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Items 1 - 15 of 15 |
One page. |
[Patients' needs and expectations regarding anaesthesiaA survey on the pre-anaesthetic visit of patients and anaesthesiologists.]
[Article in German]
Hofer CK, Ganter MT, Furrer L, Guthauser G, Klaghofer R, Zollinger A.
Institut fur Anasthesiologie und Intensivmedizin, Stadtspital Triemli, Zurich, Schweiz.
BACKGROUND. This prospective survey aimed at elucidating the patients' expectations and needs regarding the pre-anaesthetic visit and the forthcoming anaesthesia. The same questionnaire was answered by both patients and anaesthesiologists. METHODS. A total of 200 ASA I-III patients were interviewed prior to the preoperative anaesthetic visit. The questionnaire consisted of the topics preoperative affective situation, information and self-estimation of anaesthesia knowledge, expectations regarding the pre-anaesthetic visit/anaesthesia and extent of information concerning the perioperative course including risk and possible complications. The same questionnaire was presented to 35 certified anaesthesiologists with the request to estimate the patients' answers. Answers were rated using a Likert-scale, a comparison of patients'()and anaesthesiologists' replies was performed. RESULTS. For all 5 topics considerable differences between patients' answers and anaesthesiologists' rating were found (e.g. for the assessment of the affective situation, the relevance of family physicians as information source, the desired anaesthetic technique or the extent of anaesthesia-related risk information). No differences were observed for the importance of an anaesthesiologist as information source and fear reduction by the pre-anaesthetic visit. CONCLUSIONS. Anaesthesiologists tend to misinterpret many patients' expectations and attitudes. The results demonstrate the potential for quality improvement of the pre-anaesthetic visit.
PMID: 15517113 [PubMed - as supplied by publisher]
Effects of isoflurane and propofol on cortical somatosensory evoked potentials during comparable depth of anaesthesia as guided by bispectral index.
Liu EH, Wong HK, Chia CP, Lim HJ, Chen ZY, Lee TL.
Department of Anaesthesia, National University Hospital, 5 Lower Kent Ridge Road, Singapore 119074.
BACKGROUND: The aim of this study was to determine if propofol caused less suppression of cortical somatosensory evoked potentials (SSEPs) during spine surgery compared with isoflurane during comparable depth of anaesthesia as guided by bispectral index (BIS) measurements. METHODS: This was a randomized controlled trial of propofol and isoflurane involving 60 patients undergoing elective spine surgery. BIS monitoring was used to guide a consistent and comparable depth of anaesthesia, the index was maintained at between 40 and 50 during anaesthesia. The cortical SSEP P40-N50 peak-to-peak amplitude and latency time to the P40 peak were measured before induction of anaesthesia, after induction of anaesthesia, at the start of skin incision, at the start of pedicle screw insertion and at the start of rod insertion, by a neurophysiologist blinded to drug allocation. RESULTS: Both propofol and isoflurane decreased SSEP amplitude and increased latency during the course of anaesthesia. After achieving a comparable depth of anaesthesia, the SSEP amplitude was significantly lower with isoflurane, 1.5 (1.0) vs 2.4 (1.4) microV (P=0.005). Latency was significantly longer with isoflurane, 39.5 (3.9) vs 37.3 (3.1) ms (P=0.024). Isoflurane was associated with greater variability of SSEP amplitude during the course of anaesthesia and surgery, coefficient of variation 35.4 (18.0) vs 21.2 (10.2)% (P=0.008). CONCLUSIONS: Propofol anaesthesia caused less suppression of the cortical SSEP, with better preservation of SSEP amplitude, and less variability at an equivalent depth of anaesthesia.
PMID: 15516356 [PubMed - as supplied by publisher]
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Comparison of plain and hyperbaric solutions of ropivacaine for spinal anaesthesia{dagger}
Fettes PD, Hocking G, Peterson MK, Luck JF, Wildsmith JA.
University Department of Anaesthesia, Ninewells Hospital and Medical School, Dundee DD1 9SY, UK.
