About Entrez
NCBI Toolbar
Text Version
Entrez PubMed
Overview
Help |
FAQ
Tutorials
New/Noteworthy
E-Utilities
PubMed Services
Journals Database
MeSH Database
Single Citation Matcher
Batch Citation Matcher
Clinical Queries
Special Queries
LinkOut
My NCBI
Related Resources
Order Documents
NLM Mobile
NLM Catalog
NLM Gateway
TOXNET
Consumer Health
Clinical Alerts
ClinicalTrials.gov
PubMed Central
|
|
| Display Show |
 |
Use of a blunt drawing-up needle for ilio-inguinal blocks.
Sathishkumar S, Dodd P.
Publication Types:
PMID: 16288638 [PubMed - indexed for MEDLINE]
-
Generic machine checks.
Greenwood J.
Publication Types:
PMID: 16288634 [PubMed - indexed for MEDLINE]
-
Comment on:
Paternity of the Doughty technique.
Doughty A.
Publication Types:
PMID: 16288627 [PubMed - indexed for MEDLINE]
-
Comment on:
What babies want.
Hartle AJ.
Publication Types:
PMID: 16288626 [PubMed - indexed for MEDLINE]
-
Comment on:
Ephedrine, phenylephrine and fetal acidosis.
Cooper DW.
Publication Types:
PMID: 16288624 [PubMed - indexed for MEDLINE]
-
Xenon measurement in breathing systems: a comparison of ultrasonic and thermal conductivity methods.
King R, Bretland M, Wilkes A, Dingley J.
Department of Anaesthetics, Morriston Hospital, Swansea SA6 6NL, UK.
Xenon is an anaesthetic and possibly neuroprotective gas that is impossible to measure using conventional anaesthetic gas analysers. We compared the performance of two commissioned xenon analysers using ultrasonic and thermal conductivity principles against a reference method of laser refractometry. An experimental gas circuit was constructed and xenon concentrations compared over a range of 0-100% in oxygen. Eighty-two paired measurements were made comparing the experimental methods with laser refractometry. The ultrasonic method displayed good agreement with laser refractometry, with a mean difference of - 0.74% and two standard deviation limits of agreement of + 1.08% to - 2.56%. The agreement between laser refractometry and thermal conductivity was poor, the mean difference being - 5.37%, with two standard deviation limits of agreement of + 0.6% to - 11.3%. The ultrasonic method for measuring xenon concentrations can be used in breathing circuits. The thermal conductivity instrument may need further development.
Publication Types:
PMID: 16288621 [PubMed - indexed for MEDLINE]
-
A procedure-specific systematic review and consensus recommendations for analgesia after total hip replacement.
Fischer HB, Simanski CJ.
Anaesthesia and Pain Management, Department of Anaesthesia, Alexandra Hospital, Redditch, Worcestershire, UK. barrie.fischer@worcsacute.wmids.nhs.uk
Total hip replacement is a major surgical procedure usually associated with significant pain in the early postoperative period. Several anaesthetic and analgesic techniques are in common clinical use for this procedure but, to date, clinical studies of pain after total hip replacement have not been systematically assessed. Using the Cochrane protocol, we have conducted a systematic review of analgesic, anaesthetic and surgical interventions affecting postoperative pain after total hip replacement. In addition to the review, transferable evidence from other relevant procedures and clinical practice observations collated by the Delphi method were used to develop evidence-based recommendations for the treatment of postoperative pain. For primary total hip replacement, PROSPECT recommends either general anaesthesia combined with a peripheral nerve block that is continued after surgery or an intrathecal (spinal) injection of local anaesthetic and opioid. The primary analgesic technique should be combined with a step-down approach using paracetamol plus conventional non-steroidal anti-inflammatory drugs, with strong or weak opioids as required.
Publication Types:
PMID: 16288617 [PubMed - indexed for MEDLINE]
[Preoperative long-term therapy]
[Article in German]
Buhre K, de Rossi L, Buhre W.
Bundesinstitut fur Arzneimittel und Medizinprodukte, Bonn, Germany.
A large number of patients undergoing elective surgical procedures already take routine medication preoperatively. The majority of these patients use drugs for therapy of preexisting cardiovascular, pulmonary or endocrinological diseases which are independent of the planned surgical procedure. The number and type of preoperative drug therapy are correlated to age, gender and co-morbidity of the patients. Furthermore, patients with higher ASA-classes usually take more drugs, as they suffer from several medical diseases. Information about the perioperative handling of routine drug therapy is important for the planning of anaesthesia and surgery. A close cooperation of all medical specialities involved is necessary, in particular when patients take anticoagulants or other substances which should be withdrawn or replaced. This review focuses on the handling of routine preoperative medication by the anaesthesiologist in the light of available literature.
Publication Types:
PMID: 16091922 [PubMed - indexed for MEDLINE]
-
[Lateral approach to blockade of the sciatic nerve. Biometric data using magnetic resonance imaging]
[Article in German]
Neuburger M, Hendrich E, Lang D, Dinse A, Wagner F, Freund W, Brinkmann A, Buttner J.
Abteilung fur Anasthesie, BG Unfallklinik, Prof.-Kuntscher-Strasse 8, 82418 Murnau, Germany. MichaelNeuberger@aol.com
In the present study we examined 41 volunteers using magnetic resonance imaging to obtain biometric data of the thigh used for a planned blockade of the sciatic nerve via the lateral approach. At a needle entry point 12 cm proximal to the gap of the knee joint at the posterior border of the M. vastus lateralis, the sciatic nerve lies on average at a depth of 5.2 cm (39% of the femoral diameter at this site) with an angle of 10.9 degrees to the horizontal in a dorsal direction. Here the popliteal artery lies on average at a depth of 6.4 cm (48% of the femoral diameter) with an angle of 4.7 degrees to the horizontal in a ventral direction. At the marked point in the middle between the gap of the knee joint and the trochanter major at the posterior border of the M. vastus lateralis, the sciatic nerve is at an average depth of 6.2 cm (40% of the femoral diameter at this site) with an angle of 8.2 degrees in a dorsal direction. At a marked point 5 cm distal of the trochanter major at the posterior border of the M. vastus lateralis, the sciatic nerve is at a depth of 9.1 cm at a dorsal angle of 15.5 degrees (49% of the femoral diameter). The lateral blockade of the sciatic nerve at different sites of the thigh is a technique which is easy to plan with the presented biometric data. The popliteal artery could be reached only at the distal puncture point using a deep puncture and an angle in the ventral direction.
