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Items 1 - 31 of 31 |
One page. |
Sedation and fiberoptic intubation of a neonate with a cystic hygroma.
Bryan Y, Chwals W, Ovassapian A.
Department of Anesthesia and Critical Care, University of Chicago, Chicago, IL 60637, USA. ybryan@dacc.uchicago.edu
The flexible bronchoscope (FB) has been used to secure the difficult airway in pediatric patients. Difficult intubations in patients with cystic hygromas have been performed in awake patients or after the induction of general anesthesia. A recent case report acknowledges the challenges of performing intubations in pediatric patients under sedation because of their inability to fully cooperate. The following case demonstrates the two step-two fiberoptic bronchoscopic tracheal intubation performed using sedation and topical anesthesia in a neonate with a difficult airway.
Publication Types:
PMID: 15675998 [PubMed - indexed for MEDLINE]
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Guided tactile probing: a modified blind orotracheal intubation technique for the problem-oriented difficult airway.
Dutta A, Kumra VP, Sood J, Swaroop A.
Department of Anesthesiology, Pain & Perioperative Medicine, Sir Ganga Ram Hospital, Old Rajinder Nagar, New Delhi, India. duttaamitabh@yahoo.co.in
We present 'tactile probing', a guided approach to blind orotracheal intubation to secure a problem-oriented anticipated difficult airway in a 55-year-old male patient scheduled for elective surgical tracheostomy for a postradiotherapy translaryngeal carcinoma. Standard techniques to gain the airway were inapplicable in this case and awake flexible fiberoscopy-aided intubation had already failed.
Publication Types:
PMID: 15675994 [PubMed - indexed for MEDLINE]
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Unilateral bronchospasm following interpleural analgesia with bupivacaine.
Sudhakar S, Kundra P, Madhurima S, Ravishankar M.
Department of Anaesthesiology and Critical Care, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India.
The interpleural block (IPB) is a relatively safe procedure and is commonly practised to provide analgesia. A local anaesthetic injected into the interpleural space spreads widely to block various neural structures. The IPB can initiate bronchospasm by interrupting the sympathetic outflow but sparing the parasympathetic outflow to the lungs. In addition, unilateral reduction of intercostal muscle tone with consequential selective reduction of the functional residual capacity of that lung may also mimic airflow obstruction. We report a case of unilateral bronchospasm encountered following IPB.
Publication Types:
PMID: 15675993 [PubMed - indexed for MEDLINE]
Comment in:
Motor nerve blockade potency and toxicity of non-racemic bupivacaine in rats.
Trachez MM, Zapata-Sudo G, Moreira OR, Chedid NG, Russo VF, Russo EM, Sudo RT.
Universidade Federal Fluminense, Rio de Janeiro, Brazil.
BACKGROUND: Racemic [RS(+/-)] bupivacaine can be associated with severe cardiotoxicity. The S(-) isomer is known to be less neuro- and cardiotoxic, but demonstrates a lower potency to block motor activity than RS(+/-) bupivacaine. Thus, the potency and toxicity of a non-racemic bupivacaine mixture were studied. METHODS: Gastrocnemic muscle twitches induced by electrical stimulation of sciatic nerves in rats were used to compare the impact by bupivacaine solutions on motor activity. Field stimulation at 1 Hz eliciting ventricular muscle twitches was used to investigate the effects on cardiac contractility. The lethal dose of each local anesthetic agent was determined following drug infusions during general anesthesia in mechanically ventilated rats. RESULTS: Non-racemic (75S:25R) bupivacaine was more potent (P<0.05) than S(-) or R(+) enantiomers to block motor nerve activity. The concentrations of RS(+/-), 75S:25R, R(+) and S(-) bupivacaine to inhibit nerve conduction by 50% were 0.84 (0.37- 2.20), 0.84 (0.47-2.48), 2.68 (0.98-3.42) and 2.11 mM (1.5-4.03), respectively. Pronounced reductions in ventricular muscle twitches were observed with RS(+/-) and R(+) bupivacaine at low concentrations (0.5-4 microM). Lethal doses for 75S:25R (39.9 mg kg(-1)), and S(-) (34.7 mg kg(-1)) were higher (P<0.05) than for R(+) (16.2 mg kg(-1)) and RS(+/-) bupivacaine (18.4 mg kg(-1)), respectively. DISCUSSION: The potency of S(-) bupivacaine to block the motor activity in the sciatic nerve was enhanced when 25% of the S(-) isomer was replaced by the antipode R(+) bupivacaine. This effect was not associated with increased toxicity.
PMID: 15675985 [PubMed - indexed for MEDLINE]
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Cerebral blood flow velocity increases when propofol is changed to desflurane, but not when isoflurane is changed to desflurane in children.
