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Items 1 - 29 of 29 |
One page. |
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Preemptive analgesia and local anesthesia as a supplement to general anesthesia: a review.
Kaufman E, Epstein JB, Gorsky M, Jackson DL, Kadari A.
Department of Oral Medicine, The Hebrew University-Hadassah School of Dental Medicine, Jerusalem, Israel.
General anesthesia (GA) and local anesthesia (LA) evolved on separate tracks. Procedures that could not be performed under LA were typically conducted under GA. Decoding of afferent linkage of peripheral noxious stimuli has provided important understanding that may change the way we traditionally treat surgical pain. In the 1980s, animal studies suggested that preemptive peripheral blocking of painful (nociceptive) stimuli to the central nervous system with regional anesthesia or LA and nonsteroidal analgesics could be beneficial in attenuating postoperative pain. Clinical studies based on this knowledge suggest combining LA with GA, and perhaps non-steroidal analgesics with or without narcotics, to reduce the severity of postoperative pain. General anesthetics can be given in lower minimal alveolar concentration when combined with LA, and recovery characteristics are superior. Increasing evidence suggests that the combined use of GA and LA may reduce the afferent barrage of surgery, and that preemptive analgesia may reduce postoperative pain and should be used in patient care. This article reviews the evidence supporting the combined use of LA or analgesics with GA or sedation to provide improved pain management after surgery.
Publication Types:
PMID: 15859447 [PubMed - indexed for MEDLINE]
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Continuous infusion propofol general anesthesia for dental treatment in patients with progressive muscular dystrophy.
Kawaai H, Tanaka K, Yamazaki S.
Department of Dental Anesthesiology, Ohu University School of Dentistry, Fukushima, Japan.
Progressive muscular dystrophy may produce abnormal reactions to several drugs. There is no consensus of opinion regarding the continuous infusion of propofol in patients with progressive muscular dystrophy. We successfully treated 2 patients with progressive muscular dystrophy who were anesthetized with a continuous infusion of propofol. In case 1, a 19-year-old, 59-kg man with Becker muscular dystrophy and mental retardation was scheduled for dental treatment under general anesthesia. General anesthesia was maintained by a continuous infusion of 6-10 mg/kg propofol per hour and an inhalational mixture of 67% nitrous oxide and 33% oxygen. No complications were observed during or after the operation. In case 2, a 5-year-old, 11-kg boy with Fukuyama type congenital muscular dystrophy and slight mental retardation was scheduled for dental treatment under general anesthesia. General anesthesia was maintained with a continuous infusion of 6-12 mg/kg propofol per hour and an inhalational mixture of 0.5-1.5% sevoflurane in 67% nitrous oxide and 33% oxygen. No complications were observed during or after the operation. It is speculated that a continuous infusion of propofol in progressive muscular dystrophy does not cause malignant hyperthermia because serum levels of creatine phosphokinase and myoglobin decreased after our anesthetic management. Furthermore, our observations suggest that sevoflurane may have some advantages in patients with progressive type muscular dystrophies other than Duchenne muscular dystrophy and Becker muscular dystrophy. In conclusion, our cases suggest that a continuous infusion of propofol for the patients with progressive muscular dystrophy is a safe component of our anesthetic strategy.
Publication Types:
PMID: 15859443 [PubMed - indexed for MEDLINE]
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Need and demand for sedation or general anesthesia in dentistry: a national survey of the Canadian population.
Chanpong B, Haas DA, Locker D.
Faculty of Dentistry, University of Toronto, Toronto, Canada.
