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When general anesthesia is required to remove an epidural catheter.
Fukuda T, Iijima S, Takayama N, Satsumae T, Saito S, Toyooka H.
PMID: 16326689 [PubMed - in process]
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Dry tap and spinal anesthesia.
Ramachandran K, Ponnusamy N.
PMID: 16326686 [PubMed - in process]
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General anesthesia for a patient with alternating hemiplegia of childhood.
Mehrotra R.
PMID: 16326684 [PubMed - in process]
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Awake cardiac surgery using a novel anesthetic technique: [Une nouvelle technique anesthesique pour la chirurgie cardiaque vigile].
Hemmerling TM, Noiseux N, Basile F, Noel MF, Prieto I.
Centre Hospitalier de l'Universite de Montreal (CHUM), Hotel-Dieu, Universite de Montreal, 3840, rue Saint-Urbain, Montreal, Quebec H2W 1T8, Canada. thomashemmerling@hotmail.com.
Purpose: We describe the first published cases of awake cardiac surgery in Canada. In addition, a novel anesthetic technique consisting of combined femoral block/high epidural thoracic anesthesia is presented.Clinical features: Two patients, both 65 yr of age and with good left ventricular function, were scheduled to undergo off-pump coronary artery bypass grafting (OPCAB) for two grafts each. Anesthesia consisted of combined femoral 3:1 block and high thoracic epidural anesthesia. Both surgeries proceeded without hemodynamic or respiratory complications; in both cases, opening of the pleural spaces was treated with insertion of thoracic drainage tubes. Both patients were transferred to the postanesthesia care unit immediately after surgery and six hours later to the cardiac surgical ward. Both patients were discharged from the hospital within five days of surgery.Conclusion: We conclude that awake OPCAB is feasible using a combined femoral block/high thoracic epidural anesthesia technique which allows cardiac surgery and harvesting of the saphenous vein. Further clinical experience is required to define the technical limitations of this technique before randomized studies should be undertaken to better define the role of awake procedures in the future of cardiac surgery.
PMID: 16326681 [PubMed - as supplied by publisher]
Pro: vascular stents in the radiology suite-an anesthesiologist is needed.
Ellis JE, Pai SS.
Department of Anesthesia and Critical Care, The University of Chicago, Chicago, IL 60637, USA. j-ellis@uchicago.edu
PMID: 16326311 [PubMed - in process]
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Effects of preemptive epidural analgesia on post-thoracotomy pain.
Bong CL, Samuel M, Ng JM, Ip-Yam C.
Department of Paediatric Anesthesia, KK Women and Childrens' Hospital, Singapore. cchia@doctors.org.uk
OBJECTIVE: The purpose of this study was to determine whether preemptive thoracic epidural analgesia (TEA) initiated before surgical incision would reduce the severity of acute post-thoracotomy pain and the incidence of chronic post-thoracotomy pain. METHOD: Meta-analysis of randomized controlled trials (RCTs). SEARCH STRATEGY: MEDLINE, the Cochrane Central Register of Controlled Trials (CENTRAL) and EMBASE were searched from 1966 to December 2004 for prospective RCTs published in all languages using the following MeSH terms: post-thoracotomy pain, epidural analgesia, chronic pain, and preemptive analgesia. SELECTION CRITERIA: All RCTs that compared thoracic epidural analgesia initiated before surgical incision (preemptive group) versus thoracic epidural analgesia initiated after completion of surgery (control group) in adult patients undergoing unilateral thoracotomy. MEASUREMENTS AND MAIN RESULTS: Three authors reviewed all citations and simultaneously extracted data on sample size, patient characteristics, surgical and analgesic interventions, methods of pain assessment, and pain scores at 24 hours, 48 hours, and 6 months postoperatively. Six studies were included with a total of 458 patients. Pooled analyses indicated that preemptive TEA was associated with a statistically significant reduction in the severity of acute pain on coughing at 24 and 48 hours (weighted mean difference -1.17 [95% confidence interval (CI) -1.50 to -0.83] and -1.08 [95% CI -1.17 to -0.99]), respectively. Acute pain was a good predictor of chronic pain. However, there was no statistically significant difference in the overall incidence of chronic pain at 6 months between the preemptive TEA group (39.6%) and the control group (48.6%). CONCLUSION: Preemptive TEA appeared to reduce the severity of acute pain but had no effect on the incidence of chronic pain.
