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Feasibility of electromyography (sEMG) in measuring muscular activity during spinal anaesthesia in patients undergoing knee arthroplasty.
Niemi-Murola L, Paloheimo M.
Department of Anaesthesia and Intensive Care Medicine, Helsinki University Central Hospital, Helsinki, Finland.
Background: Bromage scale (0-3) is used to measure the degree of motor block during spinal anaesthesia. However, an estimation of motor block is difficult during surgery. The purpose of this study was to evaluate the feasibility of surface EMG describing spontaneous muscular activity in the lower extremities during spinal anaesthesia. Methods: In part I of the study, 13 patients undergoing day case surgery were studied. They received 10 mg hyperbaric bupivacaine at interspace L3-4. EMG, sensory and muscular block were measured at 5-min intervals during the first 30 min and then every 15 min until the patient was able to flex the knee. In part II of the study, 16 patients undergoing knee arthroplasty received 10 mg bupivacaine through spinal catheter at interspace L3-4 (Group CSA). An additional bolus of 2.5 mg was administered using EMG-guidance, if needed. Another group, 15 patients, received a single bolus of bupivacaine (15-20 mg) at L3-4 (Group Bolus). EMG, muscular and sensory block were monitored as described above. The epidural catheter was used as rescue. Results: Part I: EMG compared to modified Bromage scale showed a significant correlation (P < 0.01, Spearman rank correlation). Part II: The amount of bupivacaine was significantly reduced with EMG guidance when compared with the single bolus group (14.0 mg vs. 17.0 mg) (P < 0.05 Mann-Whitney U). Motor block started to recover before the sensory block in 7/15 CSA patients vs. 1/15 Bolus patient. Conclusion: Stable maximal sensory block does not necessarily correlate with adequate motor block in patients receiving spinal anaesthesia induced with small bolus doses. In spite of electrical noise, EMG-guided administration of spinal anaesthesia significantly reduced the amount of bupivacaine compared to the hospital routine. Further studies are needed to develop the method.
PMID: 15777306 [PubMed - in process]
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Improved analgesia with clonidine when added to local anesthetic during combined spinal-epidural anesthesia for hip arthroplasty: a double-blind, randomized and placebo-controlled study.
Dobrydnjov I, Axelsson K, Gupta A, Lundin A, Holmstrom B, Granath B.
Department of Anesthesiology and Intensive Care, University Hospital, Orebro, Sweden.
Background: The perioperative effects of intrathecal and epidural clonidine combined with local anesthetic were evaluated in 60 patients undergoing hip arthroplasty. Methods: This was a double-blinded study and the patients were randomized into three groups, with 20 patients in each group. All patients received spinal anesthesia with 17.5 mg of plain bupivacaine with 15 microg of clonidine (Group BC-RC) or without clonidine (Groups B-R and B-RC). Postoperatively, epidural infusion was administered in the following way: Group B-R - ropivacaine 4 mg h(-1); Groups B-RC and BC-RC: ropivacaine 4 mg h(-1) and clonidine 40 microg h(-1). Sensory block was assessed with light touch, pinprick, transcutaneous electrical stimulation at T12 and L2 dermatomes, and perception of thermal stimuli. Results: The maximal upper level of sensory block measured by pin-prick (T6-T7) did not differ between the groups while the partial sensory block for cold and warmth were increased two dermatomes above pin-prick level in the group with intrathecal clonidine compared to the other two groups (P < 0.05). Duration of anesthesia, analgesia and motor block were longer in Group BC-RC compared to Groups B-R and B-RC (P < 0.02). Postoperatively, both VAS score on movement and PCA-morphine consumption were higher in Group B-R than in Groups B-RC and BC-RC (P < 0.01). The arterial pressure and heart rate in Groups B-RC and BC-RC were significantly lower than in Group B-R at 10-24 and 15-24 h, respectively, after spinal injection. Conclusion: Low-dose intrathecal clonidine provided a better quality of anesthesia and longer-lasting analgesia. Epidural clonidine-ropivacaine infusion resulted in improved postoperative analgesia but was associated with a moderate decrease in blood pressure.
