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Items 1 - 34 of 34 |
One page. |
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Local anaesthetics--Nupercaine and Amethcaine.
Ball C, Westhorpe R.
Publication Types:
PMID: 15806723 [PubMed - indexed for MEDLINE]
Comment on:
Unilateral versus bilateral thoracic epidural block.
Mahajan R, Gupta R.
Publication Types:
PMID: 15675230 [PubMed - indexed for MEDLINE]
Comment on:
Randomized evaluation of the single-use softseal and the re-usable LMA classic laryngeal mask.
Al-Shaikh B, Van Zundert AA.
Publication Types:
PMID: 15675227 [PubMed - indexed for MEDLINE]
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Comparison of disposable and reusable laryngeal mask airways in spontaneously ventilating adult patients.
Cao MM, Webb T, Bjorksten AR.
Department of Anaesthesia and Pain Management, Royal Melboume Hospital, Melboume, Victoria.
Recent studies have indicated that despite stringent sterilization processes, the reusable silicone laryngeal mask airway (LMA) has the potential for disease transmission through residual biological debris. As a result, a polyvinyl chloride (PVC) disposable LMA has been introduced. This randomized trial involved 138 spontaneously ventilating adult patients who underwent elective surgery requiring airway management with an LMA to determine whether there is a clinical difference between the disposable Portex LMA (PLMA) and the standard reusable LMA in terms of ease of insertion, intra-operative cuff pressures and postoperative incidence of sore throat. There was no significant difference in first attempt insertion success rates (79% vs 84%) or difference in the incidence of postoperative sore throat observed between the two groups. Cuff pressure increases with nitrous oxide anaesthesia were significantly larger with the reusable LMA. The disposable PLMA provided a suitable airway in spontaneously ventilating patients without the risk of disease transmission inherent in a reusable device.
Publication Types:
- Clinical Trial
- Randomized Controlled Trial
PMID: 15675213 [PubMed - indexed for MEDLINE]
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Reliability of fingertip skin-surface temperature and its related thermal measures as indices of peripheral perfusion in the clinical setting of the operating theatre.
Akata T, Kanna T, Yoshino J, Higashi M, Fukui K, Takahashi S.
Department of Anesthesiology and Critical Care Medicine, Faculty of Medicine, Kyushu University, Fukuoka, Japan.
During the perioperative period, evaluation of digital blood flow would be useful in early detection of decreased circulating volume, thermoregulatory responses or anaphylactoid reactions, and assessment of the effects of vasoactive agents. This study was designed to assess the reliability of fingertip temperature, core-fingertip temperature gradients and fingertip-forearm temperature gradients as indices of fingertip blood flow in the clinical setting of the operating theatre. In 22 adult patients undergoing abdominal surgery with general anaesthesia, fingertip skin-surface temperature, forearm skin-surface temperature, and nasopharyngeal temperature were measured every five minutes during the surgery. Fingertip skin-surface blood flow was simultaneously estimated using laser Doppler flowmetry. These measurements were made in the same upper limb with an IV catheter (+ IV group, n=11) or without an IV catheter (-IV group, n=11). Fingertip blood flow, transformed to a logarithmic scale, significantly correlated with any of the three thermal measures in both the groups. Their rank order as an index of fingertip blood flow in the -IV group was forearm-fingertip temperature gradient (r=-0.86) > fingertip temperature (r=0.83) > nasopharyngeal-fingertip temperature gradient (r=-0.82), while that in the +IV group was nasopharyngeal-fingertip temperature gradient (r=-0.77) > fingertip temperature (r=0.71) > forearm-fingertip temperature gradient (r=-0.66). The relation of fingertip blood flow to each thermal measure in the -IV/group was stronger (P<0.05) than that in the +IV group. In the clinical setting of the operating theatre, using the upper limb without IV catheters, fingertip skin-surface temperature, nasopharyngeal-fingertip temperature gradients, and forearm-fingertip temperature gradients are almost equally reliable measures of fingertip skin-surface blood flow.
Publication Types:
- Clinical Trial
- Randomized Controlled Trial
PMID: 15675212 [PubMed - indexed for MEDLINE]
[Anesthesia and sleep apnea syndrome.]
[Article in German]
Hartmann B, Junger A, Klasen J.
Abteilung Anaesthesiologie, Intensivmedizin, Schmerztherapie, Universitatsklinikum Giessen, .
