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 Show: 
Items 1 - 65 of 65
One page.

1: Acta Anaesthesiol Scand. 2004 Apr;48(4):474-9. Related Articles, Links
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Comparison of 27-gauge (0.41-mm) Whitacre and Quincke spinal needles with respect to post-dural puncture headache and non-dural puncture headache.

Santanen U, Rautoma P, Luurila H, Erkola O, Pere P.

Department of Anaesthesia and Intensive Care Medicine, Helsinki University Hospital, Helsinki, Finland.

BACKGROUND: The incidence of headache after spinal anaesthesia has varied greatly between studies. We compared the incidence of postoperative headache in general and postdural puncture headache (PDPH) when using 27-gauge (G) (outer diameter 0.41 mm) Quincke and Whitacre spinal needles in ambulatory surgery performed under spinal anaesthesia. Methods: In a prospective, randomized study, 676 ASA physical status I-II day-case outpatients were given a spinal anaesthetic through either a 27-G (0.41 mm) Quincke or a 27-G (0.41 mm) Whitacre spinal needle. The incidence of any type of postoperative headache was assessed and the type of headache defined using a standardized questionnaire including PDPH criteria. The severity of the headache was defined using a 100-mm visual analogue scale. Results: For the final analysis, 529 patients were available (259 patients in the Quincke group and 270 patients in the Whitacre group). The overall incidence of postoperative headache was 20.0%, but the incidence of true PDPH was very low (1.51%). The incidence of PDPH in the Quincke group was 2.70%, while in the Whitacre group it was only 0.37% (P < 0.05). The overall incidence of non-dural puncture headache was 18.5% and did not differ between the study groups. Conclusions: True PDPH seldom occurs when a 27-G (0.41 mm) spinal needle is used, although postoperatively a non-specific headache is common. Using the 27-G (0.41 mm) Whitacre spinal needle further reduced the incidence of PDPH. Thus, we recommend routine use of the 27-G (0.41 mm) Whitacre spinal needle when performing spinal anaesthesia.

Publication Types:
  • Clinical Trial
  • Randomized Controlled Trial

PMID: 15025611 [PubMed - indexed for MEDLINE]


2: Acta Anaesthesiol Scand. 2004 Apr;48(4):463-8. Related Articles, Links
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Respiratory changes during prolonged increased intra-abdominal pressure in pigs.

Gudmundsson FF, Heltne JK.

Surgical Research Laboratory, Institute of Surgical Sciences, University of Bergen, Norway. ffgudmun@broadpark.no

BACKGROUND: Increased intra-abdominal pressure (IAP) elevates thoracic pressure and airway pressures and reduces lung compliance in humans and laboratory animals. We studied respiratory alterations and arterial blood gas changes in pigs with IAP maintained at 20 mmHg or 30 mmHg for 3 h. METHODS: Domestic pigs of both sexes weighing 30.0 +/- 5.1 kg (mean +/- SD) (n = 21) were divided into three groups. The animals were anesthetized and kept at 20 mmHg IAP (n = 7) or 30 mmHg IAP (n = 7) for 3 h. The third group (n = 7) served as control without an elevated IAP. We recorded respiratory alterations and changes in acid-based parameters at baseline and after 90 min and 180 min of increased IAP. RESULTS: No significant hypoxia or hypercarbia was found in animals with an IAP of 20 mmHg IAP. At an IAP of 30 mmHg, pO2 decreased to an average 19.6 kPa and pCO2 increased to about 6 kPa, and the animals were slightly acidotic. Airway pressure increased significantly and lung compliance decreased in both groups of elevated IAP. CONCLUSION: In our porcine model, an IAP of 20 mmHg or higher for 3 h is harmful for the respiratory function of the animals due to deterioration of respiratory parameters, increased airway pressure and decreased lung compliance.

PMID: 15025609 [PubMed - indexed for MEDLINE]


3: Acta Anaesthesiol Scand. 2004 Apr;48(4):393-5. Related Articles, Links
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Haemodynamic responses to intubation: what more do we have to know?

Randell T.

Publication Types:
  • Editorial

PMID: 15025596 [PubMed - indexed for MEDLINE]


4: Anesth Analg. 2004 Jul;99(1):309. Related Articles, Links
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A personal experience using Limoge's current during a major surgery.

Limoge A, Dixmerias-Iskandar F.

Publication Types:
  • Case Reports
  • Letter

PMID: 15281560 [PubMed - indexed for MEDLINE]


5: Anesth Analg. 2004 Jul;99(1):279-83. Related Articles, Links
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Lightwand-assisted intubation of patients in the lateral decubitus position.

Cheng KI, Chu KS, Chau SW, Ying SL, Hsu HT, Chang YL, Tang CS.

Department of Anesthesiology, Kaohsiung Medical University, Kaohsiung, Taiwan, Republic of China.

In some situations, patients need endotracheal intubation to maintain airway patency while they are constrained in the lateral position. In this study we compared lightwand-guided intubation of 120 randomly enrolled patients placed in the supine, right, or left lateral position. Group S patients were initially placed in the supine position, and subsequent to the artificial airway having been established they were turned to the lateral decubitus position. Group R patients were initially placed in a right decubitus position during induction and intubation. Group L patients were initially placed in a left decubitus position during induction and intubation. The duration of each intubation attempt, the total time to successful intubation, and the incidence of intubation-related intraoral injury, hemodynamic changes, and postoperative sore throat and hoarseness were recorded. Intubation took a similar length of time in the supine (14.5 +/- 13.4 s), left lateral (13.3 +/- 10.2 s), and right lateral positions (15.5 +/- 13.0 s) and resulted in a similar trend in hemodynamic changes. Patients in the lateral and supine positions revealed a comparable incidence of successful first-attempt intubation, sore throat, hoarseness, oral mucosal injury, and dysrhythmia. Insignificantly more esophageal intubations were performed in the lateral position in the first attempt at intubation; however, all patients were correctly intubated shortly after reattempting intubation. We concluded that lightwand-assisted intubation is easily performed and a similar technique may be used whether the patient is in a lateral, recumbent, or a supine position. This alternative technique should be practiced and is recommended for patients who must remain in a lateral position during intubation and surgery.

Publication Types:
  • Clinical Trial
  • Randomized Controlled Trial

PMID: 15281544 [PubMed - indexed for MEDLINE]


6: Anesth Analg. 2004 Jul;99(1):272-8. Related Articles, Links
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The new perilaryngeal airway (CobraPLA) is as efficient as the laryngeal mask airway (LMA) but provides better airway sealing pressures.

Akca O, Wadhwa A, Sengupta P, Durrani J, Hanni K, Wenke M, Yucel Y, Lenhardt R, Doufas AG, Sessler DI.

Outcomes Research Institute, Louisville, Kentucky 40202, USA. ozan.akca@louisville.edu

The Laryngeal Mask Airway (LMA) is a frequently used efficient airway device, yet it sometimes seals poorly, thus reducing the efficacy of positive-pressure ventilation. The Perilaryngeal Airway (CobraPLA) is a novel airway device with a larger pharyngeal cuff (when inflated). We tested the hypothesis that the CobraPLA was superior to the LMA with regard to insertion time and airway sealing pressure and comparable to the LMA in airway adequacy and recovery characteristics. After midazolam and fentanyl administration, 81 ASA physical status I-II outpatients having elective surgery were randomized to receive an LMA or CobraPLA. Anesthesia was induced with propofol (2.5 mg/kg IV), and the airway was inserted. We measured 1) insertion time; 2) adequacy of the airway (no leak at 15-cm-H2O peak pressure or tidal volume of 5 mL/kg); 3) airway sealing pressure; 4) number of repositioning attempts; and 5) sealing quality (no leak at tidal volume of 8 mL/kg). At the end of surgery, gastric insufflation, postoperative sore throat, dysphonia, and dysphagia were evaluated. Data were compared with unpaired Student's t-tests, chi2 tests, or Fisher's exact tests; P < 0.05 was significant. Patient characteristics, insertion times, airway adequacy, number of repositioning attempts, and recovery were similar in each group. Airway sealing pressure was significantly greater with CobraPLA (23 +/- 6 cm H2O) than LMA (18 +/- 5 cm H2O, P < 0.001). The CobraPLA has insertion characteristics similar to the LMA but better airway sealing capabilities.

Publication Types:
  • Clinical Trial
  • Randomized Controlled Trial

PMID: 15281543 [PubMed - indexed for MEDLINE]


7: Anesth Analg. 2004 Jul;99(1):262-71. Related Articles, Links
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A restrictive use of both autologous donation and recombinant human erythropoietin is an efficient policy for primary total hip or knee arthroplasty.

Couvret C, Laffon M, Baud A, Payen V, Burdin P, Fusciardi J.

Department of Anesthesiology and Critical Care, Trousseau University Hospital, Tours, France.

A limitation of preoperative autologous blood donation (PABD) in nonanemics and the use of recombinant human erythropoietin (EPO) in anemics (baseline hematocrit [Hct] < or = 39%) could be an efficient approach of the cost-benefit ratio of transfusion during primary total hip (THA) or knee (TKA) arthroplasties. We evaluated the consequences on transfusion rates and costs of two different applications of a transfusion policy based on personal requirements during primary THA or TKA. This quality assurance observational study compared two prospective successive time periods; each included successive patients treated by the same medical team and standardized care. In Study 1 (n = 182), PABD was indicated if there were insufficient estimated red blood cell reserve and a life expectancy > or = 10 yr, no use of EPO, and identical criteria for any transfusion. Because this policy led to a 50% allogeneic transfusion rate when baseline Hct < or = 37% and autologous blood wastage in the nonanemics (baseline Hct > 39%), 2 refinements were introduced in Study 2 (n = 708): EPO without PABD when baseline Hct < or = 37%, and life expectancy > or = 10 yr, and avoidance of PABD in nonanemics. This novel care induced a marked decrease in transfusion rates (respectively, from 41% to 7%, P < 0.0002, in nonanemics; from 58% to 27%, P < 0.003, in anemics; and from 43% to 12%, P < 0.0001, overall), with no change in allogeneic transfusion (10%) and discharge Hct, and a 39% financial savings. This saving effect is a result of the suppression of PABD in nonanemics, who represent 75% of this surgical population. Although erythropoietin is expensive, it can be used with cost savings in selected patients because the overall cost of transfusion is reduced.

Publication Types:
  • Clinical Trial

PMID: 15281542 [PubMed - indexed for MEDLINE]


8: Anesth Analg. 2004 Jul;99(1):259-61. Related Articles, Links
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Inadvertent cervical epidural catheter placement via the caudal route using electrical stimulation.

Tsui BC, Malherbe S.

