About Entrez
Text Version
Entrez PubMed
Overview
Help |
FAQ
Tutorial
New/Noteworthy
E-Utilities
PubMed Services
Journals Database
MeSH Database
Single Citation Matcher
Batch Citation Matcher
Clinical Queries
LinkOut
My NCBI
(Cubby)
Related Resources
Order Documents
NLM Catalog
NLM Gateway
TOXNET
Consumer Health
Clinical Alerts
ClinicalTrials.gov
PubMed Central
|
|
| Display Show |
 |
Items 1 - 48 of 48 |
One page. |
-
Subdural empyema due to spinal anesthesia.
Kalaycy M, Cadavi F, Altunkaya H, Gul S, Ackgoz B.
Publication Types:
PMID: 15752418 [PubMed - in process]
-
General anesthesia with remifentanil for Cesarean section in a patient with HELLP syndrome.
Richa F, Yazigi A, Nasser E, Dagher C, Antakly MC.
Department of Anesthesia and Intensive Care, Hotel-Dieu de France Hospital, Saint-Joseph University, Beirut, Lebanon. fredrich24@yahoo.com
HELLP syndrome is a severe complication of pre-eclampsia characterised by hemolysis, elevated liver enzymes and a low platelet count. It is associated with an increased risk of adverse outcome for both the mother and the fetus. Patients with HELLP syndrome are also at greater risk of pulmonary edema, adult respiratory distress syndrome, abruptio placentae, intracerebral hemorrhage, eclamptic convulsions, disseminated intravascular coagulation, ruptured liver hematomas and acute renal failure. Perinatal mortality is equally high. Before delivery, aggressive obstetric management is directed toward stabilization of the affected organ systems, if possible, and interruption of the pregnancy in the early phase of the accelerated disease progression. Definitive therapy is delivery. Parturients HELLP syndrome often require general anesthesia for Cesarean section delivery. The anesthetic technique is critical for these patients with a high risk of uncontrollable hypertension, bleeding and multiple organ failure. Remifentanil is increasingly used as a very short analgesic agent providing cardiovascular stability in high-risk patients. We report the management of a patient presenting in labor with HELLP syndrome, and describe the successful use of remifentanil as part of the anesthetic technique for her subsequent Cesarean section.
PMID: 15752413 [PubMed - in process]
-
Anesthetic effect of epidural anesthesia with cephalad or caudad catheterization for ankle surgery or hemorrhoidectomy.
Chou WY, Hsu CJ, Cheng JT, Yang LC, Lin CR, Chia YY, Yu SW, Tan PH.
Department of Anesthesia, Chang Gung Memorial Hospital, Kaohsiung, Taiwan.
BACKGROUND: The larger size of the first sacral nerve root has been reported to be an unfavorable factor leading to sacral sparing in epidural anesthesia. Previous studies have shown that an adequate analgesic effect of the epidural block was achieved with the catheter placement in the caudal direction. In this study, the anesthetic effect of epidural anesthesia with catheter placement of a cephalic or caudad direction was compared in ankle and hemorrhoid surgery. METHODS: Twenty-one ASA physical status I or II patients undergoing surgery for ankle fractures with epidural anesthesia were enrolled and randomized into two groups. The epidural catheter was placed either to a cephalad (AU group) or caudal (AD group) direction. Another 21 patients undergoing hemorrhoidectomy were also randomized into two groups to receive epidural anesthesia in a similar way (HU and HD groups). The onset for, duration of, and recovery time from epidural anesthesia and the incidence of analgesic request were recorded. RESULTS: No significant differences were demonstrated when age, height, weight or sex were compared between the four study groups. The onset time of the block and the incidence of intrasurgical analgesic request were lower in the caudal subgroup when the ankle surgery patients were compared. Otherwise, there were no significant differences in the duration of anesthesia and time to recovery or level of anesthesia. CONCLUSION: Injection of local anesthetic solution through a caudally oriented epidural catheter produces faster onset and superior quality of anesthesia in comparison with the injection through the cephaladly oriented catheter in ankle surgery, but not hemorrhoidectomy.
PMID: 15752410 [PubMed - in process]
-
Increase in the use of rebreathing gas flow systems and in the utilization of low fresh gas flows in Finnish anaesthetic practice from 1995 to 2002.
Tohmo H, Antila H.
Department of Anaesthesia and Intensive Care, Hospital District of Helsinki and Uusimaa, Hyvinkaa Hospital, Hyvinkaa, Finland. harri.tohmo@hus.fi
BACKGROUND: The use of rebreathing systems together with low fresh gas flows saves anaesthetic gases, reduces the costs of anaesthesia, causes less environmental and ergonomic adverse effects, i.e. less air contamination in the operating room, and has favourable physiological effects. We assessed whether the use of non-rebreathing vs. rebreathing gas flow systems and high vs. lower fresh gas flows has changed during recent years. METHODS: The use of rebreathing and non-rebreathing systems and the utilization of fresh gas flows were evaluated by sending a questionnaire to the heads of anaesthesia departments at all public health care hospitals in Finland in 1996 and 2003. The data was gathered from the previous years 1995 and 2002, respectively. RESULTS: The use of rebreathing systems increased from 62% to 83% of all instances of general anaesthesia (P < 0.001). In rebreathing gas flow systems, there was a significant shift from high fresh gas flows (3 l min(-1) and more) towards lower fresh gas flows (between 1 to 2 l min(-1) and even below 1 l min(-1)) (P < 0.001). CONCLUSIONS: The benefits of low fresh gas flows have now been achieved in most instances of rebreathing system anaesthesia, which was not the case in 1995.
PMID: 15752397 [PubMed - in process]
-
Less postoperative nausea and vomiting after propofol + remifentanil versus propofol + fentanyl anaesthesia during plastic surgery.
Rama-Maceiras P, Ferreira TA, Molins N, Sanduende Y, Bautista AP, Rey T.
Department of Anaesthesiology and Perioperative Medicine, Complejo Hospitalario Universitario Juan Canalejo, 15006 A Coruna, Spain. prmaceiras@wanadoo.es
BACKGROUND: The effect of different opioids on postoperative nausea and vomiting (PONV) has not been conclusively determined yet, thus the aim of this study was to compare the incidence of PONV in propofol-anaesthetized patients receiving either fentanyl or remifentanil as opioid supplement. METHODS: Sixty ASA physical status I and II patients scheduled for plastic surgery gave their written informed consent for this prospective, randomized, double-blind study. Anaesthesia was induced with propofol, rocuronium and fentanyl (n = 30; 2 microg kg(-1)) or remifentanil (n = 30; 1 microg kg(-1)). After tracheal intubation, anaesthesia was maintained with propofol, oxygen in air and an infusion of the opioid studied, which was modified according to clinical criteria. Baseline postoperative analgesia was achieved with intravenous propacetamol + metamizol. Intravenous morphine was given if visual analogic scale (VAS) for pain was > or = 4 (scale 0-10) and metoclopramide was administered if a patient presented > or = 2 PONV episodes (nausea or vomiting) in less than 30 min. Postoperatively (2, 12 and 24 h), we registered VAS, rescue morphine consumption, number of patients with episodes of PONV and number of patients requiring metoclopramide. P < 0.05 was considered significant. RESULTS: There were no significant differences between groups in the demographic parameters, ASA physical status, propofol dose, VAS, and rescue morphine requirements. Fourteen patients in the fentanyl group and four in the remifentanil group presented PONV episodes 2-12 h postoperative hours' interval; (P < 0.05). Ten patients in the fentanyl group and four in the remifentanil group presented vomiting episodes in the same period (P < 0.05); and eight patients in the fentanyl group and one in the remifentanil group required metoclopramide; (P < 0.05). The number of postoperative PONV episodes were low, both in the 0-2-h period (n = 2 vs. n = 1, fentanyl and remifentanil, respectively) and in the 12-24-h period (n = 3 vs. n = 1). CONCLUSION: Propofol + fentanyl anaesthesia resulted in a higher incidence of PONV and requirements of antiemetic drugs in the period between 2 and 12 postoperative hours compared with propofol + remifentanil, in patients undergoing plastic surgery.
