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Inadvertent subdural spread complicating injection of cervical epidural stereoid with local anaesthetic.
Oberoi G.
Publication Types:
PMID: 15649005 [PubMed - in process]
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Choice of anaesthetic maintenance technique in adult surgical patients.
Leslie K, Keane E.
Publication Types:
PMID: 15649004 [PubMed - in process]
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Epidural analgesia associated with a fatal outcome in a patient with an unrecognized brain tumour.
Tsai HJ, Tsou MY, Ho CM, Tsai SK.
Department of Anesthesiology, Taipei Veterans General Hospital, National Yang-Ming University, Taipei, Taiwan.
A fatality associated with epidural analgesia in a patient with an unsuspected brain tumour has not been reported in the literature. We describe a case of postoperative lumbar epidural analgesia in a 54-year-old female patient who had an undiagnosed brain tumour and a fatal outcome postoperatively. The factors that potentially contributed to this mishap and the possible alternative management of this patient are discussed.
PMID: 15648998 [PubMed - in process]
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Local anaesthetics--the introduction of xylocaine into clinical practice.
Ball C, Westhorpe R.
Geoffrey Kaye Museum of Anaesthetic History.
PMID: 15648980 [PubMed - in process]
Fundamentals of regional anaesthesia.
Harrop-Griffiths W.
PMID: 15644037 [PubMed - in process]
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Epidural analgesia masking a malfunctioning pneumatic compression device.
Mitchell JR, Gilkes TG.
Publication Types:
PMID: 15644032 [PubMed - in process]
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Anaesthetists' violations of safety guidelines.
Smith AF, Goodwin DS, Mort M, Pope C.
Publication Types:
PMID: 15644023 [PubMed - in process]
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Clinical comparison of three different anaesthetic depth monitors during cardiopulmonary bypass.
Tiren C, Anderson RE, Barr G, Owall A, Jakobsson JG.
Department of Cardiothoracic Anaesthetics and Intensive Care, Karolinska Hospital, Sweden.
The lack of a gold standard complicates the evaluation and comparison of anaesthetic depth monitors. This randomised study compares three different depth-of-anaesthesia monitors during cardiopulmonary bypass (CPB) at 34 degrees C with fentanyl/propofol anaesthesia adjusted clinically and blinded to the monitors. Coronary artery bypass grafting patients (n = 21) were randomly assigned to all three possible paired combinations of three monitors: Bispectral Index (Aspect Medical), AAI auditory evoked potential (Danmeter), Entropy (Datex-Ohmeda). Indices were manually recorded every 5 min during CPB. Agreement between paired indices was classified as good, non-, or disagreement. Anaesthesia was classed as adequate, inadequate, or excessive according to recommended index values. Of the 255 paired indices recorded, 62% showed good agreement, 33% showed non-agreement, and 5% showed disagreement. Using good agreement between two monitors as a gold standard, a quarter of the measurements indicate inappropriate anaesthetic depth monitoring during CPB with clinically titrated anaesthetic depth.
PMID: 15644019 [PubMed - in process]
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Evaluation of ease of intubation with the GlideScope or Macintosh laryngoscope by anaesthetists in simulated easy and difficult laryngoscopy.
Lim TJ, Lim Y, Liu EH.
Department of Anaesthesia, National University Hospital, 5 Lower Kent Ridge Road, Singapore 119074.