Department of Anesthesiology and Pain Medicine, University of Alberta Hospitals, Walter Mackenzie Health Science Centre, Edmonton, Alberta, Canada. btsui@ualberta.ca

Inadvertent placement of an epidural catheter in the cervical region via the caudal route is described in an infant who underwent revision of a fundoplication. We attempted electrical stimulation (the Tsui test) via the epidural catheter to confirm correct placement and positioning of the catheter tip. In this case, the epidural catheter was inadvertently advanced to the cervical region, resulting in stimulation of the phrenic nerve. These diaphragmatic twitches were misinterpreted as chest wall twitches, and it was incorrectly assumed that the catheter was in the thoracic region. To avoid misinterpretation of the stimulation level, the catheter should be continuously stimulated while it is advanced. We also recommend that the catheter length be estimated before insertion (although doing so did not help in this case) and that the catheter position be radiographically confirmed after surgery.

Publication Types:
  • Case Reports

PMID: 15281541 [PubMed - indexed for MEDLINE]


9: Anesth Analg. 2004 Jul;99(1):251-4. Related Articles, Links
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Postoperative analgesia after total knee replacement: the effect of an obturator nerve block added to the femoral 3-in-1 nerve block.

Macalou D, Trueck S, Meuret P, Heck M, Vial F, Ouologuem S, Capdevila X, Virion JM, Bouaziz H.

Department of Anesthesiology and Intensive Care, Central University Hospital, Nancy, France.

Femoral nerve block (FNB) does not consistently produce anesthesia of the obturator nerve. In this single-blind, randomized, controlled study we added a selective obturator nerve block (ONB) to FNB to analyze its influence on postoperative analgesia after total knee replacement (TKR). Before general anesthesia, 90 patients undergoing TKR received FNB (Group 1), FNB and selective ONB (Group 2), or placebo FNB (Group 3). Postoperative analgesia was further provided by morphine IV via patient-controlled analgesia. Analgesic efficacy and side effects were recorded in the first 6 h after surgery. Adductor strength decreased by 18% +/- 9% in Group 1 and by 78% +/- 22% in Group 2 (P < 0.0001). Total morphine consumption was reduced in Group 2 compared with Groups 1 and 3 (P < or = 0.0001). Patients in Group 2 reported lower pain scores than those in Groups 1 and 3 (P = 0.0003). The incidence of nausea was more frequent in Groups 1 and 3 (P = 0.01). We conclude that FNB does not produce complete anesthesia of the obturator nerve. Single-shot FNB does not provide additional benefits on pain at rest over opioids alone in the early postoperative period. The addition of an ONB to FNB improves postoperative analgesia after TKR.

Publication Types:
  • Clinical Trial
  • Randomized Controlled Trial

PMID: 15281539 [PubMed - indexed for MEDLINE]


10: Anesth Analg. 2004 Jul;99(1):245-50. Related Articles, Links
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Identification of the epidural space: loss of resistance with air, lidocaine, or the combination of air and lidocaine.

Evron S, Sessler D, Sadan O, Boaz M, Glezerman M, Ezri T.

Obstetric Anesthesia Unit, The Edith Wolfson Medical Center, Holon, Israel.

The ideal technique for identifying the epidural space remains unclear. Five-hundred-forty-seven women in labor who requested epidural analgesia were randomly allocated to three groups according to the technique by which the epidural space was identified: 1) loss-of-resistance with air (air; n = 180), 2) loss-of-resistance with lidocaine (lidocaine; n = 185), and 3) loss-of-resistance with both air and lidocaine (air-plus-lidocaine; n = 182). We assessed ease of epidural catheter insertion, characteristics of the blockade, quality of analgesia, and complications. The inability to thread the epidural catheter occurred in 16% of the air, 4% of the lidocaine, and 3% of the air-plus-lidocaine patients (P < 0.001). More patients from the air group had unblocked segments (6.6% versus 3.2% and 2.2%, respectively; P < 0.02). The incidence of accidental dural puncture was greater in the air group (1.7% versus 0% in the other two groups; P < 0.02). Pain scores, time to onset of analgesia, upper sensory level, motor blockade, and the incidence of hypotension, transient neurological deficits, postpartum urinary retention, and postdural puncture headache were comparable. Identification of the epidural space with air was more difficult and caused more dural punctures than with lidocaine or air plus lidocaine. Additionally, sequential use of air and lidocaine had no advantage over lidocaine alone.

Publication Types:
  • Clinical Trial
  • Randomized Controlled Trial

PMID: 15281538 [PubMed - indexed for MEDLINE]


11: Anesth Analg. 2004 Jul;99(1):166-72. Related Articles, Links
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A european, multicenter, observational study to assess the value of gastric-to-end tidal PCO2 difference in predicting postoperative complications.

Lebuffe G, Vallet B, Takala J, Hartstein G, Lamy M, Mythen M, Bakker J, Bennett D, Boyd O, Webb A.

Department of Anesthesiology 2, CHU de Lille, Lille, France.

Automated online tonometry displays a rapid, semicontinuous measurement of gastric-to-endtidal carbon dioxide (Pr-etCO2) as an index of gastrointestinal perfusion during surgery. Its use to predict postoperative outcome has not been studied in general surgery patients. We, therefore, studied ASA physical status III-IV patients operated on for elective surgery under general anesthesia and a planned duration of >2 h in a European, multicenter study. As each center was equipped with only 1 tonometric monitor, a randomization was performed if more than one patient was eligible the same day. Patients not monitored with tonometry were assessed only for follow-up. The main outcome measure was the assessment of postoperative functional recovery delay (FRD) on day 8. Among the 290 patients studied, 34% had FRD associated with a longer hospital stay. The most common FRDs were gastrointestinal (45%), infection (39%), and respiratory (35%). In those monitored with tonometry (n = 179), maximum Pr-etCO2 proved to be the best predictor increasing the probability of FRD from 34% for all patients to 65% at a cut-off of 21 mm Hg (2.8kPa) (sensitivity 0.27, specificity 0.92, positive predictive value 64%, negative predictive value 70%). We conclude that intraoperative Pr-etCO2 measurement may be a useful prognostic index of postoperative morbidity.

Publication Types:
  • Multicenter Study

PMID: 15281524 [PubMed - indexed for MEDLINE]


12: Anesth Analg. 2004 Jul;99(1):140-5. Related Articles, Links
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Preoperative sciatic nerve block decreases mechanical allodynia more in young rats: is preemptive analgesia developmentally modulated?

Ririe DG, Barclay D, Prout H, Tong C, Tobin JR, Eisenach JC.

Department of Anesthesiology and Center for the Study of Pharmacologic Plasticity in the Presence of Pain, Wake Forest University School of Medicine, Winston-Salem, North Carolina 27157-1009, USA. dririe@wfubmc.edu

Postoperative sensitivity to tactile stimuli differs as a function of age. In this study, we hypothesized that preoperative sciatic nerve block (SNB), by providing preemptive analgesia, would result in better analgesia than postoperative SNB in the young rat. With the paw incision model of postoperative pain, male Sprague-Dawley rats, aged 2 or 4 wk, underwent general anesthesia and then received a left SNB with 5 microL/g of 0.5% bupivacaine or normal saline. SNB was performed either before or after surgery. Mechanical allodynia was assessed by using von Frey filaments before and at various times after SNB and surgery. In the 2-wk-old rats, preoperative SNB produced a significant reduction in mechanical allodynia, as reflected by a higher threshold at 2, 5, and 24 h when compared with saline control (P < 0.03). At 24 h, the threshold was 4.0 +/- 0.7 g in the preoperative SNB group compared with 1.6 +/- 0.3 g in the postoperative SNB group (P = 0.004). There was no difference at any time point between the preoperative and the postoperative SNB in the 4-wk-old animals. These results suggest that preoperative SNB in young animals provides a preemptive analgesic effect on mechanical allodynia that is age or developmentally dependent.

PMID: 15281520 [PubMed - indexed for MEDLINE]


13: Anesth Analg. 2004 Jul;99(1):124-7. Related Articles, Links
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A new supraglottic airway, the Elisha Airway Device: a preliminary study.

Vaida SJ, Gaitini D, Ben-David B, Somri M, Hagberg CA, Gaitini LA.

Department of Anesthesiology, Bnai-Zion Medical Center, Haifa, Israel. sonia@netvision.net.il

We describe the Elisha Airway Device (EAD), a new reusable supraglottic ventilatory device. Its uniqueness consists of its ability to combine three functions in a single device: ventilation, blind and/or fiberoptic-aided intubation without interruption of ventilation, and gastric tube insertion. This study was performed in 70 ASA status I-II, Mallampati class I-II patients undergoing elective knee arthroscopy and receiving general anesthesia with mechanical ventilation. Anesthesia was induced with fentanyl and propofol and was maintained with isoflurane in N20/oxygen. Neuromuscular blockade was achieved with vecuronium. Blind insertion of the device was successful in 96% of patients, with a mean insertion time of 20 +/- 4 s. In these patients it was possible to maintain oxygenation and ventilation throughout the surgical procedure. Gastric tube insertion was successful in all cases. Endotracheal intubation via the EAD was attempted in 20 patients. Blind intubation was possible during the first and second attempts in 15 and 2 patients, respectively. Fiberoptic intubation was then successful in two of the remaining three patients. The EAD is a new alternative in the evolution of supraglottic ventilatory devices; however, further clinical studies are necessary to evaluate its efficacy.

Publication Types:
  • Evaluation Studies

PMID: 15281517 [PubMed - indexed for MEDLINE]


14: Anesth Analg. 2004 Jul;99(1):77-81. Related Articles, Links
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A randomized comparison of a multimodal management strategy versus combination antiemetics for the prevention of postoperative nausea and vomiting.

Habib AS, White WD, Eubanks S, Pappas TN, Gan TJ.

Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina 27710, USA.

A multimodal management strategy for the prevention of postoperative nausea and vomiting (PONV) appears to be superior to single-drug prophylaxis. We tested the hypothesis that a multimodal PONV prophylaxis regimen incorporating total IV anesthesia (TIVA) with propofol and a combination of ondansetron and droperidol is more effective than a combination of these antiemetics in the presence of an inhaled anesthetic. Ninety patients undergoing laparoscopic cholecystectomy were randomized to one of three groups. Group 1 (multimodal group) received TIVA with propofol, droperidol, and ondansetron. Group 2 (combination group) received droperidol and ondansetron with isoflurane and nitrous oxide for the maintenance of anesthesia. Group 3 (TIVA group) received propofol for the induction and maintenance of anesthesia. The complete response rate (no PONV and no rescue antiemetic) at 2 h after surgery was 90%, 63%, and 66% in Groups 1, 2, and 3, respectively (P < 0.05, Group 1 versus Group 2). At 24 h, the complete response rate was 80%, 63%, and 43% in Groups 1, 2, and 3, respectively (P < 0.05, Group 1 versus Group 3). Patient satisfaction was also greater in the multimodal group than in the other two groups in the postanesthesia care unit (P < 0.05). In conclusion, the multimodal management strategy for PONV was associated with a higher complete response rate and greater patient satisfaction when compared with similar antiemetic prophylaxis with inhaled anesthesia or TIVA with propofol.

Publication Types:
  • Clinical Trial
  • Randomized Controlled Trial

PMID: 15281507 [PubMed - indexed for MEDLINE]


15: Anesth Analg. 2004 Jul;99(1):70-6. Related Articles, Links
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Nocturnal arterial oxygen desaturation and episodic airway obstruction after ambulatory surgery.

