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[The anesthesia of anesthesia Schmerzmedizin in kulturethischer Perspektive.]
[Article in German]
Pfleiderer G.
Professur fur Systematische Theologie/Ethik, Universitat Basel, .
Viewed from a cultural-ethical perspective, anesthesiology can be understood as a comprehensive concept of medicine in general. As such it contains two dilemmas: very often pain must be inflicted in order to alleviate pain and this can only be done by somebody who is himself relatively free of pain. The necessary apathy or anesthesia of the anesthetist is correlated with a general twentieth century-type of perception: the cool observer. Nevertheless, it is also a modern variation of the original religious constellation of the priest in relationship to the sick person. Curing occurs by representation. The weak self of the sick person is able to take over the strong self, represented by the therapist. In twentieth century art and literature this process of self-therapy by representation was often illustrated. On the background of a phenomenological philosophy that process can be understood as the regaining of a balance between body and soul. In the psalms of the biblical Book of Job there a variety of fundamental forms of pain which may be helpful even in this secular age.
PMID: 15682330 [PubMed - as supplied by publisher]
The anesthetic cascade: a theory of how anesthesia suppresses consciousness.
John ER, Prichep LS.
Department of Psychiatry, Brain Research Laboratories, New York University School of Medicine, New York, USA. johnr01@endeavor.med.nyu.edu
PMID: 15681963 [PubMed - in process]
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Long-term exposure to local but not inhalation anesthetics affects neurite regeneration and synapse formation between identified lymnaea neurons.
Onizuka S, Takasaki M, Syed NI.
Calgary Brain Institute, Faculty of Medicine, University of Calgary, and Department of Anesthesiology, Miyazaki Medical College, University of Miyazaki, Japan.
BACKGROUND: General and local anesthetics are used in various combinations during surgical procedures to repair damaged tissues and organs, which in almost all instances involve nervous system functions. Because synaptic transmission recovers rapidly from various inhalation anesthetics, it is generally assumed that their effects on nerve regeneration and synapse formation that precede injury or surgery may not be as detrimental as that of their local counterparts. However, a direct comparison of most commonly used inhalation (sevoflurane, isoflurane) and local anesthetics (lidocaine, bupivacaine), vis-a-vis their effects on synapse transmission, neurite regeneration, and synapse formation has not yet been performed. METHODS: In this study, using cell culture, electrophysiologic and imaging techniques on unequivocally identified presynaptic and postsynaptic neurons from the mollusc Lymnaea, the authors provided a comparative account of the effects of both general and local anesthetics on synaptic transmission, nerve regeneration, and synapse formation between cultured neurons. RESULTS: The data show that clinically used concentrations of both inhalation and local anesthetics affect synaptic transmission in a concentration-dependent and reversal manner. The authors provided the first direct evidence that long-term overnight treatment of cultured neurons with sevoflurane and isoflurane does not affect neurite regeneration, whereas both lidocaine and bupivacaine suppress neurite outgrowth completely. The soma-soma synapse model was then used to compare the effects of both types of agents on synapse formation. The authors found that local but not inhalation anesthetics drastically reduced the incidence of synapse formation. The local anesthetic-induced prevention of synapse formation most likely involved the failure of presynaptic machinery, which otherwise developed normally in the presence of both sevoflurane and isoflurane. CONCLUSION: This study thus provides the first comparative, albeit preclinical, account of the effects of both general and local anesthetics on synaptic transmission, nerve regeneration, and synapse formation and demonstrates that clinically used lidocaine and bupivacaine have drastic long-term effects on neurite regeneration and synapse formation as compared with sevoflurane and isoflurane.
PMID: 15681951 [PubMed - in process]
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Effect of carbon dioxide pneumoperitoneum on development of atelectasis during anesthesia, examined by spiral computed tomography.
Andersson LE, Baath M, Thorne A, Aspelin P, Odeberg-Wernerman S.
Department of Anesthesiology and Intensive Care, Karolinska University Hospital, Huddinge, Sweden. lena.e.anderson@karolinska.se
BACKGROUND: Anesthesia per se results in atelectasis development in the dependent regions of the lungs. The effect of pneumoperitoneum on atelectasis formation is not known. The aim of the current study was to measure by spiral computed tomography the effect of carbon dioxide pneumoperitoneum for laparoscopic surgery on the development of atelectasis, overall lung volume, and regional tissue volumes of gas and tissue. METHODS: Seven patients (American Society of Anesthesiologists physical status I), scheduled to undergo laparoscopic cholecystectomy, were observed. After induction of anesthesia, the patients were mechanically ventilated and positioned supine on the computed tomography table. Tomography of the lungs (10 mm spiral) was performed before and 10 min after induction of carbon dioxide pneumoperitoneum at an intraabdominal pressure of 11-13 mmHg. The Student t test was used for statistical analysis. A P value less than 0.05 was considered significant. RESULTS: Induction of pneumoperitoneum increased the mean atelectasis volume in the dependent lung regions by 66% (range, 11-170%). The overall lung volume and gas as well as tissue volume significantly decreased. Relative to the total lung volume, lung tissue volume increased, while gas volume decreased significantly. Both upper and lower lobes reacted the same way. A cranial displacement of the diaphragm between 1 and 3 cm (mean, 1.9 cm) was registered. CONCLUSION: Pneumoperitoneum at an intraabdominal pressure level of 11-13 mmHg increased the volume of atelectasis. Because lung tissue volume increased in the lung, there may have been an opening of previously closed vessels, which could explain previously seen increase in arterial oxygenation after induction of pneumoperitoneum.
PMID: 15681942 [PubMed - in process]
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Impact of anesthesia management characteristics on severe morbidity and mortality.
Arbous MS, Meursing AE, van Kleef JW, de Lange JJ, Spoormans HH, Touw P, Werner FM, Grobbee DE.
Julius Center for Patient Oriented Research, Dutch Association for Anesthesiology, Utrecht, The Netherlands.