PMID: 15752393 [PubMed - in process]
-
Preoperative caudal block prevents emergence agitation in children following sevoflurane anesthesia.
Aouad MT, Kanazi GE, Siddik-Sayyid SM, Gerges FJ, Rizk LB, Baraka AS.
Department of Anesthesiology, American University of Beirut-Medical Center, Beirut, Lebanon. mm01@aub.edu.lb
BACKGROUND: The frequency of emergence agitation in children is increased following sevoflurane anesthesia. However, controversies still exist concerning the exact etiology of this postanesthetic problem. Although this phenomenon is present with adequate pain relief or even following pain-free procedures, pain is still regarded as a major contributing factor. METHODS: In a prospective, randomized, double-blind study, we enrolled 48 premedicated and calm 2-6-year-old children undergoing inguinal hernia repair. We assigned children to one of two groups: children assigned to the caudal group (n = 24) received a caudal block to supplement sevoflurane, while children assigned to the fentanyl group (n = 24) received a bolus injection of 1 microg kg(-1) intravenous fentanyl before skin incision to supplement sevoflurane. In the post anesthesia care unit, all children were received by their parent, and the incidence of emergence agitation and pain scores, as well as hemodynamic changes, were compared in both groups. RESULTS: Forty-four children completed the study. In the fentanyl group, 59% of the children were agitated following emergence from anesthesia as compared to 4.5% in the caudal group (P < 0.001). Also, pain scores, mean values of heart rate and blood pressure as well as morphine requirement were significantly higher in the post anesthesia care unit in the fentanyl group compared to the caudal group. CONCLUSION: Our results show that in children undergoing inguinal hernia repair, pain control with a preoperative caudal block as compared to intraoperative intravenous fentanyl significantly reduces the incidence of emergence agitation and pain scores following sevoflurane anesthesia.
PMID: 15752392 [PubMed - in process]
-
Delayed emergence process does not result in a lower incidence of emergence agitation after sevoflurane anesthesia in children.
Oh AY, Seo KS, Kim SD, Kim CS, Kim HS.
Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul 110-744, Korea.
BACKGROUND: Emergence agitation (EA) is more frequent after sevoflurane anesthesia than other inhalational agents but the etiology remains unclear. We investigated whether the EA after sevoflurane anesthesia is related to rapid emergence. METHODS: Eighty-five patients, aged 1-7 years, undergoing elective urology surgery were studied. After induction, anesthesia was maintained with 2.0-2.5% sevoflurane and 50% N(2)O. BIS was monitored continuously throughout surgery and emergence. At the end of surgery, the children were randomly assigned to one of two groups: group I, immediate cessation of sevoflurane; or group G, gradual decrease of sevoflurane with the rate of 0.1%.min(-1). Emergence agitation score was recorded during recovery. RESULTS: Times from immediate cessation or start of decrease of sevoflurane to BIS 70, 80, 90 and extubation were significantly longer in group G. The incidence of severe agitation (score > or =3) was not significantly different between group I and group G: which were 35.7% and 32.6%, respectively. CONCLUSION: Prolonged recovery did not reduce the incidence of EA following sevoflurane anesthesia in children.
PMID: 15752391 [PubMed - in process]
-
Peroperative depth of anaesthesia may influence postoperative opioid requirements.
Henneberg SW, Rosenborg D, Weber Jensen E, Ahn P, Burgdorff B, Thomsen LL.
Department of Anaesthesia, The Juliane Marie Centre, Rigshospitalet, Copenhagen, Denmark. steenhenneberg@rh.dk
BACKGROUND: Studies on monitoring the depth of anaesthesia have shown that with the use of these monitors the peroperative consumption of anaesthetics can be reduced. Studies have also indicated that the peroperative depth of anaesthesia may affect the postoperative course. The purpose of this study was to evaluate a possible relation between the depths of anaesthesia and the postoperative pain score and consumption of morphine. METHODS: We used middle latency auditory evoked potentials (MLAEPs) for monitoring the depth of anaesthesia. The study was prospective, observer blinded and included 50 women scheduled for elective abdominal hysterectomy. Anaesthesia was induced using propofol and remifentanil. Before leaving the recovery room the patients were provided with a programmed patient-controlled pump (PCA), which was only activated on demand. Auditory evoked potentials were registered from just before induction of anaesthesia and during the whole procedure, but the anaesthetist did not have access to the monitor. RESULTS: Fifty patients were included and seven were excluded. The remaining 43 patients were divided into two groups: Group High (n=12) with an AAI>28 for >5% of the registration time and Group Low (n=31) with an AAI>28 for <5% of the registration time. Group High had significantly higher morphine requirements in the recovery and activated the PCA-pump more frequently during the first 24 postoperative hours. CONCLUSION: The results indicate that the peroperative depth of anaesthesia may have effects on the postoperative analgesic requirements.
PMID: 15752390 [PubMed - in process]
-
EEG spectral entropy, heart rate, photoplethysmography and motor responses to skin incision during sevoflurane anaesthesia.
Seitsonen ER, Korhonen IK, van Gils MJ, Huiku M, Lotjonen JM, Korttila KT, Yli-Hankala AM.
Department of Anaesthesia and Intensive Care, Helsinki University Hospital, Helsinki, Finland. elina.seitsonen@hus.fi
BACKGROUND: Analgesia is a part of balanced anaesthesia, but direct indicators of nociception do not exist. We examined the relationship between motor reactions and physiological variables during skin incision in sevoflurane anaesthesia and hypothesized that nociception could be detected and graded by significant changes in these variables. METHODS: Thirty-one women scheduled for abdominal hysterectomy participated in the study. Anaesthesia was induced with fentanyl (1 microg kg(-1)), propofol (1 mg kg(-1)) and sevoflurane. Skin incision was performed 14 min after induction during 1.6% end-tidal sevoflurane anaesthesia without neuromuscular blockade. Electrocardiography (ECG), photoplethysmography (PPG) and electroencephalography (EEG) were registered, and a range of variables was computed from these signals. The postincision values, normalized with respect to their preincision values, of movers vs. non-movers were compared. The variables showing significant differences between movers and non-movers were used to develop a logistic regression equation for the classification of patients into movers or non-movers. RESULTS: Twenty-six patients were eligible for analysis, and 12 (46%) displayed a motor reaction to skin incision (movers). Many ECG, PPG and EEG-related variables showed significant differences between the pre- and postincision periods. The best classification performance, assessed by leave-one-out cross-validation, between movers and non-movers was achieved with the combination of response entropy of EEG, RR-interval and PPG notch amplitude. The corresponding equation yielded 96% correct classification with 90% sensitivity and 100% specificity. The classification performance of any single variable alone was considerably worse. CONCLUSION: Combination of information from different sources may be required for monitoring the adequacy of analgesia during anaesthesia.
PMID: 15752389 [PubMed - in process]
-
Impact of the AEP-Monitor/2-derived composite auditory-evoked potential index on propofol consumption and emergence times during total intravenous anaesthesia with propofol and remifentanil in children.