The perioperative risk for patients with obstructive sleep apnea syndrome and the optimal anaesthesiological management of these patients have not been well elucidated. The prevalence of obstructive sleep apnea with significant symptoms is estimated to be 4% in men and 2% in women. However, in 80-95% of patients this syndrome is not sufficiently diagnosed. Thus identification of patients at risk and a thorough multidisciplinary diagnostic approach are essential for optimal perioperative management. The risk of perioperative complications, like cardiopulmonary compromise, and difficulties in airway management is elevated. The most important aspects of perioperative management include evaluation of intubating conditions, careful search for cardiopulmonary morbidity, permanent control of patient airways, sensible use of anaesthetics, sedatives, and narcotics, and strict monitoring of vital signs. If ambulatory nasal continuous positive airway pressure (CPAP) therapy has been established preoperatively, this should be continued in the perioperative period. Postoperative monitoring should be performed in an intensive care or intermediate care unit. Controlled clinical studies on the best perioperative management of patients with obstructive sleep apnea are urgently required.
PMID: 15809854 [PubMed - as supplied by publisher]
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[Spinal anesthesia in abdominal surgery]
[Article in German]
Wulf H, Buttner J, Standl T.
Klinik fur Anaesthesiologie und Intensivtherapie, Universitatsklinikum Marburg. sek1anae@post.med.uni-marburg.de
PMID: 15622496 [PubMed - indexed for MEDLINE]
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[Current discussions in pediatric anesthesia. Pediatric Anesthesia Symposium in Zurich, 17.-18. September 2004 ]
[Article in German]
Schmid E, Johr M.
Institut fur Anasthesie, Kantonsspital Luzern, Luzern, Switzerland.
Publication Types:
PMID: 15614541 [PubMed - indexed for MEDLINE]
Comparison of the different approaches to saphenous nerve block.
Benzon HT, Sharma S, Calimaran A.
Division of Pain Medicine, Northwestern University Feinberg School of Medicine., Chicago, Illinois 60611, USA. htbenzon@nmff.org
BACKGROUND: The authors compared the efficacy of the different approaches to saphenous nerve block. METHODS: The following approaches to saphenous nerve block were compared in 10 volunteers: perifemoral, transsartorial, block at the medial femoral condyle, below-the-knee field block, and blockade at the level of the medial malleolus. Each volunteer underwent all five blocks, and the interval between blocks was 3-7 days. The sequence of injection was randomized by Latin square design. Sensory blockade at the medial aspects of the leg and foot and the strength of the anterior thigh muscles were noted. RESULTS: The transsartorial, perifemoral, and below-the-knee field block approaches were more effective than block at the medial femoral condyle in providing sensory anesthesia to the medial aspect of the leg. The transsartorial approach was more effective than block at the medial femoral condyle and below-the-knee field block in providing sensory anesthesia to the medial aspect of the foot. Compared with the perifemoral approach, the transsartorial approach did not cause weakness of the hip flexors and the knee extensors. In volunteers with partial numbness in the medial aspect of the foot, supplemental block of the medial dorsal cutaneous branch of the superficial peroneal nerve resulted in complete sensory blockade. CONCLUSIONS: Sensory blockade in the medial aspects of the leg and foot is best achieved with the transsartorial approach. In some subjects, supplementary block of the medial dorsal cutaneous branch of the superficial peroneal nerve may have to be performed to assure complete numbness of the medial aspect of the foot.
PMID: 15731603 [PubMed - indexed for MEDLINE]
Methodological approaches to anaesthetists' workload in the operating theatre.
Leedal JM, Smith AF.
Department of Anaesthesia, Royal Lancaster Infirmary, Ashton Road, Lancaster LA1 4RP, UK.
This review examines the basic concepts of workload and methods of measuring them. The components of anaesthetists' operating room activities, and the factors contributing to workload, are analysed using an ergonomic-based model for technological environments. The available evidence on the relationship between workload and training and supervision is presented and the effect of workload on the quality and safety of anaesthetic care is reviewed. There is, as yet, only a small body of work examining workload and its effects in anaesthesia. While studies have identified the general pattern of workload in relation to the different stages of the perioperative period, measurement, particularly of overlapping tasks, is still evolving. It is clear, however, that induction and emergence are the most intense periods of both practical and 'non-technical' aspects of work. Allocation of attention to a range of tasks simultaneously is a key characteristic of anaesthetic practice. Experienced staff appear to show 'spare capacity' in performance during routine cases, which, we suggest, allows them an attentional 'safety margin' should adverse events occur. The effects of production pressure and mental 'overload' remain speculative and so practical recommendations for anaesthetic staffing, both in terms of numbers and matching skills to surgical demand, cannot be made. The potential for delegation of tasks, for instance to non-physician anaesthetists, can also not be made on evidence-based grounds. Strategies for active management of workload may be useful in practice.
