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Items 1 - 35 of 35 |
One page. |
Anaesthesia for vegetarians.
Navarange S, Rathinam S, Makker R, Butler A.
PMID: 15819785 [PubMed - in process]
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Shipman and the anaesthetist.
Vickers M, Harmer M.
PMID: 15819774 [PubMed - in process]
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Effect of low dose inhaled anaesthetic agents on the ventilatory response to carbon dioxide in humans: a quantitative review.
Pandit JJ.
Consultant Anaesthetist, Nuffield Department of Anaesthetics, John Radcliffe Hospital, Oxford OX3 9 DU, UK.
Summary This paper reviews published studies (identified by a Medline-assisted search) on the effect of </= 0.2 minimum alveolar concentration inhaled anaesthetic agents on the hypercapnic ventilatory response in healthy subjects. Each article was examined for the anaesthetic agent used, whether CO(2) was administered using a rebreathing or a steady state (step hypercapnia) technique, and subject arousal (by audiovisual stimulation or by pain). Analysis of variance was used to assess the influence of each of these factors on the standardised hypercapnic response (the hypercapnic ventilatory response in l.min(-1).kPa(-1) in the presence of anaesthetic, expressed as a fraction of the response without anaesthetic). There were 21 separate studies embedded within 14 published articles. When considered together, the effect of anaesthetics on the hypercapnic ventilatory response was not significant (p = 0.089). Furthermore, when each agent was considered separately, no agent alone had a significant effect on the hypercapnic response. Neither subject arousal (p = 0.396) nor the method used to induce hypercapnia (p = 0.625) had any significant influence on the response. This suggests that the hypercapnic response is more resistant to the effects of anaesthetics than the hypoxic ventilatory response. These results indicate areas for future work. It would seem important to identify the cellular mechanisms which might underlie the difference in hypercapnic and hypoxic responses, and possible ways in which subject arousal might interact in the brain with the chemoreflexes.
PMID: 15819767 [PubMed - as supplied by publisher]
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A comparison of intrathecal fentanyl and diamorphine as adjuncts in spinal anaesthesia for Caesarean section.
Lane S, Evans P, Arfeen Z, Misra U.
Senior Registrar, Intensive Care, St George Hospital, Belgrave St, Kogarah, Sydney, NSW 2217, Australia.
Summary This randomised controlled trial examines the effects of fentanyl and diamorphine, alone and in combination, as adjuncts to spinal anaesthesia for Caesarean section. Ninety-nine women undergoing elective Caesarean section with spinal anaesthesia using 0.5% hyperbaric bupivacaine were randomly allocated to receive fentanyl 15 mug (F), diamorphine 0.25 mg (D), or fentanyl 15 mug plus diamorphine 0.25 mg (FD), intrathecally. All women received morphine via a patient controlled analgesia system after surgery. There was no significant difference between the groups in time to achieve a block, discomfort, ephedrine use, nausea and vomiting, pruritus and sedation during surgery. Significant differences were observed in morphine consumption 4, 8, 12 and 24 h after surgery between both F and D groups, and F and FD groups, and also at 2 h between F and FD groups. There was a significant difference in pruritus at 4 h between the F and FD group. Our results suggest that diamorphine alone provides optimum benefits during and after surgery, when used in combination with hyperbaric bupivacaine for Caesarean section.
PMID: 15819765 [PubMed - in process]
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Physostigmine for the prevention of postanaesthetic shivering following general anaesthesia - a placebo-controlled comparison with nefopam.
Rohm KD, Riechmann J, Boldt J, Schuler S, Suttner SW, Piper SN.
Senior House Officer, Department of Anaesthesiology and Intensive Care Medicine, Klinkum Ludwigshafen, Germany.
Summary Physostigmine was studied for its efficacy in the prevention of postanaesthetic shivering compared to nefopam and placebo. We studied 89 patients undergoing abdominal and urological surgery. The study was randomised and double-blind, the patients received physostigmine 2 mg (n = 31), nefopam 10 mg (n = 30) or saline (n = 28). Haemodynamic parameters and temperature were measured at induction of anaesthesia (T0), and 5 min (T1), 15 min (T2), 30 min (T3) and 60 min (T4) after reaching the postanaesthetic care unit (PACU). Significantly less shivering occurred following administration of physostigmine and nefopam (9.7 and 3.3%) compared to placebo (53.6%). The degree of shivering was also significantly reduced following physostigmine and nefopam (p < 0.01). Extubation time, haemodynamic parameters and tympanic temperature were found to be similar in all groups. Aldrete score, duration of PACU stay and postoperative analgesic requirements did not differ between the groups. Only nefopam significantly (p < 0.01) reduced postoperative nausea and vomiting. Physostigmine is a safe alternative to nefopam, significantly reducing the incidence and severity of postanaesthetic shivering without affecting postanaesthetic recovery.