BACKGROUND: Quantitative estimates of how anesthesia management impacts perioperative morbidity and mortality are limited. The authors performed a study to identify risk factors related to anesthesia management for 24-h postoperative severe morbidity and mortality. METHODS: A case-control study was performed of all patients undergoing anesthesia (1995-1997). Cases were patients who either remained comatose or died during or within 24 h of undergoing anesthesia. Controls were patients who neither remained comatose nor died during or within 24 hours of undergoing anesthesia. Data were collected by means of a questionnaire, the anesthesia and recovery form. Odds ratios were calculated for risk factors, adjusted for confounders. RESULTS: The cohort comprised 869,483 patients; 807 cases and 883 controls were analyzed. The incidence of 24-h postoperative death was 8.8 (95% confidence interval, 8.2-9.5) per 10,000 anesthetics. The incidence of coma was 0.5 (95% confidence interval, 0.3-0.6). Anesthesia management factors that were statistically significantly associated with a decreased risk were: equipment check with protocol and checklist (odds ratio, 0.64), documentation of the equipment check (odds ratio, 0.61), a directly available anesthesiologist (odds ratio, 0.46), no change of anesthesiologist during anesthesia (odds ratio, 0.44), presence of a full-time working anesthetic nurse (odds ratio, 0.41), two persons present at emergence (odds ratio, 0.69), reversal of anesthesia (for muscle relaxants and the combination of muscle relaxants and opiates; odds ratios, 0.10 and 0.29, respectively), and postoperative pain medication as opposed to no pain medication, particularly if administered epidurally or intramuscularly as opposed to intravenously. CONCLUSIONS: Mortality after surgery is substantial and an association was established between perioperative coma and death and anesthesia management factors like intraoperative presence of anesthesia personnel, administration of drugs intraoperatively and postoperatively, and characteristics of delivered intraoperative and postoperative anesthetic care.
PMID: 15681938 [PubMed - in process]
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Perioperative mortality: intraoperative anesthetic management matters.
Warner MA.
Publication Types:
PMID: 15681936 [PubMed - in process]
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This month in anesthesiology.
Henkel G.
PMID: 15681935 [PubMed - in process]
[Locoregional anesthesia in otorhinolaryngology: facial blocks]
[Article in French]
Deleuze A, Gentili ME, Vial G.
Departement d'anesthesie-reanimation, clinique de l'Esperance, Groupe A Tzanck, 122, avenue du Dr-M.-Donat, 06250 Mougins, France. arnaud.deleuze@free.fr
Publication Types:
PMID: 15581731 [PubMed - indexed for MEDLINE]
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"Once a tetralogy of Fallot patient--always a tetralogy of Fallot patient (?)": time for reconsideration?
Fernandez CL, Kuczkowski KM.
Publication Types:
PMID: 15581729 [PubMed - indexed for MEDLINE]
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[Laparoscopy under local anaesthesia and hypnoanaesthesia about 35 cholecystectomies and 15 inguinal hernia repair]
[Article in French]
Sefiani T, Uscain M, Sany JL, Grousseau D, Marchand P, Villate D, Vincent JL.
Service d'anesthesie, centre hospitalier de Saint-Junien, 87200 Saint-Junien, France.
OBJECTIVE: To present hypnosedation and the feasibility of this technique performed for laparoscopic procedure. STUDY DESIGN: Retrospective and descriptive study of feasibility. PATIENTS AND METHODS: Hypnosis can significantly reduce intraoperative requirements of intravenous sedation for surgery under local anaesthesia. Modifications of surgical procedure: laparoscopic surgery under local anaesthesia and hypnosis is performed using a subcutaneous lifting of anterior abdominal wall. Insufflation is only use to push out smoke. If patient or surgical uncomfort happens, moral contract with patient includes convert to general anaesthesia. RESULTS: We performed 35 cholecystectomies; 13 needed convert to general anaesthesia, mainly for peritoneal pain induced by CO(2) insufflation; 22 procedures were completed with patients' satisfaction. Upon 15-hernia repairs, only one patient needed convert to general anaesthesia, for dissection difficulty. CONCLUSION: Probably hypnosis can't be extent to intraperitoneal laparoscopic procedures. On the other hand interest of hypnosis performed for extraperitoneal laparoscopic hernia repair must be explore.
PMID: 15581727 [PubMed - indexed for MEDLINE]
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[Cervical post-traumatic pneumomyelogram: do not ignore this entity]
[Article in French]
Amathieu R, Minville V, Poloujadoff MP, Vigue B.
Samu 93 - EA 3409, universite Paris-XIII, hopital Avicenne, 93000 Bobigny, France. roland.amathieu@smbh.univ-paris13.fr
We report the case of a post-traumatic pneumomyelogram in a 51-year-old woman. The pneumomyelogram associated with a skull base fracture was revealed by systematic total body scan. The discovery of a traumatic pneumomyelogram will be probably more frequently discovered with the largest use of modern helical CT-scan in traumatized patients. We discuss the etiologies and the implications for the anesthesiologist and the intensivist of this entity.
Publication Types:
PMID: 15581726 [PubMed - indexed for MEDLINE]
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[What can be expected from off-pump coronary artery surgery?]
[Article in French]
Lehot JJ, Lefevre M, Phan T, Bastien O, Diab C, Jegaden O.
Service d'anesthesie-reanimation et equipe d'accueil 1896, hopital cardiovasculaire et pneumologique Louis-Pradel, BP Lyon-Montchat, 69394 Lyon cedex 03, France. jean-jacques.lehot@chu-lyon.fr
Coronary artery bypass surgery with beating heart (off-pump) has become more common in the last ten years allowing seven randomized studies with at least 60 patients, comparing off-pump and on-pump coronary bypass. Anaesthesia, monitoring and haemodynamic complications are described. Randomized studies concluded to less elevation of biochemical markers of myocardial and renal injury, less hydric inflation, less cerebral microemboli, reduction of homologous blood transfusions, of hospital stay and global costs. However in low risk patients no reduction in myocardial infarction, atrial fibrillation, stroke, acute renal failure, early reoperation, surgical site infection and mortality were observed. Non-randomized studies suggest a benefit in stroke and mortality in elderly patients but the possibility of incomplete revascularization remains.
