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Items 1 - 45 of 45 |
One page. |
Failure of a Luer lock.
Fletcher SJ.
Publication Types:
PMID: 15644031 [PubMed - indexed for MEDLINE]
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Full disclosure of risks.
White SM, Baldwin TJ.
Publication Types:
PMID: 15644029 [PubMed - indexed for MEDLINE]
Comment on:
Conscious sedation for children.
Lahoud G.
Publication Types:
PMID: 15644022 [PubMed - indexed for MEDLINE]
Comment on:
Conscious sedation for dental treatment.
Wildsmith JA.
Publication Types:
PMID: 15644021 [PubMed - indexed for MEDLINE]
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Failed tracheal intubation in obstetrics: no more frequent but still managed badly.
Rahman K, Jenkins JG.
Department of Anaesthesia, Royal Surrey County Hospital, Egerton Road, Guildford GU2 7XX, UK.
In the South-West Thames region of the United Kingdom, during a 5-year period from 1999 to 2003, there were 20 failed tracheal intubations occurring in 4768 obstetric general anaesthetics (incidence 1 : 238). In half of the 16 cases for which the patient's notes could be examined there was a failure to follow an accepted protocol for failed tracheal intubation.
Publication Types:
PMID: 15644015 [PubMed - indexed for MEDLINE]
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Cerebrospinal fluid and serum concentrations of beta-trace protein during pregnancy.
McArthur J, Hill J, Paech MJ, Dodd PH, Bennett EJ, Holden J.
Department of Anaesthesia and Pain Medicine, King Edward Memorial Hospital for Women, 374 Bagot Road, Subiaco, WA 6008, Australia.
We conducted a prospective observational study among a cohort of 40 term parturients undergoing spinal anaesthesia for elective Caesarean section, to determine the concentration of beta-trace protein in cerebrospinal fluid (CSF) and serum. Serum and CSF samples, taken at the time of dural puncture, were assayed by nephelometry. The mean serum beta-trace protein concentration was 0.39 mg.l(-1) and the mean CSF concentration was 27.9 mg.l(-1), giving a mean ratio of CSF to serum concentration of 76. This ratio is higher than that published for non-pregnant females and for males because of both a higher mean CSF and a lower mean serum beta-trace protein concentration. The concentration correlated positively with both serum creatinine and gestational age. If these concentrations are used to estimate the normal range, we propose that the nephelometric measurement of beta-trace protein might prove a useful diagnostic test for cerebrospinal fluid-cutaneous fistula in parturients.
Publication Types:
PMID: 15644014 [PubMed - indexed for MEDLINE]
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Comparison of the intubating laryngeal mask airway and laryngeal tube placement during manual in-line stabilisation of the neck.
Komatsu R, Nagata O, Kamata K, Yamagata K, Sessler DI, Ozaki M.
Department of Anesthesiology, University of Louisville, Louisville, KY, USA. r0koma01@gwise.louisville.edu
We compared the placement of the laryngeal tube (LT) with the intubating laryngeal mask airway (ILMA) in 51 patients whose necks were stabilised by manual in-line traction. Following induction of anaesthesia and neuromuscular blockade, the LT and ILMA were inserted consecutively in a randomised, crossover design. Using pressure-controlled ventilation (20 cmH(2)O inspiratory pressure), we measured insertion attempts, time to establish positive-pressure ventilation, tidal volume, gastric insufflation, and minimum airway pressure at which gas leaked around the cuff. Data were compared using Wilcoxon signed-rank tests; p < 0.05 was considered significant. Insertion was found to be more difficult with the LT (successful at first attempt in 16 patients) than with the ILMA (successful at first attempt in 42 patients, p < 0.0001). Time required for insertion was longer for the LT (28 [23-35] s, median [interquartile range]) than for the ILMA (20 [15-25] s, p = 0.0009). Tidal volume was less for the LT (440 [290-670] ml) than for the ILMA (630 [440-750] ml, p = 0.013). Minimum airway pressure at which gas leak occurred and incidence of gastric insufflation were similar with two devices. In patients whose necks were stabilised with manual in-line traction, insertion of the ILMA was easier and quicker than insertion of the LT and tidal volume was greater with the ILMA than the LT.
Publication Types:
- Clinical Trial
- Randomized Controlled Trial
PMID: 15644005 [PubMed - indexed for MEDLINE]
[Locoregional anesthesia and coagulation inhibitors Empfehlungen der Arbeitsgruppe Perioperative Gerinnung (AGPG) der Osterreichischen Gesellschaft fur Anasthesiologie und Intensivmedizin (OGARI).]
[Article in German]
Kozek-Langenecker SA, Fries D, Gutl M, Hofmann N, Innerhofer P, Kneifl W, Neuner L, Perger P, Pernerstorfer T, Pfanner G, Schochl H.
Universitatsklinik fur Allgemeine Anaesthesie und Intensivmedizin B, Wien.
More efficacious anticoagulant and antiplatelet agents have been introduced in vascular medicine and in the prevention of perioperative venous thromboembolisms. Patient management should be guided by familiarity with the pharmacology of coagulation-altering drugs and by consensus statements. The present paper reviews recommendations from the Austrian Task Force for Perioperative Coagulation which are based on thorough evaluation of the available pharmacological information and case reports. The consensus statement focuses on neuraxial and peripheral techniques and is designed to encourage safe and quality patient care.
PMID: 15747141 [PubMed - as supplied by publisher]
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[Influence of blockades with local anesthetics on the stimulation ability of a nerve by peripheral nerve stimulation Ergebnisse eine randomisierte Studie.]
[Article in German]
Neuburger M, Gultlinger O, Ass B, Buttner J, Kaiser H.
Abteilung fur Anasthesie, BG Unfallklinik, Murnau.
