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Items 1 - 45 of 45 |
One page. |
Comment on:
A response to 'Conscious sedation for dental treatment'.
Greenhalgh C.
Publication Types:
PMID: 15819792 [PubMed - indexed for MEDLINE]
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Use of animal products in vegetarians and others.
Sarkar S.
Publication Types:
PMID: 15819783 [PubMed - indexed for MEDLINE]
Comment on:
Conscious sedation for dental treatment.
Wildsmith JA.
Publication Types:
PMID: 15819778 [PubMed - indexed for MEDLINE]
Comment on:
Early thoughts on 'Why mothers die 2000-2002'.
McDonald NI.
Publication Types:
PMID: 15819776 [PubMed - indexed for MEDLINE]
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A comparison of direct laryngoscopy and jaw thrust to aid fibreoptic intubation.
Stacey MR, Rassam S, Sivasankar R, Hall JE, Latto IP.
Department of Anaesthetics and Intensive Care Medicine, University Hospital of Wales, Cardiff, CF14 4XW, UK. airwayman@doctors.org.uk <airwayman@doctors.org.uk>
We compared two manoeuvres, jaw thrust and laryngoscopy, to open the airway during fibreoptic intubation in 50 patients after induction of anaesthesia in a crossover study. Patients were randomly allocated to receive either jaw thrust or conventional Macintosh laryngoscopy first. Airway clearance was assessed at both the soft palate and the epiglottis. Direct laryngoscopy provided significantly better airway clearance at the level of the soft palate than jaw thrust (44 (88%) vs 31 (62%), respectively; p = 0.002). At the level of the larynx, airway clearance was equally good in both groups (45 (90%) vs 46 (92%), respectively; p = 0.56). The times to view the larynx (median (interquartile range [range]) 4 (3-5 [2-35]) s vs 3 (3-4 [2-8]) s, respectively) and intubation time (20 (17-23 [11-83]) s vs 18 (15-20 [11-28]) s, respectively) were also similar.
Publication Types:
- Clinical Trial
- Randomized Controlled Trial
PMID: 15819763 [PubMed - indexed for MEDLINE]
[Preoperative abstinence from smoking An outdated dogma in anaesthesia?]
[Article in German]
Zwissler B, Reither A.
Klinik fur Anasthesiologie, Intensivmedizin und Schmerztherapie, Johann Wolfgang Goethe-Universitat, Frankfurt/Main.
For decades it has been assumed, that smoking within 6 hours of anesthesia and surgery raises the incidence of perioperative cardiopulmonary complications (PPC) including aspiration. Therefore, every patient is adviced to stop smoking at the day before surgery, and not to smoke at all at the day of surgery. If the patient does not follow this advice, this will result in a postponement of anesthesia and surgery. The present article aims at re-investigating the scientific basis of this dogma in anesthesia, which virtually forbids smoking at short-term prior to surgery. The influence of short-term (6 h) abstinence from smoking on the perioperative pulmonary morbidity has not been systematically investigated. Interestingly, giving up smoking less than two months prior to surgery does not significantly decrease, but rather may increase the incidence of PPC. With respect to the risk of aspiration, smoking does not increase either the volume or the acidity of gastric juices. A short-lived reduction in the tone of the lower esophageal sphincter is reversible within minutes after termination of smoking. While the emptying of liquid gastric juices is not influenced by smoking, there is a certain delay in the propulgation of solid food. This effect, however, is probably of no clinical relevance in patients, who had their last solid meal the evening before surgery. Hence, we conclude that the anesthesia dogma, which rules out smoking shortly prior to anesthesia, cannot be based on an otherwise increased incidence of pulmonary aspiration or other pulmonary morbidity. However, acute smoking (probably by an increase in COHb) may increase the incidence of myocardial ischemia during exercise and anesthesia. With reference to this possible cardiac complication it still seems reasonable to discourage smoking at least 12 to 48 hours prior to surgery in patients with elevated cardiac risk.
PMID: 15895200 [PubMed - as supplied by publisher]
Comment on:
Avoid excessive sedation during cervical injections.
Gajraj NM.
Publication Types:
PMID: 15791127 [PubMed - indexed for MEDLINE]
Comment on:
Of mice and men: should we extrapolate rodent experimental data to the care of human neonates?
Soriano SG, Anand KJ, Rovnaghi CR, Hickey PR.
Publication Types:
PMID: 15791124 [PubMed - indexed for MEDLINE]
Comment on:
The right thing in the right place: lumbar plexus block in children.
Johr M.