The GlideScope is a new video laryngoscope developed for management of the difficult airway. We compared the GlideScope with the Macintosh laryngoscope in simulated easy and difficult laryngoscopy. Twenty anaesthetists were allowed three attempts to intubate in each of four laryngoscopy scenarios in a high fidelity simulator. In the simulated easy laryngoscopy scenarios, the anaesthetists took longer to intubate using the GlideScope than the Macintosh laryngoscope (mean (SD) 19.0 (9.7) s vs. 12.7 (5.9) s, respectively; p = 0.006). There was no difference in the number of successful intubations, ease of intubation or choice of intubating device. In the simulated difficult laryngoscopy scenarios, the anaesthetists took less time to intubate using the GlideScope (23.5 (12.7) s vs. 70.5 (101.2) s, respectively; p = 0.001). The slightly higher success rate with the GlideScope was not statistically significant (20/20 vs. 18/20, respectively; p = 0.5). However, the anaesthetists found it easier to intubate using the GlideScope (median (interquartile range [range]) 1 (1-2 [1-2]) vs. 2 (2-3 [1-3]), respectively; p < 0.0001).
PMID: 15644017 [PubMed - in process]
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Impact on postoperative pain of long-lasting pre-emptive epidural analgesia before total hip replacement: a prospective, randomised, double-blind study.
Klasen J, Haas M, Graf S, Harbach H, Quinzio L, Jurgensen I, Hempelmann G.
Department of Anaesthesiology, Intensive Care Medicine, Pain Therapy, University Hospital Giessen, Rudolf-Buchheim-Strasse 7, D-35392 Giessen, Germany.
Clinical studies on pre-emptive analgesia have produced inconsistent results. We conducted a clinical study investigating the effect of long-lasting pre-emptive epidural analgesia on consumption of analgesics and acute pain. Forty-two patients scheduled for elective hip replacement for osteo-arthritis were randomly assigned to receive, on the day before operation, either 5 ml.h(-1) ropivacaine 0.2% (study group, n = 21) or 5 ml.h(-1) saline (control group, n = 21). Postoperative analgesia was achieved in both groups by patient-controlled epidural analgesia (PCEA) with ropivacaine 0.2%. The main outcome measure was consumption of local anaesthetics. Additional parameters included visual analogue pain scale (VAS) scores, consumption of rescue analgesics, requests for PCEA boluses, and side-effects. The pre-operative parameters and pain scores were similar in the two groups. Epidural blocks provided sufficient operative analgesia in all patients. Pre-emptive analgesia was continued for 11-20 h and led to significantly decreased pain scores before surgery. The consumption of local anaesthetics was decreased postoperatively in the study group (194 mg vs. 284 mg in the postoperative period). Furthermore, bolus requests occurred more frequently in the control group. VAS scores did not differ significantly between groups. Long-lasting "pre-emptive" epidural analgesia decreases postoperative pain with improved pain control.
PMID: 15644006 [PubMed - in process]
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Shipman and the anaesthetist.
Harmer M.
Publication Types:
PMID: 15644004 [PubMed - in process]
GMC changes its mind over allegations against anaesthetist.
Dyer C.
Publication Types:
PMID: 15649922 [PubMed - indexed for MEDLINE]
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Intravenous anaesthetics inhibit nicotinic acetylcholine receptor-mediated currents and Ca(2+) transients in rat intracardiac ganglion neurons.
Weber M, Motin L, Gaul S, Beker F, Fink RH, Adams DJ.
PMID: 15644878 [PubMed - in process]
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Intravenous anaesthetics inhibit nicotinic acetylcholine receptor-mediated currents and Ca2+ transients in rat intracardiac ganglion neurons.
Weber M, Motin L, Gaul S, Beker F, Fink RH, Adams DJ.
School of Biomedical Sciences, University of Queensland, Brisbane, Queensland 4072, Australia.