In the present study we examined the influence of local anesthetics on the ability to stimulate a nerve by means of peripheral nerve stimulation. In 35 patients either 5 ml saline (group 1, n=18) or local anesthetics (group 2, n=17) were injected close to the sciatic nerve in a randomized and double-blind manner. The current needed to stimulate the nerve was measured 30 s and 2 min after injection. The results showed that 30 s and 2 min after injection of local anesthetics there is a strong local anesthetic effect. Therefore nerve damage might occur despite the use of peripheral nerve stimulation. Thus, the multiple injection technique in a close anatomical area has to be considered critically, because anesthetized or partially anesthetized nerves have a lower stimulating ability and could be damaged by a second or third puncture.
PMID: 15739091 [PubMed - as supplied by publisher]
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[Spondylodiscitis after perioperative peridural catheter]
[Article in German]
Muller M, Burger C, Andermahr J, Mader K, Rangger C.
Klinik und Poliklinik fur Unfallchirurgie, Universitatsklinikum Bonn. marcus_muellerde@yahoo.de
Peridural anaesthesia is used to avoid operative, postoperative and chronic pain, especially in surgery, gynecology and urology. Complications have rarely been described but can entail serious local and systemic sequelae. Three cases with spondylitis and spondylodiscitis after peridural anaesthesia are presented. The failure to recognize the peridural catheter as the cause of vertebral pain led to therapeutic delay in two cases. The result of antimicrobial therapy and in two cases radical surgical treatment was complete recovery. The occurrence of spondylodiscitis after the use of peridural catheters is often a late manifestation of disseminated pathogens. The insidious progression of infection and non-specificity of clinical symptoms may lead to diagnostic delay. Awareness of the possibility of even delayed complications after the use of peridural anaesthesia is important.
PMID: 15597159 [PubMed - indexed for MEDLINE]
ANESTHESIOLOGY CME PROGRAM.
[No authors listed]
PMID: 15731631 [PubMed - as supplied by publisher]
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Anesthesia for outpatient surgery: how fast is fast?
Williams BA, Hadzic A.
* University of Pittsburgh, Pittsburgh, Pennsylvania. williamsba@anes.upmc.edu.
PMID: 15731618 [PubMed - in process]
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Anesthesia for outpatient surgery: how fast is fast?
Norris MC.
Publication Types:
PMID: 15731616 [PubMed - in process]
-
Cervical spine considerations when anesthetizing patients with Down syndrome.
Hata T, Todd MM.
Department of Anesthesia, The University of Iowa, Iowa City 52242-1009, USA. tara-hata@uiowa.edu
PMID: 15731610 [PubMed - in process]
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Gerard W. Ostheimer "What's New in Obstetric Anesthesia" Lecture.
Tsen LC.
Department of Anesthesiology, Perioperative and Pain Medicine, Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA. ltsen@zeus.bwh.harvard.edu
PMID: 15731609 [PubMed - in process]
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Pharmacogenetics of anesthetic and analgesic agents.
Palmer SN, Giesecke NM, Body SC, Shernan SK, Fox AA, Collard CD.
Department of Cardiovascular Anesthesia, Texas Heart Institute, St. Luke's Episcopal Hospital, Houston 77030, USA.
Predicting a patient's response to a particular drug has long been a goal of clinicians. Rapid advances in molecular biology have enabled researchers to identify associations between an individual's genetic profile and drug response. Pharmacogenetics is the study of the molecular mechanisms that underlie individual differences in drug metabolism, efficacy, and side effects. The pharmacogenetics of commonly used anesthetic and analgesic agents are reviewed.
PMID: 15731608 [PubMed - in process]
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Facilitation of serotonergic activity and amnesia in rats caused by intravenous anesthetics.
Semba K, Adachi N, Arai T.
Department of Anesthesiology and Resuscitology, Ehime University School of Medicine, Japan. skazu@m.ehime-u.ac.jp
BACKGROUND: Midazolam and propofol often provoke retrograde amnesia after recovery from anesthesia in humans. Because an increase in central serotonergic activity impairs learning and memory, the authors examined the relation between changes in the serotonergic activity caused by intravenous anesthetics and memory. METHODS: Changes in extracellular concentrations of monoamines and their metabolites were investigated in rat striatum by a microdialysis procedure, and the effects of intraperitoneal injections of midazolam (5 mg/kg), propofol (60 mg/kg), and pentobarbital (15 mg/kg) were then examined. To evaluate the behavioral alteration with these agents, the authors used a step-through passive avoidance test. RESULTS: Midazolam and propofol slightly increased the extracellular concentration of 5-hydroxytryptamine in the striatum, although pentobarbital did not produce any changes. Midazolam and propofol increased the extracellular concentration of 5-hydroxyindoleacetic acid, a metabolite of 5-hydroxytryptamine, with the peak values each 138% and 138% of that in saline-injected animals, respectively. However, pentobarbital decreased the 5-hydroxyindoleacetic acid concentration to 61% of that in the saline group. Administration of midazolam or propofol immediately after the completing the passive avoidance learning reduced step-through latencies after 24 h, although pentobarbital-injected animals maintained a consistent performance. The effects of midazolam and propofol on step-through latencies were completely antagonized by intracerebroventricular administration of spiroxatrine (5 microg), a 5-hydroxytryptamine 1A antagonist, 30 min before training. CONCLUSIONS: Midazolam and propofol increased central serotonergic activity and provoked retrograde amnesia. Because amnesia was completely diminished by a 5-hydroxytryptamine antagonist, facilitation of the serotonergic system may be involved in retrograde amnesia caused by these agents.
PMID: 15731601 [PubMed - in process]
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Effects of bispectral index monitoring on recovery from surgical anesthesia in 1,580 inpatients from an academic medical center.
Pavlin JD, Souter KJ, Hong JY, Freund PR, Bowdle TA, Bower JO.
Department of Anesthesiology, University of Washington Medical Center, Seattle 98195, USA.