Publication Types:
PMID: 15791123 [PubMed - indexed for MEDLINE]
Comment on:
GW280430A.
Geldner GF, Blobner M.
Publication Types:
PMID: 15791119 [PubMed - indexed for MEDLINE]
Comment on:
GW280430A: pharmacodynamics and potential adverse effects.
Lien CA, Belmont MR, Heerdt PM.
Publication Types:
PMID: 15791118 [PubMed - indexed for MEDLINE]
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Postextubation laryngospasm in a patient with spasmodic dysphonia.
Capacchione JF, Bodily K, Hudson AJ.
Department of Anesthesiology, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814, USA. jcapacchione@usuhs.mil
Publication Types:
PMID: 15791117 [PubMed - indexed for MEDLINE]
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Pulmonary atelectasis: a pathogenic perioperative entity.
Duggan M, Kavanagh BP.
Departments of Anesthesia and Critical Care Medicine and the Lung Biology Program, Hospital for Sick Children, 555 University Avenue, Toronto, Ontario, Canada M5G 1X8.
Atelectasis occurs in the dependent parts of the lungs of most patients who are anesthetized. Development of atelectasis is associated with decreased lung compliance, impairment of oxygenation, increased pulmonary vascular resistance, and development of lung injury. The adverse effects of atelectasis persist into the postoperative period and can impact patient recovery. This review article focuses on the causes, nature, and diagnosis of atelectasis. The authors discuss the effects and implications of atelectasis in the perioperative period and illustrate how preventive measures may impact outcome. In addition, they examine the impact of atelectasis and its prevention in acute lung injury.
Publication Types:
PMID: 15791115 [PubMed - indexed for MEDLINE]
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Does preoperative coronary angioplasty improve perioperative cardiac outcome?
Godet G, Riou B, Bertrand M, Fleron MH, Goarin JP, Montalescot G, Coriat P.
Anesthesiology and Critical Care, Hospitalo-Universitaire Pitie-Salpetriere, 47 Boulevard de l'Hopital, 75651 Paris cedex 13, France. gilles.godet@psl.ap-hop-paris.fr
BACKGROUND: Percutaneous coronary intervention (PCI) is performed in patients with coronary artery disease who are undergoing major noncardiac procedures to reduce perioperative cardiac morbidity and mortality. However, the impact of this approach on postoperative outcome remains controversial. METHODS: The authors analyzed a cohort of 1,152 patients after abdominal aortic surgery in which 78 patients underwent PCI. A propensity score analysis was performed. Also, using a logistic regression model, the authors determined variables associated with a severe postoperative coronary event or a death in patients without PCI. Then, in patients with PCI, they compared the expected and observed outcome. RESULTS: Five variables (age > 75 yr, blood transfusion > 3 units, repeated surgery, preoperative hemodialysis, and previous cardiac failure) independently predicted (with 94% correctly classified) a severe postoperative coronary event, and five variables (age > 75 yr, repeated surgery, previously abnormal ST segment/T waves, previous hypertension, and previous cardiac failure) independently predicted (with 97% correctly classified) postoperative death. In the PCI group, the observed percentages of patients with a severe postoperative coronary event (9.0% [95% confidence interval, 4.4-17.4]) or death (5.1% [95% confidence interval, 2.0-12.5]) were not significantly different from the expected percentages (8.2 and 6.9%, respectively). When all patients were pooled together, the odds ratios of PCI were not significant. The propensity score analysis provided a similar conclusion. CONCLUSION: PCI did not seem to limit significantly cardiac risk or death after aortic surgery.
Publication Types:
PMID: 15791102 [PubMed - indexed for MEDLINE]
[Paracervical block]
[Article in French]
Bolandard F, Bonnin M, Mission JP, Duband P, Bazin JE.
Service d'anesthesie-reanimation, Hotel-Dieu, polyclinique, CHU de Clermont-Ferrand, boulevard Leon-Malfreyt, 63058 Clermont-Ferrand cedex 1, France. fbolandard@chu-clermontferrand.fr
Publication Types:
PMID: 15792574 [PubMed - indexed for MEDLINE]
-
[Paracervical block for hysteroscopy in patient with spinal muscular atrophy]
[Article in French]
Sleth JC, Oks S.
Publication Types:
PMID: 15792573 [PubMed - indexed for MEDLINE]
-
[Neuraxial anaesthesia and hereditary motor and sensory neuropathies]
[Article in French]
Al-Nasser B.
Publication Types:
PMID: 15792572 [PubMed - indexed for MEDLINE]
-
[Catheter-related infections: how to reduce the risk?]