PMID: 15819761 [PubMed - in process]
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Anaesthetists and Sedation in the Radiology Department: Involved or left behind?
Peden CJ.
PMID: 15819759 [PubMed - in process]
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Calibration of vaporisers.
Gorelov V.
Publication Types:
PMID: 15766360 [PubMed - indexed for MEDLINE]
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Snippet. (epidural anesthesia techniques).
Yentis SM, Barnes PK.
Magill Department of Anaesthesia, Intensive Care & Pain Management, Chelsea & Westminster Hospital, London. s.yentis@imperial.ac.uk
PMID: 15766345 [PubMed - indexed for MEDLINE]
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Randomised, crossover comparison of the single-use SoftSeal and the LMA Unique laryngeal mask airways.
Paech MJ, Tweedie O, Stannard K, Hepp M, Dodd P, Daly H, Bennett EJ, Millard A, Doherty DA.
Department of Anaesthesia and Pain Medicine, School of Medicine and Pharmacology, University of Western Australia, Perth, Western Australia, Australia. michael.paech@health.wa.gov.au
We performed a randomised, crossover, single-blind trial among 168 patients, to compare the single-use SoftSeal and LMA Unique laryngeal mask airways in spontaneously breathing adults. Size-3 and -4 laryngeal mask airways, inserted by experienced anaesthetists, performed equivalently for successful first-time placement (148 (91%) vs 155 (96%) for the SoftSeal and LMA Unique, respectively). The SoftSeal was more often rated as difficult to insert (27 (17%) vs 4 (3%); p < 0.001) and was more likely to show evidence of mucosal trauma after the first insertion (14 (10%) vs 5 (4%); OR 1.3 (95% CI 1.3-11.3); p < 0.05). The fibreoptic view of the larynx was better through the SoftSeal (vocal cords not visible in 27 (17%) vs 44 (27%); p < 0.05) and it more frequently provided a ventilation seal at 20 cmH(2)O (93 (59%) vs 62 (39%); OR 2.15 (CI 1.44-3.21); p < 0.001). In contrast to the LMA Unique(trade mark), its cuff pressure did not increase during nitrous oxide anaesthesia (median (IQR [range]) decrease 3 (- 20-23 [-40-94]) cmH(2)O vs increase of 16 (-2-39 [-54-112]) cmH(2)O; p < 0.01). Both devices were equivalent for the success of first-time insertion and performed satisfactorily clinically. There were some performance differences, but either appears suitable for airway management in spontaneously breathing patients.
Publication Types:
- Clinical Trial
- Randomized Controlled Trial
PMID: 15766338 [PubMed - indexed for MEDLINE]
Subdural empyema combined with paraspinal abscess after epidural catheter insertion.
Volk T, Hebecker R, Ruecker G, Perka C, Haas N, Spies C.
Publication Types:
PMID: 15781569 [PubMed - indexed for MEDLINE]
Comment on:
Lightwand-assisted intubation of patients in the lateral decubitus position.
Dimitriou V, Brimacombe J, Voyagis GS, Iatrou C.
Publication Types:
PMID: 15781565 [PubMed - indexed for MEDLINE]
Comment on:
Identification of the epidural space.
Halpern S, Angle P.
Publication Types:
PMID: 15781562 [PubMed - indexed for MEDLINE]
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Bronchoconstriction induced by carotid sinus stimulation during radical neck dissection.
Kido K, Shimoda H, Takahashi M.
Publication Types:
PMID: 15781559 [PubMed - indexed for MEDLINE]
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Reflex vagal withdrawal after sympathetic blockade.
Introna RP, Blair JR, Martin DC.
Publication Types:
PMID: 15781557 [PubMed - indexed for MEDLINE]
Comment on:
Asleep at the wheel?
Lang SA.
Publication Types:
PMID: 15781550 [PubMed - indexed for MEDLINE]
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A comparison of sevoflurane-propofol versus sevoflurane or propofol for laryngeal mask airway insertion in adults.
Siddik-Sayyid SM, Aouad MT, Taha SK, Daaboul DG, Deeb PG, Massouh FM, Muallem MR, Baraka AS.