The effects of intravenous (i.v.) anaesthetics on nicotinic acetylcholine receptor (nAChR)-induced transients in intracellular free Ca(2+) concentration ([Ca(2+)](i)) and membrane currents were investigated in neonatal rat intracardiac neurons.In fura-2-loaded neurons, nAChR activation evoked a transient increase in [Ca(2+)](I), which was inhibited reversibly and selectively by clinically relevant concentrations of thiopental. The half-maximal concentration for thiopental inhibition of nAChR-induced [Ca(2+)](i) transients was 28 microM, close to the estimated clinical EC(50) (clinically relevant (half-maximal) effective concentration) of thiopental. In fura-2-loaded neurons, voltage clamped at -60 mV to eliminate any contribution of voltage-gated Ca(2+) channels, thiopental (25 microM) simultaneously inhibited nAChR-induced increases in [Ca(2+)](i) and peak current amplitudes. Thiopental inhibited nAChR-induced peak current amplitudes in dialysed whole-cell recordings by approximately 40% at -120, -80 and -40 mV holding potential, indicating that the inhibition is voltage independent. The barbiturate, pentobarbital and the dissociative anaesthetic, ketamine, used at clinical EC(50) were also shown to inhibit nAChR-induced increases in [Ca(2+)](i) by approximately 40%.Thiopental (25 muM) did not inhibit caffeine-, muscarine- or ATP-evoked increases in [Ca(2+)](i), indicating that inhibition of Ca(2+) release from internal stores via either ryanodine receptor or inositol-1,4,5-trisphosphate receptor channels is unlikely. Depolarization-activated Ca(2+) channel currents were unaffected in the presence of thiopental (25 microM), pentobarbital (50 microM) and ketamine (10 microM). In conclusion, i.v. anaesthetics inhibit nAChR-induced currents and [Ca(2+)](i) transients in intracardiac neurons by binding to nAChRs and thereby may contribute to changes in heart rate and cardiac output under clinical conditions.
PMID: 15644873 [PubMed - in process]
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Contrasting anesthetic sensitivities of T-type Ca2+ channels of reticular thalamic neurons and recombinant Ca(v)3.3 channels.
Joksovic PM, Brimelow BC, Murbartian J, Perez-Reyes E, Todorovic SM.
Department of Anesthesiology, University of Virginia Health System, Mail Box 800710, Charlottesville, VA 22908-0710, U.S.A.
Reticular thalamocortical neurons express a slowly inactivating T-type Ca(2+) current that is quite similar to that recorded from recombinant Ca(v)3.3b (alpha1Ib) channels. These neurons also express abundant Ca(v)3.3 mRNA, suggesting that it underlies the native current. Here, we test this hypothesis by comparing the anesthetic sensitivities of recombinant Ca(v)3.3b channels stably expressed in HEK 293 cells to native T channels in reticular thalamic neurons (nRT) from brain slices of young rats. Barbiturates completely blocked both Ca(v)3.3 and nRT currents, with pentobarbital being about twice more potent in blocking Ca(v)3.3 currents. Isoflurane had about the same potency in blocking Ca(v)3.3 and nRT currents, but enflurane, etomidate, propofol, and ethanol exhibited 2-4 fold higher potency in blocking nRT vs Ca(v)3.3 currents. Nitrous oxide (N(2)O; laughing gas) blocked completely nRT currents with IC(50) of 20%, but did not significantly affect Ca(v)3.3 currents at four-fold higher concentrations. In addition, we observed that in lower concentration, N(2)O reversibly increased nRT but not Ca(v)3.3 currents. In conclusion, contrasting anesthetic sensitivities of Ca(v)3.3 and nRT T-type Ca(2+) channels strongly suggest that different molecular structures of Ca(2+) channels give rise to slowly inactivating T-type Ca(2+) currents. Furthermore, effects of volatile anesthetics and ethanol on slowly inactivating T-type Ca(2+) channel variants may contribute to the clinical effects of these agents.
PMID: 15644869 [PubMed - in process]
The growing field of anesthesia for liver transplantation.
Feierman DE.
PMID: 15651007 [PubMed - in process]
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Anesthetic implications of recurrent laryngeal nerve palsy after esophagectomy.
Thangathurai D, Roffey P, Mogos M, Raid M, Mikhail M.
PMID: 15651005 [PubMed - in process]
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Anesthesia in a patient with nasopharyngeal angiofibroma and hemophilia A.
Celiker V, Basgul E, Karagoz AH, Dal D.