Publication Types:
PMID: 15581721 [PubMed - indexed for MEDLINE]
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[Concerning the anaesthesia record]
[Article in French]
Granry JC; et le groupe dossier anesthesique Sfar.
Publication Types:
PMID: 15581718 [PubMed - indexed for MEDLINE]
Comment on:
Conscious sedation.
Scheer B.
Publication Types:
PMID: 15611732 [PubMed - indexed for MEDLINE]
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Steroid cover for dental patients on long-term steroid medication: proposed clinical guidelines based upon a critical review of the literature.
Gibson N, Ferguson JW.
Royal Dental Hospital and University of Melbourne, 711 Elizabeth Street, Melbourne, Australia 3000.
Based to a great extent upon mainly anecdotal case reports and theory, there is a general acceptance that patients on long-term systemic steroid medication should receive supplementary glucocorticoids or "steroid cover" when undergoing certain types of stressful treatment including dentistry. The theoretical basis to this practice is that exogenous steroids suppress adrenal function to an extent that insufficient levels of cortisol can be produced in response to stress, posing the risk of acute adrenal crisis with hypotension and collapse. The purpose of this paper is to review relevant literature and propose clinical guidelines for dental practitioners. Of numerous reported cases of adrenal crisis following procedural interventions, few stand up to critical evaluation. Other reviewers have reached similar conclusions. A number of studies confirm the low likelihood of significant adrenal insufficiency even following major surgical procedures. Various authors have suggested modified guidelines for management of patients on steroid medications. Patients on long-term steroid medication do not require supplementary "steroid cover" for routine dentistry, including minor surgical procedures, under local anaesthesia. Patients undergoing general anaesthesia for surgical procedures may require supplementary steroids dependent upon the dose of steroid and duration of treatment.
Publication Types:
PMID: 15592544 [PubMed - indexed for MEDLINE]
Intracerebral hematoma after combined spinal-epidural anesthesia: complication or coincidence?
Albaladejo P, Geffroy A, Faillot T, Marty J.
PMID: 15684269 [PubMed - in process]
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Anesthesiology: the misunderstood occupation!
Ho RY, Wong DT.
PMID: 15684267 [PubMed - in process]
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Images in Anesthesia: Airway obstruction after peanut aspiration - air trapping is due to airway distension and narrowing.
Ho AM, Soo G, Lee S, Chung DC, Critchley LA, Karmakar MK.
PMID: 15684264 [PubMed - in process]
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The addition of epidural morphine to ropivacaine improves epidural analgesia after lower abdominal surgery: [L'addition de morphine peridurale a la ropivacaine ameliore l'analgesie peridurale apres une intervention chirurgicale abdominale basse].
Niiyama Y, Kawamata T, Shimizu H, Omote K, Namiki A.
Department of Anesthesiology, Sapporo Medical University, School of Medicine, S1 W16 Chuou-ku, Sapporo, Hokkaido 060-8556, Japan. Phone: 81-11-611-2111, ext. 3568; Fax; 81-11-631-9683; E-mail; kawamata@sapmed.ac.jp.
PURPOSE: To assess the analgesic and side effects of the continuous epidural infusion of 0.2% ropivacaine combined with morphine compared to both drugs alone. METHODS: In this study, both observers and patients were blinded to patient group assignment. Sixty patients scheduled to undergo lower abdominal surgery were enrolled. Patients were randomized to one of three postoperative treatment groups: 1) combination group (a combination of 0.2% ropivacaine and 0.003% morphine); 2) morphine group (0.003% morphine); or 3) ropivacaine group (0.2% ropivacaine). Postoperatively, all solutions were administered epidurally at a rate of 6 mL.hr(-1) for 24 hr. Patients were given iv flurbiprofen as a supplemental analgesic on demand. RESULTS: The combination group showed lower visual analogue scale scores than those of patients receiving either drug alone, both at rest and on coughing. The combination group showed a slight motor block at two hours after the continuous epidural infusion, while the ropivacaine and morphine groups did not show any motor block. The incidence of itching was significantly increased in the morphine and combination groups, compared to the ropivacaine group. There was no significant difference between the numbers of patients with nausea in the three groups. No hypotension or respiratory complications were observed in the three groups. CONCLUSION: The combination of epidural 0.2% ropivacaine and 0.003% morphine has more effective analgesic effects than either of the drugs alone for postoperative pain relief after lower abdominal surgery.
PMID: 15684260 [PubMed - in process]
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Anesthesia for a patient with morbid obesity using dexmedetomidine without narcotics: [L'anesthesie chez un patient obese morbide avec la dexmedetomidine sans narcotiques].
Hofer RE, Sprung J, Sarr MG, Wedel DJ.
Mayo Clinic College of Medicine, Department of Anesthesiology, Mayo Clinic, 200 First Street S.W., Rochester, Minnesota 55905, USA. sprung.juraj@mayo.edu.
PURPOSE: To describe the anesthetic management of a patient with extreme obesity undergoing bariatric surgery whose intraoperative narcotic management was entirely substituted with dexmedetomidine. CLINICAL FEATURES: We describe a 433-kg morbidly obese patient with obstructive sleep apnea and pulmonary hypertension who underwent Roux-en-Y gastric bypass. Because of the concern that the use of narcotics might cause postoperative respiratory depression, we substituted their intraoperative use with a continuous infusion of dexmedetomidine (0.7 mug*kg(-1)*hr(-1)). The anesthesia course was uneventful, and the intraoperative use of dexmedetomidine was associated with low anesthetic requirements (0.5 minimum alveolar concentration). After completion of the operation and after tracheal extubation, the dexmedetomidine infusion was continued uninterrupted throughout the end of the first postoperative day. The analgesic effects of dexmedetomidine extended narcotic-sparing effects into the postoperative period; the patient had lower narcotic requirements during the first postoperative day [48 mg of morphine by patient-controlled analgesia (PCA)] while still receiving dexmedetomidine, compared to the second postoperative day (morphine 148 mg by PCA) with similar pain scores. CONCLUSION: Dexmedetomidine may be a useful anesthetic adjunct for patients who are susceptible to narcotic-induced respiratory depression. In this morbidly obese patient the narcotic-sparing effects of dexmedetomidine were evident both intraoperatively and postoperatively.
