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Comment on:
Bilateral occipital neuropathy, not so rare.
Singh B.
Publication Types:
- Case Reports
- Comment
- Letter
PMID: 15352974 [PubMed - indexed for MEDLINE]
-
Efficacy of oral rofecoxib versus intravenous ketoprofen as an adjuvant to PCA morphine after urologic surgery.
Cabrera MC, Schmied S, Derderian T, White PF, Vega R, Santelices E, Verdugo F.
Department of Anesthesiology, Air Force Hospital of Santiago de Chile, Santiago, Chile.
BACKGROUND: Adjunctive use of nonsteroidal anti-inflammatory drugs has become increasingly popular in the perioperative period because of their opioid-sparing effects. This randomized, controlled, double-dummy study was designed to evaluate the cost-effectiveness of using oral rofecoxib as an alternative to intravenous ketoprofen for pain management in patients undergoing urologic surgery. METHODS: Seventy patients were randomly assigned to receive either a placebo (Control) or rofecoxib 50 mg po (Rofecoxib) 1 h prior to surgery. After a standardized spinal anesthetic, patients in the Control group received ketoprofen 100 mg IV q 8 h for 24 h, while the Rofecoxib group received an equivolume of saline at 8-h intervals for 24 h. Both groups were allowed to self-administer morphine (1 mg IV boluses) using a PCA delivery system. The need for 'rescue' analgesic medication, as well as pain scores [using an 11-point verbal rating scale (VRS) (0 = none to 10-severe)], were recorded at 1, 2, 6, 12, and 24-h intervals after surgery. In addition, the incidences of side-effects were recorded at the end of the study period. RESULTS: Total amount of morphine required in the initial 24-h postoperative period was nonsignificantly reduced in the Rofecoxib group (29 +/- 2 vs. 37 +/- 4 mg). More importantly, the percentage of patients reporting moderate-to-severe pain (VRS score > or =4) during the study period was lower in the Rofecoxib group (12 vs. 22%, P < 0.05). The daily cost of rofecoxib (USD 1.14 for 50-mg dose) was also significantly less than ketoprofen (USD 3.06 for three 100-mg doses). CONCLUSION: Premedication with oral rofecoxib (50 mg) is a cost-effective alternative to the parenteral nonselective NSAID, ketoprofen (100 mg q 8 h), when used as an adjuvant to PCA morphine for pain management after urologic surgery.
Publication Types:
- Clinical Trial
- Randomized Controlled Trial
PMID: 15352968 [PubMed - indexed for MEDLINE]
-
Nitrous oxide diffusion into tracheal tube cuffs: comparison of five different tracheal tube cuffs.
Dullenkopf A, Gerber AC, Weiss M.
Department of Anesthesia, University Children's Hospital, Zurich, Switzerland. alex.dullenkopf@kispi.unizh.ch
BACKGROUND: The aim of this study was to investigate cuff compliance and cuff pressure during nitrous oxide exposure in the recently introduced Microcuff tracheal tube with a polyurethane cuff (Microcuff GmbH, Weinheim, Germany), and to compare it to conventional tracheal tubes with PVC cuffs. METHODS: In an in vitro set up, five cuffed tracheal tubes (ID 7.0 mm) from different manufacturers (Microcuff HVLP, Portex Profile Soft Seal, Mallinckrodt HiLo, Rusch Super Safety Clear and Sheridan CF) were studied. Pressure-volume curves were assessed and changes of cuff pressure during exposure to nitrous oxide (for 60 min; 66% N(2)O in oxygen) were recorded without and with restriction of the cuff in a trachea model. Each experiment was performed four times using two exemplars of each tube twice. Sixty-minute values of the Microcuff group were compared with the other groups using the Mann- Whitney test (P < 0.05). RESULTS: The Microcuff polyurethane cuff demonstrated an intermediate cuff compliance but the highest cuff pressure increase during nitrous oxide exposure under unrestricted conditions. When inflated within the artificial trachea its cuff compliance became the highest of all tested tracheal tubes. However, exposure to N(2)O, again led to a rapid increase in cuff pressure. CONCLUSION: The ultra-thin polyurethane tube cuff demonstrated higher permeability for nitrous oxide than conventional PVC cuffs and led to a rapid cuff pressure increase when exposed to N(2)O. Routinely checking of cuff-pressure or filling the cuff with nitrous oxide are more important than the brand of tube used.
PMID: 15352966 [PubMed - indexed for MEDLINE]
-
Supplemental remifentanil during coronary artery bypass grafting is followed by a transient postoperative cardiac depression.
Pleym H, Stenseth R, Wiseth R, Karevold A, Dale O.
Department of Anesthesiology, st Olav University Hospital, Trondheim, Norway. hide.pleym@stolav.no
BACKGROUND: The pharmacokinetic properties of the short-acting micro opioid receptor-agonist remifentanil makes it possible to give cardiac surgical patients a deep intraoperative anesthesia without experiencing postoperative respiratory depression and a prolonged stay in the intensive care unit (ICU). However, previous investigations have shown that patients who received remifentanil required additional analgesia during the early postoperative period as compared to patients who received fentanyl. The aim of the present study therefore was to investigate the effects of supplementing remifentanil to a standard fentanyl-based anesthesia in coronary artery bypass grafting (CABG). METHODS: The study was prospective, randomized, double-blind, and placebo-controlled. Twenty male patients aged 55-70 years were included. All patients received a standard fentanyl and isoflurane-based anesthesia. In addition, the patients were randomized to receive either remifentanil 0.5 micro g kg(-1) min(-1) or placebo during surgery. Hemodynamic recordings and measurements of blood glucose and plasma adrenaline and noradrenaline were performed intra- and postoperatively. RESULTS: Remifentanil reduced the hemodynamic and metabolic response to surgical stress compared to the standard fentanyl-based anesthetic regimen. However, the patients in the remifentanil group had a lower cardiac output (CO), left ventricular stroke work index (LVSWI), and mixed venous oxygen saturation (SvO(2)), and a higher central venous pressure (CVP) than the patients in the placebo group during the early postoperative phase, indicating a postoperative cardiac depression in the remifentanil group. CONCLUSION: In CABG, remifentanil reduces the hemodynamic and metabolic responses during surgery but seems to give a cardiac depression in the early postoperative phase.
Publication Types:
- Clinical Trial
- Randomized Controlled Trial
PMID: 15352962 [PubMed - indexed for MEDLINE]
-
Cardioprotective action of fentanyl in a model of central sympathetic overactivity in rabbits: antiarrhythmic and anti-ischemic effects.
Lessa MA, Rodrigues E, Tibirica E.
Departamento de Fisiologia e Farmacodinamica, Instituto Oswaldo Cruz, Fiocruz, Rio de Janeiro, Brazil.
BACKGROUND: Sympathetic overactivity resulting from perioperative noxious stimuli elicits hyperdynamic cardiovascular responses that may lead to myocardial ischemia and/or ventricular arrhythmia, especially in patients presenting with coronary artery disease. In the present study we investigated the cardioprotective effects of clinically relevant doses of fentanyl in an experimental model of sympathetic overactivity associated with myocardial ischemia in anesthetized rabbits. METHODS: Central sympathetic stimulation was achieved through intracerebroventricular (i.c.v.) injection of L-glutamate (10 micro mol), with simultaneous inhibition of nitric oxide (NO) synthesis through i.v. administration of N(omega)-nitro-l-arginine methyl ester (L-NAME; 40 mg kg(-1)). RESULTS: L-glutamate triggered ventricular arrhythmia and electrocardiographic alterations indicative of myocardial ischemia. The intravenous administration of fentanyl (5, 10 or 50 micro g kg(-1)) reduced the incidence of ST-segment shift (70, 20 and 10%, respectively, vs. 66.7% in controls) as well as of T-wave inversion from 58.3% to 30, 20 and 10%, respectively. The total number of ventricular premature complexes per minute fell from 65.2 +/- 16 in the control group to 6.8 +/- 3, 3.5 +/- 2 and 2.6 +/- 1.5, respectively. The occurrence of ventricular tachycardia and bigeminy was completely abolished by fentanyl. Finally, the i.v. administration of fentanyl did not induce significant hemodynamic effects (except for dP/dt(max) in the 50 micro g kg(-1)-dose). CONCLUSION: Fentanyl elicits significant cardioprotective effects in a model of arrhythmia resulting from the association of central sympathetic overactivity with myocardial ischemia in rabbits, independently from its systemic hemodynamic actions.
PMID: 15352957 [PubMed - indexed for MEDLINE]
-
Peripheral venous pressure is an alternative to central venous pressure in paediatric surgery patients.
Anter AM, Bondok RS.
Department of Anaesthesiology, Ain-Shams University Hospital, Cairo, Egypt. adelanter@hotmail.com
BACKGROUND: Peripheral venous pressure (PVP) is easily and safely measured. In adults, PVP correlates closely with central venous pressure (CVP) during major non-cardiac surgery. The objective of this study was to evaluate the agreement between CVP and PVP in children during major surgery and during recovery. METHODS: Fifty patients aged 3-9 years, scheduled for major elective surgery, each underwent simultaneous measurements of CVP and PVP at random points during controlled ventilation intraoperatively (six readings) and during spontaneous ventilation in the post-anaesthesia care unit (three readings). In a subset of four patients, measurements were taken during periods of hypotension and subsequent fluid resuscitation (15 readings from each patient). RESULTS: Peripheral venous pressure was closely correlated to CVP intraoperatively, during controlled ventilation (r=0.93), with a bias of 1.92 (0.47) mmHg (95% confidence interval = 2.16-1.68). In the post-anaesthesia care unit, during spontaneous ventilation, PVP correlated strongly with CVP (r = 0.89), with a bias of 2.45 (0.57) mmHg (95% confidence interval = 2.73-2.17). During periods of intraoperative hypotension and fluid resuscitation, within-patient changes in PVP mirrored changes in CVP (r = 0.92). CONCLUSION: In children undergoing major surgery, PVP showed good agreement with CVP in the perioperative period. As changes in PVP parallel, in direction, changes in CVP, PVP monitoring may offer an alternative to direct CVP measurement for perioperative estimation of volume status and guiding fluid therapy.
PMID: 15352955 [PubMed - indexed for MEDLINE]
-
Troponin T-values provide long-term prognosis in elderly patients undergoing non-cardiac surgery.
