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Items 1 - 40 of 40 |
One page. |
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Epidural anesthesia for laminectomy in a geriatric patient.
Gokcinar D, Tokyay M.
Publication Types:
PMID: 15352976 [PubMed - in process]
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Total spinal anaesthesia as a complication of local anaesthetic test-dose administration through an epidural catheter.
Steffek M, Owczuk R, Szlyk-Augustyn M, Lasinska-Kowara M, Wujtewicz M.
Department of Anaesthesiology and Intensive Therapy, Medical University of Gdansk, Gdansk, Poland. best@life.pl
We describe a case of total spinal anaesthesia, which occurred after a 3-ml lignocaine (20 mg ml(-1)) test dose was administered through an epidural catheter in a 79-year-old patient scheduled for gastrectomy under combined general and epidural anaesthesia. The surgery was postponed, and the patient required admission to the intensive therapy unit. Spinal MRI from the total spinal cord did not reveal any pathology. During the next 24 h the patient recovered and after 11 days was successfully operated on under general anaesthesia. No late complications followed. We presume that during placement, the epidural catheter had migrated to the spinal canal as a result of technical difficulties. Although controversial, we consider that administering a standard test dose of local anaesthetic via an epidural catheter is recommended, especially in high-risk patients and when epidural space identification or catheter placement poses technical difficulties. A test dose of local anaesthetic does not fully prevent complications.
PMID: 15352971 [PubMed - in process]
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Electromyographic assessment of blink reflexes correlates with a clinical scale of depth of sedation/anaesthesia and BIS during propofol administration.
Mourisse J, Lerou J, Zwarts M, Booij L.
Department of Anaesthesiology, Radboud University Nijmegen, Nijmegen, the Netherlands. j.mourisse@anes.umcn.nl
BACKGROUND: General anaesthesia is characterized by loss of consciousness, amnesia and obtundation of reflex responses to noxious stimuli. Quantifying the blink reflex may reflect the depression of reflex arches induced by anaesthetics and thus being informative on the anaesthetic state. METHODS: The relation between the electrically evoked blink reflexes and the depth of sedation and anaesthesia induced with intravenous propofol was investigated. Twenty patients received propofol by target-controlled infusion to create a stepwise deepening of sedation and anaesthesia. Depth of anaesthesia was assessed using the observer's assessment of anaesthesia and sedation (OAAS) scale, and by bispectral EEG analysis (BIS). Probit analysis was used to estimate the predicted propofol effect site concentrations producing unconsciousness, no response to noxious stimulation, and loss of blink reflex components. RESULTS: Latency of the first (R1) and second (R2) blink component increased, whereas duration and area decreased with increasing depth of sedation and anaesthesia. A reasonably strong correlation between OAAS and the areas of R1 and R2 components was found (Spearman's rho = 0.92 and 0.89). The areas of R1 and R2 and the OAAS also correlated with BIS (Spearman's rho = 0.91, 0.88 and 0.90). EC(50) and EC(95) for loss of R1 were 2.8 (95% CI: 2.5-3.2) micro g/ml and 4.6 (95% CI: 4.1-5.5) micro g/ml, respectively. CONCLUSIONS: Our results suggest that the differential sensitivity of the components of the blink reflex could be useful in monitoring depth of sedation and light levels of anaesthesia during the administration of propofol. Both OAAS and BIS correlate similarly with the blink reflex components.
PMID: 15352965 [PubMed - in process]
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Comparison of BIS and AAI as measures of anaesthetic drug effect during desflurane-remifentanil anaesthesia.
Kreuer S, Bruhn J, Larsen R, Bauer C, Wilhelm W.
Department of Anaesthesiology and Intensive Care Medicine, University of Saarland, Homburg /Saar, Germany. sascha.kreuer@uniklinik-saarland.de
BACKGROUND: Autoregressive modelling with exogenous input of the middle-latency auditory evoked potential has been developed for monitoring of anaesthetic depth. This study was designed to investigate the dose-response relationship between endtidal desflurane concentrations and the Alaris Autoregressive Index (AAI, Alaris Medical, Hampshire, UK, version 1.4) or the bispectral index (Aspect Medical Systems, Newton, MA, USA, version XP). METHODS: Twenty-one patients scheduled for radical prostatectomy were investigated. After premedication and induction of anaesthesia with propofol und remifentanil all patients received atracurium and a remifentanil background infusion at a constant rate of 0.1 micro g kg(-1) min(-1). During dissection of the prostate, desflurane endtidal concentrations were varied between 3 and 9 vol%. Both AAI and BIS were determined and compared with the respective endtidal desflurane concentration. RESULTS: None of the patients showed a significant change of AAI values while changing the desflurane concentrations between 3 and 9 vol%. The dose-response of BIS values and desflurane concentrations was not uniform: two patients showed increasing BIS values with increasing desflurane concentrations, while in three patients BIS values remained unchanged. In 16 patients decreasing BIS values adequately reflected an increase in desflurane concentrations. CONCLUSION: Changes of desflurane concentrations during deep anaesthesia were adequately displayed only in 16 of 21 cases by BIS but in none of the cases by AAI monitoring.
PMID: 15352964 [PubMed - in process]
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An anaesthetic protocol in the young domestic pig allowing neuromuscular blockade for studies of cardiac function following cardioplegic arrest and cardiopulmonary bypass.