Smith JH, Karsli C, Lagace A, Luginbuehl I, Barlow R, Bissonnette B.
Department of Anesthesia, The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario, Canada.
BACKGROUND: Children may exhibit delayed emergence following maintenance of anesthesia with propofol or isoflurane. Desflurane is often used towards the end of procedures to facilitate emergence. This study evaluated the effect on middle cerebral artery blood flow velocity (Vmca) in anesthetized children when propofol or isoflurane was substituted with desflurane. METHODS: Forty-two healthy children aged 1-6 years were enrolled. A standardized anesthetic induction was used. Anesthesia was maintained with remifentanil (0.5 microg.kg(-1) bolus followed by an infusion of 0.2 microg.kg(-1).min(-1)) and a randomly selected sequence of propofol/desflurane/propofol, desflurane/propofol/desflurane, isoflurane/desflurane/isoflurane or desflurane/isoflurane/desflurane. Propofol was administered to maintain a steady-state serum concentration of 3 microg.ml(-1). Desflurane and isoflurane were administered at age-corrected 1 MAC. Hemodynamic stability was maintained. Transcranial Doppler sonography was used to measure Vmca. Hemodynamic variables as well as Vmca were measured 30 min after skin incision and repeated 30 min after each change in anesthetic maintenance agent. RESULTS: The mean age and weight was 2.3 +/- 1.3 years and 13.0 +/- 3.7 kg, respectively. The Vmca (mean) increased by 35% from 37.7 +/- 10.5 cm s(-1) to 57.8 +/- 14.6 cm s(-1) (P < 0.0001) when propofol was changed to desflurane but was unaffected when desflurane replaced isoflurane. CONCLUSION: When propofol is changed to desflurane, cerebral blood flow velocity increases significantly in normal children. This cerebral vasodilatory effect may have important implications in the neurosurgical setting.
Publication Types:
- Clinical Trial
- Randomized Controlled Trial
PMID: 15675977 [PubMed - indexed for MEDLINE]
Comment on:
Less motor block with the left isomers: more questions than answers.
Vercauteren MP.
Publication Types:
PMID: 15675974 [PubMed - indexed for MEDLINE]
[The Austrian specialist examination for anaesthesiology and intensive care medicine Basic structure and experiences.]
[Article in German]
Fitzal S.
Wilhelminenspital, Wien.
In parallel with Austria's entry into the European Union, the examination system for both general practitioners and specialists at the end of their training was changed from voluntary to mandatory. Subsequent changes in laws and directives in Austria constituted the basis for the development of specific examination guidelines for each medical subspeciality. For "Anaesthesiology and Intensive Care Medicine" the decision was made for a structured oral examination after successful completion of the part 1 examination of the European Diploma of Anaesthesiology. Because of transitional regulations the actual number of candidates for the oral examination currently lies way below the expected number of 80-100. The decision to demand positive performance in the part 1 examination for the European Diploma of Anaesthesiology has, however, already proven that this type of combined examination system is of a high standard and will produce properly qualified specialists in anaesthesiology.
PMID: 15870988 [PubMed - as supplied by publisher]
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[The Anaesthesiological Questionnaire for patients in cardiac anaesthesia Results of a multicenter survey by the scientific working group for cardiac anaesthesia of the German Society for Anaesthesiology and Intensive Care Medicine.]
[Article in German]
Huppe M, Zollner M, Alms A, Bremerich D, Dietrich W, Luth JU, Michels P, Schirmer U.
Klinik fur Anasthesiologie, Universitat zu Lubeck, .
OBJECTIVE: The Anaesthesiological Questionnaire (ANP) is a self-rating method for the assessment of postoperative complaints and patient satisfaction. The questionnaire was adapted for use in cardiac anaesthesia (ANP-KA). The study was conducted to show the value of ANP-KA as a practicable means of assessing the patient's state after cardiac anaesthesia and for its use in quality assurance.METHODS: A total of 1,688 patients from 19 clinics were included who had exclusively received heart valve surgery, CABG surgery or both operations. They completed the ANP-KA between days 1 and 8 postoperatively.RESULTS: The ANP-KA was completed by 79.1% of the patients without any assistance. The highest incidence rates were reported for a dry mouth/thirst (85.1%) and for pain in the area of surgery (60.2%). Plausible and significant differences in patients' symptoms between the grading for the immediate postoperative period and the current state at filling in the questionnaire were found. Women reported more postoperative complaints than men but no differences were found between male and female patients with regard to satisfaction with anaesthesiological care and convalescence. More complaints were reported after heart valve surgery than after CABG and satisfaction with convalescence was significantly lower after heart valve surgery. The clinics differed with respect to the reported somatic complaints and satisfaction scales.CONCLUSION: The results demonstrate the practicability and validity of the ANP-KA for the assessment of postoperative complaints and patient satisfaction after cardiac surgery.