The aim of this study was to assess the need and demand for sedation or general anesthesia (GA) for dentistry in the Canadian adult population. A national telephone survey of 1101 Canadians found that 9.8% were somewhat afraid of dental treatment, with another 5.5% having a high level of fear. Fear or anxiety was the reason why 7.6% had ever missed, cancelled, or avoided a dental appointment. Of those with high fear, 49.2% had avoided a dental appointment at some point because of fear or anxiety as opposed to only 5.2% from the no or low fear group. Regarding demand, 12.4% were definitely interested in sedation or GA for their dentistry and 42.3% were interested depending on cost. Of those with high fear, 31.1% were definitely interested, with 54.1% interested depending on cost. In a hypothetical situation where endodontics was required because of a severe toothache, 12.7% reported high fear. This decreased to 5.4% if sedation or GA were available. For this procedure, 20.4% were definitely interested in sedation or GA, and another 46.1% were interested depending on cost. The prevalence of, and preference for, sedation or GA was assessed for specific dental procedures. The proportion of the population with a preference for sedation or GA was 7.2% for cleaning, 18% for fillings or crowns, 54.7% for endodontics, 68.2% for periodontal surgery, and 46.5% for extraction. For each procedure, the proportion expressing a preference for sedation or GA was significantly greater than the proportion having received treatment with sedation or GA (P < 0.001). In conclusion, this study demonstrates that there is significant need and demand for sedation and GA in the Canadian adult population.
PMID: 15859442 [PubMed - indexed for MEDLINE]
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Robert S. Locke--a Canadian dental anaesthesia pioneer.
Suljak JP.
Publication Types:
- Biography
- Editorial
- Historical Article
Personal Name as Subject:
PMID: 15859441 [PubMed - indexed for MEDLINE]
Society of neurosurgical anesthesia and critical care scientific meeting.
de Lange F.
University Medical Center Utrecht, Utrecht, The Netherlands. f.delange@azu.nl.
PMID: 15851905 [PubMed - in process]
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Is Recall during Sedation Being Confused with Recall during General Anesthesia?
Collier HW.
University of Kansas School of Medicine, Wichita, Kansas. hwcollier@hotmail.com.
PMID: 15851903 [PubMed - in process]
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Depth of anesthesia monitors and shock.
Lichtor JL.
University of Iowa, Iowa City, Iowa. lance-lichtor@uiowa.edu.
PMID: 15851901 [PubMed - in process]
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Assessing the past and shaping the future of anesthesiology: the 43rd rovenstine lecture.
Modell JH.
* Professor Emeritus of Anesthesiology.
PMID: 15851893 [PubMed - in process]
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For Outpatient Rotator Cuff Surgery, Nerve Block Anesthesia Provides Superior Same-day Recovery over General Anesthesia.
Hadzic A, Williams BA, Karaca PE, Hobeika P, Unis G, Dermksian J, Yufa M, Thys DM, Santos AC.
* Associate Professor of Anesthesiology, double dagger Regional Anesthesia Research Fellow, section sign Associate Clinical Professor of Orthopedic Surgery, Assistant Clinical Professor of Orthopedic Surgery, # Assistant Clinical Professor of Anesthesiology, ** Professor of Anesthesiology, College of Physicians and Surgeons, Columbia University. dagger Associate Professor of Anesthesiology, University of Pittsburgh, Pittsburgh, Pennsylvania.
BACKGROUND:: Both general and nerve block anesthesia are effective for shoulder surgery. For outpatient surgery, it is important to determine which technique provides more efficient recovery. The authors' goal was to compare nerve block with general anesthesia with respect to recovery profile and patient satisfaction after rotator cuff surgery. METHODS:: In this clinical trial, 50 consenting outpatients (aged 18-70 yr) were randomly assigned to receive either fast-track general anesthesia followed by bupivacaine (0.25%) wound infiltration or interscalene brachial plexus block (0.75% ropivacaine), each under standardized protocols. Blinded recovery room nurses assessed the need for pain treatment and rated patient eligibility for bypass of the phase 1 postanesthesia care unit and for discharge home. Patients were followed up for 2 weeks postoperatively. The primary outcome measures were postanesthesia care unit bypass and same-day discharge. Other same-day recovery outcomes included severity of and treatment for pain and time to ambulation. Postoperative outcomes at home included satisfaction with the anesthesia technique and absence of complications (at 2 weeks). RESULTS:: Patients who received nerve block (vs. general anesthesia) bypassed the postanesthesia care unit more frequently (76 vs. 16%; P < 0.001), reported less pain, ambulated earlier, were ready for home discharge sooner (123 vs. 286 min; P < 0.001), had no unplanned hospital admissions (vs. 4 of 25 patients who underwent general anesthesia; P = 0.05), and were more satisfied with their care. No complications were reported in either treatment group. CONCLUSIONS:: Nerve block anesthesia for outpatient rotator cuff surgery provides several same-day recovery advantages over general anesthesia.
