiments. CONCLUSIONS:: Intravenous emulsified halogenated anesthetics produce acute and delayed preconditioning against myocardial infarction.
PMID: 15505452 [PubMed - as supplied by publisher]
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Interaction of Halogenated Anesthetics with alpha- and beta-Adrenoceptor Stimulations in Diabetic Rat Myocardium.
Amour J, David JS, Vivien B, Coriat P, Riou B.
* Assistant Professor, Department of Anesthesiology, double dagger Professor of Anesthesiology, Chairman, Department of Anesthesiology and Critical Care, section sign Director of the Laboratory of Experimental Anesthesiology, Professor of Anesthesiology, Chairman, Department of Emergency Medicine and Surgery, Centre Hospitalier Universitaire Pitie-Salpetriere. dagger Assistant Professor, Department of Anesthesiology and Critical Care, Centre Hospitalier Universitaire Edouard Herriot.
BACKGROUND:: Halogenated anesthetics potentiate the positive inotropic effects of alpha- and beta-adrenoceptor stimulations. Although diabetes mellitus induces significant myocardial abnormalities, the interaction of halogenated anesthetics and adrenoceptor stimulation in diabetic myocardium remains unknown. METHODS:: Left ventricular papillary muscles were provided from healthy and streptozotocin-induced diabetic rats. Effects of 1 minimum alveolar concentration halothane, isoflurane, and sevoflurane on the inotropic and lusitropic responses of alpha (phenylephrine)- and beta (isoproterenol)-adrenoceptor stimulations were studied at 29 degrees C with 12 pulses/min. Data shown are mean percentage of baseline active force +/- SD. RESULTS:: Phenylephrine induced comparable positive inotropic effects in healthy and diabetic rats (143 +/- 8 vs. 136 +/- 18%; not significant), but the potentiation by halogenated anesthetics was abolished in the diabetic rats (121 +/- 20, 130 +/- 20, and 123 +/- 20% for halothane, isoflurane, and sevoflurane, respectively; not significant). In diabetic rats, the positive inotropic effect of isoproterenol was markedly diminished (109 +/- 9 vs. 190 +/- 18%; P < 0.05), but its potentiation was preserved with isoflurane (148 +/- 21%; P < 0.05) and sevoflurane (161 +/- 40%; P < 0.05) but not with halothane (126 +/- 16%; not significant). Halothane induced a deleterious effect on the sarcoplasmic reticulum, as shown by its impairment in the lusitropic effect of isoproterenol, compared with isoflurane and sevoflurane. CONCLUSION:: Potentiation of the positive inotropic effect of alpha-adrenoceptor stimulation by halogenated anesthetics is abolished in diabetic rats. In contrast, potentiation of beta-adrenoceptor stimulation is preserved with isoflurane and sevoflurane but not with halothane, probably because of its deleterious effects on sarcoplasmic reticulum.
PMID: 15505450 [PubMed - as supplied by publisher]
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Acute Care Skills in Anesthesia Practice: A Simulation-based Resident Performance Assessment.
Murray DJ, Boulet JR, Kras JF, Woodhouse JA, Cox T, McAllister JD.
* Director, Washington University Clinical Simulation Center, Professor, Department of Anesthesiology, Washington University School of Medicine, double dagger Associate Professor, Department of Anesthesiology, Washington University School of Medicine, section sign Administrator, Washington University Clinical Simulation Center, St. Louis, Missouri. dagger Vice President, Education Council for Foreign Medical Graduates, Philadelphia, Pennsylvania.
BACKGROUND:: A recurring initiative in graduate education is to find more effective methods to assess specialists' skills. Life-sized simulators could be used to assess the more complex skills expected in specialty practice if a curriculum of relevant exercises were developed that could be simply and reliably scored. The purpose of this study was to develop simulation exercises and associated scoring methods and determine whether these scenarios could be used to evaluate acute anesthesia care skills. METHODS:: Twenty-eight residents (12 junior and 16 senior) managed three intraoperative and three postoperative simulation exercises. Trainees were required to make a diagnosis and intervention in a simulation encounter designed to recreate an acute perioperative complication. The videotaped performances were scored by six raters. Three raters used a checklist scoring system. Three faculty raters measured when trainees performed three key diagnostic or therapeutic actions during each 5-min scenario. These faculty also provided a global score using a 10-cm line with scores from 0 (unsatisfactory) to 10 (outstanding). The scenarios included (1) intraoperative myocardial ischemia, (2) postoperative anaphylaxis, (3) intraoperative pneumothorax, (4) postoperative cerebral hemorrhage with intracranial hypertension, (5) intraoperative ventricular tachycardia, and (6) postoperative respiratory failure. RESULTS:: The high correlation among all of the scoring systems and small variance among raters' scores indicated that all of the scoring systems measured similar performance domains. Scenarios varied in their overall difficulty. Even though trainees who performed well on one exercise were likely to perform well in subsequent scenarios, the authors found that there were considerable differences in case difficulty. CONCLUSION:: This study suggests that simulation can be used to measure more complex skills expected in specialty training. Similar to other studies that assess a broad content domain, multiple encounters are needed to estimate skill effectively and accurately.
PMID: 15505443 [PubMed - as supplied by publisher]
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Severing the Link between Acute and Chronic Pain: The Anesthesiologist's Role in Preventive Medicine.
Gottschalk A, Raja SN.
* Department of Anesthesiology and Critical Care Medicine, Division of Neuroanesthesia; dagger Department of Anesthesiology and Critical Care Medicine, Division of Pain Medicine, The Johns Hopkins University, Baltimore, Maryland. sraja@jhmi.edu.
PMID: 15505440 [PubMed - as supplied by publisher]
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What makes a "good" anesthesiologist?
Gaba DM.
Stanford University School of Medicine, Stanford, California, and VA Palo Alto Health Care System, Palo Alto, California. gaba@stanford.edu.
PMID: 15505439 [PubMed - in process]
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This month in anesthesiology.
Henkel G.
PMID: 15505437 [PubMed - in process]
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