PMID: 15651002 [PubMed - in process]
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Pulseless electrical activity after induction of anesthesia: A witnessed cardiac rupture.
Chen Q, Scott BH, Bilfinger TV, Petrie J, Glass PS.
PMID: 15650990 [PubMed - in process]
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Effects of amiodarone and thoracic epidural analgesia on atrial fibrillation after coronary artery bypass grafting.
Nygard E, Sorensen LH, Hviid LB, Pedersen FM, Ravn J, Thomassen L, Svendsen JH, Eliasen K, Krogsgaard K, Aldershvile J.
Objective: This study was designed to assess the effects of a perioperative dosing regimen of amiodarone administration, high thoracic epidural anesthesia (TEA), or a combination of the 2 regimens on atrial fibrillation (AF) after coronary artery bypass grafting (CABG). Design and Setting: The study was prospective, controlled, and randomized and was performed in a tertiary health care center associated with a university. Participants: One hundred sixty-three patients scheduled for coronary artery bypass graft surgery. Interventions: In this 2 x 2 factorial-designed study the patients were randomized to 1 of 4 regimens in which group E had perioperative TEA, group E+A had TEA and amiodarone, group A had amiodarone, and group C served as control. The epidural catheter was inserted at T1-3 the day before surgery. TEA groups received TEA for 96 hours. The amiodarone regimen consisted of a single loading dose of 1,800 mg of amiodarone orally. Intravenous infusion of amiodarone was started after induction of anesthesia and was administered at 900 mg over 24 hours for the subsequent 3 days. Measurements and Main Results: AF was documented using Holter monitoring. In group E 22 of 44 (50%), in group E+A 10 of 35 (28.6%), in group A 10 of 36 (27.8%), and in the control group 20 of 48 (41.7%) patients developed AF (odds ratio amiodarone/nonamiodarone 0.47 [0.24-0.90]; P = 0.02). Conclusions: The perioperative amiodarone regimen used in this study was effective in reducing the incidence of AF after CABG while TEA was not.
PMID: 15650978 [PubMed - in process]
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The use of anesthetic rooms for pediatric anesthesia requires justification.
Das S, Picton P.
PMID: 15649174 [PubMed - in process]
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Anesthesia for microlaryngoscopy.
Orr R.
PMID: 15649173 [PubMed - in process]
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Anesthetic management of a patient with MERRF syndrome.
Vilela H, Garcia-Fernandez J, Parodi E, Reinoso-Barbero F, Duran P, Gilsanz F.
Department of Paediatric and Maternal Anaesthesia, La Paz University Hospital, Madrid, Spain.
Summary There are several specific considerations regarding anesthesia in patients with mitochondrial disease. We describe the successful administration of a combined general and epidural anesthesia with sevoflurane maintenance in a patient with myoclonic epilepsy with ragged red fibers (MERRF syndrome) scheduled for surgical treatment of bilateral clubfoot.
PMID: 15649170 [PubMed - in process]
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Spinal anesthesia in an extremely low birth weight infant.
Nickel US, Meyer RR, Brambrink AM.
Department of Anesthesiology, University Hospital Mainz, Mainz, Germany.
Summary A case of spinal anesthesia in an extremely low birth weight male infant (body weight of 930 g at time of surgery) is presented. He was born prematurely at a gestational age of 27 weeks because of a placenta tumor and had to undergo inguinal herniotomy at 34 weeks postconceptional age. He had bronchopulmonary dysplasia and oxygen supply was still required because of frequent deterioration of oxygen saturation. Spinal anesthesia was performed successfully without any complications. Relevant aspects concerning the technique and management of spinal anesthesia in preterm infants are discussed.
PMID: 15649166 [PubMed - in process]
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Total spinal anesthesia during combined general-epidural anesthesia in a 7-year-old child.
Kipnis E, Desoutter E, Dalmas S, Marciniak B.
Departement d'Anesthesie-Reanimation Chirurgicale 2, CHRU Lille, France.