Weber F, Seidl M, Bein T.
Department of Anaesthesia, University Hospital Regensburg, D-93053 Regensburg, Germany. frank.weber@klinik.uni-regensburg.de
BACKGROUND: The composite auditory evoked potential index (cAAI), derived from the AEP Monitor/2 (version 1.6; Danmeter A/S, Odense, Denmark) is a measure of the hypnotic component of general anaesthesia. The purpose of this study was to evaluate the impact of cAAI guidance on propofol consumption and emergence times in children receiving total intravenous anaesthesia (TIVA) with propofol and remifentanil. METHODS: Twenty children, aged 3-11 years, scheduled for strabismus repair under TIVA with propofol and remifentanil were enrolled. Remifentanil was given to all patients at a constant infusion rate of 0.3 microg kg(-1) min(-1) throughout the anaesthesia. Patients were randomly allocated to receive a continuous propofol infusion adjusted either according to a conventional clinical practice (Group C, n = 10) or guided by cAAI-monitoring (Group G, n = 10, target cAAI 25-35). All patients were connected to the AEP Monitor/2, but in group C the anaesthetist was blinded to cAAI values. Propofol consumption (mgkg(-1)h(-1)) and emergence times (min) were the primary and secondary outcome measures. RESULTS: Propofol consumption and emergence times (mean +/- SD) were significantly lower in group G compared to group C (Propofol: G: 4.2 +/- 1.7 vs. C 6.4 +/- 1.3 mg kg(-1) h(-1); P < 0.01; emergence times: G: 5.1 +/- 3.7 vs. C 13.2 +/- 8.2 min; P < 0.01). Intraoperative cAAI values (median [interquartile range]) were significantly higher in group G (23.9 [18-29.7]) than in group C (18.4 [16.0-22.1]; P < 0.01). Haemodynamic variables remained stable within age-related limits, and there were no observations of adverse events, especially no clinical signs of intraoperative awareness in any patient. CONCLUSION: Composite auditory evoked potential index monitoring during propofol/remifentanil-TIVA in children results in reduced propofol consumption and faster emergence.
PMID: 15752388 [PubMed - in process]
-
From crystal ball towards cognitive anaesthesiology.
Jantti V.
Publication Types:
PMID: 15752387 [PubMed - in process]
Contemporary dental practice in the UK: demographic data and practising arrangements.
Burke FJ, Wilson NH, Christensen GJ, Cheung SW, Brunton PA.
University of Birmingham School of Dentistry, St.Chad's Queensway, Birmingham B4 6NN, UK.
OBJECTIVES: To investigate, by questionnaire, various aspects of primary dental care provision in the North West of England and Scotland. METHOD: A questionnaire containing 79 questions was sent to 1,000 practitioners, selected at random, in the North West of England and Scotland. Non-responders were sent another questionnaire after a period of 4 weeks had elapsed. RESULTS: Overall a response rate of 70% was achieved. The majority of practitioners were practice principals (65%), working in a group NHS practice (80%) located in a city or town centre (49%). On average 10-20 patients were treated each session with fewer patients treated per session under private arrangements. Many practitioners were found to lack hygienist support (44%) and to employ unqualified dental nurses (82%). Younger practitioners were more likely than senior colleagues to have access to up-to-date computers whilst 37% and 74% of respondents never used CAL programmes or magnification respectively. Contemporary cross-infection control standards were used by the majority of practitioners, although 3% of practitioners reported only autoclaving their handpiece once a day. CONCLUSIONS: The majority of practitioners, involved in this study, worked under National Health Service (NHS) regulations as principals in a group practice where the workload was greater than the private/independent sector. Contemporary cross-infection procedures were used routinely. In contrast computer-aided learning programmes and magnification were not used routinely. The practitioners in this study employed significant numbers of unqualified dental nurses.
PMID: 15716892 [PubMed - indexed for MEDLINE]
CobraPLA as a conduit for flexible bronchoscopy in a child under general anaesthesia.
Szmuk P, Ghelber O, Akca O, Ezri T.
Houston, TX, USA.
PMID: 15758089 [PubMed - in process]
-
Anaphylaxis and anaesthesia.
McBrien ME, Webb ST, Breslin DS, Axon AD, Hunter JM.
Belfast, UK.
PMID: 15758088 [PubMed - in process]
-
Maternal deaths from anaesthesia. An extract from Why Mothers Die 2000-2002, the Confidential Enquiries into Maternal Deaths in the United Kingdom: Chapter 17: Trends in intensive care.
Clutton-Brock T.
University Hospital Birmingham, Birmingham, UK.
This is the second of two extracts from Why Mothers Die 2000-2002, issued on 12 November 2004 by the Confidential enquiry into Maternal and Child Health (CEMACH), reproduced with permission. The full report can be accessed via their web site: http://www.cemach.org.uk/
PMID: 15758082 [PubMed - in process]
-
Maternal deaths from anaesthesia. An extract from Why Mothers Die 2000-2002, the Confidential Enquiries into Maternal Deaths in the United Kingdom: Chapter 9: Anaesthesia.
Cooper GM, McClure JH.
University of Birmingham and Birmingham Women's Hospital, Birmingham, UK, Royal Infirmary of Edinburgh, Edinburgh, UK.
This is the first of two extracts from Why Mothers Die 2000-2002, issued on 12 November 2004 by the Confidential enquiry into Maternal and Child Health (CEMACH), reproduced with permission. The full report can be accessed via their web site: http://www.cemach.org.uk/
PMID: 15758081 [PubMed - in process]
-
Efficacy of A-lineTM AEP Monitor as a tool for predicting acceptable tracheal intubation conditions during sevoflurane anaesthesia.
Alpiger S, Helbo-Hansen HS, Vach W, Ording H.
Department of Anaesthesiology, Vejle Hospital, Vejle, Denmark.
BACKGROUND: It is essential for the clinical anaesthetist to know whether patients are sufficiently anaesthetized to tolerate direct laryngoscopy and endotracheal intubation. Because of the lack of an accurate objective method to determine the level of general anaesthesia, under- or overdosing of anaesthetics may occur. Auditory evoked potential (AEP) is one of several physiological parameters under investigation. We aimed to determine the clinically required depth of anaesthesia, measured by the A-line(TM) AEP Monitor and expressed as A-Line ARX Index(TM) (AAI) for 90% probability of acceptable conditions for endotracheal intubation. METHODS: We studied 108 patients anaesthetized by mask with increasing concentration of sevoflurane in 30% oxygen and 70% nitrous oxide. Fentanyl 1.5 microg kg(-1) and glycopyrrolate 0.2 mg were administered intravenously immediately before starting induction of anaesthesia. The monitor was programmed to give an alarm at AAI 10, 15, 20, 25 or 30 according to randomization. When the alarm sounded, the end-expiratory sevoflurane concentration was registered and endotracheal intubation was attempted. Intubation conditions were assessed by an observer blinded to the AAI. RESULTS: At AAI 10 we found acceptable conditions in 91% (confidence interval [CI 72-99%]) of patients. The prediction probability value PK of AAI was 0.69 (CI 0.59-0.79) and the PK of end-expiratory sevoflurane concentration was 0.93 (CI 0.87-0.99). ED90 (the AAI with a 90% probability of acceptable intubation conditions) was calculated as 8.5 (CI 0-17.5). CONCLUSIONS: AAI indicates the depth of anaesthesia necessary for acceptable endotracheal intubation conditions. Under the conditions of the present study, end-expiratory sevoflurane concentration was a better predictor and may turn out to be more useful in the clinical setting.
