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Items 1 - 31 of 31 |
One page. |
Another use for the LOCKIT epidural catheter clamp.
Kindler CH.
Publication Types:
PMID: 15270991 [PubMed - indexed for MEDLINE]
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Consent for publication of a case report.
Tierney E.
Publication Types:
PMID: 15270976 [PubMed - indexed for MEDLINE]
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An audit of peribulbar blockade using 15 mm, 25 mm and 37.5 mm needles, and sub-Tenon's injection.
van den Berg AA.
Department of Anaesthesiology, The University of Texas Medical School at Houston, Houston, TX 77030-1503, USA. antonvdb2000@yahoo.com
The efficacy of peribulbar anaesthesia performed with short, medium and long needles, with sub-Tenon's injection as a control, was audited. Two hundred patients undergoing cataract surgery underwent peribulbar injection using 25G needles of the following lengths: 15 mm, 25 mm or 37.5 mm. Sub-Tenon's injections were performed with a curved 25-mm sub-Tenon anaesthesia cannula. The injection technique, ocular akinesia and analgesia scoring system, and supplementary injection protocols were standardised. After initial injections of local anaesthetic via the sub-Tenon's cannula or with 37.5 mm, 25 mm and 15 mm needles, supplementation was required in one (2%), 13 (26%), 22 (44%) and 32 (64%) of patients, respectively; the total number of supplementary injections required were 1, 16, 35 and 47, respectively. It is concluded that the efficacy of peribulbar anaesthesia depends upon the proximity of the deposition of local anaesthetic solution either to the globe or orbital apex. These data justify the classification of peribulbar anaesthesia into: circum-ocular (sub-Tenon's, episcleral), peri-ocular (anterior, superficial); peri-conal (posterior, deep) and apical (ultra-deep) for teaching purposes.
PMID: 15270969 [PubMed - indexed for MEDLINE]
Local anesthetics inhibit thromboxane A2 signaling in Xenopus oocytes and human k562 cells.
Honemann CW, Hahnenkamp K, Podranski T, Strumper D, Hollmann MW, Durieux ME.
Department of Anesthesiology, University of Virginia, PO Box 800710, Charlottesville, VA 22908-0710, USA.
Thromboxane A(2) (TXA(2)) has been proposed as a mediator of perioperative myocardial ischemia, vasoconstriction, and thrombosis. As these adverse events are minimized with epidural anesthesia, rather than general anesthesia, we hypothesized that local anesthetics would inhibit TXA(2)-receptor signaling. We used fluorometric determination of intracellular [Ca(2+)] in human K562 cells and 2-electrode voltage clamp measurements in Xenopus laevis oocytes expressing TXA(2) receptors. After 10-min incubation, lidocaine (IC(50): 1.02 +/- 0.2 x 10(-3) M), ropivacaine (IC(50): ropivacaine 6.3 +/- 0.9 x 10(-5) M), or bupivacaine (IC(50): 1.42 +/- 0.08 x 10(-7) M) inhibited TXA(2)-induced [Ca(2+)](i) in K562 cells. These data were confirmed in Xenopus oocytes recombinantly expressing TXA(2) receptors, with IC(50)s of bupivacaine 1.2 +/- 0.2 x 10(-5) M, R(+) ropivacaine 4.9 +/- 1.7 x 10(-4) M, S(-) ropivacaine 5.3 +/- 0.9 x 10(-5) M, and lidocaine 6.4 +/- 2.8 x 10(-4) M. Intracellular pathways activated by IP(3) and GTPgammaS were not significantly affected by the local anesthetics tested. QX314, a positively charged lidocaine analog, inhibited only if injected intracellularly (IC(50): 5.3 +/- 1.7 x 10(-4) M), indicating one local anesthetic target is most likely inside the cell. Benzocaine (largely uncharged) inhibited with an IC(50) of 8.7 +/- 1.8 x 10(-4) M. This suggests that some of the beneficial effects of regional anesthesia techniques might be due to direct interaction of local anesthetics with the functioning of membrane proteins.
PMID: 15333434 [PubMed - indexed for MEDLINE]
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The effects of cervical and lumbar epidural anesthesia on heart rate variability and spontaneous sequence baroreflex sensitivity.
Tanaka M, Goyagi T, Kimura T, Nishikawa T.
Department of Anesthesia, Akita University School of Medicine, Akita-city 010-8543, Japan. mtanaka@med.akita-u.ac.jp
A high level of neuroaxial block may produce profound bradycardia and hypotension, possibly as a result of an imbalance between sympathetic and parasympathetic control of heart rate. We designed this study to test the hypothesis that cervical epidural anesthesia would increase the high-frequency (HF) component of heart rate variability (HRV) as a result of cardiac sympathectomy, whereas lumbar epidural anesthesia would cause sympathetic predominance. HRV and spontaneous baroreflex (SBR) sensitivity were assessed before and after cervical and lumbar epidural anesthesia by using plain 1.5% lidocaine (median upper/lower sensory block: C3/T8 for cervical and T11/L5 for lumbar) in healthy patients (n = 10 each). Electrocardiogram and noninvasive beat-to-beat arterial blood pressure were monitored. HRV was analyzed by using fast Fourier transformation. Least-square regression analysis relating R-R interval and systolic blood pressure during spontaneous fluctuation was performed to obtain SBR sensitivities. Cervical epidural group patients were significantly older (P < 0.01) and taller (P < 0.01). Cervical epidural anesthesia attenuated HF (0.15-0.4 Hz) and low-frequency (0.04-0.15 Hz) power of HRV with concomitant reductions in up- and down-sequence SBR sensitivities, suggesting decreased vagal modulation of heart rate. Lumbar epidural anesthesia resulted in a significant increase in the low-frequency/HF ratio of HRV and unchanged SBR indices, suggesting sympathetic predominance. HF power correlated well with SBR sensitivities under most of our study conditions. Respiratory rates and Paco(2) were unchanged by either epidural technique. Our results indicate that cervical, but not lumbar, epidural anesthesia depresses phasic and tonic dynamic modulation of the cardiac cycle by the vagal nerve in conscious humans.