Summary Total spinal anesthesia (TSA) is a rare complication of lumbar epidural anesthesia through inadvertent spinal injection of local anesthetics following an undiagnosed dural breach or spinal placement of the catheter. TSA has rarely been reported in children. TSA occurred during epidural anesthesia in a 7-year-old child undergoing abdominal surgery. Recent previous lumbar punctures and intrathecal chemotherapy for Burkitt's lymphoma at the same level may have facilitated dural breach. Epidural anesthesia should not be attempted at the same intervertebral level as prior recent lumbar punctures.
PMID: 15649165 [PubMed - in process]
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Spinal anesthesia for diagnostic cardiac catheterization in high-risk infants.
Katznelson R, Mishaly D, Hegesh T, Perel A, Keidan I.
Pediatric Anesthesia Division, Department of Anesthesia and Intensive Care, Sheab Medical Center, Tel Hashomer (affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv), Israel.
Summary Background : The main goals of diagnostic cardiac catheterization (DCC) in infants are to evaluate the anatomy and physiology of congenital and acquired cardiac defects while maintaining normal respiratory and hemodynamic variables. The aims of anesthesia for infants undergoing DCC are to prevent pain and movement during the procedure. General anesthesia (GA) or deep sedation could have undesirable respiratory and hemodynamic effects for conducting such studies. Furthermore, GA is associated with increased risks, especially in high-risk infants. Spinal anesthesia (SA) is a successful alternative to GA in surgery on infants with a history of prematurity and respiratory problems, with minimal respiratory and hemodynamic changes. Methods : We studied whether those advantages were applicable to DCC, and used a predetermined SA protocol in a cohort of 12 infants with compromised respiratory status. Success rate, study completion, complications, hemodynamic and respiratory effects and recovery profile were recorded. Results : Failure rate was significantly higher in infants older than 6 months. There was no significant difference between baseline and intraprocedure hemodynamic and respiratory parameters. The time to discharge was relatively short (33 +/- 12 min). Conclusions : Spinal anesthesia apparently provides stable hemodynamics and respiratory variables, rapid recovery and discharge time, and may be a viable alternative to GA or deep sedation in high-risk infants <6 months old undergoing DCC.
PMID: 15649164 [PubMed - in process]
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Dose minimization study of single-dose epidural morphine in patients undergoing hip surgery under regional anesthesia with bupivacaine.
Castillo-Zamora C, Castillo-Peralta LA, Nava-Ocampo AA.
Department of Anaesthesia and Respiratory Therapy, Hospital Infantil de Mexico Federico Gomez, Mexico DF.
Summary Background : In order to decrease the rate of adverse effects, we aimed to identify the lowest analgesic dose of epidural morphine administered to patients undergoing hip surgery. Methods : Forty-five ASA I-II children undergoing surgical correction of hip dysplasia under caudal or epidural anesthesia with bupivacaine were randomized to receive epidural morphine 11.2, 15 or 20 mug.kg(-1) (groups 1, 2 and 3, respectively; 15 patients per group) immediately after completion of surgery. Postoperative pain control, sedation, motor block, urinary retention, pruritus and vomiting were evaluated. Results : In the recovery room, 46.7% of patients from group 1, 33.3% from group 2, and 93.3% from group 3 were sleeping but were easy to arouse (x(2) = 12.2; P < 0.005). The rest of the patients from each respective group were completely asleep. The cardiovascular and respiratory parameters were within normal limits. The ability to move the legs returned approximately 1 h after surgery in all three groups. Seven patients (46.7%) from group 1, nine (60%) from group 2, and 13 patients (86.7%) from group 3 vomited (x(2) = 5.4; P = 0.06). One patient receiving 20 mug.kg(-1) morphine experienced urinary retention. One patient receiving 15 mug.kg(-1) morphine suffered from pruritus. The duration of analgesia was similar, 12-14 h, in all three groups. Conclusions : In patients undergoing hip surgery under regional anesthesia with bupivacaine, epidural morphine at a dose of 11.2 mug.kg(-1) administered immediately after completion of the procedure resulted in adequate pain relief for more than 12 h. Explanation of the high rate of patients vomiting (>45%) remains to be elucidated.
