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Items 1 - 27 of 27 |
One page. |
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Awareness and hypoxia risk with Dräger Cato and Fabius anaesthesia machines.
Murphy E, Willis S.
Publication Types:
PMID: 15535506 [PubMed - in process]
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Safety warning with Datex-Ohmeda S/5 anaesthetic delivery unit design.
Weinberg L, Sawhney S, Skewes D.
Publication Types:
PMID: 15535503 [PubMed - in process]
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Rate-dependent left bundle branch block during anaesthesia.
Tyagi A, Sethi AK, Agarwal V, Mohta M.
Department of Anaesthesiology and Critical Care, University College of Medical Sciences and GTB Hospital, Shahadra, Delhi, India.
Rate-dependent left bundle branch block during general anaesthesia is rare. Its occurrence makes electrocardiographic diagnosis of acute myocardial ischaemia or infarction difficult. It can also be confused with a slow rate ventricular tachycardia. We present a case of rate-dependent left bundle branch block in a patient with no previous history of ischaemic heart disease. Carotid sinus massage resulted in a decrease in heart rate and reversion to normal sinus rhythm.
PMID: 15535502 [PubMed - in process]
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Suggestion, hypnosis and hypnotherapy: a survey of use, knowledge and attitudes of anaesthetists.
Coldrey JC, Cyna AM.
Department of Anaesthesia, Women's and Children's Hospital, Adelaide, South Australia.
Clinical hypnosis is a skill of using words and gestures (frequently called suggestions) in particular ways to achieve specific outcomes. It is being increasingly recognised as a useful intervention for managing a range of symptoms, especially pain and anxiety. We surveyed all 317 South Australian Fellows and trainees registered with ANZCA to determine their use, knowledge of, and attitudes towards positive suggestion, hypnosis and hypnotherapy in their anaesthesia practice. The response rate was 218 anaesthetists (69%). The majority of respondents (63%) rated their level of knowledge on this topic as below average. Forty-eight per cent of respondents indicated that there was a role for hypnotherapy in clinical anaesthesia, particularly in areas seen as traditional targets for the modality, i.e. pain and anxiety states. Nearly half of the anaesthetists supported the use of hypnotherapy and positive suggestions within clinical anaesthesia. Those respondents who had experience of clinical hypnotherapy were more likely to support hypnosis teaching at undergraduate or postgraduate level when compared with those with no experience.
PMID: 15535494 [PubMed - in process]
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Adjustment of anaesthesia depth using bispectral index prolongs seizure duration in electroconvulsive therapy.
Nishihara F, Saito S.
Department of Anesthesiology & Reanimatology, Gunma University School of Medicine, Maebashi, Japan.
Electroconvulsive therapy (ECT) under propofol anaesthesia induces relatively shorter seizures compared to barbiturate anaesthesia. Since significant correlation between seizure duration and bispectral index (BIS) value immediately before electrical stimulus has been reported among patients, adjustment of anaesthesia depth as determined by BIS may be effective in obtaining a longer seizure length. In the present study, we examined this hypothesis in those patients whose muscular seizure duration was less than 40s. ECT was prescribed to 20 patients suffering from endogenous depression. General anaesthesia was induced with propofol 1 mg/kg. Succinylcholine chloride 1 mg/kg was then given. The efficacy of electrical stimulation was determined using a tourniquet technique, electromyogram, and electroencephalography. When a patient had a seizure less than 40s in their second ECT treatment, the subsequent treatment was modified such that the electrical stimulus was given after waiting for a higher BIS value (+10-20). Intensity of electrical stimulus and anaesthesia conditions were identical in the two treatments. All 20 patients had longer seizures as determined by the electromyogram and/or electroencephalography when the stimulus was delivered at the higher BIS value. Seizure duration measured by muscle movement was 31+/-5 s when the stimulus was delivered without waiting and 46+/-10 s when delivered after waiting. There was a significant difference in seizure duration between the two treatments (P<0.01). Waiting for a recovery in BIS value before electrical stimulation can prolong seizure duration.
PMID: 15535490 [PubMed - in process]
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Early and late reversal of rocuronium with pyridostigmine during sevoflurane anaesthesia in children.
Oh AY, Kim SD, Kim CS.
Department of Anesthesiology and Pain Medicine, Seoul National University Children's Hospital, Seoul, Korea.