PMID: 16326309 [PubMed - in process]
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Surgical interruption of patent ductus arteriosus in a child with severe aortic stenosis: anesthetic considerations.
Neema PK, Tambe S, Unnikrishnan M, Varma PK, Rathod RC.
Department of Anaesthesiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Kerala, India. neema@sctimst.ac.in
PMID: 16326308 [PubMed - in process]
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Thoracic epidural anesthesia and cardiac surgery: balancing postoperative risks associated with hematoma formation and thromboembolic phenomenon.
Chaney MA, Labovsky JK.
Department of Anesthesiology and Critical Care, University of Chicago, Chicago, IL 60637, USA. mchaney@dacc.uchicago.edu
PMID: 16326303 [PubMed - in process]
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Caudal anesthesia in pediatric cardiac surgery: does it affect outcome?
Leyvi G, Taylor DG, Reith E, Stock A, Crooke G, Wasnick JD.
Department of Anesthesiology, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY 10467, USA. gleyvi@montefiore.org
OBJECTIVE: The purpose of this study was to examine the influence of caudal anesthesia on outcomes (pediatric intensive care unit [PICU] length of stay, hospital length of stay, ventilatory time, early extubation rate) in pediatric patients undergoing congenital heart disease repair requiring cardiopulmonary bypass (CPB). DESIGN: Retrospective. SETTING: University teaching hospital. PARTICIPANTS: Pediatric patients undergoing surgery to treat congenital heart disease between 1999 and 2002. INTERVENTION: None. MEASUREMENTS AND MAIN RESULTS: Thirty-four patients with atrial septal defect (ASD), 37 with ventricular septal defect, and 46 with tetralogy of Fallot (TOF) were included in the analysis. No differences were found in preoperative and intraoperative data between caudal and noncaudal group for each disorder. There was no difference between caudal and noncaudal groups in PICU and hospital stay. A statistically significant difference was found in the postoperative ventilatory time in patients with ASD and TOF between caudal and noncaudal groups. The early extubation rate was higher in the TOF caudal group compared with the noncaudal group. CONCLUSIONS: This retrospective study demonstrated that postinduction placement of caudal anesthesia does not affect PICU or hospital length of stay. A well-controlled prospective study is needed to confirm these findings.
PMID: 16326297 [PubMed - in process]
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Combination of intrathecal morphine and remifentanil infusion for fast-track anesthesia in off-pump coronary artery bypass surgery.
Turker G, Goren S, Sahin S, Korfali G, Sayan E.
Department of Anesthesiology and Reanimation, Uludag University Medical School, Gorukle/Bursa, Turkey. gturker@uludag.edu.tr
OBJECTIVE: The purpose of this study was to assess the combination of intrathecal morphine and remifentanil infusion with isoflurane in off-pump coronary artery surgery, with a focus on postoperative analgesia and fast-tracking. DESIGN: Prospective, randomized, controlled, blinded clinical study. SETTING: University hospital. PARTICIPANTS: Forty-six patients who underwent elective off-pump coronary artery bypass grafting. INTERVENTIONS: Patients were randomly assigned to receive remifentanil infusion alone (control group, n = 23) or remifentanil infusion plus 10 microg/kg of intrathecal morphine (ITM group, n = 23). Induction and maintenance anesthesia were the same in both groups. Maintenance therapy was remifentanil infusion (0.25-1 microg/kg/min) and 0.5% to 1.5% isoflurane, with adjustments according to hemodynamics. After extubation, intravenous patient-controlled analgesia with morphine (1-mg bolus and 5-minute lockout) was administered, and Wilson sedation scores, visual analog pain scores (scale, 0-100 mm) at rest and during coughing, and cumulative morphine consumption were assessed at 1, 2, 4, 8, 12, 24, and 48 hours. Examiners were unaware of patients' group identities. Anesthetic recovery parameters and opioid-related, spinal anesthesia-related, and cardiac complications were recorded. MEASUREMENTS AND MAIN RESULTS: There were no differences between the groups' intraoperative hemodynamic or anesthetic recovery findings. Pain scores and morphine consumption were significantly lower in the ITM group at all time points after extubation (p = 0.0001-0.05). Group frequencies of opioid-related and cardiac complications were similar. No patient had central neuroaxial hematoma or post-spinal tap headache. CONCLUSION: In the setting of isoflurane anesthesia for off-pump coronary artery bypass grafting, ITM combined with remifentanil infusion provides better postoperative analgesia than does remifentanil infusion alone, and does not improve or negatively affect fast-tracking.