Oscarsson A, Eintrei C, Anskar S, Engdahl O, Fagerstrom L, Blomqvist P, Fredriksson M, Swahn E.
Department of Anesthesia and Intensive Care, University Hospital, Linkoping, Sweden.
BACKGROUND: The aim of this study was to evaluate the significance of elevated postoperative Troponin T (TnT) levels in an elderly population undergoing non-cardiac surgery. METHODS: Five hundred and forty-six consecutive patients aged 70 years or older undergoing non-cardiac surgery of >30-min duration were enrolled in this prospective, observational study. A postoperative TnT measurement was obtained on the 5th to 7th postoperative day. Troponin T values greater than 0.02 ng ml(-1) were considered positive. Patients were followed over a 1-year period, and mortality and non-fatal cardiac events (acute myocardial infarction and coronary interventions) were recorded. RESULTS: Troponin T concentrations greater than 0.02 ng ml(-1) were detected in 53 of the study subjects (9.7%). Eleven per cent of the patients with elevated TnT had electrocardiographic or clinical signs of myocardial ischemia. One year after surgery, 17 (32%) of the patients with abnormal TnT concentrations had died. In a multivariate Cox regression analysis adjusting for baseline and perioperative data, a TnT value >0.02 ng ml(-1) was an independent correlate of the mortality adjusted hazard ratio (HR): 14.9 (95% CI 3.7-60.3). Other independent predictors of death were tachycardia (HR, 14.9 95% CI 3.45-64.8), ASA 4 (HR, 8.1 95% CI 1.3-50.0), reoperation (HR, 6.4 95% CI 1.1-36.9), and use of diuretics (HR, 4.2 95% CI 1.3-13.8). CONCLUSION: We conclude that elevated TnT levels in the postoperative period confer a 15-fold increase in mortality during the first year after surgery. Our findings also provide evidence that silent myocardial ischemia is common in an elderly population. Routine perioperative surveillance for TnT might therefore be of use in detecting patients at an increased risk of mortality during the first postoperative year.
Publication Types:
PMID: 15352951 [PubMed - indexed for MEDLINE]
-
Sub-Tenon's block without hyaluronidase.
Radhakrishna S, Shekawat F, Furlong G.
Publication Types:
- Clinical Trial
- Letter
- Randomized Controlled Trial
PMID: 15550002 [PubMed - indexed for MEDLINE]
-
The history of spinal needles: getting to the point.
Calthorpe N.
Department of Anaesthesia, Queen Elizabeth Hospital, Metchley Park Road, Edgbaston, Birmingham B15 2TH, UK. nicolawild@doctors.org.uk
The history of the design of spinal needle tips is discussed, from the first needles used by J. Leonard Corning in 1885 to innovative, modern needle designs that continue to appear on the market. The shape of the needle tip started as a cutting bevel and developed into the atraumatic tip and the pencil-point tip in current common use. Innovative designs such as the stylet-tipped needle and the directional needle are described, as well as the needles used for continuous spinal anaesthesia.
Publication Types:
PMID: 15549987 [PubMed - indexed for MEDLINE]
-
Postoperative complications after CS spray exposure.
Davey A, Moppett IK.
Nottingham City Hospital, Hucknall Road, Nottingham NG5 1PB, UK.
Summary We report on airway complications associated with general anaesthesia in a subject who had been exposed to CS spray several hours before surgery. CS spray is a form of tear gas that is said to have a short half-life when the subject is removed from exposure. Induction of anaesthesia was uneventful. Marked laryngospasm occurred when the tracheal tube was removed at the end of the operation, and the anaesthetists experienced lacrimation and burning sensations typical of CS exposure. The effects on the attending anaesthetist made tracheal re-intubation difficult. There were no long-term adverse sequelae for the patient or anaesthetists. Suggestions are made for changes to anaesthetic practice and the advice given by the police about patients who have been exposed to CS spray.
Publication Types:
PMID: 15549983 [PubMed - indexed for MEDLINE]
-
Effective doses of vecuronium in a patient with myotonic dystrophy.
Nishi M, Itoh H, Tsubokawa T, Taniguchi T, Yamamoto K.
Department of Anaesthesiology and Intensive Care Medicine, Kanazawa University, 13-1 Takara-machi, Kanazawa 920-8641, Japan. masatosi@anaesth.m.kanazawa-u.ac.jp
Of the forms of muscular dystrophy, myotonic dystrophy has the greatest systemic involvement. Although most patients with myotonic dystrophy show normal sensitivity to non-depolarising neuromuscular blocking drugs, some have been reported to show greatly increased sensitivity to these drugs, and little is known about the sensitivity of different muscles. We compared effective doses of vecuronium in a patient with myotonic dystrophy at the orbicularis oculi, adductor pollicis and flexor hallucis brevis muscles during total intravenous anaesthesia. The calculated ED50 for the orbicularis oculi (7.77 microg x kg(-1) (95% CI 3.10-16.8 microg x kg(-1))) was lower than for the adductor pollicis (25.3 microg x kg(-1) (95% CI 20.7-43.3 microg x kg(-1))) and flexor hallucis brevis muscles (29.5 microg x kg(-1) (95% CI 11.0-85.6 microg x kg(-1); p < 0.01)). The ED90 was also lower for the orbicularis oculi (35.7 microg x kg(-1) (95% CI 14.8-66.5 microg x kg(-1))) than for the other muscles (51.8 microg x kg(-1) (95% CI 29.3-145.0 microg x kg(-1)) and 50.6 microg x kg(-1) (95% CI 5.29-642.0 microg x kg(-1)), respectively) (p < 0.01)).
Publication Types:
PMID: 15549982 [PubMed - indexed for MEDLINE]
-
Early thoughts on 'Why Mothers Die 2000-2002'.
Clyburn PA.
Publication Types:
PMID: 15549971 [PubMed - indexed for MEDLINE]
-
Sleep deprivation and performance.
Dearlove O, Briggs G.
Publication Types:
PMID: 15488077 [PubMed - indexed for MEDLINE]
Comment on:
Thoracic paravertebral blockade.
Fitzgerald K, Harmon D.
Publication Types:
PMID: 15488068 [PubMed - indexed for MEDLINE]
-
Ultrasound guidance for a lateral approach to the sciatic nerve in the popliteal fossa.
McCartney CJ, Brauner I, Chan VW.
Department of Anaesthesia, Toronto Western Hospital, University of Toronto, 399 Bathurst Street, Toronto, Ontario, M5T 2S8, Canada. colin.mccartney@uhn.on.ca
Descriptions of the use of ultrasound for nerve location have focused on upper limb blocks. We present a case in which ultrasound imaging was used for a lateral approach to the sciatic nerve in the popliteal fossa. Ultrasound images taken proximal to the popliteal crease showed tibial and common peroneal nerves as round hyperechoic structures superficial and lateral to the tibial artery. Under direct ultrasound guidance, we placed a block needle close to the tibial nerve and confirmed its position with nerve stimulation. Injected local anaesthetic was seen on ultrasound as it spread around both tibial and common peroneal nerves.
Publication Types:
PMID: 15488065 [PubMed - indexed for MEDLINE]
-
The Cardiff paediatric laryngoscope blade: a comparison with the Miller size 1 and Macintosh size 2 laryngoscope blades.
Jones RM, Jones PL, Gildersleve CD, Hall JE, Harding LJ, Chawathe MS.
University Hospital of Wales, Heath Park, Cardiff, BF14 4XW, UK.
The Cardiff paediatric laryngoscope blade is a single blade that has been designed for use in children from birth to adolescence. This open, randomised, crossover study compared the Cardiff blade with the straight, size 1, Miller laryngoscope blade in 39 infants under 1 years of age and the curved, size 2, Macintosh blade in 39 children aged 1-16 years. The same laryngoscopic view was obtained with the Cardiff and Miller blades in 26 patients; the view was better with the Cardiff blade in seven patients and better with the Miller blade in six (median (IQR [range]) grade of laryngoscopy 1 (1-2 [1-3]) vs. 1 (1-2 [1-3]), respectively; p = 0.405). The Cardiff blade was faster at gaining a view than the Miller blade (mean (SD) time 8.5 (2.9) s vs. 10.2 (3.5) s, respectively; 95% CI for difference -2.8 to -0.4; p = 0.009). The Cardiff and Macintosh blades produced the same view in 32 patients; the view was better with the Cardiff blade in seven patients (median (IQR [range]) grade of laryngoscopy 1 (1-1 [1-3]) vs. 1 (1-2 [1-3]), respectively; p = 0.008). There was no difference in time to gain these views: mean (SD) 8.7 (3.0) s vs. 9.3 (2.7) s, respectively (95% CI for difference -1.58 to 0.40; p = 0.237). The Cardiff paediatric laryngoscope blade compares favourably with these two established laryngoscope blades in children.
Publication Types:
- Clinical Trial
- Randomized Controlled Trial
PMID: 15488063 [PubMed - indexed for MEDLINE]
-
Routine pre-oxygenation - a new 'minimum standard' of care?
Bell MD.
Publication Types:
PMID: 15488049 [PubMed - indexed for MEDLINE]
Comment on:
"Tumescent anesthesia" for office-based liposuction.
de Jong RH.
Publication Types:
PMID: 15616105 [PubMed - indexed for MEDLINE]
Comment on:
Reversal of an unintentional spinal anesthetic by cerebrospinal lavage.
Singh B, Papneja C, Datt V.
Publication Types:
PMID: 15616102 [PubMed - indexed for MEDLINE]
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Continuous thoracic epidural anesthesia induces segmental sympathetic block in the awake rat.
Freise H, Anthonsen S, Fischer LG, Van Aken HK, Sielenkamper AW.