PMID: 15817711 [PubMed - as supplied by publisher]
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Explosions in anaesthesia.
Celinski M.
Portsmouth, UK.
PMID: 15814809 [PubMed - in process]
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Anaesthetic management of high-risk cardiac patients undergoing thoracic surgery with the support of intra-aortic balloon pump.
Chiu CL, Mansor M, Majid A, Marcucci C, Chassot PG, Spahn DR.
Kuala Lumpur, Malaysia.
PMID: 15814806 [PubMed - in process]
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Contamination of anaesthetic gases with nitric oxide and its influence on oxygenation.
Peyton P, Carette RM, Hendrickx JF, De Wolf AM, Hess W, Kannmacher J, Kruse J.
Heidelberg, Victoria, Australia. phil.peyton@austin.org.au.
PMID: 15814805 [PubMed - in process]
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Haemodynamic effects of haemorrhage during xenon anaesthesia in pigs.
Baumert JH, Hecker KE, Hein M, Reyle-Hahn SM, Horn NA, Rossaint R.
Klinik fuer Anaesthesiologie, Universitaetsklinikum Aaachen, Pauwelsstrasse 30, D-52074 Aachen, Germany.
BACKGROUND: It was hypothesized that xenon would stabilize mean arterial pressure (MAP) in haemorrhagic shock, recovery, and volume resuscitation, because a higher MAP has been observed with xenon, when compared with isoflurane anaesthesia. The responses to haemorrhage and subsequent volume replacement were therefore compared between xenon and isoflurane anaesthesia, in pigs. METHODS: Pigs were randomized to anaesthesia with xenon 0.55 MAC (group Xe, n=9) or isoflurane 0.55 MAC (group Iso, n=9), each with remifentanil 0.5 microg kg(-1) min(-1). MAP, heart rate, cardiac output (CO), and left ventricular fractional area change (FAC) were collected at control (1), after haemorrhage (20 ml kg(-1)) (2), after 10 min of recovery (3), after volume replacement (4), and 30 min later (5). Data were analysed by two-way repeated measures ANOVA. RESULTS: Blood loss decreased MAP (Xe: 103 [21] to 53 [24] mm Hg; Iso: 92 [18] to 55 [14] mm Hg) and CO (Xe: 4.1 [0.8] to 2.6 [0.5] litre min(-1); Iso: 5.1 [1.1] to 3.8 [1.2] litre min(-1)), in spite of significant tachycardia. MAP and CO recovered to about 75% of control, and subsequent volume replacement completely reversed symptoms in both groups, but increased FAC only with xenon. CONCLUSION: Haemodynamic response to acute haemorrhage appeared faster with xenon/remifentanil than with isoflurane/remifentanil anaesthesia. In particular MAP decrease and short-term recovery were more marked with xenon (P<0.02). In the xenon group, volume replacement increased FAC compared with control and isoflurane (P<0.02).
PMID: 15805140 [PubMed - as supplied by publisher]
Percutaneous transhepatic biliary dilatation under thoracic epidural analgesia in a patient with a recent myocardial infarction.
Agarwal A, Dhiraaj S, Raza M, Pandey R, Ranjan R, Pandey CK, Shiopriye.
PMID: 15817445 [PubMed - in process]
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Grow your own: strategies to develop anesthesia researchers.
Naik VN, Levine MF, Orser BA.
PMID: 15814763 [PubMed - in process]
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General anesthesia for patients with Brugada syndrome. A report of six cases: [L'anesthesie generale chez des patients atteints du syndrome de Brugada. Presentation de six cas].
Inamura M, Okamoto H, Kuroiwa M, Hoka S.
Department of Anesthesiology, Kitasato University Hospital, 1-15-1, Kitasato, Sagamihara, Kanagawa, 228-8555 Japan. okasuke@med.kitasato-u.ac.jp.