PMID: 16326292 [PubMed - in process]
Intranet setup of an anesthesia and critical medicine network connected to a biomedical grid.
Lanza V.
Department of Anesthesia, Ospedale Buccheri la Ferla Fatebenefratelli, Palermo, Italy. lanza@unipa.it
PMID: 16328951 [PubMed - in process]
Severe hepatotoxicity after sevoflurane anesthesia in a child with mild renal dysfunction.
Jang Y, Kim I.
Department of Anesthesiology and Pain Medicine, School of Medicine, Keimyung University, Daegu, Korea. weonjo@dsmc.or.kr
Sevoflurane, an anesthetic agent with methyl isopropyl fluorinated ether structure, has a very low potential for hepatotoxicity. Nevertheless, a few cases of hepatotoxicity have been reported since its introduction into clinical practice. The underlying pathophysiology may be multifactorial and sometimes nonspecific. We report a case of severe hepatotoxicity after anesthesia with sevoflurane in a child with preexisting mild renal dysfunction.
PMID: 16324041 [PubMed - in process]
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Moyamoya disease and anesthesia.
Baykan N, Ozgen S, Ustalar ZS, Dagcinar A, Ozek MM.
Department of Anaesthesia, Ozel Acibadem Hospital, Istanbul, Turkey.
Moyamoya disease is a condition that results from bilateral stenosis or obstruction of the intracranial arteries at the base of the brain. Patients exhibit ischemic symptoms, and vascular reconstruction is the therapy of choice. Surgical treatment for Moyamoya disease is often complicated by cerebral ischemia, so the goal in perioperative management is to maintain the balance between oxygen supply and demand in the brain. This report presents three cases of Moyamoya disease in patients under 3 years of age, and discusses anesthesia management issues for pediatric patients with this condition.
PMID: 16324034 [PubMed - in process]
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Nasal foreign bodies in children: a possible pitfall for the anesthesiologist.
Pirotte T, Ikabu C.
Service d'Anesthesiologie, Cliniques Universitaires St. Luc, Universite Catholique de Louvain, Bruxelles, Belgium. thierry.pirotte@skynet.be
Based on a recent surprising case in our institution, we analyze the possible dislodgment of an unknown foreign body in the nose during nasotracheal intubation in children. Nasal foreign bodies made of inert material can remain unnoticed for a long period of time. In addition to inserting a close-fitting suction catheter into the TT during its passage through the nasopharynx, we now suggest performing a pharyngoscopy when intubation is completed.
PMID: 16324033 [PubMed - in process]
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Anesthetic management in a child with Arnold-Chiari malformation and bilateral vocal cord paralysis.
Setz AC, De Boer HD, Driessen JJ, Scheffer GJ.
Department of Anesthesiology, Radboud University, Nijmegen, The Netherlands. a.setz@anes.umcn.nl
We report a case of a child who was scheduled for an emergency ventriculoperitoneal shunt procedure. The patient had a type II Arnold-Chiari malformation (ACM) and associated hydrocephalus and presented with near complete respiratory obstruction from bilateral abductor vocal cord palsy. Early diagnosis and management of airway abnormalities associated with ACM may be lifesaving. Chiari malformations and anesthesia management are discussed.
PMID: 16324032 [PubMed - in process]
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Does dexmedetomidine prevent emergence delirium in children after sevoflurane-based general anesthesia?
Shukry M, Clyde MC, Kalarickal PL, Ramadhyani U.