Bowdle TA.

Department of Anesthesiology, University of Washington, Seattle, Washington 98195, USA. bowdle@u.washington.edu

Some patients experience disordered breathing during sleep and arterial oxygen desaturation after major inpatient surgery. We performed this study to determine whether similar events occur after ambulatory surgery. Forty-five ambulatory surgery patients received an unrestricted anesthetic. Continuous unattended nocturnal recordings of breathing pattern and oxygen saturation were made in the patients' homes before surgery and during the first and second postoperative nights. Nine patients had a respiratory disturbance index >10 and/or >1% of recording time with oxygen saturation <90% on at least one study night. These nine patients had a significantly older median age and a significantly larger median body mass index. Their median respiratory disturbance index and median percentage of time with oxygen saturation <90% were significantly higher on the first postoperative night than on the preoperative night.

Publication Types:
  • Clinical Trial

PMID: 15281506 [PubMed - indexed for MEDLINE]


16: Anesth Analg. 2004 Jul;99(1):62-9. Related Articles, Links
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The development and application of an instrument for assessing resident competence during preanesthesia consultation.

de Oliveira Filho GR, Schonhorst L.

Department of Anesthesiology, Hospital Governador Celso Ramos, Florianopolis-SC, Brazil. grof@th.com.br

In this study, we aimed to construct, validate, and apply an instrument for assessing resident performance at outpatient preanesthesia consultation (PAC). A focus group and a Delphi panel of experts defined component items of a typical outpatient PAC, which could be used as indicators of competence. Items were incorporated in a checklist, which was further validated in a sample of consultations performed by board-certified anesthesiologists. The resulting instrument contained 37 items, grouped into five domains (physician-patient relationship, medical history, physical examination, patient education, and preanesthesia records), with high construct validity, high discriminant validity, moderate internal consistency, and high probability of inter-raters agreement. The instrument was applied to evaluate the performance of seven first-year residents at 317 consecutive PAC. Data were analyzed by constructing exponentially weighted moving average charts for domain and total scores. Statistically significant differing levels of performance could be consistently detected. Applying exponentially weighted moving average charts to the sequential analysis of the developed checklist scores can reliably assess resident performance at the devised criteria. The Preanesthesia Consultation Scoring Checklist is a potentially useful instrument for both formative and summative assessment of residents during their training in processes involved in outpatient preanesthesia evaluation.

PMID: 15281505 [PubMed - indexed for MEDLINE]


17: Anesth Analg. 2004 Jul;99(1):41-4. Related Articles, Links
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Late presentation of esophageal injury after transesophageal echocardiography.

MacGregor DA, Zvara DA, Treadway RM Jr, Ibdah JA, Maloney JD, Kon ND, Riley RD.

Department of Anesthesia, Wake Forest University School of Medicine, Winston-Salem, North Carolina 27157-1009, USA. dmacg@wfubmc.edu

Esophageal injury is a rare complication of intraoperative transesophageal echocardiography (TEE) associated with cardiac surgery. We report two cases of delayed presentation (2 and 6 days after surgery) of esophageal injury that were likely due to TEE. The differential diagnosis of postoperative pleural effusion or anemia must include esophageal injury from TEE, even 6 days after the procedure.

Publication Types:
  • Case Reports

PMID: 15281500 [PubMed - indexed for MEDLINE]


18: Anesth Analg. 2004 Aug;99(2):627-8. Related Articles, Links
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Inadvertent femoral nerve impalement and intraneural injection visualized by ultrasound.

Schafhalter-Zoppoth I, Zeitz ID, Gray AT.

Publication Types:
  • Letter

PMID: 15271763 [PubMed - indexed for MEDLINE]


19: Anesth Analg. 2004 Aug;99(2):624. Related Articles, Links
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An uncommon reason for damage to the intubating laryngeal mask airway (ILMA) endotracheal tube cuff-inflation system.

Wadhawan S, Vibha, Kumar R.

Publication Types:
  • Case Reports
  • Letter

PMID: 15271758 [PubMed - indexed for MEDLINE]


20: Anesth Analg. 2004 Aug;99(2):617-9, table of contents. Related Articles, Links
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Cerebrospinal fluid rhinorrhea after thermometer insertion through the nose.

Kuo CP, Wong CS, Borel CO, Yang CP, Yeh CC, Lu CH, Wu CT.

Department of Anesthesiology, Tri-Service General Hospital and National Defense Medical Center, #325 Section 2, Chenggung Road, Neihu 114, Taipei, Taiwan, Republic of China.

Cerebrospinal fluid (CSF) rhinorrhea is a rare clinical condition. Most leaks either are caused by traumatic head injury or are a complication of surgical procedures on the base of the skull. CSF rhinorrhea from nasal tube placement has been reported previously. We report a case of nasal thermometer placement during anesthesia complicated by a CSF leakage. We reemphasize that any material--including thermometers, nasogastric tubes, and endotracheal tubes--should be directed posteriorly after introduction into the external naris.

Publication Types:
  • Case Reports

PMID: 15271752 [PubMed - indexed for MEDLINE]


21: Anesth Analg. 2004 Aug;99(2):607-13, table of contents. Related Articles, Links
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Emergency tracheal intubation: complications associated with repeated laryngoscopic attempts.

Mort TC.

Anesthesiology, Hartford Hospital, 80 Seymour Street, Hartford, CT 06102, USA. tmort@harthosp.org

Repeated conventional tracheal intubation attempts may contribute to patient morbidity. Critically-ill patients (n = 2833) suffering from cardiovascular, pulmonary, metabolic, neurologic, or trauma-related deterioration were entered into an emergency intubation quality improvement database. This practice analysis was evaluated for airway and hemodynamic-related complications based on a set of defined variables that were correlated to the number of attempts required to successfully intubate the trachea outside the operating room. There was a significant increase in the rate of airway-related complications as the number of laryngoscopic attempts increased (</=2 versus >2 attempts): hypoxemia (11.8% versus 70%), regurgitation of gastric contents (1.9% versus 22%), aspiration of gastric contents (0.8% versus 13%) bradycardia (1.6% versus 21%), and cardiac arrest (0.7% versus 11%; P < 0.001). Although predictable, this analysis provides data that confirm the number of laryngoscopic attempts is associated with the incidence of airway and hemodynamic adverse events. These data support the recommendation of the ASA Task Force on the Management of the Difficult Airway to limit laryngoscopic attempts to three in lieu of the considerable patient injury that may occur.

PMID: 15271750 [PubMed - indexed for MEDLINE]


22: Anesth Analg. 2004 Aug;99(2):603-6, table of contents. Related Articles, Links
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Prediction of difficult tracheal intubation in thyroid surgery.

Bouaggad A, Nejmi SE, Bouderka MA, Abbassi O.

Department of Anesthesiology and Intensive Care, CHU Ibn Rochd Casablanca 20000, Morocco. bouaggad@hotmail.com

The incidence of difficult endotracheal intubation (DEI) for patients undergoing thyroidectomy has rarely been studied, and evaluation of factors linked to DEI is limited to a few studies. We undertook this prospective study to investigate the incidence of DEI in the presence of goiter (an enlargement of the thyroid gland) and to evaluate factors linked to DEI. We studied 320 consecutive patients scheduled for thyroidectomy. DEI was evaluated by an intubation difficulty scale. The trachea was intubated by an unassisted anesthesiologist, and the intubation difficulty scale was calculated. A univariate analysis was performed to identify potential factors predicting DEI, followed by a multivariate analysis. DEI was reported in 17 patients. The rate of easy tracheal intubation was 36.9%; the rate for patients who had minor difficulty of intubation was 57.8%. Sex (male), body mass index, Mallampati class, thyromental distance, neck mobility, Cormack grade, cancerous goiter, and tracheal deviation or compression were identified in the univariate analysis as potential DEI risk factors. With multivariate analysis, two criteria were recognized as independent for DEI (Cormack Grade III or IV and cancerous goiter). We conclude that the large goiter is not associated with a more frequent DEI. However, the presence of a cancerous goiter is a major factor for predicting DEI.

PMID: 15271749 [PubMed - indexed for MEDLINE]


23: Anesth Analg. 2004 Aug;99(2):598-602, table of contents. Related Articles, Links
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A simple glucose insulin regimen for perioperative blood glucose control: the Vellore regimen.

Miriam A, Korula G.

Department of Anaesthesia, Christian Medical College Hospital, Vellore-632004, India.

In this study, we sought a simple, easily implemented method of intraoperative control of blood glucose in diabetic patients in a large multispecialty teaching hospital. The Vellore regimen, which offers the advantages of a combined glucose insulin and variable rate infusion was evaluated. For every 1 to 50-mg/dL increase in blood glucose concentration more than 100 mg/dL, 1 U of insulin was added to the injection port of a 100-mL measured volume set containing 5% dextrose in water. Hourly monitoring of blood glucose was performed. The blood glucose control was compared with the different existing techniques followed in the hospital in 204 randomized patients: 98 in the study and 106 in the control group. The study group had a mean +/- sd blood glucose value of 156 +/- 36 mg/dL, and the control group's value was 189 +/- 63 mg/dL (P = 0.003). The percentage of patients who were poorly controlled (outside 100 to 200-mg/dL range) decreased from 51% to 28% (no patient less than 60 mg/dL) with this regimen as compared with the control group in which it increased from 49% to 72% (10 patients less than 60 mg/dL) (P = 0.0013). We conclude that the Vellore regimen is simple, effective, and safe for intraoperative blood glucose control.

Publication Types:
  • Clinical Trial
  • Randomized Controlled Trial

PMID: 15271748 [PubMed - indexed for MEDLINE]


24: Anesth Analg. 2004 Aug;99(2):593-4, table of contents. Related Articles, Links
Click here to read 
Seizures after a bier block with clonidine and lidocaine.

Ahmed SU, Vallejo R, Hord ED.

Massachusetts General Hospital Pain Center, WACC-324, Massachusetts General Hospital, 15 Parkman Street, Boston, MA 02114, USA. sahmed@partners.org

A 47-yr-old man with history of complex regional pain syndrome type 1 underwent an IV Bier block with a mixture of lidocaine and clonidine. The tourniquet was deflated after 60 min, and approximately 10 min later he presented with complex partial seizures. The possible mechanisms for this are discussed, and the effects of clonidine, lidocaine, and the mixture of both are reviewed, as are four additional published cases reporting seizures after the administration of clonidine.

Publication Types:
  • Clinical Trial

PMID: 15271746 [PubMed - indexed for MEDLINE]


25: Anesth Analg. 2004 Aug;99(2):589-92, table of contents. Related Articles, Links
Click here to read 
Pain relief after arthroscopic shoulder surgery: a comparison of intraarticular analgesia, suprascapular nerve block, and interscalene brachial plexus block.

Singelyn FJ, Lhotel L, Fabre B.

