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Items 1 - 18 of 18 |
One page. |
[Intrathecal misplacement of an interscalene plexus catheter.]
[Article in German]
Walter M, Rogalla P, Spies C, Kox WJ, Volk T.
Klinik fur Anasthesiologie und operative Intensivmedizin, Charite-Universitatsmedizin Berlin, Campus Mitte. mich.walter@charite.de
For perioperative anesthesia in a case of shoulder arthroscopy, a continuous interscalene plexus block according to Meier was performed in a 51-year-old female patient. The catheter was placed after stimulator-assisted punction and application of a local anesthetic. A few minutes after a further dose of local anesthetic was given via the catheter, the patient had to be intubated and ventilated with signs of total spinal anesthesia. The cervical CT showed the intrathecal displacement of the catheter, reaching the spinal canal near the root of the 7th spinal nerve. Blind advancement and deep placement increase the risk of an abnormal catheter position. Intraspinal misplacement should be reliably excluded.
Publication Types:
PMID: 15599489 [PubMed - indexed for MEDLINE]
[Anaesthetic management of the patient with acute intracranial hypertension.]
[Article in French]
Audibert G, Steinmann G, Charpentier C, Mertes PM.
Departement d'anesthesie-reanimation, hopital central, CHU de Nancy, 54000 Nancy, France.
Transcranial Doppler and, if possible, measurement of intracranial pressure (ICP) allow preoperative diagnosis of acute intracranial hypertension (ICH) after brain trauma. The main goal of the anaesthesiologist is to prevent the occurrence of secondary brain injuries and to avoid cerebral ischaemia. Treatment of high ICP is mainly achieved with osmotherapy. High-dose mannitol administration (1.4 to 2 g/kg given in bolus doses) may be considered a better option than conventional doses, especially before emergency evacuation of a cerebral mass lesion. Hypertonic saline seems as effective as mannitol without rebound effect and without diuresis increase. Haemostasis should be normalized before neurosurgery and invasive blood pressure monitoring is mandatory. For anaesthesia induction, thiopental or etomidate may be used. In case of ICH, halogenated and nitrous oxide should be avoided. Until the dura is open, mean arterial pressure should be maintained around 90 mmHg (or cerebral perfusion pressure around 70 mmHg). If a long-lasting (several hours) extracranial surgery is necessary, ICP should be monitored and treatment of ICH should have been instituted before.
PMID: 15885971 [PubMed - in process]
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[Involvement of anaesthesiologists in surgery offices: a way to an evolution of the mentalities?]
[Article in French]
Rimmele T, Bouvet L, Boselli E.
Departement d'anesthesie-reanimation, hopital Edouard-Herriot, place d'Arsonval, 69003 Lyon, France.
Publication Types:
PMID: 15885964 [PubMed - as supplied by publisher]
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[Antiplatelet agents and regional anaesthesia: experience in 130 patients.]
[Article in French]
Madi-Jebara S, Rkeiby-Kassabian N, Yazigi A.
Departement d'anesthesie-reanimation, Hotel-Dieu-de-France, Beyrouth, Liban.
Publication Types:
PMID: 15878819 [PubMed - in process]
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[The preanesthetic visit "in the hours before the moment of the intervention": considerations]
[Article in French]
Fusciardi J; Comite vie professionnelle de la Sfar.
Service d'anesthesie-reanimation II, hopital Trousseau, avenue de la Republique, 37044 Tours cedex 9, France. fusciardi@med.univ-tours.fr
PMID: 15826802 [PubMed - indexed for MEDLINE]
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Crack cocaine as a cause of acute postoperative pulmonary edema in a pregnant drug addict.
Kuczkowski KM.
Publication Types:
PMID: 15826799 [PubMed - indexed for MEDLINE]
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[Uncommon aetiology of peroneal compartment syndrome]
[Article in French]
Adam F, Roren A, Chauvin M.