PMID: 15868177 [PubMed - as supplied by publisher]
Comment on:
Delayed hypersensitivity due to epidural block with ropivacaine: report raises several issues.
Wildsmith JA.
Publication Types:
PMID: 15845994 [PubMed - indexed for MEDLINE]
Anaesthesia for peculiar cells--a century of sickle cell disease.
Firth PG.
Nuffield Department of Anaesthetics, The John Radcliffe, Headley Way, Headington, Oxford OX3 9DU, UK.
Sickle cell disease is a congenital haemoglobinopathy with a high incidence of perioperative complications. Traditional anaesthetic management, based largely on extrapolation from biochemical models, has emphasized avoidance of red cell sickling to prevent exacerbations of the disease. This historical review outlines the evolution of the traditional approach to sickle cell pathology, assesses the validity of this model, describes the emergence of the concept of the disease as one defined by chronic inflammatory vascular damage, and outlines the practical implications of this new approach.
PMID: 15863440 [PubMed - as supplied by publisher]
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Randomized comparison of three methods of induction of anaesthesia with sevoflurane{dagger}
Knaggs CL, Drummond GB.
Clinical Neurosciences, Royal Infirmary, Edinburgh EH16 4SA, UK.
BACKGROUND: Rebreathing will occur if a low gas flow and a Mapleson D circuit are used to induce anaesthesia with a volatile anaesthetic agent. This has the advantage that it allows ventilation to be sustained when consciousness is lost, and specific manoeuvres such as breath-holding or vital capacity breaths are not needed to facilitate induction of anaesthesia. However, if the fresh gas flow were too small, this would slow induction by limiting the rate of delivery of the anaesthetic agent. To assess the impact of fresh gas flow and rebreathing, we compared induction using sevoflurane 8% given by three different methods. METHODS: We randomly allocated 65 patients to receive induction of anaesthesia from either a Mapleson A breathing system with a fresh gas flow of 9 litre min(-1) (group A9), a Mapleson D system with a fresh flow of 6 litre min(-1) (group D6) or a Mapleson D system with a fresh flow of 3 litre min(-1) (group D3). We measured times for induction, end-tidal sevoflurane and end-tidal carbon dioxide. RESULTS: The median (quartiles) induction times were 58 (45, 72), 50 (42, 65) and 64 (52, 92) s in the groups A9, D6 and D3 respectively. Induction of anaesthesia took longer (P<0.01) and was more variable in group D3. In this group, end-tidal sevoflurane concentration at the time of induction of anaesthesia was lower (P<0.05). In group A9, end-tidal carbon dioxide was less (P<0.05). CONCLUSIONS: In adult patients allowed to breathe normally, prompt and consistent inhalation induction of anaesthesia with sevoflurane is obtained when fresh gas flow is limited to 6 litre min(-1) from a Mapleson D circuit, but smaller flows are impractical.
PMID: 15863438 [PubMed - as supplied by publisher]
Desflurane costs in ambulatory anesthesia.
Harris P.
PMID: 15872144 [PubMed - in process]
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Bilateral foot drop following lower limb orthopedic surgery under spinal anesthesia.
Ghai A, Hooda S, Kumar P, Kumar R, Bansal P.
PMID: 15872143 [PubMed - in process]
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Endobronchial metastasis: an anesthetic complication?
Eipe N, Dildeep A, Samuel T.
PMID: 15872142 [PubMed - in process]
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Supervising fellows and residents in pediatric anesthesia.
Vandebeek CA, Seal RF, Kearney R, Reimer E, Purewal D, Ansermino JM.
PMID: 15872139 [PubMed - in process]
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Prolonged duration of anesthesia in a patient with multiple sclerosis following paravertebral block: [Prolongation de l'anesthesie apres un bloc paravertebral chez une patiente atteinte de sclerose en plaques].
Finucane BT, Terblanche OC.
Department of Anesthesiology and Pain Medicine, University of Alberta, Clinical Sciences Building, Room 8-120, Edmonton, Alberta T6G 2G3, Canada. bfinucan@ualberta.ca.