[Article in French]
Perrigault PF, Jaber S, Eledjam JJ.
Departement d'anesthesie-reanimation B, unite de reanimation et transplantation, hopital Saint-Eloi, 34295 Montpellier cedex 05, France. pf-perrigault@chu-montpellier.fr
Subcutaneous tunnelling of short-term catheters and the choice of site of catheter insertion are the two factors which influence the risk of catheter-related infection. Catheters inserted into a femoral vein have been associated with a higher risk of infection than those inserted into a subclavian vein. However, a meta-analysis comparing the internal jugular and subclavian sites did not report any difference. Regarding tunnelling, two randomized studies showed a benefit in terms of infection rates for the jugular and femoral sites when the blood sampling was not performed via the catheters. For the subclavian site tunnelling does not seem to bring any advantage compared to conventional insertion.
Publication Types:
PMID: 15792565 [PubMed - indexed for MEDLINE]
-
[On what grounds assessing the diagnosis of catheter-related infection?]
[Article in French]
Mimoz O.
Departement d'anesthesie-reanimation, CHU, 2, rue Miletrie, 86000 Poitiers, France. o.mimoz@chu-poitiers.fr
Clinical assessment of catheter-related infection is difficult. Microbiological techniques have not always been clearly evaluated. Indirect microbiological techniques, leaving the catheter on site are reserved to well tolerated infections. In case of catheter withdrawal, quantitative culture of the endovascular tip of the catheter should be preferred.
PMID: 15792564 [PubMed - indexed for MEDLINE]
-
[Catheter-related infections: microbiology]
[Article in French]
Timsit JF.
Service de reanimation medicale, CHU, hopital Michallon, 38043 Grenoble, France. Jf.timsit@outcomerea.org
Coagulase negative staphylococci, Staphylococcus aureus and Pseudomonas sp. are the most frequent microorganisms responsible for catheter-related infections. A relative frequency of microorganisms varies according to the countries, microenvironment and outbreaks of multiresistant bacterias. Infections due to fungi, S. aureus and Pseudomonas sp. are associated with the more severe complications. Recent data suggest that chlorhexidine, either used for cutaneous antisepsis or for catheter impregnation decreases infections due to gram positive cocci. Ecological data should be taken into account when deciding a probabilistic treatment in case of suspicion of catheter-related infection.
Publication Types:
PMID: 15792563 [PubMed - indexed for MEDLINE]
-
[Epidemiology of catheter-related infections in intensive care unit]
[Article in French]
Merrer J.
Unite d'hygiene et de lutte contre les infections nosocomiales, centre hospitalier de Poissy/Saint-Germain-en-Laye, departement de sante publique, centre hospitalier, 10, rue du champ-Gaillard, 78300 Poissy, France. jmerrer@chi-poissy-st-germain.fr
Catheter-related infections remain an important cause of nosocomial infection in the ICU. They include colonization of the device, exit-site infection and catheter-related bloodstream infection with or without bacteraemia. Data from clinical studies and surveillance networks should be compared cautiously due to important methodological differences and wide variations of device-utilization ratio between units or countries. In France, two regional networks (C-CLIN Paris-Nord and C-CLIN Sud-Est) produced comparable and reproducible results. Colonization represents five-six cases per 1000 catheter-days and bacteraemia represents one case per 1000 catheter-days. Incidence rates from North American studies are usually four to five times higher. Numerous risk factors have been identified. Some of them could be used to stratify patients according to risk of catheter-related infection and to allow more valid comparison between ICU's performances. Participation of French ICUs to the recent national surveillance networks (REA RAISIN and REACAT RAISIN) should be encouraged.
PMID: 15792562 [PubMed - indexed for MEDLINE]
-
[Interest of mannequin based simulator to evaluate anaesthesia residents]
[Article in French]
Lebuffe G, Plateau S, Tytgat H, Vallet B, Scherpereel P.
