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Cardiac arrest during desflurane anaesthesia in a patient with Duchenne's muscular dystrophy.
Smelt WL.
PMID: 15715635 [PubMed - in process]
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Change in anaesthetic practice for Caesarean section in Germany.
Stamer UM, Wiese R, Stuber F, Wulf H, Meuser T.
Department of Anaesthesiology and Intensive Care Medicine, University of Bonn, Bonn, Germany.
Background: Initial data from 1996 revealed that in contrast to several other countries general anaesthesia was the preferred anaesthetic technique for Caesarean section in Germany. However, anaesthetic practice for Caesarean section has changed during the last decades world-wide. This investigation was performed to obtain more actual data on anaesthetic procedures in obstetric patients in German hospitals. Methods: Questionnaires on the practice of anaesthesia for Caesarean section were mailed to 918 German departments of anaesthesiology. Furthermore, the survey evaluated severe perioperative complications in obstetric patients. Results: The 397 completed replies in this survey represent 41.3% of all German deliveries in 2002. Spinal anaesthesia is now the most common technique (50.5%) for elective Caesarean section. In case of urgent and emergency Caesarean, delivery figures decrease to 34.6% and 4.8%, respectively. Epidural anaesthesia is performed in 21.6% of scheduled and 13.2% and 1.0% of non-scheduled urgent or emergency Caesarean sections, respectively. Four maternal deaths and several non-fatal episodes of gastric content aspiration were reported by the respondents. Conclusions: Compared to data obtained 6 years ago a significant increase in regional anaesthesia for Caesarean section has developed, with spinal anaesthesia being the preferred technique. Surveys can help to initiate discussion and improve current practice of anaesthetic care.
PMID: 15715617 [PubMed - in process]
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Pre-anesthetic presence of an injured dam influences pups' locomotor behavior during emergence from anesthesia in rats.
Arai YC, Ueda W, Al-Chaer ED.
Departments of Internal Medicine and Anatomy and Neurosciences, University of Texas Medical Branch, Galveston, TX, USA.
Background: Pre-anesthetic mother-infant interaction is an important factor for smooth emergence of pediatric anesthesia. In many mammalian species, disruptions of the mother-infant relationship cause psychological and behavioral changes. This study was to investigate whether or not pre-anesthetic presence of an injured dam has an impact on locomotor behavior of rat pups. Methods: We used a video-tracking system to test the effects of pre-anesthetic relations between pups and their dams on pups' locomotor behavior during emergence from general anesthesia, in 40 3-week-old Sprague-Dawley male rats. Pups were divided into two groups: pups housed with a dam (n = 20) and those housed with an injured dam (n = 20). Pups were anesthetized with 1.2% halothane for 30 min. At emergence, we recorded their locomotor behavior for 15 min. Results: Pre-anesthetic manipulation to dams significantly increased the distance traveled by pups. However, the manipulation did not cause any difference in the maximum velocity. Conclusion: Pre-anesthetic presence of an injured dam influenced pups' locomotor behavior at emergence from anesthesia.
PMID: 15715616 [PubMed - in process]
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Bolus injection of Ringer's solution and dextran 1 kDa during induction of spinal anesthesia.
Ewaldsson CA, Hahn RG.
Department of Anesthesia, South Hospital, Stockholm, Sweden.
Background: Arterial hypotension following induction of spinal anesthesia is difficult to prevent with infusion fluids. In a randomized, unblinded and controlled study we evaluated whether a rapid fluid administration planned according to volume kinetic analysis is followed by a more stable blood pressure. Methods: Spinal anesthesia was induced in 75 surgical patients, using one of three different fluid regimens: intravenous 'bolus injection' of 5 ml kg(-1) of Ringer's acetate over 3 min, 2 ml kg(-1) of low-molecular weight (1 kDa) dextran over 3 min, or a constant-rate infusion of 15 ml kg(-1) of Ringer's acetate over 40 min (controls). The kinetics of the fluid was studied in five patients in each group and also in eight volunteers. Results: The decrease in mean arterial pressure averaged 28%, 27% and 26%, respectively, and was fully developed 16 min after the induction. The height of the block, but not the fluid programme, correlated with the hypotension. Nausea or near-fainting associated with marked hypotension or bradycardia was recorded in none, five (20%) and two (8%) of the patients, respectively. Both bolus injections were followed by translocation of fluid from the peripheral tissues to the bloodstream, which maintained the plasma dilution at about 10% for at least 30 min until surgery began. Conclusion: A brisk infusion of Ringer's solution or dextran 1 kDa over 3 min was followed by the same decrease in arterial pressure as a longer and 3-5-times larger infusion of Ringer's solution over 40 min during induction of spinal anesthesia.
