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High-dose bupivacaine, levobupivacaine and ropivacaine in axillary brachial plexus block.
Liisanantti O, Luukkonen J, Rosenberg PH.
Department of Anaesthesiology and Intensive Care Medicine, Helsinki University Hospital, Helsinki, Finland.
BACKGROUND: Racemic bupivacaine is clinically similar to levobupivacaine, or ropivacaine. The drugs were compared in brachial plexus block for the first time in the same randomized and double-blind study. METHODS: In 90 patients scheduled for hand and forearm surgery, a perivascular axillary brachial plexus block was performed with 45 ml of 5 mg ml(-1) of either racemic bupivacaine-HCl, levobupivacaine-HCl, or ropivacaine-HCl. Sensory (cold) and motor (hand clasp, and movement of elbow) block were scored, and the patient was interviewed in the postoperative evening and the following morning. Time to normal function of the arm was registered. RESULTS: After similar onsets of sensory block, the sum of completely anaesthetized innervation areas of the four main nerves at 45 min was greater in the ropivacaine group than in the levobupivacaine group (P < 0.01). Simultaneously, complete motor block at the elbow was more frequent in the ropivacaine group (67%) than in the bupivacaine (47%) and levobupivacaine groups (30%) (P < 0.01). In the hand, the corresponding results were 83%, 77%, and 57%, respectively (NS). Two patients in the levobupivacaine and one in the ropivacaine group needed general anaesthesia. Mean duration of the blocks was similar in the bupivacaine, levobupivacaine and ropivacaine groups at 19.3 h, 19.5 h, and 17.3 h, respectively (NS). Two patients were dissatisfied with the long block duration. CONCLUSION: Ropivacaine-HCl 5 mg ml(-1) produced slightly better sensory and motor block intensity than the same dose of levobupivacaine-HCl. General success in relation to surgery and in the duration of the blocks was similar in the three groups.
Publication Types:
- Clinical Trial
- Randomized Controlled Trial
PMID: 15101856 [PubMed - indexed for MEDLINE]
-
Anaesthesia after cleft palate repair.
Dearlove O, Perkins RJ, Briggs G.
Publication Types:
PMID: 15488072 [PubMed - in process]
-
Precautions against infection from anaesthetic procedures.
Akioyame M, Radford P.
Publication Types:
PMID: 15488066 [PubMed - in process]
-
Thyroid storm prior to induction of anaesthesia.
Hirvonen EA, Niskanen LK, Niskanen MM.
Department of Anaesthesiology and Intensive Care, Kuopio University Hospital, Finland. eila.hirvonen@kuh.fi
A 53- year-old woman without a previous history of thyroid disease was scheduled for mastectomy. On arrival in the operating theatre unpremedicated she appeared restless and tachycardic. Midazolam and fentanyl was administered intravenously. Concomitantly, sinus tachycardia developed and a flush reaction was observed in the skin of the thoracic region and neck. The blood pressure increased to 265/160 mmHg and the patient lost consciousness and became apnoeic. Unconsciousness and apnoea lasted for approximately 25 min and the operation was postponed. Further investigations revealed an elevated serum free thyroxine level and suppressed serum thyrotropin diagnostic of hyperthyroidism. The serum TSH receptor antibody concentration was elevated, indicating that the patient was suffering from Graves' disease. We present a case of a previously unknown hyperthyroid patient, with breast cancer, presenting as a thyroid crisis on induction of anaesthesia. Although being quite a rare occurrence, unsuspected thyroid disease should be borne in mind when an agitated patient enters the operating theatre.
PMID: 15488064 [PubMed - in process]
-
Bibliometric analysis of original molecular biology research in anaesthesia.
Schreiber K, Girard T, Kindler CH.
Institute of Anaesthesia and Intensive Care Medicine, St. Josef-Hospital, 53827 Troisdorf, Germany.
Molecular biology has expanded the horizons of anaesthesia during the last 20 years and has led to an increase of basic science articles that are published in the specialised anaesthetic journals or originate in anaesthetic institutions. We searched for and analysed the specific features, such as year of publication, publishing journal, and country of origin, of all such molecular biology articles stored in the MEDLINE database during the period 1986-2002. We identified 1265 original articles that used molecular biology techniques; 223 (18%) of these articles were published in anaesthetic journals and 1042 (82%) articles in 556 other biomedical journals. While in the late 1980s only a few molecular biology articles were published each year by anaesthetic institutions, worldwide this number reached approximately 200 basic science articles by the end of 2002. The USA clearly dominates the field of anaesthesia with respect to molecular biology research with 839 (66%) such articles.
PMID: 15488060 [PubMed - in process]
-
Extending low-dose epidural analgesia for emergency Caesarean section using ropivacaine 0.75%.
Sanders RD, Mallory S, Lucas DN, Chan T, Yeo S, Yentis SM.
Magill Department of Anaesthesia, Intensive Care & Pain Management, Chelsea and Westminster Hospital, 369 Fulham Road, London, SW10 9NH, UK.
We compared ropivacaine 0.75% and bupivacaine 0.5% for extending low-dose epidural analgesia for emergency Caesarean section, using a prospective double-blind randomised controlled trial design. The trial was halted after 45 patients were studied (23 ropivacaine; 22 bupivacaine) because bupivacaine was replaced by levobupivacaine in our unit. Time to reach T4 for loss of cold sensation was similar in both groups, although analgesic supplementation was required less often in the ropivacaine group than in the bupivacaine group (2/23 vs. 9/21; p = 0.01).
PMID: 15488058 [PubMed - in process]
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Effect of propofol and isoflurane anaesthesia on the immune response to surgery.
Inada T, Yamanouchi Y, Jomura S, Sakamoto S, Takahashi M, Kambara T, Shingu K.
Kansai Medical University, 10-15 Fumizono-cho, Moriguchi, Osaka, 570-8507, Japan. takefumi@wd5.so-net.ne.jp
There are two major subpopulations of peripheral helper T lymphocytes: T helper 1 (Th1) and T helper 2 (Th2) cells. Surgical stress increases the number of Th2 cells, and decreases that of Th1 cells, resulting in a decrease in the Th1/Th2 ratio, and, consequently, in suppressed cell-mediated immunity. Since anaesthesia can suppress the stress response to surgery, it may inhibit the decrease in the Th1/Th2 ratio. Using flow cytometry, we studied whether propofol anaesthesia (n = 9) or isoflurane anaesthesia (n = 9) had more effect on the decrease in the Th1/Th2 ratio after surgery in patients undergoing craniotomy. The Th1/Th2 ratio decreased significantly after isoflurane anaesthesia (p = 0.011), while it did not change after propofol anaesthesia. The ratio was significantly lower with isoflurane than propofol (p = 0.009). Propofol anaesthesia attenuated the surgical stress-induced adverse immune response better than isoflurane anaesthesia.