Department of Anesthesiology, American University of Beirut Medical Center, PO Box 11 0236 Beirut, Beirut, Lebanon. ss01@aub.edu.lb
In a prospective, randomized study, we investigated the incidence of successful insertion of laryngeal mask airway (LMA) at the first attempt and the incidence of side effects after LMA insertion using the combination of sevoflurane and propofol as compared with either sevoflurane or propofol alone for induction of anesthesia. Eighty-three unpremedicated ASA physical status I-II patients were anesthetized with a single vital capacity breath (VCB) of sevoflurane 8% supplemented with IV propofol 1.5 mg/kg, a single VCB of sevoflurane 8%, or IV propofol 3 mg/kg. The coinduction technique was associated with the most frequent incidence of successful LMA insertion at the first attempt (93.5%) than either sevoflurane alone (46%) or propofol alone (61.5%) (P < 0.001). Propofol-induced induction of anesthesia allowed the fastest insertion of LMA and was associated with the least frequent incidence of postoperative nausea and vomiting. However, this advantage of propofol was offset by a frequent incidence of pain on injection (69%) and the occurrence of movements during insertion of the LMA (50% in the propofol group versus 19% and 26% in the sevoflurane and sevoflurane-propofol groups, respectively; P < 0.05), as well as a more frequent incidence of apnea (84% in the propofol group versus 7% and 16% in the sevoflurane and sevoflurane-propofol groups, respectively; P < 0.001). The report shows that induction of anesthesia with sevoflurane-propofol combined provides a frequent incidence of successful LMA insertion at the first attempt that is associated with an infrequent incidence of apnea.
Publication Types:
- Clinical Trial
- Randomized Controlled Trial
PMID: 15781547 [PubMed - indexed for MEDLINE]
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The effects of cricoid pressure, remifentanil, and propofol on esophageal motility and the lower esophageal sphincter.
Thorn K, Thorn SE, Wattwil M.
Department of Anesthesiology and Intensive Care, Orebro University Hospital, 701 85 Orebro, Sweden. kristian.thorn@orebroll.se
Cricoid pressure is the gold standard during the induction of anesthesia when there is a risk of aspiration of gastric contents. However, the effect of cricoid pressure during the different steps of complete anesthesia induction has not been studied. The purpose of this study was to investigate the effects of cricoid pressure, remifentanil, and propofol on lower esophageal sphincter (LES) and esophageal motility. We recorded LES pressure (LESP) and calculated barrier pressure ([BrP] = LESP - gastric pressure) in 10 healthy volunteers using a Dent sleeve device. There was a significant decrease in LESP and BrP when a cricoid pressure of 30 N was performed in the awake volunteers (P < 0.05). However, this effect was not seen during the infusion of remifentanil 0.2 microg . kg(-1) . min(-1). Remifentanil per se or together with a bolus dose of propofol 1 mg/kg IV did not induce any statistical change in LESP or BrP. Remifentanil abolished spontaneous esophageal motility and completely eliminated the experience of discomfort induced by cricoid pressure. In conclusion, cricoid pressure of 30 N induced a decrease of LESP and BrP in awake volunteers. These effects were not seen during the remifentanil infusion. This shows the importance of when to apply cricoid pressure during rapid-sequence induction.
PMID: 15781546 [PubMed - indexed for MEDLINE]
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The effects of stellate ganglion block on visual evoked potential and blood flow of the ophthalmic and internal carotid arteries in patients with ischemic optic neuropathy.
Liu F, Xu G, Liu Z, Zhao Y, Lv X, Wang J.
Department of Anesthesiology, The First Affiliated Hospital of China Medical University, Shenyang, 110001, China. liufeng024@yahoo.com.cn
Ischemic optic neuropathy (ION) is a common disease that can cause a loss of visual acuity in the elderly. We treated ION patients with stellate ganglion block (SGB) and investigated its effects on picture visual evoked potential (P-VEP) and blood flow in the ophthalmic artery (OA) and internal carotid artery (ICA). Twelve ischemic eyes in 12 patients diagnosed by the same ophthalmologist were investigated in this study. All patients were treated with daily SGB on the affected side with 2-3 mL of 2% lidocaine for a treatment period of 10-15 days. In ION eyes before SGB, compared with healthy eyes, the latency of P-VEP P(100) was delayed (123 +/- 14 ms versus 98 +/- 3 ms; P < 0.05), and the amplitude was reduced (4.24 +/- 1.76 microV versus 10.26 +/- 4.09 microV; P < 0.05). After SGB, the latency and amplitude returned to normal (103 +/- 6 ms versus 98 +/- 3 ms; 10.43 +/- 4.88 microV versus 10.26 +/- 4.09 microV; P > 0.05). Before treatment, the blood flow velocities of the OA and the ICA on the ischemic side were slow and the resistance indexes were high, but SGB reduced these changes. SGB did not affect the OA and the ICA on the healthy side. We conclude that SGB improves P-VEP and OA and ICA blood flow in ION eyes. Further studies are needed to confirm that this is an effective method for the treatment of ION.