PMID: 15749734 [PubMed - as supplied by publisher]
Severe hypotension following spinal anesthesia in a patient treated with risperidone.
Tarres AA, Villalonga A.
PMID: 15753510 [PubMed - in process]
-
Canadian pediatric anesthesiologists prefer inhalational anesthesia to manage difficult airways: a survey: [Les anesthesiologistes pediatriques canadiens preferent l'anesthesie par inhalation dans les cas de problemes des voies aeriennes : une enquete].
Brooks P, Ree R, Rosen D, Ansermino M.
Department of Anesthesiology, University of British Columbia, British Columbia's Children's Hospital, 4480 Oak Street, Room 1L7, Vancouver, British Columbia V6H 3V4, Canada. anserminos@yahoo.ca.
PURPOSE: To survey Canadian pediatric anesthesiologists to assess practice patterns in managing pediatric patients with difficult airways. METHODS: Canadian pediatric anesthesiologists were invited to complete a web survey. Respondents selected their preferred anesthetic and airway management techniques in six clinical scenarios. The clinical scenarios involved airway management for cases where the difficulty was in visualizing the airway, sharing the airway and accessing a compromised airway. RESULTS: General inhalational anesthesia with spontaneous respiration was the preferred technique for managing difficult intubation especially in infants (90%) and younger children (97%), however, iv anesthesia was chosen for the management of the shared airway in the older child (51%) where there was little concern regarding difficulty of intubation. Most respondents would initially attempt direct laryngoscopy for the two scenarios of anticipated difficult airway (73% and 98%). The laryngeal mask airway is commonly used to guide fibreoptic endoscopy. The potential for complete airway obstruction would encourage respondents to employ a rigid bronchoscope as an alternate technique (17% and 44%). CONCLUSION: Inhalational anesthesia remains the preferred technique for management of the difficult pediatric airway amongst Canadian pediatric anesthesiologists. Intravenous techniques are relatively more commonly chosen in cases where there is a shared airway but little concern regarding difficulty of intubation. In cases of anticipated difficult intubation, direct laryngoscopy remains the technique of choice and fibreoptic laryngoscopy makes a good alternate technique. The use of the laryngeal mask airway was preferred to facilitate fibreoptic intubation.
PMID: 15753501 [PubMed - as supplied by publisher]
-
The changing pattern of anesthesia, 1954-2004: a review based on the content of the Canadian Journal of Anesthesia in its first half-century: [La transformation du modele de l'anesthesie, 1954-2004 : une revue fondee sur le contenu du premier demi-siecle du Journal canadien d'anesthesie].
Shephard DA.
P.O. Box 31222, Greenville, North Carolina 27833, USA. acnpei@cox.net.
PURPOSE: In order to review changes and progress in anesthesiology in the second half of the 20th century, and to recognize the first half-century of the Journal's existence. SOURCE: The content of the Journal from its inauguration in 1954 through 2004 was reviewed. RESULTS: Although the data base is that of the Canadian Journal, many of the contributions were from other countries, and for this reason the findings will have relevance both in Canada and elsewhere. The review suggests that anesthesiology evolved in two phases in this period: from 1954 to 1978 and from 1979 to 2004. The first was characterized by the introduction of new drugs and adaptation to new surgical techniques; the second, by a greater emphasis on clinical excellence, outcome, quality patient care both in the operating room and elsewhere in the hospital, and research. CONCLUSIONS: Although profound advances in knowledge, techniques, and relationships, have shaped the pattern and practice of anesthesiology in this half-century, the basic concerns of anesthesiologists relating to the practice of anesthesia and to their patients remained unchanged. At the same time, the many advances that have shaped anesthesiology in this half-century have extended the understanding of the phenomenon of anesthesia and enhanced the quality of patient care, which gives rise to the hope that anesthesiologists will continue to fully achieve these twin goals in the next half-century.
PMID: 15753493 [PubMed - in process]
-
Patient-controlled regional analgesia is effective in children: a preliminary report.
Duflo F, Qamouss Y, Remond C, Pouyau A, Heilporn A, Taylor P, Paturel B, Combet S, Boselli E, Chotel F, Berard J, Chassard D.
Departement d'Anesthesie-Reanimation, Hopital Debrousse, 29, rue Soeur Bouvier, 69322 Lyon Cedex 05, France. frederic.duflo@chu-lyon.fr
PURPOSE: To report a preliminary analysis of prospectively recorded data in 27 children in whom patient-controlled regional analgesia (PCRA) was used for postoperative pain control following lower limb surgery. METHODS: Under general anesthesia, perineural catheters (popliteal and fascia iliaca compartment block) were inserted and infused with ropivacaine 0.2% (0.02 mL.kg(-1).hr(-1)). Additional demand doses were left to the child's discretion (0.1 mL.kg(-1)and a 30-min lockout interval). RESULTS: The average total dose of ropivacaine administered was 4.9 +/- 2 mg.kg(-1)over 48 hr. Visual analogue scale and Children's Hospital of Eastern Ontario Pain Scale scores were always inferior to 5/10 and 6/13, respectively. Motor block was observed in two children and two children needed rescue analgesia. CONCLUSIONS: Our preliminary observations indicate that PCRA in children provides satisfactory postoperative pain relief following lower limb surgery.
PMID: 15525620 [PubMed - indexed for MEDLINE]
-
A modified needle-inside-needle technique for the ganglion impar block.
Munir MA, Zhang J, Ahmad M.
Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, Massachusetts, USA. mmunir@partners.org
PURPOSE: The ganglion impar is the fused terminus of the paired sympathetic chain located at the level of the sacrococcygeal junction. It has been blocked using a bent and a curved spinal needle via the anococcygeal ligament. It has also been approached through the sacrococcygeal disc using a straight spinal needle. We describe a needle-inside-needle modification of the latter approach.Technical features: A 22-gauge (G), 1(1/2)-inch (38 mm) needle is introduced through the sacrococcygeal ligament under fluoroscopy via the sacrococcygeal disc. A 25-G, 2-inch (50 mm) needle is introduced through the 22-G needle. Placement is confirmed with injection of iopamidol 300, 0.2 mL in the retroperitoneal space with the comma sign. CONCLUSIONS: The bent and curved needle techniques are associated with significant discomfort, tissue trauma and risk of rectal perforation due to difficulty in obtaining a midline needle tip position. The straight spinal needle approach minimizes these problems, however there is increased risk of discitis and a longer spinal needle may help also raise incidence of needle breakage. The needle-inside-needle technique may reduce these risks.
PMID: 15525617 [PubMed - indexed for MEDLINE]
Bispectral analysis during deep sedation of pediatric oral surgery patients.
Overly FL, Wright RO, Connor FA, Jay GD, Linakis JG.