This study investigated the effect of pyridostigmine administered at different levels of recovery of neuromuscular function after rocuronium during sevoflurane anaesthesia in children. Fifty-one patients aged 3 to 10 years, ASA physical status 1 or 2 were randomized to 4 groups: a spontaneous recovery group; or, reversal with pyridostigmine 0.25 mg/kg with glycopyrrolate 0.01 mg/kg at one of three times: 5 minutes after rocuronium administration; at 1% twitch height (T1) recovery; or at a 25% twitch height (T25) recovery. Anaesthesia was induced with thiopentone (5-7 mg/kg) and maintained with 2-3% sevoflurane and 50% nitrous oxide. Atropine (0.015 mg/kg) and, after calibrating the TOF-Watch, rocuronium (0.6 mg/kg) were then administered. Maximal block occurred 1.1+/-0.5 min (mean, SD) after rocuronium administration. In the spontaneous recovery group, the clinical duration (recovery to T25) was 40.1+/-8.8 min and the recovery index (time between T25 and T75) 19.9+/-9.8 min. Recovery to TOF >0.9 from the time of rocuronium administration was reduced by approximately 30% in the pyridostigmine groups compared to the spontaneous recovery group. There was no significant difference among the three pyridostigmine groups. When pyridostigmine was given at T1 or T25, the time from pyridostigmine administration to TOF >0.9 was shorter than for the group receiving pyridostigmine 5 minutes after rocuronium.
PMID: 15535487 [PubMed - in process]
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Local anaesthetics--the origins of lignocaine.
Ball C, Westhorpe R.
Geoffrey Kaye Museum of Anaesthetic History.
PMID: 15535482 [PubMed - in process]
[Consequences of discontinuation of hyaluronidase: does it change our practice? ]
[Article in French]
Ripart J, Nouvellon E.
Departement Anesthesie-Douleur, CHU de Nimes, France. jacques.ripart@chu-nimes.fr
PMID: 15324973 [PubMed - indexed for MEDLINE]
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Differential diagnosis of shortness of breath and bronchospasm following eclamptic seizures: aspiration vs. asthma?
Kuczkowski KM, Moeller-Bertram T, Benumof JL.
Publication Types:
PMID: 15324971 [PubMed - indexed for MEDLINE]
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[Ilioinguinal and iliohypogastric nerves block for postoperative analgesia after appendicectomy]
[Article in French]
Dareau S, Bassoul B, Gros T, Delire V, Eledjam JJ.
Publication Types:
PMID: 15324970 [PubMed - indexed for MEDLINE]
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[Indication of endovascular stent grafts for traumatic rupture of the thoracic aorta]
[Article in French]
Meites G, Conil C, Rousseau H, Chabbert V, Cron C, Dambrin C, Samii K, Virenque C.
Service d'anesthesie-reanimation, hopital Rangueil, 31403 Toulouse cedex, France. meites.g@chu-toulouse.fr
OBJECTIVE: The usual treatment of traumatic aortic rupture (TAR) is surgical. This invasive technique necessitating thoracotomy and ECC is associated with a mortality rate of more than 20% and a paraplegia risk of about 10%. New minimally-invasive techniques (aortic stent-grafting) are emerging as less risky alternatives to surgery. We report our experience in the percutaneous treatment of TAR with stent-graft via a surgical femoral cut-down. PATIENTS AND METHODS: Between 1996 and 2002, 23 patients (16-65-year-old, mean 36 years) were treated by thoracic stent-grafting. An informed consent was obtained for every patients. Thirteen patients had an acute or sub-acute TAR (1-8 months, mean 5 months) and five patients had chronic TAR (13-24 years, mean 17 years). The technique was done under general anaesthesia and each patient received a preoperative blood-pressure reduction treatment. During the procedure, anticoagulation (heparin) was given and hypotension was induced when the stent-graft was deployed. Direct positioning control was obtained by means of TEE. RESULTS: Eighty percent of patients were extubed immediately after the procedure. Bleeding was <150 ml. The primary success rate was 100% with one minor type 2 endoleak that was spontaneously resolved after 2 months. There was no case of mortality or paraplegia. There were three minor complications (17%), two haematomas at the arteriotomy site and one inflammatory syndrome characterised by slight fever, raised biological markers but with negative blood culture. CONCLUSION: Percutaneous aortic stent-grafting for TAR is a minimally-invasive technique, which constitute an interesting alternative to surgery. It only necessitates a femoral surgical cut-down compared to the thoracotomy and ECC associated with surgery. The complication rate is low and no mortality or major complication was encountered in our patients. Eventually, the long-term follow-up will allow a widening of indications.