PMID: 15781544 [PubMed - indexed for MEDLINE]
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A magnetic resonance imaging analysis of the infraclavicular region: can brachial plexus depth be estimated before needle insertion?
Cornish PB, Nowitz M.
Department of Anaesthesia, Nelson Hospital, Nelson, New Zealand. philip.cornish@nmhs.govt.nz
In this study we examined the anatomy of the infraclavicular region to assess the possibility of estimating brachial plexus depth before performing an infraclavicular block, by using readily identifiable landmarks such as the coracoid process (CP) and the clavicle (CL). Four parasagittal planes across the infraclavicular region were analyzed in 21 individual series of magnetic resonance imaging studies. Measurements included distance to the plexus from the skin of the anterior chest wall, position of the plexus relative to the CL, and clavicular width. The brachial plexus is located directly below the CL in the parasagittal plane 1 cm medial to the CP. If one inserts a needle in this same plane at a point in line with the inferomedial edge of the CP, then plexus depth can be estimated as follows. If the needle is raised, as a whole, straight up from the planned point of insertion to be level with the top of the CL, then the distance from the tip of the needle to a point midway across the width of the CL is equivalent to the distance from the insertion point to the plexus. Furthermore, not only is it uncommon to find the lung in this same parasagittal plane, but when it does appear, it is well behind the plexus. Estimating plexus depth, or "depth gauging," in the infraclavicular region is achievable and is a potentially useful strategy. Further study is required to confirm this finding in the clinical environment.
PMID: 15781542 [PubMed - indexed for MEDLINE]
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The effects of clonidine added to mepivacaine for paronychia surgery under axillary brachial plexus block.
Iohom G, Machmachi A, Diarra DP, Khatouf M, Boileau S, Dap F, Boini S, Mertes PM, Bouaziz H.
Department of Anesthesiology and Intensive Care Medicine, Nancy University Hospitals, Nancy Cedex, France.
We hypothesized that onset of sensory block is delayed in infected versus healthy tissues within the same nerve distribution after axillary brachial plexus block (ABPB) and that clonidine added to mepivacaine would enhance anesthesia and postoperative analgesia. Forty-one outpatients undergoing thumb/index paronychia surgery under ABPB were randomly assigned to receive in a double-blind fashion 400 mg mepivacaine plus either 100 microg clonidine (clonidine group, n = 21) or 2 mL saline (placebo group, n = 20). Onset of sensory block in the infected area was delayed compared with healthy areas of the same nerve distribution (24.7 +/- 5.5 min versus 21.3 +/- 7.2; P = 0.02 for median and 21.6 +/- 7.8 min; P = 0.04 for radial) within the placebo group. In the clonidine group, when compared to placebo i) onset of sensory block in both the median and radial nerve territories was accelerated (11.1 +/- 5.6 and 10.5 +/- 5.2 versus 21.3 +/- 7.2 and 21.6 +/- 7.8 min, respectively; P < 0.001), ii) onset of sensory block in the region of infection was accelerated (9.1 +/- 1.9 versus 24.7 +/- 5.5 min; P < 0.001), iii) duration of anesthesia (275 +/- 75 versus 163 +/- 57; P = 0.04) and time to first analgesic requirement (279 +/- 87 versus 197 +/- 84 min; P = 0.002) were prolonged with decreased visual analog scale scores at this time (30 +/- 18 versus 70 +/- 24; P < 0.001), and iv) verbal numeric rating scores were decreased at 24 h (1.7 +/- 2.2 versus 4.1 +/- 3.0; P = 0.002) and 48 h (0.1 +/- 0.5 versus 1.5 +/- 2.4; P = 0.01) postoperatively. Our findings suggest that in the setting of distal infected tissue surgery under ABPB infected tissues are resistant to anesthesia compared with healthy areas within the same nerve distribution and clonidine added to mepivacaine enhances both anesthesia and postoperative analgesia.
Publication Types:
- Clinical Trial
- Randomized Controlled Trial
PMID: 15781541 [PubMed - indexed for MEDLINE]
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Interscalene brachial plexus block with bupivacaine and ropivacaine in patients with chronic renal failure: diaphragmatic excursion and pulmonary function changes.
Altintas F, Gumus F, Kaya G, Mihmanli I, Kantarci F, Kaynak K, Cansever MS.