PMID: 15684259 [PubMed - in process]
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Volatile anesthetics and liver injury: a clinical update or what every anesthesiologist should know/Les anesthesiques volatiles et l'atteinte hepatique : une mise a jour clinique ou ce que tout anesthesiologiste devrait savoir.
Martin JL.
Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins University School of Medicine, 600 North Wolfe Street, Tower 711 Baltimore, MD 21287-8711, USA. jmartin@jhmi.edu.
PMID: 15684249 [PubMed - in process]
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Canadian Journal of Anesthesia 2005: changing of the guard/Le Journal canadien d'anesthesie 2005 : la releve de la garde.
Miller DR.
Editor-in-Chief, Canadian Journal of Anesthesia, The Ottawa Hospital, General Campus, Room E2207, 501 Smyth Road, Ottawa, Ontario K1H 8L6, Canada. dmiller@ottawahospital.on.ca.
PMID: 15684248 [PubMed - in process]
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Anaesthetic management of the Prader-Willi syndrome.
Lirk P, Keller C, Colvin J, Rieder J, Wulf K.
Publication Types:
PMID: 15678742 [PubMed - in process]
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Anaesthetic management in vitreo-retinal surgery.
Dal D, Aykut T, Demritas F.
Publication Types:
PMID: 15678741 [PubMed - in process]
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Anaesthetic specialist registrars in Ireland: current teaching practices and perceptions of their role as undergraduate teachers.
Walsh K, Ahern S, Condon E, O'Connor M, O'Callaghan S.
Cork University Hospital, Department of Anaesthetics, Intensive Care and Pain Medicine, Wilton, Cork, Ireland. kenwalsh@ireland.com
BACKGROUND AND OBJECTIVES: Teaching is an important responsibility of non-consultant hospital doctors. In Ireland, specialist registrars (SpRs) in anaesthesia are contractually obliged to teach medical students, other doctors and nurses. Both medical students and fellow non-consultant hospital doctors attribute between 30 and 40% of their knowledge gain to non-consultant hospital doctors. METHODS: We carried out a confidential telephone survey of anaesthetic SpRs in Ireland regarding their current teaching practices and the perceptions of their role as undergraduate teachers. All the SpRs currently working in clinical practice in Ireland were eligible. RESULTS: Fifty-five of the 79 (70%) SpRs responded to the questionnaire. Only 7 (12.7%) of the respondents said they had been well trained as a teacher. The majority of the respondents stated that they would attend a learning-to-teach course/workshop if one was available, and felt that such a course would improve their ability as a teacher. Only 8 (14.5%) agreed that adequate emphasis is placed on commitment to teaching in the assessment of SpRs, both by individual departments and by the College of Anaesthetists. Anaesthetic SpRs in Ireland spend a considerable amount of time each day teaching undergraduate medical students, the majority (68.9%) stated that they had inadequate time to prepare for teaching. CONCLUSION: The majority of the respondents stated that they enjoy teaching, feel that they play an important role in undergraduate teaching but have inadequate time to prepare for teaching. An adequate emphasis is not placed on their commitment to teaching.
PMID: 15678739 [PubMed - in process]
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Performance of bispectral index and auditory evoked potential monitors in detecting loss of consciousness during anaesthetic induction with propofol with and without fentanyl.
Mi WD, Sakai T, Kudo T, Kudo M, Matsuki A.
University of Hirosaki School of Medicine, Department of Anaesthesiology, Hirosaki-Shi, Japan. wwdd1962@yahoo.com.cn
BACKGROUND AND OBJECTIVE: To investigate and compare the performance of bispectral index (BIS) and auditory evoked response index (AAI) in detecting the transition from consciousness to unconsciousness during anaesthesia induction by propofol, alone and in combination with fentanyl. METHODS: Anaesthesia was induced with either an intravenous infusion of 30 mg kg(-1)h(-1) of propofol plus 2 microg kg(-1) of fentanyl (Group PF, n = 20) or an intravenous infusion of 30 mg kg(-1) h(-1) of propofol plus normal saline (Group P, n = 20). BIS, AAI and the doses of propofol administered were recorded at the end-point of unresponsiveness to verbal commands. The propofol plasma concentration was also measured. RESULTS: The propofol dose and plasma propofol concentration required to achieve loss of consciousness were significantly lower in patients pretreated with fentanyl (P < 0.001). The mean BIS value at loss of consciousness was significantly different between the two groups (74.10 in Group PF vs. 60.80 in Group P) (P < 0.001). However, no difference in the AAI was seen between the two groups at loss of consciousness (32.90 in Group PF vs. 31.80 in Group P) (P > 0.05). In both groups, the regression analysis values (r-values) between BIS and plasma propofol concentrations at the onset of unconsciousness were higher than those between AAI and propofol concentrations (0.553 vs. 0.180 in Group P; 0.432 vs. 0.308 in Group PF). CONCLUSIONS: These results show that a fentanyl bolus is effective in augmenting the hypnotic effect of propofol during anaesthesia induction. AAI appears to be able to measure the transition from consciousness to unconsciousness at similar values, regardless of whether or not fentanyl pretreatment is used whereas the BIS values were not independent of fentanyl pretreatment. This suggests that AAI may be a better indicator of conscious status during propofol/fentanyl anaesthesia, where it appears to be independent of the anaesthesia regimen.
PMID: 15678736 [PubMed - in process]
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Haemodynamic changes during halothane, sevoflurane and desflurane anaesthesia in dogs before and after the induction of severe heart failure.
Preckel B, Mullenheim J, Hoff J, Obal D, Heiderhoff M, Thamer V, Schlack W.