Publication Types:
PMID: 15324958 [PubMed - indexed for MEDLINE]
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[Single-use laryngoscope blade assessment]
[Article in French]
Fourneret-Vivier A, Rousseau A, Shum J, Frenea S, Fargnoli JM, Mallaret MR.
Unite d'hygiene hospitaliere, CHU, BP 217, 38043 Grenoble cedex, France.
OBJECTIVES: To assess the feasibility of switching disposable laryngoscope blades and to compare the disposable blades available on the market to reusable blades within the context of a new variant of Creutzfeldt-Jakob disease. STUDY DESIGN: Comparative prospective study. MATERIAL AND METHODS: Study conducted on patients intubated for surgical procedures in all operating theatres of a university hospital. The anaesthetic practitioner filled in an assessment form giving a score on nine criteria for each blade used. Data were recorded on Epi Info software. Satisfaction scores of each criterion were compared for both disposable blades and reusable blades. RESULTS: Six brands of blades were tested with 225 blades. Disposable blades were evaluated as inferior to the reusable blades in 62% of cases. Two blades were reported as more satisfactory: the 670166 Rusch-Pilling and Vital View blades. CONCLUSION: The disposable blades were not easily accepted by the anaesthetists particularly for difficult intubations, which is why reusable blades should not be totally removed from practice. Single-use blades proposed by different manufacturers are not identical. We chose 670166 Rusch-Pilling blades, the best adapted to our institution. The switch to disposable blades would require that blade manufacturers improve the quality of the blades.
Publication Types:
PMID: 15324957 [PubMed - indexed for MEDLINE]
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[Analgesia after thoracotomy: French practice]
[Article in French]
Solier M, Liu N, Fischler M.
Service d'anesthesie, hopital Foch, 40, rue Worth, 92150 Suresnes, France.
OBJECTIVE: To estimate qualitatively and quantitatively analgesic methods used after thoracotomy. METHODS: Postal questionnaire addressed to all French public (34 academic institutions, 37 public hospitals) and private hospitals (60), which routinely perform pulmonary surgery. RESULTS: Analysis of the questionnaires related only to those coming from academic institutions (rate of response of 85%) and from private hospitals (60%). Intravenous patient-controlled analgesia, thoracic epidural analgesia and intrathecal analgesia are the most frequently suggested techniques of analgesia. Thoracic epidural analgesia is more frequently suggested in private hospitals than in academic institutions (77% vs. 55%, NS). There is no significant difference between academic institutions and private hospitals regarding the practised analgesic technique. Analysis of the practices of thoracic epidural analgesia and of intrathecal analgesia in particular showed limited impact of guidelines concerning preoperative administration of anticoagulants in 15-20% of the centres. Only six (in the academic institutions) to 18% (in the private hospitals) of the patients receiving thoracic epidural analgesia were hospitalised in a surgical ward. Thoracic epidural analgesia is continued generally for more than 48 h; there is however a significant difference between centres since epidural analgesia is continued longer in academic institutions than in private hospitals. CONCLUSION: Intravenous patient-controlled analgesia and thoracic epidural analgesia are the most commonly analgesic techniques used after thoracotomy for pulmonary surgery. In the latter case, most centres choose to maintain these patients in high dependency units.
PMID: 15324955 [PubMed - indexed for MEDLINE]
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[Target-controlled infusion of propofol for intraoperative sedation: determination of effect-site concentration and assessment of bispectral index]
[Article in French]
Quinart A, Nouette-Gaulain K, Pfeiff R, Revel P, Sztark F.
Departement d'anesthesie-reanimation-I, CHU Pellegrin, 33076 Bordeaux cedex, France.