BACKGROUND: The purpose of this study was to determine whether monitoring Bispectral Index (BIS) would affect recovery parameters in patients undergoing inpatient surgery. METHODS: Anesthesia providers (n = 69) were randomly assigned to one of two groups, a BIS or non-BIS control group. A randomized crossover design was used, with reassignment at monthly intervals for 7 months. Duration of time in the postanesthesia care unit, time from the end of surgery to leaving the operating room, and incidence of delayed recovery (> 50 min in recovery) were compared in patients treated intraoperatively with or without BIS monitoring. Data were analyzed by analysis of variance, unpaired t test, or chi-square test as appropriate. RESULTS: One thousand five hundred eighty patients in an academic medical center were studied. The mean BIS in the monitored group was 47. No differences were found in recovery parameters between the BIS-monitored group and the control group when comparisons were made using all subjects or when data were analyzed within anesthetic subgroups stratified by anesthetic agent or duration of anesthesia. There were some small reductions in the intraoperative concentration of sevoflurane (but not isoflurane). CONCLUSIONS: The use of BIS monitoring for inpatients undergoing a wide variety of surgical procedures in an academic medical center had some minor effects on intraoperative anesthetic use but had no impact on recovery parameters.
PMID: 15731595 [PubMed - in process]
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Effect of N-methyl-D-aspartate receptor epsilon1 subunit gene disruption of the action of general anesthetic drugs in mice.
Sato Y, Kobayashi E, Murayama T, Mishina M, Seo N.
Department of Anesthesiology, Division of Organ Replacement Research, Center for Molecular Medicine, Jichi Medical School, Tochigi, Japan.
BACKGROUND: Recent molecular strategies demonstrated that the N-methyl-d-aspartate (NMDA) receptor is a major target site of anesthetic agents. In a previous article, the authors showed that knocking out the NMDA receptor epsilon1 subunit gene markedly reduced the hypnotic effect of ketamine in mice. In the current study, the authors examined the in vivo contribution of the NMDA receptor epsilon1 subunit to the action of other anesthetic drugs. METHODS: The authors determined the anesthetic effects of nitrous oxide on sevoflurane potency in NMDA receptor epsilon1 subunit knockout mice compared with those in wild-type mice. They then tested the hypnotic effect of gamma-aminobutyric acid-mediated agents, such as propofol, pentobarbital, diazepam, and midazolam, in knockout mice and wild-type mice. RESULTS: The anesthetic action of sevoflurane itself was unaffected by the abrogation of the NMDA receptor epsilon1 subunit. Adding nitrous oxide reduced the required concentration of sevoflurane to induce anesthesia in wild-type mice, whereas this sparing effect was diminished in knockout mice. Furthermore, propofol, pentobarbital, diazepam, and midazolam also had markedly attenuated effects in knockout mice. CONCLUSIONS: Although it has been demonstrated that knocking out the expression of receptors may induce changes in the composition of the subunits, the network circuitry, or both, the current findings show consistently that the NMDA receptor epsilon1 subunit mediates nitrous oxide but not sevoflurane anesthesia. Furthermore, the attenuated anesthetic impact of propofol, pentobarbital, diazepam, and midazolam as well as ketamine in knockout mice suggests that the NMDA receptor epsilon1 subunit could be indirectly involved in the hypnotic action of these drugs in vivo.
PMID: 15731593 [PubMed - in process]
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Anesthesia and the human genome project: the quest for accurate prediction of drug responses.
Allen PD.
Publication Types:
PMID: 15731583 [PubMed - in process]
-
Special issue on pharmacogenomics and anesthesia: work presented at the 2004 journal symposium.
Kharasch ED.
Assistant Dean for Clinical Research, Professor and Research Director, Department of Anesthesiology, and Professor of Medicinal Chemistry (Adjunct), University of Washington, Seattle, Washington. kharasch@u.washington.edu.
PMID: 15731582 [PubMed - in process]
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This month in anesthesiology.
Henkel G.
PMID: 15731581 [PubMed - in process]
An investigation of therapeutic antibiotic prescribing for children referred for dental general anaesthesia in three community national health service trusts.
Harte H, Palmer NO, Martin MV.
North Liverpool P.C.T., 3 Glendyke Road, Liverpool L18 6JR, England, UK. hania.harte@hotmail.com
OBJECTIVE: To investigate antibiotic prescribing for paediatric dental patients requiring general anaesthesia. DESIGN: A prospective clinical study of children referred for dental treatment under general anaesthesia. METHOD: Information was collected by way of a two-stage questionnaire for children attending three community NHS trusts for dental extractions under general anaesthesia between July 2001 and January 2003. RESULTS: A total of 360 questionnaires were analysed. There was wide variation in the waiting times (0-278 days) between referral and treatment under general anaesthesia. Most children (53%) attended with dento-alveolar abscess, 46% with caries only and 1% for orthodontic extractions. Antibiotics were prescribed to 52% of patients with an abscess and 32% with caries only. Only 16% of patients presented with moderate to severe pain, 5.5% with diffuse swelling and 12% with a raised temperature. Antibiotics were prescribed for patients with diffuse swelling (63%) and raised temperature (50%) but also for patients with pain only (39%) and localised swelling (52%). Amoxicillin was the most frequently prescribed antibiotic (82%), with wide variation in all antibiotic regimens. CONCLUSION: This study provides evidence of inappropriate prescribing of antibiotics to children referred for treatment under general anaesthesia with wide variations in the regimens employed. There was no conclusive evidence that long waiting times for definitive treatment influenced antibiotic prescribing. In some areas the delay for definitive treatment for this group of vulnerable patients was unacceptably long.
PMID: 15731806 [PubMed - in process]
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Antibiotic prescribing for children awaiting dental general anaesthetic.
Mackie IC.