Klinik fur Anaesthesiologie, Universitatsklinikum, Dusseldorf, Germany. preckel@med.uni-duesseldorf.de
BACKGROUND AND OBJECTIVE: The effects of desflurane and sevoflurane on the failing myocardium are still uncertain. We investigated the effects of different concentrations of sevoflurane, desflurane and halothane in dogs with pacing induced chronic heart failure. METHODS: Global (left ventricular pressure, left ventricular dP/dt, Konigsbergtransducer) and regional myocardial function (systolic segment length shortening, ultrasonic crystals) were measured in chronically instrumented dogs with tachycardia induced severe congestive heart failure. Measurements were performed in healthy dogs and after induction of heart failure in the awake state and during anaesthesia with 0.75, 1.0, 1.25 and 1.75 minimum alveolar concentration (MAC) of halothane, sevoflurane or desflurane. RESULTS: The anaesthetics reduced dP/dtmax in a dose-dependent manner in healthy dogs (dP/dtmax decreased to 43-53% of awake values at 1.75 MAC). Chronic rapid left ventricular pacing increased heart rate and left ventricular end-diastolic pressure and decreased mean arterial pressure, left ventricular systolic pressure and dP/dtmax. The reduction in contractility was similar in the failing myocardium (to 41-50% of awake values at 1.75 MAC). Segmental shortening was reduced during anaesthesia by 50-62% after pacing compared with 22-44% in normal hearts. While there were similar effects of the different anaesthetics on diastolic function in healthy dogs, after induction of heart failure a more pronounced increase of the time constant of isovolumic relaxation and a greater decrease of dP/dtmin was observed with sevoflurane than with desflurane, indicating a stronger depression of diastolic function. CONCLUSIONS: While the negative inotropic effects of sevoflurane and desflurane were similar in normal and in the failing myocardium in vivo, desflurane led to a better preservation of diastolic function in the failing myocardium.
PMID: 15678735 [PubMed - in process]
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Sufentanil supplementation of sevoflurane during induction of anaesthesia: a randomized study.
Meaudre E, Boret H, Suppini A, Sallaberry M, Benefice S, Palmier B.
Military Teaching Hospital, Department of Anaesthesia, Toulon-Naval, France. meaudre@club-internet.fr
BACKGROUND AND OBJECTIVE: The use of opioids with sevoflurane for induction of anaesthesia is associated with fewer reactions to laryngoscopy but increases the risk of apnoea. Thus it is important to search for the optimal opioid dose. The aim of this study was to compare two sufentanil doses during induction with sevoflurane in young adults. METHODS: Sixty-three young patients (18-26 yr) undergoing wisdom-tooth extraction were randomly allocated to one of the two sufentanil dose groups: 0.15 microg kg(-1) (n = 33) or 0.30 microg kg(-1) (n = 30). Sufentanil was injected 1 min before sevoflurane inhalation. Sevoflurane was inhaled using the three-breath vital-capacity technique with 8% sevoflurane and 100% oxygen. The anaesthesiologist decided when to intubate the trachea. The length of time for intubation was measured. In addition, any apnoea, patient movement, adequacy of the laryngoscopic view, coughing and haemodynamic responses were recorded. RESULTS: Mean time to intubate the trachea, full laryngoscopy view and open-cord position were similar in both groups. The incidence of apnoea was higher in Group 0.30 (P < 0.05). The incidence of patient movement (P < 0.05) and coughing (P < 0.001) was lower in Group 0.30 than in Group 0.15. Sufentanil 0.30 microg kg(-1) attenuated the change in heart rate more effectively than sufentanil 0.15 microg kg(-1). Mean arterial pressure was similar and stable in both groups during induction of anaesthesia. CONCLUSIONS: In current clinical practice during sevoflurane induction, sufentanil 0.30 microg kg(-1) provided a better quality of induction than sufentanil 0.15 microg kg(-1), without significant cardiovascular depression, although the risk of apnoea is increased.
PMID: 15678734 [PubMed - in process]
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Rocuronium duration of action under sevoflurane, desflurane or propofol anaesthesia.
Maidatsi PG, Zaralidou AT, Gorgias NK, Amaniti EN, Karakoulas KA, Giala MM.
AHEPA University Hospital, Anaesthesiology Department, Thessaloniki, Greece. mpanagio@panafonet.gr
BACKGROUND AND OBJECTIVE: We conducted a prospective randomized study to evaluate whether the duration of action of a single bolus dose of rocuronium is influenced by maintenance of anaesthesia with sevoflurane, desflurane or propofol infusion. METHODS: Fifty-seven ASA I-II patients undergoing elective abdominal surgery were enrolled in this study. Anaesthesia was induced with thiopental 3-5 mg kg(-1) or propofol 2.5 mg kg(-1) and fentanyl 5 microg kg(-1) and tracheal intubation was facilitated with rocuronium 0.9 mg kg(-1). Thereafter patients were randomly allocated to three different groups to receive sevoflurane, desflurane or propofol for maintenance of anaesthesia. Recovery of neuromuscular function was monitored by single twitch stimulation of the ulnar nerve and by recording the adductor pollicis response using accelerometry. Intergroup recovery times to 5% of control value of single twitch were analysed using analysis of variance with Bonferroni correction. RESULTS: The mean (95% confidence interval) recovery time to 5% of control value of single twitch during desflurane anaesthesia was 90.18 (86.11-94.25) min. Significantly shorter recovery times were observed during sevoflurane or propofol anaesthesia, 58.86 (54.73-62.99) min and 51.11 (45.47-56.74) min, respectively (P < 0.001). There were also significant differences in the recovery time between groups receiving desflurane vs. sevoflurane (P < 0.001) and desflurane vs. propofol (P < 0.001). CONCLUSIONS: Desflurane anaesthesia significantly prolongs the duration of action of rocuronium at 0.9 mg kg(-1) single bolus dose, compared to sevoflurane or propofol anaesthesia maintenance regimens.
PMID: 15678732 [PubMed - in process]
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The impact of increasing the use of regional anaesthesia for emergency caesarean section.
Bjornestad E, Iversen OE, Raeder J.