OBJECTIVES: To determine the effect-site concentration (Ce) of propofol, required to achieving adequate sedation. To assess the efficacy and safety of a target-controlled infusion system during monitored anaesthesia care and to evaluate the ability of bispectral index (BIS) to predict sedation level. Study design. - Prospective clinical study. PATIENTS: Women scheduled for insertion of tension-free vaginal tape under local anaesthetic infiltration. METHODS: After premedication with hydroxyzine, 1% propofol was infused using the Diprifusor system at an initial target plasma concentration (Cc) of 1 microg/ml and then adjusted by steps of 0.2 microg/ml at 5 min intervals. The level of sedation was assessed using the observer's assessment of alertness/sedation (OAA/S) scale; the objective was to obtain an OAA/S level at 4 or 3 (response to verbal stimulation). Ce of propofol and BIS were noted every 5 min. Relation between Ce or BIS and OAA/S scale was analysed by linear regression and probability of prediction (P(K)). RESULTS: Fifty patients aged 62 +/- 12 years were studied. Sedation at level 4 or 3 was observed in all patients. Ce of propofol and BIS to maintain this OAA/S score were, respectively, 1.0 +/- 0.2 microg/ml and 87 +/- 7. There was a linear relation between OAA/S scale and BIS or Ce; however, individual values demonstrate wide variability. The average of P(K) values computed for each patient for the BIS and Ce was 0.84 and 0.83, respectively. CONCLUSIONS: Target-controlled infusion of propofol provides easy and safe management of intraoperative sedation, allowing a fast and precise adjustment of the propofol concentration to the clinical response of the patient.
PMID: 15324954 [PubMed - indexed for MEDLINE]
The GKT diploma in dental sedation--a judgement.
Little JM, Manley MC, Craig DC.
Dental Department, Union Street Clinic, Union Street, Bedford MK40 2SF, UK. raviandjane@goldstreet.freeserve.co.uk
AIMS AND OBJECTIVES: The use of sedation in the management of pain and anxiety for the provision of dental care is as vital to the dental profession as are windscreen wipers to a motor vehicle. Not for use on every patient or every occasion, but in times of need to wipe away the tears, and essential for effective work. Training in sedation techniques should be a part of the undergraduate curriculum, and postgraduate opportunities need to be developed to support this important aspect of care. This paper examines a particular training course provided within the Department of Sedation and Special Care Dentistry at GKT Dental Institute, King's College London, leading to the Diploma in Conscious Sedation for Dentistry (Dip.D.Sed). The aim of this study was to investigate what impact the course has had on the practice of sedation. Three objectives were defined: 1) Students' evaluation of the course; 2) Students' practice in sedation prior to and on completion of the course; 3) Students' involvement in sedation training of dentists or dental nurses following completion of the course. METHOD: Information was obtained by postal questionnaire from students who had attended the course since its inception in 1997 to 2000. RESULTS: 30 students completed and returned the questionnaire which represented a 100% response. There was an overall expression of satisfaction from students on the course content and the experience they had obtained. The range of experience was 70-100 treatment episodes over 40 clinical sessions. An increase in both the practice of sedation and the involvement in training (dental nurses and dentists) was also shown. The greatest clinical change was the increase in use of intravenous sedation by the students from the community dental service. CONCLUSION AND RECOMMENDATION: This study concluded that the objectives of the course had been achieved. The importance of providing training that enables the safe and effective provision of sedation within primary care as an operator sedationist was strengthened by this study. The value of an intermediate level between the two day section 63 course and the six month diploma course was suggested by students in this study. The development of a clinical attachment based on The Standard Course in Conscious Sedation was proposed as a possible option to fill the gap. The provision of postgraduate training in sedation is limited particularly in some areas of the UK. This problem should be addressed by increasing the opportunity for postgraduate training in sedation by dental schools and postgraduate deaneries. Work towards increasing the funding and opportunities for training in this important area of care needs to be undertaken.
Publication Types:
PMID: 15455001 [PubMed - indexed for MEDLINE]
Comment on:
Paternalism and tradition.
Rosie JP.
Publication Types:
PMID: 15454981 [PubMed - indexed for MEDLINE]
Pacemakers and defibrillators: anaesthetic implications.
Marchant W.
London, UK.
PMID: 15533961 [PubMed - in process]
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Editorial III: Preoperative assessment of the airway: should anaesthetists be making use of modern imaging techniques?
Gillespie S, Farling PA.
Department of Radiology Department of Anaesthesia, Royal Victoria Hospital, Belfast BT12 6BA, UK.
PMID: 15533956 [PubMed - in process]
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Randomized controlled trial of the haemodynamic and recovery effects of xenon or propofol anaesthesia.
Coburn M, Kunitz O, Baumert JH, Hecker K, Haaf S, Zuhlsdorff A, Beeker T, Rossaint R.
Department of Anaesthesiology, University Hospital of the RWTH Aachen, Pauwelsstrasse 30, D-52074 Aachen, Germany.