PMID: 16021392 [PubMed - indexed for MEDLINE]
-
[Influence of gender on the intubation conditions with rocuronium]
[Article in German]
Mencke T, Schreiber JU, Knoll H, Werth M, Grundmann U, Rensing H.
Klinik und Poliklinik fur Anasthesiologie und Intensivtherapie, Universitatsklinikum Rostock, Schillingallee 35, 18057 Rostock, Germany. thomas-mencke@uni-rostock.de
PURPOSE: There is increasing evidence for gender differences in the pharmacokinetics and pharmacodynamics of anaesthetic drugs and neuromuscular blocking agents, e.g. rocuronium (Roc). Females require 30% less Roc than males to achieve the same degree of neuromuscular block and onset times are shorter. However, whether this leads to an improvement of the intubation conditions in females is unclear. METHODS: After approval of the ethics committee 60 female and 60 male patients were each randomised into 2 groups to receive 0.6 mg/kg body weight Roc or 1.0 mg/kg succinylcholine (Sux; control group). Induction: thiopentone (5 mg/kg), fentanyl (3 microg/kg) then Roc (Roc groups) or Sux (Sux groups) and tracheal intubation after 60 s. Time to intubation, glottic exposure and intubating conditions were assessed. RESULTS: Men were significantly larger and heavier (p<0.001) than women, but the body mass index was comparable (ns). Number of attempts, time to intubation, and Cormack grades were comparable (ns). However, the rate of clinically acceptable intubation conditions was significantly higher in the female compared to the male Roc group: 80% vs 47%, p<0.05. The incidence of clinically acceptable intubation conditions in the female Roc and Sux groups were similar (80%). CONCLUSION: The intubation conditions after Roc were significantly better in women than in men. The differences were Roc-related and did not occur in the control groups.
Publication Types:
PMID: 15986229 [PubMed - indexed for MEDLINE]
-
[Unclear intraoperative cardiorespiratory decompensation. Anaphylactic reaction?]
[Article in German]
Iblher P, Rotter N, Grabbe J, Gehring H, Meier T.
Klinik fur Anasthesiologie, Universitatsklinikum Schleswig-Holstein/Campus Lubeck, Ratzeburger Allee 160, 23538 Lubeck, Germany. iblher@anaesthesie.uni-luebeck.de
During anaesthesia a patient is exposed to a variety of substances, all of which could lead to anaphylactic reactions. In addition, other drugs may exert clinical side-effects by non-immunological mechanisms, e.g. by direct stimulation of the release of histamine by mast cells. Initially, the observed symptoms, such as hypotension or tachycardia, may be misunderstood by the anaesthetist, leading to a possible delay in diagnosis and subsequent treatment of the anaphylactic event. Cardiac ischemia and lung embolisms are important differential diagnoses that often cannot be definitely ruled out during the acute situation and that have to be followed up once the patient has been stabilised. We report a case of anaphylactic reaction after the administration of ampicillin which required treatment and ventilation in the intensive care unit. Despite an accurate determination of serum tryptase levels, the diagnosis of an anaphylactic reaction to ampicillin was eventually confirmed by skin testing. During anaesthesia, anaesthetists should consider anaphylaxis when unforeseen symptoms such as bronchospasm, haemodynamical instability and/or flush arise. In cases of unexpected reactions, patients should undergo allergological follow-up to prevent fatal re-exposure.
Publication Types:
PMID: 15931531 [PubMed - indexed for MEDLINE]
Continuous anesthetic insufflation and topical anesthesia of the airway using Trachlight in chronic facial burns.
Bhardwaj A, Kidwai SN, Verma V, Nabi N, Ahmad M, Khan RM.
Publication Types:
PMID: 16368865 [PubMed - indexed for MEDLINE]
-
Comment on:
GE Healthcare response to dangerous design flaw in the Ohmeda Aespire anesthesia system.
Mitton M.
Publication Types:
PMID: 16368860 [PubMed - indexed for MEDLINE]
-
Comment on:
Cardiac arrest during neuraxial anesthesia: are all databases comparable?
Lambert DH.
Publication Types:
PMID: 16368854 [PubMed - indexed for MEDLINE]
-
Comment on:
Is local anesthetic overdose the most common cause of neuraxial cardiac arrest?
Pollard J.
Publication Types:
PMID: 16368853 [PubMed - indexed for MEDLINE]
-
Comment on:
Bradycardia and asystole during neuraxial anesthesia.
Stemp LI.
Publication Types:
PMID: 16368852 [PubMed - indexed for MEDLINE]
-
Middle ear pressure changes during anesthesia with or without nitrous oxide are similar among airway devices.
Hohlrieder M, Keller C, Brimacombe J, Eschertzhuber S, Luckner G, Abraham I, von Goedecke A.
Department of Anaesthesia and Intensive Care Medicine, Leopold-Franzens University, Innsbruck, Austria.
We tested the hypothesis that middle ear pressure (MEP) is influenced by the choice of airway device during anesthesia with or without nitrous oxide (N2O) in the gas mixture. Eighty consecutive anesthetized, paralyzed ventilated patients (ASA physical status I-II, 18-65 yr) were randomly allocated for airway management with the orally inserted tracheal tube, classic laryngeal mask airway, ProSeal laryngeal mask airway, or laryngeal tube suction with or without N2O 66% in the gas mixture. MEP was measured from both ears in random order by a blinded observer before induction of anesthesia and every 10 min for 70 min. In the N2O groups, N2O was changed to air after 40 min. There were no differences in MEP among the airway devices in the N2O or air groups. MEP was unchanged in the air groups but increased in the N2O groups with N2O (P < 0.0001) and decreased with air (P < 0.02). Baseline values for MEP were similar, but MEP was always higher for the N2O groups (P < 0.001). We conclude that the choice of airway device does not influence MEP among orally inserted tracheal tube, classic laryngeal mask airway, ProSeal laryngeal mask airway, and laryngeal tube suction during anesthesia with or without N2O in the gas mixture.