Clinique d'anesthesie-reanimation, hopital Huriez et unite fonctionnelle de recherche de la federation d'anesthesie-reanimation, CHRU de Lille, rue Michel-Polonovski, 59037 Lille cedex, France. g-lebuffe@chru-lille.fr
OBJECTIVE: The aim of this study was to test simulator validity to evaluate the ability of anaesthesia residents to solve two simulated scenarios. STUDY DESIGN: Monocentre, prospective, randomized study. POPULATION: Anaesthesia residents. METHODS: All anaesthesia residents were invited to participate into the study but were free to decline to take part. The authors developed grading forms to evaluate preoperative preparation of anaesthesia room and two simulated scenarios which had been previously validated. All residents were evaluated on the preoperative preparation of anaesthesia room. A randomization was performed to select half of the residents to be tested on one of the simulated scenario. Two experienced anaesthesiologists scored the residents' performance. At the end of the simulated session, residents rated the realism of the scenarios. RESULTS: Among 72 training residents in our institution, 48 participated with 24 beginning and 24 advanced residents. Median scores were similar between beginning (first and second year) and advanced residenced (third and fourth year) for the preoperative preparation of anaesthesia room (17 vs 17 for a maximal score of 25) while scores tended to be higher in advanced residents for simulated scenarios (scenario 1 [34 vs 19 for a maximal score of 55; p = 0.0009], scenario 2 [17 vs 13 for a maximal score of 45; p = 0.58]). However, numerous management errors were observed and some of them did not improve with training. Anaesthesia residents rated the simulator scenarios as realistic. CONCLUSION: This study suggests that mannequin-based simulator appears as a reliable and valid tool to test the performance of anaesthesia residents during critical situations.
PMID: 15792559 [PubMed - indexed for MEDLINE]
-
[Unilateral spinal anaesthesia in elderly patient for hip trauma: a pilot study]
[Article in French]
Khatouf M, Loughnane F, Boini S, Heck M, Meuret P, Macalou D, Mertes PM, Bouaziz H.
Service d'anesthesie-reanimation chirurgicale, hopital central, 29, avenue du Marechal de Lattre-de-Tassigny, 54035 Nancy cedex, France.
INTRODUCTION: Fractured neck of femur is encountered more frequently as life expectancy increases. All anaesthetic techniques aim to avoid deleterious fall in arterial blood pressure. The haemodynamic effects of hypobaric unilateral spinal anaesthesia have been rarely assessed in patients over 80 year's old. This study aims to do that in a prospective manner. PATIENTS AND METHODS: Twenty-five patients were enrolled. Following a preload with HES 240/0.576 % (Hesteril) (5 ml/kg) and the administration of an iliofascial block, patients were placed in the lateral decubitus position, operative side uppermost. 3.5 ml of 0.12% hypobaric bupivacaine was administered intrathecally at a rate of 0.25 ml/second. Patients were kept in position for 15 minutes. Systolic, mean and diastolic arterial pressures, heart rate, SaO2 % and ephedrine consumption were recorded at five minutes intervals as was the rate of onset, height and duration of sensory and motor block and extent of bilateralization. Patient and surgeon satisfaction scores were also recorded. RESULTS: No significant changes in systolic, mean and diastolic pressures, or SaO2 % occurred. Median onset times of sensory and motor block were 8+/-5 and 16+/-7 minutes on the operative side and 30+/-15 and 36+/-15 minutes on the contralateral side in those with bilateralization, respectively. The maximum height of sensory block was T6 for sept patients, T8 for huit patients and T8-T10 for the remainder. Mean duration of sensory and motor block was 134+/-26 and 119+/-24 minutes on the operative side and 100+/-26 and 98+/-25 minutes on the contralateral side, respectively. In 12 patients (48%) bilateralization of their block occurred. Patients and surgeons rated the technique highly. CONCLUSION: Hypobaric unilateral spinal anaesthesia is a simple technique, produces satisfactory operative conditions and induces very little haemodynamic change in the elderly population.
PMID: 15792557 [PubMed - indexed for MEDLINE]
-
[Regionalization of obstetric services and anaesthetic workload in a tertiary level perinatal unit]
[Article in French]
Miliani Y, Deruddre S, Benhamou D.
Departement d'anesthesie-reanimation, hopital Antoine-Beclere, 157, rue de la-Porte-de-Trivaux, BP 405, 92140 Clamart cedex, France.
OBJECTIVE: Evaluation of anaesthetic workload associated with care of high-risk pregnant women (i.e. patients transferred to a referral perinatal center). STUDY DESIGN: A case-control prospective study. METHODS: During a three-month period, 63 women with in-utero transfer and their control counterparts (63 normal pregnancies) were prospectively followed until discharge. RESULTS: At inclusion, high-risk patients (n = 63) were more frequently scored ASA 2 or more (21 vs 0%, p < 0.05). ASA score had increased at delivery in 8% of high-risk women and in none of controls. ICU admission (4 vs none), Caesarean delivery (57 vs 11%), preanaesthetic visit at night (41 vs 0%) and general anaesthesia (27 % versus none) were all more frequent in high-risk parturients (p < 0.05). CONCLUSION: Comparison of the workload associated with high-risk patients and normal pregnant women confirms the need for increased anaesthetic staffing in referral perinatal centers and provides a basis for better understanding the distribution of anaesthetic requirements in each perinatal network.
