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Items 1 - 23 of 23 |
One page. |
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Transoesophageal echocardiography in anaesthesia and intensive care medicine.
Walker MB.
PMID: 15766361 [PubMed - in process]
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Leak on Datex Aestiva/5 anaesthetic machine.
Aldridge J.
PMID: 15766359 [PubMed - in process]
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Dental anaesthesia in children.
Taylor BL, Burden RJ, Wood ML, Smith GB, Averley P.
PMID: 15766347 [PubMed - in process]
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Effects of a height and weight adjusted dose of local anaesthetic for spinal anaesthesia for elective Caesarean section*.
Harten JM, Boyne I, Hannah P, Varveris D, Brown A.
Clinical Lecturer, University of Glasgow Department of Anaesthesia, Queen Elizabeth Building, 10 Alexandra Parade, Glasgow G31.
Summary In this prospective, randomised, double-blind study, we compared the effects of two dosage regimens. Pregnant patients at term were randomly assigned to two groups to be given diamorphine 0.4 mg in hyperbaric bupivacaine 0.5% 2.4 ml or diamorphine 0.4 mg in a volume of hyperbaric bupivacaine 0.5% adjusted according to the patient's height and weight. Adequate anaesthesia was provided in all patients in both groups. The onset of the sensory block for cold and pinprick was faster with the fixed dose regimen (p = 0.01). There were more spinal blocks to above the first thoracic dermatome in the fixed dose group (17.1% vs. 2.2%, p = 0.022). Hypotension occurred in 71.7% vs. 50.0% of patients in the fixed dose and adjusted dose groups respectively (p = 0.035). In the fixed dose group, more patients required ephedrine to treat hypotension (79.5% vs. 56.8%, p = 0.022) and a larger median dose was administered (9 mg vs. 6 mg, p = 0.042). The decrease in mean (SD) arterial pressure was less in the adjusted group (35.0 (16.4) mmHg vs. 28.0 (13.5) mmHg, p = 0.036).
PMID: 15766337 [PubMed - in process]
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UK anaesthetic training and the law of unintended consequences. Cause for concern?
Spargo PM.
PMID: 15766333 [PubMed - in process]
[Anesthetic management of pediatric cleft lip and cleft palate repair.]
[Article in German]
Machotta A.
Klinik fur Anasthesiologie und operative Intensivmedizin, Charite - Universitatsmedizin Berlin, Campus Virchow-Klinikum.
We have developed a modern strategy for the anesthetic management of pediatric cleft lip and cleft palate repair using anesthetic drugs such as sevoflurane, desflurane, acetaminophen, remifentanil, and pirtitramide together with new techniques. It provides best conditions for the surgeon and maximum safety for the pediatric patient. A team of pediatricians, neonatologists, pediatric surgeons, and pediatric anesthetists have tackled the problem of management of children with craniofacial abnormalities such as cleft lip and cleft palate.The best and safest anesthetic techniques are outlined and the most frequent complications are discussed, e.g. management of the difficult airway, the airway in patients with complex craniofacial abnormalities, fiberoptic endotracheal intubation through a laryngeal mask, intraoperative dislocation of the endotracheal tube, postoperative airway obstruction and perioperative bleeding.
PMID: 15765201 [PubMed - as supplied by publisher]
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[Invasive techniques in emergency medicine. III. Intraosseous punction--an alternative vascular access in paediatric emergencies]
[Article in German]
Helm M, Gries A, Fischer S, Hauke J, Lampl L.
Abteilung fur Anasthesiologie und Intensivmedizin, Bundeswehrkrankenhaus Ulm. matthias.helm@extern.uni-ulm.de
There can be few more daunting challenges for the emergency physician than an infant or small child in shock or cardiac arrest. At the best of times, the combination of small veins and abundant subcutaneous tissue makes vascular access difficult or impossible, even in experienced hands. For these situations, the intraosseous vascular access is an easy, rapid and safe alternative. The intraosseous route is recommended for children < or =6 years of age, where conventional vascular access cannot be timely established. The preferred sites are the medial aspect of the proximal end of the tibia, just below the tibial tuberosity. Access should be obtained with a commercially available intraosseous needle. All emergency drugs and infusion fluids for intravenous usage can safely be infused via the intraosseous route (except hypertonic solutions) and it is not necessary to adjust drug dosage compared to the intravenous route. To avoid complications caused by the intraosseous needle, such as osteomyelitis, it should be replaced within 2 h by a conventional vascular access.