PURPOSE: To explore the possibility that the prolonged duration of anesthesia following paravertebral block was related to the presence of multiple sclerosis in a patient undergoing elective inguinal hernia repair. CLINICAL FEATURES: A healthy 33-yr-old female presented for elective inguinal hernia repair. The procedure was performed under general anesthesia and a paravertebral block was performed at the end of the procedure for postoperative pain relief, whilst the patient was still anesthetized. Upon recovering from general anesthesia it was noted that the patient had a flaccid paralysis of both lower extremities. She was also very nauseated and required antiemetics and vasopressors for hypotension. A differential diagnosis of subarachnoid, subdural or epidural spread was considered. The presence of an epidural hematoma was also considered. The block regressed very slowly with full return of function in 12.5 hr. The duration of action of the block was far longer than one would expect following spinal, epidural or subdural spread of a local anesthetic. Urinary catheterization was performed electively to prevent urinary retention. The patient was discharged home late that evening. Prior to discharge she volunteered that she was being investigated for multiple sclerosis. One month later the diagnosis of multiple sclerosis was confirmed. CONCLUSION: In conclusion the extended duration of central neural blockade following paravertebral block, may have been related to an abnormal uptake of local anesthetics into the spinal cord in the presence of demyelination.
PMID: 15872128 [PubMed - in process]
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Delayed recovery of vecuronium neuromuscular block in diabetic patients during sevoflurane anesthesia: [Bloc neuromusculaire au vecuronium prolonge chez des patients diabetiques pendant l'anesthesie au sevoflurane].
Saitoh Y, Hattori H, Sanbe N, Nakajima H, Akatu M, Murakawa M.
Saitama Medical School Department of Anesthesiology, 38, Morohongo, Moroyama, Iruma-gun, Saitama, 350-0495, Japan. ysys@r5.dion.ne.jp.
PURPOSE: To study recovery from vecuronium-induced neuromuscular block in diabetic patients during total iv or sevoflurane anesthesia. METHODS: 30 diabetic patients were assigned to diabetes mellitus (DM)-total iv anesthesia (TIVA); (n = 15) or DM-sevoflurane (S) groups (n = 15). Thirty healthy patients were divided into control-TIVA (n = 15) or control-S groups (n = 15). In the DM-TIVA or control-TIVA groups and DM-S or control-S groups, anesthesia was maintained with propofol and fentanyl, and nitrous oxide-oxygen-sevoflurane 1.7%, respectively. After receiving vecuronium 0.1 mg.kg(-1)iv, recovery of the train-of-four (TOF) was compared among the four groups. RESULTS: Times to the return of T2, T3, or T4 in the DM-TIVA and DM-S groups were longer than in the control-TIVA and control-S groups (46.9 +/- 13.8 vs 32.2 +/- 10.7 and 32.6 +/- 8.7 min for T2, P < 0.05). T1/control in the DM-S group was less than in the control-TIVA and DM-TIVA groups 50 to 120 and 70 to 120 min after receiving vecuronium, respectively (P < 0.05). T1/control in the control-S group was less than in the control-TIVA group 80 to 120 min after receiving vecuronium (P < 0.05). TOF ratio in the DM-S group was less than in the control-TIVA, DM-TIVA, and control-S groups, 60 to 120, 80 to 120, and 80 to 120 min after receiving vecuronium, respectively (P < 0.05). CONCLUSION: In diabetic patients receiving vecuronium, recovery of T1/control and TOF ratio are delayed during sevoflurane anesthesia, but not in association with total iv anesthesia.
PMID: 15872123 [PubMed - in process]
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A dopamine infusion decreases propofol concentration during epidural blockade under general anesthesia: [Une perfusion de dopamine diminue la concentration de propofol pendant le bloc peridural sous anesthesie generale].
Takizawa D, Nishikawa K, Sato E, Hiraoka H, Yamamoto K, Saito S, Horiuchi R, Goto F.
Department of Anesthesiology, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi City 371-8511, Japan. nishikaw@med.gunma-u.ac.jp.
PURPOSE: It is common clinical practice to use dopamine to manage the reduction in blood pressure accompanying epidural blockade. As propofol is a high-clearance drug, propofol concentrations can be influenced by cardiac output (CO). The purpose of the present study was to investigate the effects of dopamine infusions on propofol concentrations administered by a target-controlled infusion system during epidural block under general anesthesia. METHODS: 12 patients undergoing abdominal surgery were enrolled in this study. Anesthesia was induced with propofol and vecuronium 0.1 mg.kg(-1), and maintained using 67% nitrous oxide, sevoflurane in oxygen and constant infusion of propofol. Propofol was administered to all subjects via target-controlled infusion to achieve a propofol concentration at 6.0 mug.mL(-1) at intubation and 2.0 mug.mL(-1) after intubation. Before and after the administration of 10 mL of 1.5% mepivacaine from the epidural catheter and dopamine infusion at 5 mug.kg(-1).min(-1), CO and effective liver blood flow (LBF) were measured using indocyanine green. Blood propofol concentration was also determined using high-performance liquid chromatography. RESULTS: At one hour after epidural block and dopamine infusion, CO was significantly increased from 4.30 +/- 1.07 L.min(-1) to 5.82 +/- 0.98 L.min(-1) (P < 0.0001), and effective LBF was increased 0.75 +/- 0.17 L.min(-1) to 0.96 +/- 0.18 L.min(-1) (P < 0.0001). Propofol concentration was significantly decreased from 2.13 +/- 0.24 mug.mL(-1) to 1.59 +/- 0.29 mug.mL(-1) (P < 0.0001). CONCLUSIONS: Propofol concentrations decrease with an increase in CO, suggesting the possibility of inadequate anesthetic depth following catecholamine infusion during propofol anesthesia.