PMID: 15715614 [PubMed - in process]
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Anaesthetic practice for groin hernia repair - A nation-wide study in Denmark 1998-2003.
Kehlet H, Nielsen MB.
The Danish Hernia Database, Department of Surgical Gastroenterology, Hvidovre University Hospital, Denmark.
Background: Recent scientific data suggest that local infiltration anaesthesia for inguinal hernia surgery may be preferable compared to general anaesthesia and regional anaesthesia, since it is cheaper and with less urinary morbidity. Regional anaesthesia may have specific side-effects and is without documented advantages on morbidity in this small operation. Methods: To describe the use of the three anaesthetic techniques for elective open groin hernia surgery in Denmark from January 1st 1998 to December 31st 2003, based on the Danish Hernia Database collaboration. Results: In a total of 57,505 elective open operations 63.6% were performed in general anaesthesia, 18.3% in regional anaesthesia and 18.1% in local anaesthesia. Regional anaesthesia was utilized with an increased rate in elderly and hospitalized patients. Outpatient surgery was most common with local infiltration anaesthesia. Conclusion: Use/choice of anaesthesia for groin hernia repair is not in accordance with recent scientific data. Use of spinal anaesthesia should be reduced and increased use of local anaesthesia is recommended to enhance recovery and reduce costs.
PMID: 15715612 [PubMed - in process]
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Best anesthetic method for inguinal hernia repair?
Raeder J.
Ullevaal University Hospital, Oslo, Norway.
PMID: 15715610 [PubMed - in process]
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Abstracts presented at the Association of Anaesthetists of Great Britain & Ireland Annual Congress in Cardiff, 21-24 September 2004.
[No authors listed]
PMID: 15710035 [PubMed - as supplied by publisher]
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A response to 'Spinal anaesthesia despite combined clopidogrel and aspirin therapy in a patient awaiting lung transplantation: effects of platelet transfusion on clotting tests'.
Pivalizza EG, Gottschalk LI.
Department of Anaesthesiology University of Texas Health Science Center - Houston Houston, TX, USA E-mail: Evan.G.Pivalizza@uth.tmc.edu.
PMID: 15710034 [PubMed - in process]
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A response to 'Extending low-dose epidural analgesia for emergency Caesarean section using ropivacaine 0.75%'.
Moore M, O'sullivan G.
Department of Anaesthetics Guy's and St Thomas' Foundation Trust, London, UK E-mail: geraldine.o'sullivan@gstt.sthames.nhs.uk.
PMID: 15710030 [PubMed - in process]
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Allergy to anaesthesia.
Bojah H, Plaat F.
Queen Charlotte's and Hammersmith Hospitals London W12 0HS, UK E-mail: Jens.Heike@gmx.net.
PMID: 15710026 [PubMed - in process]
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Transient fixation on a non-native language associated with anaesthesia.
Webster CS, Grieve RO.
Department of Anaesthesiology, School of Medicine, University of Auckland, Private Bag 92-019, Auckland, New Zealand.
Summary We report a patient with the unusual language disturbance of transient fixation on a non-native language after otherwise uneventful general anaesthesia. The patient was unable to speak his native language for a period of 5-10 min, despite a desire to do so. He fully and spontaneously recovered from the episode. The phenomenon raises a number of interesting questions about the nature of human language, anaesthesia and consciousness. We discuss our patient in the context of some of these questions and present a review of three similar patients reported in the anaesthetic literature.
PMID: 15710014 [PubMed - in process]
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Medication errors in anaesthesia and critical care.
Wheeler SJ, Wheeler DW.