Department of Anesthesiology, School of Medicine, Catholic University of Louvain, St. Luc Hospital, Avenue Hippocrate 10/1821, B 1200 Brussels, Belgium. Singelyn@anes.ucl.ac.be

In this prospective, randomized, blinded study, we assessed the analgesic efficacy of interscalene brachial plexus block (ISB), suprascapular nerve block (SSB), and intraarticular local anesthetic (IA) after arthroscopic acromioplasty. One-hundred-twenty patients were divided into 4 groups of 30. In Group SSB, the block was performed with 10 mL of 0.25% bupivacaine. In Group IA, 20 mL of 0.25% bupivacaine was administered intraarticularly at the end of surgery. In Group ISB, the block was performed with 20 mL of 0.25% bupivacaine. A control group was included for comparison. General anesthesia was administered to all patients. Patients were observed during the first 24 h. Pain scores, supplemental analgesia, satisfaction scores, and side effects were recorded at 4 and 24 h. No significant difference was observed between the IA and control groups. When compared with these groups, Groups SSB and ISB had significantly lower pain scores. At 4-h follow-up, better pain relief on movement was noted in Group ISB than in Group SSB. When compared with controls, a significant reduction in morphine consumption and a better satisfaction score were noted only in Group ISB. We conclude that ISB is the most efficient analgesic technique after arthroscopic acromioplasty. SSN block would be a clinically appropriate alternative.

Publication Types:
  • Clinical Trial
  • Randomized Controlled Trial

PMID: 15271745 [PubMed - indexed for MEDLINE]


26: Anesth Analg. 2004 Aug;99(2):584-8, table of contents. Related Articles, Links
Click here to read 
Nerve stimulator-assisted evoked motor response predicts the latency and success of a single-injection sciatic block.

Sukhani R, Nader A, Candido KD, Doty R Jr, Benzon HT, Yaghmour E, Kendall M, McCarthy R.

Department of Anesthesiology, Northwestern University/Feinberg School of Medicine, 251 E. Huron Street, F5-704, Chicago, IL 60611, USA. radhasukhani@yahoo.com

Variable onset latency of single-injection sciatic nerve block (SNB) may result from drug deposition insufficiently close to all components of the nerve. We hypothesized that this variability is caused by the needle tip position relative to neural components, which is objectified by the type of evoked motor response (EMR) elicited before local anesthetic injection. One-hundred ASA I-II patients undergoing reconstructive ankle surgery received infragluteal-parabiceps SNB using 0.4 mL/kg (maximum 35 mL) of levobupivacaine 0.625%. The end-point for injection was the first elicited EMR: inversion (I), plantar flexion (PF), dorsiflexion (DF), or eversion (E) at 0.2-0.4 mA. The frequencies of the EMRs were: I 40%, PF 43%, E 14%, and DF 3%. SNB was considered complete if both tibial and common peroneal nerves were blocked and failed if either analgesia to pinprick was not observed at 30 min or anesthesia at 60 min. Patients with an EMR of I demonstrated shorter mean times (+/-95% confidence interval [CI]) to complete the block with 8.5 (95% CI, 6.2-10.8) min compared to 27.0 (95% CI, 20.6-33.4) min after PF (P < 0.001) and 30.4 (95% CI, 24.9-35.8) min after E (P < 0.001). No rescue blocks were required in group I compared with 24% (P = 0.001) and 71% (P < 0.001) of patients in groups PF and E, respectively. We conclude that EMR type during nerve stimulator-assisted single-injection SNB predicts latency and success of complete SNB because the observed EMR is related to the positioning of the needle tip relative to the tibial and common peroneal nerves.

Publication Types:
  • Clinical Trial
  • Randomized Controlled Trial

PMID: 15271744 [PubMed - indexed for MEDLINE]


27: Anesth Analg. 2004 Aug;99(2):502-9, table of contents. Related Articles, Links
Click here to read 
The effect of epidural clonidine on perioperative cytokine response, postoperative pain, and bowel function in patients undergoing colorectal surgery.

Wu CT, Jao SW, Borel CO, Yeh CC, Li CY, Lu CH, Wong CS.

Department of Anesthesiology, Tri-Service General Hospital, National Defense Medical Center, National Defense University, #325, Section 2, Chenggung Rd., Neihu 114, Taipei, Taiwan, Republic of China. wuchingtang@msn.com

The postoperative period is associated with an increased production of cytokines, which augment pain sensitivity. We investigated the hypothesis that epidural clonidine premedication and postoperative patient-controlled epidural analgesia (PCEA) including clonidine would decrease the release of proinflammatory (interleukin (IL)-6, IL-1beta, IL-8, and tumor necrosis factor (TNF)-alpha) and antiinflammatory (IL-1 receptor antagonist (RA)) cytokines in patients who underwent elective colorectal surgery and that they would provide better postoperative analgesia. Forty patients were randomly assigned to 1 of 2 groups of 20 each: the control group received normal saline 10 mL, whereas the clonidine group received epidural clonidine 150 microg diluted with 9 mL of normal saline 30 min before surgery. Venous blood samples for cytokine levels were obtained before induction, at the end of surgery, and after surgery at 12 and 24 h. After surgery, the clonidine group patients received PCEA with morphine (0.1 mg/mL) and clonidine (1.5 microg/mL) in 0.2% ropivacaine 100 mL, whereas control group patients received only PCEA morphine and ropivacaine. Patients in the clonidine group exhibited longer PCEA trigger times, lower pain scores at rest and while coughing, less morphine consumption, and a faster return of bowel function throughout the 72-h postoperative observation period, compared with patients in the control group. For patients in the clonidine group, production of IL-1RA, IL-6, and IL-8 was significantly less increased at the end of the surgical procedure and at 12 and 24 h after surgery. However, the concentrations of IL-1beta and TNF-alpha were not significantly increased.

Publication Types:
  • Clinical Trial
  • Randomized Controlled Trial

PMID: 15271731 [PubMed - indexed for MEDLINE]


28: Anesth Analg. 2004 Aug;99(2):386-92, table of contents. Related Articles, Links
Click here to read 
Neuromuscular pharmacodynamics of rocuronium in patients with major burns.

Han T, Kim H, Bae J, Kim K, Martyn JA.

Department of Anesthesiology and Pain Medicine, Hangang Sacred Heart Hospital, Hallym University School of Medicine, 94-200 Yongdungpo-Dong, Yongdungpo-Ku, Seoul, Korea 150-719. athan@unitel.co.kr

Rocuronium, which has a short onset time and is free of hyperkalemic effects, could be considered for rapid-sequence induction of anesthesia in patients with burns. In this study, we assessed the neuromuscular pharmacodynamics of rocuronium in patients with major burns. Adults aged 18-59 yr who had a major burn injury (n = 56) and a control group of 44 nonburned patients were included. Rocuronium was used at 3 times (0.9 mg/kg) or 4 times (1.2 mg/kg) the 95% effective dose. Anesthesia consisted of propofol and fentanyl with nitrous oxide and oxygen. Neuromuscular block was monitored with an acceleromyograph by using train-of-four stimulation. The onset time to 95% neuromuscular block was prolonged in burned compared with nonburned patients (115 +/- 58 s versus 68 +/- 16 s for 0.9 mg/kg; 86 +/- 20 s versus 57 +/- 11 s for 1.2 mg/kg). Dose escalation shortened the onset time, prolonged the duration of action, and improved intubating conditions in burned patients. All recovery profiles were significantly shorter in burned versus nonburned groups with both doses. Resistance to the neuromuscular effects of rocuronium was partially overcome by increasing the dose. A dose up to 1.2 mg/kg provides good tracheal intubating conditions after major burns.

Publication Types:
  • Clinical Trial

PMID: 15271712 [PubMed - indexed for MEDLINE]


29: Anesth Analg. 2004 Aug;99(2):383-5, table of contents. Related Articles, Links
Click here to read 
Unsuspected temporomandibular joint pathology leading to a difficult endotracheal intubation.

Small RH, Ganzberg SI, Schuster AW.

Department of Anesthesiology, The Ohio State University, 410 W. 10th Avenue, Columbus, OH 43210, USA. small.12@osu.edu

A 40-yr-old woman with an unremarkable medical history and no prior surgeries presented for ambulatory surgery. Physical examination revealed normal jaw opening. On induction of general anesthesia, her jaw was found to be locked in a nearly closed position. We discuss anesthetic considerations and the pathology of temporomandibular joint anterior disk dislocation without reduction. A simple maneuver to reduce the dislocation is described.

Publication Types:
  • Case Reports

PMID: 15271711 [PubMed - indexed for MEDLINE]


30: Anesth Analg. 2004 Aug;99(2):373-4, table of contents. Related Articles, Links
Click here to read 
The use of caudal morphine for pediatric liver transplantation.

Kim TW, Harbott M.

Department of Anesthesiology, Baylor College of Medicine, Texas Children's Hospital, 6621 Fannin Street, Ste B310, MC 2-1495, Houston, TX 77030-2399, USA. twkim@bcm.tmc.edu

A 3-yr-old female with cryptogenic cirrhosis presented for a liver transplant. After the induction and intubation, we performed a supplemental caudal block with a 22-gauge B-bevel needle in the usual sterile fashion, and 0.6 mg of Duramorph was injected without complications. Initially, the 14.9-kg child received a total of 110 microg of fentanyl in the first 2 h of the 6-h operation and was maintained on air-oxygen-isoflurane. The child was easily tracheally extubated and remained hemodynamically stable. In the pediatric intensive care unit, she was weaned off oxygen, out of bed, and required minimal pain control in the first 18 h.

Publication Types:
  • Case Reports

PMID: 15271708 [PubMed - indexed for MEDLINE]


31: Anesth Analg. 2004 Aug;99(2):370-2, table of contents. Related Articles, Links
Click here to read 
Hepatitis after sevoflurane exposure in an infant suffering from primary hyperoxaluria type 1.

Reich A, Everding AS, Bulla M, Brinkmann OA, Van Aken H.

Klinik und Poliklinik fur Anasthesiologie und Operative Intensivmedizin, Universitatsklinikum Munster, Albert Schweitzer-Strasse 33, D-48129 Munster, Germany. reich@anit.uni-muenster.de

An 11-mo-old child with primary hyperoxaluria was scheduled for a nephroureteromia procedure. Anesthesia was induced and maintained with sevoflurane. Two days after the operation, a hepatomegaly was diagnosed, and a considerable increase in liver enzymes was observed. These pathologic findings disappeared without treatment within 7 days. In a subsequent operation 2 wk later, general anesthesia was performed (sevoflurane was avoided). After the second operation, no pathologic findings could be detected. Nothing in this patient's disease or the conduct of the anesthesia suggested a cause for the injury other than an idiosyncratic response to sevoflurane.

Publication Types:
  • Case Reports

PMID: 15271707 [PubMed - indexed for MEDLINE]


32: Anesth Analg. 2004 Aug;99(2):357-9, table of contents. Related Articles, Links
Click here to read 
The role of transesophageal echocardiography in rapid diagnosis and treatment of migratory tumor embolus.

Chen H, Ng V, Kane CJ, Russell IA.