PMID: 15872122 [PubMed - in process]
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Neuraxial anesthesia and multiple sclerosis/Anesthesie neuraxiale et sclerose en plaques.
Perlas A, Chan VW.
Department of Anesthesia, Toronto Western Hospital, 399 Bathurst Street, Toronto, Ontario M5T 2S8, Canada. Vincent.Chan@uhn.on.ca.
PMID: 15872120 [PubMed - in process]
Putative role of nitric oxide synthase isoforms in the changes of nitric oxide concentration in rat brain cortex and cerebellum following sevoflurane and isoflurane anaesthesia.
Sjakste N, Sjakste J, Boucher JL, Baumane L, Sjakste T, Dzintare M, Meirena D, Sharipova J, Kalvinsh I.
Latvian Institute of Organic Synthesis, 21 Aizkraukles Street, Riga, LV-1006, Latvia; Faculty of Medicine, University of Latvia, 1a Sharlotes Street, Riga, LV-1001, Latvia.
We have previously observed an increase in nitric oxide (NO) content in rat brain cortex following halothane, sevoflurane or isoflurane anaesthesia. This study was undertaken in order to determine whether isoform-specific nitric oxide synthase (NOS) inhibitors and inducers could modify these increases in NO contents. Rats were subjected to isoflurane and sevoflurane anaesthesia with concomitant administration of neuronal nitric oxide synthase (nNOS) inhibitor 7-Nitro-indazole (7-NI), inducible nitric oxide synthase (iNOS) inhibitor 2-amino-5,6-dihydro-6-methyl-4H-1,3-thiazine (AMT) or lipopolysaccharide. NO concentration in different organs was measured by electron paramagnetic resonance (EPR) spectroscopy. 7-NI significantly decreased NO concentration in cerebellum but not in brain cortex, whereas AMT decreased NO in all the organs studied. Anaesthesia significantly increased NO concentration in brain cortex and decreased that in cerebellum. AMT abolished the NO increase in brain cortex. Anaesthesia enhanced the drastic increase in NO concentration in brain cortex after intraventricular lipopolysaccharide administration. Isoflurane was found to inhibit recombinant nNOS and iNOS activities at high concentrations (EC(50)=20 mM). Our data suggest a putative role for iNOS in the increase in NO levels produced by isoflurane and sevoflurane, whereas nNOS activity is probably inhibited during anaesthesia.
PMID: 15862801 [PubMed - in process]
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Role of the sympathetic and renin angiotensin systems in the glucose-induced increase of blood pressure in rats.
Villafana S, Huang F, Hong E.
Departamento de Farmacobiologia, CINVESTAV-I.P.N., Calzada de los tenorios 235, Col. Granjas Coapa, Deleg. Tlalpan, Mexico, D.F., C.P. 14330, Mexico.
The pressor effect induced by acute hyperglycemia is not well understood, therefore, it was of interest to study the effect of intravenous glucose infusion on the mean arterial pressure of anesthetized Wistar rats. Animals received glucose (100 mg/kg/min, i.v.), mannitol or saline during 30 min, but only glucose increased the mean arterial pressure (about 40 mm Hg), plasma glucose, insulin and nitric oxide (NO). Pretreatment with reserpine or indorenate (a central antihypertensive) inhibited completely the pressor effect of glucose. Reserpine also decreased the plasma NO levels. Pretreatment with ramipril or with streptozotocin decreased the late phase of the glucose-induced pressor response and the NO levels, the latter treatment also abolishes insulin plasma concentrations. The present results suggest that the pressor effect induced by glucose has an early phase due to an increase of efferent sympathetic discharges and a delayed phase produced by the activation of the renin angiotensin system.
PMID: 15588734 [PubMed - indexed for MEDLINE]
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Anesthetic management of neonates with congenital complete atrioventricular heart block undergoing pacemaker implantation.
Ammann J, Winter J, Sunderdiek U, Loer SA.
Department of Anesthesiology, University Hospital Dusseldorf, Dusseldorf, Germany.