Emergency Medicine and Pediatrics, Rhode Island Hospital, Brown Medical School, Providence, Rhode Island, RI 02903, USA. foverly@lifespan.org
PURPOSE: Bispectral (BIS) analysis uses electroencephalogram information from a forehead electrode to calculate an index score (0 to 100; 0 = coma; 90 to 100 = awake). This index score correlates with the level of alertness in anesthetized patients. Classically, sedation has been monitored with clinical sedation scales such as the Observers Assessment of Alertness Sedation Scale (OAA/S), Modified Ramsey Scale, or a Visual Analog Scale (VAS). Our objective was to determine the correlation between clinical sedation scales and BIS index in pediatric patients undergoing sedation in an outpatient oral surgery setting. MATERIALS AND METHODS: Prospective cohort study of patients aged 2 to 17 years undergoing sedation in an outpatient oral surgery office. Sedation was performed in the customary manner with the addition of BIS monitoring. Three clinical sedation scores (OAA/S: 5 to 1; 5 = awake, 1 = unresponsive; Modified Ramsey: 1 to 6; 1-2 = awake, 6 = unresponsive; VAS: 0 to 10; 0 = awake, 10 = unresponsive) were assigned every 5 minutes by an investigator blinded to the BIS index. Data were analyzed using a repeated measures linear regression model. RESULTS: Sixteen subjects undergoing oral surgery, ages 4.5 years to 17 years, were enrolled, mean age 12.6 years +/- 4.3 years (standard deviation). Patients received methohexital in addition to 1 or more of the following: nitrous oxide, fentanyl, or midazolam. The results of the longitudinal regression analysis showed a highly significant association between the sedation scales and the BIS index. CONCLUSION: The BIS monitor may be a useful adjunct in monitoring pediatric patients receiving sedation in the outpatient setting.
Publication Types:
- Clinical Trial
- Controlled Clinical Trial
PMID: 15690290 [PubMed - indexed for MEDLINE]
-
These go to eleven.
Gerancher JC, Weller RS.
Publication Types:
PMID: 15372405 [PubMed - indexed for MEDLINE]
-
Tremor of the forearm during performance of axillary brachial plexus block.
Moorthy SS, Dill DW.
Publication Types:
PMID: 15372404 [PubMed - indexed for MEDLINE]
Comment on:
Stimulating catheter and electrophysiologic effect of the flush injectates: exciting.
Pham Dang C.
Publication Types:
PMID: 15372403 [PubMed - indexed for MEDLINE]
-
Lateral popliteal nerve block with ultrasound guidance.
Gray AT, Huczko EL, Schafhalter-Zoppoth I.
Publication Types:
PMID: 15372402 [PubMed - indexed for MEDLINE]
Comment on:
At the cords, the pinkie towards: interpreting infraclavicular motor responses to neurostimulation.
Groen GJ, Gielen MJ, Jack NT, Knape JT.
Publication Types:
PMID: 15372400 [PubMed - indexed for MEDLINE]
-
Is neuraxial blockade contraindicated in the patient with aortic stenosis?
McDonald SB.
Department of Anesthesiology, Virginia Mason Medical Center, Seattle, WA 98111, USA. anesbm@vmmc.org
Publication Types:
- Review
- Review of Reported Cases
PMID: 15372397 [PubMed - indexed for MEDLINE]
-
Ultrasound visibility of needles used for regional nerve block: an in vitro study.
Schafhalter-Zoppoth I, McCulloch CE, Gray AT.
Department of Anesthesia and Perioperative Care, University of California, San Francisco, San Francisco General Hospital, San Francisco, CA 94110, USA.
BACKGROUND AND OBJECTIVES: Ultrasound visibility of regional block needles is a critical component for safety and success of regional anesthetic procedures. The aim of the study was to formally assess factors that influence ultrasound visibility of needles used in regional anesthesia. METHODS: Regional block needles between 17- and 22-G diameter were inserted in a tissue equivalent phantom at angles from 0 degrees to 65 degrees relative to the phantom surface. For visibility enhancement, the needles were primed with air or water in combination with stylets and different size guide wires. Ultrasound measurements of needle tips and shafts were performed using transversal and longitudinal imaging with a linear 15-MHz transducer. Univariate and multivariate statistical analyses were performed on 719 visibility measurements. RESULTS: Hustead tip needles exhibited best ultrasound visibility. Ultrasound visibility of the needle tip was increased by insertion of a medium size guide wire. Water or air priming of the needle, insulation, and the insertion of a stylet did not influence needle visibility. Long axis imaging of the needle for shallow insertion angles (<30 degrees in relation to the phantom surface) and short-axis imaging for steep angles (>60 degrees ) provided the best ultrasound visibility of the needle tips. Needle visibility decreased linearly with steeper insertion angles ( P <.001) and smaller needle diameters ( P <.001). CONCLUSIONS: The results of our in-vitro study suggest a number of factors enhancing ultrasound visibility of regional block needles. The use of needles in the largest possible size inserted with a medium-size guide wire provides the best ultrasound visibility. Analysis of the approach angle favors needle insertion parallel to the transducer. The consideration of these factors may improve safety and success of ultrasound-guided regional blocks.
PMID: 15372394 [PubMed - indexed for MEDLINE]
-
A study of the characteristics of single-injection insulated block needles in a biologic model.
Sardesai AM, Denny NM, Herrick MJ, Lynch A, Harrop-Griffiths AW.
Department of Anaesthesia, Norfolk and Norwich University Hospital, Norwich, United Kingdom. Sardesai1@aol.com
BACKGROUND AND OBJECTIVES: Single-injection block needles are manufactured in many different lengths, diameters, and tip designs, but the literature contains no reports of methods to assess clinical characteristics of regional-block needles. A novel animal model for the assessment of the characteristics of single-injection regional anesthesia needles is described. METHODS: Nine different needles designed for peripheral nerve blocks that were fitted with identical hubs were used. Pork bellies were used as the biologic model. The bellies were mounted such that the needles passed from inside to outside. The last layer to be penetrated was the skin. Ten experienced and blinded anesthesiologists scored the feel, resistance, and usability of the 9 needles during their passage through similarly prepared pork bellies. Two identical (index) needles were included in the study to assess the internal validity of the study. RESULTS: The overall scoring was acceptably consistent and repeatable and showed statistically significant differences between the needles tested. The needles that were judged the most usable were those with a moderate resistance to passage through the tissue and a high degree of feel, which was defined as the ability to appreciate the passage of the needle through the tissue planes. Needles with very high or very low resistances and those with poor feel scored poorly on the usability scale. Differences in individuals' assessment of the index needles suggested some within-subject variability during the study. CONCLUSIONS: This type of biologic model can be used for the quantifiable and repeatable assessment of different needle tip designs. Needles with moderate resistance and high feel were preferred.
PMID: 15372393 [PubMed - indexed for MEDLINE]
-
Headache management for the pain specialist.
Ashkenazi A, Silberstein SD.
Jefferson Headache Center, Thomas Jefferson University Hospital, Philadelphia, PA 19107, USA. avi.ashkenazi@mail.tju.edu
Headache is a common symptom caused by a wide variety of diseases. Primary headaches include migraine, cluster headache, tension-type headache, and other less common diseases. It is important to differentiate these headaches from secondary headaches caused by vascular, neoplastic, infectious, metabolic, or toxic disorders. Most primary headaches have a genetic basis, with environmental factors acting as triggers. Recent advances in basic research resulted in the development of more specific and effective therapies. Medication-overuse headache is a very common cause of chronic daily headache. Detoxification from the offending drug is essential for headache improvement. Cervicogenic headache is common and needs to be diagnosed correctly since it may require specific therapy. Nerve blocks are useful for some patients with primary, as well as secondary, headaches.
Publication Types:
PMID: 15372392 [PubMed - indexed for MEDLINE]
-
Neuraxial and sympathetic blocks in herpes zoster and postherpetic neuralgia: an appraisal of current evidence.
Kumar V, Krone K, Mathieu A.