PMID: 15488052 [PubMed - in process]
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Left ventricular mechanical performance in elderly patients after induction of anaesthesia. A comparison of inhalational induction with sevoflurane and intravenous induction with fentanyl and propofol.
Nishikawa K, Kanaya N, Kawamata M, Namiki A.
Department of Anaesthesiology, Sapporo Medical University, School of Medicine, South-1, West-16, Chuo-ku, Sapporo, Hokkaido 060-8543, Japan. nkouki@sapmed.ac.jp
We investigated changes in left ventricular mechanical performance in 40 patients aged > 70 years in whom anaesthesia had been induced with sevoflurane or with fentanyl and propofol. The ratio of ventricular contractility to arterial properties, which reflects left ventricular performance, was estimated from the ratio of ventricular end-systolic elastance to effective arterial elastance. This ratio decreased after induction in both groups, the magnitude of the decrease being significantly greater in the fentanyl/propofol group than in the sevoflurane group. Decreases in mean arterial pressure after induction of anaesthesia in the two groups were similar, whereas the magnitude of the decrease in heart rate in the sevoflurane group was greater than that in the fentanyl/propofol group. Sevoflurane may therefore be preferable to fentanyl and propofol for induction of anaesthesia in elderly patients because of its lesser effect on left ventricular performance.
PMID: 15488051 [PubMed - in process]
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[Algorithm development for airway management]
[Article in German]
Meissner A, Van Aken H.
Publication Types:
PMID: 15452977 [PubMed - indexed for MEDLINE]
[Anesthesia in newborn and infants]
[Article in German]
Gabriel A, Zimpfer M.
Klinik fur Anaesthesie und Allgemeine Intensivmedizin, Allgemeines Krankenhaus der Stadt Wien, Wien.
PMID: 15316644 [PubMed - indexed for MEDLINE]
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[Iloprost. Pharmacology and clinical application during surgery]
[Article in German]
Wilhelm W, Grundmann U.
Klinik fur Anasthesiologie und operative Intensivmedizin, St.-Marien-Hospital, Lunen. wolfram.wilhelm@smh-online.de
Iloprost is a long-acting prostacyclin analogue with potent vasodilating properties. When applied per inhalation, iloprost rapidly and remarkably reduces pulmonary vascular resistance and thereby pulmonary artery pressure for approximately 60-120 min. In addition, if iloprost is inhaled and not infused, major systemic side-effects such as a significant reduction of the systemic arterial pressure can mostly be circumvented. Inhaled iloprost can be applied by means of ultrasound or by oxygen flow with both techniques being available for intensive care ventilators. For use in the anaesthesia circuit a special construction was built.
Publication Types:
PMID: 15241524 [PubMed - indexed for MEDLINE]
Comment on:
The effects of epidural needle rotation.
Lee JS.
Publication Types:
PMID: 15385405 [PubMed - indexed for MEDLINE]
Comment on:
Overnight stay lowers incidence of lidocaine radiculotoxicity ("TNS").
de Jong RH.
Publication Types:
PMID: 15385402 [PubMed - indexed for MEDLINE]
Comment on:
Epidural hematoma after anticoagulation with a thoracic epidural catheter in place: a mere coincidence?
Hemmerling TM, Olivier JF, Basile F, Prieto I.
Publication Types:
PMID: 15385398 [PubMed - indexed for MEDLINE]
Comment on:
Persistent cerebrospinal fluid leak.
Steel AG, Watson BJ, Abdy S, Allen JG.
Publication Types:
- Case Reports
- Comment
- Letter
PMID: 15385396 [PubMed - indexed for MEDLINE]
Comment on:
Does an epidural catheter impede or stimulate dural inflammatory response and normal dural closure after dural puncture?
Kuczkowski KM.
Publication Types:
PMID: 15385395 [PubMed - indexed for MEDLINE]
Comment on:
Treatment of persistent cerebrospinal fluid leak with an epidural blood patch.
Katz J.
Publication Types:
PMID: 15385394 [PubMed - indexed for MEDLINE]
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A patient with Glanzmann's thrombasthenia for emergent abdominal surgery.
Uzunlar HI, Eroglu A, Senel AC, Bostan H, Erciyes N.
Department of Anesthesiology and Reanimation, Karadeniz Technical University Faculty of Medicine, Trabzon, Turkey. uzunlar@gmx.com.tr
Glanzmann's thrombasthenia is a rare autosomal recessive disease characterized by potentially major mucocutaneous complications and nose bleeds. It is considered hazardous for these surgical patients to conceive, with a high risk of urgent surgery. The treatment of bleeding or prevention of hemorrhage for surgery or invasive procedures is based on platelet transfusion. However, platelet transfusions may be responsible for the development of alloimmunization, with a high risk of future platelet refractoriness. We report a surgical case of Glanzmann's thrombasthenia complicated by nasopharyngeal bleeding and managed with platelet transfusions, recombinant activated factor VII, and postoperative airway management in the intensive care unit.
Publication Types:
PMID: 15385386 [PubMed - indexed for MEDLINE]
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Perioperative plasma concentrations of stable nitric oxide products are predictive of cognitive dysfunction after laparoscopic cholecystectomy.
Iohom G, Szarvas S, Larney V, O'Brien J, Buckley E, Butler M, Shorten G.
Department of Anesthesia and Intensive Care Medicine, Cork University Hospital, Cork, Ireland.