Publication Types:
PMID: 16368850 [PubMed - indexed for MEDLINE]
-
Gender and recovery after general anesthesia combined with neuromuscular blocking drugs.
Buchanan FF, Myles PS, Leslie K, Forbes A, Cicuttini F.
Department of Anesthesia and Pain Management, Alfred Hospital, Melbourne, Australia. frankbuchanan@optusnet.com.au
Previous studies suggest that women recover faster from general anesthesia than men, but it is unclear whether this is a result of a gender effect or differences in the pattern of drug administration or type of surgery. We performed a subset analysis comparing recovery characteristics from general anesthesia combined with neuromuscular blocking drugs of female and male patients, at risk of awareness, enrolled in a large trial testing the effectiveness of bispectral index (BIS) monitoring. We used multivariate statistical methods to adjust for differences in baseline characteristics, duration and extent of surgery, and anesthetic drug administration in 1079 patients (584 male, 495 female). Female patients had higher BIS values than male patients despite similar amounts of anesthetic drug administration (time-averaged mean [sd] BIS: male 44.6 [7.1] versus female 46.4 [6.6]; P = 0.005). Time to eye opening after anesthesia and time to eligibility to discharge from the postanesthesia care unit were less in women than men (male 13.9 [13.2] min versus female 10.6 [11.6] min; P < 0.001; male 133 [209] min versus female 78 [106] min; P < 0.001, respectively). These differences persisted after multivariate adjustment (both P < or = 0.001). Gender has an independent effect on recovery times in patients undergoing general anesthesia combined with neuromuscular blocking drugs, with women recovering faster than men. Higher BIS values during maintenance of anesthesia in women, despite similar amounts of anesthetic drug administration, suggests that women are less sensitive to the hypnotic effect of anesthetic drugs than men and may help explain faster recovery times in women.
PMID: 16368846 [PubMed - indexed for MEDLINE]
-
The influence of hyperbaric bupivacaine temperature on the spread of spinal anesthesia.
Arai YC, Ueda W, Takimoto E, Manabe M.
Department of Anesthesiology, Kochi Municipal Hospital, Marunouchi, Japan. arainon@aichi-med-u.ac.jp
The distribution of spinal anesthesia is affected by the density and viscosity of the local anesthetic solution that, in turn, may be influenced by the temperature of the injectate. Our hypothesis in the present study was that the temperature of the injectate influences its distribution into the subarachnoid space. We measured the density and viscosity of hyperbaric 0.5% bupivacaine at 25 degrees C and 37 degrees C and tested the onset and extent of spinal anesthesia achieved by these solutions in 36 patients. The densities of the two solutions were similar (mean [sd]): 25 degrees C, 1.028 [0.000], versus 37 degrees C, 1.028 [0.000] (g/mL), but the viscosity was more at 25 degrees C than at 37 degrees C (0.01116 [0.00003] versus 0.00843 [0.00002] g x cm(-1) x s(-1); P < 0.001). The maximum cephalad extent of loss of pinprick sensation was significantly higher with 37 degrees C (T2 with 37 degrees C versus T5 with 25 degrees C; P < 0.001), but the time to achieve peak block height was similar. In conclusion, we showed a consistent, but modest, increase in the cephalad level of spinal anesthesia by warming hyperbaric bupivacaine 0.5% from 25 degrees C to 37 degrees C. Viscosity was reduced in the warmed solution, but it is unclear if this or other factors led to the difference in spinal anesthetic level.
Publication Types:
PMID: 16368842 [PubMed - indexed for MEDLINE]
-
The sitting versus right lateral position during combined spinal-epidural anesthesia for cesarean delivery: block characteristics and severity of hypotension.
Coppejans HC, Hendrickx E, Goossens J, Vercauteren MP.
Department of Anesthesia, University Hospital Antwerp, Edegem, Belgium.
In the present study we evaluated whether the sitting position during initiation of small-dose combined spinal-epidural anesthesia (CSE) would induce less hypotension as compared with the lateral position. Sixty women undergoing elective cesarean delivery were randomly assigned to receive a spinal injection consisting of 6.6 mg hyperbaric bupivacaine with sufentanil 3.3 microg in either the lateral or the sitting position. After securing the epidural catheter, patients were turned to a 15 degrees left lateral supine position. Ephedrine 5 mg IV was administered prophylactically and subsequently in case of nausea/vomiting and/or hypotension, defined as a systolic blood pressure less than 95 mm Hg or a 25% decrease from baseline values. Although the incidence of ephedrine supplementation was not different, females in the sitting group required less ephedrine (P = 0.012) and there were fewer problems with identifying the epidural space (P = 0.01). However, more patients in this group required epidural supplementation (35% versus 3%; P = 0.007). In the lateral group, blocks extended more cephalad than with the sitting position (P = 0.014). Apgar scores did not differ, but umbilical artery pH values were significantly higher in patients of the sitting group (7.31 +/- 0.04 versus 7.26 +/- 0.03; P = 0.02). We conclude that performing a CSE technique for cesarean delivery in the sitting position was technically easier and induced less severe hypotension.
Publication Types:
PMID: 16368837 [PubMed - indexed for MEDLINE]
-
Comment in:
Accreditation Council for Graduate Medical Education competencies and the American Board of Anesthesiology Clinical Competence Committee: a comparison.
Rose SH, Burkle CM; American Board of Anesthesiology Clinical Competence Committee.
Department of Anesthesiology, Mayo Clinic College of Medicine, Rochester, Minnesota 55905, USA. rose.steven@mayo.edu
We compared the Accreditation Council for Graduate Medical Education (ACGME) Outcome Project to the long-standing requirement of the American Board of Anesthesiology for a Clinical Competence Committee Report. There are many similarities between these two systems of resident evaluation. However, the ACGME Outcome Project requires the use of more numerous and diverse metrics when compared with the traditional global evaluation alone. In addition, the Clinical Competence Committee Report is primarily a summative evaluation for the purpose of assigning credit for training. The ACGME Outcome Project may be used as a component of a summative evaluation, but the primary emphasis is on formative assessment.