ObjectiveTo investigate antibiotic prescribing for paediatric dental patients requiring general anaesthesia.DesignA prospective clinical study of children referred for dental treatment under general anaesthesia.MethodInformation was collected by way of a two-stage questionnaire for children attending three community NHS trusts for dental extractions under general anaesthesia between July 2001 and January 2003.ResultsA total of 360 questionnaires were analysed. There was wide variation in the waiting times (0-278 days) between referral and treatment under general anaesthesia. Most children (53%) attended with dento-alveolar abscess, 46% with caries only and 1% for orthodontic extractions. Antibiotics were prescribed to 52% of patients with an abscess and 32% with caries only. Only 16% of patients presented with moderate to severe pain, 5.5% with diffuse swelling and 12% with a raised temperature. Antibiotics were prescribed for patients with diffuse swelling (63%) and raised temperature (50%) but also for patients with pain only (39%) and localised swelling (52%). Amoxicillin was the most frequently prescribed antibiotic (82%), with wide variation in all antibiotic regimens.ConclusionThis study provides evidence of inappropriate prescribing of antibiotics to children referred for treatment under general anaesthesia with wide variations in the regimens employed. There was no conclusive evidence that long waiting times for definitive treatment influenced antibiotic prescribing. In some areas the delay for definitive treatment for this group of vulnerable patients was unacceptably long.
PMID: 15731802 [PubMed - in process]
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Surgical endodontics.
Carrotte P.
Department of Adult Dental Care, Glasgow Dental Hospital and School, 378 Sauchiehall Street, Glasgow G2 3JZ. p.carrotte@dental.gla.ac.uk
Root canal treatment usually fails because infection remains within the root canal. An orthograde attempt at re-treatment should always be considered first. However, when surgery is indicated, modern microtechniques coupled with surgical magnification will lead to a better prognosis. Careful management of the hard and soft tissues is essential, specially designed ultrasonic tips should be used for root end preparation which should ideally be sealed with MTA. All cases should be followed up until healing is seen, or failure accepted, and should form a part of clinical audit.
PMID: 15702099 [PubMed - indexed for MEDLINE]
Comment on:
Intrathecal drug spread.
Hutter CD.
Publication Types:
PMID: 15702499 [PubMed - indexed for MEDLINE]
Comment on:
Intrathecal drug spread.
Akerman N.
Publication Types:
PMID: 15629908 [PubMed - indexed for MEDLINE]
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Deep venous thrombosis revealed during ultrasound-guided femoral nerve block.
Sutin KM, Schneider C, Sandhu NS, Capan LM.
Department of Anesthesiology, New York University School of Medicine, 550 First Avenue, New York, NY 10016, USA. kensutin@yahoo.com
Ultrasound imaging used to facilitate performance of a femoral nerve block also affords imaging of adjacent anatomical structures. Following a fracture of the femur, an ultrasound guided femoral nerve block (UGFNB) was performed to provide analgesia; this led to the incidental finding of a previously undiagnosed femoral vein thrombosis (DVT), resulting in a change in patient management before surgery. An inferior vena cava (IVC) filter was placed before intramedullary nailing of the fracture.
Publication Types:
PMID: 15579489 [PubMed - indexed for MEDLINE]
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Evaluation of genitofemoral nerve block, in addition to ilioinguinal and iliohypogastric nerve block, during inguinal hernia repair in children.
Sasaoka N, Kawaguchi M, Yoshitani K, Kato H, Suzuki A, Furuya H.
Department of Anesthesiology, Nara Medical University, Nara, Japan. ne6n-ssok@asahi-net.or.jp
BACKGROUND: Ilioinguinal and iliohypogastric (IG-IH) nerve block has been widely used in children undergoing inguinal hernia repair. This technique may provide insufficient analgesia for intraoperative management as the inguinal region may receive sensory innervation from genitofemoral nerve. We proposed that addition of a genitofemoral nerve block might improve the quality of analgesia. METHODS: Ninety-eight children undergoing inguinal hernia repair were assigned randomly to receive either IG-IH nerve block (Group I) or IG-IH and genitofemoral nerve blocks (Group II). Systolic arterial pressure (SAP) and heart rate (HR) were recorded before surgery (control), after skin incision, at sac traction and at the end of surgery. Postoperative analgesic requirements and incidence of complications were recorded until discharge. RESULTS: At sac traction, SAP and HR were significantly higher in Group I (P<0.05), and the incidence of episodes of increased HR was also significantly higher in Group II (29 vs 12%, respectively, P<0.05). There were no significant differences in SAP and HR at other time points, postoperative analgesic requirements or incidence of complications between the groups. CONCLUSIONS: The benefit of the additional genitofemoral nerve block to IG-IH nerve block was limited only to the time of sac traction without any postoperative effect. This suggests there is little clinical benefit in the addition of a genitofemoral nerve block.
Publication Types:
- Clinical Trial
- Randomized Controlled Trial
PMID: 15567812 [PubMed - indexed for MEDLINE]
Comment on:
Ropivacaine plasma concentrations are similar during continuous lumbar plexus blockade using two techniques: pharmacokinetics or pharmacodynamics?
Blumenthal S, Ekatodramis G, Borgeat A.
Publication Types:
PMID: 15470181 [PubMed - indexed for MEDLINE]
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Laryngo-tracheo-bronchial stenosis in a patient with primary pulmonary amyloidosis: a case report and brief review.
Minogue SC, Morrisson M, Ansermino M.