In this study our objectives were to determine the incidence of postoperative cognitive dysfunction (POCD) after laparoscopic cholecystectomy under sevoflurane anesthesia in patients aged >40 and <85 yr and to examine the associations between plasma concentrations of i) S-100beta protein and ii) stable nitric oxide (NO) products and POCD in this clinical setting. Neuropsychological tests were performed on 42 ASA physical status I-II patients the day before, and 4 days and 6 wk after surgery. Patient spouses (n = 13) were studied as controls. Cognitive dysfunction was defined as deficit in one or more cognitive domain(s). Serial measurements of serum concentrations of S-100beta protein and plasma concentrations of stable NO products (nitrate/nitrite, NOx) were performed perioperatively. Four days after surgery, new cognitive deficit was present in 16 (40%) patients and in 1 (7%) control subject (P = 0.01). Six weeks postoperatively, new cognitive deficit was present in 21 (53%) patients and 3 (23%) control subjects (P = 0.03). Compared with the "no deficit" group, patients who demonstrated a new cognitive deficit 4 days postoperatively had larger plasma NOx at each perioperative time point (P < 0.05 for each time point). Serum S-100beta protein concentrations were similar in the 2 groups. In conclusion, preoperative (and postoperative) plasma concentrations of stable NO products (but not S-100beta) are associated with early POCD. The former represents a potential biochemical predictor of POCD.
Publication Types:
PMID: 15385384 [PubMed - indexed for MEDLINE]
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Predicting allogeneic blood transfusion use in total joint arthroplasty.
Rashiq S, Shah M, Chow AK, O'Connor PJ, Finegan BA.
Department of Anesthesiology and Pain Medicine, University of Alberta, Edmonton, Alberta, Canada. srashiq@ualberta.ca
Total joint arthroplasty (TJA) patients often receive allogeneic blood transfusion. In this study we sought to create and validate a clinical prediction rule for transfusion in TJA using data that are easily available when scheduling the procedure. Logistic regression modeling was applied to retrospective data from all TJA procedures performed in Edmonton, Alberta in 2000 (n = 1875). The area under the receiver operating curve for the resulting model in the training and validation data sets was 0.80 and 0.76 respectively. By assigning a simple score based on six independent predictors (age, gender, weight, hemoglobin, ASA operative risk classification and whether revision surgery was planned), it was possible to classify a given subject's risk of receiving allogeneic transfusion. We conclude that accurate prediction of transfusion risk in TJA is possible using a rule based on simple preoperative clinical and laboratory data. Such prediction could allow transfusion prevention strategies to be applied selectively to those at greatest risk.
PMID: 15385383 [PubMed - indexed for MEDLINE]
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Small-dose intrathecal clonidine and isobaric bupivacaine for orthopedic surgery: a dose-response study.
Strebel S, Gurzeler JA, Schneider MC, Aeschbach A, Kindler CH.
Department of Anesthesia, University Clinics, Kantonsspital, Basel, Switzerland.
We examined the dose-response relationship of intrathecal clonidine at small doses (<or=150 microg) with respect to prolonging bupivacaine spinal anesthesia. We aimed for establishing doses of intrathecal clonidine that would produce clinically relevant prolongation of spinal anesthesia and pain relief without significant side effects. Eighty orthopedic patients were randomly assigned to intrathecally receive isobaric 0.5% bupivacaine, 18 mg, plus saline (Group 1), clonidine 37.5 microg (Group 2), clonidine 75 microg (Group 3), and clonidine 150 microg (Group 4). Duration of the sensory block (regression below level L1) was increased in patients receiving intrathecal clonidine: 288 +/- 62 min (Group 1, control), 311 +/- 101 min in Group 2 (+8%), 325 +/- 69 min in Group 3 (+13%), and 337 +/- 78 min in Group 4 (+17%) (estimated parameter for dose 0.23 [95% confidence interval -0.05-0.50]). Duration of pain relief from intrathecal clonidine administration until the first request for supplemental analgesia was significantly prolonged: 295 +/- 80 min (Group 1, control), 343 +/- 75 min in Group 2 (+16%), 381 +/- 117 min in Group 3 (+29%), and 445 +/- 136 min in Group 4 (+51%) (estimated parameter for dose 1.02 [95% confidence interval 0.59-1.45]). Relative hemodynamic stability was maintained and there were no between-group differences in the sedation score. We conclude that small doses of intrathecal clonidine (<or=150 microg) significantly prolong the anesthetic and analgesic effects of bupivacaine in a dose-dependent manner and that 150 microg of clonidine seems to be the preferred dose, in terms of effect versus unwarranted side effects, when prolongation of spinal anesthesia is desired.
Publication Types:
- Clinical Trial
- Randomized Controlled Trial
PMID: 15385382 [PubMed - indexed for MEDLINE]
-
Analgesia before performing a spinal block in the sitting position in patients with femoral shaft fracture: a comparison between femoral nerve block and intravenous fentanyl.
Sia S, Pelusio F, Barbagli R, Rivituso C.
Department of Anesthesiology, Centro Traumatologico Ortopedico, Azienda Ospedaliera Careggi, Firenze, Italy. sia3@interfree.it
We conducted this prospective, randomized study to compare the analgesic effect of femoral nerve block and IV fentanyl administration when given to facilitate the sitting position for spinal anesthesia in patients undergoing surgery for femoral shaft fracture. Five minutes before the placement of spinal block, group FEM patients (n = 10) received a femoral nerve block with lidocaine 1.5% 15 mL, and group IVA patients (n = 10) received IV fentanyl 3 microg/kg. Visual analog scale values during positioning (median and range) were lower in group FEM: 0.5 (0-1) versus 3 (2-6) (P < 0.001). Time to perform spinal anesthesia (mean +/- sd) was shorter in group FEM: 1.8 +/- 0.7 min versus 3.0 +/- 1.1 min (P < 0.05). Quality of patient positioning for spinal anesthesia (0 = not satisfactory, 1 = satisfactory, 2 = good, and 3 = optimal) (median and range) was higher in group FEM: 3 (2-3) versus 1.5 (1-3) (P < 0.005). Patient acceptance was less in group IVA (P < 0.05). In one group IVA patient, an oxygen saturation <90% was recorded during the procedure. We conclude that femoral nerve block is more advantageous than IV administration of fentanyl to facilitate the sitting position for spinal anesthesia in patients undergoing surgery for femoral shaft fractures.
Publication Types:
- Clinical Trial
- Randomized Controlled Trial
PMID: 15385380 [PubMed - indexed for MEDLINE]
-
Large-dose intrathecal sufentanil prevents the hormonal stress response during major abdominal surgery: a comparison with intravenous sufentanil in a prospective randomized trial.