Clinical Research Associate, University Department of Anaesthesia, University of Cambridge, BOX 93, Addenbrooke's Hospital, Cambridge, CB2 2QQ, UK.
Summary There is an increasing recognition that medication errors are causing a substantial global public health problem, as many result in harm to patients and increased costs to health providers. However, study of medication error is hampered by difficulty with definitions, research methods and study populations. Few doctors are as involved in the process of prescribing, selecting, preparing and giving drugs as anaesthetists, whether their practice is based in the operating theatre, critical care or pain management. Anaesthesia is now safe and routine, yet anaesthetists are not immune from making medication errors and the consequences of their mistakes may be more serious than those of doctors in other specialties. Steps are being taken to determine the extent of the problem of medication error in anaesthesia. New technology, theories of human error and lessons learnt from the nuclear, petrochemical and aviation industries are being used to tackle the problem.
PMID: 15710011 [PubMed - in process]
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Flow cytometric investigation of peri-anaesthetic anaphylaxis using CD63 and CD203c.
Sudheer PS, Hall JE, Read GF, Rowbottom AW, Williams PE.
Department of Anaesthetics and Intensive Care Medicine, Wales College of Medicine, Cardiff University, Cardiff, CF14 4XN, United Kingdom.
Summary The investigation of anaphylactic reactions in the peri-operative period is difficult. Elevation of serum tryptase levels is a good indicator of an anaphylactic event but the ability of subsequent investigations to identify the drug(s) responsible for the reaction is still potentially unreliable. The aim of this study was to examine basophil activation as an investigative tool. We performed flow cytometric analysis of the expression on the cell surface of the basophil activation markers CD63 and CD203c and measured histamine release in 21 patients who were referred with possible peri-operative anaphylaxis. The sensitivity of CD63, CD203c, basophil histamine release and skin prick for the muscle relaxants was found to be 79%, 36%, 36% and 64%, respectively; the specificity was found to be 100%. These results demonstrate the difficulty in investigating the cause of an unexpected clinical event following drug administration, but the higher sensitivity of neo-expression on the cell surface of CD63 suggests that flow cytometric analysis of its neo-expression on basophils in vitro may be a diagnostic aid.
PMID: 15710010 [PubMed - in process]
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Psychometric characteristics of simulation-based assessment in anaesthesia and accuracy of self-assessed scores*.
Weller JM, Robinson BJ, Jolly B, Watterson LM, Joseph M, Bajenov S, Haughton AJ, Larsen PD.
Associate Professor of Medical Education & Director, Faculty Education Unit, Faculty of Medical and Health Sciences, University of Auckland, Private Bag 92019, Auckland, New Zealand.
Summary The purpose of this study was to define the psychometric properties of a simulation-based assessment of anaesthetists. Twenty-one anaesthetic trainees took part in three highly standardised simulations of anaesthetic emergencies. Scenarios were videotaped and rated independently by four judges. Trainees also assessed their own performance in the simulations. Results were analysed using generalisability theory to determine the influence of subject, case and judge on the variance in judges' scores and to determine the number of cases and judges required to produce a reliable result. Self-assessed scores were compared to the mean score of the judges. The results suggest that 12-15 cases are required to rank trainees reliably on their ability to manage simulated crises. Greater reliability is gained by increasing the number of cases than by increasing the number of judges. There was modest but significant correlation between self-assessed scores and external assessors' scores (rho = 0.321; p = 0.01). At the lower levels of performance, trainees consistently overrated their performance compared to those performing at higher levels (p = 0.0001).
PMID: 15710009 [PubMed - in process]
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Dreaming during anaesthesia in patients at high risk of awareness.
Leslie K, Myles PS, Forbes A, Chan MT, Swallow SK, Short TG.
Head of Research, Department of Anaesthesia and Pain Management, Royal Melbourne Hospital, Melbourne, Australia, and Associate Professor, Department of Pharmacology, University of Melbourne, Australia.