Department of Anesthesiology, Duke Pain and Palliative Care Clinic, Duke University Medical Center, 932 Morreene Road, Durham, NC 27713, USA. chen0025@mc.duke.edu

Transesophageal echocardiography (TEE) is sometimes used in renal cell carcinoma excision for evaluating the extension of tumor in the inferior vena cava (IVC), characterizing the tumor anatomy, monitoring the tumor during surgical mobilization, and assessing cardiac function. Although the risk for embolization is small, when embolization does occur, its consequences can be catastrophic. In this case report, we describe the crucial role of TEE in diagnosing an intraoperative migratory embolus from the IVC to the pulmonary artery and also provide both single-frame photographs and Internet-accessible videos of the event. Our case illustrates the key role that TEE played in the intraoperative management of a patient with renal cell carcinoma undergoing surgical excision of tumor. TEE aided in accurately defining the cephalad extent of the thrombus, provided continuous monitoring of the thrombus during surgical manipulation, and allowed immediate identification of its embolization and proper notification of the surgeons. This case illustrates the crucial role TEE played in the management of a migratory tumor embolus and argues for its routine use during excision of renal cell carcinomas invading the IVC.

Publication Types:
  • Case Reports

PMID: 15271705 [PubMed - indexed for MEDLINE]


33: Anesth Analg. 2004 Aug;99(2):350-2, table of contents. Related Articles, Links
Click here to read 
Postoperative death in a patient with unrecognized arrhythmogenic right ventricular dysplasia syndrome.

Toh KW, Nadesan K, Sie MY, Vijeyasingam R, Tan PS.

Department of Anesthesiology, Faculty of Medicine, University of Malaya, 27 Jalan Burhanuddin Helmi, Taman Tun Dr. Ismail, 60000 Kuala Lumpur, West Malaysia. tohkhaywee@hotmail.com

Arrhythmogenic right ventricular dysplasia is an inherited disease causing fatty replacement of heart tissue. This disease often presents as T-wave inversion in the anterior leads of the electrocardiogram (ECG) with life-threatening ventricular arrhythmias. In older patients, progressive right and left ventricular failure can develop. This is a case report of postoperative death occurring in a 59-yr-old woman with undiagnosed arrhythmogenic right ventricular dysplasia after hepatic cystectomy. The patient had T-wave inversion in the inferior ECG leads and no history of arrhythmias. During general anesthesia, cardiovascular collapse occurred in the absence of arrhythmias that was unresponsive to resuscitation.

Publication Types:
  • Case Reports

PMID: 15271703 [PubMed - indexed for MEDLINE]


34: Anesth Analg. 2004 Aug;99(2):344-9, table of contents. Related Articles, Links
Click here to read 
Regional cerebral oxygen saturation is a sensitive marker of cerebral hypoperfusion during orthotopic liver transplantation.

Plachky J, Hofer S, Volkmann M, Martin E, Bardenheuer HJ, Weigand MA.

Department of Anesthesiology, University of Heidelberg, Im Neuenheimer Feld 110, D-69120 Heidelberg, Germany. Jens_Plachky@med.uni-heidelberg.de

Neurological complications contribute significantly to morbidity and mortality of patients after orthotopic liver transplantation (OLT). One possible cause of postoperative neurological complications is cerebral ischemia during the surgical procedure. In this study, we investigated the relationship between intraoperative changes in regional cerebral oxygen saturation (rSo(2)) and postoperative values of neuron-specific enolase (NSE) and S-100, which are specific variables that indicate cerebral disturbances due to hypoxia/ischemia. The rSo(2) was monitored continuously by near-infrared spectroscopy in 16 patients undergoing OLT. In addition, NSE and S-100 were determined in arterial blood before surgery and 24 h after reperfusion of the donor liver. Interestingly, clamping of the recipient's liver led to a significant decline in rSo(2) in eight patients, whereas the others tolerated clamping without major changes in rSo(2). The decrease in rSo(2) after clamping correlated significantly with postoperative increases in NSE (r(2) = 0.57) and S-100 (r(2) = 0.52). However, there were no significant differences between patients with and without rSo(2) decline concerning hemodynamic variables. There were no significant correlations between DeltarSo(2) and cardiac output (r(2) = 0.20), NSE and cardiac output (r(2) = 0.37), or S-100 and cardiac output (r(2) = 0.24). Monitoring of rSo(2) may be a useful noninvasive tool to estimate disturbances in rSo(2) during OLT.

Publication Types:
  • Clinical Trial

PMID: 15271702 [PubMed - indexed for MEDLINE]


35: Anesth Analg. 2004 Aug;99(2):339-43, table of contents. Related Articles, Links
Click here to read 
Midazolam: an effective antiemetic after cardiac surgery--a clinical trial.

Sanjay OP, Tauro DI.

DNB, Department of Anesthesiology, St. John's Medical College Hospital, Bangalore 560034, Karnataka, India. sanjaysanjay_op@rediffmail.com

Cardiac surgery has been associated with a significant incidence of postoperative nausea and vomiting (PONV). To assess the antiemetic property of midazolam, we undertook this double-blinded, randomized trial in 200 patients undergoing cardiac surgery involving cardiopulmonary bypass, and we compared its efficacy with that of ondansetron in preventing PONV. Assessments on the occurrence of PONV were made at regular intervals for the first 24 h after tracheal extubation, along with sedation and pain scoring. We report a 6% incidence of nausea and no incidence of vomiting in the midazolam group, compared with a 21% incidence of PONV in the ondansetron group (P < 0.001). All 21 patients (18 women and 3 men) in the ondansetron group and none of the 6 patients (all women) in the midazolam group required a rescue antiemetic drug (P < 0.001). The sedation scores and postoperative pain scores were comparable in both groups. We conclude that midazolam, instituted as a continuous infusion in a dose of 0.02 mg. kg(-1). h(-1), is a more effective antiemetic than ondansetron in a dose of 0.1 mg/kg IV every 6 h for the prevention of PONV after cardiac surgery.

Publication Types:
  • Clinical Trial
  • Randomized Controlled Trial

PMID: 15271701 [PubMed - indexed for MEDLINE]


36: Anesth Analg. 2004 Aug;99(2):325-31, table of contents. Related Articles, Links
Click here to read 
The effect of diabetes on the interrelationship between jugular venous oxygen saturation responsiveness to phenylephrine infusion and cerebrovascular carbon dioxide reactivity.

Kadoi Y, Saito S, Goto F, Fujita N.

Department of Intensive Care, Gunma University, Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi, Gunma 371-8511, Japan. kadoi@med.gunma-u.ac.jp

In this study, we examined whether cerebrovascular carbon dioxide (CO(2)) reactivity was related to the response of jugular venous oxygen saturation (SjvO(2)) to phenylephrine infusion in diabetic patients during cardiopulmonary bypass. Forty diabetic patients scheduled for coronary artery bypass graft surgery were studied, and 40 age-matched nondiabetic cardiopulmonary bypass patients served as controls. Cerebrovascular CO(2) reactivity was measured continuously using transcranial Doppler. Mean arterial blood pressure (MAP) was increased by repeated phenylephrine infusion until reaching 100% of baseline values. There was a significant difference in absolute CO(2) reactivity between the diabetic and control groups (controls, 2.8 +/- 0.7 cm. s(-1). mm Hg(-1); diabetics, 2.2 +/- 1.1 cm. s(-1). mm Hg(-1); P = 0.02). Among the diabetics, absolute CO(2) reactivity in insulin-dependent patients was less than that in noninsulin-dependent patients (diet therapy group, 3.2 +/- 0.7; glibenclamide group, 2.6 +/- 0.7; insulin-dependent group, 1.0 +/- 0.7; P < 0.01). There was a correlation between absolute CO(2) reactivity and the mean slope of SjvO(2) versus MAP for increasing MAP (r = 0.54; P < 0.0001). In conclusion, we found that the interrelationship between SjvO(2) responsiveness to phenylephrine infusion and cerebrovascular CO(2) reactivity, as well as impaired cerebrovascular autoregulation, were associated with previous hyperglycemia.

Publication Types:
  • Clinical Trial

PMID: 15271699 [PubMed - indexed for MEDLINE]


37: Anesthesiology. 2004 Sep;101(3):796-8. Related Articles, Links
Click here to read 
Reversal of minimum alveolar concentrations of volatile anesthetics by chromosomal substitution.

Stekiel TA, J Contney S, Bosnjak ZJ, Kampine JP, Roman RJ, Stekiel WJ.

Department of Physiology, The Medical College of Wisconsin, Milwaukee, Wisconsin 53226, USA. tstekiel@mcw.edu

PMID: 15329608 [PubMed - indexed for MEDLINE]


38: Anesthesiology. 2004 Sep;101(3):787-90. Related Articles, Links

Comment in: Click here to read 
Dexmedetomidine as a total intravenous anesthetic agent.

Ramsay MA, Luterman DL.

Department of Anesthesiology & Pain Management, Baylor University Medical Center, Dallas, Texas 75246, USA. docram@baylorhealth.edu

Publication Types:
  • Case Reports

PMID: 15329604 [PubMed - indexed for MEDLINE]


39: Anesthesiology. 2004 Sep;101(3):766-85. Related Articles, Links
Click here to read 
Sickle cell disease and anesthesia.

Firth PG, Head CA.

Tufts University School of Medicine, Department of Anesthesia, Tufts-New England Medical Center, Boston, Massachusetts, USA.

Publication Types:
  • Review
  • Review of Reported Cases

PMID: 15329603 [PubMed - indexed for MEDLINE]


40: Anesthesiology. 2004 Sep;101(3):703-9. Related Articles, Links
Click here to read 
Inhaled anesthetic enhancement of amyloid-beta oligomerization and cytotoxicity.

Eckenhoff RG, Johansson JS, Wei H, Carnini A, Kang B, Wei W, Pidikiti R, Keller JM, Eckenhoff MF.

Department of Anesthesia, University of Pennsylvania, Philadelphia, Pennsylvania 19104-4283, USA. roderic.eckenhoff@uphs.upenn.edu

BACKGROUND: The majority of surgical patients receive inhaled anesthetics, principally small haloalkanes and haloethers. Long-term cognitive problems occur in the elderly subsequent to anesthesia and surgery, and previous surgery might also be a risk factor for neurodegenerative disorders like Alzheimer and Parkinson disease. The authors hypothesize that inhaled anesthetics contribute to these effects through a durable enhancement of peptide oligomerization. METHODS: Light scattering, filtration assays, electron microscopy, fluorescence spectroscopy and size-exclusion chromatography was used to characterize the concentration-dependent effects of halothane, isoflurane, propofol, and ethanol on amyloid beta peptide oligomerization. Pheochromocytoma cells were used to characterize cytotoxicity of amyloid oligomers with and without the above anesthetics. RESULTS: Halothane and isoflurane enhanced amyloid beta oligomerization rates and pheochromocytoma cytotoxicity in vitro through a preference for binding small oligomeric species. Ethanol and propofol inhibited oligomerization at low concentration but enhanced modestly at very high concentration. Neither ethanol nor propofol enhanced amyloid beta toxicity in pheochromocytoma cells. CONCLUSIONS: Inhaled anesthetics enhance oligomerization and cytotoxicity of Alzheimer disease-associated peptides. In addition to the possibility of a general mechanism for anesthetic neurotoxicity, these results call for further evaluation of the interaction between neurodegenerative disorders, dementia, and inhalational anesthesia.