Department of Anesthesiology, Metabolism Division Laboratory, Istanbul University Cerrahpasa Medical School, Istanbul, Turkey. fatisaltintas@hotmail.com
In this randomized, double-blind study, we compared the anesthetic characteristics and pulmonary function changes of 0.33% bupivacaine and 0.33% ropivacaine used for interscalene brachial plexus (IBP) anesthesia in patients with chronic renal failure. Forty-two patients undergoing IBP anesthesia for creation of arteriovenous fistulas were randomly allocated to receive either 30 mL of 0.33% bupivacaine (Group B) or 0.33% ropivacaine (Group R). Block onset time, diaphragmatic excursion (ultrasonographic evaluation), and free plasma concentrations of bupivacaine and ropivacaine were evaluated. Negative motion or immobility of the ipsilateral hemidiaphragm and a decrease of >10 mm in positive motion were defined as diaphragmatic paresis. The pulmonary function variables were measured by bedside spirometry equipment. Seven patients needed supplemental local anesthetic, one with total spinal block; these patients were excluded from the study. The success rate was 80.9%. Block quality was similar in the two groups. Ipsilateral hemidiaphragmatic excursion was decreased in both groups compared with baseline values (P < 0.05). Diaphragmatic paresis was identified in 10 of 16 patients and 8 of 18 patients in Groups B and R, respectively (P > 0.05). Pulmonary function significantly decreased from baseline in both groups (forced vital capacity (FVC) 30%, forced expiratory volume at 1 second (FEV(1)) 32%, and peak expiratory flow (PEF) 31% in Group B and FVC 17%, FEV(1) 17%, and PEF 5% in Group R) (P < 0.001). The decreases in Group B were larger than those in Group R (P < 0.05). Three patients in Group B and one in Group R had mild respiratory problems (P > 0.05). Concentrations of bupivacaine and ropivacaine were below toxic levels rather than "normal range." We conclude that pulmonary function decreased more after IBP with 0.33% bupivacaine than with 0.33% ropivacaine.
Publication Types:
- Clinical Trial
- Randomized Controlled Trial
PMID: 15781539 [PubMed - indexed for MEDLINE]
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The effect of posture and baricity on the spread of intrathecal bupivacaine for elective cesarean delivery.
Hallworth SP, Fernando R, Columb MO, Stocks GM.
Department of Anesthetics, Royal Free Hospital, Pond Street, London NW3 2QG, United Kingdom.
Posture and baricity during induction of spinal anesthesia with intrathecal drugs are believed to be important in determining spread within the cerebrospinal fluid. In this double-blind prospective study, 150 patients undergoing elective cesarean delivery were randomized to receive a hyperbaric, isobaric, or hypobaric intrathecal solution of 10 mg bupivacaine during spinal anesthesia induced in either the sitting or right lateral position. After an intrathecal injection using a combined-spinal technique patients were placed in the supine wedged position. We determined the densities of the three intrathecal solutions from a previously validated formula and measured using a DMA-450 density meter. Data collection included sensory level, motor block, episodes of hypotension, and ephedrine use. Statistical analysis included analysis of variance and Cuzick's trend. In the lateral position, baricity had no effect on the spread of sensory levels for bupivacaine compared to the sitting position, where there was a statistically significant difference in spread with the hypobaric solution producing higher levels of analgesia than the hyperbaric solution (P = 0.002). However, the overall differences in maximal spread only differed by one dermatome, with the hyperbaric solution achieving a median maximum sensory level to T3 compared with T2 for the isobaric and hypobaric solutions. Motor block was significantly (P = 0.029) reduced with increasing baricity and this trend was significant (P = 0.033) for the lateral position only. Hypotension incidence and ephedrine use increased with decreasing baricity (P = 0.003 and 0.004 respectively), with the hypobaric sitting group having the most frequent incidence of hypotension (76%) as well as cervical blocks (24%; P = 0.032).
Publication Types:
- Clinical Trial
- Randomized Controlled Trial
PMID: 15781538 [PubMed - indexed for MEDLINE]
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Intrathecal neostigmine prevents intrathecal clonidine from attenuating hypercapnic cerebral vasodilation in rabbits.
Takenaka M, Iida H, Iida M, Sumi K, Kumazawa M, Tanahashi S, Dohi S.
Department of Anesthesiology and Pain Medicine, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu City, Gifu 501-1194, Japan.