Department of Anesthesiology and Intensive Care Medicine, University Hospital of Muenster, Albert Schweitzer Strasse 33, 48149 Muenster, Germany. freiseh@uni-muenster.de
Thoracic epidural anesthesia (TEA) is used increasingly in critical care, especially for cardiac and intestinal sympathetic block. In this study we evaluated cardiorespiratory function and sympathetic activity in a new model of continuous TEA in awake rats. Thirteen rats received epidural saline control (CON) or bupivacaine 0.5% epidural infusion (EPI) at 15 microl/h for 2 h on day 1 and day 3. Mean arterial blood pressure, heart rate, respiration rate, arterial PCO2, and motor score were recorded at baseline and after 30, 60, 90, and 120 min. Skin temperature was measured at front paws, high-thoracic, mid-thoracic, and low-thoracic, hind paws, and the proximal and distal tail. Changes in sympathetic activity were assessed by skin temperature changes from baseline (DeltaT). In the EPI group, hemodynamics and respiration remained unchanged and only mild motor deficits occurred. DeltaT in thoracic segments was higher in the EPI than in the CON group (P <0.001 at all times at high-thoracic, mid-thoracic, and low-thoracic segments). Skin temperature decreased in the distal tail in the EPI group, e.g., after 90 min DeltaT=-0.86 +/- 0.25 degrees C (EPI) versus 0.4 +/- 0.12 degrees C (CON) (P <0.05 at 60, 90, and 120 min). DeltaT on day 3 was comparable to day 1. TEA induced stable segmental sympathetic block without cardiorespiratory and motor side effects in awake rats. This new technique may be applied in prolonged models of critical illness.
PMID: 15616087 [PubMed - indexed for MEDLINE]
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Inhibition of the stress response to breast cancer surgery by regional anesthesia and analgesia does not affect vascular endothelial growth factor and prostaglandin E2.
O'Riain SC, Buggy DJ, Kerin MJ, Watson RW, Moriarty DC.
Department of Anaesthesia, Regional Hospital Limerick, Limerick, Ireland. oriains@gofree.indigo.ie
Angiogenesis is essential for breast cancer metastases formation and is mediated by vascular endothelial growth factor (VEGF) and prostaglandin E2 (PGE2). We hypothesized that serum levels of VEGF and PGE2 are increased by the stress response to breast cancer surgery and attenuated by paravertebral anesthesia and analgesia (PVAA). Thirty women undergoing mastectomy were enrolled in this prospective, randomized study, to receive general anesthesia (GA) and postoperative opioid analgesia (morphine 0.1 mg/kg bolus and patient-controlled infusion) or GA and PVAA (72-h infusion). All patients received rectal diclofenac. Venous blood samples were taken preoperatively and at 4 and 24 h postoperatively for serum glucose, cortisol, C-reactive protein, VEGF, and PGE2. PVAA inhibited the surgical stress response, as indicated by significantly less plasma glucose, cortisol, and C-reactive protein. VEGF and PGE2 values did not differ significantly between the groups. Mean (SD) percentage change in VEGF at 4 and 24 h respectively were 3% +/- 44% versus 9% +/- 80%, P=0.29 and 5% +/- 43% versus -10% +/- 63%, P=0.41 for patients with combined general and PVAA and GA alone, respectively. Mean percentage change in postoperative PGE2 at 4 and 24 h respectively was 10% +/- 17% versus 11% +/- 69%, P=0.29 and 34% +/- 19% versus 47% +/- 18%, P=0.15. We conclude that despite inhibiting the surgical stress response, PVAA had no effect on serum levels of putative breast cancer angiogenic factors, VEGF and PGE2.
Publication Types:
- Clinical Trial
- Randomized Controlled Trial
PMID: 15616085 [PubMed - indexed for MEDLINE]
-
The evolving and important role of anesthesiology in palliative care.
Fine PG.
Department of Anesthesiology, Pain Management Center, Ste. 200, 615 Arapeen Dr., University of Utah, Salt Lake City, UT 84109, USA. fine@aros.net
A small but clinically significant proportion of dying patients experience severe physically or psychologically distressing symptoms that are refractory to the usual first-line therapies. Anesthesiologists, currently poorly represented in the rapidly evolving specialties of hospice and palliative medicine, are uniquely qualified to contribute to the comprehensive care of patients who are in this category. Anesthesiologists' interpersonal capabilities in the management of patients and families under duress, their knowledge and comfort level with the application of potent analgesic and consciousness-altering pharmacology, and their titrating and monitoring skills would add a valuable dimension to palliative care teams. This article summarizes the state of the art and means by which anesthesiologists might contribute to improvements in the important end-of-life outcome of safe and comfortable dying.
Publication Types:
PMID: 15616075 [PubMed - indexed for MEDLINE]
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The detection of cerebral hypoperfusion with bispectral index monitoring during general anesthesia.
Morimoto Y, Monden Y, Ohtake K, Sakabe T, Hagihira S.
Department of Anesthesiology-Resuscitology, Yamaguchi University School of Medicine, 1-1-1 Minami-Kogushi Ube, Yamaguchi, 755-8505, Japan. yamorimo@nifty.com
We describe a patient in whom the bispectral index (BIS) decreased to 0 during surgery. A 42-yr-old man with chronic renal failure was scheduled to undergo construction of an arteriovenous shunt. He had a history of acute cerebral hemorrhage. An intracranial hematoma had been removed a month earlier with almost complete neurological recovery. He had uncontrolled hypertension. His systolic blood pressure was 180 mm Hg before anesthesia induction. Anesthesia was induced with 100 mg of propofol and 3% sevoflurane. After laryngeal mask insertion, anesthesia was maintained with nitrous oxide 60% in oxygen and sevoflurane. BIS decreased to near 0 on 2 occasions: after anesthesia induction and shortly after the start of the surgery. His systolic blood pressure decreased to 110 mm Hg and BIS increased when his blood pressure was increased to 130-140 mm Hg. The decrease in BIS was suspected to be the result of decreased cerebral blood flow. The systolic blood pressure of 110 mm Hg (mean blood pressure, 80 mm Hg) was probably less than the lower limit of autoregulation. Although BIS has some limitations as a cerebral monitor, it was useful for detecting possible cerebral hypoperfusion in this case.
PMID: 15616071 [PubMed - indexed for MEDLINE]
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Peribulbar anesthesia: a percutaneous single injection technique with a small volume of anesthetic.
Rizzo L, Marini M, Rosati C, Calamai I, Nesi M, Salvini R, Mazzini C, Campana F, Brizzi E.
Department of Critical Care Medicine and Surgery, Section of Anesthesiology, University of Florence, Viale Morgagni 85, 50134, Florence, Italy. leonardorizzo@inwind.it
We evaluated the efficacy and safety of a single injection technique with a small volume of anesthetic for ocular peribulbar anesthesia. We included 857 patients undergoing various ophthalmic procedures. Anesthesia consisted of a medial percutaneous injection of 5-6.5 mL of 2% lidocaine. At 2 min 85.6% of the patients had a motor block of at least 50% and at 5 min 78.6% had a motor block >80%. After 5 min 100% of the patients had adequate surgical anesthesia. There were no serious block-related complications. The described technique is a simple and satisfactory alternative to the classical techniques.
Publication Types:
PMID: 15616059 [PubMed - indexed for MEDLINE]
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Is ketamine a safe anesthetic for percutaneous liver biopsy in a liver transplant recipient immunosuppressed with cyclosporine?
Agarwal A, Raza M, Dhiraaj S, Saxena R, Singh PK, Pandey R.
Department of Anesthesia, Sanjay Gandhi Post Graduate Institute of of Medical Sciences, Lucknow 226 014, India. aagarwal@sgpgi.ac.in
A 6-yr-old male patient underwent live related left lateral segment liver transplant for cryptogenic cirrhosis with portal hypertension. One month after the liver transplant the patient had an isolated liver transaminases increase. He was posted for percutaneous liver biopsy for suspected graft rejection under general anesthesia. The patient was administered ketamine 7 mg/kg along with glycopyrrolate 0.01 mg/kg IM in the preoperative area. He developed generalized tonic clonic seizures just before the biopsy and was treated with IV midazolam 1 mg and thiopental 60 mg. Percutaneous liver biopsy was obtained once the convulsions subsided. Both ketamine and cyclosporine have been implicated as having proconvulsant properties and may have been responsible for the seizures in our patient. Our experience prompted us to suggest that ketamine in a patient immunosuppressed with cyclosporine may not be safe and that alternative anesthetics may need to be considered for such procedures.
Publication Types:
PMID: 15616057 [PubMed - indexed for MEDLINE]
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Isobaric ropivacaine 5 mg/ml for spinal anesthesia in children.
Kokki H, Ylonen P, Laisalmi M, Heikkinen M, Reinikainen M.
Department of Anesthesiology and Intensive Care, Kuopio University Hospital, PO Box 1777, FI-70211 Kuopio, Finland. hannu.kokki@kuh.fi
In this clinical trial, we evaluated the clinical effects of ropivacaine for spinal anesthesia in children. An open, prospective study was performed on 93 children, aged 1-17 yr, undergoing elective lower abdominal or lower limb surgery. A plain solution of ropivacaine 5 mg/mL at a dose of 0.5 mg/kg body weight (up to 20 mg) was administered via the L3-4 or L4-5 interspace with the patient in the lateral decubitus position. After injection, the patients were placed supine. The spread and duration of sensory analgesia and the degree of motor block were recorded. Satisfactory surgical anesthesia was achieved in 92 of the 93 children. Three children received general anesthesia; in one child spinal anesthesia failed, and in two cases surgery outlasted the duration of the sensory block. Four children received supplemental analgesia for skin incision. The mean highest level of sensory block was T6 (range, T2 to T12), and the mean time to the regression of sensory block to T10 was 96 min (range, 34-210 min). One child developed transient bradycardia and one hypotension. After discharge four children developed mild transient radiating neurologic symptoms and one epidural blood patch was performed for persistent position-dependent headache. We conclude that the block performance of intrathecal isobaric ropivacaine in children (>1 yr) is similar to that obtained in adults but the safety of the larger dose used in children warrants further studies.
Publication Types:
PMID: 15616053 [PubMed - indexed for MEDLINE]
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Anesthesia for the child with an upper respiratory tract infection: still a dilemma?
Tait AR, Malviya S.
Department of Anesthesiology, University of Michigan Health Systems, 1500 E. Medical Center Dr., Ann Arbor, MI 48109, USA. atait@umich.edu
One of the most controversial issues in pediatric anesthesia has revolved around the decision to proceed with anesthesia and surgery for the child who presents with an upper respiratory tract infection (URI). In the past, doctrine dictated that children with URIs have their surgery postponed until the child was symptom free. This practice was based on the empirically supported premise that anesthesia increased the risk of serious complications and complicated the child's postoperative course. Although recent clinical data confirm that some children with URIs are at increased risk of perioperative complications, these complications can, for the most part, be anticipated, recognized, and treated. Although the child with a URI still presents a challenge, anesthesiologists are now in a better position to make informed decisions regarding the assessment and management of these children, such that blanket cancellation has now become a thing of the past.