PMID: 15329595 [PubMed - indexed for MEDLINE]


41: Anesthesiology. 2004 Sep;101(3):687-94. Related Articles, Links
Click here to read 
Inhibitory effects of the anesthetics propofol and sevoflurane on spontaneous lymphatic vessel activity in rats.

Hattori J, Yamakage M, Seki S, Okazaki K, Namiki A.

Sapporo Medical University, Sapporo, Japan.

BACKGROUND: The effects of propofol and sevoflurane on lymphatic vessel activity are unknown. This study aimed to clarify the effects of these anesthetics on lymphatic vessel activity in rats by the use of a technique for mechanical removal of the endothelium. METHODS: The authors first examined the effects of propofol (8 mg/kg) and sevoflurane (2.0%) on in vivo lymphatic flow by injection of dye into the femoral regions of rats. In the in vitro study, the ends of the vessel segments of rat thoracic duct were connected to a syringe and stopcock, respectively. Spontaneous changes in diameter of each segment were monitored, and the extraluminal side of each segment was exposed to propofol (1 x 10(-6) approximately 3 x 10(-5) M) or sevoflurane (0.5 approximately 2.0%). Endothelial function was eliminated by perfusion of air into the lumen. RESULTS: In the dye uptake study, 80% of iliac lymphatic nodes were positively stained in a control group, whereas only 10% and 20% were positively stained in propofol and sevoflurane groups, respectively. In the in vitro study, both of the anesthetics significantly decreased the amplitude of spontaneous activity of lymphatic vessels with or without endothelial function. Sevoflurane inhibited the frequency of lymphatic vessel activity but propofol had no effect on it. When the endothelial function was eliminated, both anesthetics decreased the frequency of spontaneous activity of lymphatic vessels. CONCLUSIONS: Propofol and sevoflurane seem to have some different effects on endothelial function, which regulates the pacemaking of spontaneous contraction of lymphatic vessels.

PMID: 15329593 [PubMed - indexed for MEDLINE]


42: id: 15329578 Error occurred: Document retrieval error: document does not exist
43: Anesthesiology. 2004 Aug;101(2):556; author reply 556-8. Related Articles, Links

Comment on: Click here to read 
Does the hole in the dura mater really matter: what's the evidence?

Bernards CM.

Publication Types:
  • Comment
  • Letter

PMID: 15277952 [PubMed - indexed for MEDLINE]


44: Anesthesiology. 2004 Aug;101(2):550; author reply 550-1. Related Articles, Links

Comment on: Click here to read 
Is the minimum local analgesic concentration method robust enough?

Lacassie HJ, Lacassie HP, Muir HA.

Publication Types:
  • Comment
  • Letter

PMID: 15277943 [PubMed - indexed for MEDLINE]


45: Anesthesiology. 2004 Aug;101(2):488-94. Related Articles, Links
Click here to read 
Clonidine prolongation of lidocaine analgesia after sciatic nerve block in rats Is mediated via the hyperpolarization-activated cation current, not by alpha-adrenoreceptors.

Kroin JS, Buvanendran A, Beck DR, Topic JE, Watts DE, Tuman KJ.

Department of Anesthesiology, Rush Medical College, 1653 W. Congress Parkway, Chicago, Illinois 60612, USA. jkroin@rush.edu

BACKGROUND: Although clonidine is commonly combined with local anesthetics to extend duration of peripheral nerve block, the mechanism by which clonidine potentiates local anesthetic action in vivo is unclear. METHODS: Male Sprague-Dawley rats received percutaneous injections of 1% lidocaine with/without clonidine or epinephrine into the sciatic notch and duration of sensory blockade was quantified by inhibition of pinprick foot withdrawal. The antagonists prazosin or yohimbine were injected before lidocaine with clonidine or epinephrine to determine the role of alpha-adrenergic receptors. The role of the hyperpolarization-activated cation current (Ih) was evaluated by injecting the current blocker ZD 7288 as well as the current enhancers forskolin and 8-Br-cAMP before lidocaine alone or with 15 micrograms/ml clonidine. RESULTS: Mean duration of sensory block for lidocaine alone was 69 +/- 2 min. Sensory block duration increased monotonically with increasing doses of added clonidine or epinephrine. Preinjection of prazosin but not yohimbine prevented the increase in block duration seen with epinephrine. Neither alpha-adrenergic antagonist attenuated the extended duration of block with clonidine. ZD 7288 extended sensory blockade equivalent to the prolongation observed with clonidine. There was no additive effect when ZD 7288 and clonidine were combined, and a decreased duration of nerve block when either forskolin or 8-Br-cAMP preceded injection of lidocaine with clonidine. CONCLUSIONS: The findings indicate that prolongation of duration of in vivo lidocaine nerve blockade by clonidine is not mediated by an alpha-adrenergic mechanism but likely involves the Ih current.

PMID: 15277933 [PubMed - indexed for MEDLINE]


46: Anesthesiology. 2004 Aug;101(2):327-39. Related Articles, Links
Click here to read 
Hemofiltration but not steroids results in earlier tracheal extubation following cardiopulmonary bypass: a prospective, randomized double-blind trial.

Oliver WC Jr, Nuttall GA, Orszulak TA, Bamlet WR, Abel MD, Ereth MH, Schaff HV.

Mayo Medical School, Rochester, Minnesota, USA. oliver.william@mayo.edu

BACKGROUND: Activation of the inflammatory cascade is thought to account for some of the respiratory dysfunction and prolonged mechanical ventilation associated with cardiopulmonary bypass. The objective of this investigation was to identify whether perioperative steroids or hemofiltration during cardiopulmonary bypass, by their attenuation of inflammation, would reduce duration of mechanical ventilation after cardiac surgery. METHODS: After Institutional Review Board approval and informed consent, 192 patients scheduled to undergo elective primary coronary artery bypass grafting or valvular replacement or repair were randomized in a double-blind prospective study into three groups. One group (Control) received saline at induction and at 6-h intervals for four doses. Another group (Hemofil) received saline and hemofiltration to obtain 27 ml/kg of hemofiltrate. The final group (Steroid) received 1 g methylprednisolone before anesthesia induction and then 4 mg of dexamethasone at 6-h intervals for four doses. All patients underwent normothermic cardiopulmonary bypass and received propofol for postoperative sedation. Separate two-sample comparisons were performed to compare each experimental group versus the control group using the Wilcoxon rank sum test for continuous variables and Fisher exact test for categorical variables. In all cases, two-tailed P values </= 0.05 were considered statistically significant. RESULTS: The median time until the patient reached an intermittent mandatory ventilation of 4/min (258.5 versus 385.0 min, respectively; P = 0.02) and tracheal extubation (352.0 versus 518.0 min; P = 0.03) was significantly reduced for group Hemofil but no different for Steroid compared to Control. CONCLUSIONS: Hemofiltration and steroids are both previously reported to attenuate the inflammatory response but only hemofiltration reduced time to tracheal extubation for adults after cardiopulmonary bypass in this study.

Publication Types:
  • Clinical Trial
  • Randomized Controlled Trial

PMID: 15277915 [PubMed - indexed for MEDLINE]


47: Anesthesiology. 2004 Aug;101(2):316-20. Related Articles, Links
Click here to read 
A randomized controlled trial comparing the ProSeal Laryngeal Mask Airway with the Laryngeal Tube Suction in mechanically ventilated patients.

Gaitini LA, Vaida SJ, Somri M, Yanovski B, Ben-David B, Hagberg CA.

Anesthesia Department, Bnai-Zion Medical Center, Haifa, Israel. gaitini@netvision.net.il

BACKGROUND: The ProSeal Laryngeal Mask Airway (PLMA) (Laryngeal Mask Company, Henley-on-Thames, United Kingdom) is a new laryngeal mask with a modified cuff designed to improve its seal and a drain tube for gastric tube placement. Similarly, the Laryngeal Tube Suction (LTS) (VBM Medizintechnik Gmbh, Sulz a.N, Germany) is a new laryngeal tube that also has an additional channel for gastric tube placement. This study compared the placement and functions of these two devices. METHODS: One hundred fifty patients undergoing general anesthesia for elective surgery were randomly allocated to the PLMA (n = 75) or LTS (n = 75). Oxygenation and ventilation, ease of insertion, fiberoptic view, oropharyngeal leak pressure, ventilatory data, ease of gastric tube insertion, and postoperative airway morbidity were determined. RESULTS: After successful insertion of the devices in 96% of patients with the PLMA and in 94.4% with the LTS it was possible to maintain oxygenation, ventilation, and respiratory mechanics during the entire duration of surgery. Successful first and second attempt insertion rates were 57 patients (76%) and 15 patients (20%), respectively, for the PLMA and 60 patients (80%) and 11 patients (14.6%), respectively, for the LTS. Airway placement was unsuccessful with the PLMA in three patients and with the LTS in four patients. Time to achieve an effective airway was 36 +/- 24 s with the PLMA versus 34 +/- 25 s with the LTS. Gastric tube insertion was possible in 97.3% of patients with the PLMA and in 96% with the LTS. CONCLUSIONS: With respect to both physiologic and clinical function, the PLMA and LTS are similar and either device can be used to establish a safe and effective airway in mechanically ventilated anesthetized adult patients.

Publication Types:
  • Clinical Trial
  • Randomized Controlled Trial

PMID: 15277913 [PubMed - indexed for MEDLINE]


48: Anesthesiology. 2004 Aug;101(2):299-310. Related Articles, Links
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Cardioprotective properties of sevoflurane in patients undergoing coronary surgery with cardiopulmonary bypass are related to the modalities of its administration.

De Hert SG, Van der Linden PJ, Cromheecke S, Meeus R, Nelis A, Van Reeth V, ten Broecke PW, De Blier IG, Stockman BA, Rodrigus IE.

Division of Cardiothoracic and Vascular Anesthesia, University Hospital Antwerp. stefan.dehert@ua.ac.be

BACKGROUND: Experimental studies have related the cardioprotective effects of sevoflurane both to preconditioning properties and to beneficial effects during reperfusion. In clinical studies, the cardioprotective effects of volatile agents seem more important when administered throughout the procedure than when used only in the preconditioning period. The authors hypothesized that the cardioprotective effects of sevoflurane observed in patients undergoing coronary surgery with cardiopulmonary bypass are related to timing and duration of its administration. METHODS: Elective coronary surgery patients were randomly assigned to four different anesthetic protocols (n = 50 each). In a first group, patients received a propofol based intravenous regimen (propofol group). In a second group, propofol was replaced by sevoflurane from sternotomy until the start of cardiopulmonary bypass (SEVO pre group). In a third group, propofol was replaced by sevoflurane after completion of the coronary anastomoses (SEVO post group). In a fourth group, propofol was administered until sternotomy and then replaced by sevoflurane for the remaining of the operation (SEVO all group). Postoperative concentrations of cardiac troponin I were followed during 48 h. Cardiac function was assessed perioperatively and during 24 h postoperatively. RESULTS: Postoperative troponin I concentrations in the SEVO all group were lower than in the propofol group. Stroke volume decreased transiently after cardiopulmonary bypass in the propofol group but remained unchanged throughout in the SEVO all group. In the SEVO pre and SEVO post groups, stroke volume also decreased after cardiopulmonary bypass but returned earlier to baseline values than in the propofol group. Duration of stay in the intensive care unit was lower in the SEVO all group than in the propofol group. CONCLUSION: In patients undergoing coronary artery surgery with cardiopulmonary bypass, the cardioprotective effects of sevoflurane were clinically most apparent when it was administered throughout the operation.