Fannelop T, Dahle GO, Matre K, Segadal L, Grong K.
Surgical Research Laboratory, Department of Surgical Sciences, University of Bergen, Bergen, Norway. tfan@haukeland.no
BACKGROUND: Neuromuscular blockade should, for ethical reasons, not be allowed in animal experiments unless the use is strongly motivated. Beforehand, the anaesthetic protocol must be documented without muscle relaxation in the species studied. Documentation is difficult to obtain from the scientific literature. When focusing on cardiac function over time, in particular, the ideal anaesthetic protocol should cause no or minor alterations in cardiac variables. METHODS: We intended to document an anaesthetic protocol involving ventilation with N(2)O combined with loading doses and continuous infusions of pentobarbital, fentanyl and midazolam in seven pigs by applying potentially painful stimuli every 15 min for 7 h. Subsequently, left ventricular global and regional function was studied with conductance catheter and strain rate imaging by echocardiography in eight pigs with pancuronium included. RESULTS: Pigs without pancuronium were completely immobilized and unresponsive to potentially painful stimuli and sternotomy, with no accumulation or degradation of anaesthetic agents. With pancuronium included, left ventricular preload gradually decreased together with reduction of cardiac index from 3.52 +/- 0.14 at 2 h to 2.84 +/- 0.11 L min(-1). m(-2) (+/-SEM) after 7 h of observation. Preload recruitable stroke work decreased after 7 h, whereas peak systolic strain in the anterior left ventricular wall and load-independent indices of diastolic function were not significantly altered. CONCLUSION: In specific experimental protocols, the anaesthetic protocol described could allow the use of muscular paralysis in young domestic pigs, for instance when involving hypothermic cardiopulmonary bypass, cardioplegic arrest and reperfusion.
PMID: 15352961 [PubMed - in process]
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Comparison of laryngeal mask airway with tracheal tube for ophthalmic surgery in paediatric patients.
Gulati M, Mohta M, Ahuja S, Gupta VP.
Department of Anaesthesiology and Critical Care, University College of Medical Sciences and Guru Teg, Bahadur Hospital, Delhi, India.
This study of sixty ASA grade 1 or 2 children, aged 1 to 12 years, undergoing elective ophthalmic procedures, compared the use of the laryngeal mask airway (LMA) with that of an endotracheal tube. Changes in intraocular pressure and haemodynamic parameters, and intraoperative and postoperative complications were measured Patients were randomly allocated into two groups of 30 patients. In group 1, the airway was secured with an LMA and in group 2 with an endotracheal tube. A standard technique of general anaesthesia incorporating positive pressure ventilation was used in both groups. The changes in intraocular pressure, heart rate (HR) and mean arterial pressure (MAP) were observed before and after insertion of the airway device, two minutes after insertion, and pre and post removal of the device. The incidence of airway complications was also noted. There was no significant change in mean intraocular pressure after insertion of the LMA, but removal caused a significant increase to 19.3 +/- 7.6 mmHg (from a baseline of 13.9 +/- 4.3 mmHg). In the endotracheal tube group, intubation increased the mean intraocular pressure significantly to 19.9 +/- 7.3 mmHg (from a baseline of 13.1 +/- 4.0 mmHg) and extubation caused an increase to 24.6 +/- 10.4 mmHg which was clinically as well as statistically significant. The incidence of postoperative coughing was lower in the LMA group, but the incidence of vomiting higher. Two patients had displacement of the LMA during the procedure. We conclude that the use of an LMA is associated with less increase in intraocular pressure than the use of an endotracheal tube in children.
Publication Types:
- Clinical Trial
- Randomized Controlled Trial
PMID: 15264735 [PubMed - indexed for MEDLINE]
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Impediments to the use of ankle block in Australia.
Rudkin GE, Micallef TA.
Specialist Anaesthetic Services, Adelaide, South Australia.
Anaesthetic trainees and consultants who enrolled in a regional anaesthetic workshop completed a questionnaire regarding their own ankle block practice. The questionnaire focused on frequency of use, barriers to use, technique and perceived success rate. One hundred and twelve respondents participated, with 73% performing less than 10 ankle blocks per year. Forty-eight per cent believed that they did not have an appropriate operating list or a suitable patient, whilst 27% believed time constraints were the major barrier. Of those performing less than 10 ankle blocks peryear, 22% cited lack of anatomical knowledge or technique as their major barrier and 71% perceived their success rate as medium to low. Eighty per cent performed their ankle block with the patient fully awake or sedated. Sixty-five per cent did not know the length of action of their ankle block. This survey supports recent suggestions that the practice of ankle block is under-utilized. Teaching workshops and clinical training for peripheral nerve blocks should receive high priority for the future.
PMID: 15264732 [PubMed - indexed for MEDLINE]
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Perioperative intravenous ketamine infusion for the prevention of persistent post-amputation pain: a randomized, controlled trial.
Hayes C, Armstrong-Brown A, Burstal R.
Department of Anaesthesia, Intensive Care and Pain Management John Hunter Hospital, Newcastle, New South Wales.