PMID: 15868531 [PubMed - in process]
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Immediate extubation after aortic valve surgery using high thoracic epidural analgesia or opioid-based analgesia.
Hemmerling TM, Le N, Olivier JF, Choiniere JL, Basile F, Prieto I.
Perioperative Cardiac Research Group (PeriCARG, Department of Anesthesiology, Centre Hospitalier de l'Universite de Montreal (CHUM), Montreal, Quebec, Canada. thomashammerling@hotmail.com
OBJECTIVE: Fast-track anesthesia has gained widespread use in cardiac centers around the world. No study has been published focusing on immediate extubation after aortic valve surgery. This study examines the feasibility and hemodynamic stability of immediate extubation after simple or combined aortic valve surgery using either thoracic epidural analgesia or opioid-based analgesia. DESIGN: Prospective audit, pilot study. SETTING: Single-institution university medical center. PARTICIPANTS: Adult patients undergoing aortic valve replacement (N = 45). INTERVENTIONS: Forty-five patients undergoing aortic valve surgery with an ejection fraction of more than 30% were included in this prospective audit. Induction of anesthesia was done using fentanyl, 2 to 4 mug/kg, propofol, 1 to 2 mg/kg, and endotracheal intubation facilitated by rocuronium; anesthesia was maintained using sevoflurane titrated according to bispectral index (BIS [BIS target: 50]). Perioperative analgesia was provided by high thoracic epidural analgesia (TEA group, bupivacaine 0.125%, 6 to 14 mL/h) or fentanyl, up to 10 microg/kg, followed by patient-controlled analgesia with morphine (OPIOID group). MEASUREMENTS AND MAIN RESULTS: Success of extubation within 30 minutes after surgery was recorded. Hemodynamic data during surgery were compared by using an analysis of variance test; p < 0.05 was considered as showing a significant difference. Data presented as median (25th-75th percentile). In the TEA group, patients underwent simple aortic valve replacement (N = 21) or combined aortic valve surgery (N = 14), with additional coronary artery bypass grafting (N = 10) and replacement of the ascending aorta (Bentall, N = 4). In the OPIOID group, patients underwent simple aortic valve replacement (N = 5) or combined aortic valve surgery (N = 5), with additional aortocoronary bypass grafting (N = 2), replacement of the ascending aorta (Bentall, N = 2), and reconstruction of the mitral valve (N = 1). All 45 patients were extubated within 15 minutes after surgery. There was no need for reintubation; pain scores were lower in the TEA group than in the OPIOID group immediately after surgery and at 6 hours, 24 hours, and 48 hours after surgery. For the TEA group and OPIOID group, the pain scores were 0 (0-2), 0 (0-2), 0 (0-1.5), and 0 (0-0) and 5 (4-5.75), 4 (3-4.5), 4 (3.25-4), and 1 (0-2.5), respectively. During and up to 6 hours after surgery, there was no significant hemodynamic difference between the TEA and OPIOID groups. Eighteen of 45 patients needed temporary pacemaker activation. There were no epidural hematoma or neurologic complications related to TEA. CONCLUSION: Immediate extubation is feasible after aortic valve surgery using either high thoracic epidural analgesia or opioid-based analgesia; both techniques maintain hemodynamic stability throughout surgery. TEA provides superior pain control.
PMID: 15868524 [PubMed - in process]
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Evaluation of patient-controlled remifentanil application in third molar surgery.
Esen E, Ustun Y, Balcioglu YO, Alparslan ZN.
Department of Oral and Maxillofacial Surgery, Cukurova University, 01330 Balcali, Adana, Turkey.
PURPOSE: The aim of this study was to evaluate the clinical efficacy and safety of patient-controlled remifentanil application in combination with intravenous (IV) midazolam sedation during third molar surgery. PATIENTS AND METHODS: Twenty healthy patients with symmetrically placed impacted bilateral mandibular third molars were included in this prospective, placebo-controlled, double-blind, cross-over, randomized clinical study. A bolus dose of 0.05 mg/kg intravenous midazolam was applied to each patient. Remifentanil was administered (group MR) by patient controlled infusion (PCI) either in the first or the second operation. In the other operation, a placebo (group MP) was given in the same manner. Perioperative blood samples were obtained to determine the changes in the stress hormone (aldosterone, adrenocorticotropic hormone [ACTH], renin) levels. Vital signs and oxygen saturation were recorded. Ramsey's sedation scale and modified Steward's recovery scale was used for evaluation of consciousness. Pain, patient satisfaction, cooperation score, reaction to local anesthetic injection, and degree of amnesia were also assessed. RESULTS: Remifentanil significantly increased the level of sedation, patient cooperation, and satisfaction; decreased the oxygen saturation, heart rate, and pain. While renin levels were significantly different, ACTH and aldosteron levels did not differ significantly between the 2 groups. Aldosterone and ACTH levels significantly decreased, whereas the renin level significantly increased in both groups during the operations. Remifentanil did not significantly alter the recovery time. CONCLUSION: Patient-controlled remifentanil application in combination with IV midazolam sedation seems to be a safe and reliable method, which effectively eliminates pain and provides a satisfactory sedation level, without any serious side effect.