Summary Dreaming during anaesthesia is commonly reported but remains poorly understood. In this study, adult surgical patients at high risk of awareness were randomly assigned to receive bispectral index (BIS)-guided anaesthesia or routine care, and were interviewed about dreaming three times postoperatively. Dreaming patients (n = 134) were compared with all other patients who were interviewed at least once (n = 2251). Intraoperative dreaming was reported by 4.2%, 3.9% and 3.4% of patients at 2-4 h, 24-36 h and 30 days after surgery, respectively. Fewer BIS-monitored patients reported intra-operative dreaming at 2-4 h than control patients (2.7% vs. 5.7%; p = 0.004). Reports of dreaming were similar in the two groups at 24-36 h and 30 days. Dreaming patients were younger (p = 0.001); healthier (p < 0.001) and more likely to be women (p < 0.001), and were less satisfied with anaesthetic care (p = 0.004) than other patients.
PMID: 15710008 [PubMed - in process]
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SNAP index and Bispectral index during different states of propofol/remifentanil anaesthesia*.
Schmidt GN, Bischoff P, Standl T, Lankenau G, Hellstern A, Hipp C, Schulte Am Esch J.
Resident in Anaesthesiology.
Summary The accuracy of the new SNAP index with the Bispectral index (BIS) to distinguish different states of propofol/remifentanil anaesthesia was compared in 19 female patients who were undergoing minor gynaecological surgery. Comparisons of the SNAP index, BIS, spectral edge frequency, mean arterial blood pressure and heart rate were performed. The ability of all parameters to distinguish between the steps of anaesthesia -awake vs. loss of response, awake vs. anaesthesia, anaesthesia vs. first reaction and anaesthesia vs. extubation - were analysed with the prediction probability. The prediction probability to differentiate between two interesting nuances of anaesthetic states -loss of response vs. first reaction - was calculated. Only the BIS showed no overlap between the investigated steps of anaesthesia. Both the SNAP index and BIS failed to differentiate the nuances of anaesthesia. The SNAP index and BIS were superior to mean arterial blood pressure and heart rate and spectral edge frequency in distinguishing between different steps of anaesthesia with propofol and remifentanil and provided useful additional information.
PMID: 15710006 [PubMed - in process]
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Drug error in anaesthetic practice: a review of 896 reports from the Australian Incident Monitoring Study database.
Abeysekera A, Bergman IJ, Kluger MT, Short TG.
Consultant, Department of Anaesthesiology & Perioperative Medicine, North Shore Hospital, Auckland, New Zealand.
Summary Eight hundred and ninety-six incidents relating to drug error were reported to the Australian Incident Monitoring Study. Syringe and drug preparation errors accounted for 452 (50.4%) incidents, including 169 (18.9%) involving syringe swaps where the drug was correctly labelled but given in error, and 187 (20.8%) due to selection of the wrong ampoule or drug labelling errors. The drugs most commonly involved were neuromuscular blocking agents, followed by opioids. Equipment misuse or malfunction accounted for a further 234 (26.1%) incidents; incorrect route of administration 126 (14.1%) incidents; and communication error 35 (3.9%) incidents. The outcomes of these events included minor morbidity in 105 (11.7%), major morbidity in 42 (4.7%), death in three (0.3%) and awareness under anaesthesia in 40 (4.4%) incidents. Contributing factors included inattention, haste, drug labelling error, communication failure and fatigue. Factors minimising the events were prior experience and training, rechecking equipment and monitors capable of detecting the incident. The information gained suggests areas where improved guidelines are required to reduce the incidence of drug error. Further research is required into the effectiveness of preventive strategies.
PMID: 15710005 [PubMed - in process]
[Evaluation of a cadaver workshop for education in regional anesthesia.]
[Article in German]
Lirk P, Colvin JM, Biebl M, Mitterschiffthaler G, Moser PL, Lorenz IH, Kolbitsch C.
Klinik fur Anasthesie und Allgemeine Intensivmedizin, Medizinische Universitat, Innsbruck, Osterreich.