Departement d'anesthesie-reanimation, hopital Ambroise-Pare, assistance publique-hopitaux de Paris, 9, avenue Charles-de-Gaulle, 92100 Boulogne-Billancourt, France. frederic.adam@apr.ap-hop-paris
Compartment syndromes are well recognized following major trauma. However, although uncommon, they may occur following athletic activity. We report a case of acute exertional peroneal compartmental syndrome in a 32-year-old that developed following horse riding. Because of the ignorance of pathology, a regional analgesia was carried out resulting in delayed diagnosis. Postoperative electromyography showed the absence of a fibula nerve compound action potential. At one-year follow-up visit following decompressive fasciotomy, muscular strength of the muscles of the anterior tibial compartment almost returned to normal. The presentation of this case of compartmental syndrome following horse riding allows to discuss the place of the regional anaesthesia. Because this anaesthesia technique can delay the diagnosis and the surgical treatment, it should not be used in first intention in the treatment of severe pain associated with compartmental syndrome.
Publication Types:
PMID: 15826796 [PubMed - indexed for MEDLINE]
Minimum effective local anaesthetic dose for spinal anaesthesia.
Wildsmith JA.
Publication Types:
PMID: 15878897 [PubMed - in process]
Epidural blood patch in a Jehovah's Witness patient with post-dural puncture cephalgia.
Jagannathan N, Tetzlaff JE.
Publication Types:
PMID: 15625269 [PubMed - indexed for MEDLINE]
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Continuous extrapleural infusion of ropivacaine in children: is it safe?
Maurer K, Rentsch KM, Dullenkopf A, Pretre R, Schmid ER.
Publication Types:
PMID: 15625268 [PubMed - indexed for MEDLINE]
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The StyletScope is a better intubation tool than a conventional stylet during simulated cervical spine immobilization.
Kihara S, Yaguchi Y, Taguchi N, Brimacombe JR, Watanabe S.
Department of Anesthesia, Pain Clinic, and Clinical Toxicology, Mito Saiseikai General Hospital, Ibaraki, Japan.
PURPOSE: We compare the StyletScope fibreoptic stylet (FOS) and the Satin Slip conventional metal stylet (CMS), during simulated difficult airway management with manual-in-line stabilization in terms of ease of intubation and esophageal intubation. METHODS: 193 patients (ASA I-II, 18-80 yr) were studied in a non-crossover, randomized fashion. Manual-in-line stabilization was applied and the best laryngoscopic view obtained. For the CMS, the primed tracheal tube was advanced under direct vision if Cormack-Lehane grade 1/2, placed behind the epiglottis and advanced blindly if grade 3, and intubation was not attempted if grade 4. For the FOS, the primed tracheal tube was advanced under the direct vision if grade 1/2 and under fibreoptic vision if grade 3/4. RESULTS: Intubation was successful more frequently (P = 0.02) and required fewer attempts (P = 0.003) with the FOS than the CMS. Intubation with the FOS was successful more frequently (P = 0.02) and required fewer attempts (P = 0.007) than the CMS if grade 3/4. For both stylets, intubation required fewer attempts (P < 0.007) and was quicker (P <or= 0.0001) for grade 1/2 than 3/4. Esophageal intubation occurred more frequently with the CMS (14 vs 0, P = 0.0001). CONCLUSION: Tracheal intubation is more successful, requires fewer attempts and esophageal intubation is less frequent with the FOS than the CMS during cervical spine immobilization using manual-in-line axial stabilization. The FOS is a more effective intubation instrument compared to the CMS in patients with simulated cervical spine immobilization.
Publication Types:
- Clinical Trial
- Randomized Controlled Trial
PMID: 15625266 [PubMed - indexed for MEDLINE]
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The "BURP" maneuver worsens the glottic view when applied in combination with cricoid pressure.
Snider DD, Clarke D, Finucane BT.
Department of Anesthesiology and Pain Medicine, University of Alberta Hospital, Canada.
PURPOSE: The purpose of this study was to determine if the application of a BURP maneuver to the cricoid cartilage would combine the benefits of both the BURP and the Sellick maneuvers, resulting in an improved glottic view and offer the potential of protection against passive gastric regurgitation. METHODS: This was a double-blind, prospective, randomized, crossover trial. Forty-three patients scheduled for elective surgery participated in this study. General anesthesia was induced using fentanyl, propofol and rocuronium. In a random sequence for each case and blinded to the laryngoscopist, one of three maneuvers was carried out. Direct vertical pressure, using 30 newtons, a BURP maneuver with cricoid pressure, or no pressure was applied to the cricoid and the laryngoscopic view was ascertained. A separate laryngoscopy was conducted for each maneuver and the views were graded as good (part of the glottis seen), poor (only the arytenoids were seen) or no view (only the epiglottis was seen). Endotracheal intubation was then performed in each case. RESULTS: The results showed that the combination of the BURP maneuver and cricoid pressure worsened the view obtained at laryngoscopy in 30% of cases (P = 0.007). Cricoid pressure alone worsened the view in 12.5% of cases (P = 0.279). No difference was seen in 65% of cases. All patients but one were intubated easily. CONCLUSION: There is no benefit to routinely applying a modified "BURP" maneuver to the cricoid cartilage during rapid sequence induction of anesthesia.