Publication Types:
- Clinical Trial
- Randomized Controlled Trial
PMID: 15789316 [PubMed - indexed for MEDLINE]
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Involvement of ionotropic glutamate receptors in low frequency electroacupuncture analgesia in rats.
Choi BT, Lee JH, Wan Y, Han JS.
Department of Anatomy, College of Oriental Medicine, Research Institute of Oriental Medicine, Dong-Eui University, Busan 614-052, Korea. choibt@deu.ac.kr
The present study was conducted to determine whether blockage of both N-methyl-D-aspartate (NMDA) and alpha-amino-3-hydroxy-5-methylisoxazole-4-proprionic acid/kainate (AMPA/KA) receptors influences the induction of low frequency electroacupuncture (EA) analgesia. Although neither intrathecal injection of NMDA antagonist D-2-amino-5-phosphonopentanoic acid (D-AP-5) or AMPA/KA antagonist 1,2,3,4-tetrahydro-6-nitro-2,3-dioxo-benzo[f]quinoxaline-7-sulfonami-de (NBQX) disodium alone had an effect on analgesia, spinal application of D-AP-5 and NBQX disodium significantly prevented analgesia induced by 2 Hz EA. The intrathecal injection of the excitatory amino acid NMDA produced analgesia for several minutes after intrathecal injection, as did EA stimulation. These results suggest that ionotropic glutamate receptors may be involved in the induction of 2 Hz EA analgesia.
PMID: 15755523 [PubMed - indexed for MEDLINE]
Changes in fetal position during labor and their association with epidural analgesia.
Lieberman E, Davidson K, Lee-Parritz A, Shearer E.
Departments of Obstetrics and Gynecology, Brigham and Women's Hospital, Harvard Medical School, and Boston Medical Center, Boston, Massachusetts.
OBJECTIVE: To evaluate whether epidural analgesia is associated with a higher rate of abnormal fetal head position at delivery. METHODS: We conducted a prospective cohort study of 1,562 women to evaluate changes in fetal position during labor by using serial ultrasound examinations. Ultrasound examinations were performed at enrollment, epidural administration, 4 hours after the initial ultrasonography if epidural had not been administered, and late in labor (> 8 cm). Information about fetal head position at delivery was obtained from the provider. RESULTS: Regardless of fetal head position at enrollment (occiput transverse, occiput posterior, or occiput anterior), most fetuses were occiput anterior at delivery (enrollment position: occiput transverse 78%, occiput posterior 80%, occiput anterior 83%, P = .1). Final fetal position was established close to delivery. Of fetuses that were occiput posterior late in labor, only 20.7% were occiput posterior at delivery. Changes in fetal head position were common, and 36% of women had an occiput posterior fetus on at least one ultrasound examination. Women receiving epidural did not have more occiput posterior fetuses at the enrollment (23.4% epidural versus 26.0 no epidural, P = .9) or the epidural/4-hour ultrasound examination (24.9% epidural, 28.3% no epidural), but did have more occiput posterior fetuses at delivery (12.9% epidural versus 3.3% no epidural, P = .002); the association remained in a multivariate model (adjusted odds ratio 4.0, 95% confidence interval 1.4-11.1). CONCLUSION: Fetal position changes are common during labor, with the final fetal position established close to delivery. Our demonstration of a strong association of epidural with fetal occiput posterior position at delivery represents a mechanism that may contribute to the lower rate of spontaneous vaginal delivery consistently observed with epidural. LEVEL OF EVIDENCE: II-2.
PMID: 15863533 [PubMed - in process]
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Caudal block: the 'no turn technique'.
Ivani G.
Publication Types:
PMID: 15649175 [PubMed - indexed for MEDLINE]
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A rare tracheal lesion.
Birch CW, Salkeld LJ.
Department of Anaesthesia, Middlemore Hospital, Otahuhu, Auckland, New Zealand. cbirch@middlemore.co.nz
We report a potentially life-threatening tracheal lesion that caused postextubation stridor in a child following dental surgery. The child developed a cough, dysphonia, stridor, and respiratory distress hours after his operation. Standard therapy for postextubation stridor was ineffective. A lateral neck X-ray suggestive of subglottic pathology prompted an endoscopy. This revealed a fibrinous membrane that was attached to the anterior trachea and required mechanical ablation. The child made an uneventful recovery. This lesion has not been reported in children before and we believe that it is important in the differential diagnosis of postextubation stridor as it requires specific therapy.