Olentangy Pain Clinic, Columbus, OH 43235, USA. vkumarmd@att.net
BACKGROUND AND OBJECTIVES: Epidural, intrathecal, and sympathetic blocks are used for the treatment of pain caused by herpes zoster (HZ) and postherpetic neuralgia (PHN). This study was undertaken to evaluate and synthesize existing evidence for using these nerve blocks with various injectates (local anesthetic [LA] alone, LA + steroids) in treating pain of HZ, PHN (>6 months), and its prevention. METHODS: A computerized search of published trials in the English language from 1966 to 2001 was carried out on Medline, EMBASE, and Cochrane Clinical Trial databases. Levels of evidence and grades of recommendations were made based on criteria published by the Oxford Centre for Evidence-Based Medicine. RESULTS: Among the studies meeting inclusion criteria, treatment was initiated during acute pain in 71% (15/21) and PHN in 29% (6/21). Randomized controlled trials (RCTs, level 1b evidence) constituted 19% (4/21), individual cohort (levels 2b, 3b) 29% (6/21), and case series (level 4) 43% (9/21). Overall, 80% (15/21) of trials showed a positive outcome with these blocks. The use of sympathetic (LA) and epidural blocks (LA + steroid) for pain of HZ was supported by 1 RCT each, and intrathecal block (LA + steroid) for PHN was supported by 2 RCTs. CONCLUSIONS: Evidence for the beneficial effect of epidural LA + steroid in HZ, and intrathecal LA + steroid in PHN appears to be consistent (grade A). If given within 2 months of HZ, epidural LA + steroid may reduce the incidence of PHN after 1 year (grade A). Evidence for use of sympathetic blocks in HZ and PHN, although generally useful (Grade B), requires RCTs for validation.
Publication Types:
PMID: 15372391 [PubMed - indexed for MEDLINE]
-
Comparison of 0.2% ropivacaine, 0.125% bupivacaine, and 0.25% bupivacaine for duration and magnitude of action in peripheral arterial blood flow induced by sympathetic block in dogs.
Takahashi Y, Yamaguchi S, Tezuka M, Kimura Y, Nagao M, Yamazaki H, Hamaguchi S.
Department of Anesthesiology, Dokkyo University School of Medicine, Tochigi, Japan.
BACKGROUND AND OBJECTIVES: The aim of this study is to compare 0.2% ropivacaine with 0.125% bupivacaine or 0.25% bupivacaine for the duration and magnitude of the vasodilation effect induced by sympathetic block. METHODS: We measured mean arterial pressure, heart rate, and right and left brachial artery blood flow (BABF) before and after cervicothoracic sympathetic block in 24 dogs. The experimental protocol was designed as follows: (1) left cervicothoracic sympathetic block with 1.0 mL 0.2% ropivacaine (n =8), (2) left cervicothoracic sympathetic block with 1.0 mL 0.125% bupivacaine (n=8), and (3) left cervicothoracic sympathetic block with 1.0 mL 0.25% bupivacaine (n=8). RESULTS: Mean arterial pressure and heart rate did not change significantly throughout the study in either group. Left cervicothoracic sympathetic block with 0.2% ropivacaine increased left BABF significantly from 5 to 100 minutes after the block (baseline, 100%; peak at 10 minutes after the block, 254 +/- 38%; P <.01). Left cervicothoracic sympathetic block with 0.125% bupivacaine increased left BABF significantly from 5 to 80 minutes after the block (baseline, 100%; peak at 10 minutes after the block, 144 +/- 9%; P <.01). Left cervicothoracic sympathetic block with 0.25% bupivacaine increased left BABF significantly from 5 to 100 minutes after the block (baseline, 100%; peak at 10 minutes after the block, 235 +/- 61%; P <.01). CONCLUSION: Ropivacaine may be equally potent to bupivacaine at equal concentrations in sympathetic block in dogs.
PMID: 15372389 [PubMed - indexed for MEDLINE]
-
Neurologic and histopathologic evaluation after high-volume intrathecal amitriptyline.
Sudoh Y, Desai SP, Haderer AE, Sudoh S, Gerner P, Anthony DC, De Girolami U, Wang GK.
Department of Anesthesiology, Brigham and Women's Hospital, Boston, MA 02115, USA.
BACKGROUND AND OBJECTIVES: Accumulating evidence indicates that amitriptyline decreases pain sensation when administered orally, intraperitoneally, or for sciatic nerve block. Previous reports of intrathecal administration of amitriptyline have yielded inconsistent results. The failure of amitriptyline to provide antinociception may partly be related to its high logP (octanol-water partition coefficient) and consequent poor spread within the cerebrospinal fluid. We evaluated spinal block after various concentrations of amitriptyline administered intrathecally in a fixed high volume. METHODS: We administered 100 microL of 5, 10, 15.9 (0.5%), 25, 50, or 100 mmol/L amitriptyline hydrochloride solution or 100 microL of 15.4 mmol/L (0.5%) bupivacaine hydrochloride solution intrathecally to rats. The neurologic deficit was evaluated by antinociceptive, motor, and proprioceptive responses, and the spinal cord was examined for histopathologic changes. RESULTS: Doses of 100 microL amitriptyline at 15.9 mmol/L (0.5%) and 25 mmol/L produced longer complete nerve block than did bupivacaine at 15.4 mmol/L (0.5%); 5 and 10 mmol/L amitriptyline produced only partial nerve block. However, with 100 microL intrathecal amitriptyline at 50 and 100 mmol/L, many rats did not fully recover from spinal block. Severe axonal degeneration, myelin breakdown, and replacement of neuronal structures by vacuoles were seen in the spinal root section of animals injected with concentrations higher than 25 mmol/L amitriptyline. CONCLUSIONS: At lower doses, intrathecal injection of high volumes of amitriptyline results in long-acting spinal block. At higher doses, intrathecal amitriptyline results in irreversible neurologic deficit. Therefore, we do not recommend the use of intrathecal amitriptyline because of a very low therapeutic index.
PMID: 15372388 [PubMed - indexed for MEDLINE]
-
Combination of intraneural injection and high injection pressure leads to fascicular injury and neurologic deficits in dogs.
Hadzic A, Dilberovic F, Shah S, Kulenovic A, Kapur E, Zaciragic A, Cosovic E, Vuckovic I, Divanovic KA, Mornjakovic Z, Thys DM, Santos AC.
Department of Anesthesiology, St. Luke's-Roosevelt Hospital Center, New York, NY 10025, USA. admir@nysora.com
BACKGROUND: Unintentional intraneural injection of local anesthetics may cause mechanical injury and pressure ischemia of the nerve fascicles. One study in small animals showed that intraneural injection may be associated with higher injection pressures. However, the pressure heralding an intraneural injection and the clinical consequences of such injections remain controversial. Our hypothesis is that an intraneural injection is associated with higher pressures and an increase in the risk of neurologic injury as compared with perineural injection. METHODS: Seven dogs of mixed breed (15-18 kg) were studied. After general endotracheal anesthesia, the sciatic nerves were exposed bilaterally. Under direct microscopic guidance, a 25-gauge needle was placed either perineurally (into the epineurium) or intraneurally (within the perineurium), and 4 mL of lidocaine 2% (1:250,000 epinephrine) was injected by using an automated infusion pump (4 mL/min). Injection pressure data were acquired by using an in-line manometer coupled to a computer via an analog digital conversion board. After injection, the animals were awakened and subjected to serial neurologic examinations. On the 7th day, the dogs were killed, the sciatic nerves were excised, and histologic examination was performed by pathologists blinded to the purpose of the study. RESULTS: Whereas all perineural injections resulted in pressures < or =4 psi, the majority of intraneural injections were associated with high pressures (25-45 psi) at the beginning of the injection. Normal motor function returned 3 hours after all injections associated with low injection pressures (< or =11 psi), whereas persistent motor deficits were observed in all 4 animals having high injection pressures (> or =25 psi). Histologic examination showed destruction of neural architecture and degeneration of axons in all 4 sciatic nerves receiving high-pressure injections. CONCLUSIONS: High injection pressures at the onset of injection may indicate an intraneural needle placement and lead to severe fascicular injury and persistent neurologic deficits. If these results are applicable to clinical practice, avoiding excessive injection pressure during nerve block administration may help to reduce the risk of neurologic injury.