Publication Types:
PMID: 15616052 [PubMed - indexed for MEDLINE]
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Anesthetic preconditioning: the role of free radicals in sevoflurane-induced attenuation of mitochondrial electron transport in Guinea pig isolated hearts.
Riess ML, Kevin LG, McCormick J, Jiang MT, Rhodes SS, Stowe DF.
Anesthesiology Research Laboratories, Department of Anesthesiology, Medical College of Wisconsin, 8701 Watertown Plank Rd., Milwaukee, WI 53226, USA.
Cardioprotection by anesthetic preconditioning (APC) can be abolished by nitric oxide (NO*) synthase inhibitors or by reactive oxygen species (ROS) scavengers. We previously reported attenuated mitochondrial electron transport (ET) and increased ROS generation during preconditioning sevoflurane exposure as part of the triggering mechanism of APC. We hypothesized that NO* and other ROS mediate anesthetic-induced ET attenuation. Cardiac function and reduced nicotinamide adenine dinucleotide (NADH) fluorescence, an index of mitochondrial ET, were measured online in 68 Langendorff-prepared guinea pig hearts. Hearts underwent 30 min of global ischemia and 120 min of reperfusion. Before ischemia, hearts were temporarily perfused with superoxide dismutase, catalase, and glutathione to scavenge ROS or N(G)-nitro-L-arginine-methyl-ester (L-NAME) to inhibit NO* synthase in the presence or absence of 1.3 mM sevoflurane (APC). APC temporarily increased NADH before ischemia, i.e., it attenuated mitochondrial ET. Both this NADH increase and the cardioprotection by APC on reperfusion were prevented by superoxide dismutase, catalase, and glutathione and by N(G)-nitro-L-arginine-methyl-ester. Thus, ROS and NO*, or reaction products including peroxynitrite, mediate sevoflurane-induced ET attenuation. This may lead to a positive feedback mechanism with augmented ROS generation to trigger APC secondary to altered mitochondrial function.
PMID: 15616050 [PubMed - indexed for MEDLINE]
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Parasternal block and local anesthetic infiltration with levobupivacaine after cardiac surgery with desflurane: the effect on postoperative pain, pulmonary function, and tracheal extubation times.
McDonald SB, Jacobsohn E, Kopacz DJ, Desphande S, Helman JD, Salinas F, Hall RA.
Department of Anesthesiology, Virginia Mason Medical Center, 1100 Ninth Ave., PO Box 900, Mailstop B2-AN, Seattle, WA 98111, USA. anesbm@vmmc.org
Early tracheal extubation has become common after cardiac surgery. Anesthetic techniques designed to achieve this goal can make immediate postoperative analgesia challenging. We conducted this randomized, placebo-controlled, double-blind study to investigate the effect of a parasternal block on postoperative analgesia, respiratory function, and extubation times. We enrolled 20 patients having cardiac surgery via median sternotomy; 17 patients completed the study. A de-sflurane-based, small-dose opioid anesthetic was used. Before sternal wire placement, the surgeons performed the parasternal block and local anesthetic infiltration of sternotomy and tube sites with either 54 mL of saline placebo or 54 mL of 0.25% levobupivacaine with 1:400,000 epinephrine. Effects on pain and respiratory function were studied over 24 h. Patients in the levobupivacaine group used significantly less morphine in the first 4 h after surgery (20.8 +/- 6.2 mg versus 33.2 +/- 10.9 mg in the placebo group; P=0.013); they also had better oxygenation at the time of extubation. Four of nine in the placebo group needed rescue pain medication, versus none of eight in the levobupivacaine group (P=0.08). Peak serum levobupivacaine concentrations were below potentially toxic levels in all patients (0.64 +/- 0.43 microg/mL; range, 0.24-1.64 microg/mL). Parasternal block and local anesthetic infiltration of the sternotomy wound and mediastinal tube sites with levobupivacaine can be a useful analgesic adjunct for patients who are expected to undergo early tracheal extubation after cardiac surgery.
Publication Types:
- Clinical Trial
- Randomized Controlled Trial
PMID: 15616047 [PubMed - indexed for MEDLINE]
Comment on:
Arterial oxygenation during one-lung anesthesia.
Levin AI, Coetzee JF.
Publication Types:
PMID: 15616044 [PubMed - indexed for MEDLINE]
Comment in:
Anesthetic management and one-year mortality after noncardiac surgery.
Monk TG, Saini V, Weldon BC, Sigl JC.
Department of Anesthesiology Duke University Medical Center, Durham, NC 27705, USA. terri.monk@duke.edu
Little is known about the effect of anesthetic management on long-term outcomes. We designed a prospective observational study of adult patients undergoing major noncardiac surgery with general anesthesia to determine if mortality in the first year after surgery is associated with demographic, preoperative clinical, surgical, or intraoperative variables. One-year mortality was 5.5% in all patients (n = 1064) and 10.3% in patients > or =65 yr old (n=243). Multivariate Cox Proportional Hazards modeling identified three variables as significant independent predictors of mortality: patient comorbidity (relative risk, 16.116; P <0.0001), cumulative deep hypnotic time (Bispectral Index <45) (relative risk=1.244/h; P=0.0121) and intraoperative systolic hypotension (relative risk=1.036/min; P=0.0125). Death during the first year after surgery is primarily associated with the natural history of preexisting conditions. However, cumulative deep hypnotic time and intraoperative hypotension were also significant, independent predictors of increased mortality. These associations suggest that intraoperative anesthetic management may affect outcomes over longer time periods than previously appreciated.
PMID: 15616043 [PubMed - indexed for MEDLINE]
Comment on:
Anesthetic depth is not (yet) a predictor of mortality!
Cohen NH.
Publication Types:
PMID: 15616042 [PubMed - indexed for MEDLINE]
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Hyperbaric oxygen therapy and pain management in a child with continuous infraclavicular brachial plexus block.
Minville V, Chassery C, Kern D, Fourcade O, Dadure C.
Publication Types:
PMID: 15562104 [PubMed - indexed for MEDLINE]
Comment on:
The supraclavicular block with a nerve stimulator: where is the needle tip, that is the question.
Blumenthal S, Nadig M, Borgeat A.
Publication Types:
PMID: 15562097 [PubMed - indexed for MEDLINE]
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The mechanical properties of continuous spinal small-bore catheters.
Deusch E, Benrath J, Weigl L, Neumann K, Kozek-Langenecker SA.
Department of Anesthesiology and Intensive Care-B, Vienna Medical University, General Hospital Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria, E.C. engelbert.deusch@meduniwien.ac.at
Continuous spinal anesthesia (CSA) has a nearly 100-yr history. In situations of difficult removal of a CSA small-bore catheter, mechanical properties of the different catheters might be important, because breakage could occur. We compared 5 different CSA small-bore catheters, 22- to 28-gauge from 3 manufacturers, for tensile strength, tensile stress, distension, and yield strength. Maximal tensile strength is the force applied before breakage of the catheter. The material characteristics of different CSA small-bore catheters for maximal tensile strength were: 22-gauge = 29.56 +/- 1.56 (mean +/- sd) Newton (N), 24-gauge = 16.77 +/- 1.61 N, 25-gauge = 9.20 +/- 0.48 N, 27-gauge = 4.61 +/- 0.25 N, 28-gauge = 5.07 +/- 0.59 N at room temperature. A strong correlation between maximal tensile strength and the outer diameter (r = 0.957, P < 0.001) and maximal tensile strength and the wall thickness (r = 0.9, P < 0.001) was observed. Although extrapolation from experimental studies to clinical routine should be made with care, our data suggest that catheters with higher-strength characteristics may reduce the risk of catheter breakage in patients, although clinical correlations are lacking.
Publication Types:
PMID: 15562084 [PubMed - indexed for MEDLINE]
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Paramedian lumbar epidural catheter insertion with patients in the sitting position is equally successful in the flexed and unflexed spine.
Podder S, Kumar N, Yaddanapudi LN, Chari P.
Department of Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India. podder_s@yahoo.co.in
Positioning for placement of an epidural catheter can be quite painful for patients with lower limb injuries. We randomly allocated 50 patients scheduled for surgery after lower limb injuries for placement of a lumbar epidural catheter in the sitting position with the back in the neutral unflexed position by either the midline or paramedian approach. If the approach failed after two attempts, patients were placed in a flexed-spine position, and the procedure was attempted again. Technical difficulties and complications were recorded. In 17 patients in the midline group, and 1 patient in the paramedian group, it was not possible to insert the needle initially, and a flexed-spine position was required (P < 0.05). The incidences of resistance to catheter insertion (eight versus one), paresthesia (seven versus zero), and appearance of blood in the catheter (six versus zero) were significantly more frequent in the midline compared with the paramedian approach. The midline group also experienced more discomfort than the paramedian group. We conclude that, with the patient sitting with an unflexed spine, it is usually possible to insert an epidural catheter with the paramedian approach.
Publication Types:
- Clinical Trial
- Randomized Controlled Trial
PMID: 15562081 [PubMed - indexed for MEDLINE]
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Is intrathecal magnesium sulfate safe and protective against ischemic spinal cord injury in rabbits?
Saeki H, Matsumoto M, Kaneko S, Tsuruta S, Cui YJ, Ohtake K, Ishida K, Sakabe T.
Department of Anesthesiology-Resuscitology, Yamaguchi University School of Medicine, 1-1-1 Minami-Kogushi, Ube, Yamaguchi, 755-8505, Japan.