Haukeland University Hospital, Departments of Anaesthesiology and Intensive Care, Bergen, Norway. elbj@helse-bergen.no
BACKGROUND AND OBJECTIVE: In 1991 general anaesthesia was used extensively for emergency Caesarean section at Haukeland University Hospital even in patients with an ongoing epidural infusion. With increased knowledge of the potential safety benefits of regional anaesthesia and increased experience with the technique, we decided to use indwelling epidural catheters for emergency Caesarean section. METHODS: We conducted a retrospective analysis of a full annual data set on emergency Caesarean section in parturients with ongoing epidural analgesia in 1997 and compared it with a similar data set from 1991. RESULTS: Epidural anaesthesia was used significantly more often in 1997 with 115 (78%) cases than in 1991 with five (12%) cases (P < 0.001). Elapsed time before adequate anaesthesia and the start of surgery was significantly shorter in 1991 (mean 8.3 min) compared to 1997 (mean 13 min) (P < 0.001). No deaths or major complications were observed in either group. Intraoperative minor complications were observed more frequently in 1997 with 70 cases (47%) than in 1991 with two cases (6%) (P < 0.001). The principal complications were hypotension and nausea. Postoperative complications in mother and neonate were similar in both groups. There was a significantly shorter mean hospital stay in 1997 (6 days), compared with 1991 (8 days) (P < 0.001). CONCLUSION: The increase in the use of indwelling epidural catheters for emergency Caesarean section has resulted in a significant increase in the use of regional anaesthesia. A modest increase in time elapsed before start of surgery was observed although there were no significant differences in the number of neonates with low Apgar scores. No major complications were observed, but there was an increased frequency of minor complications in 1997.
PMID: 15678731 [PubMed - in process]
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Postoperative magnesium sulphate infusion reduces analgesic requirements in spinal anaesthesia.
Apan A, Buyukkocak U, Ozcan S, Sari E, Basar H.
Kirikkale University Faculty of Medicine, Department of Anaesthesiology, Kirikkale, Turkey. alpaslanapan@doctor.com
BACKGROUND AND OBJECTIVES: Magnesium sulphate infusion during general anaesthesia reduces anaesthetic consumption and analgesic requirements. The aim of this study was to assess the effects of postoperative magnesium infusion on duration of block, sedation and analgesic consumption after spinal anaesthesia. METHODS: Fifty ASA I-II patients were included in the randomized double blind study. Spinal anaesthesia was performed at L3-4 or L4-5 interspace with 12.5 mg 0.5% heavy bupivacaine, using a 25 G Quincke needle. Patients received a 5 mg kg(-1) bolus of magnesium sulphate followed by a 500 mg h(-1) infusion or saline in the same volumes for 24 h. Time to first pain, analgesic request, return of motor function, visual analogue pain and sedation scores were evaluated every 4 h during the 24 h postoperative period. The t- and U-tests were used for statistical analyses. Data were expressed as mean +/- SD, with P < 0.05 being considered significant. RESULTS: Vital signs were stable during spinal anaesthesia and postoperative period. When compared to the control group, time to analgesic need was increased and total analgesic consumption was reduced in the magnesium group (meperidine consumption 60.0 +/- 73.1 mg control group, 31.8 +/- 30.7 mg magnesium group, P = 0.02). CONCLUSIONS: Magnesium sulphate infusion may be used as an adjunct for reducing analgesic consumption after spinal anaesthesia.
PMID: 15678729 [PubMed - in process]
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Reporting systems in healthcare from a case-by-case experience to a general framework: an example in anaesthesia.
Nyssen AS, Aunac S, Faymonville ME, Lutte I.
University of Liege, Department of Work Psychology, Liege, Belgium. asnyssen@ulg.ac.be
Reporting systems are becoming more widespread in healthcare. Since they may become mandatory under the pressure of insurance companies and administrative organizations, it is important to begin to go beyond a case-by-case approach and to move to a system where there is a general reflection on the best conditions of development and setting up of such systems in medicine. In this paper, we review existing reporting systems, break down their components, examine how they are constructed and propose some ideas on how to articulate them in a dynamic process in order to improve the validity of the tool as mediator of safety, quality and well-being at work.
PMID: 15678728 [PubMed - in process]
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Temporary neurologic deficits in patients undergoing cardiac surgery with thoracic epidural supplementation.
Chakravarthy M, Nadiminti S, Krishnamurthy J, Thimmannagowda P, Jawali V, Royse CF, Minzter BH.
Publication Types:
- Case Reports
- Clinical Conference
PMID: 15365938 [PubMed - indexed for MEDLINE]
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Living-related lobar lung transplantation.
Veeken C, Palmer SM, Davis RD, Grichnik KP.
University of Leiden, Leiden, The Netherlands.
Publication Types:
PMID: 15365937 [PubMed - indexed for MEDLINE]
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Off-pump coronary artery bypass surgery: to do or not to do? Current best available evidence.
Raja SG, Dreyfus GD.
Department of Cardiac Surgery, Harefield Hospital, Middlesex, United Kingdom. drrajashahzad@hotmail.com
Publication Types:
PMID: 15365936 [PubMed - indexed for MEDLINE]
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Analgesic effects of interpleural bupivacaine with fentanyl for post-thoracotomy pain.
Karakaya D, Baris S, Ozkan F, Demircan S, Gok U, Ustun E, Tur A.