PMID: 16368832 [PubMed - indexed for MEDLINE]
-
The local anesthetic butamben inhibits and accelerates low-voltage activated T-type currents in small sensory neurons.
Beekwilder JP, van Kempen GT, van den Berg RJ, Ypey DL.
Department of Neurophysiology, Leiden University Medical Center, Leiden, The Netherlands.
Butamben (BAB) is a local anesthetic that can be used in epidural suspensions for long-term selective suppression of dorsal root pain signal transmission and in ointments for the treatment of skin pain. Previously, high-voltage activated N-type calcium channel inhibition has been implicated in the analgesic effect of BAB. In the present study we show that low-voltage activated or T-type calcium channels may also contribute to this effect. Typical transient T-type barium currents, selectively evoked by low-voltage (-40 mV) clamp stimulation of small (approximately 20 microm diameter) dorsal root ganglion neurons from newborn mice, were inhibited by BAB with an IC50 value of approximately 200 microM. Furthermore, 200 microM BAB accelerated T-type current activation, deactivation, and inactivation kinetics, comparable to earlier observations for N-type calcium channels. Finally, 200 microM BAB had no effect on the midpoint potential and slope factor of the activation curve, although it caused a approximately 3 mV hyperpolarizing shift of the inactivation curve, without affecting the slope factor. We conclude that BAB inhibits T-type calcium channels with a mechanism associated with channel kinetics acceleration.
PMID: 16368819 [PubMed - indexed for MEDLINE]
-
The effect of nefopam on morphine overconsumption induced by large-dose remifentanil during propofol anesthesia for major abdominal surgery.
Tirault M, Derrode N, Clevenot D, Rolland D, Fletcher D, Debaene B.
Department of Anesthesiology and Intensive Care, Hopital J. Bernard, Poitiers, France. m.tirault@chu-poitiers.fr
Opioids may activate pain facilitatory systems opposing analgesia. We investigated whether large-dose remifentanil given during IV anesthesia caused postoperative morphine overconsumption and whether nefopam (a centrally acting analgesic) could reduce this. Sixty patients scheduled for abdominal surgery were included in this prospective, randomized study. The first 30 patients received either small-dose (Group S: 3 ng/mL) or large-dose (Group L: 8 ng/mL) remifentanil administrated by a target-controlled infusion during propofol anesthesia. Before skin closure, patients received morphine 0.15 mg/kg. Another 30 patients also received nefopam 20 mg intraoperatively. Postoperative pain was controlled by titration of morphine, followed by patient-controlled morphine analgesia (PCA). Morphine was requested earlier in Group L than in Group S (10 [1-63] min versus 37 [5-90] min, median [range]; P < 0.002). The dose of morphine by titration was larger in Group L than in Group S (0.28 [0.04-0.38] mg/kg versus 0.16 [0.03-0.41] mg/kg; P < 0.05). PCA morphine consumption and pain scores were similar. There were no differences between the nefopam groups in the time to first morphine request or in the dose of morphine by titration. Postoperative morphine overconsumption occurred after large-dose remifentanil and propofol anesthesia during the early postoperative period. Pretreatment with nefopam could be useful to prevent pain sensitization induced by opioids.
Publication Types:
PMID: 16368814 [PubMed - indexed for MEDLINE]
-
Predicting which child-parent pair will benefit from parental presence during induction of anesthesia: a decision-making approach.
Kain ZN, Caldwell-Andrews AA, Maranets I, Nelson W, Mayes LC.
Center for the Advancement of Perioperative Health, Yale University School of Medicine, New Haven, Connecticut 06510, USA. zeev.kain@yale.edu
Using a multiply matched, concurrent cohort analysis, with 568 subjects matched from data obtained by our laboratory over the past 7 yr, we examined whether parental presence during induction of anesthesia (PPIA) reduces children's anxiety depending on the interaction between child and parent's baseline anxiety. Children's and parents' baseline anxiety was assessed preoperatively; children's anxiety was again assessed during induction of anesthesia. We found that anxious children who received PPIA from a calm parent were significantly less anxious during induction of anesthesia as compared with anxious children who did not receive PPIA (P = 0.03). In contrast, calm children who received PPIA from an overly anxious parent were significantly more anxious as compared with calm children who were not accompanied by a parent (P = 0.002). We found no effect of PPIA on children's anxiety during induction of anesthesia when calm parents accompanied calm children into the operating room (P = 0.15) or when overly anxious parents accompanied anxious children (P = 0.49). We conclude that the presence of a calm parent does benefit an anxious child during induction of anesthesia and the presence of an overly anxious parent has no benefit.
PMID: 16368808 [PubMed - indexed for MEDLINE]
-
Comment in:
The physiologic effects of isoflurane anesthesia in neonatal mice.
Loepke AW, McCann JC, Kurth CD, McAuliffe JJ.
Department of Anesthesia, Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, Ohio 45229, USA. andreas.loepke@cchmc.org
In neonatal rodents, isoflurane has been shown to confer neurological protection during hypoxia-ischemia and to precipitate neurodegeneration after prolonged exposure. Whether neuroprotection or neurotoxicity result from a direct effect of isoflurane on the brain or an indirect effect through hemodynamic or metabolic changes remains unknown. We recorded arterial blood pressure, heart rate, blood gases, and glucose in 10-day-old mice during 60 min of isoflurane anesthesia with spontaneous or mechanical ventilation, as well as during 60 min of hypoxia-ischemia with isoflurane anesthesia or without anesthesia. During isoflurane anesthesia, hypoglycemia and metabolic acidosis occurred with spontaneous and mechanical ventilation. During hypoxia-ischemia, isoflurane was fatal with spontaneous breathing but survivable with mechanical ventilation, with arterial blood pressure and heart rate being similar to that observed in unanesthetized animals. Minimum alveolar concentration (MAC) was 2.3% in 10-day-old mice. In summary, isoflurane anesthesia precipitated hypoglycemia, which may have contributed to the neurodegeneration observed in neonatal rodents. Use of 0.8 MAC isoflurane for evaluation of neuroprotection during hypoxia-ischemia requires mechanical ventilation and glucose supplementation in this model.