PMID: 15792556 [PubMed - indexed for MEDLINE]
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[The neurostimulator for brachial plexus blockade by the axillary approach: a metaanalysis on its efficacy to increase the success rate]
[Article in French]
Guay J.
Departement d'anesthesie-reanimation, hopital Maisonneuve-Rosemont, universite de Montreal, 5415, boulevard l'Assomption, Montreal, Quebec, Canada H1T 2M4. joanne.guay@umontreal.ca
OBJECTIVE: To evaluate the effectiveness of the neurostimulator to improve the success rate of a brachial plexus blockade by the axillary approach. STUDY DESIGN: Metaanalysis. METHODS: Ten prospective randomized studies comparing a neurostimulating technique (NST) of brachial plexus blockade performed by the axillary approach to another technique were kept for analysis. A successful block was defined as blockade of the four following nerves: radial, median, ulnar and musculocutaneous. Data were entered on an intention to treat basis and were analyzed with a random model. A p<0.05 was considered significant. RESULTS: Data were heterogenous (p < 0.001) and the Cochran-Mantel-Haenzel test showed that the neurostimulator does not improve the success rate of brachial plexus blocks performed by the axillary approach when all available studies are considered as a whole (p = 1). For the subgroup of studies where four nerves were stimulated however, the NST decreases the incidence of failed block by 25% (95% CI = 7-42%) (p < 0.0001). There were 12 patients with systemic signs of local anesthetics toxicity when a NST was used compared to 28 when it was not (p = 0.04), relative risk of 0.7 (95% CI= 0.6-0.8). CONCLUSION: This study shows that the neurostimulator improves the success rate of brachial plexus blocks performed by the axillary approach only when three nerves or more are stimulated and its use decreases the incidence of systemic local anaesthetics toxicity.
Publication Types:
PMID: 15792555 [PubMed - indexed for MEDLINE]
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[Nerve stimulation, nerve stimulator and the reasoned multiple nerve stimulation technique...]
[Article in French]
Jochum D, Delaunay L.
Publication Types:
PMID: 15792554 [PubMed - indexed for MEDLINE]
Comment on:
What's the evidence that NICE guidance has been implemented? Analysis is subject to confounding.
Tilley C, Crawford F, Clarkson J, Pitts N, McCann M.
Publication Types:
PMID: 15879402 [PubMed - indexed for MEDLINE]
Comment on:
Contamination of anaesthetic gases with nitric oxide and its influence on oxygenation.
Carette RM, Hendrickx JF, De Wolf AM.
Publication Types:
PMID: 15892187 [PubMed - indexed for MEDLINE]
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The use of transillumination for peripheral venous access in paediatric anaesthesia.
Atalay H, Erbay H, Tomatir E, Serin S, Oner O.
Publication Types:
PMID: 15892415 [PubMed - in process]
-
Anaesthesia in vitreo-retinal surgery.
Absalom A, Mitchell E, Goldsmith C, Burton R.
Publication Types:
PMID: 15892414 [PubMed - in process]
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Fentanyl reduces cortisol and blood glucose changes during cataract surgery under retrobulbar anaesthesia.
Sivaci RG, Ermis S, Ozturk F.
Publication Types:
PMID: 15892413 [PubMed - in process]
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Time course and train-of-four fade of mivacurium block during sevoflurane and intravenous anaesthesia.
Barrio J, SanMiguel G, Asensio I, Molina I, Lopez F, Garcia V.