BACKGROUND: The aim of the present investigation was to survey former participants (n=869) of a cadaver workshop using a mail questionnaire to assess the demographic data and the impact of these courses on daily practice.METHODS: The deadline for acceptance of return mail was 60 days. Descriptive statistics were employed for analysis of results.RESULTS: The response rate was 36.7% and the course was judged to be recommendable by 98.2%. The average course attendant was board certified and had spent a mean time of 9+/-6 years in anesthesiology. The highest quality and degree of subsequent practicability in daily routine was attributed to peripheral nerve block training on cadavers. Of the course participants two-thirds performed regional anesthesia procedures more often following attendance. The majority of course attendants had to defray at least a part of the course fee themselves, and one-third was required to invest leisure time to attend.CONCLUSION: Attendance of a cadaver workshop increased knowledge of clinical anatomy and enhanced performance of regional anesthesia procedures. Courses of this format constitute a currently underestimated adjunct to contemporary regional anesthesia education.
PMID: 15711813 [PubMed - as supplied by publisher]
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[Teaching methods in anesthesia and intensive care medicine Chancen der neuen Approbationsordnung fur das Fachgebiet.]
[Article in German]
Stehr SN, Muller M, Frank MD, Grass R, Rammelt S, Dieter P, Hetze AM, Koch T, Ragaller MJ.
Klinik und Poliklinik fur Anasthesiologie und Intensivtherapie, Universitatsklinikum Carl Gustav Carus, Dresden.
BACKGROUND: As of October 1, 2003, a new government-initiated legislative basis for undergraduate medical education was initiated in Germany which resulted in substantial changes to the structure of the medical curriculum and in a heightened teaching load.METHODS: The Medical Faculty of the University of Dresden established an interdisciplinary reform curriculum in 1998. Since then a hybrid model of traditional lectures, seminars, practical and problem-based learning courses has been implemented for all courses in undergraduate medical training (Dresdener Integrated Problem-based Learning: DIPOL((R))).RESULTS: Exemplarily for all other DIPOL((R)) courses, the 2003 evaluation results of the "Emergency medicine-Injuries-Intensive care medicine" are presented and show that the course was very well received by students and tutors, and that 95% of the students passed the exams.CONCLUSIONS: The DIPOL((R)) anesthesiology course conforms with the new German federal law. A continuous further evaluation is an essential part of quality control and is necessary for the further development of a new curriculum.
PMID: 15711812 [PubMed - as supplied by publisher]
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[Inadvertant epidural placement of a psoas compartment catheter. Case report of a rare complication]
[Article in German]
Rotzinger M, Neuburger M, Kaiser H.
Klinik fur Anasthesiologie, Intensivmedizin und Schmerztherapie, Rechbergklinik Bretten, Akademisches Lehrkrankenhaus der Universitat Heidelberg.
Due to total knee replacement, a 67-year-old female patient had received a combination of general anesthesia and continuous psoas compartment block. An epidural block was detected postoperatively. An X-ray after the injection of contrast medium showed a typical epidurography with the catheter tip projecting into the epidural space. After drawing back the catheter, another X-ray showed a correct placement of the catheter and a typical spreading of the contrast medium and the catheter could be used for pain relief. In retrospect, it turned out that the catheter had been placed too far over the tip of the stimulation needle. The recommendations of different authors on this problem vary and are actually quite contradictive. We would recommend not to place the catheter further than 5 cm over the tip of the needle. After the first injection the quality of monitoring should correspond with that of an epidural anesthesia. In doubtful cases an injection of contrast medium and an X-ray can be performed.
Publication Types:
PMID: 15235791 [PubMed - indexed for MEDLINE]
Comment on:
What is meant by a "safe and effective sedation technique"?
Weaver JM.
Publication Types:
PMID: 15675258 [PubMed - indexed for MEDLINE]
Clonidine produces a dose-dependent impairment of baroreflex-mediated thermoregulatory responses to positive end-expiratory pressure in anaesthetized humans.
Mizobe T, Nakajima Y, Sunaguchi M, Ueno H, Sessler DI.
Department of Anesthesiology, Kyoto Prefectural University of Medicine, Kyoto, Japan.