PMID: 16368807 [PubMed - indexed for MEDLINE]
-
Comment in:
The safety and efficacy of spinal anesthesia for surgery in infants: the Vermont Infant Spinal Registry.
Williams RK, Adams DC, Aladjem EV, Kreutz JM, Sartorelli KH, Vane DW, Abajian JC.
Department of Anesthesia, University of Vermont, College of Medicine and Vermont Children's Hospital, Burlington, Vermont 05405, USA. robert.williams@vtmednet.org
Studies with modest numbers of patients have suggested that spinal anesthesia in infants is associated with a very infrequent incidence of complications, such as hypoxemia, bradycardia, and postoperative apnea. Although spinal anesthesia would seem to be a logical alternative to general anesthesia for many surgical procedures, it remains an underutilized technique. Since 1978, clinical data concerning all infants undergoing spinal anesthesia at the University of Vermont have been prospectively recorded. In all, 1554 patients have been studied. Anesthesia was performed by anesthesia trainees and attending anesthesiologists. The success rate for LP was 97.4%. An adequate level of spinal anesthesia was achieved in 95.4% of cases. The average time required to induce spinal anesthesia was 10 min. Oxygen hemoglobin desaturation to <90% was observed in 10 patients. Bradycardia (heart rate <100 bpm) occurred in 24 patients (1.6%). This study confirms the infrequent incidence of complications associated with spinal anesthesia in infants. Spinal anesthesia can be performed safely, efficiently, and with the expectation of a high degree of success. Spinal anesthesia should be strongly considered as an alternative to general anesthesia for lower abdominal and lower extremity surgery in infants.
PMID: 16368805 [PubMed - indexed for MEDLINE]
-
Comment on:
Spinal anesthesia in infants: is the impractical practical?
Suresh S, Hall SC.
Publication Types:
PMID: 16368804 [PubMed - indexed for MEDLINE]
-
Intrathecal and epidural anesthesia and analgesia for cardiac surgery.
Chaney MA.
Department of Anesthesia and Critical Care, University of Chicago, Chicago, Illinois 60637, USA. mchaney@dacc.uchicago.edu
Adequate postoperative analgesia prevents unnecessary patient discomfort. It may also decrease morbidity, postoperative hospital length of stay and, thus, cost. Achieving optimal pain relief after cardiac surgery is often difficult. Many techniques are available, and all have specific advantages and disadvantages. Intrathecal and epidural techniques clearly produce reliable analgesia in patients undergoing cardiac surgery. Additional potential benefits include stress response attenuation and thoracic cardiac sympathectomy. The quality of analgesia obtained with thoracic epidural anesthetic techniques is sufficient to allow cardiac surgery to be performed in awake patients without general endotracheal anesthesia. However, applying regional anesthetic techniques to patients undergoing cardiac surgery is not without risk. Side effects of local anesthetics (hypotension) and opioids (pruritus, nausea/vomiting, urinary retention, and respiratory depression), when used in this manner, may complicate perioperative management. Increased risk of hematoma formation in this scenario has generated much of lively debate regarding the acceptable risk-benefit ratio of applying regional anesthetic techniques to patients undergoing cardiac surgery.
Publication Types:
PMID: 16368803 [PubMed - indexed for MEDLINE]
-
Effects of sevoflurane anesthesia on carotid-cardiac baroreflex responses in humans.
Umehara S, Tanaka M, Nishikawa T.
Department of Anesthesia, Akita University School of Medicine, Akita-city, Japan.
Sevoflurane depresses cardio-vagal baroreflex gain (ability of vagally mediated R-R interval response to arterial blood pressure change). We examined the effects of sevoflurane anesthesia on maximum buffering capacity of vagally mediated hemodynamic control (baroreflex range) by examining the entire stimulus-response baroreflex relation. Electrocardiogram and invasive arterial blood pressure were monitored in 11 healthy volunteers. Carotid-cardiac baroreflex responses were elicited by increasing neck chamber pressure (external pressure applied over the bilateral carotid sinuses) to 40 mm Hg for 5 heartbeats followed by decreasing chamber pressure by successive 15-mm Hg R-wave triggered decrements to -65 mm Hg during held expiration. R-R intervals were plotted as functions of preceding carotid distending pressure. Range, maximum gain, and operational point (relative position of the resting set point within the entire baroreflex response curve) were determined at conscious baseline, during 2% (end-tidal) sevoflurane anesthesia, without and with phenylephrine infusion to maintain conscious arterial blood pressure, and at 30, 60, 120, and 180 min after emergence from anesthesia. Sevoflurane anesthesia significantly depressed maximum gain (from 3.84 +/- 0.99 to 1.04 +/- 0.40 ms/mm Hg [mean +/- sd]; P < 0.001) and range (from 207 +/- 43 to 52 +/- 19 ms; P < 0.001) of the reflex relation, both of which recovered at 120 and 180 min after emergence. Phenylephrine infusion only partially restored these variables. The operational point was unchanged throughout the study. Our results indicate that maximum cardio-vagal compensatory response to buffer hemodynamic perturbation is depressed during sevoflurane anesthesia. Sevoflurane-induced hypotension, which produced vagal withdrawal, did not play an important role in depressing cardio-vagal reflex function.
PMID: 16368802 [PubMed - indexed for MEDLINE]
-
Carotid endarterectomy using single injection posterior cervical paravertebral block.
Boezaart AP, Nosovitch MA.
Publication Types:
PMID: 16301284 [PubMed - indexed for MEDLINE]
-
Persistent cauda equina syndrome with no identifiable facilitating condition after an uneventful single spinal administration of 0.5% hyperbaric bupivacaine.
Chabbouh T, Lentschener C, Zuber M, Jude N, Delaitre B, Ozier Y.
Universite Paris-Descartes, Faculte de Medecine; Assistance Publique--Hopitaux de Paris, Hopital Cochin, France.