Ondokuz Mayis University, Tip Fakultesi, Anesteziyoloji ve Reanimasyon, Anabilim Dali, 55139, Kurupelit, Samsun, Turkey. denizk@omu.edu.tr
OBJECTIVE: The analgesic effect of bupivacaine/fentanyl with epinephrine given interpleurally after thoracotomy was investigated in a randomized placebo and intravenous controlled study. DESIGN: Prospective clinical study. SETTING: University teaching hospital. PARTICIPANTS: Sixty American Society of Anesthesiologists physical status II and III patients scheduled for posterolateral thoracotomy with general anesthesia. INTERVENTIONS: Patients were randomly divided into 4 groups to receive either 0.5% bupivacaine/1.5 microg/kg of fentanyl with 5 microg/mL of epinephrine (n = 15, group IPBF), 0.5 % bupivacaine with 5 microg/mL of epinephrine (n = 15, group IPB), or saline (n = 15, group IPS) in a total volume of 15 to 20 mL in 60 seconds by an interpleural catheter placed at the end of surgery by direct vision. The same volume of bupivacaine 0.25% and 1.5 microg/kg of fentanyl with 5 microg/mL of epinephrine to group IPBF, bupivacaine 0.25% with 5 microg/mL of epinephrine to group IPB or saline to group IPS was injected through the interpleural catheter every 6 hours for 48 hours postoperatively. Intravenous fentanyl (n = 15, group IVF) and interpleural saline groups received 1.5 microg/kg of fentanyl intravenously at the first complaint of pain. All patients also received patient-controlled analgesia (PCA) with fentanyl for 48 hours postoperatively. Metamizol sodium was used as a rescue analgesic. MEASUREMENTS and MAIN RESULTS: Adequacy of pain relief was evaluated with the "Prince Henry Pain Scale" and visual analog pain scale. Fentanyl consumption via PCA and complications were evaluated for 48 hours. Visual analog scale scores were significantly higher in the interpleural saline group at 4 and 12 hours (6.6 +/- 1.2 and 5.0 +/- 2.1, respectively) postoperatively. Significantly more patients in the IPBF group had lower pain scores during coughing and deep breathing. Fentanyl consumption via PCA device was significantly higher in the intravenous fentanyl group (1,069 +/- 96.9 microg) than the interpleural groups (577.3 +/- 72.2 microg, 651.1 +/- 61.9 microg, and 601.0 +/- 22.6 microg in IPBF, IPB, and IPS groups, respectively). CONCLUSION: It is concluded that total fentanyl consumption via PCA decreased in all interpleural groups, but pain during coughing and deep breathing was significantly reduced in only the interpleural bupivacaine/fentanyl with epinephrine group.
Publication Types:
- Clinical Trial
- Randomized Controlled Trial
PMID: 15365929 [PubMed - indexed for MEDLINE]
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Intrathecal morphine for off-pump coronary artery bypass grafting.
Metz S, Schwann N, Hassanein W, Yuskevich B, Nixon T.
Department of Anesthesiology, Drexel University College of Medicine, Philadelphia, PA, USA. Samuel.Metz@Drexel.edu
OBJECTIVE: To determine if preinduction intrathecal morphine is associated with successful intraoperative extubation in patients undergoing off-pump coronary artery bypass grafting. DESIGN: A retrospective noncontrolled chart review of all patients undergoing off-pump coronary artery bypass grafting. SETTING: Single university hospital. PARTICIPANTS: One hundred twelve patients. INTERVENTIONS: One hundred twelve of 150 patients received preinduction intrathecal morphine as part of routine anesthetic care for off-pump coronary artery bypass grafting. Patients received a mean of 1.0 mg of intrathecal morphine (range 0.3-1.6 mg); average weight-corrected dose was 13.2 microg/kg (range 5-24 microg/kg). MEASUREMENTS and MAIN RESULTS: This study included intraoperative extubation rate, delayed respiratory depression, and other complications potentially attributable to intrathecal morphine. An intraoperative extubation rate of 77% was found. Five patients received naloxone postoperatively, 4 of them for delayed respiratory depression. CONCLUSIONS: It is concluded that intrathecal morphine is associated with a high intraoperative extubation rate in patients undergoing off-pump coronary artery bypass grafting. The authors' practice included 24-hour respiratory monitoring to detect delayed respiratory depression.
PMID: 15365926 [PubMed - indexed for MEDLINE]
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Relationship between peripheral and central venous pressures in different patient positions, catheter sizes, and insertion sites.
Tugrul M, Camci E, Pembeci K, Al-Darsani A, Telci L.
Department of Anaesthesiology, Istanbul University, Istanbul, Turkey. mtugrul@isbank.net.tr
OBJECTIVE: To investigate the relationship between peripheral and central venous pressures in different patient positions (supine, prone, lithotomy, Trendelenburg, and Fowler), different catheter diameters (18 G and 20 G), and catheterization sites (dorsal hand and forearm) during surgical procedures. DESIGN: Prospective clinical study. SETTINGS: University hospital. PARTICIPANTS: Five hundred adult patients. INTERVENTIONS: Peripheral over-the-needle intravenous catheters were placed in the dorsal hand or forearm. Central venous catheters were inserted via the internal jugular or subclavian vein after induction of anesthesia. MEASUREMENTS and MAIN RESULTS: Simultaneous measurements of central and peripheral venous pressures were made during stable conditions at random time points in surgery; 1953 paired measurements were performed. Mean central venous pressure was 11 +/- 3.7 mmHg and peripheral venous pressure was 13 +/- 4 mmHg (p = 0.0001). The overall correlation between central venous and peripheral venous pressures was found to be statistically significant (r = 0.89, r(2) = 0.8, p = 0.0001). Mean difference between peripheral and central venous pressure was 2 +/- 1.8 mmHg. Ninety-five percent limits of agreement were 5.6 to -1.6 mmHg. CONCLUSION: It has been assumed that replacing central venous pressure by peripheral venous pressure would cause problems in clinical interpretation. If the validity of this data is confirmed by further studies, the authors suggest that central venous pressure could be estimated by using regression equations to compare the 2 methods.
PMID: 15365925 [PubMed - indexed for MEDLINE]
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Office-based ambulatory anesthesia: Factors that influence patient satisfaction or dissatisfaction with deep sedation/general anesthesia.
Coyle TT, Helfrick JF, Gonzalez ML, Andresen RV, Perrott DH.