PMID: 15333433 [PubMed - indexed for MEDLINE]
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The effect of lengthening anesthesiology residency on subspecialty education.
Havidich JE, Haynes GR, Reves JG.
Department of Anesthesiology and Perioperative Medicine, The Medical University of South Carolina, 171 Ashley Avenue, Charleston, SC 29425, USA. havidicj@musc.edu
In this study, we sought to determine the long-term effect of the additional year of anesthesia residency (postgraduate year [PGY]-4) instituted in 1989 by the American Board of Anesthesiology on the number of individuals who pursued 12-mo subspecialty anesthesia training. We tested the hypothesis that extending education by a year would decrease the number of anesthesia subspecialty trainees. Surveys were collected from approved anesthesia residency training programs in the United States from 1989 to 2001. The questionnaires determined the number of individuals pursuing subspecialty training during PGY-4 and PGY-5. The subspecialties included cardiac anesthesia, pediatric anesthesia, pain management, obstetrical anesthesia, neuroanesthesia, outpatient anesthesia, intensive care medicine, and research. The number of anesthesiology residents (PGY-5) pursuing 12-mo subspecialty training increased over this period. The specific subspecialty distribution of fellows changed, with the largest increase in number and percentage occurring in pain management. The largest declines occurred in critical care medicine and research. Our data do not indicate a decrease in the number of anesthesiology subspecialists. Factors other than the duration of training appear responsible for the selection of subspecialty education.
PMID: 15333421 [PubMed - indexed for MEDLINE]
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Do anesthesia information systems increase malpractice exposure? Results of a survey.
Feldman JM.
Department of Anesthesiology, Children's Hospital of Philadelphia, 34th and Civic Center Boulevard, Philadelphia, PA 19104, USA.
Anesthesia information systems (AIS) record data from patient monitors and create a detailed electronic anesthesia record. Because the anesthesia record is a primary piece of evidence used in court during a malpractice proceeding, the ability to create an anesthesia record has fostered considerable debate concerning the impact of this method of record keeping on malpractice exposure. Fifty-five departments using AIS were surveyed to document their medicolegal experience with electronic anesthesia records. Twenty-four departments responded to the survey, 18 of which had more than 5 yr experience with the technology. Respondents reported 41 malpractice cases filed since adopting AIS technology. Of the cases filed, 30 were dropped, and 11 went on to settlement or litigation. There were no reported cases in which the automated record hindered the defense process. Eighteen respondents viewed this technology as valuable for risk management, and three more viewed it as essential. The experience reported by these departments indicates that AIS are useful for managing malpractice risk.
PMID: 15333420 [PubMed - indexed for MEDLINE]
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The incidence of awareness during anesthesia: a multicenter United States study.
Sebel PS, Bowdle TA, Ghoneim MM, Rampil IJ, Padilla RE, Gan TJ, Domino KB.
Department of Anesthesiology, Emory University School of Medicine, 49 Jesse Hill Jr. Drive S.E., Atlanta, GA 30303, USA. peter_sebel@emoryhealthcare.org
Awareness with recall after general anesthesia is an infrequent, but well described, phenomenon that may result in posttraumatic stress disorder. There are no recent data on the incidence of this complication in the United States. We, therefore, undertook a prospective study to determine the incidence of awareness with recall during general anesthesia in the United States. This is a prospective, nonrandomized descriptive cohort study that was conducted at seven academic medical centers in the United States. Patients scheduled for surgery under general anesthesia were interviewed in the postoperative recovery room and at least a week after anesthesia and surgery by using a structured interview. Data from 19,575 patients are presented. A total of 25 awareness cases were identified (0.13% incidence). These occurred at a rate of 1-2 cases per 1000 patients at each site. Awareness was associated with increased ASA physical status (odds ratio, 2.41; 95% confidence interval, 1.04-5.60 for ASA status III-V compared with ASA status I-II). Age and sex did not influence the incidence of awareness. There were 46 additional cases (0.24%) of possible awareness and 1183 cases (6.04%) of possible intraoperative dreaming. The incidence of awareness during general anesthesia with recall in the United States is comparable to that described in other countries. Assuming that approximately 20 million anesthetics are administered in the United States annually, we can expect approximately 26,000 cases to occur each year.
Publication Types:
PMID: 15333419 [PubMed - indexed for MEDLINE]
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Inhibition of platelet function by hydroxyethyl starch solutions in chronic pain patients undergoing peridural anesthesia.
Scharbert G, Deusch E, Kress HG, Greher M, Gustorff B, Kozek-Langenecker SA.
Department of Anesthesiology and Intensive Care, University of Vienna, Wahringer Gurtel 18-20, 1090-Vienna, Austria.