Department of Anaesthesia, Vancouver General Hospital, Vancouver, British Columbia, Canada. minogues@indigo.ie <minogues@indigo.ie>
PURPOSE: To report a case of lower respiratory tract obstruction occurring in a patient with primary pulmonary amyloidosis and discuss anesthetic management. CLINICAL FEATURES: A 53-yr-old man was referred to our institution for microlaryngoscopy and laser treatment of the larynx. He presented with a five-year history of primary laryngo-tracheo-bronchial amyloidosis and symptoms consistent with narrowing of the conducting airways. General anesthesia was induced with iv propofol 150 mg and remifentanil 50 microg. Mivacurium 20 mg provided muscle relaxation for endotracheal intubation. Following endotracheal intubation, the airway became obstructed and patient ventilation impossible. The endotracheal tube was removed and a Dedo laryngoscope inserted. Gas exchange was maintained using supraglottic jet ventilation via a distal port of the laryngoscope. Rigid bronchoscopy showed tissue partially obstructing the lumen of the lower trachea. This was removed and the airway appeared patent. At the end of the case, a further episode of lower airway obstruction occurred requiring reinsertion of the laryngoscope and resumption of jet ventilation. Extensive debridement through the bronchoscope was required before adequate ventilation could be restored. Some days later when the patient's condition deteriorated again and he required further debridement of the trachea and insertion of a tracheostomy, guide wires were positioned in the femoral vessels in the event that cardiopulmonary bypass was required for gas exchange. CONCLUSIONS: Primary laryngo-tracheo-bronchial amyloidosis is a recurrent disease, requiring repetitive surgical procedures. Airway compromise can be a persistent problem. Awareness of this uncommon disease process and its presentation may serve to caution the anesthesiologist presented with this type of case.
Publication Types:
PMID: 15470177 [PubMed - indexed for MEDLINE]
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Bilateral sixth cranial nerve palsy after unintentional dural puncture.
Arcand G, Girard F, McCormack M, Chouinard P, Boudreault D, Williams S.
Department of Anesthesiology, CHUM, Notre-Dame Hospital, Montreal, Quebec, Canada.
PURPOSE: Bilateral sixth nerve palsy is a known though uncommon complication following dural puncture. The recommended treatment consists of hydration and alternate monocular occlusion. The value and the timing of an epidural blood patch (EBP) for sixth nerve palsy remains controversial as some authors have demonstrated benefits in performing an EBP early in course of the nerve palsy whereas others have not found any advantage when an EBP was performed later. CLINICAL FEATURES: A 40-yr-old woman developed bilateral sixth nerve palsy ten days after an unintentional dural puncture. An EBP was done within 24 hr after the onset of the symptoms and immediate improvement of the diplopia was noted by the patient and confirmed by an ophthalmologist. Complete resolution of the diplopia occurred 36 days after the dural puncture. CONCLUSION: Blood patching within 24 hr of the onset of diplopia may be a reasonable treatment for ocular nerve palsy as it relieved the postdural puncture headache and produced partial improvement of the diplopia.
Publication Types:
PMID: 15470172 [PubMed - indexed for MEDLINE]
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Sciatic nerve block in the popliteal fossa: description of a new medial approach.
Guntz E, Herman P, Debizet E, Delhaye D, Coulic V, Sosnowski M.
Departments of Anesthesiology, Universite Libre de Bruxelles, C.H.U Saint-Pierre, Brussels, Belgium. eguntz@ulb.ac.be <eguntz@ulb.ac.be>
PURPOSE: Sciatic nerve blocks through lateral approaches in the popliteal fossa have been proposed. We describe a new medial approach to the sciatic nerve at this level. METHODS: After an anatomical study on six cadavers, we performed sciatic nerve blocks on 20 patients. A 100-mm insulated needle and a nerve stimulator were used; 20 mL of lidocaine 1.5% with epinephrine were injected. RESULTS: Patients lied in the supine position, the thigh flexed, abducted and rotated externally (30 degrees in all directions). The leg was flexed at 130 degrees . In this position, above the adductor tubercle, a depression known as Jobert's fossa is palpated. Through this groove, a medial approach to the sciatic nerve at the level of the popliteal fossa is possible. The mean distance between the adductor tubercle and the puncture site is 6.18 cm (range 4-8 cm) and the mean distance between the skin and the sciatic nerve is 6.62 cm (range 4-9 cm). Mean time to perform the block was 100 sec (range 55-165 sec). Complete motor blockade was obtained after a mean time of 30 min (range 5-60 min) inside the common peroneal nerve area and 43 min (range 15-75 min) inside the tibial nerve area. Motor block was complete in 17 patients and sensory block in 18 patients. No vessel puncture was observed. CONCLUSION: We describe a new medial approach to the sciatic nerve in the popliteal fossa. More studies will be required to demonstrate the technique is effective and safe.
Publication Types:
PMID: 15470171 [PubMed - indexed for MEDLINE]
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Increased body mass index and ASA physical status IV are risk factors for block failure in ambulatory surgery - an analysis of 9,342 blocks.
Cotter JT, Nielsen KC, Guller U, Steele SM, Klein SM, Greengrass RA, Pietrobon R.
University of North Carolina School of Medicine, USA.
PURPOSE: Regional anesthesia can be the technique of choice for selected ambulatory surgery procedures, but in spite of its benefits, it has an inherent failure rate even in experienced hands. We examine the efficacy and factors associated with failure of ambulatory regional anesthesia techniques. METHODS: This study included 9,342 blocks performed on 7,160 patients at the Duke University Ambulatory Surgery Center. Blocks were classified as interscalene, supraclavicular, axillary, lumbar plexus, femoral, sciatic, ankle, paravertebral, spinal, and other (frequency less than 100). A block was considered surgical if a single attempt at placing the block resulted in a complete sensory, motor, and sympathetic nerve block. Multiple logistic regression analyses were used to assess the risk-adjusted association between patient characteristics and block failure. RESULTS: Paravertebral blocks and those considered in the "other" category had significantly higher failure rates (P < 0.001), while spinal and lumbar plexus blocks had lower than average rates of failure (P < 0.001 and P = 0.03, respectively).In multiple logistic regression analyses excluding paravertebral blocks, body mass index (BMI) scores greater than 25 (P values: BMI 25-29: < 0.001; BMI 30-34: P < 0.001; BMI 35: P < 0.001) and ASA physical status IV (P < 0.001) were significantly associated with higher block failure rates. CONCLUSION: High BMI and ASA IV are independent risk factors for block failure in ambulatory surgery patients.