Publication Types:
PMID: 15625599 [PubMed - indexed for MEDLINE]
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[Shone's anomaly Fallbericht und Hintergrund]
[Article in German]
Derrer F, Gisin S, Linka A, Kindler CH.
Departement Anasthesie, Universitatsspital, Basel.
Shone's anomaly was first described in 1963 as a developmental complex of four potentially obstructive cardiac lesions including a supravalvular fibrous mitral ring, deformity of the mitral and/or subvalvular apparatus, subvalvular aortic stenosis and coarctation of the aorta. While paediatric patients with Shone's anomaly have been reported in the literature, only a few adult patients presenting with this anomaly have been described in the perioperative period. However, patients with an undiagnosed, incomplete form of Shone's anomaly might occasionally present for non-cardiac surgery as adults. In this case report we describe the anaesthetic management of an adult patient scheduled for a non-cardiac operation, who suffered from Shone's anomaly that was unrecognised prior to the operation.
Publication Types:
PMID: 15551106 [PubMed - indexed for MEDLINE]
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[An unexpected difficult intubation. Bonfils rigid fiberscope]
[Article in German]
Maybauer MO, Maier S, Thierbach AR.
Klinik fur Anasthesiologie, Klinikum der Johannes Gutenberg Universitat, Mainz.
A solution to managing intubation difficulties during anaesthesia induction is described in this article. After two attempts at laryngoscopy had failed, endotracheal intubation was achieved by the combined use of a laryngoscope and the Bonfils rigid fiberscope. The successful technique involved two anaesthesiologists, one who displaced the patient's tongue to the left ventral part of the mouth with a laryngoscope and cleared the airway by suctioning, and one who accomplished the intubation using the Bonfils rigid fiberscope by following the blade of the laryngoscope to the larynx. After securing a good view of the vocal cords, the tube was successfully inserted into the trachea. The entire procedure of intubation was accomplished within 20 s.
Publication Types:
PMID: 15517112 [PubMed - indexed for MEDLINE]
Tourniquet palsy or residual block?
Eipe N, Padhi NR.
Publication Types:
PMID: 15728102 [PubMed - indexed for MEDLINE]
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A new friendly approach to pediatric inhaled induction.
El Sayed Shawky J.
Publication Types:
PMID: 15728097 [PubMed - indexed for MEDLINE]
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Extremely prolonged unilateral block (20 hours) with spinal ropivacaine used for cervical cerclage placement.
James ML, Panni MK.
Publication Types:
PMID: 15728090 [PubMed - indexed for MEDLINE]
Comment on:
Exhaled CO after surgery: a consequence of postoperative narcotics?
Dunning MB 3rd, Woehlck HJ.
Publication Types:
PMID: 15728089 [PubMed - indexed for MEDLINE]
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Intravenous but not perineural clonidine prolongs postoperative analgesia after psoas compartment block with 0.5% levobupivacaine for hip fracture surgery.
Mannion S, Hayes I, Loughnane F, Murphy DB, Shorten GD.
Department of Anaesthesia and Intensive Care, Cork University Hospital, Cork, Ireland. mannionstephen@hotmail.com
We evaluated the systemic and local effects of clonidine as an analgesic adjunct to psoas compartment block (PCB) with levobupivacaine. In a randomized, prospective, double-blind trial, 36 patients requiring hip fracture surgery received PCB and general anesthesia. Patients were randomized into three groups. Each patient received PCB with 0.4 mL/kg of levobupivacaine 0.5%. The control group (group L) received IV saline, the systemic clonidine group (group IC) received IV clonidine 1 mug/kg, and the peripheral clonidine group (group C) received IV saline and PCB with clonidine 1 microg/kg. The interval from time of completion of block injection to first supplementary analgesic administration was longer in group IC compared with group L (mean +/- sd, 13.4 +/- 6.1 versus 7.3 +/- 3.6 h; P = 0.03). There was no difference between group C and group L (10.3 +/- 5.9 versus 7.3 +/- 3.6 h; P > 0.05). The groups were similar in terms of 24 h cumulative morphine and acetaminophen consumption. There were no significant differences among groups regarding postoperative adverse effects (bradycardia, hypotension, sedation, and nausea). We conclude that IV but not perineural clonidine (1 microg/kg) prolongs analgesia after PCB without increasing the incidence of adverse effects.