Department of Anesthesiology, Tulane University, New Orleans, LA, USA. mohanad-shukry@ouhsc.edu
BACKGROUND : Emergence agitation or delirium (ED) is a frequent phenomenon in children recovering from general anesthesia (GA). Dexmedetomidine, an alpha2 receptor agonist, has analgesic and sedative properties that might be helpful in the management of ED. We studied the effects of a continuous perioperative infusion of 0.2 microg.kg(-1).h(-1) dexmedetomidine on the incidence of ED in 50 children aged 1-10 years scheduled for sevoflurane-based GA. METHODS : Following inhalation induction of GA, the children were randomly assigned into dexmedetomidine or placebo Groups D and S, respectively. The infusion of 0.2 microg.kg(-1).h(-1) dexmedetomidine or equal volume of saline was started after securing the airway. Depth of anesthesia was maintained by adjusting the concentration of sevoflurane to achieve a Bispectral Index Score of 40-60. Intraoperative hemodynamics were recorded every 5 min and the trachea was extubated at the end of the procedure. Perioperative pain management was determined by the blinded anesthesia team, and the study drug infusion was maintained for 15 min following the postanesthesia care unit (PACU) admission. ED and pain scores were evaluated by a blinded observer. RESULTS : The incidence of ED was statistically significantly different between the two groups, 26% in Group D Vs 60.8% in Group S (P = 0.036). Additionally, the number of episodes of ED was lower in Group D (P < 0.017). Pain scores and the times to extubate and discharge from PACU were the same. CONCLUSIONS : The perioperative infusion of 0.2 microg.kg(-1).h(-1) dexmedetomidine decreases the incidence and frequency of ED in children after sevoflurane-based GA without prolonging the time to extubate or discharge.
PMID: 16324031 [PubMed - in process]
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CSF pressure measurement during anesthesia: an unreliable technique.
Eidlitz-Markus T, Stiebel-Kalish H, Rubin Y, Shuper A.
Department of Pediatrics E-Ambulatory Day Care Center, Schneider Children's Medical Center of Israel, Petah Tiqva, Israel. eidlitz@post.tau.ac.il
BACKGROUND: The measurement of cerebrospinal fluid (CSF) pressure is necessary for many clinical indications. Its accuracy may be compromised in frightened or uncooperative children who find it difficult to relax sufficiently. The aim of the present study was to evaluate possible effects of general anesthesia on CSF pressure values. METHODS: Lumbar puncture was performed under general anesthesia in 15 patients aged 4.5-20 years for the evaluation of headaches associated with a swollen optic nerve. Cerebrospinal fluid pressure was measured with a manometer when the patient was fully anesthetized (opening pressure) and then continuously recorded until the patient regained consciousness. The opening pressure was compared with the lowest pressure measured at the termination of the procedure (end-measurement pressure). RESULTS: Seventeen pressure measurements were performed in 15 patients. In all but two measurements, differences were noted between the opening and end pressure, ranging from 5 to 13 cmH(2)O. The opening pressure was abnormally high in 16 measurements, and the end pressure was abnormally high in seven. The difference between the two measurements was highly significant (P < 0.001). CONCLUSIONS: Lumbar puncture performed under general anesthesia may yield two pressure measurements. Many factors, such as hypercarbia and the anesthetic agent used, may influence the results. Owing to the dynamic changes in CSF pressure, measurements made under anesthesia may be unreliable.
PMID: 16324027 [PubMed - in process]
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Clonidine added to bupivacaine in neonatal spinal anesthesia: a prospective comparison in 124 preterm and term infants.
Rochette A, Troncin R, Raux O, Dadure C, Lubrano JF, Barbotte E, Capdevila X.