Publication Types:
- Clinical Trial
- Randomized Controlled Trial
PMID: 15625265 [PubMed - indexed for MEDLINE]
Comment in:
Low dose intrathecal morphine facilitates early extubation after cardiac surgery: results of a retrospective continuous quality improvement audit.
Parlow JL, Steele RG, O'Reilly D.
Department of Anesthesiology, Queen's University and Kingston General Hospital, Kingston, Ontario, Canada. parlowj@post.queensu.ca <parlowj@post.queensu.ca>
PURPOSE: To document one centre's experience with a multimodal analgesic approach, with or without low dose intrathecal morphine (ITM), in facilitating "fast-track" recovery in patients undergoing cardiac surgery. METHODS: Records of 131 consecutive patients who underwent first time elective cardiac surgery during a four-month period in 2000 were reviewed. Patients were divided into two groups: those receiving and those not receiving preoperative low dose ITM (< 5 microgxkg(-1)) as part of a multimodal analgesic technique. Demographic and surgical characteristics, postoperative morphine use, time to extubation and requirement for antiemetics were recorded. RESULTS: Overall, 75% of patients were extubated within two hours, and 93% within six hours. Fifty-five patients received, and 76 did not receive, ITM (mean +/- SD 259 +/- 53 microg) along with a multimodal analgesic technique (parasternal infiltration, acetaminophen and indomethacin, and postoperative i.v. morphine). Anesthetic technique involved modest dose opioids, volatile agent and propofol infusion. The groups were similar with respect to preoperative, intraoperative and anesthetic characteristics. Mean extubation time for fast-track patients receiving vs not receiving ITM was 75 +/- 65 vs 117 +/- 85 min (P = 0.003). Intravenous morphine use for the first 12 hr after surgery was also reduced in the ITM group (4.6 +/- 4.1 vs 10.0 +/- 14.8 mg, P = 0.009). There was no difference in rescue antiemetic or antipruritic requirements, failed fast-tracking, or serious adverse events. CONCLUSIONS: Multimodal postoperative analgesia allowed for uneventful early extubation and low opioid requirements. Low dose ITM further facilitated early extubation, and reduced postoperative analgesic requirements.
PMID: 15625264 [PubMed - indexed for MEDLINE]
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Needle placement and injection posterior to the axillary artery may predict successful infraclavicular brachial plexus block: a report of three cases.
Porter JM, McCartney CJ, Chan VW.
Department of Anesthesia, Toronto Western Hospital, University Health Network, 399 Bathurst St., EC 2-046, Toronto, Ontario M5T 2S8, Canada.
PURPOSE: The combined use of ultrasound and nerve stimulation for localization of the brachial plexus during infraclavicular block has not been evaluated. We describe three cases of infraclavicular block where we used ultrasound to place the needle and catheter, observe type of muscle twitch obtained and local anesthetic spread after injection. CLINICAL FEATURES: Injection of local anesthetic after obtaining proximal muscle stimulation was associated with local anesthetic spread between the axillary artery and pectoral muscle. This resulted in block failure (case 1).In case 2, proximal stimulation was associated with anterior spread after a test injection. The needle and subsequently the catheter were repositioned posterior to the axillary artery and distal muscle stimulation obtained. Injection through the catheter resulted in local anesthetic spread posterior to the artery and successful block.In case 3, no distal twitch could be obtained but in light of previous experience the needle and then the catheter were placed posterior to the axillary artery. Posterior local anesthetic spread was observed and successful block ensued despite absence of any muscle stimulation. CONCLUSION: Ultrasound guidance during infraclavicular brachial plexus block enables direct visualization of needle/catheter tip location and confirmation of appropriate local anesthetic spread. Our early experience suggests that spread of injectate posterior to the second part of the axillary artery is associated with successful block.