BACKGROUND: Preliminary work has shown that ropivacaine provides spinal anaesthesia of shorter duration than bupivacaine, and may be of particular use in the day-case setting. However, there are few data comparing the actions of plain and hyperbaric solutions of this drug. METHODS: Forty ASA grade I-II patients undergoing elective perineal surgery under spinal anaesthesia were randomized to receive 3 ml ropivacaine 5 mg ml(-1), either in plain solution or with glucose 50 mg ml(-1). The extent and duration of sensory and motor block, pulse rate, blood pressure, and time to mobilization were recorded. RESULTS: Two patients (one per group) were withdrawn because of total block failure. There were significant differences in median time to onset of sensory block at T10 (plain 10 min; hyperbaric 5 min; P<0.01), median maximum extent (plain T8; hyperbaric T4; P<0.05), and median duration of sensory block at T10 (plain 25 min; hyperbaric 115 min; P<0.001). However, median times to complete regression of both sensory (270 vs 240 min; P<0.05) and motor (180 vs 120 min; P<0.001) block were longer in the plain group. Patients therefore mobilized sooner in the hyperbaric group (218 [n=16] vs 286 min [n=17]; P<0.01). All the hyperbaric blocks were adequate for surgery, but three patients receiving plain ropivacaine required general anaesthesia. CONCLUSION: Addition of glucose 50 mg ml(-1) to ropivacaine 5 mg ml(-1) increases the speed of onset, block reliability, duration of useful block for perineal surgery, and speed of recovery. Plain solutions are less reliable for surgery above a dermatomal level of L1.
PMID: 15516352 [PubMed - as supplied by publisher]
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Clonidine as an adjuvant to local anaesthetic axillary brachial plexus block: a randomized, controlled study.
Duma A, Urbanek B, Sitzwohl C, Kreiger A, Zimpfer M, Kapral S.
Department of Anesthesiology and General Intensive Care, Medical University of Vienna, Waehringer Guertel 18-20/9i, 1090 Vienna, Austria.
BACKGROUND: We compared the effects of clonidine added to levobupivacaine and bupivacaine on axillary brachial plexus block as well as the effectiveness of levobupivacaine alone compared with bupivacaine alone. METHODS: In this prospective, randomized, controlled, double-blind trial, four groups of 20 patients each were investigated, using (i) 40 ml of levobupivacaine 0.5% plus 0.150 mg of clonidine, (ii) 40 ml of levobupivacaine 0.5% plus 1 ml of NaCl 0.9%, (iii) 40 ml of bupivacaine 0.5% plus 0.150 mg of clonidine, and (iv) 40 ml of bupivacaine 0.5% plus 1 ml of NaCl 0.9%, respectively. The onset of motor and sensory block and duration of sensory block were recorded. RESULTS: There was no significant difference in duration between groups, but a significantly higher variance (P<0.001) was found in the two groups with clonidine than in the two groups without. CONCLUSIONS: These findings suggest responder and non-responder behaviour is a result of the addition of clonidine.
PMID: 15516351 [PubMed - as supplied by publisher]
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In vitro effects of local anaesthetics on the thromboelastographic profile of parturients.
Siau C, Ng HP, Tan GM, Ho BS, Pua HL.
Department of Anaesthesia, National University Hospital 5, Lower Kent Ridge, Singapore 119074, Singapore.
BACKGROUND: /B>. Post-dural puncture headache can be an incapacitating complication of obstetric epidural analgesia/anaesthesia and early or prophylactic epidural blood patch (EBP) is one of the treatment options. Although local anaesthetic (LA) agents have been shown to have anticoagulation effects in vitro, peri-partum women are known to be hypercoagulable. We postulated that the presence of residual LA might not result in impaired haemostasis of the EBP in parturients. METHODS: Blood samples from 10 healthy term parturients were subjected to thromboelastography after the addition of four different LA (lidocaine, bupivacaine, levobupivacaine, and ropivacaine) preparations. RESULTS: There was a significant reduction in reaction (R) and coagulation (K) time (P<0.001, P<0.05) and an increase in alpha degrees angle (P<0.01) when comparing undiluted blood with the saline control group. Maximum amplitude (MA) and clot lysis (Ly30) did not change significantly despite the 50% dilution. The thromboelastographic parameters of all four LA-treated groups were no different from their saline controls and from each other. CONCLUSION: At clinical dosages, LA did not cause any hypocoagulable changes on the thromboelastographic profile of healthy parturients.