Department of Anesthesiology and Intensive Care Medicine A, University Hospital Lapeyronie, Montpellier, France. a-rochette@chu-montpellier.fr
BACKGROUND: Spinal anesthesia (SA) remains the 'gold standard' in neonatal anesthesia for inguinal herniorrhaphy but its short duration impedes its usefulness. We previously demonstrated that clonidine prolongs neonatal SA without immediate side effects. METHODS: We conducted a prospective observational study of 124 infants undergoing herniorrhaphy under SA with bupivacaine and clonidine. Two cohorts, term (n = 57) and former preterm (n = 67) infants, were evaluated and compared with regard to episodes of apnea, desaturation, and bradycardia within 24 h of SA. RESULTS: In both groups, postoperative desaturation episodes were unchanged after SA, compared with the 12 preoperative hours, despite significantly increased apnea (P < 0.003 and <0.011 respectively). Transient bradycardias occurred in former preterm infants (P < 0.014): they spontaneously resolved in all cases. Mean arterial pressure did not vary during the study. Upper sensory level of SA, sedation on entering the postanesthesia care unit (PACU) and duration of stay in the PACU were similar in both groups. CONCLUSIONS: The clinical significance of short apneas, recovering spontaneously without desaturation, remains debatable. It is concluded that addition of clonidine to neonatal SA results in acceptable side effects. Side effects must be compared with the potential advantages before future recommendations.
PMID: 16324026 [PubMed - in process]
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Anesthetic management of the neonate with congenital complete heart block: a 16-year review.
Kussman BD, Madril DR, Thiagarajan RR, Walsh EP, Laussen PC.
Department of Anesthesiology, Perioperative and Pain Medicine, Children's Hospital Boston, MA 02115, USA. barry.kussman@childrens.harvard.edu
BACKGROUND: Anesthesia for patients with complete heart block can be associated with significant hemodynamic instability. The aim of this study is to review our anesthetic experience of neonates with congenital complete heart block (CCHB) who underwent placement of either a temporary epicardial pacing system or a permanent epicardial pacemaker. METHODS: The anesthetic management of neonates with CCHB who underwent pacemaker placement at a single institution over a 16-year period was reviewed. RESULTS: Twenty-four neonates were identified, 17 with a structurally normal heart (NL) and seven with associated congenital heart defects (CHD). Median (range) gestational age was 36.9 (26-41) weeks, birth weight 2.9 (1.0-4.1) kg, and baseline heart rate 47 (38-80) b.min(-1). A temporary epicardial pacing system was placed in six patients (four CHD, two NL; P = 0.003) following institution of mechanical ventilation and inotropic support for a low cardiac output state, and a permanent epicardial pacemaker was placed in 18 patients. Atropine 0.02 mg.kg(-1) IV prior to induction (n = 5) increased heart rate less than 20%. Intraoperative hypotension was documented in nine neonates, five of seven with CHD and four of 17 with NL (P = 0.02). In four patients (44%) hypotension occurred despite concurrent inotropic support. Intraoperative cardiac arrest occurred in one neonate, necessitating institution of extracorporeal membrane oxygenation. Two patients (8.3%) died in hospital from complex CHD and complications of prematurity. CONCLUSIONS: Early institution of mechanical ventilation, inotropic support and pacing are necessary in the neonate with CCHB and poor hemodynamic function, particularly with coexisting CHD or prematurity.
PMID: 16324024 [PubMed - in process]
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A 15-year review of children with Kawasaki's Syndrome having general anesthesia or deep sedation.
Morrison JE, Anderson M, Chan KC, Pietra B, Zuk J, Gnadinger P.
Department of Anesthesiology, The Children's Hospital, University of Colorado Health Sciences Center, Denver, CO 80218, USA. john.morrison@uchsc.edu
BACKGROUND: Children with Kawasaki's syndrome (KS), also known as Kawasaki's disease or 'mucocutaneous lymph node syndrome', have approximately 20-25% incidence of developing coronary artery aneurysms (CAA), stenosis or obliteration if not appropriately diagnosed and treated. In addition some children have myocarditis, pericardial effusions and/or cardiac arrhythmias during the acute phase of KS. Even with current treatment protocols, 2-4% will still be at risk of coronary artery pathology and the long-term implications regarding future coronary artery disease are unknown. Many of these children present for surgical or diagnostic procedures requiring general anesthesia or deep sedation. Only sporadic case reports have been published on the anesthetic experiences of such patients. METHODS: With Institutional Review approval, we reviewed the medical records of all children with discharge diagnosis of KS from 1985 to 2000 for those receiving general anesthesia or deep sedation. Data abstracted from the medical records included information on any surgical procedures performed any time after onset of KS symptoms, type of anesthetic, perioperative monitoring and presence or absence of operative or perioperative complications. RESULTS: A total of 178 children with KS were identified of whom 47 (26.4%) received either general anesthesia (34) or deep sedation (13). There were no deaths; one child developed congestive heart failure in the immediate postoperative period associated with KS myocarditis. Five (15%) of those having general anesthesia initially were either not diagnosed as having KS or had no preoperative cardiac evaluations. None of the children having general anesthesia had ST segment analysis, invasive monitoring or troponin measurements perioperatively. CONCLUSIONS: The high incidence of serious myocardial complications attributable to KS reported in the pediatric literature is rarely noted in the anesthesia literature. We feel there is a potential for more serious perioperative complications among KS children, although we can only speculate why complications are not more frequently encountered. Anesthetists involved in pediatric services are encouraged to consider KS in their diagnosis of children presenting with febrile illnesses with rashes and to consider the possibility of KS myocardial compromise if they encounter unexpected deterioration perioperatively. Preoperative ultrasound examination and perioperative monitoring (e.g. ST segment analysis and troponin measurements) for myocardial compromise are encouraged if KS is suspected.