PMID: 15372385 [PubMed - indexed for MEDLINE]
-
Bier block with methylprednisolone and lidocaine in CRPS type I: a randomized, double-blinded, placebo-controlled study.
Taskaynatan MA, Ozgul A, Tan AK, Dincer K, Kalyon TA.
Department of Physical Medicine and Rehabilitation, Gulhane Military Medical Academy, Ankara, Turkey. matask@gata.edu.tr
BACKGROUND AND OBJECTIVE: To investigate the effect of intravenous regional anesthesia (Bier block) with methylprednisolone and lidocaine in complex regional pain syndrome (CRPS) type I in a randomized, double-blinded, and placebo-controlled study. METHODS: Twenty-two patients with the diagnosis of CRPS of their upper limb were divided randomly into 2 groups. The mean age was 22.3 +/-1.6 years. Average pain duration was 3.1 +/- 1.4 months. In the placebo group (10 patients), patients received only 100 mL of saline. In the study group (12 patients), 40 mg of methylprednisolone and 10 mL of 2% lidocaine were added to the saline. Treatments were applied once a week. Unless significant adverse effects occurred, 3 sessions of blockade were completed. Pain severity, range of motion (ROM), and volumetric edema measurements were obtained before treatment. Pain severity and satisfaction (resolved, better, no change, or worse) were recorded after each session. The final assessment was performed 1.5 months later. ROM and volumetric measurements were repeated the day after the block and at the final assessment. RESULTS: Differences in pretreatment features of the patients were not statistically significant ( P >.05). In all assessment periods during the study, improvement in pain severity was statistically significant ( P <.05) in both groups. This statistically significant difference disappeared at the final assessment ( P >.05). No statistically significant difference was obtained in ROM and volumetric measures in any assessment period before and after the block. Satisfaction scores between the groups were also not different in any assessment period. CONCLUSIONS: Bier block with methylprednisolone and lidocaine in CRPS type I does not provide long-term benefit in CRPS, and its short-term benefit is not superior to placebo.
Publication Types:
- Clinical Trial
- Randomized Controlled Trial
PMID: 15372383 [PubMed - indexed for MEDLINE]
Comment on:
Ask about prior and former pain, too.
Whitman SM.
Publication Types:
PMID: 15305271 [PubMed - indexed for MEDLINE]
Comment on:
Horner's syndrome is not a complication of a brachial plexus block.
Avidan A.
Publication Types:
PMID: 15305263 [PubMed - indexed for MEDLINE]
Comment on:
The dreaded complications from neurolytic celiac plexus blocks are preventable!
Moore DC.
Publication Types:
PMID: 15305261 [PubMed - indexed for MEDLINE]
-
Ultrasound guidance for difficult lateral popliteal catheter insertion in a patient with peripheral vascular disease.
Minville V, Zetlaoui PJ, Fessenmeyer C, Benhamou D.
Departement d'Anesthesie-Reanimation, Hopital de Bictere, Le Kremlin-Bictere, France.
OBJECTIVE: Interest in ultrasound-guided nerve block is increasing, but clinical utility still is being determined. We report a case in which ultrasound imaging aided nerve localization during popliteal block. CASE REPORT: We report a case in which failure of nerve stimulation to locate the sciatic nerve at the popliteal fossa in a patient with underlying neuropathy was overcome by ultrasound guidance, which allowed quick and easy catheter placement. After failure of the stimulation technique, ultrasound permitted us to observe advancement of the needle, placement of the catheter, and spread of local anesthetic around the nerve. CONCLUSION: Ultrasound guidance can facilitate lateral popliteal catheter insertion in patients in whom electrolocation has failed.
Publication Types:
PMID: 15305259 [PubMed - indexed for MEDLINE]
-
Femoral nerve injury complicating continuous psoas compartment block.
Al-Nasser B, Palacios JL.
Department of Anesthesia and Intensive Care, Clinique du Parc Saint Lazare, Beauvais, France. balnasser@wanadoo.fr
OBJECTIVES: The objective of this case report is to describe a femoral nerve injury after a psoas compartment block (PCB) and to discuss the probable mechanisms of injury and neuron regeneration. To date, this is the first report of severe femoral nerve injury after PCB. CASE REPORT: A 60-year-old, American Society of Anesthesiologists II woman underwent right total knee replacement under general anesthesia and continuous PCB for postoperative analgesia. Postoperatively, she showed signs of severe femoral nerve injury. A physical therapy program and muscle electrical stimulation were instituted and continued for 6 months. The patient recovered completely with no residual motor or sensory deficit and had no other complication. CONCLUSIONS: Severe nerve injuries after regional anesthesia techniques remain infrequent and probably unreported. Our case report suggests that severe femoral nerve injury should be added to the list of reported complications during PCB. This case report is also encouraging because it shows the possibility of a good recovery after such injury.
Publication Types:
PMID: 15305257 [PubMed - indexed for MEDLINE]
-
Combined spinal-epidural technique for vaginal hysterectomy in a patient with Machado-Joseph disease.
Teo AY, Goy RW, Woon YS.
Department of Anaesthesia and Surgical Intensive Care, National University Hospital, Singapore, Singapore. al2001@vin@yahoo.com
OBJECTIVE: Machado-Joseph disease is a form of progressive spino-cerebellar ataxia with both bulbar and peripheral neurological manifestations. To date, anesthesia for patients affected by this disease has not been described. General anesthesia may be problematic because of the risk of pulmonary aspiration and hypoxia. We describe our experience with the successful use of combined spinal-epidural in a patient with Machado-Joseph Disease (MJD).CASE REPORT: A 38-year-old woman with MJD complicated by significant bulbar and peripheral neuropathy presented for an elective vaginal hysterectomy. She had no other medical history of note. After informed consent, subarachnoid block was performed by combined spinal-epidural anesthesia at the L2-3 lumbar intervertebral space with hyperbaric bupivacaine 12 mg, morphine 100 microg, and fentanyl 10 microg. Surgery proceeded uneventfully, with excellent postoperative analgesia. There was full recovery of preinduction neurologic function by the sixth postoperative hour. CONCLUSIONS: Central neuraxial anesthesia is an option for patients with MJD presenting for lower abdominal and lower extremity operations. Combined spinal-epidural anesthesia confers hemodynamic stability yet allows for augmentation of intraoperative anesthesia and postoperative analgesia.
Publication Types:
PMID: 15305255 [PubMed - indexed for MEDLINE]
-
Neurologic deficits and labor analgesia.
Wong CA.
Department of Anesthesiology, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA. c-wong@northwestern.edu
Publication Types:
PMID: 15305254 [PubMed - indexed for MEDLINE]
-
Patients' perception of pain during axillary and humeral blocks using multiple nerve stimulations.
Koscielniak-Nielsen ZJ, Rasmussen H, Nielsen PT.