We previously demonstrated that lumbar intrathecal alpha(2) agonists attenuate hypercapnia-induced cerebral vasodilation. The combination of intrathecal clonidine and neostigmine is being investigated as pain therapy. The effects of their combination on cerebrovascular reactivity are unknown. We allocated rabbits anesthetized with pentobarbital to two groups: (a) clonidine (normal saline followed 30 min later by clonidine 2 microg/kg, both into the lumbar intrathecal space; n = 6), and (b) neostigmine-pretreatment (neostigmine 2 microg/kg followed 30 min later by clonidine 2 microg/kg, both into the lumbar intrathecal space; n = 6). We then evaluated the hypercapnia-induced changes in pial arteriolar diameter in these two groups using the closed cranial window preparation. The pial arteriolar dilator response to hypercapnia was significantly attenuated in the clonidine group (14% +/- 4%, 4% +/- 4%, 6% +/- 6%, and 5% +/- 7% for before and 30, 60, and 90 min, respectively). Neither normal saline nor neostigmine alone induced any change in the cerebral reactivity to hypercapnia. Pretreatment with neostigmine completely prevented the clonidine-induced attenuation of the hypercapnic cerebral vasodilation attenuated by intrathecal clonidine (16% +/- 7%, 15% +/- 6%, 12% +/- 6%, and 16% +/- 8%, respectively).
PMID: 15781525 [PubMed - indexed for MEDLINE]
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Surgical field fire during a repair of bronchoesophageal fistula.
Singla AK, Campagna JA, Wright CD, Sandberg WS.
Department of Anesthesia and Critical Care, Massachusetts General Hospital, Harvard Medical School, Boston, USA.
Most surgical fires involve the airway but they can also occur in the surgical field. Herein, we report an intraoperative fire in the surgical field during repair of a bronchoesophageal fistula. During the portion of the surgery after the fistula was divided and the bronchus was open to atmosphere, continuous positive airway pressure was applied to the nondependent lung, and in conjunction with the use of electrocautery and dry sponges in the field, resulted in a fire. Anesthesia for thoracic surgery carries unique risks of fire because these patients frequently require large oxygen concentrations, special interventions for improving oxygenation, and have variable degrees of airway disruption. This report highlights unique safety concerns during anesthesia for thoracic surgery, and addresses more general safety issues relating to fire risk in all surgical patients.
Publication Types:
PMID: 15781523 [PubMed - indexed for MEDLINE]
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A comparison of bispectral index and entropy, or how to misinterpret both.
Soto R, Nguyen TC, Smith RA.
Department of Anesthesiology, University of South Florida College of Medicine, Tampa, FL 33612, USA. rsoto@hsc.usf.edu
Consciousness monitoring has become increasingly popular in general anesthesia cases, and a new technology has recently been introduced with potential advantages over the other available products. In this case report, we discuss a patient who was monitored simultaneously with Bispectral Index and Entropy and evaluate the differences between the two. More importantly, we emphasize the importance of vigilance when using new technologies and discuss the potential impact of lack of vigilance on patient outcome.
Publication Types:
PMID: 15781522 [PubMed - indexed for MEDLINE]
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Preventing the withdrawal response associated with rocuronium injection: a comparison of fentanyl with lidocaine.
Ahmad N, Choy CY, Aris EA, Balan S.
Clinical Anesthesiology Specialist, Hospital Sultanah Aminah, Johor Bahru, Malaysia. dr_ezalee@time.net.my
We compared the efficacy of IV fentanyl with IV lidocaine as pretreatment for the prevention of withdrawal response after rocuronium injection. For this prospective, randomized, placebo-controlled, double-blind study we recruited 90 patients aged between 18 and 65 yr, ASA physical status I or II, who had undergone elective surgery requiring general anesthesia and positive pressure ventilation. Patients were randomly allocated to 1 of 3 groups: group F received 2 mL IV fentanyl 50 microg/mL (100 microg), group L received 2 mL of preservative-free lidocaine 2% (40 mg), and group P (placebo) received 2 mL of normal saline. The incidence of withdrawal response after rocuronium was 57%, 30%, and 7% in the placebo, lidocaine, and fentanyl groups, respectively. We found a significant reduction in incidence of withdrawal response in both the fentanyl and lidocaine groups when compared with the placebo group (P < 0.05), with the fentanyl group being most effective (P < 0.05). In conclusion, both fentanyl and lidocaine are effective clinical treatments to alleviate the withdrawal response associated with rocuronium injection, with fentanyl being more effective.
Publication Types:
- Clinical Trial
- Randomized Controlled Trial
PMID: 15781511 [PubMed - indexed for MEDLINE]
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The perioperative management of a patient with complex single ventricle physiology and pheochromocytoma.
Sparks JW, Seefelder C, Shamberger RC, McGowan FX.
Division of Periopertive Medicine, Department of Anesthesiology, Children's Hospital and Harvard Medical School, 300 Longwood Ave, Boston, MA 02115, USA.