We diagnosed cauda equina syndrome 15 h after uneventful single spinal administration of 0.5% hyperbaric bupivacaine 12.5 mg through a 27-gauge pencil-point type needle. No preexisting neurologic disorder was recorded. There was no pain or paresthesia during needle placement or drug injection. The sensory levels were bilateral, symmetric, and caudal to T8. Resolution of most of the symptoms occurred within a few days but some foot drop persisted for 2 yr after the procedure. Bupivacaine neurotoxicity is suggested by the absence of any other identifiable cause for this neurologic deficit.
Publication Types:
PMID: 16301272 [PubMed - indexed for MEDLINE]
-
Signs of inflammation after sciatic nerve block in pigs.
Voelckel WG, Klima G, Krismer AC, Haslinger C, Stadlbauer KH, Wenzel V, von Goedecke A.
Department of Anesthesiology and Critical Care Medicine, Innsbruck Medical University, Anichstrasse 35, 6020 Innsbruck, Austria. wolfgang.voelckel@uibk.ac.at
Nerve stimulators are widely used to assist with peripheral nerve blocks but do not eliminate the risk of nerve injury. We evaluated the histologic findings 6 h after sciatic nerve block with bupivacaine in pigs. When a motor response was still obtained with a current <0.2 mA (n = 10), the postmortem microscopic evaluation revealed lymphocytes and granulocytes sub-, peri-, and intraneurally in 5 (50%) of 10 pigs. No signs of inflammation were observed when the muscle contraction was achieved with a current between 0.3 and 0.5 mA (P = 0.03). In conclusion, the current required to elicit a motor response, the position of the needle tip, and the subsequent likelihood of nerve damage merit further evaluation.
PMID: 16301271 [PubMed - indexed for MEDLINE]
-
The use of central neuraxial techniques in parturients with factor V leiden mutation.
Harnett MJ, Walsh ME, McElrath TF, Tsen LC.
Department of Anesthesia, Perioperative and Pain Med, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA.
The factor V Leiden (FVL) mutation is a leading cause of thrombosis, particularly during pregnancy. During pregnancy, women with thrombotic disorders including FVL are often considered candidates for antepartum anticoagulation with low molecular weight heparin. Pregnancy complications related to thrombosis and the unpredictable timing of labor cause unique challenges with regard to the provision of regional anesthesia. A patient with heterozygotic FVL presenting with thrombotic disease and a complicated anticoagulation status lead us to review 16 additional parturients with FVL. This report focuses on the anesthetic implications that arise in parturients with FVL. We recommend that anesthesiologists be made aware of FVL patients before their due date, anticoagulation with low molecular weight heparin should be transitioned to unfractionated heparin before the 38th gestational week, and multidisciplinary collaborative investigation and care should continue for this disorder.
Publication Types:
PMID: 16301266 [PubMed - indexed for MEDLINE]
-
The influence of a muscle relaxant bolus on bispectral and datex-ohmeda entropy values during propofol-remifentanil induced loss of consciousness.
Liu N, Chazot T, Huybrechts I, Law-Koune JD, Barvais L, Fischler M.
Department of Anesthesiology, Hopital Foch, 40 rue Worth, 92151 Suresnes, France.
Studies investigating the influence of muscle relaxants on the bispectral index have yielded contradictory results. In our prospective, randomized, double-blind experiments, patients received a fixed target concentration of remifentanil along with a target-controlled infusion of propofol, titrated until loss of consciousness. Two minutes after loss of consciousness, the study group received a bolus injection of atracurium, whereas the control group received a placebo. The following variables were recorded: bispectral index, spectral edge frequency, electromyographic activity, state entropy, and response entropy provided by the Datex-Ohmeda Entropy monitor. Similar values were obtained in both groups at loss of consciousness. Placebo administration induced a decrease in bispectral index (P < 0.002), spectral edge frequency (P < 0.05), electromyographic activity (P < 0.02), state entropy (P < 0.05), and response entropy (P < 0.01) compared with the values measured at loss of consciousness. Atracurium administration induced a decrease in bispectral index (P < 0.0001), spectral edge frequency (P < 0.01), electromyographic activity (P < 0.0001), state entropy (P < 0.0001), and response entropy (P < 0.0001) values. Decreases in bispectral index (P < 0.05), electromyographic activity (P < 0.0001), and response entropy (P < 0.01) were larger after atracurium than placebo injection. In lightly anesthetized patients, myorelaxant administration decreases bispectral index and response entropy, but not state entropy values.
Publication Types:
PMID: 16301247 [PubMed - indexed for MEDLINE]
-
Peripheral nerve block techniques for ambulatory surgery.
Klein SM, Evans H, Nielsen KC, Tucker MS, Warner DS, Steele SM.
Division of Ambulatory Anesthesia, Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina 27710, USA. klein006@mc.duke.edu
Peripheral nerve blocks (PNBs) have an increasingly important role in ambulatory anesthesia and have many characteristics of the ideal outpatient anesthetic: surgical anesthesia, prolonged postoperative analgesia, and facilitated discharge. Critically evaluating the potential benefits and supporting evidence is essential to appropriate technique selection. When PNBs are used for upper extremity procedures, there is consistent opioid sparing and fewer treatment-related side effects when compared with general anesthesia. This has been demonstrated in the immediate perioperative period but has not been extensively investigated after discharge. Lower extremity PNBs are particularly useful for procedures resulting in greater tissue trauma when the benefits of dense analgesia appear to be magnified, as evidenced by less hospital readmission. The majority of current studies do not support the concept that a patient will have difficulty coping with pain when their block resolves at home. Initial investigations of outpatient continuous peripheral nerve blocks demonstrate analgesic potential beyond that obtained with single-injection blocks and offer promise for extending the duration of postoperative analgesia. The encouraging results of these studies will have to be balanced with the resources needed to safely manage catheters at home. Despite supportive data for ambulatory PNBs, most studies have been either case series or relatively small prospective trials, with a narrow focus on analgesia, opioids, and immediate side effects. Ultimately, having larger prospective data with a broader focus on outcome benefits would be more persuasive for anesthesiologists to perform procedures that are still viewed by many as technically challenging.
Publication Types:
PMID: 16301239 [PubMed - indexed for MEDLINE]
Mothballs and obstetric anesthesia.