We hypothesized that perioperative ketamine administration would modify acute central sensitization following amputation and hence reduce the incidence and severity of persistent post-amputation pain (both phantom limb and stump pain). In a randomized, controlled trial, 45 patients undergoing above- or below-knee amputation received ketamine 0.5 mg x kg(-1) or placebo as a pre-induction bolus followed by an intravenous infusion of ketamine 0.5 mg x kg(-1) x h(-1) or normal saline for 72 hours postoperatively. Both groups received standardized general anaesthesia followed by patient-controlled intravenous morphine. The surface area of allodynia over the stump was mapped at days 3 and 6. Postamputation pain was assessed at days 3 and 6 and at 6 months postoperatively. We found no significant difference between groups in the surface area of stump allodynia or in morphine consumption. There was an unexplained, but significant, increase in the incidence of stump pain in the ketamine group at day 3. At six-month review, the incidence of phantom pain was 47% in the ketamine group and 71% in the control group. This did not reach statistical significance (P=0.28) as the power of the study was based on the search for a large treatment effect. The incidence of stump pain at six months was 47% in the ketamine group and 35% in the control group (P=0.72). There were no significant between-group differences in pain severity throughout the study period. Ketamine at the dose administered did not significantly reduce acute central sensitization or the incidence and severity of post-amputation pain.
Publication Types:
- Clinical Trial
- Randomized Controlled Trial
PMID: 15264726 [PubMed - indexed for MEDLINE]
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[Venous thromboembolism prophylaxis]
[Article in German]
Dohmen B, Gogarten W, Kuhlen R, Rossaint R.
Klinik fur Anasthesiologie, Aachen, Germany. bdohmen@ukaachen.de
Venous thromboembolism is a common and frequent complication of hospitalized patients. Some venous thromboembolisms may be subclinical, while others present as symptomatic deep vein thrombosis and/or pulmonary embolism. Venous thromboembolism and pulmonary embolism contribute significantly to inhospital morbidity and mortality. The risk of venous thromboembolism is aggravated by dispositional and/or expositional risk factors. In patients at intermediate or high risk of venous thromboembolism, additional pharmacological thromboembolism prophylaxis becomes mandatory.
Publication Types:
PMID: 15292966 [PubMed - indexed for MEDLINE]
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["Relaxant" awake but still relaxed]
[Article in German]
Pilgram B, Krombach J, Ladra A, Kampe S.
Klinik fur Anasthesiologie und Operative Intensivmedizin, Universitat zu Koln. barbara.pilgram@gmx.de
We report on a 23-year-old female patient who underwent removal of the implants after maxillary surgery. At the end of surgery the administration of anaesthetic agents was discontinued. During the following 30 min several attempts were made to wake the patient, but she did not respond to verbal or pain stimuli. No changes in heart rate, blood pressure vegetative reactions such as sweating, lacrimation, or mydriasis were noted. Protective reflexes like coughing could not be elicited. After 30 min neuromuscular monitoring was applied and indicated residual muscle paralysis after the use of mivacurium. The patient was again sedated and transferred to the ICU, where she was mechanically ventilated for an additional 9 h. An atypical cholinesterase was determined as the underlying reason for the prolonged action of mivacurium. Retrospectively, the patient remembered the attempted wake-up period in detail. However, she reported no feelings of fear or helplessness because she had faith in the anaesthesiologist, a close friend of the patient's family for many years, who kept her calm and comfortable by talking to her during the entire period. Several months after the incident, the patient reported having neither increased fear of surgery nor any negative psychological effects on her life following this incident of awareness.
Publication Types:
PMID: 15292965 [PubMed - indexed for MEDLINE]
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[Total intravenous anesthesia in children]
[Article in German]
Sommer M, Willigers H, Marcus M.
Publication Types:
PMID: 15205834 [PubMed - indexed for MEDLINE]
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[Spinal anesthesia with bupivacaine]
[Article in German]
Biscoping J.
Publication Types:
PMID: 15197464 [PubMed - indexed for MEDLINE]
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[The "Würzburg T". A concept for optimization of early multiple trauma care in the emergency department]
[Article in German]
Kuhnigk H, Steinhubel B, Keil T, Roewer N.
Klinik und Poliklinik fur Anasthesiologie, Julius-Maximilians-Universitat Wurzburg. kuhnigk_h@klinik.uni-wuerzburg.de
INTRODUCTION: Anaesthesia management, radiological diagnostic and the concept of damage control surgery should be combined in the resuscitation room. Defined clinical targets and their realisation are a CT-scan and complete damage control surgery in the shock room. Furthermore minimised patient transfer and positioning with continuous access to the head, upper parts of the body and anaesthesia machine should be realised during diagnostic procedures. METHODS: Based on a carbon-slide fixed on a turntable and innovative alignment of diagnostic devices, a three phase treatment algorithm has been established. RESULTS: Phase A includes primary survey, anaesthetic management and ultrasound examination. Following a turn of the table conventional x-ray diagnostic is assessed in phase B. Tracks for the slide enable immediate transfer to a spiral CT-scan without additional patient positioning (phase C). Following complete CT-scan rearrangement of the table to phase A facilitates immediate damage control surgery. To accelerate device operation and treatment the integrated anaesthesia workstation is ceiling-mounted and manoeuvres close to the patient. CONCLUSIONS: This concept realizes complete diagnostic procedures and damage control surgery without time consuming patient transfer or rearrangement.