Publication Types:
- Clinical Trial
- Randomized Controlled Trial
PMID: 15728081 [PubMed - indexed for MEDLINE]
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Adding clonidine to the induction bolus and postoperative infusion during continuous femoral nerve block delays recovery of motor function after total knee arthroplasty.
Casati A, Vinciguerra F, Cappelleri G, Aldegheri G, Fanelli G, Putzu M, Chelly JE.
Department of Anesthesiology, University of Parma, Italy. acasati.@ao.pr.i
We evaluated the effects of adding clonidine for continuous peripheral nerve infusions. Sixty patients undergoing total knee arthroplasty under combined single-injection sciatic block and continuous femoral infusion were randomly allocated to three groups: block induction with 0.75% ropivacaine followed by 0.2% ropivacaine (group control; n = 20); block induction with 0.75% ropivacaine and 1 microg/kg clonidine followed by 0.2% ropivacaine (group cloni-bolus; n = 20), and block induction with 0.75% ropivacaine and 1 microg/kg clonidine followed by 0.2% ropivacaine with 1 microg/mL clonidine (group cloni-infusion; n = 20). After surgery, continuous femoral infusion was provided with a patient-controlled infusion pump (basal infusion rate, 6 mL/h; incremental dose, 2 mL; lockout time, 15 min). The median (range) onset time of surgical block was 15 min (5-30 min) in group control, 10 min (5-35 min) in group cloni-bolus, and 10 min (5-30 min) in group cloni-infusion (P = 0.07). No differences were reported among groups in the degree of pain measured with the visual analog scale. The total consumption of local anesthetic solution after a 24-h infusion was 170 mL (144-220 mL) in group control, 169 mL (144-260 mL) in group cloni-bolus, and 164 mL (144-248 mL) in group cloni-infusion (P = 0.51); after the second day of infusion, total consumption was 168 mL (144-200 mL) in group control, 156 mL (144-288 mL) in group cloni-bolus, and 150 mL (144-210 mL) in group cloni-infusion (P = 0.48). Hemodynamic profiles and sedation were similar in the three groups. Motor function impairment after 48 h of infusion was observed in 27% of cloni-infusion patients but in only 6% of both the control and cloni-bolus groups (P = 0.05). We conclude that adding clonidine 1 microg/mL to local anesthetic for continuous femoral nerve block does not improve the quality of pain relief but has the potential for delaying recovery of motor function.
Publication Types:
- Clinical Trial
- Randomized Controlled Trial
PMID: 15728080 [PubMed - indexed for MEDLINE]
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Threshold current of an insulated needle in the intrathecal space in pediatric patients.
Tsui BC, Wagner AM, Cunningham K, Perry S, Desai S, Seal R.
Department of Anesthesiology and Pain Medicine, University of Alberta, Edmonton, Alberta, Canada. btsui@ualberta.ca
A threshold current of <1 mA has been suggested to be sufficient to produce a motor response to electrical stimulation in the intrathecal space. We designed this study to determine the threshold current needed to elicit motor activity for an insulated needle in the intrathecal space. Twenty pediatric patients aged 7.3 +/- 3.9 yr scheduled for lumbar puncture were recruited. After sedation with propofol, patients were turned to the lateral position and an 18-gauge or 20-gauge introducer needle was placed at the L4-5 level through which an insulated 24-gauge Pajunck unipolar needle (with a Sprotte tip and stylet) was inserted. The needle was advanced into the intrathecal space as suggested by the presence of a "pop." At this point, a nerve stimulator was attached to the insulated needle and the current was gradually increased until motor activity was evident. The needle hub was checked for cerebrospinal fluid. If cerebrospinal fluid was not present, the needle was advanced further until cerebrospinal fluid was present. The threshold current was retested. The mean current in the intrathecal space required to elicit a motor response was 0.6 +/- 0.3 mA (range, 0.1-1 mA). In 19 patients, the twitches were observed at the L4-5 myotomes and 1 patient had twitches at L2. Twitches were observed unilaterally in 19 children and bilaterally in one child. This confirms the hypothesis that the threshold current in the intrathecal space is <1 mA and that it differs significantly from the threshold currents reported for electrical stimulation in the epidural space.
PMID: 15728047 [PubMed - indexed for MEDLINE]
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Angiotensin system inhibitors in a general surgical population.