BACKGROUND: There is limited clinical experience with xenon in a large number of patients. We present intra- and postoperative haemodynamic and recovery data comparing xenon and total intravenous anaesthesia with propofol. METHODS: A total of 160 patients aged 18-60 years (ASA I and II) undergoing elective surgery took part in this prospective non-blinded randomized controlled trial. After local ethics committee approval and written informed consent, patients were allocated randomly to either the xenon or the propofol group. Anaesthesia was induced with propofol and remifentanil and was maintained with xenon at 60% (minimal alveolar concentration 0.95) or with propofol 0.1-0.12 mg kg(-1) min(-1). Remifentanil was titrated to clinical need in both groups. RESULTS: The two study groups were comparable with respect to age, weight, height, gender and ASA classification. Baseline in heart rate and systolic arterial pressure (SAP) were comparable in both groups. Following induction, SAP initially decreased but returned to baseline values over 15 min in the xenon group and differed significantly from the propofol group. Heart rate decreased significantly only in the xenon group and remained at stable values. Occurrence and duration of hypertension, hypotension and bradycardia showed no significant difference between groups. Patient recovery time in the post-anaesthetic care unit and recovery from anaesthesia was similar in the two groups. CONCLUSIONS: After induction the xenon/opioid regimen maintains systolic blood pressure at baseline levels and a low heart rate. No differences between groups were found in haemodynamic stability during anaesthesia. Recovery from xenon anaesthesia was similar to that observed in the propofol group.
PMID: 15531620 [PubMed - as supplied by publisher]
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Inadvertent epidural administration of cisatracurium.
Vassilakos D, Tsakiliotis S, Veroniki F, Zachariadou C, Giala M.
Publication Types:
PMID: 15473627 [PubMed - indexed for MEDLINE]
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The analgesic and sedative effects of intrathecal midazolam in perianal surgery.
Yegin A, Sanli S, Dosemeci L, Kayacan N, Akbas M, Karsli B.
Akdeniz University Medical Faculty, Department of Anaesthesiology, Antalya, Turkey. ayegin@superonline.com
BACKGROUND AND OBJECTIVE: Our purpose was to evaluate the analgesic and sedative effects of intrathecal midazolam when added to spinal bupivacaine in patients undergoing perianal surgery under spinal anaesthesia. METHODS: Forty-four patients were randomly allocated into two equal groups: Group I (B) received hyperbaric bupivacaine 0.5% 2 mL + saline 0.9% 1 mL in a total volume of 3 mL intrathecally; Group II (BM) received hyperbaric bupivacaine 0.5% 2 mL + 1 mL of 2mg preservative-free midazolam in a total volume of 3 mL intrathecally. In both groups, the onset and recovery times of sensory block, the degree and recovery times of motor block as well as the sedation and visual analogue pain scores were recorded, and statistically compared. RESULTS: In Group BM, the postoperative visual analogue pain scores were significantly lower at the first 4 h (P < 0.05), the average time until the first dose of additional analgesic requirement was significantly longer (P < 0.05), and sedation scales were significantly higher (P < 0.05), compared to Group B. There were no statistically significant differences in the onset and the full recovery times of sensory and motor blocks in the two groups. CONCLUSION: The use of intrathecal midazolam combined with intrathecal bupivacaine produces a more effective and longer analgesia with a mild sedative effect in perianal surgery.
Publication Types:
- Clinical Trial
- Randomized Controlled Trial
PMID: 15473622 [PubMed - indexed for MEDLINE]
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Remifentanil provides better protection against noxious stimuli during cardiac surgery than alfentanil.
Heijmans JH, Maessen JG, Roekaerts PM.
University Hospital Maastricht, Department of Anaesthesiology, Maastricht, The Netherlands.