PMID: 15851888 [PubMed - as supplied by publisher]
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Volatile Anesthetics Enhance Flash-induced gamma Oscillations in Rat Visual Cortex.
Imas OA, Ropella KM, Ward BD, Wood JD, Hudetz AG.
* Postdoctoral Fellow, section sign Research Technician, Department of Anesthesiology, double dagger Senior Biostatistician, Department of Biophysics, parallelProfessor, Departments of Anesthesiology, Physiology, and Biophysics, Medical College of Wisconsin. dagger Professor and Chair, Department of Biomedical Engineering, Marquette University, Milwaukee, Wisconsin.
BACKGROUND:: The authors sought to understand neural correlates of anesthetic-induced unconsciousness. Cortical gamma oscillations have been associated with neural processes supporting conscious perception, but the effect of general anesthesia on these oscillations is controversial. In this study, the authors examined three volatile anesthetics, halothane, isoflurane, and desflurane, and compared their effects on flash-induced gamma oscillations in terms of equivalent concentrations producing the loss of righting reflex (1 minimum alveolar concentration for the loss of righting [MACLR]). METHODS:: Light flashes were presented every 5 s for 5 min, and event-related potentials were recorded from primary visual cortex of 15 rats with a chronically implanted bipolar electrode at increasing anesthetic concentrations (0-2.4 MACLR). Early cortical response was obtained by averaging poststimulus (0-100 ms) potentials filtered at 20-60 Hz across 60 trials. Late (100-1,000 ms) gamma power was calculated using multitaper power spectral technique. Wavelet decomposition was used to determine spectral and temporal distributions of gamma power. RESULTS:: The authors found that (1) halothane, isoflurane, and desflurane enhanced the flash-evoked early cortical response in a concentration-dependent manner; (2) the effective concentration for this enhancement was the lowest for isoflurane, intermediate for halothane, and the highest for desflurane when compared at equal fractions of the concentration that led to a loss of righting; (3) the power of flash-induced late (> 100 ms) gamma oscillations was augmented at intermediate concentrations of all three anesthetic agents; and (4) flash-induced gamma power was not reduced below waking baseline even in deep anesthesia. CONCLUSIONS:: These findings suggest that a reduction in flash-induced gamma oscillations in rat visual cortex is not a unitary correlate of anesthetic-induced unconsciousness.
PMID: 15851880 [PubMed - as supplied by publisher]
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Anaphylaxis during Anesthesia in Norway: A 6-Year Single-center Follow-up Study.
Harboe T, Guttormsen AB, Irgens A, Dybendal T, Florvaag E.
* Resident, dagger Consultant, Department of Anesthesia and Intensive Care, double dagger Statistician, Department of Occupational Medicine, Associate Professor, Laboratory of Clinical Biochemistry, Haukeland University Hospital. section sign Senior Pharmacist, Kongsvinger Hospital Pharmacy, Kongsvinger, Norway.
BACKGROUND:: Several studies have recognized neuromuscular blocking agents as the most common cause of anaphylaxis during general anesthesia, but the reported frequencies vary considerably between countries. In Norway, the issue has raised special concern because of reports from the Norwegian Medicines Agency that suggest a high prevalence. This article presents the results from a standardized allergy follow-up examination of 83 anaphylactic reactions related to general anesthesia performed at one allergy center in Bergen, Norway. METHODS:: Eighty-three cases were examined during the 6-yr period of 1996-2001. The diagnostic protocol consisted of case history, serum tryptase measurements, specific immunoassays, and skin tests. RESULTS:: Immunoglobulin E-mediated anaphylaxis was established in 71.1% of the cases, and neuromuscular blocking agents were by far the most frequent allergen (93.2%). Suxamethonium was the most frequently involved substance, followed by rocuronium and vecuronium. The few reactions in which other allergies could be detected were mainly linked to latex (3.6%). CONCLUSIONS:: Neuromuscular blocking agents were the dominating antigens causing immunoglobulin E-mediated anaphylaxis in this study. The data could not be used for estimation of the incidence of allergy toward neuromuscular blocking agents in Norway. Larger patient samples, standardization of reporting, and diagnostic protocols should be pursued by network formation to produce data more suitable for epidemiologic research.