Publication Types:
PMID: 15625259 [PubMed - indexed for MEDLINE]
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Nerve stimulator guided pudendal nerve block decreases posthemorrhoidectomy pain.
Naja Z, Ziade MF, Lonnqvist PA.
Department of Anesthesia and Intensive Care, Makassed General Hospital, B.O. Box: 11-6301 Riad El-Solh 11072210, Beirut, Lebanon. zouhnaja@yahoo.com
PURPOSE: Based on our institution's initial results that reflected reduced postoperative pain using a modified pudendal nerve block technique, we conducted a prospective, randomized, double-blind study to investigate whether a combination of general anesthesia and bilateral nerve stimulator guided pudendal nerve blocks could provide better postoperative pain relief compared to general anesthesia alone or in combination with placebo nerve blocks. METHODS: Following Ethical Committee approval and informed consent 90 patients scheduled for hemorrhoidectomy were randomized to three different groups of 30 patients each: general anesthesia alone, general anesthesia plus nerve stimulator guided pudendal nerve block or general anesthesia plus placebo nerve blocks. Postoperative pain, the primary outcome variable of the study, was assessed by visual analogue scale scores at predetermined time intervals during the postoperative period. Total amount of analgesics, time to return to normal activities and patient satisfaction were also recorded. RESULTS: The pudendal nerve block group was found to have better postoperative pain-relief (P < 0.005), reduced need for analgesics (P < 0.05), and also a more rapid return to normal activities (P < 0.001) compared to general anesthesia alone or in combination with placebo blocks. The pudendal nerve block group was also associated with significantly higher patient satisfaction (P < 0.001) compared to the other two groups. CONCLUSION: A combination of general anesthesia and nerve stimulator guided pudendal nerve block showed significantly reduced postoperative pain, shortened hospital stay, and earlier return to normal activity. Thus, this technique deserves more widespread use in patients undergoing hemorrhoidectomy.
Publication Types:
- Clinical Trial
- Randomized Controlled Trial
PMID: 15625258 [PubMed - indexed for MEDLINE]
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A priming technique accelerates onset of neuromuscular blockade at the laryngeal adductor muscles.
Schmidt J, Irouschek A, Muenster T, Hemmerling TM, Albrecht S.
Department of Anesthesiology, University of Erlangen-Nuremberg, Krankenhausstr. 12, D-91054 Erlangen, Germany. joachim.schmidt@gmx.ch
PURPOSE: Priming is a known technique to accelerate onset of neuromuscular blockade (NMB). Its effect on NMB of the larynx has not been studied yet. METHODS: We compared a priming technique with a bolus application of rocuronium on the onset of NMB at the laryngeal adductor and the adductor pollicis muscles (AP). In 30 female patients, after induction of anesthesia a tube with a surface electrode was placed into the trachea prior to the administration of any neuromuscular blocking agent to monitor electromyography (EMG) of the laryngeal adductor muscles. Neuromuscular monitoring consisted of EMG of the laryngeal adductor muscles and the left AP. Patients were randomized into two groups. After transcutaneous stimulation of the recurrent laryngeal nerve and ulnar nerve, a bolus of rocuronium 0.6 mg x kg(-1) (Bolus group) or a priming dose of rocuronium 0.06 mg x kg(-1) followed by rocuronium 0.54 mg x kg(-1) three minutes later (Priming group) were injected. Lag time, onset 90%, onset time and peak effect of NMB were recorded and compared; a P < 0.05 was considered significant. RESULTS: The onset 90% and onset time measured at the laryngeal adductor muscles (onset: 44.7 +/- 7.4 vs 74.0 +/- 23.8 sec) and at the AP (onset: 105.4 +/- 29.9 vs 139.2 +/- 51.5 sec) were significantly shorter in the Priming group than in the Bolus group. Within groups, the onset times were significantly shorter at the laryngeal muscles in comparison to AP. CONCLUSION: Our results indicate that a priming technique with rocuronium significantly accelerates the onset of NMB at the laryngeal adductor muscles. Our results further support the use of rocuronium as an alternative to succinylcholine for rapid sequence induction.