PMID: 15516349 [PubMed - as supplied by publisher]
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Bispectral index and A-line AAI index as guidance for desflurane-remifentanil anaesthesia compared with a standard practice group: a multicentre study{dagger},{ddagger}
Bruhn J, Kreuer S, Bischoff P, Kessler P, Schmidt GN, Grzesiak A, Wilhelm W.
Department of Anaesthesiology and Intensive Care Medicine, University of Bonn, Germany.
BACKGROUND: This study was designed to investigate the impact of bispectral index (BIS) or A-line AAI index (based on middle-latency auditory evoked potential) monitoring on recovery times and drug consumption when compared with standard anaesthetic practice during desflurane-remifentanil anaesthesia. METHODS: After having obtained approval from the institutional review board and written informed consent, 200 adult patients undergoing minor surgical procedures were randomized to receive a desflurane-remifentanil anaesthetic controlled either solely by clinical parameters or by BIS or AAI to the following target values: during maintenance of anaesthesia to a value of '50' (BIS) or '30' (AAI), 15 min before the end of surgery to '60' (BIS) or '45' (AAI). Recovery times and drug consumption were recorded by a blinded investigator. RESULTS: Compared with standard practice, patients with BIS or AAI monitoring needed similar desflurane concentrations (standard practice 2.9 [0.5] vol%, BIS 3.3 [0.9] vol%, AAI 2.6 [0.5] vol%), and had similar recovery times (open eyes 5.6 [2.5] min, 5.9 [3.4] min, 5.0 [3.1] min; extubation 6.3 [2.4] min, 6.6 [3.5] min, 5.6 [3.0] min; stating name 7.3 [2.4] min, 7.6 [3.5] min, 7.3 [6.6] min). CONCLUSIONS: Compared with standard anaesthetic practice BIS and AAI guided titration to the used target ranges did not result in a reduction of desflurane consumption or recovery times during minor surgery with use of remifentanil.
PMID: 15516347 [PubMed - as supplied by publisher]
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Minimum effective local anaesthetic dose of isobaric levobupivacaine and ropivacaine administered via a spinal catheter for hip replacement surgery.
Sell A, Olkkola KT, Jalonen J, Aantaa R.
Department of Anaesthesia and Intensive Care, Tartu University Clinics, Tartu, Estonia.
BACKGROUND: /B>. Continuous spinal anaesthesia with spinal catheters allows incremental dosing of local anaesthetic and, consequently, less haemodynamic changes. However, little is known about the required doses. Therefore, we designed a study to assess the minimum effective local anaesthetic dose (MLAD) of levobupivacaine and ropivacaine in this context. METHODS: Forty-one patients undergoing hip replacement surgery were randomly allocated to one of the two local anaesthetic groups in a double-blind manner. The initial dose of local anaesthetic was determined by the response of the previous patient: the effective dose resulted in a 1 mg decrease in the dose of levobupivacaine or ropivacaine, and an ineffective dose resulted in a 1 mg increase. The MLAD was calculated by the Dixon up-and-down method. RESULTS: The MLAD of levobupivacaine was 11.7 mg (95% CI, 11.1-12.4) and that of ropivacaine 12.8 mg (95% CI, 12.2-13.4). CONCLUSIONS: These doses are significantly smaller than doses reported before for single-shot spinal anaesthesia. Continuous spinal anaesthesia allows the use of relatively small doses of local anaesthetic.
PMID: 15516345 [PubMed - as supplied by publisher]
Under "real world" conditions, desflurane increases drug cost without speeding discharge after short ambulatory anesthesia compared to isoflurane.
Schwarz SK, Butterfield NN, Macleod BA, Kim EY, Franciosi LG, Ries CR.