Borgdorff PJ, Ionescu TI, Houweling PL, Knape JT.
Department of Anaesthesiology, Diakonessenhuis Hospital, Utrecht, The Netherlands. pborgdorff@diakhuis.nl
We studied the effect of large-dose intrathecal sufentanil (ITS) for major abdominal surgery on the hormonal stress response. Forty patients were randomly allocated to receive either IV sufentanil (IVS) or 150 microg of ITS as part of general anesthesia. In the IVS group, adrenocorticotropic hormone (ACTH) and cortisol concentrations were larger than baseline and the ITS group, 60 min after incision and at skin closure. Plasma concentrations of cortisol and ACTH were not different from baseline in the ITS group during surgery. Six hours after skin closure, cortisol concentrations were larger than baseline in both groups. Twenty-four and 48 h after skin closure, ACTH and cortisol values were similar between groups. Norepinephrine concentrations increased after surgery in both groups. Blood glucose levels increased in both groups during and after surgery. Pain scores and morphine consumption during the first 48 h after surgery were lower in the ITS group. The data show that large-dose ITS prevents the intraoperative hormonal stress response in comparison with balanced anesthesia. We speculate that this is due to the highly specific binding of sufentanil to spinal and supraspinal receptors. This technique improves postoperative analgesia when compared with balanced anesthesia.
Publication Types:
- Clinical Trial
- Randomized Controlled Trial
PMID: 15385360 [PubMed - indexed for MEDLINE]
-
Isoflurane inhalation enhances increased physiologic deadspace volume associated with positive pressure ventilation and compromises arterial oxygenation.
Praetel C, Banner MJ, Monk T, Gabrielli A.
University of Florida College of Medicine, Department of Anesthesiology, Gainesville, FL 32610-0254, USA.
Abnormally increased physiologic deadspace volume (Vd(phys)), consisting of alveolar deadspace volume and airway deadspace volume, is one of several causative factors predisposing to compromised arterial blood gas exchange. We compared the effects of two methods of general anesthesia on Vd(phys) when combined with positive pressure ventilation (PPV): total IV anesthesia (TIVA) and inhaled anesthesia with isoflurane. Forty patients with no history of pulmonary pathology undergoing elective surgery in the supine position were studied. A crossover design was used, and all patients received both anesthetic methods sequentially in randomized order. PPV and TIVA significantly increased Vd(phys) compared with baseline (preoperative and breathing spontaneously) from 164 +/- 60 mL to 264 +/- 79 mL (P < 0.05). Isoflurane inhalation combined with PPV significantly enhanced this increase, resulting in a twofold increase in Vd(phys) to 315 +/- 80 mL (P < 0.05). Also, alveolar deadspace volume increased by more than 200% with isoflurane. Furthermore, isoflurane inhalation (1.15% end-tidal concentration) resulted in impaired arterial oxygenation, as evidenced by a significant decrease in the Pao(2)/fractional inspired oxygen concentration ratio compared with baseline values from 387 +/- 35 to 310 +/- 70 (P < 0.05). Although significant increases in Vd(phys) resulted with PPV combined with TIVA, these adverse changes were much less compared with isoflurane inhalation and PPV. These findings may apply to subjects with compromised pulmonary function (i.e., acute respiratory distress syndrome or severe inhalational burn injury).
Publication Types:
- Clinical Trial
- Randomized Controlled Trial
PMID: 15385359 [PubMed - indexed for MEDLINE]
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The effects of cisatracurium on morbidly obese women.
Leykin Y, Pellis T, Lucca M, Lomangino G, Marzano B, Gullo A.
Department of Anesthesia, Pain, Perioperative Medicine and Intensive Care, Santa Maria degli Angeli Hospital, Pordenone, Italy. yigal.leykin@aopn.fvg.it
There is conflicting evidence on the duration of action of atracurium in obese patients. Cisatracurium is one of the stereoisomers of atracurium. We investigated the neuromuscular effects of cisatracurium in morbidly obese patients. Twenty obese female patients (body mass index >40) were randomized in two groups. Group I (n = 10) received 0.2 mg/kg of cisatracurium on the basis of real body weight (RBW), whereas in Group II (n = 10) the dose was calculated on ideal body weight (IBW). In a control group of 10 normal weight female patients (body mass index 20-24), the dose of cisatracurium was based on RBW. Neuromuscular transmission was monitored using acceleromyography of the adductor pollicis, and anesthesia was induced and maintained with remifentanil and propofol. Onset time was comparable between Group I and the control group (132 s versus 135 s; P = ns). The duration 25% was longer in Group I than in the control group (74.6 min versus 59.1 min; P = 0.01) and in the control group compared with Group II (45.0 min; P = 0.016). In conclusion, the duration of action of cisatracurium was prolonged in morbidly obese patients when dosed according to RBW compared with a control group of normal weight patients. Duration was also prolonged in the control group patients compared with morbidly obese patients to whom the drug was administered on the basis of IBW.
Publication Types:
- Clinical Trial
- Randomized Controlled Trial
PMID: 15385356 [PubMed - indexed for MEDLINE]
-
Propofol-induced injection pain: comparison of a modified propofol emulsion to standard propofol with premixed lidocaine.
Adam S, van Bommel J, Pelka M, Dirckx M, Jonsson D, Klein J.
Department of Anesthesiology, Erasmus Medical Center Rotterdam, The Netherlands. s.adam@erasmusmc.nl
Propofol is well known for its association with pain on injection. The most frequently used method to reduce this pain is premixture with lidocaine. Recently, a modified lipid emulsion of propofol containing medium-chain triglycerides (MCT) with long-chain triglycerides (LCT), in contrast to the usual LCT formulation, has been advocated to alleviate pain. In a randomized, prospective, controlled, double-blind study on 222 surgical patients, we compared the effect of the two solutions on the incidence and intensity of injection pain. Patients were randomly allocated to receive either propofol MCT/LCT (group M; n = 109) or standard propofol LCT with the addition of 20 mg of lidocaine (2 mL of lidocaine 1%) to 200 mg of propofol (group L; n = 113). Pain scores were assessed using a verbal analog scale (VAS) ranging from 0-10. Group L was found to have significantly less pain on the injection of propofol (mean VAS, 2.5 +/- 2.9) (mean +/- sd) than group M (mean VAS, 3.8 +/- 3.2; P = 0.002). Regarding postoperative recall of pain on injection, patients in group L indicated significantly less pain (mean VAS, 2.2 +/- 2.4) than patients in group M (mean VAS, 3.0 +/- 2.7; P = 0.02). Premixing of 20 mg of lidocaine (2 mL of lidocaine 1%) to 200 mg of standard propofol LCT causes less pain on injection than propofol MCT/LCT and thus increases patient comfort.