PMID: 15127153 [PubMed - indexed for MEDLINE]
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[Selective intestinal decontamination in intensive care. Reduction inpatient mortality without an increase in resistant pathogens]
[Article in German]
Buchinger H.
Klinik fur Anaesthesiologie und Intensivmedizin, Universitatsklinikum des Saarlandes, Homburg/Saar. anhbuc@med-rz.uni-sb.de
PMID: 15098096 [PubMed - indexed for MEDLINE]
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Epidural catheter disconnection: an equipment failure or an operator error?
Kuczkowski KM.
Publication Types:
PMID: 15234744 [PubMed - indexed for MEDLINE]
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[Ropivacaine acute toxicity: when local anaesthasia must be stopped?]
[Article in French]
Leclerc C, Rouaud J, Haond P, Bottet P, Bonnamy C.
Publication Types:
PMID: 15234742 [PubMed - indexed for MEDLINE]
Comment on:
No fly zone.
Veerkamp JS.
Publication Types:
PMID: 15272325 [PubMed - indexed for MEDLINE]
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Spread of subarachnoid block, intraoperative local anaesthetic requirements and postoperative analgesic requirements in Caesarean section and total abdominal hysterectomy.
Fassoulaki A, Gatzou V, Petropoulos G, Siafaka I.
Department of Anaesthesiology, Aretaieion Hospital, Medical School, University of Athens, 76 Vassilissis Sofias Avenue, Athens 11528, Greece.
BACKGROUND: Pregnancy is associated with a higher spread of subarachnoid anaesthesia and increased pain threshold. The study was designed to assess the spread of subarachnoid block and the intra- and postoperative analgesic requirements in pregnant vs non-pregnant women. METHODS: We assessed the level of subarachnoid anaesthesia after 1.8 ml of hyperbaric lidocaine 5% and the postoperative analgesic requirements in women undergoing Caesarean section and undergoing abdominal hysterectomy (30 each group). Intraoperatively epidural ropivacaine was given as required. All patients received 10 ml of ropivacaine 0.2% epidurally 2, 10, and 24 h after operation and the VAS pain score was assessed. They also had access to patient controlled analgesia i.v. morphine. RESULTS: Duration of surgery was 64 (13.7) vs 127 (33.8) min (P<0.0001) in the pregnant and non-pregnant groups. Ten minutes after subarachnoid injection, sensory block was higher by three dermatomes in the pregnant group (P<0.0001). Time to first ropivacaine dose was 37 (19.7) vs 19 (12.2) min (P<0.001) and the ropivacaine normalized for the duration of anaesthesia was 0.8 (0.6) vs 1.3 (0.5) mg(-1) (P=0.001) in the pregnant and non-pregnant groups, respectively. The time between the first and second ropivacaine dose was similar in the two groups (P=0.070). Fewer pregnant women (81 vs 100%) required ropivacaine intraoperatively (P=0.017). The VAS scores were similar but parturients consumed more i.v. morphine (33 (14) vs 24 (12) mg, P=0.016) during the first 24 h after operation. CONCLUSIONS: Pregnant patients exhibited a higher level of subarachnoid sensory block and required more i.v. morphine after operation.
PMID: 15347609 [PubMed - as supplied by publisher]
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Comparison of hyperbaric and plain ropivacaine 15 mg in spinal anaesthesia for lower limb surgery.
Kallio H, Snall EV, Tuomas CA, Rosenberg PH.
Department of Anaesthesia, Forssa Hospital, Forssa, Finland.
BACKGROUND: Previously, plain ropivacaine 15 mg given intrathecally has been shown to be feasible for ambulatory surgery of lower-extremities. Hypothetically, hyperbaric solution could improve and shorten the block. METHODS: This prospective, randomized, double-blind study included 56 patients undergoing surgery of lower extremities. They received intrathecally either 1.5 ml of ropivacaine 10 mg ml(-1) and 0.5 ml of glucose 300 mg ml(-1) (HYP) or 2 ml of ropivacaine 7.5 mg ml(-1) (PL). RESULTS: All patients in Group HYP achieved T10 dermatome analgesia but only 64% (18/28) of Group PL. T10 analgesia was reached in 5 min (median, range 5-20 min) in the HYP group vs 10 min (5-45 min) in the PL group (P=0.022), and full motor block in 10 min (5-45 min) vs 20 min (5-60 min) (P=0.003), respectively. Group HYP had a longer duration of analgesia at T10; 83 min (5-145 min) vs 33 min (0-140 min) (P=0.004). Duration of sensory block from injection of the anesthetic to complete recovery was shorter in Group HYP than in Group PL, 210 min (120-270 min) vs 270 min (210-360 min) (P<0.001), as was duration of motor block, 120 min (5-150 min) vs 210 min (120-330 min) (P<0.001). Patients of Group HYP attained discharge criteria earlier than those of Group PL (P=0.009). CONCLUSION: In comparison with the plain solution, 15 mg of intrathecal hyperbaric ropivacaine produced a faster onset, greater success rate of analgesia at the level of T10 dermatome, and faster recovery of the block.
PMID: 15347608 [PubMed - as supplied by publisher]
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Anaesthetic management of the newborn with multiple congenital epulides.
Canavan-Holliday KS, Lawson RA.
Department of Anaesthesia, Crosshouse Hospital, Kilmarnock KA2 0BE, UK.