PMID: 15649160 [PubMed - in process]
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Propofol total intravenous anesthesia for MRI in children.
Usher AG, Kearney RA, Tsui BC.
Department of Anesthesiology and Pain Medicine, University of Alberta Hospital, Edmonton, Alberta, Canada.
Summary Background: The aim of this study was to assess clinical signs of airway patency, airway intervention requirements and adverse events in 100 children receiving propofol total intravenous anesthesia for magnetic resonance imaging, with spontaneous ventilation and oxygenation via nasal prongs. Methods: Airway patency was clinically assessed and stepwise interventions were performed until a satisfactory airway was achieved. Propofol requirements, vital signs, procedure times and adverse events were also recorded. Results: Ninety-three per cent of children had no signs of airway obstruction when positioned with a shoulder roll only, two required a chin lift, four required an oral airway and one required lateral positioning. The mean propofol induction dose was 3.9 mg.kg(-1) (range 1.8-6.4 mg.kg(-1)). The mean propofol infusion rate was 193 mug.kg(-1).min(-1) (range 150-250 mug.kg(-1).min(-1)). The initial and final mean respiratory rates were 26 and 23 b.min(-1) (P < 0.05). Movement was more likely at lower infusion rates (mean 175 mug.kg(-1).min(-1)). There were no respiratory or cardiovascular complications (calculated risk: 95% CI = 0-3%). The mean time from end of scan to discharge home was 44 min. Conclusions: This study demonstrates good preservation of upper airway patency and rapid recovery using general anesthetic doses of propofol in children.
PMID: 15649159 [PubMed - in process]
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The role of corticosteroids in Duchenne muscular dystrophy: a review for the anesthetist.
Ames WA, Hayes JA, Crawford MW.
Department of Anesthesia, The Hospital for Sick Children, Toronto, Ontario, Canada.
PMID: 15649156 [PubMed - in process]
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Sevoflurane sedation in infants - a fine line between sedation and general anesthesia.
Ng A.
Department of Anaesthesia, KK Womens and Children's Hospital, Singapore.
PMID: 15649155 [PubMed - in process]
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Evaluating the efficacy of EMLA topical anesthetic in sealant placement with rubber dam.
Lim S, Julliard K.
Department of Pediatric Dentistry, Lutheran Medical Center, Brooklyn, NY, USA.
PURPOSE: The purpose of this study was to investigate the efficacy of EMLA (eutectic mixture of local anesthetics, 2.5% lidocaine and 2.5% prilocaine) cream in reducing discomfort from pressure applied by rubber dam clamp. METHODS: A consecutive sample of 31 patients, ages 6 to 12 years who presented for sealants from September 2002 through March 2003, participated in this within-subjects controlled clinical study. The facial pain scale (FPS) measured discomfort of dental dam placement on first permanent molars on opposite sides of the mouth after EMLA and placebo application for 5 minutes on the gingiva surrounding each tooth. RESULTS: 18 subjects (58%) were female, and 13 (42%) were male. Twenty (65%) of the teeth studied were permanent maxillary first molars, and 11 (35%) were permanent mandibular first molars. Fourteen (44%) patients were 9 years old or younger, and 17 (56%) patients were over 9 years old. The mean FPS score for EMLA teeth of 0.47+/-0.27 was significantly lower than that for non-EMLA teeth of 0.64+/-0.24 (P<.001). EMLA vs non-EMLA FPS scores by age, gender, and arch were not significantly different. CONCLUSIONS: The EMLA cream was effective in reducing discomfort caused by the dental dam clamp.
PMID: 15646911 [PubMed - in process]
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