The use of hydroxyethyl starch (HES) solutions as a fluid replacement before peridural blockade may compromise blood coagulation, thus increasing the risk of neuraxial bleeding. In this prospective, double-blind, placebo-controlled, crossover study, we compared the influence of HES 130 (molecular weight in kilodalton), HES 200, and lactated Ringer's solution on platelet function and hemodynamics in chronic low back pain patients scheduled for peridural blockades. Patients received 3 test infusions of 10 mL/kg each administered IV for 30 min. Collagen/epinephrine and collagen/adenosine diphosphate were used as agonists for assessment of platelet function analyzer-closure times. Arterial blood pressure, heart rate, platelet counts, and hemoglobin levels were documented. Platelet function analyzer-closure times remained stable after lactated Ringer's solution but were significantly prolonged after HES. The platelet-inhibiting effect of HES 200 was more than that of HES 130. Hemodynamic stability was sufficiently maintained by all test infusions. In contrast to previous observations, a relevant antiplatelet effect of both low and medium molecular weight HES solutions was found in this study in chronic pain patients undergoing peridural anesthesia. Because hemostasiological competence is a prerequisite for safe neuraxial blockade, the decision of HES for intravascular fluid administration before blockade should be critically made.
Publication Types:
- Clinical Trial
- Randomized Controlled Trial
PMID: 15333417 [PubMed - indexed for MEDLINE]
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The effect of different stages of neuromuscular block on the bispectral index and the bispectral index-XP under remifentanil/propofol anesthesia.
Dahaba AA, Mattweber M, Fuchs A, Zenz W, Rehak PH, List WF, Metzler H.
Department of Anaesthesiology and Intensive Care Medicine, Faculty of Medicine, Karl-Franzens University, Auenbruggerplatz 29, A-8036 Graz, Austria. ashraf.dahaba@meduni-graz.at
Facial electromyographic activity and neuromuscular block could influence bispectral index (BIS) depth of anesthesia monitoring. In this study we examined, in 30 patients undergoing general surgical procedures, the effect of different stages of neuromuscular block on BIS monitoring and compared the conventional A-2000 BIS trade mark (BIS(3.4)) with the new BIS-XP trade mark (BIS(XP)). At deep surgical anesthesia BIS(3.4) of approximately 40, under a propofol 3.61 microg/mL target-controlled infusion and a 0.15-0.3 microg. kg(-1). min(-1) remifentanil infusion, mivacurium 0.15 mg/kg was administered. The onset of neuromuscular block triggered a brief transient odd divergence in response that manifested as a BIS(3.4) increase from 43 +/- 4 to 49 +/- 7 (P = 0.007) and a BIS(XP) decline from 41 +/- 3 to 35 +/- 3 (P = 0.003) at 1 +/- 0.2 min. Then, 2.5 +/- 1 min after mivacurium administration, both monitors returned to baseline values of 43 +/- 5 and 40 +/- 4, respectively. After that, BIS(3.4) and BIS(XP) did not significantly change during complete neuromuscular block or during various levels of neuromuscular recovery. At all phases, BIS(XP) was significantly lower than BIS(3.4). Our study indicated that the BIS(3.4)/BIS(XP) bias and the wide limits of agreement do not allow values given by the two monitors to be used interchangeably.
PMID: 15333411 [PubMed - indexed for MEDLINE]
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Ocular microtremor during general anesthesia: results of a multicenter trial using automated signal analysis.
Heaney M, Kevin LG, Manara AR, Clayton TJ, Timmons SD, Angel JJ, Smith KR, Ibata B, Bolger C, Cunningham AJ.
Department of Anesthesia, Beaumont Hospital, PO Box 1297, Dublin, Ireland.
Ocular microtremor (OMT) is a fine physiologic tremor of the eye related to neuronal activity in the reticular formation of the brainstem. The frequency of OMT is suppressed by propofol and sevoflurane and predicts the response to command at emergence from anesthesia. Previous studies have relied on post hoc computer analysis of OMT wave forms or on real-time measurements confirmed visually on an oscilloscope. Our overall aim was to evaluate an automated system of OMT signal analysis in a diverse patient population undergoing general anesthesia. In a multicenter trial involving four centers in three countries, we examined the accuracy of OMT to identify the unconscious state and to predict movement in response to airway instrumentation and surgical stimulation. We also tested the effects of neuromuscular blockade and patient position on OMT. We measured OMT continuously by using the closed-eye piezoelectric technique in 214 patients undergoing extracranial surgery with general anesthesia using a variety of anesthetics. OMT decreased at induction in all patients, increased transiently in response to surgical incision or airway instrumentation, and increased at emergence. The frequency of OMT predicted movement in response to laryngeal mask airway insertion and response to command at emergence. Neuromuscular blockade did not affect the frequency of OMT but decreased its amplitude. OMT frequency was unaffected by changes in patient position. We conclude that OMT, measured by an automated signal analysis module, accurately determines the anesthetic state in surgical patients, even during profound neuromuscular blockade and after changes in patient position.
Publication Types:
PMID: 15333410 [PubMed - indexed for MEDLINE]
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Fires from the interaction of anesthetics with desiccated absorbent.
Laster M, Roth P, Eger EI 2nd.
Department of Anesthesia, S-455, University of California, San Francisco, CA 94143-0464, USA.
Rarely, fire and patient injury have resulted from the degradation of sevoflurane by desiccated carbon dioxide absorbent. Desiccated absorbent also can degrade desflurane and isoflurane, and in the present investigation we sought to determine whether a danger of fire also arose with their use in the presence of desiccated absorbent. Baralyme was desiccated by heating and directing a 10 L/min flow of oxygen through the absorbent. Approximately 1200 g of this desiccated absorbent was used to fill a standard absorber placed in a standard anesthetic circuit to which we directed a 6 L/min flow of oxygen containing 1.5 or 3.0 MAC desflurane, isoflurane, or sevoflurane. A 3-L reservoir bag served as a surrogate lung, and we ventilated this lung with a minute ventilation of 10 L/min. With desflurane or isoflurane, at both 1.5 MAC and 3.0 MAC, temperatures increased in 30 to 70 min to a peak of approximately 100 degrees C and then decreased. With 1.5 MAC sevoflurane (3.0 MAC was not studied), temperatures increased to over 200 degrees C, and in 2 of 5 studies, flames appeared in the anesthetic circuit. In a separate study, we found that concurrent delivery of carbon dioxide and desflurane did not increase peak temperatures. We conclude that the interaction of desflurane or isoflurane with desiccated absorbent is not likely to produce the conflagrations possible with sevoflurane.