Publication Types:
- Clinical Trial
- Randomized Controlled Trial
PMID: 15385353 [PubMed - indexed for MEDLINE]
-
A randomized controlled comparison of electro-acupoint stimulation or ondansetron versus placebo for the prevention of postoperative nausea and vomiting.
Gan TJ, Jiao KR, Zenn M, Georgiade G.
Department of Anesthesiology, Duke University Medical Center, Durham, NC 27710, USA. gan00001@mc.duke.edu
In this study we evaluated the efficacy of electro-acupoint stimulation, ondansetron versus placebo for the prevention of postoperative nausea and vomiting (PONV). Patients undergoing major breast surgery under general anesthesia were randomized into active electro-acupoint stimulation (A), ondansetron 4 mg IV (O), or sham control (placement of electrodes without electro-acupoint stimulation; placebo [P]). The anesthetic regimen was standardized. The incidence of nausea, vomiting, rescue antiemetic use, pain, and patient satisfaction with management of PONV were assessed at 0, 30, 60, 90, 120 min, and at 24 h. The complete response (no nausea, vomiting, or use of rescue antiemetic) was significantly more frequent in the active treatment groups compared with placebo both at 2 h (A/O/P = 77%/64%/42%, respectively; P = 0.01) and 24 h postoperatively (A/O/P = 73%/52%/38%, respectively; P = 0.006). The need for rescue antiemetic was less in the treatment groups (A/O/P = 19%/28%/54%; P = 0.04). Specifically, the incidence and severity of nausea were significantly less in the A group compared with the other groups, and in the O group compared with the P group (A/O/P = 19%/40%/79%, respectively). The A group experienced less pain in the postanesthesia care unit, compared with the O and P groups. Patients in the treatment groups were more satisfied with their management of PONV compared with placebo. When used for the prevention of PONV, electro-acupoint stimulation or ondansetron was more effective than placebo with greater degree of patient satisfaction, but electro-acupoint stimulation seems to be more effective in controlling nausea, compared with ondansetron. Stimulation at P6 also has analgesic effects.
Publication Types:
- Clinical Trial
- Randomized Controlled Trial
PMID: 15385352 [PubMed - indexed for MEDLINE]
-
Preoperative evaluation of pediatric surgical patients with multisystem considerations.
Ferrari LR.
Medical Director Perioperative Services, Children's Hospital, and Department of Anesthesia, Harvard Medical School, Boston, Massachusetts 02115, USA. Ferrari@childrens.harvard.edu
Fewer and fewer patients spend time in the hospital in advance of a surgical or interventional procedure requiring anesthesia care. As a result, there is increasing reliance on a thorough preoperative evaluation directed toward identifying anesthetic risks. For this to occur, each medical institution must have a clear and comprehensive system that processes patients during the preoperative period. There are specific and unique personnel and system requirements for the accumulation of multidisciplinary information in the pediatric patient population. The justification for the cost of this type of program is the savings realized by the decrease in wasted operating room time due to inadequate or incomplete patient preparation. The following is a description of a successful perioperative evaluation and preparation process that has been in place for 7 yr in a major pediatric academic institution.
Publication Types:
PMID: 15385351 [PubMed - indexed for MEDLINE]
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Iatrogenic hyperthermia during cardiac magnetic resonance imaging.
Kussman BD, Mulkern RV, Holzman RS.
Department of Anesthesiology, Perioperative and Pain Medicine, Children's Hospital, Boston, MA 02115, USA. kussman@childrens.harvard.edu
We report the occurrence of accidental hyperthermia in a young child undergoing anesthesia for cardiac magnetic resonance imaging. Although the tendency during anesthesia is to develop hypothermia, the absorbed radiofrequency energy from magnetic resonance scanning is added to metabolic energy and must be balanced by appropriate heat loss to maintain normothermia. In addition to stressing the clinical importance of temperature monitoring, this report suggests that the recommended specific absorption rates to prevent excessive patient heating may need to be revised for infants and young children.
Publication Types:
PMID: 15385349 [PubMed - indexed for MEDLINE]
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The cerebrovascular response to hypocapnia in children receiving propofol.
Karsli C, Luginbuehl I, Bissonnette B.
Department of Anesthesia, The Hospital for Sick Children, University of Toronto, Ontario, Canada. cengiz.karsli@sickkids.ca
Hypocapnia is used to treat acute increases in intracranial pressure during neurosurgery. Cerebrovascular reactivity to carbon dioxide (CCO(2)R) is preserved above 35 mm Hg ETco(2) in children during propofol anesthesia; however, a plateau effect has been suggested below 35 mm Hg. To further delineate this phenomenon, we measured CCO(2)R by transcranial Doppler (TCD) sonography over small increments in ETco(2) in 27 healthy children. Anesthesia comprised a standardized propofol infusion and a caudal epidural block. A TCD probe was placed to measure middle cerebral artery blood flow velocity (V(mca)). ETco(2) was adjusted between 24 and 40 mm Hg at 1-2 mm Hg increments using an exogenous source of CO(2). There was an exponential relationship between ETco(2) and V(mca) above an ETco(2) value of 30 mm Hg (r = 0.82). However, V(mca) did not change with ETco(2) less than 30 mm Hg (r = 0.06). There were no significant changes in heart rate or arterial blood pressure. We conclude that when contemplating methods to decrease brain volume and intracranial pressure, hyperventilation to ETco(2) values less than 30 mm Hg may not be necessary in children receiving propofol, as no further reduction in cerebral blood flow velocity will be achieved.
PMID: 15385348 [PubMed - indexed for MEDLINE]
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Does off-pump coronary artery bypass reduce the incidence of clinically evident renal dysfunction after multivessel myocardial revascularization?
Schwann NM, Horrow JC, Strong MD 3rd, Chamchad D, Guerraty A, Wechsler AS.