Publication Types:
- Clinical Trial
- Randomized Controlled Trial
PMID: 15625256 [PubMed - indexed for MEDLINE]
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Vital capacity and patient controlled sevoflurane inhalation result in similar induction characteristics.
Yogendran S, Prabhu A, Hendy A, McGuire G, Imarengiaye C, Wong J, Chung F.
Department of Anesthesia, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada. Suntheralingam.yogendran@uhn.on.ca <Suntheralingam.yogendran@uhn.on.ca>
PURPOSE: To compare patient controlled inhalational induction (PCI) with the most commonly used sevoflurane induction technique, vital capacity inhalational induction (VCI). METHODS: Following approval of the Research Ethics Board, 124 outpatients undergoing knee arthroscopy were randomly assigned to receive either PCI or VCI sevoflurane followed by laryngeal mask airway (LMA) insertion and sevoflurane maintenance. In the PCI group, the circle circuit was not primed. The patients were asked to hold the facemask themselves and breathe normally with sevoflurane 8% in oxygen at a flow rate of 4 L x min(-1). In the VCI group, the circle circuit was primed and patients were asked to take vital capacity breaths with sevoflurane 8% at an oxygen flow rate of 8 L x min(-1). The LMA was inserted as soon as the patient's jaw was relaxed. Time from induction to LMA insertion was recorded and insertion conditions rated. The amount of sevoflurane used for LMA insertion was calculated. Vital signs were monitored at one-minute intervals until ten minutes after LMA insertion. RESULTS: Demographic data were comparable. There were no differences with respect to LMA insertion time (PCI - 3.4 min vs VCI - 3.3 min), laryngospasm (PCI - 7% vs VCI - 5%), mean arterial pressure, heart rate, SaO(2) as well as patient's overall satisfaction. CONCLUSION: PCI was comparable to VCI in sevoflurane induction with respect to the speed of induction, side effects during induction and patient satisfaction. However, PCI requires no special training and is widely applicable to all patient populations.
Publication Types:
- Clinical Trial
- Randomized Controlled Trial
PMID: 15625255 [PubMed - indexed for MEDLINE]
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Xenon does not reduce opioid requirement for orthopedic surgery.
Luginbuhl M, Petersen-Felix S, Zbinden AM, Schnider TW.
Department of Anesthesiology, University Hospital, CH-3010 Bern, Switzerland. martin.luginbuehl@dkf.unibe.ch
PURPOSE: Is to test the hypothesis that 70% xenon has a relevant opioid sparing effect compared to a minimum alveolar concentration (MAC)-equivalent combination of N(2)O and desflurane. METHODS: In this randomized, controlled study of 30 patients undergoing major orthopedic surgery, we determined the plasma alfentanil concentration required to suppress response to skin incision in 50% of patients (Cp(50)) anesthetized with xenon (70%) or a combination of N(2)O (70%) and desflurane (2%). A response was defined as movement, pressor response > 15 mmHg, heart rate > 90 beats x min(-1), autonomic reactions or a combination of these. At skin incision, alfentanil was administered at a randomly selected target plasma concentration thereafter the concentration was increased or decreased according to the patient's response. After skin incision, desflurane was adjusted to maintain the bispectral index below 60 and prevent responsiveness in both groups. RESULTS: The Cp(50) (+/- standard error) of alfentanil was 83 +/- 48ng x mL(-1) with xenon and 49 +/- 26 ng x mL(-1) with N(2)O/desflurane (P =0.451). During surgery five xenon and 15 N(2)O/desflurane patients were given desflurane at 1.0 +/- 0.5 volume % and 2.5 +/- 0.7 volume %. The total age adjusted MAC was 0.97 +/- 0.07 and 0.94 +/- 0.07 respectively (P = 0.217). The intraoperative plasma alfentanil concentrations were 95 +/- 80 and 93 +/- 60 ng x mL(-1) respectively (mean +/- SD; P = 0.451). Patients given xenon were slightly more bradycardic, whereas blood pressure was similar. CONCLUSION: Xenon compared to a MAC-equivalent combination of N(2)O and desflurane does not substantially reduce opioid requirement for orthopedic surgery. A small but clinically irrelevant difference cannot be excluded, however.
Publication Types:
- Clinical Trial
- Randomized Controlled Trial
PMID: 15625254 [PubMed - indexed for MEDLINE]
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