PMID: 15851874 [PubMed - as supplied by publisher]
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This month in anesthesiology.
Henkel G.
PMID: 15851869 [PubMed - in process]
[Obstetrical anaesthesia and porphyrias]
[Article in French]
Consolo D, Ouardirhi Y, Wessels C, Girard C.
Departement d'anesthesie-reanimation, CHU le Bocage, 2, boulevard Marechal-de-Lattre-de-Tassigny, 21000 Dijon, France. djconsolo@yahoo.fr
Acute hepatic porphyrias are genetic diseases, characterized by acute neurological symptoms, sometimes fatal, triggered by different factors, in particular by many anaesthetic drugs, and also by pregnancy. We report here the experience of three porphyric patients'deliveries, allowing us to consider a proposition of management in this context. After discussion between anaesthesiologist, obstetrician and porphyria specialist, two types of management of such patients can be foresee. Asymptomatic patients, or in long remission, can benefit from locoregional anesthesia techniques with bupivacaine for both labour analgesia and Caesarean section. Spinal anaesthesia is then the technique of choice, allowing using smaller quantity of local anaesthetic than epidural anaesthesia. For symptomatic patients, or in crisis, we have rather choose intravenous narcotics for labour analgesia, and general anaesthesia for Caesarean section. The hypnotic agent of choice for both induction and maintenance of such anaesthesia is then propofol.
Publication Types:
PMID: 15826795 [PubMed - indexed for MEDLINE]
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[Anaesthesia and prostate surgery]
[Article in French]
Lepage JY, Rivault O, Karam G, Malinovsky JM, Le Gouedec G, Cozian A, Malinge M, Pinaud M.
Service d'anesthesie et de reanimation chirurgicale, Hotel-Dieu, 44093 Nantes, France. jylepage@chu-nantes.fr
OBJECTIVES: To review the current data about anaesthetic management in prostate surgery with special regards on analysis and prevention of specific risks, appropriate anaesthetic procedure keeping with surgery and patient, recognition and treatment of adverse events. DATA SOURCES AND EXTRACTION: The Pubmed database was searched for articles (1990-2004) combined with references analysis of major articles on the field. DATA SYNTHESIS: It is strongly recommended to settle germfree urine in the preoperative period. The thromboembolic risk of radical retropubic prostatectomy for cancer parallels lower abdomen oncologic surgery and is prolonged. Preoperative evaluation of cardiovascular, respiratory, neurological and metabolic comorbidity is a source of prognostic information and an essential tool in the management of elderly patients with prostate disease. Extreme patient positioning applied in prostate surgery induces haemodynamic and respiratory changes and are associated with severe muscular and nervous injuries. The laparoscopic access for radical prostatectomy is a growing alternative to the open surgical procedure. Acute normovolaemic haemodilution is a consistent and cost-effective blood conservation strategy in reducing allogenic blood transfusion for radical retropubic prostatectomy. Whether open transvesical or transurethral prostatectomy for treatment of benign hypertrophy depends on the size of the gland: transurethral resection is safe up to 80 g. Intrathecal anaesthesia with a T9 cephalad spread of sensory block, produces adequate conditions for transurethral prostatectomy and allows a rapid diagnosis of irrigating fluid absorption syndrome. In spite of recommended preoperative antibiotic prophylaxis, bacteriemias are frequent during transurethral prostate resection.
Publication Types:
PMID: 15826790 [PubMed - indexed for MEDLINE]
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[Anaesthetic-induced myocardial preconditioning: fundamental basis and clinical implications]
[Article in French]
Chiari P, Bouvet F, Piriou V.