Publication Types:
  • Clinical Trial
  • Randomized Controlled Trial

PMID: 15277911 [PubMed - indexed for MEDLINE]


49: Anesthesiology. 2004 Aug;101(2):284-93. Related Articles, Links
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Effect of clonidine on cardiovascular morbidity and mortality after noncardiac surgery.

Wallace AW, Galindez D, Salahieh A, Layug EL, Lazo EA, Haratonik KA, Boisvert DM, Kardatzke D.

Department of Anesthesia and Perioperative Care, University of California, USA. awallace@cardiacengineering.com

BACKGROUND: Perioperative myocardial ischemia occurs in 20-40% of patients at risk for cardiac morbidity and is associated with a ninefold increase in risk of cardiac morbidity. METHODS: In a prospective, double-blinded, clinical trial, we studied 190 patients with or at risk for coronary artery disease in two study groups with a 2:1 ratio (clonidine, n = 125 vs. placebo, n = 65) to test the hypothesis that prophylactic clonidine reduces the incidence of perioperative myocardial ischemia and postoperative death in patients undergoing noncardiac surgery. Clonidine (0.2 mg orally as well as a patch) or placebo (tablet and patch) was administered the night before surgery, and clonidine (0.2 mg orally) or placebo (tablet) was administered on the morning of surgery. The patch or placebo remained on the patient for 4 days and was then removed. RESULTS: The incidence of perioperative myocardial ischemia was significantly reduced with clonidine (intraoperative and postoperative, 18 of 125, 14% vs. placebo, 20 of 65, 31%; P = 0.01). Prophylactic clonidine administration had minimal hemodynamic effects. Clonidine reduced the incidence of postoperative mortality for up to 2 yr (clonidine, 19 of 125 [15%] vs. placebo, 19 of 65 [29%]; relative risk = 0.43 [confidence interval, 0.21-0.89]; P = 0.035). CONCLUSIONS: Perioperative administration of clonidine for 4 days to patients at risk for coronary artery disease significantly reduces the incidence of perioperative myocardial ischemia and postoperative death.

Publication Types:
  • Clinical Trial
  • Randomized Controlled Trial

PMID: 15277909 [PubMed - indexed for MEDLINE]


50: Ann Fr Anesth Reanim. 2004 Jul;23(7):758-60. Related Articles, Links
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Peripartum anesthetic management of the parturient with severe aortic stenosis: regional vs. general anesthesia?

Kuczkowski KM, Chow I.

Publication Types:
  • Letter

PMID: 15324972 [PubMed - in process]


51: Ann Fr Anesth Reanim. 2004 Jul;23(7):730-2. Related Articles, Links
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[Prolonged motor blockade after combined epidural and general anaesthesia for oncologic gynaecological surgery]

[Article in French]

Leblanc M, Bonnin M, Bolandard F, Mage G, Bazin JE.

Departement d'anesthesie-reanimation, polyclinique, Hotel-Dieu, CHU, 63003, Clermont-Ferrand, France.

The case described is a patient submitted to an oncologic gynaecological surgery under combined epidural and general anaesthesia. The anaesthesia involved complications, a prolonged motor blockade for up to 9 h whereas recommended doses had been respected. A few later after a magnetic resonance imaging that did not showed any extradural haematoma, full recovery occurred. The combined epidural and general anaesthesia was approved as an interesting technique for both per and postoperative analgesia, but also for postoperative rehabilitation. Nevertheless, for older patients, inhalational anaesthetics and opioids have to be decreased during the intervention, moreover local anaesthetics doses for epidural anaesthesia have to be reduced too, in order to control motor blockade duration.

PMID: 15324962 [PubMed - in process]


52: Br J Anaesth. 2004 Aug 20 [Epub ahead of print] Related Articles, Links
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Randomized double-blind clinical trial comparing topical and sub-Tenon's anaesthesia in routine cataract surgery{dagger}

Srinivasan S, Fern AI, Selvaraj S, Hasan S.

Department of Ophthalmology, Hairmyres Hospital, Lanarkshire Acute Hospitals NHS Trust, Lanarkshire, UK; Tennent Institute of Ophthalmology, Gartnavel General Hospital, Glasgow, UK.

BACKGROUND: Several local anaesthetic techniques are available for cataract surgery. Recently, topical anaesthesia has gained in popularity. A randomized trial was designed to compare patient discomfort and intraoperative complications following routine cataract surgery under topical or sub-Tenon's anaesthesia. METHODS: A randomized double-blinded placebo-controlled clinical trial of 210 patients assigned to either a sub-Tenon's group (sub-Tenon's anaesthesia with placebo topical balanced salt solution, n=140) or a topical anaesthesia group (topical anaesthesia with placebo sub-Tenon's injection of balanced salt solution, n=70) was carried out. All patients underwent phacoemulsification with intraocular lens implantation. Patients in the sub-Tenon's group received a single injection (3 ml) of a combination of lidocaine 2% (2 ml) and bupivacaine 0.75% (1 ml), and four doses of topical placebo (balanced salt solution). Patients in the topical anaesthesia group received four doses of topical proxymethocaine 0.5% and a placebo sub-Tenon's injection (3 ml) of balanced salt solution. No intracameral injection of local anaesthetic was given. A 10-point visual analogue pain scale was used preoperatively and for postoperative pain assessment immediately after the operation and 30 min postoperatively. The intraoperative complications in the two groups were recorded. RESULTS: The mean pain score immediately after surgery was 2.42 (SD 2.2) in the sub-Tenon's group and 3.44 (2.3) in the topical anaesthesia group (P=0.0043). The mean pain score 30 min after surgery was 1.24 (1.7) in the sub-Tenon's group and 2.25 (2.2) in the topical anaesthesia group (P=0.0009). CONCLUSIONS: Patients undergoing cataract surgery under topical anaesthesia experience more postoperative discomfort than patients receiving sub-Tenon's anaesthesia. Surgery-related complications were similar in both groups.

PMID: 15321935 [PubMed - as supplied by publisher]


53: Br J Anaesth. 2004 Oct;93(4):521-4. Epub 2004 Aug 20. Related Articles, Links
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Structured assessment tool to evaluate patient suitability for cataract surgery under local anaesthesia.

MacPherson R.

Department of Anaesthesia and Pain Management, Royal North Shore Hospital, St Leonards, NSW 2065, Australia.

Introduction. Cataract extraction and intraocular lens implantation is a common surgical procedure. While the vast majority of these operations are performed under local anaesthesia (LA), this is not an appropriate technique for every patient. Likewise it is time-consuming to assess all patients fitness for general anaesthesia when most will not need it. METHODS: We developed an eight-item questionnaire that can be administered before admission to assess patient suitability for surgery under LA. In a prospective study over a 9-month period, 128 patients were seen in a pre-admission clinic, and according to the responses to the questionnaire administered by junior medical staff, 123 were deemed suitable for surgery under LA, and five under general anaesthetic (GA). RESULTS: All 123 patients went on to have surgery successfully performed under LA. A further two patients from the GA group were determined by the attending anaesthetist to be suitable for surgery under LA. CONCLUSION: This assessment instrument has been shown to be a highly specific means of selecting patients for surgery under LA, and can be administered by medical or nursing staff.

PMID: 15321931 [PubMed - in process]


54: Eur J Anaesthesiol. 2004 Apr;21(4):329-30. Related Articles, Links

Comment on:
Historical data on the neuraxial administration of opioids.

Magora F.

Publication Types:
  • Comment
  • Historical Article
  • Letter

PMID: 15109202 [PubMed - indexed for MEDLINE]


55: Eur J Anaesthesiol. 2004 Apr;21(4):284-8. Related Articles, Links

Comparison of patient-controlled and operator-controlled conscious sedation for restorative dentistry.

Bavisha KA, Elias M, Paris S, Leon AR, Flynn PJ.

Barts and The London NHS Trust, The Royal London Hospital, London, UK. k.b.bavisha@qmul.ac.uk

BACKGROUND AND OBJECTIVE: The use of midazolam for conscious sedation is an accepted method of anxiety control in restorative dentistry. A lack of predictability in its effects requires the dose of midazolam to be adjusted to individual patient's requirements. We determined whether patient-controlled sedation was a suitable alternative to operator-controlled sedation in restorative dentistry. METHODS: A randomized crossover clinical trial involving 35 consecutive patients undergoing similar dental procedures. Patients were randomly given midazolam, administered either by the patient or by the operator at the first visit and the alternative option on the second visit. All patients were ASA I-II and their ages ranged between 20 and 48 yr. Blood pressure, heart rate, oxygen saturation and patient satisfaction were recorded. RESULTS: The onset time and initial dose for sedation were similar with the two methods of administration and the sedation scores and vital signs were satisfactory. In the patient-controlled group the mean total dose of midazolam was 7.9 (+/- 4.2 SD) mg cf. 4.2 (+/- 1.8 SD) mg in the operator-controlled group (P < 0.05). The time to fitness for discharge (15.4 (+/- 11.9 SD) min) was greater in the patient-controlled group cf. the operator-controlled group (8.5 (+/- 9.5 SD) min), P < 0.05. CONCLUSION: This study shows that patient-controlled sedation is a suitable alternative to operator-controlled sedation in the management of anxious dental patients.

Publication Types:
  • Clinical Trial
  • Randomized Controlled Trial

PMID: 15109191 [PubMed - indexed for MEDLINE]


56: Eur J Anaesthesiol. 2004 Apr;21(4):265-71. Related Articles, Links

Conventional stepwise vs. vital capacity rapid inhalation induction at two concentrations of sevoflurane.

Martin-Larrauri R, Gilsanz F, Rodrigo J, Vila P, Ledesma M, Casimiro C.