PMID: 15777303 [PubMed - in process]
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Efficacy of sufentanil addition to ropivacaine epidural anaesthesia for Caesarean section.
Bachmann-Mennenga B, Veit G, Steinicke B, Biscoping J, Heesen M.
Departments of Anaesthesiology, Klinikum Minden, Minden, St. Vincentius Kliniken, Karlsruhe and Klinikum Bamberg, Germany.
Background: This prospective double-blind trial evaluated the effect of sufentanil addition to epidural ropivacaine for elective Caesarean section. Methods: Sixty healthy parturients were randomly assigned to receive an initial dose of 90 mg of plain ropivacaine, or 90 mg of ropivacaine plus 10 or 20 microg of sufentanil (n = 20 each). Before surgery, if necessary, additional epidural ropivacaine was injected. Primary outcome parameter was time to achieve sensory block at T4. Results: Time to reach the sensory block was remarkably reduced (P < 0.001 each) by addition of 10 or 20 microg of sufentanil (21 +/- 8 min, 15 +/- 5 min, 11 +/- 4 min in the plain ropivacaine, the 10- and 20-microg sufentanil groups, respectively) whereas the visual analogue scale (VAS) scores at delivery were significantly reduced (P = 0.028) only by 20 microg of sufentanil (32 +/- 35 mm in the plain ropivacaine vs. 9 +/- 19 mm in the 20-microg sufentanil groups). The total dose of ropivacaine was significantly lower (P = 0.005) in patients receiving 20 microg of sufentanil (100.5 +/- 15.0 mg) compared with those treated with plain ropivacaine (118.5 +/- 17.3 mg). The incidence of maternal side-effects (hypotension, bradycardia, nausea, vomiting, shivering, pruritus) and neonatal outcome [APGAR score, neurologic and adaptive capacity (NAC) score, umbilical cord blood-gas values] did not differ between the groups. Conclusion: Our results suggest that addition of 20 microg of sufentanil improved the epidural anaesthesia with ropivacaine 0.75% for Caesarean section.
PMID: 15777302 [PubMed - in process]
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Effect of Xenon on elevated intracranial pressure as compared with nitrous oxide and total intravenous anesthesia in pigs.
Schmidt M, Marx T, Armbruster S, Reinelt H, Schirmer U.
Department Cardiac Anesthesia, University of Ulm, Ulm, Germany.
Background: Xenon in low concentrations has been investigated in neuroradiology to measure cerebral blood flow (CBF). Several reports have suggested that inhalation of Xenon might increase intracranial pressure (ICP) by increasing the cerebral blood flow and blood volume, raising concerns about using Xenon as an anesthetic in higher concentrations for head-injured patients. A porcine study is presented in which the effects of inhaled 75% Xenon on elevated ICP, cerebral perfusion pressure and the efficacy of hyperventilation for ICP treatment were compared with nitrous oxide anesthesia and total intravenous anesthesia (TIVA). Methods: Twenty-one pentobarbital-anesthetized pigs (age: 12-16 weeks) were randomly assigned to three groups to receive either 4 h of Xenon-oxygen ventilation, nitrous oxide-oxygen ventilation or air-oxygen (75%/25%) ventilation, respectively. After instrumentation for parenchymal ICP measurement and ICP manipulation, an epidurally placed 6-F balloon catheter was inflated until a target ICP of 20 mmHg was achieved. After 4 h of anesthesia hyper- and hypoventilation maneuvers were performed and consecutive ICP and CBF changes were investigated. Results: Intracranial pressure and CBF increased significantly in the nitrous oxide group as compared with the controls. There was no increase of ICP or CBF in the Xenon or control group. Intracranial pressure changed in all three groups corresponding to hyper- and hypoventilation. Conclusions: During Xenon anesthesia, elevated ICP is not increased further and is partially reversible by hyperventilation. Our study suggests that inhalation of 75% Xenon seems not to be contraindicated in patients with elevated ICP.
PMID: 15777297 [PubMed - in process]
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Effect of additives in lidocaine spray on postoperative sore throat, hoarseness and dysphagia after total intravenous anaesthesia.
Hara K, Maruyama K.
Department of Anaesthesiology, Iida Municipal Hospital, Nagano, Japan.