Inserm E 0226, departement d'anesthesie-reanimation, hopital cardiovasculaire Louis-Pradel, 28, avenue Doyen-Lepine, 69500 Lyon Bron, France.
OBJECTIVE: Volatile halogenated anaesthetics offer a myocardial protection when they are administrated before a myocardial ischaemia. Cellular mechanisms involved in anaesthetic preconditioning are now better understood. The objectives of this review are to understand the anaesthetic-induced preconditioning underlying mechanisms and to know the clinical implications. DATA SOURCES: References were obtained from PubMed data bank (http://www.ncbi.nlm.nih.gov/entrez/query.fcgi) using the following keywords: volatile anaesthetic, isoflurane, halothane, sevoflurane, desflurane, preconditioning, protection, myocardium. DATA SYNTHESIS: Ischaemic preconditioning (PC) is a myocardial endogenous protection against ischaemia. It has been described as one or several short ischaemia before a sustained ischemia. These short ischaemia trigger a protective signal against this longer ischaemia. An ischemic organ is able to precondition a remote organ. It is possible to replace the short ischaemia by a preadministration of halogenated volatile anaesthetic with the same protective effect, this is called anaesthetic PC (APC). APC and ischaemic PC share similar underlying biochemical mechanisms including protein kinase C, tyrosine kinase activation and mitochondrial and sarcolemnal K(ATP) channels opening. All halogenated anaesthetics can produce an anaesthetic PC effect. Myocardial protection during reperfusion, after the long ischaemia, has been shown by successive short ischaemia or volatile anaesthetic administration, this is called postconditioning. Ischaemic PC has been described in humans in 1993. Clinical studies in human cardiac surgery have shown the possibility of anaesthetic PC with volatile anaesthetics. These studies have shown a decrease of postoperative troponin in patient receiving halogenated anaesthetics.
Publication Types:
PMID: 15826789 [PubMed - indexed for MEDLINE]
Effect of intrathecal diamorphine on block height during spinal anaesthesia for Caesarean section with bupivacaine.
Akerman N, Saxena S, Wilson R, Columb M, Lyons G.
Department of Obstetric Anaesthesia, St James' University Hospital, Leeds, UK.
BACKGROUND: Opioid analgesics are commonly added to intrathecal bupivacaine to improve patient comfort during Caesarean section under spinal anaesthesia, and provide post-operative pain relief. We sought to discover if the addition of diamorphine influenced block height when given with 0.5% w/v hyperbaric bupivacaine. METHOD: Eighty ASA I and II women of at least 37 weeks gestation and planned for elective Caesarean section under combined spinal-epidural anaesthesia were recruited. They were randomized into two groups to receive intrathecal hyperbaric bupivacaine 0.5% at an initial dose of 13 mg, with the next dose determined by the response of the previous patient (dose interval 1 mg). One group also received diamorphine 400 microg intrathecally. If a block height of T5 to blunt light touch had been achieved after 20 min, the block was deemed effective. A difference in the ED50 for hyperbaric bupivacaine between the groups would indicate that diamorphine influenced block height. Intraoperative patient discomfort and need for analgesic supplementation was noted. RESULTS: The median effective dose (ED50) to achieve a T5 block to light touch for Caesarean section using hyperbaric bupivacaine 0.5% was 9.95 mg [95% confidence interval (CI) 9.0-10.90] and with the addition of diamorphine it was 9.3 mg (95% CI 8.15-10.40), while the ED95 was 13.55 mg (95% CI 10.10-17.0) and 13.6 mg (95% CI 9.15-18.05), respectively. Five women who had received intrathecal diamorphine and 13 who had not received diamorphine needed intraoperative supplementation (not significant). CONCLUSION: The addition of intrathecal diamorphine does not appear to influence block height.
PMID: 15849209 [PubMed - in process]
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Confidential enquiries into maternal deaths: 50 years of closing the loop.
Ngan Kee WD.
Publication Types:
PMID: 15758080 [PubMed - indexed for MEDLINE]
Comparison of the antinociceptive activity of two new NO-releasing derivatives of the NSAID S-ketoprofen in rats.