Epulis of the newborn is a granular cell tumour that originates from the dental alveolar mucosa. We report a case of a neonate with multiple congenital masses of the alveolar mucosa who presented for surgery with a potential airway problem. Intubation was achieved uneventfully using a gaseous induction with a large facemask and displacement of the epulides to allow cautious laryngoscopy.
PMID: 15347607 [PubMed - as supplied by publisher]
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Recent advances in intravenous anaesthesia.
Sneyd{dagger} JR.
Peninsula Medical School, Portland Square, University of Plymouth, Drake Circus, Plymouth PL4 8AA, UK.
Efforts to develop new hypnotic compounds continue, although several have recently failed in development. Propofol has been reformulated in various presentations with and without preservatives. Pharmacokinetic and pharmacodynamic differences exist between some of these preparations, and it is currently unclear whether any have substantial advantages over the original presentation. The use of target-controlled infusion (TCI) has been extended to include paediatric anaesthesia and sedation. Application of TCI to remifentanil is now licensed. Linking of electroencephalogram (EEG) monitoring to TCI for closed-loop anaesthesia remains a research tool, although commercial development may follow. The availability of stereoisomer ketamine and improved understanding of its pharmacology have increased non-anaesthetic use of ketamine as an adjunct analgesic. It may be useful in subhypnotic doses for postsurgical patients with pain refractory to morphine administration.
PMID: 15347606 [PubMed - as supplied by publisher]
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Awake intubation using the GlideScope video laryngoscope: initial experience in four cases.
Doyle DJ.
Publication Types:
PMID: 15128649 [PubMed - indexed for MEDLINE]
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Maxillary jewelry in a parturient: a new cause for concern.
Kuczkowski KM, Bui PK.
Publication Types:
PMID: 15128648 [PubMed - indexed for MEDLINE]
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Remifentanil pretreatment for propofol injection pain in children.
Batra YK, Al-Qattan AR, Ward VD, Kuriakose D, Ali SS, Alexander D.
Publication Types:
PMID: 15128647 [PubMed - indexed for MEDLINE]
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Possible asymptomatic cerebrospinal fluid leak following successful labour epidural catheter placement.
Ayad S, Narouze S, Tetzlaff JE.
Publication Types:
PMID: 15128646 [PubMed - indexed for MEDLINE]
Comment on:
Epidural spread depends on the approach used for posterior lumbar plexus block.
Mannion S.
Publication Types:
PMID: 15128643 [PubMed - indexed for MEDLINE]
-
Stellate ganglion block and regional cerebral blood volume and oxygenation.
Yokoyama K, Kishida T, Sugiyama K.
Publication Types:
PMID: 15128642 [PubMed - indexed for MEDLINE]
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Estimating the incidence of epidural hematoma - is there enough information?
Guay J.
Publication Types:
PMID: 15128640 [PubMed - indexed for MEDLINE]
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Sevoflurane for interventional neuroradiology procedures is associated with more rapid early recovery than propofol.
Castagnini HE, van Eijs F, Salevsky FC, Nathanson MH.
Neuroradiology Research Institute FLENI, Buenos Aires, Argentina.
PURPOSE: Sevoflurane and propofol are both suitable for neuroanesthesia but have not previously been compared as maintenance agents for long duration (one to five hours) procedures. METHODS: Using a multicentre international study protocol, 103 patients were randomized to receive either sevoflurane or propofol for maintenance of anesthesia during interventional neuroradiology procedures. After a standardized induction of anesthesia with propofol, 53 patients received sevoflurane 1 to 3% with 60% nitrous oxide (N(2)O) in oxygen (O(2)), and 50 patients received propofol 4 to 10 mg x kg(-1) x hr(-1) with 60% N(2)O in O(2). Maintenance agents were titrated against systemic arterial blood pressure (baseline mean arterial pressure +/- 20%). Recovery times, changes in sedation, pain, nausea and vomiting and psychomotor function during recovery and use of rescue medication were recorded. RESULTS: The group receiving sevoflurane had a more rapid recovery to spontaneous ventilation, extubation, eye opening and orientation compared to the group receiving propofol (3 vs 4 min, P = 0.01; 5 vs 6 min, P = 0.015; 7 vs 10 min, P < 0.001; 13 vs 17 min, P = 0.028; respectively). Sedation, pain, nausea and vomiting, and psychomotor function scores were similar in the two groups. Use of opioid boluses and vasopressors were similar. CONCLUSION: The use of sevoflurane for maintenance of anesthesia for prolonged neuroradiological procedures is associated with more rapid early recovery than propofol and is associated with similar side effects. Sevoflurane and propofol can both be recommended for these procedures. The clinical benefit of the more rapid recovery with sevoflurane is unknown.
Publication Types:
- Clinical Trial
- Multicenter Study
- Randomized Controlled Trial
PMID: 15128636 [PubMed - indexed for MEDLINE]
Comment on:
Cautious optimism on reducing spinal headache with spinal catheters.
Lambert D.
Publication Types:
PMID: 15138919 [PubMed - indexed for MEDLINE]
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Ultrasound-guided ulnar nerve block in the presence of a superficial ulnar artery.
Schafhalter-Zoppoth I, Gray AT.