Comfere T, Sprung J, Kumar MM, Draper M, Wilson DP, Williams BA, Danielson DR, Liedl L, Warner DO.
Department of Anesthesiology, Mayo Clinic College of Medicine, 200 First St. S.W., Rochester, MN 55905, USA.
We studied the relationship between the timing of discontinuing chronic angiotensin-converting enzyme inhibitors (ACEI) and angiotensin II receptor subtype 1 antagonists (ARA) and hypotension after the induction of general anesthesia in a general surgical population. We retrospectively studied 267 hypertensive patients receiving chronic ACEI/ARA therapy undergoing elective noncardiac surgery under general anesthesia. During preoperative visits, patients were asked to either take their last ACEI/ARA therapy on the morning of surgery or withhold it up to 24 h before surgery. The number of hours from the last ACEI/ARA dose to surgery was recorded during the preoperative interview. Electronic medical and anesthesia records were reviewed for comorbidities, type and dose of anesthetics used, intraoperative hemodynamics, IV fluids, perioperative vasopressor administration, and rate of severe postoperative complications. Arterial blood pressure (BP) and heart rate were recorded during the 60-min postinduction period, and hypotension was classified as moderate (systolic BP <or=85 mm Hg) and severe (systolic BP <or=65 mm Hg). We analyzed all variables separately for patients who took their last ACEI/ARA therapy <10 h and >or=10 h before surgery. During the first 30 min after anesthetic induction, moderate hypotension was more frequent in patients whose most recent ACEI/ARA therapy was taken <10 h (60%) compared with those who stopped it >or=10 h (46%) before induction (P = 0.02). The adjusted odds ratio for moderate hypotension was 1.74 (95% confidence interval, 1.03-2.93) for those who took their ACEI/ARA therapy <10 h before surgery (P = 0.04). There were no differences between groups in the incidence of severe hypotension, nor was there a difference in the use of vasopressors. During the 31-60 min after induction, the incidence of either moderate (P = 0.43) or severe (P = 0.97) hypotension was similar in the two groups. No differences in postoperative complications were found between groups. In conclusion, discontinuation of ACEI/ARA therapy at least 10 h before anesthesia was associated with a reduced risk of immediate postinduction hypotension.
PMID: 15728043 [PubMed - indexed for MEDLINE]
Risk factors for bacterial catheter colonization in regional anaesthesia.
Morin AM, Kerwat KM, Klotz M, Niestolik R, Ruf VE, Wulf H, Zimmermann S, Eberhart LH.
BACKGROUND: Although several potential risk factors have been discussed, risk factors associated with bacterial colonization or even infection of catheters used for regional anaesthesia are not very well investigated. METHODS: In this prospective observational trial, 198 catheters at several anatomical sites where placed using a standardized technique. The site of insertion was then monitored daily for signs of infection (secretion at the insertion site, redness, swelling, or local pain). The catheters were removed when clinically indicated (no or moderate postoperative pain) or when signs of potential infection occurred. After sterile removal they were prospectively analyzed for colonization, defined as > 15 colony forming units. RESULTS: 33 (16.7%) of all catheters were colonized, and 18 (9.1%) of these with additional signs of local inflammation. Two of these patients required antibiotic treatment due to superficial infections. Stepwise logistic regression analysis was used to identify factors associated with catheter colonization. Out of 26 potential factors, three came out as statistically significant. Catheter placement in the groin (odds-ratio and 95%-confidence interval: 3.4; 1.5-7.8), and repeated changing of the catheter dressing (odds-ratio: 2.1; 1.4-3.3 per removal)increased the risk for colonization, whereas systemic antibiotics administered postoperatively decreased it (odds ratio: 0.41; 0.12-1.0). CONCLUSION: Colonization of peripheral and epidural nerve catheter can only in part be predicted at the time of catheter insertion since two out of three relevant variables that significantly influence the risk can only be recorded postoperatively. Catheter localisation in the groin, removal of the dressing and omission of postoperative antibiotics were associated with, but were not necessarily causal for bacterial colonization. These factors might help to identify patients who are at increased risk for catheter colonization.
PMID: 15774007 [PubMed - as supplied by publisher]
Detection of hypoventilation during thoracoscopy: combined cutaneous carbon dioxide tension and oximetry monitoring with a new digital sensor.