PMID: 15333409 [PubMed - indexed for MEDLINE]
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Local anesthetics adsorbed onto infusion balloon.
Mizogami M, Tsuchiya H, Takakura K.
Department of Anesthesiology, Asahi University School of Dentistry, 1851-1 Hozumi, Mizuho, Gifu 501-0296, Japan. makikai@dent.asahi-u.ac.jp
We compared the adsorption of different local anesthetics onto infusion balloons and studied one of the possible mechanisms for adsorption. After injection of lidocaine, bupivacaine, ropivacaine, and mepivacaine solutions (1 mM each; pH 7.4) into balloons of 100-mL volume, their concentrations in effluents flowing out at 4 mL/h were determined over time by high-performance liquid chromatography. All were adsorbed in a structure-dependent manner, and the concentration decreased by 6%-14% within 5 min. Bupivacaine was most strongly adsorbed, followed by lidocaine, ropivacaine, and mepivacaine. QX-314, a quaternary ammonium derivative of lidocaine, was only weakly adsorbed compared with the parent compound lidocaine. The extent of adsorption of local anesthetics was related to their hydrophobicity (evaluated by reversed-phase chromatography) and was much more at pH 7.4 than at pH 6.0. A hydrophobic interaction with balloon materials appears to be responsible for the adsorption of local anesthetics. When infusion balloons are used for the continuous administration of local anesthetics, attention should be paid to the possibility that their actual concentrations in effluents are smaller than those present when they are initially prepared.
PMID: 15333408 [PubMed - indexed for MEDLINE]
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The soluble guanylyl cyclase inhibitor ODQ, 1H-[1,2,4]oxadiazolo[4,3-a]quinoxalin-1-one, dose-dependently reduces the threshold for isoflurane anesthesia in rats.
Cechova S, Pajewski TN.
Department of Anesthesiology, University of Virginia Health System, Box 800710, Charlottesville, VA 22908-0710, USA.
Nitric oxide (NO), a cell messenger for activating soluble guanylyl cyclase, is produced by activation of the enzyme NO synthase (NOS) in a wide variety of tissues, including the central nervous system. We have previously demonstrated that inhibition of NOS decreased the minimum alveolar anesthesia concentration (MAC) for isoflurane anesthesia. Moving more distally in the NOS-guanylyl cyclase signaling pathway, we investigated the effects of the specific soluble guanylyl cyclase inhibitor ODQ, 1H-(1,2,4)oxadiazolo[4,3-a]quinoxalin-1-one, on anesthetic requirements. The effect of ODQ on the MAC of isoflurane anesthesia was investigated in Sprague-Dawley rats while concurrently monitoring the their arterial blood pressure and heart rate. After determining control MAC, ODQ 20-500 mg/kg was administered intraperitoneally 30 min before re-determining MAC in the presence of the soluble guanylyl cyclase inhibitor. In one series, the effect of 250 mg/kg of ODQ on neuronal cyclase guanosine monophosphate production was determined by microdialysis. ODQ produced a statistically significant, dose-dependent decrease from isoflurane control MAC (maximal effect 52.4% +/- 2.7%). No ceiling effect was observed over the dose-range studied. This reduction in isoflurane MAC was not accompanied by changes in either heart rate or blood pressure. Inhibition of the NOS-guanylyl cyclase signaling pathway decreased the MAC for isoflurane, which suggests that inhibition of this pathway may play a role in the anesthetic state. The MAC reduction by the soluble guanylyl cyclase inhibitor ODQ was devoid of any significant hemodynamic effects. The current findings, along with the previous observations that structurally distinct NOS inhibitors and the nonspecific soluble guanylyl cyclase inhibitor methylene blue decrease the MAC for volatile anesthetics, support that this is an effect specific to the NOS-guanylyl cyclase signaling pathway.
PMID: 15333406 [PubMed - indexed for MEDLINE]
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Derivation of preliminary three-dimensional pharmacophores for nonhalogenated volatile anesthetics.
Sewell JC, Sear JW.
Nuffield Department of Anesthetics, University of Oxford, The John Radcliffe Hospital, Headington, Oxford OX3 9DU, UK.
We investigated the molecular basis for the immobilizing activity of nonhalogenated volatile anesthetics by using comparative molecular field analysis (CoMFA). In vivo potency data (expressed as minimum alveolar anesthetic concentrations) for 38 structurally diverse drugs were obtained from the literature. The anesthetics were randomly divided into a training-set (n = 28) used to formulate the activity models and a test-set (n = 10) used to independently assess the models' predictive power. The anesthetic structures were aligned to maximize their similarity in molecular shape and electrostatic potential to conformers of the most active drug in the group: hexanol. The individual conformers and alignments with maximum similarity (calculated with combined Carbo indices) were retained and used to derive the CoMFA activity models. The final CoMFA model explained 95.5% of the variance in the observed activities of the training-set anesthetics. The model had good predictive capability for both the training-set drugs (cross-validated r(2) = 0.824) and the randomly excluded test-set anesthetics (r(2) = 0.921). Pharmacophoric maps were derived by identifying the spatial distribution of key areas in which steric and electrostatic interactions are important in determining the immobilizing activity of the anesthetics considered.