PMID: 16324023 [PubMed - in process]
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The evaluation of propofol dosage for anesthesia induction in children with cerebral palsy with bispectral index (BIS) monitoring.
Saricaoglu F, Celebi N, Celik M, Aypar U.
Department of Anaesthesiology and Reanimation, Hacettepe University, Ankara, Turkey. fatmasaricao@yahoo.com
BACKGROUND: We designed a randomized prospective study to investigate whether developmentally delayed children with cerebral palsy (CP) need a lower dosage of propofol for induction than normal children using bispectral index (BIS) monitoring criteria. METHODS: After approval by the University Ethical Committee and written informed consent obtained from parents, 20 children with noncommunicative/nonverbal CP and 20 normal children requiring general anesthesia for elective orthopedic surgery were enrolled in the study. The patients were not premedicated. BIS leads were placed before the induction of anesthesia. Propofol was administered at a rate of 20 mg.30 s(-1) (i.e. 40 mg.min(-1)).When BIS value had reached a steady number of 35-45, infusion was stopped. RESULTS: There was no significant difference between Group N and Group CP in age and sex distribution (P > 0.05), however children in Group CP weighed less than Group N (P = 0.05). The propofol dosage for induction was significantly lower in Group CP than Group N (P = 0.03). There were no differences in propofol doses administered to children using anticonvulsants and those not on anticonvulsants in Group CP. BIS values were comparable between the two groups (i.e. Group N and Group CP) at baseline and after propofol administration. CONCLUSIONS: Our data suggest that noncommunicative/nonverbal children with CP require less propofol to obtain the same BIS values (i.e. 35-45) than do otherwise healthy children.
PMID: 16324022 [PubMed - in process]
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Epidural catheter entrapment caused by a double knot after combined spinal-epidural anesthesia.
Gabopoulou Z, Mavrommati P, Chatzieleftheriou A, Vrettou V, Konstandinidou M, Velmachou K.
Publication Types:
PMID: 16326346 [PubMed - in process]
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Acute toxicity of local anesthetics: underlying pharmacokinetic and pharmacodynamic concepts.
Mather LE, Copeland SE, Ladd LA.
Department of Anaesthesia and Pain Management, University of Sydney at Royal North Shore Hospital, Sydney, NSW 2065, Australia. lmather@med.usyd.edu.au
The risk of accidental intravascular injection and consequent acute toxicity is ever-present with most neural blockade techniques. The severity of cardiovascular and central nervous system (respectively, CVS and CNS) toxicity is directly related to the local anesthetic potency, dose, and rate of administration. Nonetheless, although the anesthetic potency of ropivacaine and levobupivacaine is similar to that of bupivacaine, at usual clinical doses, ropivacaine and levobupivacaine are less likely than bupivacaine to cause convulsions or lethal dysrhythmias. Signs of CNS stimulation, ranging from tremors to convulsions and perhaps cardiac dysrhythmias, can be described in terms of a chaos-derived state change in which the local anesthetic appears to act as an initiator. Both CNS and CVS effects are rather poorly correlated with arterial drug concentrations but better correlated with concentrations in the respective regional venous drainage. Lung uptake reduces the maximum drug concentration by approximately 40%. Prolonging intravenous administration from 1 to 3 minutes results in a similar decrease in maximum concentration. This is an underlying tenet of dose fractionation, but the main advantage of dose fractionation is that the anesthesiologist is able to cease administration with less of the dose given if signs or symptoms of toxicity occur. Overall, it appears that the gains in safety from ropivacaine and levobupivacaine are due more to favorable pharmacodynamic enantioselectivity than to pharmacokinetic factors. This essay presents some pharmacokinetic aspects relevant to acute toxicity of local anesthetics, mainly using data from the authors' studies in a sheep model of simulated accidental intravenous administration.