Department of Pharmacology and Therapeutics, The University of British Columbia, 2176 Health Sciences Mall, Vancouver, B.C. V6T 1Z3, Canada. stephan.schwarz@ubc.ca.
PURPOSE: To compare the measured "real world" perioperative drug cost and recovery associated with desflurane- and isoflurane-based anesthesia in short (less than one hour) ambulatory surgery. METHODS: We conducted a prospective, randomized, blinded trial with patients undergoing arthroscopic meniscectomy under general anesthesia. Following iv induction, patients received either isoflurane (group I; n = 25) or desflurane (group D; n = 20) for maintenance. The primary outcome variable was total perioperative drug cost per patient in Canadian dollars. Secondary outcome variables included volatile agent consumption and cost, adjuvant anesthetic and postanesthesia care unit (PACU) drug cost, readiness for PACU discharge, and incidence of adverse events. RESULTS: Total perioperative drug cost per patient was $14.58 +/- 6.83 (mean +/- standard deviation) for group I, and $21.47 +/- 5.18 for group D (P < 0.001). Isoflurane consumption per patient was 6.0 +/- 3.0 mL compared to 18.6 +/- 7.7 mL for desflurane (P < 0.0001); corresponding costs were $0.83 +/- 0.42 vs $7.61 +/- 3.15 (P < 0.0001). There were no differences in adjuvant anesthetic or PACU drug cost. All but one patient from each group were deemed ready for PACU discharge at 15 min postoperatively (Aldrete score >/= 9). One patient in group D experienced postoperative nausea. No other adverse events were noted. CONCLUSIONS: Measured total perioperative drug cost for a short ambulatory procedure (less than one hour) under general anesthesia was higher when desflurane rather than isoflurane was used for maintenance, essentially due to volatile agent cost. Desflurane use did not translate into faster PACU discharge under "real world" conditions.
PMID: 15528176 [PubMed - in process]
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Anesthetic management of a patient with Cantrell's pentalogy diagnosed prenatally.
Saito T, Suzuki A, Takahata O, Iwasaki H.
PMID: 15525629 [PubMed - in process]
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Anesthetic management of laparoscopic surgery for twin to twin transfusion syndrome.
Davies S, Mordani K.
PMID: 15525628 [PubMed - in process]
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Difficulties in anesthetizing a 106-yr-old patient for total hip replacement.
Avitsian R, Borkowski R, Tetzlaff J.
PMID: 15525625 [PubMed - in process]
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Images in Anesthesia: Transesophageal echocardiography enhances endovascular stent placement in traumatic trans-section of the thoracic aorta.
Dobson G, Petrasek P, Alvarez N.
PMID: 15525621 [PubMed - in process]
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Anesthetic management of Cesarean delivery in a patient with hypoplastic anemia and severe pre-eclampsia: [L'anesthesie pendant une cesarienne chez une patiente qui presente une anemie hypoplasique et une preeclampsie severe].
Wong AY, Chan RS, Irwin MG.
Department of Anaesthesiology F2, Queen Mary Hospital, 102 Pokfulam Road, Hong Kong, China. wongyca@so-net.com.hk.
PURPOSE: To describe the anesthetic management of Cesarean delivery in a patient with hypoplastic anemia and severe pre-eclampsia. CLINICAL FEATURES: A 28-yr-old parturient with a history of thrombocytopenia was admitted with signs of pre-eclampsia (blood pressure of 140/90 mmHg, heavy proteinuria and moderate bilateral ankle edema) at 25 weeks of gestation. Laboratory studies revealed pancy-topenia (hemoglobin 6.4 g.dL(-1), white cell count 3.43 x 10(9).L(-1), platelet count 20 x 10(9).L(-1)) and bone marrow biopsy showed hypoplastic anemia. As pre-eclampsia worsened, a Cesarean delivery was performed at 27 weeks with prophylactic platelet transfusion and meticulous blood pressure control. The procedure was uneventful, conducted under general anesthesia with an estimated blood loss of around 600 mL and a live female baby was delivered. Postoperatively her blood pressure and neurological symptoms improved but thrombocytopenia remained at discharge. CONCLUSIONS: Hypoplastic anemia is rare in pregnancy but it poses an increased risk for both mother and fetus. The mother is at risk of life-threatening episodes of bleeding and infection and a multidisciplinary team approach (obstetrician, anesthesiologist, hematologist and pediatrician) is essential. An accurate assessment of the hematological condition should be made and abnormalities corrected before surgery. Regional anesthesia may not be possible in this circumstance.