PMID: 15333405 [PubMed - indexed for MEDLINE]
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The anesthetic management of a patient with Cohen syndrome.
Meng L, Quinlan JJ, Sullivan E.
Department of Anesthesiology, University of Pittsburgh, C205 PUH, 200 Lothrop St., Pittsburgh, PA 15213, USA. mengl@anes.upmc.edu
Cohen syndrome is a rare genetic disorder caused by autosomal recessive inheritance and is characterized by the following features: mental retardation, infantile hypotonia, micrognathia, narrow and high-arched palate, microcephaly, prominent upper central incisors, poor dentition, short stature, and truncal obesity. Some patients have strabismus, myopia, optic atrophy, and total blindness. A small number of cases present with heart defects or mitral valve prolapse. Only approximately 100 cases have been reported in the world literature. The administration of general anesthesia in patients with Cohen syndrome can be a challenge because most of these patients are mentally retarded and uncooperative and have facial malformations that may make intubation difficult. We present our experience with the anesthetic management of a patient with Cohen syndrome.
Publication Types:
PMID: 15333397 [PubMed - indexed for MEDLINE]
"Code blue": monitoring the vital signs of academic anesthesia.
Kuczkowski KM.
Publication Types:
PMID: 15345259 [PubMed - in process]
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[Prolonged asystole after spinal anesthesia in a patient with Gallavardin's syndrome]
[Article in French]
Quiniou C, Pandin P, Renard M, Lambert M, Vandesteene A.
Service d'anesthesie-reanimation, cliniques universitaires de Bruxelles, hopital Erasme, universite Libre de Bruxelles, Bruxelles, Belgique.
A clinical case of spontaneous ventricular dysrythmia in a 47-year-old patient scheduled for ankle osteosynthesis is reported. During initial peripheral vein canulation, a spontaneous ventricular tachycardia occurred and disappeared spontaneously in about 3 min. It was decided to proceed with surgery. Thirty minutes after spinal anaesthesia, asystole occurred. Normal sinus rhythm was rapidly restored after basic life support. There was no harmful consequence for the patient. He had a history of repetitive monomorphic ventricular tachycardia (Gallavardin type). The aetiologies of asystole after spinal anaesthesia are well known and will be not discussed in the text. Although the origin of the asystole is unclear in this case, the literature on Gallavardin's syndrome is reviewed, showing that a prolonged and complex preoperative assessment is not mandatory in this syndrome.
PMID: 15345255 [PubMed - in process]
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[Laboratory animal anaesthesia: influence of anaesthetic protocols on experimental models]
[Article in French]
Bazin JE, Constantin JM, Gindre G.
Departement d'anesthesie-reanimation, Hotel-Dieu, CHU de Clermont-Ferrand, boulevard Leon-Malfreyt, 63058 Clermont-Ferrand, France. jebazin@chu-clermontferrand.fr <jebazin@chu-clermontferrand.fr>
The use of experimental animals requires anaesthesia to provide immobility and analgesia. Animals require anaesthesia not only for ethical reasons but also because pain and stress can alter the quality of research results. Recognition of pain, and its treatment is important throughout the procedure. Before anaesthesia, animals are acclimated and rehydrated. Except in small rodents and in ruminants, in order to avoid vomiting, a fast of 8 to 12 hours before anaesthesia is recommended. In order to protect animals against suffering and distress during transfer, restraint and management, a premedication is administered. Most human anaesthetic products can be used in animals. There are some specific veterinary anaesthetics. Moreover, the anaesthetic effects could be different from specie to an other. In most big animals, induction is realized by intravenous administration. In small rodents, venous puncture and contention could be difficult, and anaesthetic agents may be injected via intraperitoneal or intramuscular way. The principal inconvenient of these administration routes is the impossibility to adjust dose to animal response. In large animals, human anaesthesia material can be used. Some technical adaptations could be necessary in smaller animals. In rodents or in neonatology, specific devices are recommended. ECG, arterial pressure, tidal volume, expired CO(2) and oxygen saturation monitoring assess quality of, and tolerance to anaesthesia. If animals are awaked after anaesthesia, postoperative management is closed to human clinical problems. During animal experimentations, anaesthesia may interact with results. All anaesthetic drugs alter normal physiology in some way and may confound physiologic results. In the literature, most publications do not mention this possible interaction. Investigators need to understand how animals are affected by anaesthetic drugs in order to formulate anaesthetic protocols with minimal effects on data. Extrapolation between different animal species and human and animals about the effects of anaesthetic agents are very hazardous. Great differences exist between the effects observed in vitro and in whole animals. The effects of the anaesthetics could be totally different if they are used alone or in association. The same anaesthetic could have opposite effects from an organ to another. For results validation, the anaesthesia side effects (hypoventilation, hypotension, cooling em leader ) have to be minimized. All new experimental models should require discussing the possible interferences between anaesthesia and results and to compare results obtained with different anaesthetic protocols.
PMID: 15345253 [PubMed - in process]
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[French residents in anaesthesia and critical care - a nationwide survey]
[Article in French]
Gautier JF, N'Guyen JL, Soltner C, Beydon L.
Departement d'anesthesie-reanimation, CHU d'Angers, 49093 Angers cedex 01, France.