PURPOSE: To review six cases of Brugada syndrome presenting for insertion of a cardioverter-defibrillator under general anesthesia. CLINICAL FEATURES: All patients had a history of syncope, ST segment elevation in the right precordial lead of the electrocardiogram (ECG) which became prominent after a pilsicainide challenge test. Routine monitors, right precordial lead of the ECG and an external defibrillator were installed prior to anesthesia. We administered propofol/midazolam for induction, and propofol/sevoflurane combined with fentanyl for maintenance of anesthesia. Atropine and ephedrine were administered to decrease vagal tone. No ECG change or arrhythmia was observed perioperatively. After the successful implantation of the defibrillator, all patients were discharged without any adverse event. CONCLUSION: By avoiding agents or conditions that may exacerbate Brugada syndrome during anesthesia, we were able to manage the patients uneventfully for implantation of a cardioverter-defibrillator.
PMID: 15814757 [PubMed - in process]
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Survey of chronic pain practice by anesthesiologists in Canada: [Enquete sur la pratique en douleur chronique des anesthesiologistes du Canada].
Peng PW, Castano ED.
Department of Anesthesiology and Pain Management, EC 2-046 Toronto Western Hospital, 399 Bathurst Street, Toronto, Ontario M5T 2S8, Canada. Philip.peng@uhn.on.ca.
PURPOSE: To describe the pattern of chronic pain practice (CPP) among anesthesiologists in Canada. METHODS: Following hospital Ethics Committee approval, a detailed postal questionnaire was sent to all active members of the Canadian Anesthesiologists' Society. A second mailing was conducted two months later. RESULTS: The overall response rate was 53%. While 38% of responding anesthesiologists were involved in CPP, in the majority of cases, this accounted for less than 20% of their clinical time. Thirty percent of those involved in CPP had previous training in pain management. The types of CPP included nerve blocks (84%) and pharmacological treatment (60%) in non-cancer pain (85%) and cancer pain (50%) patients. Ten percent and 28% of anesthesiologists were involved in research and teaching respectively while 26% were affiliated with a multidisciplinary clinic. The healthcare professions that anesthesiologists had access to or were directly working with in their practice were as follows: acupuncture (18%), nursing (36%), psychology (28%), psychiatry (35%) and physiotherapy (58%). Epidural steroid injection was the most commonly practiced intervention (82%). This was followed by trigger point injection (70%), stellate ganglion block (61%), occipital nerve block (60%) and lumbar sympathetic block (50%). Practice of interventional procedures was highly diverse.Seventy percent of anesthesiologists prescribed opioids as part of their CPP. However, half of them never incorporated an opioid agreement with patients. Opioids were most commonly used in the sustained release form. CONCLUSION: Approximately one-third of anesthesiologists surveyed incorporate chronic pain in their practice and their pattern of practice is widely diversified.
PMID: 15814753 [PubMed - in process]
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Noncardiac surgery in patients with coronary artery stent: what should the anesthesiologist know?/La chirurgie non cardiaque chez des patients porteurs d'une endoprothese coronaire : que devraient savoir les anesthesiologistes ?
Dupuis JY, Labinaz M.
Cardiac Division of Anesthesiology, University of Ottawa Heart Institute, 40 Ruskin Street, Room H2410, Ottawa, Ontario K1Y 4W7, Canada. jydupuis@ottawaheart.ca.
PMID: 15814748 [PubMed - in process]
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In collaboration with the Canadian Critical Care Society, the Canadian Journal of Anesthesia is proud to publish the best posters presented at the Toronto Critical Care Medicine Symposium 2004 (Adult and Pediatric) held in Toronto, Ontario, October 21 - October 23, 2004.
[No authors listed]
PMID: 15814745 [PubMed - as supplied by publisher]
Comment in:
Should we use etomidate as an induction agent for endotracheal intubation in patients with septic shock?: a critical appraisal.
Jackson WL Jr.
Walter Reed Army Medical Center, Department of Surgery, Critical Care Medicine Service, Building 2, Room 3M12, 6900 Georgia Ave NW, Washington, DC 20307-5001, USA. William.Jackson1@NA.AMEDD.ARMY.MIL
Etomidate is commonly used for the facilitation of endotracheal intubation. While etomidate possesses multiple qualities that are beneficial in hemodynamically unstable patients who require a sedative or amnestic, its potential to negatively impact corticosteroid production is well-documented. Given the frequency of relative adrenal insufficiency observed in the critically ill and the increasing use of corticosteroids in patients with septic shock, an appraisal of the status of etomidate as an induction agent in patients with evolving or established septic shock is indicated. A review of the relevant literature suggests that its use in this setting may be harmful. It is proposed that, pending the performance of a randomized, controlled clinical trial, considerable caution should accompany its administration in patients with evolving or established septic shock. The potential role for concomitant empiric steroid replacement and the comparability of alternative induction regimens are also discussed.