Department of Anesthesiology, Drexel University College of Medicine, Philadelphia, PA 19102, USA. schwann@drexel.edu
In this prospective, observational trial, we determined whether off-pump coronary artery bypass (OPCAB) was associated with less postoperative renal dysfunction (RD) compared with coronary bypass surgery with cardiopulmonary bypass (CABG). All patients undergoing primary, isolated coronary surgery at our institution in the year 2000 participated. Data collected on each patient included demographics, preoperative risk factors for RD, perioperative events, and serum creatinine concentrations from date of admission until discharge or death. The criteria for RD was both a >or=50% increase from preoperative creatinine and an absolute postoperative creatinine >or=2.0 mg/dL (177 microM). Student's t-test or the Fisher's exact test was used to compare groups. Stepwise multiple logistic regression identified determinants of RD; P < 0.05 significant. The CABG group (n = 119) differed from the OPCAB group (n = 220) with respect to age (64 +/- 13 versus 67 +/- 10 yr, P = 0.0074) and number of distal grafts (median 4 versus 3, P = 0.0003). Type of operation did not associate with the presence of postoperative RD: 18 (8.2%) of 220 OPCAB patients versus 12 (10%) of 119 CABG patients (P = 0.55). Our data suggest that choice of operative technique (OPCAB versus CABG) is not associated with reduced renal morbidity.
Publication Types:
PMID: 15385334 [PubMed - indexed for MEDLINE]
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Anesthetic management of a child with congenital central hypoventilation syndrome (CCHS, Ondine's curse) for dental treatment.
Ishibashi H, Umezawa K, Hayashi S, Shibutani K.
Department of Anesthesiology, Nihon University School of Dentistry at Matsudo, Chiba, Japan. ishibash@mascat.nihon-u.ac.jp
Congenital Central Hypoventilation Syndrome (CCHS, also known as Ondine's Curse) is a rare syndrome characterized by apnea, cyanosis, and hypotonia. A 4-year-old, 90-cm, 12-kg girl with CCHS, mental retardation (MR), and Hischsprung's disease (HD) was treated under general anesthesia. Intravenous drugs were not used, but sevoflurane, a volatile anesthetic, was used. As a result, the recovery time from the end of the operation to returning to the ward was very short, only 18 minutes. There was no trouble during the perioperative period. We safely performed general anesthesia and dental treatment for a girl who had CCHS with HD and MR.
PMID: 15497300 [PubMed - in process]
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Anesthetic efficacy of the anterior middle superior alveolar (AMSA) injection.
Lee S, Reader A, Nusstein J, Beck M, Weaver J.
Department of Endodonics, College of Dentistry, The Ohio State University, Columbus, OH 43218, USA.
The purpose of this prospective, randomized, blinded study was to determine the anesthetic efficacy of the anterior middle superior alveolar (AMSA) injection using the computer-assisted Wand Plus injection system versus a conventional syringe. The authors, using a crossover design, randomly administered in a blind manner 2 AMSA injections utilizing the computer-assisted injection system and a conventional syringe to 40 subjects during 2 separate appointments. A pulp tester was used to test for anesthesia, in 4-minute cycles for 60 minutes, of the central and lateral incisors, canine, and first and second premolars. Anesthesia was considered successful when 2 consecutive no responses (80 readings) with the pulp tester were obtained. For all teeth, except the central incisor, the use of the computer-assisted injection system was significantly (P < .05) more likely to result in pulpal anesthesia than the use of the conventional syringe technique. For the computer-assisted injection system, successful pulpal anesthesia ranged from 35 to 58%, and for the conventional syringe, successful pulpal anesthesia ranged from 20 to 42%. For both techniques, the onset of pulpal anesthesia was slow, and duration of pulpal anesthesia declined steadily over 60 minutes. We conclude that although the AMSA injection using the computer-assisted injection system was more successful than the conventional syringe technique, the rather modest to low success rates, slow onset, and declining duration of pulpal anesthesia over 60 minutes would not ensure predictable pulpal anesthesia from the second premolar to the central incisor.
PMID: 15497297 [PubMed - in process]
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Increased anesthetic risk for patients with obesity and obstructive sleep apnea.
Weaver JM.
Publication Types:
PMID: 15497295 [PubMed - in process]
When patients follow commands.
Ortega RA.
Publication Types:
PMID: 15448566 [PubMed - indexed for MEDLINE]
Comment on:
Is it in the episcleral space or in the medial canthal extraconal space?
Fanning GL.
Publication Types:
PMID: 15448558 [PubMed - indexed for MEDLINE]
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Intraneural injection during anterior approach for sciatic nerve block.
Sala-Blanch X, Pomes J, Matute P, Valls-Sole J, Carrera A, Tomas X, Garcia-Diez AI.
Department of Anesthesiology, Hospital Clinic, University of Barcelona, C/Villaroel 170, 08036-Barcelona, Spain. xsala@clinic.ub.es
Publication Types:
PMID: 15448541 [PubMed - indexed for MEDLINE]
Comment in:
Severe neurological complications after central neuraxial blockades in Sweden 1990-1999.
Moen V, Dahlgren N, Irestedt L.
Department of Anesthesiology and Intensive Care, County Hospital, S-391 85 Kalmar, Sweden. vibekem@Itkalmar.se
BACKGROUND: Central neuraxial blockades find widespread applications. Severe complications are believed to be extremely rare, but the incidence is probably underestimated. METHODS: A retrospective study of severe neurologic complications after central neuraxial blockades in Sweden 1990-1999 was performed. Information was obtained from a postal survey and administrative files in the health care system. During the study period approximately 1,260,000 spinal blockades and 450,000 epidural blockades were administered, including 200,000 epidural blockades for pain relief in labor. RESULTS:: The 127 complications found included spinal hematoma (33), cauda equina syndrome (32), meningitis (29), epidural abscess (13), and miscellaneous (20). Permanent neurologic damage was observed in 85 patients. Incidence of complications after spinal blockade was within 1:20-30,000 in all patient groups. Incidence after obstetric epidural blockade was 1:25,000; in the remaining patients it was 1:3600 (P < 0.0001). Spinal hematoma after obstetric epidural blockade carried the incidence 1:200,000, significantly lower than the incidence 1:3,600 females subject to knee arthroplasty (P < 0.0001). CONCLUSIONS:: More complications than expected were found, probably as a result of the comprehensive study design. Half of the complications were retrieved exclusively from administrative files. Complications occur significantly more often after epidural blockade than after spinal blockade, and the complications are different. Obstetric patients carry significantly lower incidence of complications. Osteoporosis is proposed as a previously neglected risk factor. Close surveillance after central neuraxial blockade is mandatory for safe practice.