BACKGROUND: Perioperative hypothermia is common and results from anaesthesia-induced inhibition of thermoregulatory control. Hypothermia is blunted by baroreceptor unloading caused by positive end-expiratory pressure (PEEP), and is mediated by an increase in the vasoconstriction threshold. Premedication with clonidine impairs normal thermoregulatory control. We therefore determined the effect of clonidine on PEEP-induced hypothermia protection. METHODS: Core temperature was evaluated in patients undergoing combined general and epidural anaesthesia for lower abdominal surgery. They were assigned to an end-expiratory pressure of zero (ZEEP) or 10 cm H2O PEEP. The PEEP group was divided into three blinded subgroups that received placebo (Cl-0), clonidine 150 microg (Cl-150) and clonidine 300 microg (Cl-300) respectively. Placebo or clonidine was given orally 30 min before surgery. We evaluated core temperature and thermoregulatory vasoconstriction. We also determined plasma epinephrine, norepinephrine, angiotensin II concentrations and plasma renin activity. RESULTS: Core temperature after 180 min of anaesthesia was 35.1 (0.4) degrees C in the ZEEP group. PEEP significantly increased final core temperature to 35.8 (0.5) degrees C (Cl-0 group). Clonidine produced a linear, dose-dependent impairment of PEEP-induced hypothermia protection: final core temperatures were 35.4 (0.3) degrees C in the Cl-150 group and 35.0 (0.6) degrees C in the Cl-300 group. Similarly, clonidine produced a linear and dose-dependent reduction in vasoconstriction threshold: Cl-0, 36.4 (0.3) degrees C; Cl-150, 35.8 (0.3) degrees C; Cl-300, 35.4 (0.6) degrees C. Plasma norepinephrine, angiotensin II concentrations and renin activity were consistent with the thermoregulatory responses. CONCLUSION: Baroreceptor unloading by PEEP normally moderates perioperative hypothermia. However, clonidine premedication produces a linear, dose-dependent reduction in this benefit.
PMID: 15708868 [PubMed - as supplied by publisher]
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General anaesthesia in a patient with motor neuron disease.
Moser B, Lirk P, Lechner M, Gottardis M.
Publication Types:
PMID: 15717714 [PubMed - in process]
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Anesthetic management of a patient with histiocytosis X and pulmonary complications during Caesarean section.
Broscheit J, Eichelbroenner O, Greim C, Bussen S.
Publication Types:
PMID: 15717713 [PubMed - in process]
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Anaesthesiologists' views on the need for point-of-care information system in the operating room: a survey of the European Society of Anaesthesiologists.
Perel A, Berkenstadtt H, Ziv A, Katzenelson R, Aitkenhead A.
Department of Anaesthesiology and Intensive Care, Tel Aviv University, Sheba Medical Centre, Tel Hashomer, Israel.
BACKGROUND AND OBJECTIVE: In this preliminary study we wanted to explore the attitudes of anaesthesiologists to a point-of-care information system in the operating room. The study was conducted as a preliminary step in the process of developing such a system by the European Society of Anaesthesiologists (ESA). METHODS: A questionnaire was distributed to all 2240 attendees of the ESA's annual meeting in Gothenburg, Sweden, which took place in April 2001. RESULTS: Of the 329 responders (response rate of 14.6%), 79% were qualified specialists with more than 10 yr of experience (68%), mostly from Western Europe. Most responders admitted to regularly experiencing lack of medical knowledge relating to real-time patient care at least once a month (74%) or at least once a week (46%), and 39% admitted to having made errors during anaesthesia due to lack of medical information that can be otherwise found in a handbook. The choice ofa less optimal but more familiar approach to patient management due to lack of knowledge was reported by 37%. Eighty-eight percent of responders believe that having a point-of-care information system for the anaesthesiologists in the operating room is either important or very important. CONCLUSIONS: This preliminary survey demonstrates that lack of knowledge of anaesthesiologists may be a significant source of medical errors in the operating room, and suggests that a point-of-care information system for the anaesthesiologist may be of value.
PMID: 15717707 [PubMed - in process]
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Assessment of neuromuscular and haemodynamic effects of cisatracurium and vecuronium under sevoflurane-remifentanil anaesthesia in elderly patients.
Keles GT, Yentur A, Cavus Z, Sakarya M.