BACKGROUND AND OBJECTIVE: We hypothesized that remifentanil-propofol cardiac anaesthesia, plus administration of pirinitramide (piritramide) upon cessation of the remifentanil infusion, would be associated with a shorter time to tracheal extubation than alfentanil-propofol anaesthesia, without the occurrence of major haemodynamic instability. METHODS: Haemodynamic stability and recovery characteristics of two remifentanil infusion regimens (0.5 microg kg(-1)min(-1); 0.25 microg kg(-1)min(-1)) were therefore compared with an alfentanil infusion regimen (1 microg kg(-1)min(-1)), in combination with target-controlled infusion of propofol, in a randomized blinded trial in 75 coronary artery surgery patients. RESULTS: Pirinitramide provided good postoperative analgesia without prolonging extubation times: median extubation time in minutes after stopping the opioid-sedative drugs was 300 in the higher-dose remifentanil group and 270 in the lower-dose remifentanil group and alfentanil group (P = 0.606). Significant time-by-treatment interactions were seen for systolic arterial pressure (P = 0.015), mean arterial pressure (P = 0.009) and diastolic arterial pressure (P = 0.006). No significant interaction (P = 0.489) and no constant treatment effect were seen for heart rate (P = 0.288). Time effects were highly significant (P < 0.0001) for all haemodynamic variables. Heart rate remained stable in all groups. In the higher-dose remifentanil group, blood pressure was significantly different and lower during surgery and in this group less bolus doses of the opioid-sedative drugs (P = 0.015) had to be given. CONCLUSION: The higher-dose remifentanil infusion provided superior suppression of haemodynamic responses to noxious stimuli with better haemodynamic stability.
Publication Types:
- Clinical Trial
- Randomized Controlled Trial
PMID: 15473615 [PubMed - indexed for MEDLINE]
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Shoulder pain after gynaecological laparoscopy caused by arm abduction.
Kojima Y, Yokota S, Ina H.
Publication Types:
PMID: 15318475 [PubMed - indexed for MEDLINE]
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The effects of sevoflurane, isoflurane and desflurane on QT interval of the ECG.
Yildirim H, Adanir T, Atay A, Katircioglu K, Savaci S.
Ataturk Teaching Hospital, Department of Anaesthesiology, Izmir, Turkey. drhalilyildirim@hotmail.com
BACKGROUND AND OBJECTIVE: To determine if there is any significant difference between the effects of desflurane, isoflurane and sevoflurane on the QT interval, QT dispersion, heart rate corrected QT interval and QTc dispersion of the electrocardiogram. METHODS: The study was conducted in a prospective, double blind and randomized manner in a teaching hospital. Ninety ASA I patients, aged 16-50 yr, undergoing general anaesthesia for noncardiac surgery were studied. RESULTS: There was no significant change in QT intervals during the study in any group (P > 0.05). QT dispersion in the sevoflurane group 49+/-14 ms vs. 37+/-10 ms; in the desflurane group 55+/-16 and 62+/-21 ms vs. 35+/-14 ms and in the isoflurane group 54+/-26 and 59+/-24 ms vs. 42+/-19 ms were significantly increased at 3 and 10 min after 1 MAC of steady end-tidal anaesthetic concentration compared with baseline values (P < 0.05). QTc values in the sevoflurane group were 444+/-24 and 435+/-2 1ms vs. 413+/-19 ms (P < 0.05), in the isoflurane group were 450+/-26 and 455+/-34 ms vs. 416+/-34 ms (P < 0.05), in the desflurane group were 450+/-26 and 455+/-34 ms vs. 416+/-34 ms (P < 0.05) at 3 and 10 min after reaching 1 MAC of anaesthetic concentration and significantly increased compared with baseline values. QTc dispersion increased significantly with sevoflurane 62+/-14 ms vs. 45+/-16 ms (P < 0.05); isoflurane 70+/-36 ms at 3 min and 75+/-36 ms at 10 min after reaching 1 MAC of anaesthetic concentration vs. 50+/-24 ms (P < 0.05); desflurane 67+/-25 ms at 3 min and 74+/-27 ms at 10 min after 1 MAC concentration vs. 41+/-22 ms (P < 0.05). CONCLUSION: Sevoflurane, isoflurane and desflurane all prolonged QTd, QTc and QTcd but there were no significant intergroup differences.
Publication Types:
- Clinical Trial
- Randomized Controlled Trial
PMID: 15318470 [PubMed - indexed for MEDLINE]
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Comparison of single-breath vital capacity rapid inhalation with sevoflurane 5% and propofol induction on QT interval and haemodynamics for laparoscopic surgery.
Sen S, Ozmert G, Boran N, Turan H, Caliskan E.