Department of Anesthesia and Operative Services, Center of Head and Orthopedics, Copenhagen University Hospital, Copenhagen, Denmark . zjkn@rh.dk
BACKGROUND AND OBJECTIVES: Axillary or humeral blocks by multiple nerve stimulation (MNS) are used for ambulatory hand surgery. This double-blind study identified which of the three main components of the procedure (repeated needle passes, local anesthetic injections, or electrical stimulations) is most painful, quantified its intensity, and recorded patients' preferences for a future anesthetic. METHODS: Eighty unsedated ambulatory patients were randomized to 2 equal groups: axillary (A) and humeral (H). In each patient, 4 terminal motor nerves (musculocutaneous, median, ulnar, and radial) were electrolocated by use of an initial current of 2 mA, 0.1 ms and a target current of 0.1 to 0.5 mA. After block placement and before the start of surgery, patients were requested to identify which of the 3 main components of the block was most unpleasant and to quantify its intensity on a visual analog scale (VAS) of 0 to 100. Twenty minutes after completion of the block, the unblocked nerves were electrolocated at the elbow and supplemented. Patients were declared ready for surgery when they had complete analgesia of the hand and forearm. Before discharge from the hospital, patients indicated which anesthetic method (block alone, block plus sedation, or general anesthesia) they would choose for future hand surgery. RESULTS: Twenty-seven patients in group A vs. 17 patients in group H reported electrical stimulations as the most unpleasant block component (P =.03). No significant differences occurred in any of the VAS scores. Patients' request for the same anesthetic, 35 in group A and 37 in group H, were similar. Group A patients were ready for surgery sooner than group H patients (mean 26 minutes vs. mean 30 minutes for group H patients; P =.04). No serious complications were observed. CONCLUSIONS: This study found that more axillary-block patients compared with humeral-block patients reported electrical stimulation as the most unpleasant part of the block but failed to detect significant differences in the intensity of the 3 block components (repeated needle passes, local anesthetic injections, and electrical stimulations). Most patients in both groups would accept the same block for future hand operations. Patients were ready for surgery sooner after axillary block, but the clinical importance of this finding is doubtful.
Publication Types:
- Clinical Trial
- Randomized Controlled Trial
PMID: 15305252 [PubMed - indexed for MEDLINE]
-
Addition of dexmedetomidine prolongs duration of vasodilation induced by sympathetic block with mepivacaine in dogs.
Tezuka M, Kitajima T, Yamaguchi S, Kimura Y, Hamaguchi S.
Department of Anesthesiology, Dokkyo University School of Medicine, Tochigi, Japan.
BACKGROUND AND OBJECTIVES: The aim of this study was to examine the duration of vasodilation induced by sympathetic block with the addition of dexmedetomidine to mepivacaine. METHODS: We measured right and left brachial artery blood flow (BABF) before and after stellate ganglion block used as a sympathetic block in dogs. The experimental protocol was designed as follows: (1) left stellate ganglion block using 1.0 mL 0.5% mepivacaine (n = 8), (2) left stellate ganglion block using the addition of dexmedetomidine 0.5 microg to 1.0 mL 0.5% mepivacaine (n = 8), and (3) left stellate ganglion block using the addition of dexmedetomidine 0.5 microg to 1.0 mL physiological saline solution (n = 8). RESULTS: Left stellate ganglion block with mepivacaine alone increased left BABF significantly from 5 minutes through 50 minutes after the block (baseline, 100%; peak at 10 minutes after SGB, 181 +/- 27%; P <.01). Left stellate ganglion block with the addition of dexmedetomidine to mepivacaine induced a significant increase of left BABF from 5 minutes through 90 minutes after the block (baseline, 100%; peak at 10 minutes after SGB, 174 +/- 36%; P <.01). Left and right BABF did not change significantly after stellate ganglion block with dexmedetomidine only. Right BABF decreased significantly after left stellate ganglion block with mepivacaine alone or the addition of dexmedetomidine to mepivacaine throughout the study. CONCLUSIONS: The addition of dexmedetomidine prolongs the duration of vasodilation induced by stellate ganglion block with mepivacaine used for sympathetic block in dogs.
PMID: 15305251 [PubMed - indexed for MEDLINE]
-
Effects of head-up tilt after stellate ganglion block on QT interval and QT dispersion.
Fujii K, Yamaguchi S, Egawa H, Hamaguchi S, Kitajima T, Minami J.
Department of Anesthesiology, Dokkyo University School of Medicine, Tochigi, Japan.
BACKGROUND AND OBJECTIVES: The aim of this study is to examine the effects of head-up tilt (70 degrees ) 30 minutes after right or left stellate ganglion block (SGB) on RR interval, QT interval, the rate-corrected QT (QTc) interval, QT dispersion (QTD), and the rate-corrected QT dispersion (QTcD) using computerized measurement. METHODS: Ten healthy volunteers underwent both right and left SGBs using 7 mL 1% mepivacaine with a 7-day interval between the two blocks. A 12-lead electrocardiogram was monitored to measure parameters before SGB; 30 minutes after SGB (before head-up tilt); and immediately, 5, 10, and 15 minutes after head-up tilt. RESULTS: Right SGB induced significant increases in QT interval, QTc interval, QTD, and QTcD from 30 minutes after the block through 15 minutes after head-up tilt. There were significant increases of QT interval, QTc interval, and QTcD between before and immediately after head-up tilt in right SGB. Left SGB induced significant decreases of QT interval and QTc interval from 30 minutes after SGB through 15 minutes after head-up tilt. Left SGB also induced a significant decrease of QTD from immediately after through 10 minutes after head-up tilt. CONCLUSIONS: Significant increases of QT interval, QTc interval, and QTcD, which are associated with an increased risk of ventricular arrhythmias and cardiac events, occur immediately after head-up tilt in right SGB. However, head-up tilt does not induce increases of QT interval, QTc interval, QTD, and QTcD in left SGB.
PMID: 15305250 [PubMed - indexed for MEDLINE]
-
Ropivacaine 3.75 mg/ml, 5 mg/ml, or 7.5 mg/ml for cervical plexus block during carotid endarterectomy.
Umbrain VJ, van Gorp VL, Schmedding E, Debing EE, von Kemp K, van den Brande PM, Camu F.
Department of Anesthesiology (V.J.U., V.L.V.G., F.C.), Academisch Ziekenhuis, Vrije Universiteit Brussel, Laarbeeklaan, Brussels, Belgium. Vincent.Umbrain@az.vub.ac.be
OBJECTIVE: To examine the effect of 225 mg (7.5 mg/mL), 150 mg (5 mg/mL), and 112.5 mg (3.75 mg/mL) ropivacaine on quality of cervical plexus block during carotid endarterectomy. METHODS: Patients (n = 93) scheduled for carotid endarterectomy were randomized to receive a cervical plexus block with deep infiltration of 10 mL and superficial infiltration of 20-mL volumes of ropivacaine 7.5, 5.0, or 3.75 mg/mL. Pain, coughing, hemodynamic consequences of the block, postoperative visual analog scores, and pain satisfaction index were recorded. If necessary, anesthesia supplements with aliquots of 3 mL lidocaine 1% were given during surgery. RESULTS: Incidences of coughing and hoarseness were similar in all groups. More local anesthetic infiltrations were required in the ropivacaine 3.75-mg/mL and 5-mg/mL groups. Postoperatively, no intragroup differences were observed. A trend toward better pain satisfaction was observed in the ropivacaine 7.5-mg/mL group. CONCLUSION: The best quality of cervical plexus block associated with the smallest incidence of pain for patients undergoing carotid endarterectomy was obtained with 30 mL of 225 mg and 150 mg of ropivacaine, respectively.
Publication Types:
- Clinical Trial
- Randomized Controlled Trial
PMID: 15305249 [PubMed - indexed for MEDLINE]
| Display Show |
|
|