Department of Anaesthesiology and Reanimation, Faculty of Medicine, University of Celal Bayar, Manisa, Turkey. gonul.keles@bayar.edu.tr
BACKGROUND AND OBJECTIVE: Neuromuscular block times, quality of muscle relaxation for tracheal tube insertion, and the haemodynamic effects after cisatracurium and vecuronium under sevoflurane-remifentanil anaesthesia were compared in elderly patients. METHODS: The study was performed in 40 patients over 65 yr of age. Anaesthesia was induced with thiopental, and maintained with sevoflurane in N2O/O2 and remifentanil. Cisatracurium 0.15 mg kg(-1) or vecuronium 0.1 mg kg(-1) were administered after induction. Intubation was attempted when neuromuscular block was 95%. Onset time, clinical duration of action, recovery index, spontaneous recovery time and tracheal intubation conditions were assessed. Haemodynamic parameters were also monitored. RESULTS: The average ages of the patients were 72.5 +/- 5.1 and 73.6 +/- 6.3 in the cisatracurium and vecuronium groups, respectively. Onset time was significantly shorter after vecuronium, 158 +/- 34 s vs. 200 +/- 50s, respectively. Recovery index was significantly shorter after cisatracurium, 19.5 +/- 7.5 s vs. 33.7 +/- 18.6 s (P < 0.05). Clinical duration and spontaneous recovery time were similar in both groups as well as haemodynamic variables. CONCLUSIONS: In elderly patients, vecuronium has a faster onset time while cisatracurium has a shorter recovery index under sevoflurane-remifentanil anaesthesia.
PMID: 15717704 [PubMed - in process]
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Epidural anaesthesia with bupivacaine does not cause increased oedema in small gut anatomoses in pigs.
Fedder A, Dall R, Laurberg S, Rodt SA.
Institute for Experimental Clinical Research, Skejby, Aarhus University Hospital, Denmark.
BACKGROUND AND OBJECTIVE: Epidural analgesia is widely used for abdominal surgery due to the properties of 'stress-free' anaesthesia and superior pain control. Nevertheless, sympathomimetics are known to antagonize inflammation. The present study was performed to investigate if epidural local anaesthetics caused increased local oedema formation. METHODS: Thirty Dansk Landrace pigs were randomized into three groups: epidural bupivacaine, epidural morphine or intravenous (i.v.) fentanyl. All animals were anaesthetized with isoflurane and i.v. midazolam and received an identical fluid regimen. Six small bowel resections were performed over a 3-h period and during the following 3 h the anastomoses were resected. Primary end-points were water content in small bowel and mesentery samples before and after gut anastomosis, lymph flow and urine production. RESULTS: The water content in the small bowel samples was not changed by surgery or by the different anaesthetic protocols. In the mesenteric tissue, there was a highly significant increase in water content of the postanastomotic samples compared to pre-anastomotic samples (P < 0.001) and a significant time treatment interaction was revealed (P < 0.05) suggesting an increase in oedema formation in the epidural local anaesthetic group. Lymph flow did not change during the experiments and there were no significant differences between the groups (P = 0.80). The mean total urine output was 44% higher in the epidural morphine group compared to the local anaesthetic group (P = 0.17). CONCLUSIONS: Surgery did not increase gut wall water content, but acute oedema formation resulted in the peri-resectional mesenterial tissue, more prominently so in the bupivacaine group.
PMID: 15717702 [PubMed - in process]
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Combined epidural/spinal anaesthesia: needle-through-needle or separate spaces?
Backe SK, Sheikh Z, Wilson R, Lyons GR.
St. James's University Hospital, Leeds, UK. Samyuktha@doctors.org.uk
BACKGROUND AND OBJECTIVE: This prospective, randomized and blinded study compared the performance of a new needle-through-needle (NTN) kit (Epistar; Medimex, Germany) with the double-space technique for providing combined spinal epidural anaesthesia during Caesarean section. METHODS: Following local Ethics Committee approval and patient consent, 200 females were randomized to receive combined spinal epidural anaesthesia by the double-space (n = 100) or NTN (n = 100) technique. The frequency with which the intrathecal component could achieve a T5 block to touch for Caesarean section without the need for epidural augmentation or an alternative technique was determined. The time from start of procedure to achieving a block height to T5 was recorded. Pain and backache at insertion, and at 24 h follow-up were recorded using a visual analogue scale. To remove any bias due to posture, 50% of each group were further randomized to receive their block in the sitting or in the left lateral position. To evaluate improvement of performance over time the success in the first 100 study patients were compared to the success in the second 100. RESULTS: A successful block to T5 with the double-space and NTN techniques were 80 vs. 54, odds ratio 0.29. Failure to enter the intrathecal space once the epidural space had been located occurred in 29 patients in the NTN group. Time to readiness for surgery was 15 min (95% confidence interval (CI): 12.7-17.4) and 12.9 min (95% CI: 11.5-14.3) for the double-space and NTN techniques, respectively. The median (interquartile range) visual analogue scores for discomfort at insertion were 30 (12.5-51.5) and 32 (12.75-60) and for postoperative backache 0 (0-10) and 0 (0-10.75) in the double-space and NTN groups, respectively. The number of epidural augmentations was similar in both the groups and posture made no difference. There was a tendency to increased success in the second half of the study. CONCLUSION: The double-space technique had a greater success rate than the NTN technique.