Chhajed PN, Kaegi B, Rajasekaran R, Tamm M.
Division of Respiratory Medicine and Pulmonary Cell Research, University Hospital Basel, Petersgraben 4, CH-4031, Basel, Switzerland. PChhajed@uhbs.ch
BACKGROUND: Changes in Paco(2) have not been described during thoracoscopy under sedation-assisted local anesthesia. We hypothesized that hypoventilation might occur secondary to administration of sedatives and decreased ventilation in one lung.Aim: Prospectively measure cutaneous carbon dioxide tension (Pcco(2)) in addition to pulse oximetric saturation (Spo(2)) using a new combined digital sensor to examine the occurrence of hypoventilation during thoracoscopy under sedation-assisted local anesthesia. SETTING: University hospital. METHODS: Following validation studies, Pcco(2) was prospectively measured in 16 consecutive patients undergoing thoracoscopy under sedation-assisted local anesthesia using a combined digital earlobe sensor measuring Spo(2) (percentage) and Pcco(2) (millimeters of mercury). All patients received supplemental oxygen. Routine BP monitoring and Spo(2) was continued. Patients received IV hydrocodone, 5 mg, and intermittent boluses or IV midazolam and pethidine. RESULTS: Mean baseline Pcco(2) measurement was 39.1 +/- 7.2 mm Hg (+/- SD) [range, 27.5 to 50.5 mm Hg], and peak measurement during the procedure was 52.3 +/- 10.3 mm Hg (range, 37.2 to 77 mm Hg) [p < 0.001]. Median and mean changes in Pcco(2) measurement from baseline were 13.0 mm Hg and 13.2 +/- 5.3 mm Hg (range, 5.5 to 27.8 mm Hg), respectively. Mean fall in Spo(2) during the procedure was 4.6 +/- 3.2% (range, 1 to 14%). CONCLUSIONS: Thoracoscopy performed under sedation-assisted local anesthesia is associated with significant hypoventilation. Combined measurement of Spo(2) and Pcco(2) during thoracoscopy is a novel approach in the monitoring of ventilation, enhancing patient safety, and might allow to guide the administration of sedation in a better way.
PMID: 15706000 [PubMed - indexed for MEDLINE]
Bacterial meningitis ten days after spinal anesthesia.
Bussink M, Gramke HF, Van Kleef M, Marcus M.
PMID: 15765468 [PubMed - in process]
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Continuous peripheral nerve block for battlefield anesthesia and evacuation.
Buckenmaier CC, McKnight GM, Winkley JV, Bleckner LL, Shannon C, Klein SM, Lyons RC, Chiles JH.
Peripheral nerve and continuous peripheral nerve block (CPNB) have the potential to be valuable techniques in combat anesthesia. We describe the first successful application of CPNB in the pain management and surgical management of a combat casualty as he was evacuated from the Iraqi battlefield to the United States.
PMID: 15765463 [PubMed - in process]
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Continuous epidural analgesia for colonic surgery-but what about the future?
Carli F, Kehlet H.
PMID: 15765456 [PubMed - in process]
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The early recovery of cognitive function after total-hip replacement under hypotensive epidural anesthesia.
Sharrock NE, Fischer G, Goss S, Flynn E, Go G, Sculco TP, Salvati EA.
Background and objectives Recovery of cognitive function immediately after major surgery has not been previously reported, partly because of residual drug effects and pain. Methods Changes in cognitive function were assessed using the Stroop Color and Word Test (SCWT), which was performed preoperatively, and 1 and 2 hours after total-hip replacement performed under hypotensive epidural anesthesia. In this case series, patients were sedated with propofol alone and had a lumbar plexus block performed at the end of surgery. Results The SCWT was completed in 52 of 55 patients at either 1 or 2 hours after surgery. A significant reduction in cognitive function was noted 1 hour after surgery but a return toward baseline occured 2 hours after surgery. Age older than 70 years adversely affected recovery of cognitive function, but neither the preoperative diagnosis of hypertension nor the degree or duration of intraoperative hypotension (mean arterial pressure less than 45 mmHg) influenced cognitive function. Conclusion The Stroop Color and Word Test can be used to assess change in cognitive function immediately after surgery. Total-hip replacement performed under regional anesthesia with propofol sedation enables recovery of cognitive function (as assessed by SCWT) 2 hours after surgery.
PMID: 15765453 [PubMed - in process]
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