We performed three sets of experiments to investigate the safety of intrathecal magnesium and to determine its optimal dose for protection, if any, against ischemic spinal cord injury in rabbits. First, we examined neurotoxicity of 0.3, 1, 2, or 3 mg/kg of magnesium sulfate (n = 6 each). Significant sensory dysfunction was observed in the 3-mg/kg group 7 days after administration. Motor dysfunction was found in two rabbits in both the 2- and 3-mg/kg groups. The area of destruction in laminae V-VII was observed in one, two, and one rabbit in the 1-, 2-, and 3-mg/kg groups, respectively. Second, we investigated the temporal profile (6 h, 48 h, and 96 h [n = 3 each]) of histopathologic changes after 3 mg/kg of magnesium sulfate and confirmed similar changes in the rabbits with motor dysfunction at 48 and 96 h. Third, we evaluated the effects of 0.3 mg/kg or 1 mg/kg of magnesium sulfate or saline (n = 6 each) administered before ischemia on hindlimb motor function and histopathology after spinal cord ischemia (15 min). Magnesium did not improve neurologic or histopathologic outcome 96 h after reperfusion. The results indicate that intrathecal magnesium has a risk of neurotoxicity and shows no evidence of protective effects against ischemic spinal cord injury.
PMID: 15562076 [PubMed - indexed for MEDLINE]
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Risk factors assessment of the difficult airway: an italian survey of 1956 patients.
Cattano D, Panicucci E, Paolicchi A, Forfori F, Giunta F, Hagberg C.
Department of Surgery, Anaesthesia and Intensive Care Division, Spedali Riuniti S. Chiara, University of Pisa, Pisa, Italy. davidecattano@hotmail.com
Over the last decade, there has been a heightened awareness and an increase in the amount of literature being published on recognition and prediction of the difficult airway. During the preoperative evaluation of the airway, a thorough history and physical specifically related to the airway should be performed. Various measurements of anatomic features and noninvasive clinical tests can be performed to enhance this assessment. In this study we correlated the Mallampati modified score and several other indexes with the laryngoscopic view to identify anatomical and clinical risk factors related to the difficult airway. We prospectively collected data on 1956 consecutive patients scheduled to receive general anesthesia requiring endotracheal intubation for elective surgery. The Mallampati classification versus the Cormack-Lehane (C-L) linear correlation index was 0.904. A Mallampati Class 3 correlated with a C-L Grade 2 (0.94), whereas a Mallampati Class 4 correlated with a C-L Grade 3 (0.85) and a C-L Grade 4 (0.80). Operator evaluation, performed by a simplified tracheal intubation difficulty scale, showed a linear correlation of 0.96 compared with the C-L groups. Although there is a correlation between oropharyngeal volume and difficult intubation, the Mallampati score by itself is insufficient for predicting difficult endotracheal intubation.
PMID: 15562070 [PubMed - indexed for MEDLINE]
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Measuring depth of sedation with auditory evoked potentials during controlled infusion of propofol and remifentanil in healthy volunteers.
Haenggi M, Ypparila H, Takala J, Korhonen I, Luginbuhl M, Petersen-Felix S, Jakob SM.
Department of Intensive Care Medicine, University Hospital Bern (Inselspital) CH-3010 Bern, Switzerland.
Avoiding excessively deep levels of sedation is a major problem in intensive care patients. We studied whether clinically relevant levels of sedation can be objectively assessed using long latency auditory evoked potentials. We measured the auditory evoked potentials at 100 ms after the stimulus (N100) in 10 healthy volunteers during stepwise increasing, clinically relevant levels of sedation (Ramsay score [RS] 2-4). The volunteers were studied on three separate occasions and received an infusion of either propofol or a combination of propofol and remifentanil. Effects of remifentanil infusion alone were tested during target controlled infusion (target plasma concentrations: 1, 2, and 3 ng/mL). Remifentanil did not affect evoked potential amplitudes and latencies. During both propofol-induced and propofol/remifentanil-induced sedation, the N100 amplitude decreased similarly without an effect on the latencies as the level of sedation increased from Ramsay score 2 to Ramsay score 4 (P < 0.01). At the same clinical level of sedation, propofol plasma concentrations were larger when sedation was achieved by propofol alone (propofol versus propofol/remifentanil, RS 3: 2.12 mug/mL +/- 0.51 versus 1.32 +/- 0.43, P < 0.01; RS 4: 3.37 +/- 0.47 versus 1.86 +/- 0.34, P < 0.01). Our results suggest that long latency auditory evoked potentials provide an objective electrophysiological analog to the clinical assessment of sedation independent of the sedation regime used.
PMID: 15562062 [PubMed - indexed for MEDLINE]
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Sevoflurane decreases bispectral index values more than does halothane at equal MAC multiples.
Schwab HS, Seeberger MD, Eger EI 2nd, Kindler CH, Filipovic M.
Department of Anesthesia, University Clinics Basel, CH-4031 Basel, Switzerland.
At the minimum alveolar concentration (MAC) of inhaled anesthetics, 50% of subjects move in response to noxious stimulation. Similarly, at MAC-awake, 50% of subjects respond appropriately to command. The bispectral index (BIS) nominally measures the effect of anesthetics on wakefulness or consciousness. We postulated that the use of halothane with a larger MAC-awake/MAC ratio than sevoflurane would produce higher BIS values at comparable levels of MAC. We studied 33 unpremedicated patients anesthetized by inhalation, 18 with sevoflurane and 15 with halothane. We measured BIS before and during anesthesia at 1 MAC, both before and after tracheal intubation facilitated by fentanyl and rocuronium and then at 1.5 MAC. BIS measurements were made after meeting steady-state conditions. No surgery was performed during this study. BIS values in awake patients did not differ between the sevoflurane and halothane groups (96 +/- 2 and 96 +/- 2, mean +/- sd, respectively). At 1 MAC without and with neuromuscular blockade and at 1.5 MAC, BIS values for patients anesthetized with halothane (54 +/- 7, 56 +/- 7, and 49 +/- 7, respectively) exceeded those for patients anesthetized with sevoflurane (34 +/- 6, 34 +/- 6, and 29 +/- 5, respectively) (P < 0.0001). This finding adds to other evidence indicating that BIS is drug specific.
Publication Types:
- Clinical Trial
- Randomized Controlled Trial
PMID: 15562061 [PubMed - indexed for MEDLINE]
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Intravenous lidocaine suppresses fentanyl-induced coughing: a double-blind, prospective, randomized placebo-controlled study.
Pandey CK, Raza M, Ranjan R, Lakra A, Agarwal A, Singh U, Singh RB, Singh PK.
Department of Anaesthesiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow 226014, India. ckpandey@sgpgi.ac.in
IV lidocaine is effective in suppressing the cough reflex of tracheal intubation, extubation, bronchography, bronchoscopy, and laryngoscopy. We investigated this effect of lidocaine on fentanyl-induced cough in 502 patients of ASA physical status I and II scheduled for elective surgery. The patients were assigned to 2 equal groups to receive either lidocaine 1.5 mg/kg or placebo (0.9% saline) over 5 s 1 min before the administration of fentanyl 3 mug/kg in a randomized and double-blind fashion. Coughs were classified as coughing and graded as mild (1-2), moderate (3-4), or severe (5 or more). The results of the study suggest that IV lidocaine 1.5 mg/kg, when administered 1 min before fentanyl, is significantly effective in suppressing fentanyl-induced cough compared to placebo (0.9% saline) (218 versus 165 patients) (P < 0.002) but without affecting the severity of cough (P > 0.05).
Publication Types:
- Clinical Trial
- Randomized Controlled Trial
PMID: 15562056 [PubMed - indexed for MEDLINE]
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Postoperative confusion increases in elderly long-term benzodiazepine users.
Kudoh A, Takase H, Takahira Y, Takazawa T.
Department of Anesthesiology, Hirosaki National Hospital, 1 Tominocho, Hirosaki 036-8545, Aomori, Japan. masuika@cc.hirosaki-u.ac.jp
We investigated the relationship between postoperative confusion and duration of benzodiazepine exposure, preoperative anxiety, depressive state, and cognitive function in elderly patients regularly taking benzodiazepines. We studied 328 patients ranging in age from 65 to 80 yr who underwent orthopedic surgery. Information on benzodiazepine use was obtained by face-to-face interview and visual assessment of the patient's medicine chest. Postoperative confusion was assessed by using a confusion-assessment method. The patients were divided into two groups: those who regularly took benzodiazepines and those who did not. Fifty-seven (17%) of 328 patients were treated with benzodiazepines. There were no significant differences in preoperative Mini-Mental State (MMS) scores, anxiety scores, or depression scores between benzodiazepine users and nonusers. Postoperative confusion occurred in 15 (26%) of 57 benzodiazepine users and in 34 (13%) of 271 nonusers (P < 0.01). The patients who had a score <23 on the MMS were 5 (9%) of 57 benzodiazepine users and 8 (3%) of 271 nonusers (P < 0.05). Postoperative confusion occurred in 13 (35%) of 37 long-term benzodiazepine users (daily use for >1 yr) and in 2 (10%) of 20 short-term users (daily use for <1 yr). The incidence of postoperative confusion was significantly more frequent in long-term than in short-term benzodiazepine users or nonusers of benzodiazepines. The patients who developed a score <23 on the MMS were 5 (14%) of 37 long-term benzodiazepine users and 0 (0%) of 20 short-term benzodiazepine users. In conclusion, the incidence of postoperative confusion was significantly more frequent in long-term benzodiazepine users.
Publication Types:
PMID: 15562052 [PubMed - indexed for MEDLINE]
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Preoperative anxiety and emergence delirium and postoperative maladaptive behaviors.
Kain ZN, Caldwell-Andrews AA, Maranets I, McClain B, Gaal D, Mayes LC, Feng R, Zhang H.
Department of Anesthesiology, Yale University School of Medicine 333 Cedar Street, New Haven, CT 06510, USA. zeev.kain@yale.edu
Based on previous studies, we hypothesized that the clinical phenomena of preoperative anxiety, emergence delirium, and postoperative maladaptive behavioral changes were closely related. We examined this issue using data obtained by our laboratory over the past 6 years. Only children who underwent surgery and general anesthesia using sevoflurane/O(2)/N(2)O and who did not receive midazolam were recruited. Children's anxiety was assessed preoperatively with the modified Yale Preoperative Anxiety Scale (mYPAS), emergence delirium was assessed in the postanesthesia care unit, and behavioral changes were assessed with the Post Hospital Behavior Questionnaire (PHBQ) on postoperative days 1, 2, 3, 7, and 14. Regression analysis showed that the odds of having marked symptoms of emergence delirium increased by 10% for each increment of 10 points in the child's state anxiety score (mYPAS). The odds ratio of having new-onset postoperative maladaptive behavior changes was 1.43 for children with marked emergence status as compared with children with no symptoms of emergence delirium. A 10-point increase in state anxiety scores led to a 12.5% increase in the odds that the child would have a new-onset maladaptive behavioral change after the surgery. This finding is highly significant to practicing clinicians, who can now predict the development of adverse postoperative phenomena, such as emergence delirium and postoperative behavioral changes, based on levels of preoperative anxiety.