Publication Types:
PMID: 15138917 [PubMed - indexed for MEDLINE]
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Clinical evaluation of a modified posterior anatomical approach to performing the popliteal block.
Borgeat A, Blumenthal S, Karovic D, Delbos A, Vienne P.
Department of Anesthesiology,Orthopedic University Clinic Balgrist/Zurich, Forchstrasse 340, 8008 Zurich, Switzerland. aborgeat@balgrist.unizh.ch
BACKGROUND: Tibial and common peroneal nerves can be blocked by the posterior approach to the popliteal fossa. Techniques using fixed measured distances between knee skin crease and puncture point have been described. We report on an approach that is based on manual identification of the apex of the popliteal fossa. METHODS: Five-hundred patients undergoing surgery of ankle or foot were prospectively included. The apex of the popliteal fossa (determined by the crossing point of the biceps femoris and the semitendinosus and semimembranosus muscles) was assessed by manual palpation. The puncture point was 0.5 cm below the apex, on the medial side of the biceps femoris muscle. When indicated for postoperative analgesia, a perineural catheter was placed. We assessed success rate, number of attempts, the distance between knee skin crease and the apex of the popliteal fossa, nerve depth, and acute and late complications. RESULTS: Block success rate was 94% and 92% when the block was performed through the needle and the catheter, respectively. Inversion was the motor response with the highest success rate. The first attempt was successful in 97.5% of the patients. Mean depth of the nerve was 4.5 cm (range, 2.0 to 7.0 cm) and mean knee skin crease to apex of popliteal fossa distance was 9 cm (range, 7.0 to 12.0 cm). Nine patients (2%) had acute complications. There were no technical problems associated with the perineural nerve catheter. After 12 weeks, no late complications were observed. CONCLUSIONS: The modified posterior anatomical approach for popliteal sciatic nerve block is easy to perform, has a high success rate, and has a low complication rate. The location of the needle insertion point is assessed without any measurement, thus avoiding inaccuracies caused by repeated skin-distance measurements.
Publication Types:
PMID: 15138916 [PubMed - indexed for MEDLINE]
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Selective nerve root blocks for low back pain and radiculopathy.
Gajraj NM.
McDermott Center for Pain Management, Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75235-9068, USA. noor.gajraj@UTSouthwestern.edu
In the management of patients with low back pain and radiculopathy, selective nerve root blocks (SNRBs) are now a common procedure for both diagnostic and therapeutic purposes. This article reviews the available studies as well as the relevant anatomy, pathology, technical considerations, and complications.
Publication Types:
PMID: 15138911 [PubMed - indexed for MEDLINE]
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Spinal cord compression from intrathecal catheter-tip inflammatory mass: case report and a review of etiology.
Peng P, Massicotte EM.
Department of Anesthesiology,Toronto Western Hospital EC 2-046, 399 Bathurst Street, Toronto, Ontario, Canada M5T 2S8. Philip.peng@uh.on.ca
OBJECTIVES: The majority of intrathecal pumps are implanted by anesthesiologists. Despite a recent increase in case reports involving intrathecal catheter-tip inflammatory masses, this complication is rarely reported in the anesthesiology literature. The present case report describes a patient with spinal cord compression as a result of an inflammatory mass and reviews the current literature as to the etiology of inflammatory mass formation. CASE REPORT: A 47-year-old man with intractable neck and arm pain received an intrathecal pump implantation in 2001, at a stable dose of morphine 8 mg and clonidine 40 microg/d. After an injury in late 2001, his dose requirement for intrathecal morphine steadily increased. In May 2002, hydromorphone was substituted for morphine. The concentrations of hydromorphone and clonidine were 12.5 mg/mL and 150 microg/mL, respectively, infusing at 0.3 mL/d. In October 2003, he developed progressive T9 paraparesis. A computed tomography scan with myelogram showed complete blockage of contrast flow at T8-9. Surgical exploration found an intradural-extramedullary mass compressing the spinal cord anteriorly and to the left. Four weeks after surgical removal of the mass, the patient's neurologic function had improved minimally. All the microbiological analyses were negative. Review of the current literature suggests that the development of an inflammatory mass is related to the delivery of the high dose opioids in the intrathecal space. CONCLUSION: Delivery of high-dose intrathecal opioids can result in the formation of an inflammatory mass, leading to poor pain control and neurologic complications. Anesthesiologists should be vigilant as to these complications when managing patients receiving intrathecal pump therapy.
Publication Types:
- Case Reports
- Review
- Review, Tutorial
PMID: 15138910 [PubMed - indexed for MEDLINE]
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Synovial cysts and the lithotomy position causing cauda equina syndrome.
Wills JH, Wiesel S, Abram SE, Rupp FW.
Department of Anesthesiology and CCM, MSC 11-6120, 1 University of New Mexico, Albuquerque, NM 87131, USA. jwills@salud.unm.edu
We describe a case of cauda equina syndrome caused by synovial cysts and the lithotomy position. A transurethral resection of the prostate was performed under spinal anesthesia in the lithotomy position. We believe that this is the first case report of facet joint synovial cysts and the lithotomy position causing ischemic neurologic injury to the cauda equina. Other etiologies such as needle trauma, neurotoxicity, hematoma, and abscess were not evident. We believe that positioning the patient in the lithotomy position narrowed the cross-sectional area of the spinal canal in a patient with a coexisting critically stenosed lumbar spinal canal. The resultant mechanical pressure caused an ischemic compression injury to the cauda equina.