Publication Types:
PMID: 15764790 [PubMed - indexed for MEDLINE]
Comment on:
Etomidate for endotracheal intubation in sepsis: acknowledging the good while accepting the bad.
Murray H, Marik PE.
Publication Types:
PMID: 15764747 [PubMed - indexed for MEDLINE]
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Costs of anaesthesia.
Loop T, Priebe HJ.
Publication Types:
PMID: 15816601 [PubMed - in process]
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The effect of hypotensive anaesthesia on cognitive functions and recovery at endoscopic sinus surgery.
Sartcaoglu F, Celiker V, Basgul E, Yapakci O, Aypar U.
Publication Types:
PMID: 15816598 [PubMed - in process]
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Impact of patient age on propofol consumption during propofol-remifentanil anaesthesia.
Kreuer S, Schreiber JU, Bruhn J, Wilhelm W.
University of Saarland, Department of Anaesthesiology and Intensive Care Medicine, Homburg/Saar, Germany.
BACKGROUND: This study was designed to investigate the impact of patient age on propofol consumption and recovery time using a propofol-remifentanil anaesthetic standardized with Narcotrend EEG monitoring. The Narcotrend is a monitor for measuring the depth of anaesthesia based upon a six-letter classification from A (awake) to F (increasing burst suppression) including 14 substages. METHODS: In 200 patients scheduled for minor orthopaedic surgery Narcotrend EEG electrodes were positioned on the patient's forehead as recommended by the manufacturer. Anaesthesia was induced with remifentanil 0.4 microg kg(-1) min(-1) and 2 mg kg(-1) propofol. Immediately after intubation remifentanil was reduced to a constant rate of 0.2 microg kg(-1) min(-1) whereas a propofol infusion was now started at 3 mg kg(-1) h(-1) and then adjusted accordingly to achieve a target Narcotrend stages of D(0-2) indicating general anaesthesia. At the end of surgery the propofol and remifentanil infusions were stopped without tapering, the time to unstimulated opening of eyes was determined, and the propofol consumption (given as mg kg(-1) h(-1)) was calculated from the total amount of infused propofol but without the induction bolus, from the actual body weight and the duration of propofol infusion. Furthermore, a linear regression analysis was applied for propofol consumption vs. age. RESULTS: The ages of the patients studied ranged from 16 to 83 yr old and patients were classified as ASA I-III. Propofol consumption significantly decreased with the patients' age: 30 yr of age or below the propofol consumption was calculated as 5.9 +/- 1.7 mg kg(-1) h(-1), for 31-50 yr as 5.4 +/- 1.8 mg kg(-1) h(-1), for 51-70 yr as 4.5 +/- 1.7 mg kg(-1) h(-1) and above 70 yr as 3.5 +/- 1.4 mg kg(-1) h(-1). Linear regression analysis revealed propofol (mg kg(-1) h(-1)) = 9.136 - (0.0597 x age (yr)); R = 0.53. Concomitantly, the recovery time to opening of eyes increased with the patients' age: < or = 30 yr, 7.4 +/- 3.7 min; 31-50 yr, 9.5 +/- 4.0 min; 51-70 yr, 9.8 +/- 4.1 min; and > or = 71 yr, 14.9 +/- 12.1 min. CONCLUSIONS: We conclude that with Narcotrend guidance, mean propofol consumption and recovery times are age dependent. However, as a result of large inter-individual variability, age per se does not allow a prediction of individual propofol need or recovery time.
PMID: 15816591 [PubMed - in process]
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Spinal anaesthesia in full-term infants of 0-6 months: are there any differences regarding age?
Koroglu A, Durmus M, Togal T, Ozpolat Z, Ersoy MO.