Gaitan G, Ahuir FJ, Del Soldato P, Herrero JF.
Departamento de Fisiologia, Facultad de Medicina, Universidad de Alcala, Madrid, Spain.
1 Nonsteroidal anti-inflammatory drugs (NSAIDs) inhibit cyclooxygenase (COX) enzymes inducing analgesic, anti-inflammatory and antipyretic actions. They are not devoid of severe side effects and so, the search for new compounds with similar or higher effectiveness and a lower incidence of undesired actions is important. Nitric oxide (NO)-releasing NSAIDs resulted from this search. 2 We have compared the antinociceptive effectiveness of cumulative doses of two new NO-releasing derivatives of S-ketoprofen, HCT-2037 and HCT-2040, using the recording of spinal cord nociceptive reflexes in anesthetized and awake rats and after intravenous and oral administration. 3 S-ketoprofen and HCT-2040 were equieffective in reducing responses to noxious mechanical stimulation after i.v. administration in anesthetized animals (ID50s: 1.3+/-0.1 and 1.6+/-0.2 micromol kg(-1) respectively), but did not modify wind-up. HCT-2037 was two-fold more potent (ID50 of 0.75+/-0.1 micromol kg(-1)) in responses to mechanical stimuli and very effective in reducing wind-up (63+/-17% of control; P<0.01; MED: 0.4 micromol kg(-1)), indicating a greater activity than the parent compound. 4 In awake animals with inflammation, HCT-2037 p.o. fully inhibited mechanical allodynia, 91+/-12% reduction, and hyperalgesia, 94+/-8% reduction. Equivalent doses of S-ketoprofen only partially reduced either allodynia (50+/-11%) or hyperalgesia (40+/-4%). The effect on responses to noxious thermal stimulation was similar for the two compounds. 5 We conclude that the molecular changes made in the structure of S-ketoprofen including an NO moiety in its structure, improve the antinociceptive profile of the compound opening new perspectives in a safer use of NSAIDs as analgesic drugs.
PMID: 15451773 [PubMed - indexed for MEDLINE]
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Failed spinal anaesthesia after intrathecal chemotherapy.
Westphal M, Gotz T, Booke M.
Publication Types:
PMID: 15852999 [PubMed - in process]
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A comparison of propofol and sevoflurane anaesthesia for percutaneous trigeminal ganglion compression.
Bilotta F, Spinelli F, Centola G, Caramia R, Rosa G.
Publication Types:
PMID: 15852998 [PubMed - in process]
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Insignificant effect of desflurane-fentanyl-thiopental on hepatocellular integrity--a comparison with total intravenous anaesthesia using propofol-remifentanil.
Rohm KD, Suttner SW, Boldt J, Schollhorn TA, Piper SN.
Department of Anaesthesiology and Intensive Care Medicine, Klinikum Ludwigshafen, Ludwigshafen, Germany. k.d.roehm@t-online.de
BACKGROUND AND OBJECTIVE: Inhalational anaesthetics have been associated with hepatotoxicity. Even desflurane, with its low solubility in blood and tissues, and its minimal hepatic biotransformation, is known to affect hepatic integrity. The effects of propofol on hepatic function are, however, a matter of controversy. Alpha-glutathione S-transferase (alpha-GST), a sensitive and specific biomarker for hepatic integrity, was measured to assess the influence of total intravenous anaesthesia (TIVA) with propofol vs. anaesthesia with desflurane. METHODS: Forty-two patients scheduled for elective prostatectomy were randomly allocated to receive either desflurane, fentanyl and thiopental (desflurane group) or propofol and remifentanil (TIVA group). Depth of anaesthesia was guided by bispectral index. Plasma concentrations of alpha-GST and aminotransferases were measured before induction of anaesthesia (TO), at the end of surgery (T1), as well as 2 h (T2) and 24 h (T3) postoperatively. Haemodynamic parameters and bispectral index values were documented. RESULTS: alpha-GST increased significantly in the desflurane group from TO (3.0 +/- 2.2 microg L(-1)) to T1 and T2 (5.5 +/- 4.3 and 5.6 +/- 3.7 microg L(-1), respectively), whereas no changes were seen in the TIVA group. alpha-GST values above the normal upper limit (> 7.5 microg L(-1)) were seen in 24% of the patients receiving desflurane. Aminotransferases remained unchanged in both groups throughout the study period. CONCLUSIONS: The use of propofol as part of a TIVA regimen seems to have no influence on hepatocellular function during and after surgery. In contrast, patients receiving desflurane showed a transient slight, but significant, increase of alpha-GST to above the normal upper limit after anaesthesia, although this was without further clinical relevance.