Publication Types:
PMID: 15138909 [PubMed - indexed for MEDLINE]
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Electrical nerve stimulation using a stimulating catheter: what is the lower limit?
Wehling MJ, Koorn R, Leddell C, Boezaart AP.
Department of Anesthesiology, College of Nursing, University of Iowa, 200 Hawkins Drive, 6-JCP, Iowa City, IA 52242, USA.
OBJECTIVES: To minimize the risk of intraneural injection when performing nerve blocks, some authors caution against injecting through a needle placed with motor responses observed at nerve stimulator output settings of 0.3 mA or less. We present a case of placing a continuous cervical paravertebral catheter with brisk motor response while stimulating the catheter at 0.05 mA, with no adverse sequelae. CASE REPORT: A 56-year-old man scheduled for rotator cuff repair received a continuous cervical paravertebral block for intraoperative and postoperative pain control. A stimulating catheter was used for the block. During catheter placement, nerve stimulator output was decreased to 0.05 mA at 300 micros and the motor response remained brisk. The patient was not significantly sedated and experienced no pain during placement or with injection of 40 mL of 0.5% ropivacaine through the catheter. Narcotic drugs were not required during surgery, and the block provided excellent postoperative pain control. Catheter position was evaluated by fluoroscopy to further identify the catheter's relationship to the brachial plexus. The nerve trunks of C5 and C6 were clearly visible after 1 mL of iohexol (Omnipaque) was injected through the catheter. The catheter was removed the following day. At the follow-up visit 2 weeks later, the patient's neurological examination remained unremarkable. CONCLUSION: We present a single case of successful placement of a stimulating catheter with no neurological injury even when motor response occurred at very low nerve stimulator output settings.
Publication Types:
PMID: 15138908 [PubMed - indexed for MEDLINE]
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Spinal ropivacaine or bupivacaine for cesarean delivery: a prospective, randomized, double-blind comparison.
Danelli G, Fanelli G, Berti M, Cornini A, Lacava L, Nuzzi M, Fanelli A.
Department of Anesthesiology, Intensive Care and Pain Therapy, University of Parma, Via Gramsci 14, 43100 Parma, Italy. gdanelli@ao.pr.it
BACKGROUND AND OBJECTIVES: The aim of this prospective, randomized, double-blinded study was to compare clinical efficacy and safety of ropivacaine and bupivacaine given intrathecally in combination with morphine for cesarean delivery. METHODS: With ethical committee approval and a written informed consent, 60 women scheduled for elective cesarean delivery under spinal anesthesia were randomly allocated to receive spinal anesthesia with either 20 mg ropivacaine plus 0.1 mg morphine (n = 30) or 15 mg bupivacaine plus 0.1 mg morphine (n = 30). Profile of spinal block (onset and recovery times), cardiovascular effects, and quality of postoperative analgesia (patient-controlled morphine) were recorded by a blinded observer. RESULTS: The onset time of motor block was shorter after bupivacaine (8 +/- 2 min) than after ropivacaine (12 +/- 5 minutes) (P <.05), whereas duration of both sensory and motor blocks was longer after bupivacaine (139 +/- 37 minutes and 254 +/- 76 minutes) than after ropivacaine (112 +/- 27 minutes and 211 +/- 48 minutes) (P <.01 and P <.05, respectively). No differences in intraoperative quality of anesthesia and clinical hypotension requiring ephedrine administration were observed between the two groups. Postoperative analgesia was similarly effective in both groups; however median consumption of patient-controlled morphine during the first 24 hours after surgery was higher in patients of group Ropivacaine (5 mg; range, 0 to 18 mg) than in patients of group Bupivacaine (2 mg; range, 0 to 7 mg) (P <.01). CONCLUSION: Spinal anesthesia produced with 20 mg ropivacaine plus 0.1 mg morphine is as effective and safe as that provided by 15 mg bupivacaine plus 0.1 mg morphine, with an earlier recovery of sensory and motor functions after surgery.
Publication Types:
- Clinical Trial
- Randomized Controlled Trial
PMID: 15138906 [PubMed - indexed for MEDLINE]
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Prospective comparison of continuous femoral nerve block with nonstimulating catheter placement versus stimulating catheter-guided perineural placement in volunteers.
Salinas FV, Neal JM, Sueda LA, Kopacz DJ, Liu SS.