Purpose The purpose of this report was to analyze data collected in an outcomes study in an attempt to identify factors that may be significant predictors of either patient satisfaction or dissatisfaction with deep sedation/general anesthesia (DS/GA) administered in an office-based setting. Materials and methods To address the research purpose, we used a prospective cohort study design and sample of patients undergoing procedures in the office-based ambulatory setting of oral and maxillofacial surgeons practicing in the United States who received local anesthesia (LA), conscious sedation (CS), or DS/GA. The predictor variables were categorized as demographic, anesthetic technique, adverse events, and patient-oriented outcomes (satisfaction/dissatisfaction). Appropriate descriptive and exact P values were completed as indicated. Statistical significance was set at P < .05. Multivariate analyses were performed to support the interpretation of univariate findings. Results The sample was composed of 34,191 patients, of whom 71.9% patients received DS/GA. There were 20,455 patient satisfaction forms completed, of which 14,912 forms were from patients undergoing DS/GA. Of patients who received DS/GA, 95.8% were extremely or moderately satisfied, 3.1% were neutral, and 1.1% moderately or extremely dissatisfied. Increased age and memory of postoperative instructions were identified as factors, which predicted satisfaction. The addition of nitrous oxide to some regimens also appeared to increase satisfaction. Young age, anxiety, pain, vomiting, and being awake during the procedure were predictors of dissatisfaction. Conclusions The findings of this study indicate that patients are overwhelmingly satisfied with DS/GA provided in an office-based ambulatory setting. Items identified as significant predictors of dissatisfaction (anxiety, pain, vomiting, being awake) generally confirm preexistent suppositions. Surprisingly, patient age (<10 years old) and memory of postoperative instructions appear to have relevance to dissatisfaction as well. Lack of specific regimens and controls prevents confirmation that nitrous oxide improves patient satisfaction rates. Although statistically significant, the variations, which resulted in a higher or lower satisfaction rate, are of questionable clinical significance in many cases.
PMID: 15690283 [PubMed - in process]
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Analgesic effect of extracts of Chinese medicinal herbs Moutan cortex and Coicis semen on neuropathic pain in mice.
Tatsumi S, Mabuchi T, Abe T, Xu L, Minami T, Ito S.
Department of Anesthesiology, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki 569-8686, Japan.
Neuropathic pain arising from peripheral nerve injury is a clinical disorder characterized by a combination of spontaneous pain, hyperalgesia and tactile pain (allodynia), and remains a significant clinical problem since it is often poorly relieved by conventional analgesics. To seek an analgesic compound(s) in Chinese herbs, we examined the effect of seven Chinese herbs that are routinely prescribed for pain management in two neuropathic pain models: allodynia induced by intrathecal administration of prostaglandin F2alpha (PGF2alpha) and by selective L5 spinal nerve transection. The extracts of Moutan cortex and Coicis semen dose-dependently alleviated the PGF2alpha-induced allodynia by oral administration 1 h before intrathecal injection of PGF2alpha. When orally administrated every day for 7 days, these extracts attenuated neuropathic pain in the ipsilateral side, but not in the contralateral side, day 7 after L5 spinal nerve transection. The increase in NADPH diaphorase activity in the spinal cord associated with neuropathic pain was also blocked by these extracts. These results suggest that Moutan cortex and Coicis semen contain substances effective in neuropathic pain.
PMID: 15488309 [PubMed - indexed for MEDLINE]
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Ketamine potentiates the effect of electroacupuncture on mechanical allodynia in a rat model of neuropathic pain.
Huang C, Li HT, Shi YS, Han JS, Wan Y.
Key Laboratory of Neuroscience, Neuroscience Research Institute, Peking University, 38 Xueyuan Road, Beijing 100083, PR China.
Mu-opioid agonists and N-methyl-d-aspartate (NMDA) receptor antagonists have been shown to attenuate mechanical allodynia in neuropathic pain models. We have previously reported that 2Hz electroacupuncture (EA) produced analgesia via releasing endogenous opioid peptides (i.e. beta-endorphin and endomorphin) and the activated micro-opioid receptors. The present study aimed to examine whether ketamine, an NMDA receptor antagonist, can enhance the anti-allodynic effects induced by 2Hz EA in a rat model of neuropathic pain following spinal nerve ligation (SNL). The results are as follows: (1) EA itself or i.p. injection of ketamine reduced mechanical allodynia (i.e. increase in withdrawal threshold). (2) Although injection of ketamine at a low dose (1.0mg/kg) alone did not influence mechanical withdrawal threshold, combination of ketamine at this dose with EA produced more potent anti-allodynic effect than that induced by EA alone. (3) The anti-allodynic effect of EA combined with ketamine could be reversed by i.p. injection of naloxone (2.0 mg/kg). These results suggested that ketamine potentiate the anti-allodynic of EA in rats with spinal nerve ligation, and endogenous opioid system is likely to be involved in this process.
PMID: 15364421 [PubMed - indexed for MEDLINE]
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Potentially concerning reason why adding methylprednisolone to local anesthetic may increase the duration of axillary block.
Lipman ZJ, Isaacson SA.
PMID: 15690279 [PubMed - in process]
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Regional anesthesia for eye surgery.
Ripart J, Nouvellon E, Chaumeron A.
PMID: 15690272 [PubMed - in process]
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Anesthetic techniques and postoperative emesis in pediatric strabismus surgery.
Chhabra A, Pandey R, Khandelwal M, Subramaniam R, Gupta S.
Background and objectives Postoperative emesis after pediatric strabismus surgery continues to be a problem, despite the use of antiemetics. The purpose of this study was to identify an anesthetic technique associated with the lowest incidence of vomiting after pediatric strabismus surgery. Methods A prospective, randomized, double-blind study was conducted to evaluate the effect of intravenous fentanyl, meperidine, or peribulbar block with propofol infusion on emesis in 105 pediatric patients undergoing strabismus surgery. Anesthesia was maintained with nitrous oxide, oxygen, and propofol infusion. Ketorolac 1.0 mg/kg -1 intramuscular was administered to all patients after induction. Patients were given either a peribulbar block, intravenous fentanyl 2 mug/kg -1 , or intravenous meperidine 1mg/kg -1 for perioperative analgesia. The emesis scores were observed for the first 24 hours postoperatively. Results The incidence of emesis was significantly lower (1 of 35; 2.9%) in the peribulbar group compared with the meperidine group (9 of 35; 25.6%) ( P < .01) in the first 24 hours. The fentanyl group had a higher incidence of postoperative vomiting (4 of 35; 11.4%) than did the peribulbar group; the difference, however, was not statistically significant. Conclusion Among the three techniques, peribulbar block with propofol-based anesthesia is the technique with the lowest incidence of postoperative emesis. Fentanyl-propofol is an equally acceptable alternative; however, meperidine-propofol is associated with a high incidence of postoperative emesis.
PMID: 15690267 [PubMed - in process]
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