PMID: 15562048 [PubMed - indexed for MEDLINE]
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An evaluation of a noninvasive cardiac output measurement using partial carbon dioxide rebreathing in children.
Levy RJ, Chiavacci RM, Nicolson SC, Rome JJ, Lin RJ, Helfaer MA, Nadkarni VM.
Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, 34th St. and Civic Center Blvd., Philadelphia, PA 19104, USA. levyri@email.chop.edu
Cardiac output (CO) is an important hemodynamic measure that helps to guide the therapy of critically ill patients. Invasive CO assessment in infants and children is often avoided because of the inherent risks. A noninvasive CO monitor that uses partial rebreathing has been recently developed to determine CO via the Fick principle for carbon dioxide. There have been no clinical studies confirming its accuracy in pediatric patients. This is a prospective observational study of 37 children <12 yr of age who underwent cardiac catheterization. Under general anesthesia via an endotracheal tube without a leak, we made multiple CO measurements using thermodilution and compared them with noninvasively determined CO measurements. Paired measurements were analyzed for bias, precision, and correlation via Bland-Altman plot and linear regression. Noninvasive measurements showed a linear correlation with thermodilution CO assessment with an r value of 0.83 (P < 0.03). Bland-Altman analysis yielded a bias of -0.27 L/min and a precision +/-1.49 L/min. Cardiac index measurements demonstrated a decreased r value of 0.67 (P = 0.15) and a bias of -0.18 L . min(-1) . m(-2) and precision of +/-2.13 L . min(-1) . m(-2). Differences between partial rebreathing measurements and thermodilution measurements were largest in children with a body surface area of </=0.6 m(2) ventilated with tidal volumes <300 mL. Based on these findings, noninvasive CO measurement using partial rebreathing may be clinically acceptable in children with >0.6 m(2) body surface area and >300 mL tidal volume.
Publication Types:
PMID: 15562047 [PubMed - indexed for MEDLINE]
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The development and validation of a risk score to predict the probability of postoperative vomiting in pediatric patients.
Eberhart LH, Geldner G, Kranke P, Morin AM, Schauffelen A, Treiber H, Wulf H.
Department of Anesthesia and Intensive Care, Philipps-University, Baldingerstr. 1, D-35033 Marburg, Germany. eberhart@mailer.uni-marburg.de
Risk scores to predict the occurrence of postoperative vomiting (PV) or nausea and vomiting that were developed for adult patients do not fit for children, because several risk factors are difficult to assess or are usually not applicable in pediatric patients (e.g., smoking status). Thus, in the present study, we sought to develop and to validate a simple score to predict PV in children (POVOC-score). Development and validation of the new score was based on data from 4 independent institutions of 1257 children (aged 0-14 yr) undergoing various types of surgery under general anesthesia without antiemetic prophylaxis. Preoperatively, several potential risk factors were recorded. Postoperatively, the occurrence of PV was observed for up to 24 h. The dataset was randomly split into an evaluation set (n = 657) that was analyzed using a forward logistic regression technique and a validation set (n = 600) that was used to confirm the accuracy of prediction by means of the area under a receiver operating characteristic curve. Four independent risk factors for PV were identified in the final analysis: duration of surgery >/=30 min, age >/=3 yr, strabismus surgery, and a positive history of PV in the children or PV/postoperative nausea and vomiting in relatives (mother, father, or siblings). The incidence of PV was 9%, 10%, 30%, 55%, and 70% for 0, 1, 2, 3, and 4 risk factors observed. Using these incidences as cut-off values in the validation dataset, the area under the receiver operating characteristic curve was 0.72 (95% confidence interval: 0.68-0.77). Our data suggest that PV can be predicted with an acceptable accuracy using a four-item simplified risk score.
Publication Types:
PMID: 15562045 [PubMed - indexed for MEDLINE]
Comment on:
Pacemaker misinformation in the perioperative period: programming around the problem.
Rozner M.
Publication Types:
PMID: 15562035 [PubMed - indexed for MEDLINE]
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Comment on:
Anesthesia-compatible magnetic resonance imaging.
Miyasaka K, Kondo Y, Tamura T, Sakai H.
Publication Types:
PMID: 15618811 [PubMed - indexed for MEDLINE]
49: id: 15618810 Error occurred: Document retrieval error: document is empty
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Anesthesia for patients with congenital long QT syndrome.
Kies SJ, Pabelick CM, Hurley HA, White RD, Ackerman MJ.
Department of Anesthesiology, Mayo Clinic College of Medicine, Rochester, Minnesota 55905, USA.
Long QT syndrome is a malfunction of cardiac ion channels resulting in impaired ventricular repolarization that can lead to a characteristic polymorphic ventricular tachycardia known as torsades de pointes. Stressors, by increasing sympathetic tone, and drugs can provoke torsade de pointes, leading to syncope, seizures, or sudden cardiac death in these patients. Beta blockade, implantation of cardioverter defibrillators, and left cardiac sympathetic denervation are used in the treatment of these patients. However, these treatment modalities do not guarantee the prevention of sudden cardiac death. Certain drugs, including anesthetic agents, are known to contribute to QT prolongation. After reviewing the literature the authors give recommendations for the anesthetic management of these patients in the perioperative period.
Publication Types:
PMID: 15618804 [PubMed - indexed for MEDLINE]
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Influence of obesity on surgical regional anesthesia in the ambulatory setting: an analysis of 9,038 blocks.
Nielsen KC, Guller U, Steele SM, Klein SM, Greengrass RA, Pietrobon R.
Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina 27710, USA. niels006@mc.duke.edu
BACKGROUND: Regional anesthesia is increasing in popularity for ambulatory surgical procedures. Concomitantly, the prevalence of obesity in the United States population is increasing. The objective of the present investigation was to assess the impact of body mass index (BMI) on patient outcomes after ambulatory regional anesthesia. METHODS: This study was based on prospectively collected data including 9,038 blocks performed on 6,920 patients in a single ambulatory surgery center. Patients were categorized into three groups according to their BMI (<25 kg/m2, 25-29 kg/m2, > or =30 kg/m2). Block efficacy, rate of acute complications, postoperative pain (at rest and with movement), postoperative nausea and vomiting, rate of unscheduled hospital admissions, and overall patient satisfaction were assessed. Linear and logistic multivariable analyses were used to obtain the risk-adjusted effect of BMI on these outcomes. RESULTS: Of all patients 34.8% had a BMI <25 kg/m2, 34.0% were overweight (BMI 25-29 kg/m2), and 31.3% were obese (BMI > or = 30 kg/m2). Patients with BMI > or =30 kg/m2 were 1.62 times more likely to have a failed block (P = 0.04). The unadjusted rate of acute complications was higher in obese patients (P = 0.001). However, when compared with patients with a normal BMI, postoperative pain at rest, unanticipated admissions, and overall satisfaction were similar in overweight and obese patients. CONCLUSIONS: The present investigation shows that obesity is associated with higher block failure and complication rates in surgical regional anesthesia in the ambulatory setting. Nonetheless, the rate of successful blocks and overall satisfaction remained high in patients with increased BMI. Therefore, overweight and obese patients should not be excluded from regional anesthesia procedures in the ambulatory setting.
PMID: 15618802 [PubMed - indexed for MEDLINE]
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Isoflurane protects against myocardial infarction during early reperfusion by activation of phosphatidylinositol-3-kinase signal transduction: evidence for anesthetic-induced postconditioning in rabbits.
Chiari PC, Bienengraeber MW, Pagel PS, Krolikowski JG, Kersten JR, Warltier DC.
Departments of Anesthesiology, (Division of Cardiovascular Diseases), the Medical College of Wisconsin, the Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, Wisconsin, USA.
BACKGROUND: Brief episodes of ischemia during early reperfusion after coronary occlusion reduce the extent of myocardial infarction. Phosphatidylinositol-3-kinase (PI3K) signaling has been implicated in this "postconditioning" phenomenon. The authors tested the hypothesis that isoflurane produces cardioprotection during early reperfusion after myocardial ischemia by a PI3K-dependent mechanism. METHODS: Pentobarbital-anesthetized rabbits (n = 80) subjected to a 30-min coronary occlusion followed by 3 h reperfusion were assigned to receive saline (control), three cycles of postconditioning ischemia (10 or 20 s each), isoflurane (0.5 or 1.0 minimum alveolar concentration), or the PI3K inhibitor wortmannin (0.6 mg/kg, intravenously) or its vehicle dimethyl sulfoxide. Additional groups of rabbits were exposed to combined postconditioning ischemia (10 s) and 0.5 minimum alveolar concentration isoflurane in the presence and absence of wortmannin. Phosphorylation of Akt, a downstream target of PI3K, was assessed by Western blotting. RESULTS: Postconditioning ischemia for 20 s, but not 10 s, reduced infarct size (P < 0.05) (triphenyltetrazolium staining; 20 +/- 3% and 34 +/- 3% of the left ventricular area at risk, respectively) as compared with control (41 +/- 2%). Exposure to 1.0, but not 0.5, minimum alveolar concentration isoflurane decreased infarct size (21 +/- 2% and 43 +/- 3%, respectively). Wortmannin abolished the protective effects of postconditioning (20 s) and 1.0 minimum alveolar concentration isoflurane. Combined postconditioning (10 s) and 0.5 minimum alveolar concentration isoflurane markedly reduced infarct size (17 +/- 5%). This action was also abolished by wortmannin (44 +/- 2%). Isoflurane (1.0 minimum alveolar concentration) increased Akt phosphorylation after ischemia (32 +/- 6%), and this action was blocked by wortmannin. CONCLUSIONS: Isoflurane acts during early reperfusion after prolonged ischemia to salvage myocardium from infarction and reduces the threshold of ischemic postconditioning by activating PI3K.