Department of Anesthesiology, Virginia Mason Medical Center, 1100 9th Avenue, B2-AN, Seattle, WA 98101, USA. anefvs@vmmc.org
BACKGROUND AND OBJECTIVES: Stimulating catheter-guided perineural placement may potentially increase the success rate and quality of continuous femoral nerve block as compared with a nonstimulating catheter technique. These hypotheses have not been rigorously tested. METHODS: Twenty volunteers underwent placement of bilateral femoral nerve catheters in this prospective, randomized, double-blind study. For each side, a stimulating needle was advanced until quadriceps contractions were obtained at < or =0.5 mA. On one side, a stimulating catheter was advanced 4 to 5 cm beyond the needle tip while eliciting quadriceps contractions via the catheter. If quadriceps contractions decreased or disappeared, the catheter position was adjusted until quadriceps contractions could be elicited at < or =0.5 mA. On the contralateral side, an identical catheter was advanced 4 to 5 cm beyond the needle tip without attempts to elicit quadriceps contractions via the catheter. After bolus injection of 10 mL lidocaine 1%, ropivacaine 0.2% at 10 mL/h was continuously infused through both catheters for 4 hours. Success of femoral block was defined as loss of sensation to cold and pinprick stimuli. Quality of successful block was determined by tolerance to transcutaneous electrical stimulation and force dynamometry of quadriceps strength. RESULTS: Block success was 100% via the stimulating catheters versus 85% via the nonstimulating catheters (P =.07). Overall tolerance to transcutaneous electrical stimulation (P =.009) and overall depth of motor block (P =.03) was significantly higher in the stimulating catheter-guided femoral nerve blocks. CONCLUSIONS: In this volunteer study, there was no statistically significant difference in block success between the two techniques. However, stimulating catheter-guided placement provided an increased overall quality of continuous femoral perineural blockade. Further studies are needed to verify these observations in the clinical setting.
Publication Types:
- Clinical Trial
- Randomized Controlled Trial
PMID: 15138905 [PubMed - indexed for MEDLINE]
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Percutaneous electrode guidance using the insulated needle for prelocation of peripheral nerves during axillary plexus blocks.
Capdevila X, Lopez S, Bernard N, Dadure C, Motais F, Biboulet P, Choquet O.
Department of Anesthesia and Critical Care Medicine, Lapeyronie University Hospital, Avenue du Doyen Giraud, 34295 Montpellier Cedex 5, France. x-capdevila@chu-montpellier.fr
BACKGROUND AND OBJECTIVES: Short reports have noted that percutaneous prelocation is helpful in determining the anatomic course of a peripheral nerve, and, thereby, may serve as a guide for block needle insertion. We prospectively studied percutaneous electrode guidance to assist axillary brachial plexus blocks. METHODS: In 131 consecutive patients, the tip of an insulated needle emitting 5 mA was placed on the skin above and below the axillary artery to obtain a hand motor response characteristic of the median, ulnar, and radial nerves in succession. The current was reduced until all movement had ceased. The needle was then inserted toward the nerve to be blocked, decreasing the intensity from 2 mA to 0.5 mA, so that the same selected motor response was still obtained. The length of the needle inserted was noted, and 1.5% lidocaine was injected. Pain verbal analogic score (VAS) values were noted during both procedures. Complete sensory blockade was evaluated at 30 min. RESULTS: Rates of successful percutaneous electrode guidance were 94.6% for the median nerve, 89.4% for the radial nerve, 88.5% for the ulnar nerve, and 85.5% for all 3 nerves together. A significant correlation was found between the lowest percutaneous current applied and the depth of the nerve stimulated at 0.5 mA. Pain VAS values were significantly lower during percutaneous stimulation than during needle insertion (P <.05). Sensory block for all 3 nerves was noted in 92% of patients. CONCLUSIONS: Percutaneous electrode guidance using the insulated needle enabled clinicians to locate the terminal branches of the plexus in the axilla and appreciate their depth. This method could, therefore, minimize patient discomfort and perhaps the risk of nerve trauma.
PMID: 15138904 [PubMed - indexed for MEDLINE]
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Locating the target nerve and injectate spread in rabbit sciatic nerve block.
Sung DH.
Department of Physical Medicine and Rehabilitation, Sungkyunkwan University School of Medicine, Samsung Medical Center, #50 Irwon-Dong, Gangnam-Gu, Seoul 136-710, Korea. dhsung@smc.samsung.co.kr
BACKGROUND AND OBJECTIVES: The purpose of this study is to determine how close the needle tip is placed to the target nerve using a nerve stimulator and to determine how far the injectate spreads in percutaneous nerve blocks. METHODS: Twenty-four sciatic nerves of New Zealand white rabbits were located with a 2-dimensional needle manipulator and a nerve stimulator (pulse width: 100 micros for group I, 250 micros for group II). The stimulation current required to elicit a motor response for each insertion depth of the needle and the nerve-needle distance at which the required current reached the minimum were measured. Another 10 sciatic nerves were located manually using a nerve stimulator and neurolyzed with a mixed solution of 5% phenol and Indian ink (100 microL). RESULTS: The nerve-needle distance was in the range of -1.2 mm to +2.8 mm in group I (1.1 +/- 0.9 mm [mean +/- standard error] in absolute value) and -0.2 mm to +4.8 mm (2.2 +/- 1.7 mm [mean +/- standard error] in absolute value) in group II (positive values signify the center of the beveled surface is past the nerve), when the stimulation current reached the minimum (average minimum current: 0.47 mA in group I, 0.37 mA in group II). Indian ink spread over a significant distance (25.4 +/- 0.5 mm [mean +/- standard error]; range, 19-31 mm) longitudinally within the perineural tissue, and axonal degeneration was observed linearly at the peripheral portion of the nerve fascicle in a similar pattern as Indian ink spread. CONCLUSIONS: The target nerve was located within 5 mm from the needle with less than 0.5-mA stimulation current. The injectate spread to more than 20 mm on average even when a small volume (100 microL) of the injectate was injected in rabbit sciatic nerves.
PMID: 15138902 [PubMed - indexed for MEDLINE]
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