Pheochromocytoma is associated with intense physiologic effects of alpha- and beta-adrenergic stimulation from catecholamine secretion. Perioperative management for these patients includes alpha-adrenergic receptor blockade, intravascular volume replacement, and, if necessary, beta-adrenergic receptor blockade. Significant perioperative changes in preload and afterload, fluid status, heart rate and rhythm, and inotropy can occur and may be contrary to anesthetic management goals for patients with certain conditions of congenital heart disease. We report the perioperative management with doxazosin of a patient with single ventricle physiology and cavo-pulmonary and aorto-pulmonary lung perfusion who presented for resection of a pheochromocytoma.
Publication Types:
PMID: 15781508 [PubMed - indexed for MEDLINE]
The early steps of chloroform anaesthesia in Turkey during the Ottoman Empire in the 19th century.
Ulman YI.
Cerrahpasa Medical Faculty, Department of Medical History and Ethics, Istanbul, Turkey. yesimul@yahoo.com
OBJECTIVE: The aim of this study was to research the pioneering steps for the employment of chloroform in Turkey in comparison with the developments in the West i.e. in the United States and in Europe. The development of anaesthesiology in the West started in the first half of the 19th century. As an anaesthetic substance, ether was first employed in a medical operation by R. Liston in December 1846. But taking into consideration of its bronchially irritant effect, British gynaecologist Dr. J.Y. Simpson preferred to utilize chloroform in obstetrical operations in 1847. The paper aims at shedding light on the earlier steps for modern anaesthesiology in Turkey in that sense. METHODS: The survey used evaluation of archival documents, first hand-original sources such as the annual medical reports of the Medical School, books, official journals, and newspapers of the time, and also secondary sources concerned with the subject. RESULTS: In view of the findings of the survey, chloroform, as an anaesthetic material, began to be administered surgically in Turkey much earlier than it was already known. It was experienced and used in operations at the surgical clinic of the Imperial School of Medicine at the Capital city, Istanbul in 1848. The Crimean War (1853-1855) induced to the prevalent surgical use of chloroform in Istanbul on the soldiers back from the front. In other words, it was evidenced that surgeons started to make use of this anaesthetic substance in the Ottoman Empire, shortly after it was put into medical practice in Europe. CONCLUSION: This study deals with that phenomenal progress of chloroform anaesthesia in the medical history in Turkey during the second half of the 19th century.
PMID: 15826788 [PubMed - in process]
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Delayed awakening from general anesthesia in a hypovolemic infant.
Fuzaylov G, Kim AH, Rosow CE.
PMID: 15828999 [PubMed - in process]
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Anesthetic management in Friedreich's ataxia.
Pancaro C, Renz D.
PMID: 15828998 [PubMed - in process]
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Anesthesia in a child with homozygous porphobilinogen deaminase deficiency: a severe form of acute intermittent porphyria.
Sheppard L, Dorman T.
Department of Anaesthesia, Sheffield Children's Hospital, Western Bank, Sheffield, UK.
Summary We report a case history of the anesthetic management of a child with a severe form of acute intermittent porphyria (AIP). AIP is an autosomal dominant condition with incomplete penetrance, caused by deficiency of porphobilinogen deaminase, an enzyme found in the synthetic pathway for heme. Anesthesia and surgery may present many precipitants for a potentially fatal acute porphyric attack. These include fasting, dehydration, stress, infection and drugs. Here, we describe the safe use of sevoflurane in the maintenance of anesthesia. Its relative insolubility and low metabolism suggest that sevoflurane may be a reasonable agent for anesthesia in the porphyric patient.
PMID: 15828996 [PubMed - in process]
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Induction of anesthesia in a combative child; management and issues.
Christiansen E, Chambers N.
Department of Anaesthesia, Princess Margaret Hospital For Children, Perth, WA, Australia.
Summary A developmentally delayed, 13-year old autistic boy required management of multifocal cerebral and pulmonary tumors, involving several anesthetics over a 4-month period. At each anesthetic he refused premedication, displayed increasing anxiety and became more combative. With parental guidance and involvement, a variety of anesthetists tried a range of techniques to achieve induction, each ultimately resorting to the use of physical restraint. Principles essential to the care of such a child include early recognition, parental support, multi-disciplinary planning of procedures requiring general anesthesia, continuity of anesthesia care, and clear guidelines about the perioperative management of uncooperative children, including the ethical use of restraint.
PMID: 15828995 [PubMed - in process]
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Combined propofol and remifentanil intravenous anesthesia for pediatric patients undergoing magnetic resonance imaging.
Tsui BC, Wagner A, Usher AG, Cave DA, Tang C.
Department of Anesthesiology and Pain Medicine, University of Alberta, Edmonton, Alberta, Canada.