Inonu University, Faculty of Medicine, Department of Anaesthesiology, Malatya, Turkey. akoroglu@inonu.edu.tr
BACKGROUND AND OBJECTIVE: The aim of the study was to report our experience concerning the effectiveness, complications and safety of spinal anaesthesia, and to determine whether spinal anaesthesia was effective in full-term infants undergoing elective inguinal hernia repair. METHODS: Sixty-eight full-term infants aged < 6 months were included in the study. Infants were divided into three groups; Group I (< 1 month, n = 20), Group II (> 1 and < 3 months, n = 26), and Group III (3-6 months, n = 22). All spinal blocks were performed under mask inhalation anaesthesia. A dose of bupivacaine 0.5% 0.5 mg kg(-1) was used for infants under 5kg and 0.4 mg kg(-1) for those over 5 kg. Heart rate, mean arterial pressure, respiratory rate and SPO2 were recorded before and after spinal anaesthesia at 5 min intervals. Time to onset of analgesia, time to start of operation, duration of operation, anaesthesia and hospitalization, postoperative analgesic requirement and complications were recorded. RESULTS: Adequate spinal anaesthesia without sedation was better, time to obtain maximum cutaneous analgesia was shorter and need for sedation and postoperative analgesic requirement were significantly lower in Group I. Although heart rate, mean arterial pressure and respiratory rate decreased < 20% in all groups following spinal analgesia, the decrease in Group I was lower than the others. CONCLUSIONS: Spinal anaesthesia is an effective choice in inguinal hernia repair for full-term infants aged < 1 month, providing excellent and reliable surgical conditions. However, this technique is not as useful for infants aged between 1 and 6 months.
PMID: 15816589 [PubMed - in process]
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Is there a place for interscalene block performed after induction of general anaesthesia?
Bogdanov A, Loveland R.
Royal Berkshire Hospital, Reading, Berkshire, UK. alex@bogdanov.freeserve.co.uk
BACKGROUND AND OBJECTIVE: The timing of interscalene block in relation to general anaesthesia remains a controversial subject. We believe that the results of our study demonstrate that this block may be performed safely on anaesthetized patients, providing that certain conditions are met. METHODS: Five hundred and forty-eight cases of arthroscopic shoulder surgery were analysed retrospectively in order to identify the results of interscalene block performed after induction of general anaesthesia, but before the start of surgery. Patients were kept in hospital for 24 h and assessed before being discharged from the hospital and again in the period from 4 to 8 weeks after surgery. Duration of the block, quality of postoperative pain relief and neurological complications were recorded. RESULTS: Our study failed to reveal any permanent or long-term neurological complications attributable to interscalene block performed after induction of general anaesthesia. CONCLUSION: It is our opinion that the primary factor for safe interscalene block is modification of the anaesthetic technique rather than the timing of regional block in relation to induction of general anaesthesia.
PMID: 15816588 [PubMed - in process]
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Serum creatinine and perioperative outcome--a matched-pairs approach using computerised anaesthesia records.
Dehne MG, Junger A, Hartmann B, Quinzio L, Rohrig R, Benson M, Hempelmann G.
University Hospital Giessen, Department of Anesthesiology, Intensive Care Medicine, and Pain Therapy, Giessen, Germany.
BACKGROUND AND OBJECTIVE: A study was designed to utilise the resources of our computerised anaesthesia record keeping system to assess the attributable effects of increased preoperative creatinine (> 1.3 mg dL(-1)) on outcome in patients undergoing non-cardiac surgery. METHODS: This retrospective study was based on data sets of 58 458 patients recorded with a computerised anaesthesia record keeping system over a period of 4 yr at a tertiary care university hospital. Cases were defined as patients with a preoperative creatinine > 1.3 mg dL(-1); controls (creatinine < or = 1.3 mg dL(-1)) were selected and automatically matched according to several parameters (ASA physical status, high risk and urgency of surgery, age and gender) in a stepwise fashion. Main outcome measures were hospital mortality and the incidence of intraoperative cardiovascular events. RESULTS: Three-thousand-and-twenty-eight patients (5.2%) had preoperative creatinine values > 1.3 mg dL(-1). Matching was successful for 54.5% of the cases, leading to 1649 cases (mean creatinine 3.3 +/- 2.2 mg dL(-1)) and 1649 controls (1.0 +/- 0.2 mg dL(-1)). The crude mortality rates for the cases and matched controls were 2.2% (n = 36) and 0.9% (n = 15), respectively (P = 0.003). Intraoperative cardiovascular events were found in 30.1% of the patients (n = 496) and in 28.3% of the matched controls (n = 466; P = 0.25, power = 0.46). Using logistic regression analyses a significant association between preoperative increased creatinine and hospital mortality was found (odds ratio 2.62; 95% confidence interval [1.39; 4.931). CONCLUSIONS: An increased preoperative serum creatinine in patients undergoing non-cardiac surgery is associated with an increased perioperative risk, but not with a higher incidence of intraoperative cardiovascular events.