PMID: 15717699 [PubMed - in process]
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Recent advances in local anaesthetics for spinal anaesthesia.
Milligan KR.
Department of Anaesthesia, Musgrave Park Hospital, Belfast, Northern Ireland. kevin.milligan@virgin.net
Although local anaesthesia is mentioned in historical manuscripts, it is only a hundred years since Bier first reported the intrathecal use of local anaesthetic agents. This has been followed by a rapid progression in the art and science of spinal anaesthesia. Isomerically pure agents with favorable clinical profiles, such as ropivacaine and levobupivacaine are now available. Spinal anaesthesia is commonly used in a variety of situations, including orthopaedic, abdominal, gynaecological surgery, Caesarean section and the relief of pain in childbirth. Hyperbaric solutions of local anaesthetics appear to produce more consistent results than plain solutions and the addition of other drugs, such as opioids and clonidine may improve analgesia. In addition to traditional spinal anaesthesia, local anaesthetics are now being evaluated in continuous spinal anaesthesia and combined epidural-spinal anaesthesia. This article reviews clinical experience with levobupivacaine and ropivacaine. Compared with levobupivacaine, ropivacaine generally produces a less intense motor block of shorter duration, which has advantages for earlier mobilization and discharge from hospital and may be particularly useful in obstetrics and ambulatory surgery.
PMID: 15717697 [PubMed - in process]
Endothelial dysfunction in aortic rings and mesenteric beds isolated from deoxycorticosterone acetate hypertensive rats: possible involvement of protein kinase C.
Fatehi-Hassanabad Z, Fatehi M, Shahidi MI.
Department of Physiology and Pharmacology, Faculty of Medicine, Mashhad University of Medical Sciences, P.O. Box 91775 1843, Meshed, Iran. z_fatehi@yahoo.com
The main objectives of this study were to investigate the effects of deoxycorticosterone acetate (DOCA)-induced hypertension on the aortic and mesenteric vascular responses to vasodilator and vasoconstrictor agents and also to elucidate whether protein kinase C (PKC) was involved in these responses, by using chelerythrine and calphostin C, the inhibitors of protein kinase C. Hypertension was induced in male Sprague-Dawley rats (200-250 g) by DOCA-salt injection [20 mg/kg, twice weekly for 5 weeks, subcutaneously (s.c.)] and NaCl (1%) was added to their drinking water. Control rats received a saline injection (0.5 ml/kg, twice weekly for 5 weeks, s.c.), then the animals were anaesthetised [thiopental, 30 mg/kg, intraperitoneally (i.p.)] and the arterial blood pressure was measured. Mean arterial blood pressure in control and hypertensive rats were 98+/-7.5 and 163+/-3.5 mmHg, respectively (P<0.0001). In the in vitro studies, rings of descending aorta and mesenteric beds were precontracted with phenylephrine and then concentration-response curves to acetylcholine and sodium nitroprusside were constructed. In the tissue removed from hypertensive rats, the responses to acetylcholine, but not to sodium nitroprusside, were significantly reduced. However, addition of chelerythrine (10 microM) or calphostin C (100 nM) to the organ bath significantly restored these impaired responses. Our data suggest that protein kinase C plays a crucial role in the endothelial dysfunction induced by hypertension.
PMID: 15212975 [PubMed - indexed for MEDLINE]
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