OBJECTIVE: We surveyed the residents in their first (R1) and fourth (R4, last) years of residency in anaesthesia and intensive care in France. METHODS: The questionnaires mailed to each resident were designed to obtain personal data, motivation for specializing in anaesthesia and their opinion of their training. RESULTS: The response rates were 48% for the R1 residents and 77% for the R4 residents. There were 40% females in this population and the R1 residents were 25 +/- 1 year old, 29 +/- 2 year-old for the R4 residents. Almost half (46%) of the R1 responders were married as were 74% of the R4 residents. They spent an average of 726 each year on books, computers and other educational items. Most (71%) had opted for anaesthesia after considering other medical specialties, but only 12% had considered surgery. Half (51%) were on a training program that was far away from their home. They thought highly of their training, with the clinical training being rated above the non-clinical component. About half of them had obtained specialized certificates (mainly additional certification in intensive care and antibiotic therapy) during their residency. Two thirds of those in R4 expected to work in a public hospital and about one third expected to work in intensive care. Money was an important factor in their choice of profession. A majority planned to remain in the area where they had graduated in anaesthesia after their residency. Finally, 96% declared that they would choose anaesthesia again if they had to do so. CONCLUSION: French residents in anaesthesia are satisfied of their initial choice for anaesthesia and don't regret it at the end of their residency training.
PMID: 15345250 [PubMed - in process]
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[Intraoperative arterial hypotension recorded by an anaesthesia information management system]
[Article in French]
Luce V, Auroy Y, Ausset S, Luci P, Velay H, Benhamou D.
Departement d'anesthesie-reanimation, hopital Antoine-Beclere, 157, rue de la Porte-de-Trivaux, BP 405, 92141 Clamart cedex, France.
OBJECTIVES: In order to evaluate the benefits arising from regular recording of intraoperative adverse events, we extracted from our database all episodes of intraoperative hypotension and studied the risk factors of this event. STUDY DESIGN: Retrospective analysis of a large database from two university teaching hospitals evaluating the incidence and the risk factors of intraoperative hypotension by logistic regression. PATIENTS AND METHODS: A data collection chart describing the patient's characteristics, the anaesthetic technique and selected intraoperative incidents was filled for each anaesthetised patient in the operating room and then recorded in the computer database. Data collected in 2001 in patients undergoing general anaesthesia for orthopaedic and general surgery were reviewed and univariate and multivariate analysis were performed using Statview 5.0 and Stata 7.0. RESULTS: Among 11 820 patients who underwent anaesthesia, 2691 were selected. The incidence of intraoperative arterial hypotension was 16.8%. The associated factors were duration of surgery, age and ASA status of the patients. The use of etomidate for induction was not associated with a decreased risk of intraoperative hypotension. CONCLUSION: Systematic recording of intraoperative events in a database has been suggested as useful by many experts for quality-assurance and safety analysis purposes. Analysis of a frequent anaesthesia-related (i.e. hypotension) event did not disclose any relevant factor that might lead to improvement. Running such databases is time-consuming and may be expensive. This leads us to question the efficiency of such databases.
PMID: 15345249 [PubMed - in process]
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Effects of tamsulosin on hypogastric nerve stimulation-induced intraurethral pressure elevation in male and female dogs under anesthesia.
Ohtake A, Sato S, Saitoh C, Yuyama H, Sasamata M, Miyata K.
Pharmacology Laboratories, Institute for Drug Discovery Research, Yamanouchi Pharmaceutical Co., Ltd., 21 Miyukigaoka, Tsukuba, Ibaraki 305-8585, Japan. ohtake@yamanouchi.co.jp
The aim of the present study was to investigate the effects of tamsulosin, an alpha(1)-adrenoceptor antagonist, on hypogastric nerve stimulation-induced intraurethral pressure elevation in anesthetized male and female dogs and to evaluate sex differences in these effects. Additionally, the effects of tamsulosin were also compared with those of other alpha(1)-adrenoceptor antagonists, namely prazosin, naftopidil and urapidil. Tamsulosin dose-dependently inhibited hypogastric nerve stimulation-induced intraurethral pressure elevation, with doses required to induce 50% inhibition of the elevation (ED(50) values) of 0.72 and 0.74 microg/kg i.v. in anesthetized male and female dogs, respectively. Mean arterial blood pressure slightly decreased after administration of tamsulosin at a dose which inhibited intraurethral pressure elevation almost completely. Prazosin, naftopidil and urapidil also inhibited increases in intraurethral pressure in a dose-dependent fashion, but caused decreases in mean arterial blood pressure at the same doses. The estimated rank order of inhibitory potency for urethral response was tamsulosin>prazosin>naftopidil=urapidil. In conclusion, tamsulosin dose-dependently inhibited increases in intraurethral pressure with little effect on mean arterial blood pressure in both male and female dogs, and these effects were almost equipotent. These results indicate that tamsulosin will be useful in the treatment of dysuria associated with lower urinary tract symptoms in women as well as men.
PMID: 15336951 [PubMed - in process]
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Sensory nitrergic meningeal vasodilatation and non-nitrergic plasma extravasation in anaesthesized rats.
Peitl B, Nemeth J, Szolcsanyi J, Szilvassy Z, Porszasz R.