PMID: 15525619 [PubMed - in process]
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Arousal with iv epinephrine depends on the depth of anesthesia: [Le reveil avec epinephrine iv depend de la profondeur de l'anesthesie].
Shin HW, Ban YJ, Lee HW, Lim HJ, Yoon SM, Chang SH.
Department of Anesthesiology, Korea University Anam Hospital, 126-1, 5-Ka, Anam-dong, Sungbuk-Ku, Seoul, South Korea 136-705. hyewonmd@unitel.co.kr.
PURPOSE: To investigate whether the depth of anesthesia affects the change in the bispectral index (BIS) caused by iv epinephrine during propofol anesthesia. METHODS: Forty women undergoing elective lower abdominal surgery received a propofol target controlled infusion (TCI) to maintain a modified Observer's Assessment of Alertness/Sedation (OAA/S) score of 2 (sedation period). Subsequently anesthesia was induced with propofol TCI 5 mug.mL(-1) and rocuronium 0.9 mg.kg(-1), and propofol continued so as to maintain general anesthesia at a BIS of 50 (general anesthesia period). Intravenous epinephrine at a dose of 10 mug.5 mL(-1) in normal saline (epinephrine group, n = 20) or normal saline 5 mL (control group, n = 20) was administered during both periods. The BIS, mean arterial pressure (MAP) and heart rate (HR) were measured immediately before, and one, two, three, four, six, eight, and ten minutes after injection. The modified OAA/S scale was evaluated during the sedation period. RESULTS: There was no significant change in the modified OAA/S scale, BIS, or hemodynamic variables compared to preinjection values during either sedation or general anesthesia in the control group. Intravenous epinephrine increased the BIS and modified OAA/S scale during sedation, but there was no increase in BIS during general anesthesia. Increases in HR and MAP were observed during both periods after iv epinephrine. CONCLUSION: Intravenous epinephrine 10 mug resulted in an arousal effect and an increase in BIS during sedation, but did not change the BIS during general anesthesia. These results suggest that the arousal effect of iv epinephrine during propofol anesthesia depends on anesthetic depth.
PMID: 15525612 [PubMed - in process]
Rapid vestibular compensation in guinea pig even with prolonged anesthesia.
Gliddon CM, Darlington CL, Smith PF.
Vestibular Research Group, Department of Pharmacology and Toxicology, School of Medical Sciences, University of Otago Medical School, Dunedin, New Zealand.
The results of previous studies have suggested that prolonged anesthesia following unilateral labyrinthectomy (UL) results in a retardation of vestibular compensation, the process of behavioral recovery that occurs following the lesion. In this study we investigated the effects of short-term (25min) and long-term (4h) anesthesia with isoflurane on the time course of vestibular compensation following UL in guinea pig. Although there were significant differences in the frequency of spontaneous nystagmus (SN) (p < 0.05) and its rate of compensation (p < 0.05) between the 25min and 4h isoflurane groups, these differences appeared to be due largely to the 5, 9 and 13h time points. There was also a significant difference in the rate of yaw head tilt (YHT) compensation, largely due to the 5h time point. When exponential regression analysis was performed to evaluate the overall pattern of compensation, there was no significant difference in the time required to reach 100% SN or YHT compensation between the 25min and 4h isoflurane groups. Furthermore, there were no significant differences in roll head tilt (RHT) compensation between the two groups. These results suggest that the time course of vestibular compensation is largely independent of the duration of the anesthesia used for UL surgery.
PMID: 15519744 [PubMed - in process]
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