PMID: 15852994 [PubMed - in process]
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The effect of inhalational anaesthetics on QTc interval.
Karagoz AH, Basgul E, Celiker V, Aypar U.
Hacettepe University, Faculty of Medicine, Department of Anaesthesiology and Reanimation, Ankara, Turkey. heves@ada.net.tr
BACKGROUND AND OBJECTIVE: The aim of this study was to assess time dependent cumulative effects of three different inhalation anaesthetics on QTc interval during the maintenance of anaesthesia. METHOD: Seventy-five ASA I-II male patients undergoing inguinal herniorrhaphy were randomly allocated into three groups. No premedication was given. Anaesthesia was induced with thiopental and tracheal intubation was facilitated by vecuronium in all groups. Anaesthesia was maintained with 0.8% halothane (Group I) (n = 25), 1% isoflurane (Group II) (n = 25), or 2% sevoflurane (Group III) (n = 25) and 66% nitrous oxide in oxygen. Three lead electrocardiogram recordings were taken before induction, 2, 5, 10, 15, 30 and 45 min after induction and after extubation. Heart rate, systolic, diastolic, mean arterial pressure and SpO2 were recorded at the same time. Heart rate and corrected QT interval were evaluated by using Bazett's formula. Multivariate analysis of variance for repeated measures was used to determine intergroup and intragroup differences. RESULTS: There was no statistically significant difference in the baseline QTc values of the groups. There was no difference between QTc values with halothane and sevoflurane. There was a difference between QTc values with isoflurane and those with the other two inhalation anaesthetics (P < 0.05). Although QTc values in the isoflurane group were higher at all times, the critical value of 440 ms was not exceeded. CONCLUSION: We conclude that halothane 0.8%, isoflurane 1% and sevoflurane 2% do not prolong QTc interval.
PMID: 15852988 [PubMed - in process]
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Rapid in vitro elimination of anesthetic doses of thiopental in the isolated guinea pig brain.
Librizzi L, Pastori C, de Grazia U, Croci D, de Curtis M.
Department of Experimental Neurophysiology, Istituto Nazionale Neurologico Carlo Besta, via Celoria 11, 20133 Milano, Italy.
Electrophysiological and metabolic activities in brain tissue preparations maintained in vitro may be influenced by the persistent effect of anesthetic drugs utilized during tissue dissection. In order to clarify this issue, we studied elimination kinetics of the barbiturate thiopental from the brain parenchyma in the isolated guinea pig brain maintained in vitro, arterially perfused with a protein-free saline solution [M. de Curtis, G. Biella, C. Buccellati, G. Folco, Simultaneous investigation of the neuronal and vascular compartments in the guinea pig brain isolated in vitro, Brain Res. Protoc. 3 (1998) 21-28]. At the onset of anesthesia induced by a single i.p. injection of 125 mg/kg thiopental, the brain concentration of the drug, measured by high-performance liquid chromatographic assay, was 44.22+/-5.1 mg/L (mean+/-S.E.; n=7). After 30 min of arterial perfusion in vitro with a thiopental-free solution, the cerebral levels of the barbiturate decreased to 2.03+/-0.56 mg/L (n=3), and reached values close to zero within 1 h. No significant changes in thiopental elimination curve were observed when in vitro perfusion rate was either increased or decreased. The study demonstrates that thiopental is rapidly eliminated from the brain tissue with a mono-exponential kinetic. It can be concluded that barbiturate anesthesia utilized during brain dissection is not likely to influence activities recorded from the in vitro isolated brain preparation.