Department of Pharmacology and Pharmacotherapy, University of Debrecen, Nagyerdei krt. 98, Debrecen H-4032, Hungary. barna.peitl@king.pharmacol.dote.hu
The aim of the present study was to evaluate the role of nitric oxide (NO) of sensory neural origin in neurogenic inflammatory response in the trigeminovascular system. Antidromic vasodilatation and plasma extravasation in response to electrical stimulation (15 V, 5 Hz, 0.5 ms, 100 impulses) of the trigeminal ganglion were investigated in the dura mater and nasal mucosa/upper eyelid by laser Doppler flowmetry and [(125)I]-labelled bovine serum albumin, respectively. Electrical stimulation of the trigeminal ganglion of rats elicited a reproducible ipsilateral enhancement of both meningeal and nasal mucosal blood flow. N(omega)-nitro-L-arginine (L-NNA; 4, 8, and 16 mg/kg, i.v.), a nonselective inhibitor of nitric oxide synthase (NOS), inhibited antidromic vasodilatation both in the dura mater (15.86+/-2.05%, 22.82+/-2.51%, and 36.28+/-4.37%) and nasal mucosa (35.46+/-8.57%, 58.72+/-9.2%, and 89.99+/-8.94%) in a dose-dependent manner. Specific inhibitors of neuronal NOS, 7-nitroindazole (7-NI; 20 mg/kg, i.v.) and 3-bromo-7-nitroindazole (3Br-7NI; 10 mg/kg, i.v.) were administered to assess the possible role of NO released from the trigeminal sensory fibres. The meningeal vasodilatation was inhibited by both 3Br-7NI and 7-NI (63.36+/-7.7% and 49+/-6.5%, respectively). The nasal hyperaemic response was also reduced by 3Br-7NI (78.26+/-8.7%). Plasma extravasation in the dura mater and upper eyelid evoked by electrical stimulation of the trigeminal ganglion (25 V, 5 Hz, 0,5 ms, 5 min), expressed as extravasation ratios (ERs) of the stimulated vs. nonstimulated sides, was 1.80+/-0.8 and 4.63+/-1.24, respectively. This neurogenic oedema formation was not inhibited by neither L-NNA nor 3Br-7NI. It is concluded that neural nitrergic mechanisms are involved in the meningeal vasodilatation evoked by electrical stimulation of the trigeminal ganglion.
PMID: 15336947 [PubMed - in process]
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Acupuncture and endorphins.
Han JS.
Neuroscience Research Institute, Peking University and Key Laboratory of Neuroscience (Peking University), Ministry of Education, 38 Xue-Yuan Road, Beijing 100083, PR China. hanjisheng@bjmu.edu.cn
Acupuncture and electroacupuncture (EA) as complementary and alternative medicine have been accepted worldwide mainly for the treatment of acute and chronic pain. Studies on the mechanisms of action have revealed that endogenous opioid peptides in the central nervous system play an essential role in mediating the analgesic effect of EA. Further studies have shown that different kinds of neuropeptides are released by EA with different frequencies. For example, EA of 2 Hz accelerates the release of enkephalin, beta-endorphin and endomorphin, while that of 100 Hz selectively increases the release of dynorphin. A combination of the two frequencies produces a simultaneous release of all four opioid peptides, resulting in a maximal therapeutic effect. This finding has been verified in clinical studies in patients with various kinds of chronic pain including low back pain and diabetic neuropathic pain.
Publication Types:
PMID: 15135942 [PubMed - indexed for MEDLINE]
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Preoperative and perioperative management of a patient with Lowe syndrome diagnosed to have Fanconi's syndrome.
Saricaoglu F, Demirtas F, Aypar U.
Publication Types:
PMID: 15153226 [PubMed - indexed for MEDLINE]
Comment on:
Caudal clonidine in neonates and small infants and respiratory depression.
Hansen TG, Henneberg SW.
Publication Types:
PMID: 15153225 [PubMed - indexed for MEDLINE]
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Analgesic effect of clonidine added to bupivacaine 0.125% in paediatric caudal blockade.
Joshi W, Connelly NR, Freeman K, Reuben SS.
Department of Anesthesiology, Baystate Medical Center, Springfield, MA 01199, USA.
BACKGROUND: Caudals are a common method of providing pain relief in children undergoing surgery. Clonidine, an alpha(2) agonist, exhibits significant analgesic properties. The current investigation sought to determine whether caudal clonidine added to caudal bupivacaine would decrease pain in paediatric patients undergoing surgery. METHODS: Thirty-six children undergoing elective surgery were studied. Following anaesthetic induction, a caudal was placed (1 mg.kg(-1) bupivacaine 0.125%) with an equal volume of either clonidine (2 microg.kg(-1)) or saline. Perioperative analgesic requirements in the postanaesthesia care unit (PACU) and at home following hospital discharge, and parental pain scores were evaluated. RESULTS: There were no significant demographic, haemodynamic, or pain score differences between the groups. There was no difference in analgesic duration between groups. There were significantly more children who vomited during the first 24 postoperative hours in the clonidine group than in the saline group (eight in clonidine, two in saline; P < 0.05). CONCLUSION: We do not recommend adding clonidine (2 microg.kg(-1)) to a bupivacaine (0.125%) caudal block in children undergoing surgery.
Publication Types:
- Clinical Trial
- Randomized Controlled Trial
PMID: 15153211 [PubMed - indexed for MEDLINE]
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Comparison of ropivacaine with bupivacaine and lidocaine for ilioinguinal block after ambulatory inguinal hernia repair in children.
Tsuchiya N, Ichizawa M, Yoshikawa Y, Shinomura T.