PMID: 15618793 [PubMed - indexed for MEDLINE]
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No evidence of memory function during anesthesia with propofol or isoflurane with close control of hypnotic state.
Kerssens C, Ouchi T, Sebel PS.
Department of Anesthesiology, Emory University School of Medicine, Atlanta, Georgia 30303, USA. chantal_kerssens@emoryhealthcare.org
BACKGROUND: The authors previously demonstrated memory function during apparently adequate general anesthesia in trauma patients. Hypnotic state fluctuations, stress, and variable amnesic qualities of commonly used anesthetics could account for this effect. METHODS: The authors replicated the trauma investigation in 90 elective surgical patients to enable anesthetic titration to a bispectral index value of 50-55 during auditory presentation of word stimuli. Patients were randomly assigned to maintenance with propofol (n = 48) or isoflurane (n = 42). Before surgery, state anxiety and trait anxiety were assessed using self-report measures. Postoperative memory assessment relied on the process dissociation procedure using a word stem completion task. RESULTS: There were no differences between groups for relevant demographic, preoperative, or supplemental drug variables. Ninety-eight percent of words were presented within a bispectral index range of 40-60, with values averaging 48.8 (SD = 5.7) during word presentation. Neither the process dissociation procedure nor standard measures of conscious recall and recognition memory showed evidence of explicit or implicit memory. Preoperative stress levels did not correlate with postoperative memory test scores in either study group. CONCLUSIONS: In contrast to the results of their previous study, the authors found no evidence of memory function with close control of hypnotic state. This suggests that hypnotic state fluctuations are important to memory activation under anesthesia. Other variables may contribute to preserved memory function as well. Propofol and isoflurane block memory equally well during adequate anesthesia.
Publication Types:
- Clinical Trial
- Randomized Controlled Trial
PMID: 15618787 [PubMed - indexed for MEDLINE]
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Terlipressin versus norepinephrine to counteract anesthesia-induced hypotension in patients treated with renin-angiotensin system inhibitors: effects on systemic and regional hemodynamics.
Morelli A, Tritapepe L, Rocco M, Conti G, Orecchioni A, De Gaetano A, Picchini U, Pelaia P, Reale C, Pietropaoli P.
Department of Anesthesiology and Intensive Care, University of Rome La Sapienza, Rome, Italy. andrea.morelli@uniroma1.it
BACKGROUND: Terlipressin has been suggested as the ideal drug to treat anesthesia-induced hypotension in patients under long-term renin-angiotensin system inhibitor treatment for arterial hypertension. The authors compared the effects of terlipressin and norepinephrine on systemic hemodynamic parameters and gastric mucosal perfusion using a laser Doppler flowmetry technique in patients treated with renin-angiotensin system inhibitors who experienced hypotension at induction of anesthesia. METHODS: Thirty-two patients scheduled for carotid endarterectomy under general anesthesia and treated with renin-angiotensin system inhibitors had hypotension after induction of general anesthesia. They were randomized to receive 1 mg of terlipressin (n = 16) or norepinephrine infusion (n = 16) to counteract anesthesia-induced hypotension. A laser Doppler probe was introduced into the gastric lumen. All measurements were performed just before surgery, during hypotension, at 30 min, and at 4 h. RESULTS: Terlipressin produced an increase in mean arterial pressure and a decrease in gastric mucosal perfusion detected by laser Doppler flowmetry (P < 0.05) over 30 min that were sustained for 4 h. During the infusion, norepinephrine produced an increase in mean arterial pressure and in gastric mucosal perfusion detected by laser Doppler flowmetry (P < 0.05). If compared to norepinephrine, terlipressin reduced oxygen delivery and oxygen consumption (P < 0.05) and increased arterial lactate concentrations (P < 0.05). CONCLUSION: This study showed the efficacy of terlipressin in the treatment of hypotension episodes in anesthetized patients chronically treated with renin-angiotensin system inhibitors, angiotensin converting-enzyme inhibitors, and angiotensin II receptor antagonists. However, the negative effects on gastric mucosal perfusion and the risk of iatrogenic oxygen supply dependency of terlipressin need to be taken into account.
Publication Types:
- Clinical Trial
- Randomized Controlled Trial
PMID: 15618781 [PubMed - indexed for MEDLINE]
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Perinatal asphyxia and inadvertent neonatal intoxication from local anaesthetics given to the mother during labour.
Pignotti MS, Indolfi G, Ciuti R, Donzelli G.
Department of Paediatrics, Anna Meyer Children's Hospital, Via L Giordano 13, 50132 Florence, Italy. m.pignotti@meyer.it
Publication Types:
PMID: 15626804 [PubMed - indexed for MEDLINE]
Use of three-dimensional animation for regional anaesthesia teaching: application to interscalene brachial plexus blockade.
Lim MW, Burt G, Rutter SV.
Nuffield Department of Anaesthetics, John Radcliffe Hospital, Headley Way, Headington, Oxford OX3 9DU, UK.
BACKGROUND: Using commercial computer graphics software (TrueSpace), we constructed a virtual-reality model for teaching interscalene brachial plexus block. This tool combines the clarity of schematic drawings and the clinical relevance of video clips and live demonstrations. The aim is to accelerate learning and aid retention of relevant information. Method. We made a series of continuous short virtual-reality animations demonstrating the steps to perform an interscalene block. Superficial structures were made transparent to show the anatomical relevance of landmarking and needle manipulation. The clips were presented to delegates at a training course in Oxford. Delegates were surveyed to ascertain whether or not the presentation enhanced their understanding of anatomy and regional block technique. Before and after the presentation, delegates indicated surface landmarking, needle angulation, and movement on photographs of the lateral and anterolateral neck views of two volunteers. The markings were analysed by two independent assessors and rated as 'good', 'bad', or 'ungradeable'. The percentage improvement for each skill group was calculated and McNemar's test applied. RESULTS: Of 24 respondents, the majority thought that the presentation enhanced their understanding of the anatomical (87.5%) and technical principles (79.2%) of interscalene blocks. Analysis of the marked photographs showed an overall 24.1% improvement in landmarking skills after the teaching presentation (P<0.001). Changes were significant in moderately experienced skill groups (P<0.001) but not for the very experienced (P>0.5) and the inexperienced skill groups (P<0.1). There was 76.3% concordance in scoring between the two assessors. CONCLUSION: Three-dimensional animation is a promising new tool to accelerate the learning of regional anaesthetic techniques.
PMID: 15619604 [PubMed - as supplied by publisher]
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Epidural analgesia after spinal surgery via intervertebral foramen.
Sice PJ, Chan D, Macintyre PA.
Department of Anaesthesia, Royal Devon and Exeter Foundation Trust, Barrack Road, Exeter, UK.
Patients undergoing major spinal surgery may experience significant postoperative pain. Epidural analgesia has previously been shown to be safe and effective and may confer some advantages over opioid-based postoperative analgesia. We discuss the case of a 47-yr-old female patient undergoing the prolonged anterior component of a lower thoracic/upper lumbar spine correction involving the stripping of the diaphragm from the lower thoracic spine and retraction of the left lower lobe of the lung. Despite initially planning opioid-based postoperative analgesia, a joint anaesthetic and surgical decision was made to use epidural analgesia in an attempt to avoid potential postoperative respiratory complications. Because of the surgical anatomy of the correction, the catheter was inserted via the T11 intervertebral foramen. A bolus of bupivacaine 0.25% intraoperatively with a postoperative infusion of bupivacaine 0.167% with diamorphine 0.1 mg ml(-1) provided excellent analgesia. The technique was associated with no postoperative complications.
PMID: 15619602 [PubMed - as supplied by publisher]
Regional anesthesia in parturients with low platelet counts.
Frenk V, Camann W, Shankar KB.
PMID: 15625271 [PubMed - in process]
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Failed spinal anesthesia after a psoas compartment block: [L'echec de la rachianesthesie apres le bloc de la loge du psoas].
Lang SA, Prusinkiewicz C, Tsui BC.
Department of Anesthesiology and Pain Medicine, University of Alberta Hospitals, 8-120 Clinical Sciences Building, Edmonton, Alberta T6G 2G3, Canada. btsui@ualberta.ca.
PURPOSE: To report the case of a patient who experienced failed spinal anesthesia following a psoas compartment block (PCB) and discuss its implications. CLINICAL FEATURES: A 70-yr-old male was scheduled for a right total hip arthroplasty. He agreed to a PCB for postoperative analgesia and a spinal anesthetic. The spinal anesthetic was performed after completion of the PCB. Free flow of clear fluid was demonstrated at the beginning and at the end of the presumed intrathecal injection. General anesthesia had to be induced because of failure of the spinal anesthetic. The patient awoke from his general anesthetic with a functional PCB and no evidence of residual neuraxial anesthesia. The possibility of epidural spread of local anesthetic from the PCB impairing the ability to perform spinal anesthesia is discussed and reviewed. We hypothesize that local anesthetic in the epidural space may have falsely reassured the anesthesiologist that the needle was properly placed. CONCLUSION: We describe a case of failed spinal anesthesia following a PCB and discuss its implications.
PMID: 15625260 [PubMed - in process]
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A demand-based assessment of the Canadian anesthesia workforce - 2002 through 2007: [Evaluation des effectifs canadiens en anesthesie fondee sur la demande - de 2002 a 2007].
Engen DA, Morewood GH, Ghazar NJ, Ashbury T, Vandenkerkhof EG, Wang L.
Department of Anesthesiology, University of Pennsylvania Health System -Presbyterian Medical Center, 51 North 39th Street, Philadelphia, PA 19104, USA. morewoog@uphs.upenn.edu.