PMID: 16326341 [PubMed - in process]
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Influence of spinal anesthesia on corrected QT interval.
Owczuk R, Sawicka W, Wujtewicz MA, Kawecka A, Lasek J, Wujtewicz M.
Department of Anaesthesiology and Intensive Therapy, Medical University of Gdansk, Debinki 7 str., 80-211 Gdansk, Poland. r.owczuk@amg.gda.pl
BACKGROUND AND OBJECTIVES: Prolongation of the QT interval may result in grave cardiac arrhythmias, polymorphic ventricular tachycardia ("torsades de pointes"), and ventricular fibrillation. We assessed the influence of spinal anesthesia on the QTc interval and the potential arrhythmogenicity of this method of anesthesia. METHODS: Assessment was performed in 20 male unpremedicated patients, I or II American Society of Anesthesiologists physical status, who underwent spinal anesthesia for elective surgical procedures. Values of the QTc interval, heart rate, and arterial pressure were measured before spinal anesthesia as well as after 1, 3, 5, and 15 minutes of adequate blockade. RESULTS: Statistically significant lengthening of the QTc interval (compared with initial values) was observed in the first minute after blockade and in subsequent measurements. No differences were observed between mean values of the QTc interval after the onset of blockade. No significant changes in heart rate were noted. From the third minute on, significant decreases of the systolic, diastolic, and mean arterial blood pressure were observed as compared with baseline. These decreases in systolic, diastolic, and mean arterial blood pressure persisted for the entire study duration. No one patient developed clinically important cardiac arrhythmias. CONCLUSIONS: Spinal anesthesia provokes significant QTc interval prolongation in patients without cardiovascular disorders.
PMID: 16326340 [PubMed - in process]
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Perioperative pain management education: a short structured regional anesthesia course compared with traditional teaching among medical students.
Hanna MN, Donnelly MB, Montgomery CL, Sloan PA.
Department of Anesthesiology, The Johns Hopkins University, 600 N. Wolfe Street, Baltimore, MD 21287, USA. mhanna9@jhmi.edu
BACKGROUND AND OBJECTIVES: Previous research has demonstrated that a brief course on pain management improved knowledge and attitudes toward analgesic use among medical students. The purpose of this study is to compare a structured clinical instruction course on regional anesthesia techniques for perioperative pain management with traditional teaching given to senior medical students. METHODS: During a 1-month clerkship in anesthesiology, 40 fourth-year medical students were randomly and equally divided into 2 groups. The study group received a 2-hour structured course on regional anesthesia techniques for pain management, whereas the control group received a 1-hour lecture tutorial on regional anesthesia techniques for perioperative pain management and 1 hour of bedside teaching on acute pain management. Each student completed an objective structured clinical examination (OSCE) 2 weeks after completion of the course. RESULTS: The study group performed better on each of the 11 items of the OSCE and on the total performance scores (mean +/- SD of 36.2 +/- 7.3 for study group versus 14.8 +/- 8.4 for the control group; P < .05). All students rated the clinical course highly valuable (4.7 +/- 0.5). CONCLUSION: A structured clinical instructional course on regional techniques for perioperative pain management given to fourth-year medical students can significantly improve their understanding and knowledge compared with traditional teaching.
PMID: 16326336 [PubMed - in process]
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Local anesthetics: helpful science, but don't forget the basic clinical safety steps.
Mulroy MF.
Publication Types:
PMID: 16326334 [PubMed - in process]
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