Publication Types:
PMID: 15470170 [PubMed - indexed for MEDLINE]
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Caudal neostigmine with bupivacaine produces a dose-independent analgesic effect in children.
Mahajan R, Grover VK, Chari P.
Department of Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, H.No.53, Sector 24-A, Chandigarh-160023, India.
PURPOSE: To evaluate the analgesic efficacy and duration of varying doses of caudal neostigmine with plain bupivacaine and its side effects in children undergoing genito-urinary surgery. METHODS: In a randomized double-blind prospective study 80 boys aged two to eight years scheduled for surgical repair of hypospadias were allocated randomly to one of four groups (n = 20 each) and received either only caudal 0.25% plain bupivacaine 0.5 mL.kg(-1) (Group I) or 0.25% plain bupivacaine 0.5 mL.kg(-1) with neostigmine (Groups II-IV) in doses of 2, 3 and 4 microg.kg(-1) respectively. Postoperative pain was assessed for 24 hr using an objective pain score. Blood pressure, heart rate, oxygen saturation, total amount of analgesic consumed and adverse effects were also recorded. RESULTS: The duration of postoperative analgesia in Group I (5.1 +/- 2.3 hr) was significantly shorter than in the other three groups (II -16.6 +/- 4.9 hr; III - 17.2 +/- 5.5 hr; IV - 17.0 +/- 5.8 hr; P < 0.05). Total analgesic (paracetamol) consumption was significantly more in Group I (697.6 +/- 240.7 mg) than in the groups receiving caudal neostigmine (II - 248.0 +/- 178.4; III - 270.2 +/- 180.8 and IV -230.6 +/- 166.9 mg; P < 0.05). Groups II, III and IV were comparable with regards to duration of postoperative analgesia and total analgesic consumption (P > 0.05). Incidence of nausea and vomiting were comparable in all four groups. No significant alteration in vital signs or any other adverse effects were observed. CONCLUSIONS: Caudal neostigmine (2, 3 and 4 microg.kg(-1)) with bupivacaine produces a dose-independent analgesic effect ( approximately 16-17 hr) in children as compared to those receiving caudal bupivacaine alone (approximately five hours) and a reduction in postoperative rescue analgesic consumption without increasing the incidence of adverse effects.
Publication Types:
- Clinical Trial
- Randomized Controlled Trial
PMID: 15310639 [PubMed - indexed for MEDLINE]
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Prophylactic ondansetron does not reduce the incidence of itching induced by intrathecal sufentanil.
Waxler B, Mondragon SA, Patel SN, Nedumgottil K.
Division of Postanesthesia Care, Department of Anesthesiology and Pain Management, John H. Stroger Jr. Hospital of Cook County, 1901 West Harrison Street, Chicago, IL 60612, USA. 74731.463@compuserve.com
PURPOSE: Postoperative itching after intrathecal (IT) narcotics may be a difficult and important problem for both the anesthesiologist and the patient in the postanesthetic care unit. Since some studies have reported success in preventing itching with ondansetron, we designed a prospective, randomized, double-blinded, and controlled study to test whether prophylactic iv ondansetron effectively reduces the incidence of IT sufentanil-induced pruritus. METHODS: Thirty-four patients (ASA I-III, age 18-74 yr) underwent ambulatory surgery after spinal anesthesia with IT lidocaine (15-100 mg) and IT sufentanil (10 microg). The patients were randomized into two groups to receive iv either 4 mL saline (n = 13) or 8 mg ondansetron (n = 21) before the IT injection. The incidence of pruritus and other variables was recorded. Pruritus scores were obtained with a verbal analogue score with 0 meaning none and 10 the worst itching that the patient could imagine. Statistical difference was assumed if P < 0.05. RESULTS: Ondansetron did not reduce the incidence of pruritus (77 vs 81%) compared to placebo (P = 1.000). The pruritus scores (4.4 vs 3.6) of the two groups were not significantly different (P = 0.670). CONCLUSIONS: There are contradictory findings in the literature regarding the effectiveness of ondansetron in preventing narcotic-induced itching. Although some studies have indicated that ondansetron could prevent this side effect of IT narcotics, a recent report suggested that ondansetron is not effective in preventing narcotic-induced itching (sufentanil-morphine) after a Cesarean section. In the present study we obtained similar, negative results.
Publication Types:
- Clinical Trial
- Randomized Controlled Trial
PMID: 15310636 [PubMed - indexed for MEDLINE]
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Intrathecal lidocaine and sufentanil shorten postoperative recovery after outpatient rectal surgery.
Waxler B, Mondragon SA, Patel SN, Nedumgottil K.
Division of Postanesthesia Care, Department of Anesthesiology and Pain Management, John H. Stroger Jr. Hospital of Cook County, 1901 West Harrison Street, Chicago, IL 60612, USA. 74731.463@compuserve.com
PURPOSE: A short recovery time for same day surgery is important to the patient and the hospital. A prospective, randomized, double-blinded study in the postanesthetic care unit was designed to compare the recovery time from spinal anesthesia with low-dose intrathecal (IT) lidocaine and sufentanil to that with IT lidocaine alone. The incidence of adverse effects was also assessed. METHODS: Forty-nine patients (ASA I-III, age 20-69 yr) underwent spinal anesthesia for rectal surgery. The patients were randomized into two groups. One group (n = 28) received low-dose IT lidocaine (15 mg) and sufentanil (10 microg) and the other group (n = 21) received IT lidocaine (50 mg). The time to ambulation, the incidence of pruritus, and other variables were recorded. Statistical difference was assumed if P < 0.05. RESULTS: Our results show a significantly shorter ambulation time (120 +/- 26 min) after IT low-dose lidocaine (15 mg) and 10 microg sufentanil vs 50 mg IT lidocaine (162 +/- 32 min, P < 0.0001). Patients who received IT lidocaine and sufentanil recovered faster. Fifty percent of the patients who received IT sufentanil suffered from pruritus. CONCLUSION: IT lidocaine (15 mg) and sufentanil resulted in a shorter time to ambulation compared to IT lidocaine (50 mg) alone and provided excellent anesthesia despite its disadvantage of pruritus.