Summary Background : A prospective observational case series of children receiving light general anesthesia for magnetic resonance imaging (MRI) was performed. Our purpose was to examine the merit of anesthesia and recovery/discharge times of combined remifentanil and propofol total intravenous anesthesia (TIVA) in spontaneously breathing children. Methods : After IRB approval and informed consent, 56 patients receiving Remi/Propofol TIVA (Remifentanil 10 mug.ml(-1) Propofol 10 mg.ml(-1)) were observed. Blood pressure, respiratory rate, endtidal CO(2) (P(E)CO(2)), oxygen saturation and temperature were recorded at the start and finish of anesthesia. In addition, induction and recovery times were noted. Recovery time was from scan completion until discharge from the initial recovery area. Discharge time was from scan completion to discharge home. Results : Fifty-six patients received Remi/Propofol TIVA. The mean Remi/Propofol recovery and discharge times were 8.9 and 28.2 min, respectively. There was a statistically significant decrease in respiratory rate and increase in CO(2) from the start to the end of the procedure. During the scan, seven patients moved. One patient experienced postprocedure nausea and or vomiting. Conclusions : The combination of remifentanil and propofol for TIVA may be an effective method of light general anesthesia in pediatric patients undergoing MRI.
PMID: 15828991 [PubMed - in process]
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Clinical assessment of the laryngeal tube in pediatric anesthesia.
Richebe P, Semjen F, Cros AM, Maurette P.
Department of Anaesthesiology 3, Hopital Saint Andre, Centre Hospitalier et Universitaire de Bordeaux, Bordeaux Cedex, France.
Summary Background : The aim of this study was to evaluate a new device for airway management in children: the laryngeal tube (LT(TM)). Methods : The LT(TM) is available in sizes S0-S3 for pediatric anesthesia. This prospective open study included 70 children ASA 1. The local Ethics Committee approval and parental consent were collected. The primary criterion was the success rate for insertion and ventilation. Secondary criteria were additional maneuvers and incidents elicited from LT use. Results : Seventy children were included: S0 = 5, S1 = 8, S2 = 36, and S3 = 21. Insertion was successful: at the first attempt in 78.6%, second in 17.1%, and third or more in 4.3%. In 12% of cases it was not possible to successfully insert the LT and proceed to adequate ventilation. Failures were explained by: inability to obtain satisfying ventilation (n = 4), hypoxemia (n = 1), gastric insufflation (n = 6), cough (n = 1), and laryngospasm or stridor (n = 2), some with the same child. Minimal additional maneuvers for adequate ventilation were necessary in 35% of cases (all groups), but <20% when considering only sizes 2 and 3. Moreover, after five cases, the anesthesiologists became more proficient at inserting the LT(TM) (respectively 73.3% failure before five cases vs 13% afterwards). Gastric insufflation occurred in eight cases (11.4%). Controlled ventilation was used in 30 children and peak inspiratory pressure was 19.2 +/- 4 cmH(2)O. Conclusions : The LT(TM) is not recommended for children <10 kg. Over 10 kg, it provides a clear airway in most children, with a low rate of minimal additional maneuvers for sizes 2 and 3. The failure rate also decreases with the operator's training.
PMID: 15828990 [PubMed - in process]
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Mask fear in children presenting for anesthesia: aversion, phobia, or both?
Przybylo HJ, Tarbell SE, Stevenson GW.
Departments of Anesthesia and Child Psychiatry, Children's Memorial Hospital, Chicago, IL, USA.
Summary Background : Anesthesia induction in children is commonly accomplished by introducing volatile agents by mask. Occasionally a child describes an excessive fear of the anesthesia facemask. Little is known of the cause of the fear or of the quality or magnitude of the feelings the child is experiencing. The purpose of this study was to allow children who have established mask fear as demonstrated by volunteering the presence of fear and requesting no mask be placed on the face during the induction of anesthesia and their parents to describe and compare the distress from the mask to the alternative intravenous anesthesia induction. Methods : Eight children describing mask fear on the preanesthetic examination were studied. An Anesthesia Mask Fear questionnaire developed by the investigators was answered by the children and their parents. Results : Six children and their parents completed the study. The age at presentation of mask fear ranged from 1.4 to 14 years. There were one to 16 anesthetic exposures prior to reporting mask fear. One child described an aversion to the odor of the mask. Another boy developed mask fear after a single anesthetic exposure. He was subsequently diagnosed with a generalized anxiety disorder. Four female children developed mask fear after repeated anesthetic exposures. These children rated mask fear with the greatest discomfort possible while venous cannulation was scored at half or less that of the mask discomfort. Conclusions : Care must be taken when developing a plan for anesthesia induction in children requiring multiple procedures. Children may develop an aversion to the odor or feel of the mask, or have a true phobia (irrational fear) of the mask. Those children with a phobia might also have other underlying anxieties.
PMID: 15828986 [PubMed - in process]
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