Kuczkowski KM.
Departments of Anesthesiology and Reproductive Medicine, UCSD Medical Center, University of California San Diego, 200 W. Arbor Drive, San Diego, CA 92103-8770, USA.
Publication Types:
PMID: 16364591 [PubMed - as supplied by publisher]
[Anaesthesia for cerebral radiotherapy: about 35 repeated intubations for a same 30 months old child.]
[Article in French]
Izard P, Pierre S, Pouymayou J, Laprie A, Rouge P.
Departement d'anesthesie-reanimation, institut Claudius-Regaud, 20-22, rue du pont Saint-Pierre, 31052 Toulouse, France.
Publication Types:
PMID: 16361077 [PubMed - as supplied by publisher]
Effect of oral gabapentin on postoperative epidural analgesia.
Turan A, Kaya G, Karamanlioglu B, Pamukcu Z, Apfel CC.
Department of Anaesthesiology, Trakya University, Turkey.
BACKGROUND: Gabapentin has been used successfully as a non-opioid analgesic adjuvant for postoperative pain management. We hypothesized that gabapentin might be a useful adjuvant for postoperative analgesia provided with patient-controlled epidural analgesia (PCEA). METHODS: Forty patients undergoing lower extremity surgery procedures were randomly assigned to receive (i) placebo capsules (control) or (ii) gabapentin (1.2 g day(-1)) before and for 2 days after surgery. Anaesthetic technique was standardized. Postoperative assessments included verbal rating scale scoring for pain and sedation, PCEA usage, quality of recovery assessment, times of GI function recovery, and patient satisfaction scoring for pain management. RESULTS: Pain scores at 1, 4, 8, 12, and 16 h (P<0.001), PCEA bolus requirements (n) at 24 [21 (3), 14 (2)], 48 [15 (4), 10 (3)] and 72 [8 (5), 2 (3)] (P<0.05) and paracetamol (mg) consumption [700 (523), 350 (400)]; P<0.05), were significantly lower in the gabapentin-treated patients than in the control group. Patient satisfaction with postoperative pain management at 24 h was better in gabapentin-treated patients [85.5 (7.5), 66.5 (15)]; P<0.001). Gabapentin-treated patients had less motor block when compared with control group. Times of return of bowel function, hospitalization, and resumption of dietary intake were similar in the groups. However, the incidence of dizziness was higher in the gabapentin group (35% vs 5%; P<0.05). CONCLUSIONS: Oral gabapentin (1.2 g day(-1)) as an adjunct to epidural analgesia decreased pain and analgesic consumption. Despite an increased incidence of dizziness it also increased patient satisfaction.
PMID: 16361302 [PubMed - in process]
-
Epidural haematoma after a combined spinal-epidural anaesthetic in a patient treated with clopidogrel and dalteparin.
Tam NL, Pac-Soo C, Pretorius PM.
Department of Anaesthesia, Wycombe General Hospital, Queen Alexandra Road, High Wycombe, Buckinghamshire HP11 2TT, UK.
We report a case of a spinal-epidural haematoma occurring in a patient after a combined spinal-epidural anaesthetic. She had been taking clopidogrel and had received perioperative dalteparin for thromboprophylaxis. Despite adhering to standard guidelines concerning administration of low molecular weight heparin perioperatively and stopping the clopidogrel 7 days before the anaesthetic, the patient developed an epidural haematoma.
PMID: 16361301 [PubMed - in process]
-
"Gas off" or "vaporizer off".
Scott JR, Ruttman TG.
Publication Types:
PMID: 16286356 [PubMed - indexed for MEDLINE]
-
The laryngeal tube.
Asai T, Shingu K.
Department of Anaesthesiology, Kansai Medical University, 10-15 Fumizono-cho, Moriguchi City, Osaka 570-8507, Japan. asait@takii.kmu.ac.jp
The laryngeal tube (VBM Medizintechnik, Sulz, Germany) is a relatively new extraglottic airway, designed to secure a patent airway during either spontaneous breathing or controlled ventilation. In this review article, we have assessed the potential role of the laryngeal tube during anaesthesia and during cardiopulmonary resuscitation. There are four variations of the laryngeal tube: standard laryngeal tube, disposable laryngeal tube, laryngeal tube-Suction II and disposable laryngeal tube-Suction II. The design of the device has been revised several times. Insertion of the standard laryngeal tube is as easy as with the laryngeal mask airway classic. The laryngeal tube may provide a better sealing effect than the laryngeal mask. The incidence of complications with the two devices is similar, although the laryngeal tube may require more re-adjustments of its position to obtain a clear airway. Compared with the ProSeal laryngeal mask, the laryngeal tube may be less effective. The efficacy of the standard laryngeal tube is unclear, particularly in patients breathing spontaneously or in children. The efficacy of the laryngeal tube Suction-II and disposable devices is also not clear. From the limited number of studies and reports available, it can be concluded that the laryngeal tube is potentially useful in maintaining a clear airway during anaesthesia and cardiopulmonary resuscitation. In addition, the device may be useful as an aid to tracheal intubation.
Publication Types:
PMID: 16286348 [PubMed - indexed for MEDLINE]
-
Comment on:
Pre-emptive analgesia with thoracic paravertebral blockade?
Lonnqvist PA.
Publication Types:
PMID: 16286347 [PubMed - indexed for MEDLINE]
-
Use of the ProSeal laryngeal mask airway for pressure-controlled ventilation with and without positive end-expiratory pressure in paediatric patients: a randomized, controlled study.
Goldmann K, Roettger C, Wulf H.