PMID: 15448529 [PubMed - indexed for MEDLINE]
Comment on:
Risk assessment and control require analysis of both outcomes and process of care.
Auroy Y, Benhamou D, Amaberti R.
Publication Types:
PMID: 15448511 [PubMed - indexed for MEDLINE]
Risks of general anaesthesia in people with obstructive sleep apnoea.
den Herder C, Schmeck J, Appelboom DJ, de Vries N.
Department of Otolaryngology/Head and Neck Surgery, St Lucas Andreas Hospital, Jan Tooropstraat 164, 1006 AE, Amsterdam, Netherlands. c.denherder@slaz.nl
Publication Types:
PMID: 15499112 [PubMed - indexed for MEDLINE]
Abstracts of the Anaesthetic Research Society Meeting. Liverpool, United Kingdom, July 8-9, 2004.
[No authors listed]
Publication Types:
PMID: 15495350 [PubMed - indexed for MEDLINE]
Comment on:
Editorial II: Who is at increased risk of pulmonary aspiration?
Asai T.
Publication Types:
PMID: 15361474 [PubMed - indexed for MEDLINE]
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Delayed retroperitoneal haematoma after failed lumbar plexus block.
Aveline C, Bonnet F.
Departement d'Anesthesie-Reanimation, Polyclinique Sevigne, 3 rue du Chene Germain, F-35510 Cesson-Sevigne, France. caveline@club-internet.fr
A 72-yr-old patient was to undergo a left lumbar plexus block by the posterior approach to achieve postoperative analgesia after hip replacement. The block failed after three unsuccessful attempts to identify nerve structures and a fascia iliaca compartment block was performed. Postoperatively the patient received enoxaparin and then phenylindanedione for thromboprophylaxis. She was re-admitted 2 weeks after surgery because of a lower limb motor deficit and a left retroperitoneal haematoma requiring blood transfusion. Clinicians need to be aware of this potential complication of lumbar plexus block in patients receiving thrombphylaxis.
Publication Types:
PMID: 15321930 [PubMed - indexed for MEDLINE]
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Effect of age on the clinical profile and systemic absorption and disposition of levobupivacaine after epidural administration.
Simon MJ, Veering BT, Stienstra R, van Kleef JW, Burm AG.
Department of Anaesthesiology, Leiden University Medical Centre, PO Box 9600, 2300 RC Leiden, The Netherlands. m.j.g.simon@lumc.nl
BACKGROUND: Pharmacokinetic and/or pharmacodynamic changes, which may occur with increasing age, could alter the clinical profile of the new local anaesthetic levobupivacaine. We investigated the effect of age on the absorption and disposition kinetics and the neural block characteristics after epidural administration of levobupivacaine 0.75%. METHODS: Thirty-one patients were enrolled in one of three age groups (Group 1, 18-44 yr; Group 2, 45-70 yr; Group 3, >70 yr). Twenty-five minutes after epidural administration of levobupivacaine (127.5 mg), they received approximately 25 mg deuterium-labelled levobupivacaine (D(3)-levobupivacaine) intravenously. Arterial blood samples were collected until 24 h after the epidural administration. Plasma concentrations were determined using liquid chromatography mass spectrometry. Plasma concentration-time data were analyzed by compartmental and non-compartmental analysis. Assessments of analgesia and motor block were made at set intervals until complete regression of the block. RESULTS: The upper levels of analgesia in the two oldest groups of patients were 3 dermatomes (95% confidence interval (95% CI): 0.5-5.0 dermatomes) higher than in the youngest group. The fraction absorbed (F(1)) was 0.07 (95% CI: 0.02-013) smaller and the absorption half-life (t(1/2,a1)), characterizing the initial fast absorption phase, 3.6 min (95% CI: 0.8-6.4) shorter in the oldest group compared with the youngest group. CONCLUSIONS: Age influences the pharmacokinetics, in particular the early absorption kinetics, and the neural block characteristics after epidural administration of levobupivacaine. Changes in the upper level of analgesia are best explained by anatomical considerations and possibly pharmacodynamic changes in the elderly.
PMID: 15321929 [PubMed - indexed for MEDLINE]
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Comparison of manufacturers' specifications for 44 types of heat and moisture exchanging filters.
Dellamonica J, Boisseau N, Goubaux B, Raucoules-Aime M.
Department of Anaesthesia and Intensive Care "Ouest", Hopital l'Archet 151, route de Saint-Antoine-de-Ginestiere, BP 3079, 06202 Nice Cedex 3, France.
BACKGROUND: Although heat and moisture exchanging filters (HMEF) are recommended for use during anaesthesia, the criteria for choosing a filter are not clearly defined. Manufacturers offer many different types of HMEF with various technical characteristics. We compared the technical specifications provided by the manufacturers for different types of HMEF. METHODS: Filter manufacturers were asked to provide technical information. Additional information was obtained from websites. Information about 44 filters (16 mechanical and 28 electrostatic) was collated. RESULTS: Filter performances were estimated with different sizes of microorganism and durations of challenge. Twenty-eight filters had not been tested by independent laboratories. For 12 of the filters, information obtained from websites and from the manufacturers differed. Most filter specifications claimed high efficiency, particularly for filtration, microbial challenge number and test duration. Electrostatic filters used in anaesthesia were claimed to have high filtration efficiency, similar to the efficiency provided by mechanical filters. Excluding moisture output values did not alter the general conclusions. CONCLUSIONS: Technical aspects of the tests, international standards, and independent validation should be considered when a filter is chosen.
PMID: 15298877 [PubMed - indexed for MEDLINE]
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Comparison of the LMA-ProSeal and LMA-Classic in children.
Shimbori H, Ono K, Miwa T, Morimura N, Noguchi M, Hiroki K.