PURPOSE: The number of anesthesia providers required by the Canadian health care system remains controversial. Questions persist regarding both the adequacy of the current supply and what the future demand will be. The purpose of this study was to quantify the number and adequacy of anesthesia providers in 2002, and predict the same for the year 2007. METHODS: All licensed health care facilities potentially employing anesthetic services were identified. On February 1(st), 2002 a questionnaire was mailed to each institution. On April 1(st), a second mailing was sent to non-responders. Those facilities that did not respond to either mailing were contacted by telephone. RESULTS: Responses were obtained from 831 of 891 (93%) health care facilities. Four hundred and twenty-six of the facilities employed anesthetic services. There were 1,610 operating rooms (ORs) in use daily, and 2,134 full-time equivalent (FTE) anesthesia providers were available to the institutions surveyed. Respondents identified an immediate need for 228 additional FTEs. Hospitals with less than five ORs or five FTEs reported higher vacancy rates than hospitals with greater than five ORs or five FTEs (P < 0.0001). Ontario (n = 85) and Quebec (n = 69) had the largest absolute deficits of FTEs and significantly greater odds of vacancies than western provinces (Ontario OR = 1.84, Quebec OR = 2.50). The projected need for 2007 was an additional 560 FTEs. CONCLUSION: This is the first study to survey a national census of "consumers" of anesthetic services: Canadian health care facilities. The results indicate substantial current and worsening future shortages of anesthesia providers in Canada.
PMID: 15625251 [PubMed - in process]
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Regional analgesia and ultra-fast-track cardiac anesthesia/Analgesie regionale et procedure ultra-acceleree d'anesthesie cardiaque.
Cheng DC.
London Health Sciences Centre, 339 Windermere Road, Room 3CA19, London, Ontario N6A 5A5, Canada. davy.cheng@lhsc.on.ca.
PMID: 15625250 [PubMed - in process]
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Anesthesia physician resources - time to change the focus/Les ressources medicales en anesthesie - il est temps d'ajuster l'objectif.
Donen N, Hardy JF.
Department of Continuing Medical Education and Professional Development, Vancouver Island Health Authority, 103 Begbie Hall, Royal Jubilee Hospital, 1900 Fort Street, Victoria, British Columbia V8R 1J8, Canada. ndonen@shaw.ca.
PMID: 15625248 [PubMed - in process]
Obstetric implications of antepartum corticosteroid therapy for HELLP syndrome.
Rose CH, Thigpen BD, Bofill JA, Cushman J, May WL, Martin JN Jr.
Department of Obstetrics and Gynecology, University of Mississippi Medical Center, Jackson, Mississippi 39216-4505, USA. crose@ob-gyn.umsmed.edu
OBJECTIVE: We reviewed the impact of intravenous high-dose corticosteroid administration for preterm hemolysis, elevated liver enzymes, low platelets (HELLP) syndrome on vaginal delivery rate and degree of clinically significant thrombocytopenia. METHODS: Retrospective analysis of 1991-2000 HELLP syndrome (platelets < 100,000/uL, lactate dehydrogenase > 600 IU/L, aspartate aminotransferase and/or alanine aminotransferase > 70 IU/L) data focusing on labor inductions for gestations of less than 34 weeks and increase in platelet count sufficient to permit regional anesthetic techniques. RESULTS: Antepartum high-dose corticosteroid use increased from 32% (1991-1995) to 67% (1996-2000) for 350 patients studied (n = 199, < 34 weeks; n = 151, > 34 weeks). Corresponding vaginal delivery rates were 32% for gestations of less than 30 weeks, 61% at 30-31 weeks, and 62% at 32-33 weeks. Similarly, 27% of patients with a platelet count of less than 75,000/uL and 52% with a platelet count of less than 100,000/uL who received high-dose corticosteroids during the study interval subsequently achieved a 100,000/uL threshold in time to perform regional anesthesia for delivery. CONCLUSION: Administration of intravenous high-dose corticosteroids for preterm HELLP syndrome increases probability of successful labor induction and candidacy for regional anesthesia. LEVEL OF EVIDENCE: II-3.
PMID: 15516393 [PubMed - indexed for MEDLINE]
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Treacher Collins syndrome with choanal atresia: one way to handle the airway.
Nilsson E, Ingvarsson L, Isern E.
Publication Types:
PMID: 15283837 [PubMed - indexed for MEDLINE]
Comment on:
A rare cause of upper airway obstruction in a 5-year-old girl: a laryngeal web.
Berry J, Johnson A.
Publication Types:
- Case Reports
- Comment
- Letter
PMID: 15283833 [PubMed - indexed for MEDLINE]
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Axillary brachial plexus block for treatment of severe forearm ischemia after arterial cannulation in an extremely low birth-weight infant.
Breschan C, Kraschl R, Jost R, Marhofer P, Likar R.
Department of Anaesthesia, LKH Klagenfurt, Klagenfurt, Austria. breschan.ch@chello.at
Severe limb ischemia after arterial catheterization in neonates and premature infants is a well-recognized problem. The usual treatment of ischemic injuries includes removal of the catheter and elevation of the effected limb. If unsuccessful, tissue necrosis and loss may follow. We report the case of a 700 g infant with severe distal forearm ischemia after right radial and ulnar artery catheterization. Immediate removal of the arterial line did not improve ischemia. Thirty-six hours later a brachial plexus block via the axillary approach with 0.5 ml bupivacaine 0.125% was performed resulting in rapid improvement, restricting ischemia eventually to fingers II-V as well as the distal part of the thumb. Brachial plexus blockade and active vasodilatation in tiny neonates after severe local ischemia are discussed.
Publication Types:
PMID: 15283829 [PubMed - indexed for MEDLINE]
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Minimum effective dose of dexamethasone after tonsillectomy.
Celiker V, Celebi N, Canbay O, Basgul E, Aypar U.
Department of Anaesthesiology and Reanimation, Faculty of Medicine, Hacettepe University, Ankara, Turkey.
BACKGROUND: The minimum effective dose of dexamethasone in conjunction with 50 microg x kg(-1) ondansetron was evaluated in the treatment for vomiting after elective tonsillectomy or adenotonsillectomy. METHODS: A total of 102 healthy children between 2 and 12 years of age participated in this prospective, randomized, double-blind study. A single intravenous (i.v.) dose of dexamethasone (50, 100, 150 microg x kg(-1), maximum dose 8 mg) with ondansetron (50 microg x kg(-1)) was administered just before the end of surgery. Equal volumes of normal saline were given to the control group. General anaesthesia was induced and maintained by inhalation of N2O/O2 and sevoflurane. All other preoperative and postoperative medications (including a supplementary dose of antiemetics if necessary), anaesthesia and surgical techniques were standardized. RESULTS: No significant differences were observed between groups in postoperative vomiting on the day of surgery and the next day, or in the need for postoperative pain medication and supplementary doses of antiemetics (P > 0.05). CONCLUSIONS: These results indicate that surgical technique and anaesthetic management used in this study could be the cause of the lower incidence of nausea and vomiting. Assessment of nausea and vomiting in a prospective study with larger groups of patients may reflect different results.
Publication Types:
- Clinical Trial
- Randomized Controlled Trial
PMID: 15283826 [PubMed - indexed for MEDLINE]
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Evaluation of adding preoperative or postoperative rectal paracetamol to caudal bupivacaine for postoperative analgesia in children.
Ozyuvaci E, Altan A, Yucel M, Yenmez K.
Department of Anesthesiology, SSK Okmeydani Educational Hospital, Istanbul, Turkey. ehozyuvaci@bnet.net.tr
BACKGROUND: Our aim was to investigate whether effects of caudal analgesia could be extended by preoperative or postoperative rectal paracetamol administration in children undergoing surgical repair of hypospadias. METHODS: The group consisted of 60 ASA I boys, aged 3-12 years, who were operated for surgical repair of hypospadias. The patients were randomized into three groups: patients in group I received rectal paracetamol (20-25 mg x kg(-1)) just before the operation. Group II received only caudal bupivacaine. Group III patients received rectal paracetamol (20-25 mg x kg(-1)) at the end of the operation. Pain was assessed by Children's Hospital of Eastern Ontario Pain Scale (CHEOPS) and the degree of sedation was evaluated. During the first 24 h, time to the patients' first analgesic requirement and the number of supplementary analgesics needed were recorded. RESULTS: There was no difference between the demographic and haemodynamic data of the three groups. In addition, the duration of surgery and anaesthesia, pain scores and sedation scores of the groups were not significantly different. CONCLUSIONS : Addition of preoperative or postoperative rectal paracetamol in the doses used did not show an effect on the duration and intensity of postoperative analgesia obtained by caudal bupivacaine.
Publication Types:
- Clinical Trial
- Randomized Controlled Trial
PMID: 15283825 [PubMed - indexed for MEDLINE]
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Endoscopic intratracheal carbon dioxide measurements during pediatric flexible bronchoscopy.
Chang AB, Moloney GE, Harms PJ, Masters IB.
Department of Respiratory Medicine, Royal Children's Hospital, Herston, Queensland, Australia. annechang@ausdoctors.net
BACKGROUND: CO2 monitoring is recommended for thoracic telescopic procedures and for spontaneous breathing general anesthesia in children. During flexible bronchoscopy (FB) in children, the various currently available methods of CO2 measurements are limited. The CO2 falls and increases have been reported in FB but it is unknown whether airway lesions predispose to CO2 change. The aim of this study was to describe and validate endoscopic intratracheal CO2 measurements in children undergoing FB under spontaneously breathing GA. METHODS: Endtidal CO2 (P(E)CO2) measurements at the start (Start-CO2) and end (End-CO2) of FB on 100 consecutive children were performed using a newly designed endoscopic intratracheal method. To validate the method blood gas sampling was simultaneously performed in 28 children and results analyzed using the Bland and Altman method, intraclass correlation and 95% range for repeatability. RESULTS: End-CO2 and CO2-change (End-CO2 minus Start-CO2) were significantly different in children with airway lesions (CO2 change: no lesion = 3 mmHg, extrathoracic airway lesion = 4.5, intrathoracic airway lesion = 8, P = 0.038). There was no significant difference in Start-CO2 values among the groups. CO2-change in those aged < or =12 months was similar to those >12 months. Intratracheal CO2 measurements were comparable with arterial blood values in the Bland and Altman plots. The intraclass correlation was 0.69 and 95% range for repeatability was 3.7-4.17 mmHg. CONCLUSIONS: Midtracheal P(E)CO2 provides a useful estimate of P(a)CO2 for monitoring the respiratory status of children undergoing FB. The presence of airway lesions rather than age is associated with significant increased PCO2 rise.
Publication Types:
PMID: 15283823 [PubMed - indexed for MEDLINE]
Comment on:
Tracheal intubation without intravenous access.
Mohiuddin S, Mayhew JF.
Publication Types:
PMID: 15283818 [PubMed - indexed for MEDLINE]
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