Background: Laryngo-tracheal lidocaine spray before intubation is associated with an increased risk of postoperative throat problems. Our study investigated the effect of additives contained in lidocaine spray on postoperative sore throat, hoarseness and dysphagia. Methods: We compared the incidence and severity of postoperative throat complications after laryngo-tracheal application of lidocaine spray (40 mg), lidocaine (40 mg) or normal saline as placebo during laryngoscopy with total intravenous anaesthesia in 122 ASA I-III patients aged 15-87 years in a double-blinded, placebo-controlled study. The incidence and severity of postoperative sore throat, hoarseness and dysphagia were evaluated on the day of and the day after surgery. Results: Sore throat and dysphagia were significantly more severe after lidocaine spray was used than after lidocaine or placebo was used. However, there was no significant difference in the incidence or severity of postoperative sore throat, hoarseness or dysphagia between the lidocaine group and the placebo group throughout the study. Conclusion: These results suggest that additives in lidocaine spray, not lidocaine itself, contribute to the increase in postoperative throat problems. Therefore, lidocaine spray should be avoided to prevent these unnecessary complications. Our findings also confirm that laryngo-tracheal lidocaine application does not prevent sore throat, hoarseness or dysphagia after total intravenous anaesthesia.
PMID: 15777293 [PubMed - in process]
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Anaesthetists should wear gloves - touch sensitivity is improved with a new type of thin glove.
Kopka A, Crawford JM, Broome IJ.
Department of Anaesthesia, Gartnavel General Hospital, Glasgow, UK.
Background: Sterile gloves should be worn for all invasive procedures. However, loss of touch sensitivity when wearing gloves leads to poor compliance among anaesthetists in the UK. Our aim was to investigate whether new surgical glove types, such as extra-thin or latex-free gloves, offer any advantage in touch sensitivity. Methods: The skin-pressure sensibility threshold of the gloved pulp of the dominant index finger was established in 24 anaesthetists using nine self-made modified von Frey hairs. The range of forces generated by nylon monofilaments was evenly distributed between 0.5 and 17 mN. The gloves tested were latex Biogel standard, latex-free Biogel Neotech, and extra-thin latex Ansell microthin surgical gloves. The different glove types were assessed in a counterbalancing algorhythm, the individual was blinded, and the filaments were applied in random order. Results: The median threshold force to touch was significantly lower for the extra-thin surgical gloves in comparison to the standard latex (P = 0.014) and latex-free gloves (P = 0.001). There was no significant difference between the standard latex and latex-free gloves (P = 0.166). Conclusion: We have demonstrated that wearing extra-thin surgical gloves offers increased touch sensitivity. This may improve dexterity when carrying out delicate invasive procedures. Latex-free surgical gloves performed similar to standard latex gloves. Our findings should encourage more widespread glove use among anaesthetists.
PMID: 15777292 [PubMed - in process]
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Effect of alfentanil on intracranial pressure during propofol-fentanyl anesthesia for craniotomy. A randomized prospective dose-response study.
Olsen KS, Juul N, Cold GE.
Department of Anesthesia and Intensive Care, Glostrup Hospital, University of Copenhagen, Denmark.
Background: The effect of alfentanil on intracranial pressure (ICP) in patients with supratentorial cerebral tumors has only been sparsely examined and with somewhat contradictory results. Methods: Thirty-one patients were anesthetized with propofol and fentanyl. After removal of the bone flap a bolus-dose of alfentanil 10 (group 1), 20 (group 2), or 30 microg kg(-1) (group 3) was administered followed by an infusion of 10, 20, or 30 microg.kg(-1).h(-1) to patients in groups 1, 2, and 3, respectively. A control group received no alfentanil. Subdural ICP, mean arterial blood pressure (MAP), and cerebral perfusion pressure (CPP) were monitored and arterial and jugular bulb blood were sampled before and every minute for 5 min after the bolus administration of alfentanil and again after 5 min of hyperventilation to be able to calculate cerebral arterio-venous oxygen content difference (AVDO(2)) and carbon dioxide reactivity (CO(2)-reactivity). Results: No changes in subdural ICP or AVDO(2) from alfentanil in the study period were observed within the groups. However, alfentanil decreased MAP and CPP. The maximum CPP decrease (mean value of each group) was 4 mmHg, 8 mmHg, and 18 mmHg in groups 1, 2, and 3, respectively. There was no difference between groups as regards the CO(2)-reactivity. Conclusion: We conclude that administration of alfentanil to propofol-fentanyl anesthetized patients with supratentorial cerebral tumors decreases MAP and CPP in a dose-related way, but does not influence subdural ICP, AVDO(2) or the CO(2)-reactivity.