PMID: 15816585 [PubMed - in process]
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Thoracic epidural analgesia for coronary artery surgery. A bridge too far?
Kamming D, Davies W.
Publication Types:
PMID: 15816584 [PubMed - in process]
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The laryngeal mask airway (LMA) in paediatric ophthalmic anaesthesia practice.
Balkan BK, Gunenc F, Iyilikci L, Gokel E, Yaman A, Berk AT.
Publication Types:
PMID: 15816583 [PubMed - in process]
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Comparison of three modes of patient-controlled epidural analgesia during labour.
Siddik-Sayyid SM, Aouad MT, Jalbout MI, Zalaket MI, Mouallem MR, Massouh FM, Rizk LB, Maarouf HH, Baraka AS.
American University of Beirut, Department of Anesthesiology, Beirut, Lebanon.
BACKGROUND AND OBJECTIVES: This study compares three modes of patient-controlled epidural analgesia in parturients during labour. METHODS: Eighty-four women were randomized to one of three groups. The epidural solution used in all the three groups was 0.1% bupivacaine with fentanyl 2 microg mL(-1). Patients were able to self administer a demand dose of 3 mL with a lockout interval of 6 min in Group A, 6 mL with a lockout interval of 12 min in Group B and 9 mL with lockout interval of 18 min in Group C. All patients received a background infusion at a rate of 6 mL h(-1). Visual analogue pain scores, pinprick analgesia and motor block were assessed hourly by a blinded observer. The physician-administered supplementation and the cumulative dose of bupivacaine were also compared between the three groups. RESULTS: Pain scores, sensory level and motor block were not different among the study groups. Patients' satisfaction was rated good to excellent with no difference among groups. The cumulative dose of bupivacaine was not significantly different. However, there was a trend towards a decreased need for rescue analgesia in Group C. Within each group, the physician-administered supplementations were significantly higher during the second stage of labour than during the first stage (P < 0.05). CONCLUSION: The three modes of patient-controlled epidural analgesia supplemented by a background infusion of 6 mL h(-1) were equally effective for labour analgesia with a trend for decreased rescue analgesia in the group with a larger bolus dose and a longer lockout interval.
PMID: 15816570 [PubMed - in process]
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Upper cervical vertebrae movement during intubating laryngeal mask, fibreoptic and direct laryngoscopy: a video-fluoroscopic study.
Sahin A, Salman MA, Erden IA, Aypar U.
Hacettepe University, Faculty of Medicine, Department of Anaesthesiology, Ankara, Turkey. asahin@hacettepe.edu.tr
BACKGROUND AND OBJECTIVE: Minimizing cervical vertebrae motion during endotracheal intubation is important in patients with cervical instability. The aim of this study was to compare upper cervical spine extension during endotracheal intubation using three different techniques. METHODS: Duration of intubation and movement of upper cervical vertebrae during endotracheal intubation were compared in 33 patients undergoing lumbar laminectomy. Patients requiring tracheal intubation under general anaesthesia and neuromuscular blockade were randomly allocated into three groups - direct laryngoscopy, intubating laryngeal mask (LM) airway and fibreoptic laryngoscopy. The procedure was recorded by video-fluoroscopy and analysed with computer-assisted measurements. The maximum movement of the C1/C2 and C2/C3 vertebrae during intubation were obtained. Data were analysed using one-way analysis of variance with Bonferroni and Kruskal-Wallis tests. RESULTS: We found statistically significant movement between the first and second, but not between the second and third cervical vertebrae. The mean (+/-SD) movement at C1/C2 was 10.2 +/- 7.3 degrees with direct laryngoscopy, 5.0 +/- 6.3 degrees with LM and 1.6 +/- 3.2 degrees with fibreoptic laryngoscopy. This difference was statistically significant (P = 0.01) between the direct and fibreoptic laryngoscopy groups. The maximum movement at C2/C3 was 2.2 +/- 10.1 degrees with direct laryngoscopy, 3.5 +/- 5.1 degrees with LM and 0.5 +/- 3.2 degrees with fibreoptic laryngoscopy. Duration of intubation was significantly longer in the intubating LM group (P < 0.001). CONCLUSION: We conclude that fibreoptic laryngoscopy is the more suitable intubation technique when cervical spine movement is not desired.