Hospital La Milagrosa, Department of Anaesthesiology, Madrid, Spain. rmlarrauri@adv.es

BACKGROUND AND OBJECTIVE: A multicentre study was conducted to compare three methods of inhalation induction with sevoflurane in adult premedicated patients. METHODS: One-hundred-and-twenty-five adult patients of ASA I-II were scheduled for short elective surgical procedures (< 90 min) under general anaesthesia with spontaneous ventilation of the lungs via a laryngeal mask airway. Patients were randomly assigned to one of three groups: conventional stepwise inhalation induction group (Group C) or vital capacity rapid inhalation induction groups at 4.5% (Group VC4.5) or at 8% sevoflurane (Group VC8). Before anaesthetic induction, fentanyl 1 micro kg(-1) was given and the face mask applied with the anaesthetic breathing system primed with sevoflurane 4.5% or 8% in the respective vital capacity groups. Loss of eyelash reflex, time to cessation of finger tapping, laryngeal mask insertion, side-effects and adequacy of induction were recorded. RESULTS: The time to loss of eyelash reflex was significantly shorter in both vital capacity groups vs. the control group: VC8: 68 +/- 7 s; and VC4.5: 94 +/- 6.5 s vs. C: 118 +/- 6.4s (P < 0.0001). Significant differences were found in all pairwise comparisons for time to cessation of tapping: Group VC8 (62 +/- 7 s), Group VC4.5 (85 +/- 6 s) and Group C (116 +/- 6 s; P < 0.0001). The time to laryngeal mask insertion was significantly shorter in the Group VC8 (176 +/- 13 s) compared with the other two groups, Group VC4.5 (219 +/- 13 s) and Group C (216 +/- 9 s). There were no significant differences in the incidence of side-effects between the three groups. CONCLUSIONS: Inhalation induction of anaesthesia with sevoflurane with the three techniques tested is safe, reliable and well accepted by the patients. The vital capacity rapid inhalation group primed with sevoflurane 8% was the fastest method with no relevant side-effects.

Publication Types:
  • Clinical Trial
  • Multicenter Study
  • Randomized Controlled Trial

PMID: 15109188 [PubMed - indexed for MEDLINE]


57: Neurosci Lett. 2004 Sep 2;367(2):171-6. Related Articles, Links
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Effect of simple spike firing mode on complex spike firing rate and waveform in cerebellar Purkinje cells in non-anesthetized mice.

Servais L, Bearzatto B, Hourez R, Dan B, Schiffmann SN, Cheron G.

Laboratory of Neurophysiology, CP601 Universite Libre de Bruxelles (ULB), Campus Erasme 808 Route de Lennik, 1070 Brussels, Belgium. servais.laurent@ulb.ac.be

Cerebellar Purkinje cells receive two different excitatory inputs from parallel and climbing fibers, causing simple and complex spikes, respectively. Purkinje cells present three modes of simple spike firing, namely tonic, silent and bursting. The influence of complex spike firing on simple spike firing has been extensively studied. However, it is unknown whether and how the simple spike firing mode may influence complex spike waveform and firing rate in vivo. We studied complex spike firing during tonic and silent mode periods in non-anesthetized mice. We found that complex spike firing rate is not influenced by simple spike firing modes, but that the complex spike waveform is altered following high frequency simple spike firing. This alteration is a specific decrement of the second depolarizing component of the complex spike. We demonstrate that the amplitude of the second depolarizing component is inversely proportional to the simple spike firing rate preceding the complex spike and that this amplitude is independent of previous complex spike firing. This waveform modulation is different from previously reported modulation in paired-pulse depression and refractoriness.

PMID: 15331146 [PubMed - in process]


58: Neurosci Lett. 2004 Aug 12;366(2):215-9. Related Articles, Links
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Expression of c-fos in the nucleus of the solitary tract following electroacupuncture at facial acupoints and gastric distension in rats.

Liu JH, Li J, Yan J, Chang XR, Cui RF, He JF, Hu JM.

Department of Analysis and Measurement Science, Wuhan University, Wuhan 430072, PR China.

Clinical practice has shown that acupuncture at facial acupoints has curative effects on some visceral diseases (especially gastrointestinal diseases). However, the physiological basis has not been clarified yet. In the present study, expression of c-fos in the nucleus of the solitary tract (NTS) of rats following gastric distension and electroacupuncture (EA) at Yangbai (GB14) and Sibai (ST2) as well as Jiache (ST6) acupoints was observed by using immunohistochemistry technique. After EA at the three facial acupoints, c-fos immunoreactive (c-fos-IR) neurons were mainly distributed in the medial (mNTS) and intermediate subnucleus of the NTS, and a few were scatteredly distributed in the dorsalmedial and commissural subnucleus of the NTS. Furthermore, there is difference in the number of c-fos-IR neurons in the mNTS following EA at the three facial acupoints. The number in the EA at ST2 and GB14 group is the highest and the lowest, respectively. Gastric distension induces obviously the expression of c-fos, which is mainly confined in the mNTS. The results suggest that the noxious visceral and somatic afferent information from the stomach and face may converge in the mNTS, which may be involved in the effect of EA at facial acupoints on the gastrointestinal pain.

PMID: 15276250 [PubMed - indexed for MEDLINE]


59: Paediatr Anaesth. 2004 Sep;14(9):803. Related Articles, Links
Click here to read 
Paediatric anaesthesia.

Thomas M.

Great Ormond Street Hospital, London, UK (email: thomam@gosh.nhs.uk)

PMID: 15330970 [PubMed - in process]


60: Paediatr Anaesth. 2004 Sep;14(9):792-7. Related Articles, Links
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Anesthetic implications of Leigh's syndrome.

Shear T, Tobias JD.

University of Missouri School of Medicine, Columbia, MO 65212, USA.

Leigh's syndrome (LS) is a mitochondrial disorder characterized by progressive neurodegenerative changes with loss of developmental milestones, abnormalities of central control of respiration, and metabolic derangements. The primary genetic defect involves the respiratory chain complex and pyruvate dehydrogenase complex resulting in abnormal mitochondrial function and defective oxidative phosphorylation. While most patients have respiratory and neurological impairment, involvement of the cardiovascular and musculoskeletal systems may also occur. The authors present the use of spinal anesthesia for muscle biopsy in a 19 month old with LS and review the potential anesthetic implications of this syndrome.

PMID: 15330965 [PubMed - in process]


61: Paediatr Anaesth. 2004 Sep;14(9):787-91. Related Articles, Links
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Combined general and epidural anesthesia for a child with alagille syndrome: a case report.

Subramaniam K, Myers LB.

Department of Anesthesiology and Critical Care Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02115, USA.

Alagille syndrome (syndromic paucity of interlobular bile ducts) is the most common form of familial intrahepatic cholestasis. We describe the perioperative management of a pediatric patient with Alagille syndrome undergoing ileal exclusion and the specific issues associated with epidural anesthesia with this syndrome.

PMID: 15330964 [PubMed - in process]


62: Paediatr Anaesth. 2004 Sep;14(9):778-80. Related Articles, Links
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Anesthesia in Beckwith-Wiedemann syndrome.

Celiker V, Basgul E, Karagoz AH.

Department of Anaesthesiology and Reanimation, Hacettepe University Faculty of Medicine, Ankara, Turkey.

Anesthetic management of a 3-month-old boy with Beckwith-Wiedemann syndrome for bronchoscopy is reported. Management may be complicated by a difficult airway, congenital heart disease, and hypoglycemia. We did not have difficulty in airway management either with tracheal intubation or rigid bronchoscopy, but we could not extubate the baby because of tracheomalacia.

PMID: 15330962 [PubMed - in process]


63: Paediatr Anaesth. 2004 Sep;14(9):768-73. Related Articles, Links
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Pupillary reflex dilation and skin temperature to assess sensory level during combined general and caudal anesthesia in children.

Emery J, Ho D, MacKeen L, Heon E, Bissonnette B.

Department of Anaesthesia, University of Toronto and The Hospital for Sick Children, Toronto, Ontario, Canada. jgbemery@doctors.org.uk

BACKGROUND: Regional anesthesia causes sympathetic blockade, vasodilation and higher skin temperature in anesthetized dermatomes. Measurement of skin temperature changes might provide a useful estimate of the level of caudal anesthesia in children. Pupillary reflex dilation (PRD) allows estimation of the sensory level during combined general/epidural anesthesia in adults, but has not been assessed in children. This study was designed to evaluate skin temperature and PRD as methods of estimating sensory level in children receiving combined general/caudal epidural anesthesia. METHODS: Twenty ASA I and II children aged 10 months-5 years were enrolled. Anesthesia was induced with sevoflurane and N2O in O2 and maintained with 1 MAC isoflurane and air in O2. Caudal epidural anesthesia was achieved by injection of 1 ml x kg(-1) 0.25% bupivacaine. Skin temperature was measured by rapid response infrared thermometry. PRD was measured using an ophthalmic ultrasound biomicroscope (UBM). The three criteria used to estimate sensory level were a drop in skin temperature of 0.5 degrees C between dermatomes, PRD of 50% and PRD of 0.2 mm. RESULTS: A drop in skin temperature of 0.5 degrees C between dermatomes allowed estimation of the sensory level in only 20% of patients. PRD of 50%, and PRD of 0.2 mm allowed estimation of the sensory level in 45 and 100% of patients, respectively. PRD was significantly greater above the T10 dermatome compared with L2 (P < 0.01). The maximum pupillary dilation was significantly greater in children over 2 years of age [1.3 +/- 0.8 mm sd)] compared with children less than two years of age [0.6 +/- 0.3 mm sd)]. CONCLUSIONS: Skin temperature cannot be used to estimate sensory level during combined general/caudal epidural anesthesia. PRD of 0.2 mm is sensitive to the loss of analgesia but is not clinically useful. PRD may be useful above 2 years of age.

PMID: 15330960 [PubMed - in process]


64: Paediatr Anaesth. 2004 Sep;14(9):733-8. Related Articles, Links
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Frequency of anesthesia-related complications in children with Down syndrome under general anesthesia for noncardiac procedures.

Borland LM, Colligan J, Brandom BW.

Department of Pediatric Anesthesiology, Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA. blckrose@pitt.edu

BACKGROUND: Craniofacial and cardiac anomalies of Down syndrome (DS; trisomy 21) would seem to place these patients at higher risk of anesthesia-related complications (ARCs), but to date no comprehensive large-scale study has quantified this risk. METHODS: A retrospective chart review was conducted on all patients with DS undergoing anesthesia between April 1, 1988, and May 31, 1995, at Children's Hospital of Pittsburgh. In addition, the Anesthesiology Department Quality Assurance (QA) System database of concurrently collected anesthesia information on all patients undergoing anesthesia at the hospital since 1985 was analyzed. RESULTS: Of the total 74,021 anesthetic encounters during the study period, 930 anesthetic encounters in 488 patients with DS undergoing noncardiac procedures were analyzed. The most frequent ARCs were bradycardia (severe) (3.66%), natural airway obstruction (1.83%), difficult intubation (0.54%), postintubation croup (1.83%), and bronchospasm (0.43%). CONCLUSIONS: Comprehensive reporting is needed to capture all significant adverse events. The incidences of bradycardia on induction, natural airway obstruction, and postintubation (or instrumentation) croup were significantly higher in the DS noncardiac group compared with the remaining population. Current anesthesia techniques and agents must be compared using quantitative QA data to ensure use of the safest options for each patient.

PMID: 15330954 [PubMed - in process]


65: Paediatr Anaesth. 2004 Sep;14(9):716-23. Related Articles, Links
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Diabetes mellitus and the pediatric anesthetist.

Chadwick V, Wilkinson KA.

Department of Anaesthesia, Norfolk and Norwich University Hospital NHS Trust, Colney Lane, Norwich, NR4 7UY, UK.

PMID: 15330952 [PubMed - in process]


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