PMID: 15777290 [PubMed - in process]
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Anaphylactic reactions during anaesthesia - let us treat the problem rather than debating its existence.
Mertes PM.
Service d'Anaesthesie-Reanimation, Hopital Central, Nancy Cedex, France.
PMID: 15777287 [PubMed - in process]
Comment on:
A response to 'Routine pre-oxygenation - a new "minimum standard" of care?'.
Palmer J.
Publication Types:
PMID: 15710031 [PubMed - indexed for MEDLINE]
Comment on:
A response to 'Routine pre-oxygenation - a new "minimum standard" of care?'.
Aveling W.
Publication Types:
PMID: 15710028 [PubMed - indexed for MEDLINE]
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Using atmospheric pressure to inflate the cuff of the Portex Laryngeal Mask.
Al-Shaikh B, George William M, Van Zundert AA.
Publication Types:
- Evaluation Studies
- Letter
PMID: 15710025 [PubMed - indexed for MEDLINE]
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Incorrectly assembled nerve block catheter sets.
Bhimarsetty C, Mutagi HS, Geoghehan J.
Publication Types:
PMID: 15710020 [PubMed - indexed for MEDLINE]
Comment on:
Routine pre-oxygenation.
Tallach RE, Ball DR.
Publication Types:
PMID: 15710015 [PubMed - indexed for MEDLINE]
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'Where there is error, may we bring truth.' A misquote by Margaret Thatcher as she entered No 10, Downing Street in 1979.
Adams H.
Princess Royal Hospital, Haywards Heath, W. Sussex RH16 4EX, UK. hazel.adams@bsuh.nhs.uk
Publication Types:
PMID: 15710012 [PubMed - indexed for MEDLINE]
[Pre-operative measurement of heart rate variability in diabetics: a method to estimate blood pressure stability during anaesthesia induction.]
[Article in German]
Knuttgen D, Trojan S, Weber M, Wolf M, Wappler F.
Klinik fur Anasthesiologie, Universitat Witten/Herdecke, Lehrstuhl fur Anasthesiologie II, Krankenhaus Koln-Merheim, .
BACKGROUND: In diabetics severe hyopotension can occur during anaesthesia as a consequence of cardiovascular autonomic neuropathy (CAN). A simple approach to recognize CAN is heart rate variability (HRV) measured at rest. The aim of this study was to determine the relationship between pre-operatively measured HRV and blood pressure stability during induction phase of anaesthesia.PATIENTS AND METHODS: A total of 35 diabetics undergoing an ophthalmosurgical procedure under general anaesthesia were investigated. HRV was examined one day before surgery by the following parameters: coefficient of variation (CV), root mean squared successive difference (RMSSD), and power spectrum. Anaesthesia was induced with thiopental and fentanyl and maintained with enflurane/N(2)O; tracheal intubation was performed after relaxation with vecuronium. Patients who developed a drop in systolic blood pressure below 90 mmHg during anaesthesia induction were assigned to group H (hypotensive), the other patients to group N (normotensive). The groups were compared regarding HRV and other variables.RESULTS: Of all patients 13 developed hypotension during anaesthesia induction (group H). The groups were comparable regarding the demographic data. Parameters of HRV, with the exception of spectral power in low frequency (LF) band of power spectrum, were significantly lower in group H. The groups differed mainly in relation to spectral power in the mid-frequency (MF) band of the power spectrum, and especially regarding CV. In patients with normal CV incidence of hypotension after anaesthesia induction was 11%, but in patients with abnormally reduced CV, 65% (p=0.002).CONCLUSION: The results confirm a significant relationship between HRV pre-operatively measured at rest and blood pressure stability during anaesthesia induction in diabetics. Particularly examination of CV, a simple test feasible within few minutes, may be useful in pre-operative risk stratification of these patients. Application of the time consuming traditional test combination to identify CAN seems to be unnecessary.