Hospital Arnau de Vilanova, Department of Anaesthesiology, Valencia, Spain. jabama16@hotmail.com
BACKGROUND AND OBJECTIVE: Volatile anaesthetics inhibit nicotinic acetylcholine receptors at clinically relevant concentrations with higher affinity for the neuronal nicotinic receptor. The inhibitory effects of propofol on nicotinic receptors have only been documented at supraclinical concentrations. The aim of this study was to determine recovery properties and train-of-four (TOF) fade of mivacurium during sevoflurane and propofol anaesthesia, in order to examine any differences both in the enhancement of the neuromuscular block (postjunctional effects) and in TOF fade (prejunctional effects). METHODS: Twenty ASA I-II adult patients were randomly allocated to maintenance of anaesthesia with sevoflurane (end-tidal concentration 2%) or propofol. Neuromuscular block was assessed by acceleromyography and a single dose of mivacurium (0.15 mg kg(-1)) was administered (in the sevoflurane group after 30 min of exposure to sevoflurane). We measured time for recovery of the first twitch of the TOF (T1) from 25-75%, time from 25% recovery of T1 to achieving a TOF ratio (TOFR) of 0.8, TOFR at 50%, 75% and 90% recovery of T1, and height of T1 at TOFR of 0.7 and 0.9. Data were tested using t-test for independent samples. RESULTS: Recovery times (mean (95% confidence interval, CI)) of mivacurium in the sevoflurane group (T1 25-75%, 11.3 (8.1-14.5) min; T1 25%-TOFR0.8, 19.1 (15.7-22.5) min) were significantly longer (P < 0.05) than in the propofol group (T1 25-75%, 6.5 (5.2-7.7) min; T1 25%-TOFR0.8, 11.3 (7.8-10.3) min). No differences were found in the relations between TOFR and T1 or vice versa, between the groups. CONCLUSIONS: Recovery times after a single dose of mivacurium were prolonged by sevoflurane compared with propofol but no differences in TOF fade were observed between the two anaesthetics.
PMID: 15892410 [PubMed - in process]
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Anaesthesia and circulating blood volume.
Sano Y, Sakamoto A, Oi Y, Ogawa R.
Nippon Medical School, Department of Anaesthesiology, Tokyo, Japan. yuka-ki@bd5.so-net.ne.jp
BACKGROUND AND OBJECTIVE: The exact change in circulating blood volume (BV) during general anaesthesia is still unknown because there is no standard method of evaluating BV. We evaluated the changes in BV by general anaesthesia using simple and easy estimation methods. METHODS: Fourteen patients scheduled for minor surgery under general anaesthesia were enrolled. Propofol and vecuronium bromide were used for the induction of anaesthesia, and anaesthesia was maintained with sevoflurane and nitrous oxide. Haematocrit (Hct), total protein concentration (TP), as well as colloid osmotic pressure (COP) measured using a colloid osmometer, were determined before anaesthesia, and 30, 60 and 90 min after the induction of general anaesthesia. BV was calculated using Allen's formula and the changes in Hct, TP and COP. The estimated BV was compared with directly measured BV using indocyanine green dilution method (BV(ICG)). RESULTS: Hct, TP and COP significantly decreased after the induction of anaesthesia (Hct: 42.1-39.4%; TP: 7.3-6.9 g dL(-1); COP: 23-19 mmHg). The calculated BV as well as BV(ICG) significantly increased after induction of anaesthesia (calculated by COP: 4.13-5.03 L; BV(ICG): 4.54-5.56 L). The change rate in BV calculated by the change of COP was larger than other calculated BVs, and was approximated to the change rate in BV(ICG). After emergence from anaesthesia, all values tended to return to baseline. CONCLUSIONS: General anaesthesia increases BV. The value of BV calculated from the change in COP was most changeable.
PMID: 15892402 [PubMed - in process]
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Impact of nitric oxide synthase inhibitor and chloride channel antagonist on mesenteric vascular conductance in anesthetized Dahl normotensive and hypertensive rats.
Parai K, Tabrizchi R.
Division of Basic Medical Sciences, Faculty of Medicine, Memorial University of Newfoundland, St. John's, Newfoundland, Canada.
The effects of nitric oxide synthase inhibitor N-nitro-L-arginine methyl ester (L-NAME) and chloride channel antagonist niflumic acid on vascular responsiveness to the effect of alpha1-adrenoceptor stimulation in the mesenteric bed of Dahl salt-resistant normotensive (SRN) and salt-sensitive hypertensive (SSH) rats were examined. Dahl salt-resistant and salt-sensitive rats were fed a high-salt diet (4% NaCl) for 7 weeks, and blood pressure, heart rate, and mesenteric blood flow were measured before and after treatment with L-NAME (0.3 mg/kg, IV) and/or niflumic acid (10 mg/kg, IV). Morphometry of the primary mesenteric blood vessel was also assessed. Administration of alpha1-adrenoceptor agonist cirazoline produced a dose-dependent increase in blood pressure, decrease in heart rate, mesenteric blood flow, and mesenteric vascular conductance in SRN and SSH rats. L-NAME significantly increased basal blood pressure and decreased basal mesenteric blood flow and vascular conductance in SRN but not in SSH rats. Niflumic acid attenuation of cirazoline-mediated decreases in mesenteric blood flow and vascular conductance was more pronounced in the SRN than SSH rats. This difference in the inhibitory actions of niflumic acid was absent following its concomitant administration with L-NAME. It seems that tonic release of nitric oxide modulates niflumic acid-sensitive chloride channels in vascular muscle. Blood vessels from SSH rats had significantly larger smooth muscle thickness and lumen diameter, but the ratio of the 2 were not different between the SRN and SSH. Our findings support the view that alterations in receptor-mediated signal transduction, rather than just changes in blood vessel architecture, are responsible for differences in behavior of blood vessels in salt-induced hypertensive rats.