Publication Types:
- Clinical Trial
- Randomized Controlled Trial
PMID: 15310635 [PubMed - indexed for MEDLINE]
Milrinone efficiently potentiates insulin secretion induced by orally but not intravenously administered glucose in C57BL6J mice.
Degerman E, Manganiello V, Holst JJ, Ahren B.
Department of Cell and Molecular Biology, Biomedical Center, C11, 22184 Lund, Sweden.
To study the effect of phosphodiesterase (PDE) 3 inhibition on plasma insulin and glucose levels, the selective PDE 3 inhibitor milrinone (0.25, 1.0, and 2.5 mg/kg) was given orally to anesthetized CL57Bl/6J mice 10 min before a gastric glucose gavage (150 mg/mouse). It was found that milrinone augmented the glucose-mediated increase in plasma insulin at 1.0 and 2.5 mg/kg without, however, any improvement in glucose elimination. In contrast, when given 10 min before intravenous glucose (1 g/kg), milrinone (1 mg/kg) did not affect the insulin response to glucose. The increase in glucagon-like peptide-1 (GLP-1) levels after gastric glucose was not altered by milrinone. However, the PDE3 inhibitor augmented the insulin response to intravenous GLP-1 (2.8 nmol/kg). We therefore conclude that PDE3 inhibition by milrinone augments insulin secretion in vivo in mice after oral but not after intravenous glucose, which may be explained by enhanced response to the cAMP-dependent insulinotropic action of endogenously released GLP-1.
PMID: 15364011 [PubMed - indexed for MEDLINE]
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Surgery for dysphagia lusoria caused by right aberrant subclavian artery: Anesthesia perspective.
Gadhinglajkar SV, Sreedhar R, Unnikrishnan M, Varma R.
PMID: 15747277 [PubMed - in process]
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Fast-track coronary artery bypass grafting surgery under general anesthesia with remifentanil and spinal analgesia with morphine and clonidine.
Lena P, Balarac N, Arnulf JJ, Bigeon JY, Tapia M, Bonnet F.
OBJECTIVE: Effective postoperative analgesia is a critical part of fast-track cardiac surgery. This study compared the postoperative analgesic effect of fast-track anesthesia with remifentanil and spinal morphine and clonidine with that of sufentanil anesthesia followed by patient-controlled administration of intravenous morphine. Design: Prospective, blinded, randomized study. Setting: Single private institution. Participants: Forty patients selected for coronary artery bypass graft surgery allocated randomly into 2 groups. Interventions: General anesthesia was performed with etomidate, isoflurane, cisatracurium, and either remifentanil (0.10-0.25 mug/kg/min) or sufentanil (up to 3.5 mug/kg). In the remifentanil group, patients received spinal morphine (4 mug/kg) and clonidine (1 mug/kg) before induction. Postoperatively, patients in both groups were connected to an intravenous patient-controlled analgesia (PCA) morphine pump that delivered a 1-g bolus with a 7-minute lockout interval. Measurements and Main Results: Patients were evaluated for pain on a visual analog scale (VAS), at rest and on deep breathing, and for intravenous PCA morphine consumption during 24 hours. The intravenous PCA morphine 24-hour cumulative dose was lower in the fast-track than in the control group (15.8 +/- 12.6 v 32.7 +/- 22.3 mg, p < 0.05). Before extubation, VAS scores were higher in the fast-track group, but after they were lower both at rest and during deep breathing. Extubation delay was shorter in the fast-track group (156.5 +/- 46.1 v 272 +/- 116.4 minutes, p < 0.05). Conclusion: The combination of anesthesia with remifentanil and spinal analgesia with morphine and clonidine produces effective analgesia after coronary artery surgery and a rapid extubation time.
PMID: 15747269 [PubMed - in process]
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Thoracic epidural anesthesia in cardiac surgical patients: A prospective audit of 2,113 cases.
Chakravarthy M, Thimmangowda P, Krishnamurthy J, Nadiminti S, Jawali V.
OBJECTIVE: The purpose of this study was to present an audit report of thoracic epidural anesthesia without permanent neurologic deficits in more than 2,000 patients undergoing cardiac surgery. Design: A prospective audit of cases conducted over a 13-year period. Setting: Tertiary referral heart hospital. Participants: Two thousand one hundred thirteen patients over a period of 13 years. Interventions: Epidural catheters were inserted at the C7 to T3 intervertebral space on the day before the operation in all patients; cardiac surgery was performed with or without cardiopulmonary bypass. Measurements and Results: The authors did not encounter any permanent neurologic deficits in their series. The authors encountered 18 (0.85%) primary dural punctures and 4 cases (0.18%) of temporary neurologic deficits. Conclusion: This series adds to the worldwide experience of the use of epidural analgesia concomitantly with anticoagulation in cardiac surgery without serious complications.
PMID: 15747268 [PubMed - in process]
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Comparison of three anesthetic techniques for off-pump coronary artery bypass grafting: General anesthesia, combined general and high thoracic epidural anesthesia, or high thoracic epidural anesthesia alone.
Kessler P, Aybek T, Neidhart G, Dogan S, Lischke V, Bremerich DH, Byhahn C.