PMID: 15778806 [PubMed - as supplied by publisher]
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[Anaesthesia in patients with Parkinson's disease.]
[Article in German]
Kalenka A, Hinkelbein J.
Institut fur Anasthesiologie und Operative Intensivmedizin, Universitatsklinikum Mannheim, .
The neurodegenerative death of dopaminergic neurons of the pars compacta of the substantia nigra leads to the classical triad of resting tremor, muscle rigidity, and bradykinesia of Parkinson's disease. Parkinson's disease is a common disease of elderly patients requiring perioperative anaesthesia. Particular anaesthetic problems are neurological, respiratory, and cardiovascular. The clinical features and the interaction of common anaesthetics with the drug therapy of the patient present an anaesthetic challenge and directly influence perioperative morbidity and mortality.
PMID: 15778805 [PubMed - as supplied by publisher]
Regional anesthesia under general anesthesia and spinal cord injury.
Drasner K.
PMID: 15781554 [PubMed - in process]
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Cerebrospinal lavage seems to be safe and effective in the reversal of inadvertent spinal anesthetic injection.
Liu H.
Publication Types:
PMID: 15781553 [PubMed - in process]
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Cerebrospinal lavage seems to be safe and effective in the reversal of inadvertent spinal anesthetic injection.
Tsui BC.
PMID: 15781552 [PubMed - in process]
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Regional anesthesia under general anesthesia and spinal cord injury.
Benumof JL.
Publication Types:
PMID: 15781549 [PubMed - in process]
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The chewing of betel quid and oral submucous fibrosis and anesthesia.
Eipe N.
Department of Anesthesia, Padhar Hospital, Padhar. Betul, Madhya Pradesh- 460005. India. neipe@yahoo.com
Oral submucous fibrosis (OSMF) is a premalignant lesion of the buccal mucosa caused by chewing betel quid. It results in progressive inability to open the mouth. OSMF causes difficulty in laryngoscopy and intubation of the trachea. Patients with OSMF require anesthesia for trismus correction, resection, and reconstructive (oncoplastic) surgery for coexisting oral malignancies or other unrelated surgeries. Our review of the anesthetics of 44 patients with oral malignancies suggested that 8 had OSMF. The preoperative airway assessment, including the Mallampati score and the clinical Tumor Node Metastasis stage, were useful in predicting the need for fiberoptic intubation. Patients with oral malignancies and OSMF had increased requirement for fiberoptic endotracheal intubations (62.5%) compared with those without OSMF (44.4%). Three different techniques of airway management (tracheal intubation after direct laryngoscopy, fiberoptic tracheal intubation, and tracheostomy) in four patients with OSMF are described. OSMF contributes to the development of the malignancy, delays the diagnoses, and complicates the anesthetic management.
PMID: 15781548 [PubMed - in process]
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Guillain-Barre syndrome in a patient with pancreatic cancer after an epidural-general anesthetic.
Bamberger PD, Thys DM.
Columbia University, College of Physician and Surgeons, Chairman, Department of Anesthesiology, St. Luke's-Roosevelt Hospital Center, New York, NY 10019, USA. pdb9@columbia.edu
Guillain-Barre syndrome is a rare occurrence in medicine and is probably rarer still as a postoperative complication. We report an uneventful operative course, during epidural-general anesthesia, in a patient undergoing pancreatectomy who presented with acute paralysis mimicking an acute cervical spinal cord syndrome or brachial plexus neuropathy. The signs and symptoms of right upper extremity paralysis occurred within 2 h postoperatively. Immediate work-up, which included magnetic resonance imaging, electromyography, and nerve conduction velocity studies, provided the diagnosis.
PMID: 15781545 [PubMed - in process]
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Intravenous regional anesthesia using lidocaine and magnesium.
Turan A, Memis D, Karamanlioglu B, Guler T, Pamukcu Z.