PMID: 15649169 [PubMed - indexed for MEDLINE]
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Unexpected ST segment changes in children--a case report.
Alfirevic A, Mossad E, Niezgoda J.
Division of Anesthesiology and Critical Care Medicine, The Cleveland Clinic Foundation, Cleveland, OH 44195, USA.
In children, myocardial ischemic changes during anesthesia are a rare event unless there is underlying pathology. The patient in this case report was an apparently healthy child scheduled for adenoidectomy and bilateral tympanostomy. Occurrence of significant ST changes as well as intraoperative and postoperative hypoxemia required further diagnostic work-up. Postoperative echocardiographic findings were suspicious of intrapulmonary right to left shunting. The pulmonary arteriovenous fistula is probably the major pathophysiological factor for the development of hypoxemia and paradoxical air embolism especially during positive pressure ventilation in our patient. Unexpected ST segment changes might also occur in patients with anomalous origin of coronary arteries. Although diagnostic work-up was inconclusive, it is necessary to rule out any underlying pathological process. Further follow-up is also important in order to learn more about these disease states that often have subclinical, but potentially fatal presentation.
Publication Types:
PMID: 15649167 [PubMed - indexed for MEDLINE]
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Comparison of laser acupuncture and metoclopramide in PONV prevention in children.
Butkovic D, Toljan S, Matolic M, Kralik S, Radesic L.
Department of Anesthesiology, Reanimatology and Intensive Care, Children's Hospital Zagreb, Zagreb 10 000, Croatia. diana.butkovic1@zg.htnet.hr
BACKGROUND: Postoperative nausea and vomiting (PONV) are frequent side effects of general anesthesia in children. The aim of this study was to compare the effectiveness of laser acupuncture with metoclopramide in prevention of PONV in children after sevoflurane anesthesia. METHODS: A total of 120 children ASA I and II, scheduled for hernia repair, circumcision or orchidopexy were randomly assigned into three groups: group I, received laser acupuncture on P6 point and saline infusion; group II, metoclopramide 0.1 mg.kg(-1) i.v. and sham laser; group III had sham laser and saline infusion. Anesthesia was maintained with sevoflurane and N(2)O/O(2). Patients were monitored for any symptoms of retching and vomiting at 2, 6 and 24 h postoperatively. RESULTS: The incidence of vomiting was higher in the control group in the first 2 h postoperatively (P < 0.001), compared with the other groups. There was no statistically significant difference between acupuncture and metoclopramide groups in occurrence and timing of vomiting (P < 0.001). CONCLUSION: Laser acupuncture is equally effective as metoclopramide in preventing PONV in children.
Publication Types:
- Clinical Trial
- Randomized Controlled Trial
PMID: 15649161 [PubMed - indexed for MEDLINE]
Comment in:
Sevoflurane sedation in infants undergoing MRI: a preliminary report.
Sury MR, Harker H, Thomas ML.
Department of Anaesthesia, Great Ormond Street Hospital for Children NHS Trust, London WC1N 3JH, UK. surym@gosh.nhs.uk
BACKGROUND: Stillness during natural sleep after feeding may not be sufficient for successful magnetic resonance imaging (MRI) in small infants less than 5 kg. Sedation, using an oral agent, is often successful although the timing and depth of sedation is variable. In contrast anesthesia is always effective but is invasive and is associated with postanesthesia apnea and bradycardia in preterm and ex-preterm infants. We are developing an alternative technique involving insufflation of sevoflurane and present our initial experience. METHODS: Infants presenting for MRI were sedated by nasal insufflation of sevoflurane carried by 2 l.min(-1) oxygen. We recorded the sevoflurane administered, timing of sedation and scanning, conscious level, oxygen saturations, and recovery profile. RESULTS: Of the 13 infants studied (median postconceptional age: 46 weeks, range: 40-70 weeks; median weight: 4.4 kg, range: 3.3-6.5 kg), sevoflurane caused sleep and enabled successful imaging in 12. Six infants fell asleep within 10 min and the median maximum sevoflurane vaporizer setting for successful sedation was 4% (range: 4-8%). Before scanning, 10 infants remained easily roused by touch and two became unresponsive; one desaturated to 85% and required repositioning of the head to maintain a clear airway. Immediately after scanning all infants were easily roused by touch. CONCLUSIONS: Sedation by insufflation of sevoflurane in small infants is a simple and practical alternative technique for painless imaging such as MRI; further experience is necessary to determine its limitations.
PMID: 15649158 [PubMed - indexed for MEDLINE]
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