OBJECTIVE: This study compared general anesthesia (GA), combined GA plus thoracic epidural anesthesia (TEA), and TEA alone in patients scheduled for off-pump coronary artery bypass grafting. Design: Prospective, nonrandomized clinical study Setting: University hospital. Participants: Ninety consenting patients undergoing beating-heart coronary artery revascularization with comparable coronary status and left ventricular function. Interventions: GA (n = 30) was conducted with propofol, remifentanil, and cisatracurium or combined with TEA (GA + TEA, n = 30) or TEA as the sole anesthetic with ropivacaine plus sufentanil (TEA, n = 30). Measurements and Main Results: Groups were comparable regarding the surgical approaches and the number of anastomoses. Four patients (GA, n = 2; GA + TEA, n = 2) who required unplanned cardiopulmonary bypass, and 4 patients in the TEA group who underwent unexpected intubation because of pneumothorax (n = 2), phrenic nerve palsy, or incomplete analgesia were excluded from further analysis. Intraoperative heart rate decreased significantly with both GA + TEA and TEA. None of the patients with TEA alone was admitted to the intensive care unit, they all were monitored on average for 6 hours postoperatively in the intermediate care unit and allowed to eat and drink as desired on admission. Postoperative pain scores were lower in both groups with TEA. There were no differences among groups in patients overall satisfaction. Conclusion: Based on the authors data, all anesthetic techniques were equally safe from the clinicians standpoint. However, GA + TEA appeared to be most comprehensive, allowing for revascularization of any coronary artery, providing good hemodynamic stability and reliable postoperative pain relief. Nonetheless, the actual and potential risks of TEA during cardiac surgery should not be underestimated.
PMID: 15747266 [PubMed - in process]
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Resource utilization in on- and off-pump coronary artery surgery: Factors influencing postoperative length of stay-an experience of 1,746 consecutive patients undergoing fast-track cardiac anesthesia.
Scott BH, Seifert FC, Grimson R, Glass PS.
OBJECTIVE: The purpose of the present investigation was to examine factors influencing resource utilization in patients undergoing on-pump coronary artery bypass graft and off-pump coronary artery bypass (OPCAB) graft surgery at a major university hospital. The resources examined were time to extubation, packed red blood cell (PRBC) transfusion, intensive care length of stay (ICULOS), preoperative and postoperative length of stay (PLOS), and total length of stay (LOS). Design: Observational study of consecutive patients undergoing on- and off-pump coronary artery bypass surgery. Setting: Tertiary care cardiac referral center. Participants: One thousand seven hundred forty-six consecutive male and female patients undergoing primary coronary artery bypass graft (CABG) surgery over a period of 3 years (1999-2001). Eight hundred eighty-one patients underwent CABG with pump, and 865 patients underwent off-pump coronary artery bypass (OPCAB) surgery. Interventions: None. Measurements and Main Results: The mean time to extubation after surgery was 7.4 hours for on-pump patients and 5.8 hours for the OPCAB group ( p </= 0.001); 73.7% of patients on pump received PRBC transfusion as compared with 48.6% of the OPCAB group ( p </= 0.001). The mean ICULOS for the on-pump group was 1.6 days and 1.4 days for the OPCAB group ( p = 0.006). PLOS was 6.5 days for the on-pump group and 5.6 days for the OPCAB group ( p </= 0.001). Mean total LOS was 9.7 days for the on-pump group and 8.8 days for the OPCAB group ( p </= 0.001). PLOS is correlated with several clinical and demographic variables. Linear and logistic regression models were used to assess the effects of on/off pump on PLOS. Use of pump is significantly correlated with increased PLOS ( p </= 0.001, Kendalls correlation), and pump use is strongly associated with transfusion (odds ratio = 2.95, p </= 0.001), which in turn is a determinant of PLOS. There were no significant differences between the on- and off-pump groups in the incidence of postoperative complications except for bleeding requiring reexploration and ventilatory support for more than 72 hours. Incidence of bleeding was 3.3% in the on-pump group and 1.7% in the OPCAB group ( p = 0.038). In the on-pump group, 3% of patients required >72 hours to postoperative tracheal extubation compared with 1.5% in the OPCAB group ( p = 0.041). Hospital mortality was 2.7% for the on-pump group and 1.0% for the OPCAB group ( p = 0.010). Conclusion: The authors found that patients undergoing on-pump CABG have significantly longer time to tracheal extubation, increased blood use, longer ICULOS, PLOS, and total LOS and higher in-hospital mortality, which would translate into significant differences in the expenses associated with these 2 surgical approaches to coronary surgery.
PMID: 15747265 [PubMed - in process]
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Levosimendan in off-pump coronary artery bypass: a four-times masked controlled study.
Barisin S, Husedzinovic I, Sonicki Z, Bradic N, Barisin A, Tonkovic D.
Clinical Department of Anesthesiology, Reanimatology, and Intensive Care Medicine, University Hospital Dubrava, Zagreb, Croatia. abarisin@kbd.hr
We tested the hypothesis that levosimendan produced beneficial hemodynamic effects during and after off-pump coronary artery bypass grafting in patients with good preoperative left ventricular function. Levosimendan at low dose (12 microg/kg), high dose (24 microg/kg), or placebo were administered in thirty-one patients in a randomized and four-times masked controlled study. Heart rate was not significantly different between experimental groups. Significant increases in cardiac output and left ventricular ejection fraction occurred after high-dose (P < 0.001; P = 0.006) and low-dose levosimendan (P = 0.001; P = 0.002). Both doses of levosimendan produced significant increased stroke volume and decreased systemic vascular resistance. Mean arterial pressure, pulmonary capillary wedge pressure, and left ventricular end-systolic volume were not significantly different between groups.The low-dose levosimendan produced better hemodynamic response than high-dose and may be preferable in patients undergoing off-pump coronary artery bypass grafting.
Publication Types:
- Clinical Trial
- Randomized Controlled Trial
PMID: 15550791 [PubMed - indexed for MEDLINE]
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Bilateral lingual anesthesia following surgically assisted rapid palatal expansion: report of a case.
Chuah C, Mehra P.
Department of Oral and Maxillofacial Surgery, Boston University School of Dental Medicine, MA, USA.
PMID: 15742300 [PubMed - in process]
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