PMID: 15854752 [PubMed - in process]
Comment on:
Interpreting infraclavicular motor responses to neurostimulation of the brachial plexus: from anatomic complexity to clinical evaluation simplicity.
Sala-Blanch X, Carrera A, Morro R, Llusa M.
Publication Types:
PMID: 15635526 [PubMed - indexed for MEDLINE]
Comment on:
Selective nerve root block--is the position of the needle transforaminal or paraforaminal? Call for a need to reevaluate the terminology.
Datta S, Pai U.
Publication Types:
PMID: 15635523 [PubMed - indexed for MEDLINE]
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Dr. George Crile--early contributions to the theoretic basis for twenty-first century pain medicine.
Tetzlaff JE, Lautsenheiser F, Estafanous FG.
Center for Anesthesiology Education, Division of Critical Centre, E30, The Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195, USA. tetzlaj@ccf.org
Publication Types:
- Biography
- Historical Article
Personal Name as Subject:
PMID: 15635520 [PubMed - indexed for MEDLINE]
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Management of perioperative pain in patients chronically consuming opioids.
Carroll IR, Angst MS, Clark JD.
Veterans Affairs, Palo Alto Health Care System, and Stanford University Department of Anesthesiology, 3801 Miranda Ave., Palo Alto, CA 94304, USA.
BACKGROUND: The prevalence of licit and illicit opioid use is growing, and a greater percentage of chronically opioid-consuming patients are presenting for surgery. These patients can be expected to experience increased postoperative pain, greater postoperative opioid consumption, and prolonged use of healthcare resources for managing their pain. METHODS: Achieving adequate pain control in these patients can be challenging because commonly used strategies for alleviating postoperative pain may have diminished effectiveness. We explore the prevalence and characteristics of opioid use in the United States and discuss its impact on the perioperative management of pain. We examine mechanistically why adequate perioperative pain control in chronically opioid-consuming patients may be difficult. CONCLUSIONS: We present strategies for providing adequate analgesia to these patients that include the optimal use of opioids, adjuvant medications, and regional anesthetic techniques.
Publication Types:
PMID: 15635517 [PubMed - indexed for MEDLINE]
Comment in:
Median versus musculocutaneous nerve response with single-injection infraclavicular coracoid block.
Rodriguez J, Taboada-Muniz M, Barcena M, Alvarez J.
Department of Anesthesiology, Complexo Hospitalario Universitario de Santiago, s.n 15706, Santiago de Compostela, Spain. jaimerodriguezgarcia@nacom.es
BACKGROUND AND OBJECTIVES: Local anesthetic injection after elicitation of a distal motor response with a nerve stimulator is believed to produce a more clinically efficient infraclavicular coracoid block than after elicitation of a proximal motor response. The aim of this study was to investigate whether elicitation of a median or of a musculocutaneous-type nerve response influenced the quality of anesthesia. METHODS: Randomized, prospective, single-blind study. One hundred thirty patients received a coracoid block with 40 mL plain mepivacaine 1.5% after stimulation of median nerve fibers (group 1) or musculocutaneous nerve fibers (group 2). Patients were assessed for sensory and motor block at 5 and 20 minutes. RESULTS: Significantly higher rates of complete anesthesia at 20 minutes were found in the cutaneous distributions of the radial and ulnar nerves in group 1. Significantly higher rates of complete paralysis were found for elbow extension, wrist flexion, and finger and thumb movements in group 1 at 20 minutes. Differences in the extent of anesthesia and paralysis were more remarkable at 5 minutes than at 20 minutes. CONCLUSIONS: Elicitation of a median nerve response improved the efficacy of infraclavicular coracoid block when compared with a musculocutaneous nerve response. Complete paralysis and complete anesthesia of the upper limb were low in both groups.
Publication Types:
- Clinical Trial
- Randomized Controlled Trial
PMID: 15635511 [PubMed - indexed for MEDLINE]
Comment on:
Brachial plexus block: "best" approach and "best" evoked response--where are we?
Weller RS, Gerancher JC.
Publication Types:
PMID: 15635508 [PubMed - indexed for MEDLINE]
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