PMID: 15897785 [PubMed - in process]
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Maximum recommended doses of local anesthetics: a constant cause of confusion.
Reynolds F.
PMID: 15898045 [PubMed - in process]
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High potential for epidural analgesia neuraxial block-associated hypotension in conjunction with heated intraoperative intraperitoneal chemotherapy.
De la Chapelle A, Perus O, Soubielle J, Raucoules-Aime M, Bernard JL, Bereder JM.
PMID: 15898044 [PubMed - in process]
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Labeling as a tool to reduce drug error in anesthesia practice.
Al-Nasser B.
PMID: 15898042 [PubMed - in process]
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Use of colored syringes reduces the incidence of syringe swap during anesthesia.
Hirabayashi Y, Seo N.
PMID: 15898040 [PubMed - in process]
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Rapid onset of massive subdural anesthesia.
Wills JH.
Objective This case report describes the accidental placement of a lumbar labor epidural catheter into the subdural space resulting in the rapid onset of massive subdural anesthesia. Case Report A single-orifice open-ended catheter was accidentally placed in the lumbar subdural space. After a test dose of 3 mL 1.5% lidocaine with 15 mug of epinephrine and 2 minutes after a bolus of 5 mL of 0.25% bupivacaine, there was a rapid onset of massive subdural anesthesia with a loss of consciousness, respiratory arrest, and absent pulses. The subdural catheter placement was confirmed by injection of a contrast agent under fluoroscopy. Conclusion Massive subdural anesthesia is a complication of epidural catheter placement and may have a rapid onset causing a loss of consciousness, respiratory arrest, and absent pulses.
PMID: 15898035 [PubMed - in process]
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Two-pore domain potassium channels: new sites of local anesthetic action and toxicity.
Kindler CH, Yost CS.
Potassium (K + ) channels form the largest family of ion channels with more than 70 such genes identified in the human genome. They are organized in 3 superfamilies according to their predicted membrane topology: (1) subunits with 6 membrane-spanning segments and 1-pore domain, (2) subunits with 2 membrane-spanning segments and 1-pore domain, and (3) subunits with 4 membrane-spanning segments and 2-pore domains arrayed in a tandem position. The last family has most recently been identified and comprises the so-called 2-pore domain potassium (K 2P ) channels, believed responsible for background or leak K + currents. Despite their recent discovery, interest in them is growing rapidly with more than 270 references in the literature reported ( www.ipmc.cnrs.fr/ approximately duprat/2p/ref2p.htm#2P , accessed October 30, 2004). K 2P channels are widely expressed in the central nervous system and are involved in the control of the resting membrane potential and the firing pattern of excitable cells. This article will therefore review recent findings on actions of local anesthetics with respect to K 2P channels. It begins with an overview of the role of background K + channels in neuronal excitability and nerve conduction and is followed by a description of the K 2P channel family including experimental evidence for the contribution of K 2P channels to the mechanism of action and toxicity of local anesthetics.
PMID: 15898030 [PubMed - in process]
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Medial canthus single-injection peribulbar anesthesia: a prospective randomized comparison with classic double-injection peribulbar anesthesia.
Deruddre S, Benhamou D.
Background and Objectives The authors report the first prospective randomized comparison of the medial canthus single-injection peribulbar anesthesia (also called caruncular anesthesia) with the classic double-injection peribulbar technique. Methods One hundred patients scheduled for cataract surgery were randomly assigned to either a single medial canthus injection or a double peribulbar injection of mepivacaine 2%. The amount of anesthetic agent injected was clinically adapted to each patient. Akinesia, volume injected, pain, reinjections, and complications were assessed after the procedure. Results The medial canthus single-injection peribulbar anesthesia was significantly less painful and required less anesthetic agent than the double-injection peribulbar anesthesia. Akinesia score and the reinjection rate were similar in the 2 groups, whereas chemosis was significantly more frequent in the double-injection group. Conclusions Medial canthus single-injection peribulbar anesthesia appears to be an effective alternative to the usual double-injection peribulbar anesthesia.