Trakya University Tip Fakultesi, Anesteziyoloji ve Reanimasyon AD, 22030 Edirne, Turkey. alparslanturan@yahoo.co.
We conducted this study to evaluate the effects of magnesium, when added to lidocaine for IV regional anesthesia (IVRA), on tourniquet pain. Thirty patients undergoing elective hand surgery during IVRA were randomly assigned to two groups. IVRA was achieved with 10 mL of saline plus 3 mg/kg lidocaine 0.5% diluted with saline to a total of 40 mL in group C or with 10 mL of 15% magnesium sulfate (12.4 mmol) plus 3 mg/kg lidocaine 0.5% diluted with saline to a total of 40 mL in group M. Injection pain, sensory and motor block onset and recovery time, tourniquet pain, and anesthesia quality were noted. Patients were instructed to receive 75 mg of IM diclofenac when the visual analog scale (VAS) score was >4, and analgesic requirements were recorded. Sensory and motor block onset times were shorter and recovery times were prolonged in group M (P < 0.05). VAS scores of tourniquet pain were lower in group M at 15, 20, 30, 40, and 50 min (P < 0.001). Anesthesia quality, as determined by the anesthesiologist and surgeon, was better in group M (P < 0.05). Time to the first postoperative analgesic request in group C was 95 +/- 29 min and in group M was 155 +/- 38 min (P < 0.05). Postoperative VAS scores were higher for the first postoperative 6 h in group C (P < 0.05). Diclofenac consumption was significantly less in group M (50 +/- 35 mg) when compared with group C (130 + 55 mg) (P < 0.05). We conclude that magnesium as an adjunct to lidocaine improves the quality of anesthesia and analgesia in IVRA.
PMID: 15781543 [PubMed - in process]
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Non-zero basal oxygen flow a hazard to anesthesia breathing circuit leak test.
Tokumine J, Sugahara K, Gushiken K, Ohta M, Matsuyama T, Saikawa S.
Department of Anesthesiology, Faculty of Medicine, University of the Ryukyus, Japan. tokumine2003@yahoo.co.jp
The non-zero basal flow (BF) of oxygen in anesthesia machines has been set to supply the basal metabolic requirement of oxygen. However, there is no scientific evidence of its necessity. In this study we sought to clarify whether non-zero BF affects leak detection during preanesthetic inspections. Twenty-five participants performed leak tests on anesthesia machines to detect breathing circuit leaks. Artificial leak-producing devices were used to create leaks from 0 to 1.0 L/min. The investigator randomly chose the leak device and connected it into the breathing circuit. Participants, blinded as to the presence or the type of leak producing device, then tested the breathing circuit for leaks. The conventional breathing system leak test was performed with and without BF. The results of leak detection in each leak procedure were analyzed statistically. The leak detection rate of leak test with BF was less than without BF (P < 0.01). We demonstrated that non-zero BF of oxygen decreases the leak detection rate and is an obstacle for leak detection, especially for small leaks. Therefore, we recommend that breathing circuit leak tests should be performed in the absence of BF of oxygen.
PMID: 15781521 [PubMed - in process]
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Twelve-lead high-frequency QRS electrocardiography during anesthesia in healthy subjects.
Spackman TN, Abel MD, Schlegel TT.
Department of Anesthesiology, Division of Cardiovascular/Thoracic Anesthesiology, Mayo Clinic College of Medicine, Rochester, MN, USA. spackman.thomas@mayo.edu
Analysis of the high-frequency (HF) components of the QRS complex has been shown to be a more sensitive indicator of myocardial ischemia and infarction than conventional ST segment analysis in settings outside of the operating room. In this study, we documented the effect of general anesthesia on HF QRS analysis in healthy patients as the first step in determining the potential of this technique for monitoring anesthetized patients. HF QRS electrocardiograms (ECGs) were obtained from all 12 ECG leads in 30 healthy subjects before and after the induction of anesthesia. When compared with preinduction values, there were significant postinduction changes in multiple variables of the HF QRS in many leads studied that were within previously described normal limits. Additional study is needed to understand the potential of this monitoring technique for enhancing detection of myocardial ischemia in the anesthetized population.