Publication Types:
- Clinical Trial
- Randomized Controlled Trial
PMID: 15678738 [PubMed - indexed for MEDLINE]
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Remifentanil vs. alfentanil infusion in non-paralysed patients: a randomized, double-blind study.
Mortensen CR, Larsen B, Petersen JA, Rotboll P, Riist J, Thorshauget H, Engbaek J, Troelsen S, Viby-Mogensen J.
Copenhagen University Hospital, Centre of Head and Orthopaedics, Department of Anaesthesia and Operating Theatre Services, Rigshospitalet, Copenhagen, Denmark. crm@rh.dk
BACKGROUND AND OBJECTIVE: Remifentanil has a short duration of action and constant elimination, which allow administration of high doses, without prolonging recovery. Remifentanil has been compared to alfentanil, as part of a total intravenous anaesthetic technique, where remifentanil provided better anaesthetic conditions than alfentanil, without adverse effect on recovery. However, these results were obtained during anaesthesia involving neuromuscular blockade, which may mask both signs of insufficient anaesthesia and side-effects such as muscle rigidity. The aim of this study was to compare remifentanil with alfentanil for anaesthesia without neuromuscular blockade. METHODS: We performed a prospective, randomized, double-blind, four-centre study to compare remifentanil infusion 15 microg kg(-1) h(-1) and alfentanil infusion 60 microg kg(-1) h(-1), using a total intravenous technique for non-paralysed patients, and the laryngeal mask airway for airway management. We enrolled 192 patients, 18-65 yr of age with ASA I-II, undergoing minor surgery. The primary endpoint was the number of patients having pre-defined responses to surgical stimulation. A number of secondary criteria was evaluated to assess undesirable properties of the procedures. RESULTS: In the alfentanil group, 85% of patients responded to surgical stimulation, vs. 35% in the remifentanil group (P < 0.0001). No difference was found in recovery data, or in any other parameter than those related to insufficient anaesthesia. CONCLUSIONS: The remifentanil-based technique provided significantly better anaesthetic conditions than the alfentanil-based technique in the setting of this study, without causing any significant adverse effects.
Publication Types:
- Clinical Trial
- Multicenter Study
- Randomized Controlled Trial
PMID: 15678733 [PubMed - indexed for MEDLINE]
Isoallopregnanolone; an antagonist to the anaesthetic effect of allopregnanolone in male rats.
Backstrom T, Wahlstrom G, Wahlstrom K, Zhu D, Wang MD.
Umea Neurosteroid Research Center, Department of Clinical Science, Obstetrics and Gynaecology, Umea University, Umea, Sweden; Umea Neurosteroid Research Center, Department of Pharmacology and Clinical Neuroscience, Umea University, Umea, Sweden.
The interaction of isoallopregnanolone (3beta-OH-5alpha-pregnan-20-one) on allopregnanolone (3alpha-OH-5alpha-pregnan-20-one) induced anaesthesia was studied in male rats using burst suppression of 1 s ("silent second") with an electroencephalographic-threshold method. The i.v. administration of isoallopregnanolone was varied in relation to induction of "silent second". Pre-treatment with isoallopregnanolone (12.5-50 mg/kg iv) 2 min prior to the threshold test gave an increase in the threshold dose of allopregnanolone (ANOVA df(3;36), F=13.61, P<0.001), which was dose dependent (r=0.73, b [slope]=0.08, df=38, P<0.001). After isoallopregnanolone pre-treatment, but not in the controls, anaesthesia time was positively related to the dose of allopregnanolone (r=0.52, b=1.72, df=28, P<0.01). Anaesthesia times were not influenced by a corresponding administration of isoallopregnanolone immediately after induction of "silent second". When allopregnanolone and isoallopregnanolone were infused together at molar ratios of 1:1, 1:1.23, 1:1.43, a linear increase of the threshold doses of allopregnanolone was seen in relation to the dose of isoallopregnanolone (r=0.86, b=0.40, df=8, P<0.01). Thus isoallopregnanolone can antagonise the anaesthetic action of allopregnanolone.
PMID: 15814085 [PubMed - in process]
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