Department of Anaesthesia, Kanagawa Children's Medical Centre, 2-138-4 Mutsukawa, Minami-ku, Yokohama 232-8555, Japan. epi@yk.rim.or.jp
BACKGROUND: The LMA-ProSeal is a new laryngeal mask airway with a rear cuff and drainage tube that allows a higher seal pressure than the LMA-Classic for the same intra-cuff pressure, and it permits drainage of gastric secretions and access to the alimentary tract. The LMA-ProSeal can be used in children but it does not have a rear cuff. This study compared the LMA-ProSeal and the LMA-Classic in children for ease of insertion, airway sealing pressure and fibre-optic visualization. METHODS: Sixty ASA I-II children undergoing herniorrhaphy, orchiopexy or myringotomy were included. The patients were randomly assigned to size 2 LMA-Classic trade mark or size 2 LMA-ProSeal groups for airway management. We assessed success rates at first attempt of insertion, airway sealing pressure, fibre-optic position, success rates of gastric tube placement and postoperative blood staining of the device, tongue-lip-dental trauma and hoarseness. RESULTS: There was no statistical difference between the two groups for the success rates at first attempt of insertion, airway sealing pressure and fibre-optic position. Gastric tube insertion was successful in 90% of cases in the LMA-ProSeal group. The LMA-Classic had a higher rate of postoperative blood staining, but there was no tongue-lip-dental trauma or hoarseness in either group. CONCLUSION: We conclude that ease of insertion and airway sealing pressure are similar between the LMA-ProSeal and the LMA-Classic in children.
Publication Types:
- Clinical Trial
- Randomized Controlled Trial
PMID: 15298876 [PubMed - indexed for MEDLINE]
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Audit of double-lumen endobronchial intubation.
Seymour AH, Prasad B, McKenzie RJ.
Department of Anaesthetics, Birmingham Heartlands Hospital, Bordesley Green East, Birmingham B9 5SS, UK. alan.seymour@heartsol.wmids.nhs.uk
BACKGROUND: Many technical variations are possible in the placing and management of a double-lumen tube (DLT). We surveyed our practice to relate these variations to the course of the anaesthetic. METHODS: We used a questionnaire to obtain details of technique in 506 consecutive double lumen intubations. The details were related to the incidence of secretions, tube displacement, and decreases of oxygen saturation (<88%) during one lung anaesthesia (OLA). RESULTS: Robertshaw tubes were used for 482 of the 506 intubations. During OLA there were 48 instances of desaturation (<88%), 19 cases of upper lobe obstruction, 15 of carinal obstruction, 16 of isolation failure, eight of excessive secretions (none of whom had received an antisialogogue; P<0.01) and 12 miscellaneous events. The experience of the anaesthetist or use of a fibre-optic bronchoscope did not affect these events. Air was of no advantage as a maintenance gas. Atropine 400-600 micro g appeared to prevent desaturation on OLA (P<0.05) but glycopyrrolate 200 micro g did not. CONCLUSION: Most factors had little effect on the progress of the anaesthetic, but an antimuscarinic usefully reduced secretions, and atropine (but not glycopyrrolate) was associated with less desaturation during OLA.
PMID: 15247113 [PubMed - indexed for MEDLINE]
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Intrathecal drug spread.
Hocking G, Wildsmith JA.
University Department of Anaesthesia, Ninewells Hospital and Medical School, Dundee DD1 9SY, Scotland, UK.
Publication Types:
PMID: 15220175 [PubMed - indexed for MEDLINE]
Effects of trimetazidine on myocardial preconditioning in anesthetized rats.
Kara AF, Demiryurek S, Celik A, Tarakcioglu M, Demiryurek AT.
Department of Pharmacology, Faculty of Medicine, University of Gaziantep, 27310 Gaziantep, Turkey.
Trimetazidine is a widely used anti-ischemic agent, but its effect on myocardial preconditioning in anesthetized animals has not been investigated. The aim of this study was to examine the effects of trimetazidine on ischemic preconditioning and carbachol preconditioning in anesthetized rats. Ischemic preconditioning, induced by 5-min coronary artery occlusion and 5-min reperfusion, decreased the incidence of ventricular tachycardia and abolished the occurrence of ventricular fibrillation during 30-min ischemia. Trimetazidine (10 mg/kg, i.v.) alone attenuated these parameters of arrhythmia. Carbachol infusion induced preconditioning with a marked depression of mean arterial blood pressure, heart rate and ventricular tachycardia. The marked reductions in parameters of arrhythmia induced by ischemic preconditioning and carbachol preconditioning were preserved in the presence of trimetazidine. Arrhythmia scores and myocardial infarct size were significantly reduced with ischemic preconditioning or carbachol preconditioning and were not inhibited by trimetazidine. These results show that trimetazidine protects the heart against ischemia-induced arrhythmias, reduces myocardial infarct size, preserves the effects of ischemic preconditioning and pharmacological preconditioning, and is able to mimic ischemic preconditioning in anesthetized rats.
PMID: 15496308 [PubMed - as supplied by publisher]
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General anesthetics inhibit the nitrous-oxide-induced activation of corticotropin releasing factor containing neurons in rats.
Sawamura S, Obara-Nawata M, Takeda K, Hanaoka K.
Department of Anesthesia, Showa General Hospital, 2-450, Tenjin-cho, Kodaira, Tokyo 187-8510, Japan.
The activation of intracerebral corticotropin releasing factor (CRF) system is involved in nitrous oxide analgesia. We evaluated the effect of general anesthetics on nitrous-oxide-induced CRF activation and antinociception. Male Sprague-Dawley rats inhaled isoflurane (0%, 0.6%, 1.0% and 1.5%) or were administered with intravenous propofol (0, 0.1 and 0.2 mg/kg/min), with or without 75% nitrous oxide inhalation, for 90 min. The brain was fixed with fixative, and brain sections, including the paraventricular nucleus of the hypothalamus, were double immunostained with c-Fos and CRF antibodies to assess the activation of CRF-containing neurons. In other groups of rats, the effect of propofol on nitrous oxide antinociception was evaluated with tail flick latency tests. Both inhaled isoflurane and intravenous propofol inhibited nitrous-oxide-induced activation of CRF neurons, suggesting that these general anesthetics may inhibit one of the analgesic mechanisms of nitrous oxide. Indeed, propofol inhibited the antinociceptive action of nitrous oxide, as evaluated with tail flick latencies (TFL).
PMID: 15496295 [PubMed - in process]
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