Department of Anaesthesia and Intensive Care Therapy, Philipps University Marburg, 35033 Marburg, Germany. kaigoldmann1@aol.com
BACKGROUND: Tracheal intubation and positive end-expiratory pressure (PEEP) are frequently used in children to avoid airway closure and atelectasis during general anaesthesia. Also, the laryngeal mask airway (LMA(dagger)) is frequently used. However, one of the limitations with its use in children is that its low-pressure seal is often inadequate for positive pressure ventilation with PEEP. The ProSeal LMA (PLMA) has been shown to form a more effective seal than the Classic LMA. The ability to apply PEEP with the PLMA might improve gas exchange during positive pressure ventilation in children when the LMA is used. METHODS: Twenty anaesthetized, non-paralysed children aged 55 (range 27-89) months, weighing 18 (sd 3) kg, were randomly allocated into two groups. Anaesthesia management and positive pressure ventilation were standardized. Size 2 and 2(1/2) PLMA were used. Artificial ventilation in Group I was with pressure controlled ventilation (PCV) and PEEP=5 cm H(2)O, in Group II with PCV without PEEP. A Fi(o(2)) = 1.0 was used for 20 min during induction of anaesthesia. Sixty minutes after induction of anaesthesia an arterial blood gas sample was taken under a Fi(o(2)) = 0.3. RESULTS: Groups were comparable with respect to demographic data. Pa(o(2)) in Group I [22.1 (1.6) kPa] was significantly (P=0.001) higher than in Group II [19.2 (1.7) kPa]. CONCLUSIONS: The PLMA can be used for PCV with PEEP in paediatric patients. Application of PEEP improves gas exchange.
Publication Types:
PMID: 16199419 [PubMed - indexed for MEDLINE]
-
Comment in:
Single-injection thoracic paravertebral block for postoperative pain treatment after thoracoscopic surgery.
Vogt A, Stieger DS, Theurillat C, Curatolo M.
Department of Anaesthesiology, Division of Thoracic Surgery, University Hospital of Bern, Inselspital, 3010 Bern, Switzerland. andreas.vogt@insel.ch
BACKGROUND: Thoracoscopic surgery can be associated with considerable postoperative pain. While the benefits of paravertebral block on pain after thoracotomy have been demonstrated, no investigations on the effects of paravertebral block on pain after thoracoscopy have been conducted. We tested the hypothesis that a single-injection thoracic paravertebral block, performed preoperatively, reduces pain scores after thoracoscopic surgery. METHODS: Of 45 patients recruited, 40 completed the study. They were randomly allocated to two groups: the paravertebral group received i.v. patient-controlled analgesia (PCA) with morphine plus single-injection thoracic paravertebral block with bupivacaine 0.375% and adrenaline 1:200 000 0.4 ml kg(-1) (n=20). The control group was treated with a back puncture without injection and morphine PCA (n=20). RESULTS: The main outcomes recorded during 48 h after surgery were pain scores using the visual analogue scale (VAS, 0-100). Secondary outcomes were cumulative morphine consumption and peak expiratory flow rate (PEFR). Half an hour and 24 h after surgery, median (25th-75th percentiles) VAS on coughing in the paravertebral group was 31.0 (20.0-55.0) and 30.5 (17.5-40.0) respectively and in the control group it was 70.0 (30.0-100.0) and 50.0 (25.0-75.0) respectively. The difference between the groups over the whole observation period was statistically significant (P<0.05). Twenty-four and 48 h after surgery, median (25th-75th percentiles) cumulative morphine consumption (mg) was 49.0 (38.3-87.0) and 69.3 (38.8-118.5) respectively in the paravertebral group and 51.2 (36.0-84.1) and 78.1 (38.4-93.1) in the control group (statistically not significant). No differences were found in PEFR or the incidence of any side-effects between groups. CONCLUSION: We conclude that single-shot preoperative paravertebral block improves post-operative pain treatment after thoracoscopic surgery in a clinically significant fashion.
Publication Types:
PMID: 16199417 [PubMed - indexed for MEDLINE]
-
Onset and duration of mivacurium-induced neuromuscular block in patients with Duchenne muscular dystrophy.
Schmidt J, Muenster T, Wick S, Forst J, Schmitt HJ.
Department of Anaesthesiology, Friedrich-Alexander University, Erlangen-Nuremberg, Krankenhausstrasse 12, D-91054 Erlangen, Germany.
BACKGROUND: To determine the response to mivacurium, we prospectively studied onset time and complete spontaneous recovery from mivacurium-induced neuromuscular block in patients with Duchenne muscular dystrophy (DMD). METHODS: Twelve boys with DMD, age 5-14 yr, seven of them wheelchair-bound, ASA II-III, and 12 age- and sex-matched controls (ASA I) were enrolled in the study. Anaesthesia was induced with fentanyl 2-3 microg kg(-1) and propofol 3-4 mg kg(-1) titrated to effect, and maintained by continuous i.v. infusion of propofol 8-12 mg kg(-1) and remifentanil as required. The lungs were ventilated with oxygen in air. Neuromuscular transmission was assessed by acceleromyography using train-of-four (TOF) stimulation every 15 s. After baseline readings, a single dose of mivacurium 0.2 mg kg(-1) was given. The following variables were recorded: (i) lag time; (ii) onset time; (iii) peak effect; (iv) recovery of first twitch from the TOF response to 10, 25 and 90% (T(10), T(25), T(90)) relative to baseline; (v) recovery index (time between 25 and 75% recovery of first twitch); and (vi) recovery time (time between 25% recovery of first twitch and recovery of TOF ratio to 90%). For comparison between the groups the Mann-Whitney U-test was applied. RESULTS: There were no differences between the groups in lag time, onset time and peak effect. However, all recorded recovery indices were significantly (P<0.05) prolonged in the DMD group. The median (range) for time points T(10), T(25) and T(90) in the DMD and control group was 12.0 (8-16) vs 8.4 (5-15) min, 14.1 (9-20) vs 10.5 (7-17) min and 26.9 (15-40) vs 15.9 (12-23) min, respectively. The recovery index and recovery time were similarly prolonged in the DMD group. CONCLUSIONS: These results support the assumption that mivacurium-induced neuromuscular block is prolonged in patients with DMD.
PMID: 16183677 [PubMed - indexed for MEDLINE]
Hypertension: classification, pathophysiology, and management during outpatient sedation and local anesthesia.
Holm SW, Cunningham LL Jr, Bensadoun E, Madsen MJ.
Oral and Maxillofacial Surgery, Carle Foundation Hospital, Urbana, IL, USA.
PMID: 16360867 [PubMed - in process]
| Display Show |
|
|