Adnan Menderes University, Department of Anesthesiology, Aydin, Turkey. uzmdrsenselda@mynet.com
BACKGROUND AND OBJECTIVE: To compare two techniques to achieve induction of anaesthesia for laparoscopic surgery. A single-breath vital capacity rapid inhalation induction with sevoflurane was compared to intravenous propofol. Their effects on haemodynamics and the QT interval of the electrocardiogram were assessed. METHODS: Forty-four ASA I-II patients scheduled to undergo elective laparoscopic gynaecological surgery were divided into two groups. In the sevoflurane group (Group S, n = 22), general anaesthesia was induced with a single-breath vital capacity rapid inhalation of sevoflurane 5% with nitrous oxide (N2O) 65% in O2 and then anaesthesia was maintained with sevoflurane 1-1.5% with N2O 65% in O2. In the propofol group (Group P, n = 22), general anaesthesia was induced with propofol 2 mg kg(-1) intravenously and maintained with propofol 6 mg kg(-1) h(-1). Systolic, diastolic and mean arterial pressures, heart rate and end-tidal CO2 values were recorded before anaesthesia (basic value), during the induction period (time X), at 10 min (time Y) and at 30 min (time Z) of CO2 insufflation in all patients. QT intervals were calculated using Bazett's equation. RESULTS: Systolic, diastolic and mean arterial pressure values during the induction period (time X) were lower than the basic value in both groups (P < 0.05). In Group S, QTc intervals were significantly longer during the induction period (time X) and at the tenth min of CO2 insufflation (time Y) than Group P (P < 0.05). Five patients at time X and two patients at time Y developed ventricular dysrhythmias, which improved spontaneously in Group S. In Group P, there was no significant difference in QTc intervals and only one patient developed a ventricular dysrhythmia at time Y. CONCLUSIONS: Single-breath vital capacity rapid inhalation induction technique with sevoflurane can cause prolongation of the QT interval and dysrhythmias, compared with induction and maintenance of anaesthesia with propofol in laparoscopic surgery.
Publication Types:
- Clinical Trial
- Randomized Controlled Trial
PMID: 15318466 [PubMed - indexed for MEDLINE]
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The sounds of saturation.
Santamore DC, Cleaver TG.
Department of Anesthesiology, University of Louisville Hospital, 530 South Jackson Street, Louisville, KY 40202-3617, U.S.A. dcsant02@gwise.louisville.edu
Audible pulse tones, based on a variable-pitch frequency scale, allow the anesthesiologist to determine the patient's oxygen saturation without constant visual examination of the monitor display. The ability to reliably detect oxygen saturation levels based on audible pulse tones may be compromised when multiple pulse oximeter systems are used. The goal of this observational study was to examine the pitch frequency scales from several different pulse oximeter manufacturers. Using simulator technology, incremental oxygen saturations between 80% and 100% were created. The frequencies of various pulse tones in this range were measured with an oscilloscope. From this data, the relationship between oxygen saturation and corresponding pulse tone frequency was examined. Diagrammed results showed wide variation in the pulse frequency scales used by the pulse oximeters tested. At any oxygen saturation level between 80% and 100%, none of the monitors had the same pulse tone frequency. With such variation among systems, the ability to accurately determine oxygen saturation from a pulse tone may be hindered. In locations where different pulse oximeter systems are encountered, the potential for confusion exists. Anesthesiologists need to be aware of these differences, and should familiarize themselves with the audible frequency scale of a particular pulse oximeter model before its use.
Publication Types:
PMID: 15362270 [PubMed - indexed for MEDLINE]
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An on line technique to detect cardiac output variations and cardiovascular performances during abdominal aortic surgery.
Clemente F, D'Avino E, Guaragno M, Menichetti A.
CNR, Istituto di Ingegneria Biomedica, Sezione di Roma, Via C. Marx 43, 00137 Roma, Italy. clemente@isib.cnr.it
Cardiac output (CO) is a parameter usually requested to assess hemo dynamic status of patient and efficacy of therapy especially in critically ill patients. This paper, in line with other research activities and new market availability, intends to correlate a parameter derived from data already acquired in standard patient monitoring (systemic arterial pressure--Pas) in order to identify CO trends and, more generally, to obtain information on the efficiency of cardiovascular system of the patient in examination. Attention has been focussed on patients undergoing abdominal aneurysm aortic (AAA) surgery with combined anaesthesia (epidural and light general). Awake correlation was found between maximum value of Pas time derivative, max (dPas/dt), and CO measured with thermodilution method on 56 measurements on 10 patients. To evaluate further diagnostic capability of max (dPas/dt), we compare its trend with other parameters but no statistical significant results have been obtained. Therefore the target parameter can be profitably used in the examined patients to monitor CO trend and, in correlation with other parameters, as a sign of efficiency of the cardio circulatory system.
Publication Types:
PMID: 15362269 [PubMed - indexed for MEDLINE]
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