PMID: 15898029 [PubMed - in process]
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Resident versus staff anesthesiologist performance: coracoid approach to infraclavicular brachial plexus blocks using a double-stimulation technique.
Minville V, Asehnoune K, Chassery C, N'guyen L, Gris C, Fourcade O, Samii K, Benhamou D.
Objectives Infraclavicular brachial plexus block with double stimulation (ICB) is a safe technique for upper-limb anesthesia. However, the experience of learning this technique by anesthesiology residents has not been reported. The aim of this study was to compare staff with resident anesthesiologists in the performance of ICB. Methods Patients scheduled for orthopedic surgery of the upper limb were included in a prospective, comparative, randomized study and were given ICB by either staff anesthesiologist (Group S, n = 110 patients) or resident anesthesiologist (Group R, n = 110 patients). Results Time to perform the block was 3.9 minutes (95% confidence interval [CI95%] = 3.5 to 4.3) for Group S and 5.8 minutes (CI95% = 5.2 to 6.4) for Group R ( P < .05). The onset time was 14.4 minutes (CI95% = 13.5 to 15.3) for Group S and 15.9 minutes (CI95% = 14.7 to 17.1) for Group R ( P = NS). Success rate was 93% for Group S and 90% for Group R ( P = NS). Supplementation was performed in 8 patients in Group S versus 11 patients in Group R ( P = NS). No patient needed general anesthesia. One self-limited vascular puncture was made in Group S versus 3 in Group R ( P = NS). Conclusion This report determines whether residents can perform this technique with comparable efficiency compared with staff. We conclude that ICB should be taught as part of all resident training programs.
PMID: 15898025 [PubMed - in process]
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The training and careers of regional anesthesia fellows-1983-2002.
Neal JM, Kopacz DJ, Liguori GA, Beckman JD, Hargett MJ.
Background and Objectives The education and subsequent careers of regional anesthesia fellows have not been examined but may provide insight into improving future fellowship training and/or the future of the subspecialty. Methods Regional anesthesia fellows educated during a 20-year period (1983-2002) were asked to complete a comprehensive survey that detailed their training, current professional setting, and use of regional anesthesia, and how they foresee the future of regional anesthesia. A separate survey of academic anesthesiology chairs assessed the role of and need for regional anesthesiologists in teaching departments. Results Twelve regional anesthesia fellowship programs in the United States and Canada provided contact information on 176 former fellows. The survey response rate from those practicing in North America was 49% (77/156). Two of the 12 responding institutions have trained 68% of regional anesthesia fellows. Of respondents, 61% are or have been in academic practice. Regional anesthesia remains an integral part of most respondents' current practice, as evidenced by significant use of regional techniques, active involvement in subspecialty societies, and participation in continuing medical education programs. Academic chairs indicate that fellowship-trained regional anesthesiologists play important roles in resident education and are in demand by academic departments. Conclusions This report details how regional anesthesia fellows from 1983 to 2002 were trained and how they currently practice and examines their insights regarding the strengths and weaknesses of past and future regional anesthesia education.
PMID: 15898024 [PubMed - in process]
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Guidelines for regional anesthesia fellowship training.
Hargett MJ, Beckman JD, Liguori GA, Neal JM.
Background The number of regional anesthesia fellowships has grown over the past 2 decades. There currently exist no guidelines for what constitutes ideal regional anesthesia fellowship training. Methods Regional anesthesia fellowship program directors and other advocates of regional anesthesia were invited to participate in a collaborative project to establish a standardized curriculum for regional anesthesia fellowships. Guidelines were created based on the existing template of Accreditation Council of Graduate Medical Education program requirements for residency education in anesthesiology. The resulting draft guidelines were distributed at a meeting of the program directors, who were then asked to forward all comments and relevant training material from their respective institutions to a coordinating institution. Results All received materials were reviewed, and selected components were collated into a consensus document, which was then reviewed, modified, and eventually approved by the program directors over a 2-year series of meetings. The program directors agreed to adopt the guidelines as their fellowship curriculum and to evaluate their effectiveness in 2 years' time. Conclusions The intent of these initial guidelines is to improve the quality and consistency of regional anesthesia fellowship training. The creation process also led to an affirmation of the directors' commitment to continued dialogue for the purpose of facilitating the exchange of ideas among programs.
PMID: 15898023 [PubMed - in process]
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Fellowship training in regional anesthesia.
Brown DL.
PMID: 15898022 [PubMed - in process]
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