Department of Anaesthesia, Otsu Red Cross Hospital, Otsu, Japan. tnao@iris.eonet.ne.jp
BACKGROUND: We have compared ropivacaine with bupivacaine and lidocaine for ilioinguinal block in thirty children undergoing ambulatory inguinal hernia repair. METHODS: Patients were assigned randomly to receive 0.5 ml.kg(-1) of 0.2% ropivacaine (Group R, n = 10), 0.25% bupivacaine (Group B, n = 10) or 1% lidocaine (Group L, n = 10). The patients' parents, who were not informed of the type of local anaesthetic employed, evaluated the postoperative pain at 2 h and 6 h after operation using the Wong-Baker FACES Pain Rating Scale. RESULTS: There was a significant difference in the face scale score between Group R and Group L, and Group B and Group L. There was no difference in the face scale score between Group R and Group B. There were no complications or clinical evidence of local anaesthetic toxicity. CONCLUSIONS: We have confirmed that bupivacaine and ropivacaine are more effective than lidocaine in the prevention of postoperative pain after children's inguinal hernia repair. We suggest that ropivacaine 0.2% is an alternative to bupivacaine 0.25% for ilioinguinal block in ambulatory paediatric surgery.
Publication Types:
- Clinical Trial
- Randomized Controlled Trial
PMID: 15153208 [PubMed - indexed for MEDLINE]
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Dosage scheme for propofol in children under 3 years of age.
Steur RJ, Perez RS, De Lange JJ.
University Medical Center Vrije Universiteit, Department of Anesthesiology, Amsterdam, The Netherlands. steur@vumc.nl
BACKGROUND: Propofol is a well-known drug for adults for total intravenous anaesthesia. Since 1999, the use of propofol has been approved for children less than 3 years of age. However, a suitable dosage scheme for these age groups was not available. The purpose of this study was to describe our clinical experience with the use of a new dosage scheme for propofol in patients under 3 years of age, based on experimental data and known pharmacological principles in children. METHODS: A pilot study of 50 patients undergoing TIVA was performed to adapt the existing adult dosage scheme to the requirements of the younger population. Total number and time of administration of boluses and time to awakening were registered and used as criteria to adjust the dosage scheme. The subsequent dosage scheme was then evaluated in 2271 children undergoing anaesthesia for various procedures. Usual anaesthetic parameters were measured to monitor the safety of the patient: ECG, O2 saturation, respiratory frequency and blood pressure. Most of the patients were mechanically ventilated; only 15% were breathing spontaneously. RESULTS: Overall, few side effects were recorded [bradycardia (12%), blood pressure fall (8%), desaturation (1%)], which were easily countered by routine measures. CONCLUSIONS: This dosage scheme provides safe and smooth anaesthesia in children less than 3 years of age and is therefore a useful tool for a TIVA technique in small children.
PMID: 15153207 [PubMed - indexed for MEDLINE]
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A comparison between single- and double-breath vital capacity inhalation induction with 8% sevoflurane in children.
Ho KY, Chua WL, Lim SS, Ng AS.
Department of Anaesthesia (Paediatrics), KK Women's and Children's Hospital, Singapore. hokokyuen@yahoo.com.sg
BACKGROUND: This study was conducted to determine if a double-breath (DB) vital capacity (VC) rapid inhalation induction using immediate high-inspired concentration of sevoflurane is as well tolerated as a single-breath (SB) technique and if it results in a shorter induction time. METHODS: A total of 104 children, ASA I-II, 6 year and above, undergoing elective surgery were randomly assigned to two groups: SB VC inhalation induction or DB VC inhalation induction with 8% sevoflurane in 66% nitrous oxide. The induction time, complications (cough, laryngospasm, breath-hold, movement, salivation) and level of satisfaction were documented. RESULTS: Induction was significantly faster in the DB group (41 +/- 9 s) compared with the SB group (50 +/- 14 s). DB inhalation induction was associated with fewer complications (15.4%) than the SB technique (50%). CONCLUSIONS: Double-breath VC inhalation induction with 8% sevoflurane is as well tolerated as a SB technique and results in a faster onset of anaesthesia.
Publication Types:
- Clinical Trial
- Randomized Controlled Trial
PMID: 15153206 [PubMed - indexed for MEDLINE]
Headache and backache after lumbar puncture in children and adolescents: a prospective study.
Ebinger F, Kosel C, Pietz J, Rating D.
University Pediatric Hospital, Department of Child Neurology, Heidelberg, Germany. friedrich_ebinger@med.uni-heidelberg.de
OBJECTIVE: After lumbar puncture, many adults develop headaches or backaches. Postpuncture complaints are believed to be rare in children and adolescents, but their exact incidence is unclear because there is a paucity of data derived from general pediatric patients. In a prospective study of general pediatric and neuropediatric patients, we investigated the frequency of postlumbar puncture headaches or backaches and factors that might influence their occurrence. METHODS: Conducted over 12 months, the prospective study included 112 patients aged 2 to 16 years. We evaluated them for factors that might influence the rate of postpuncture complaints: age, gender, use of local anesthesia, cannula gauge, bevel orientation, number of puncture attempts, volume of cerebrospinal fluid (CSF) aspirated, and cell count in CSF. RESULTS: Twenty-seven percent of the patients experienced headaches (positional headache in 9%), and 40% developed backache. Frequency of complaints increased in relation to patients' age. In older children, girls reported complaints more frequently than did boys. Patients with higher cell counts in CSF had more frequent headaches than did patients without pleocytosis. Cannula gauge or bevel orientation did not influence outcome. CONCLUSION: The frequency of positional and nonpositional headaches after lumbar puncture is lower in children than in adults. Backaches contribute significantly to postpuncture morbidity. With puberty, the incidences of postpuncture complaints increase, and girls start to become more prone to develop postpuncture headaches. Recommendations regarding cannula gauge or bevel orientation that derive from studies in adults are not confirmed for children.
PMID: 15173478 [PubMed - indexed for MEDLINE]
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