PMID: 15781519 [PubMed - in process]
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Illustrations of inhaled anesthetic uptake, including intertissue diffusion to and from fat.
Eger EI 2nd, Saidman LJ.
Department of Anesthesia and Perioperative Care, S-455, University of California, San Francisco, CA 94143-0464, USA. egere@anesthesia.ucsf.edu
Although several mathematical and computer simulations of inhaled anesthetic pharmacokinetics have been devised, their complexity sometimes limits an intuitive appreciation of the interactions produced by the determinants of kinetics. In this essay, we illustrate the factors that govern inhaled anesthetic pharmacokinetics with drawings that consider delivery of anesthetic by ventilation to the lungs and dispersion of the anesthetic to tissue depots by the circulation. The illustrations incorporate the effects of both blood flow and blood solubility as determinants of the extent of dispersion. They incorporate tissue volume and solubility as determinants of the capacity of the tissue depots. Capacity to hold (take up) anesthetic is depicted by areas representing specific tissues, and the extent of anesthetic movement is depicted by the length and breadth of arrows to and from the areas depicting capacity. The illustrations incorporate increasingly important elements to kinetics, such as obesity. Obesity increases the depots available for storage of anesthetic, including anesthetic that reaches fat by intertissue diffusion. Such anesthetic returns to the circulation to delay recovery in healthy and obese patients, particularly with more soluble anesthetics. However, the increased anesthetic in fat occurs at a lower partial pressure and thus might not influence emergence materially. We hope that these illustrations will allow anesthesia practitioners to appreciate the interactions of the factors that govern inhaled anesthetic pharmacokinetics.
PMID: 15781517 [PubMed - in process]
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Solubility of volatile anesthetics in bovine white matter, cortical gray matter, thalamus, hippocampus, and hypothalamic area.
Neumann MA, Eger EI 2nd, Weiskopf RB.
Department of Anesthesia and Periopertive Care, University of California, San Francisco, San Francisco, CA 94143-0464, USA.
Although known for whole brain, values are lacking for solubilities of modern volatile anesthetics in specific brain regions. Some regions should differ from others (e.g., gray matter versus white matter) because they differ in lipid content and because potent inhaled anesthetics are lipophilic. In the present report, we examined this issue in bovine brain, finding that white matter/gas partition coefficients are 1.6 (desflurane) to 2.4 (halothane) times larger than gray matter/gas partition coefficients, with values for isoflurane and sevoflurane lying between these at 1.9. Values for thalamus/gas, hypothalamic area/gas, and hippocampal/gas partition coefficients lie between those for gray and white matter. These data may be useful in defining the parts of the brain involved with return to consciousness during recovery from anesthesia.
PMID: 15781514 [PubMed - in process]
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The role of adrenergic and cholinergic transmission in volatile anesthetic-induced pain enhancement.
Rowley TJ, Daniel D, Flood P.
Department of Anesthesiology, Columbia University, 630 West 168th Street, NY, NY 10032, USA.
Volatile anesthetic drugs have a biphasic effect on pain transmission. At very small concentrations they enhance pain sensitivity whereas at larger subanesthetic concentrations they have an analgesic effect. Previous work has suggested that nicotinic inhibition could mediate the pronociceptive action of isoflurane. Furthermore, activation of nicotinic receptors facilitates the release of norepinephrine in the spinal cord. We hypothesize that nicotinic modulation of norepinephrine release in the spinal cord mediates isoflurane's pronociceptive action. We used hindpaw withdrawal latency as a measure of pain sensitivity after inhibition of adrenergic activity or treatment with nicotine in mice. Isoflurane's effect on pain is separable by concentration. The 50% effective concentration for pain enhancement is 0.16% isoflurane whereas the 50% effective concentration for the antinociceptive action of isoflurane is 0.8%. Depletion of systemic norepinephrine with the neurotoxin DSP-4 caused a reduction in baseline withdrawal latencies and prevented isoflurane pronociception. Baseline latency was also reduced by intrathecal yohimbine. After treatment with yohimbine, isoflurane had no additional pronociceptive effect. Nicotine administered through intracerebroventricular injection increased baseline latency but did not prevent isoflurane pronociception. Conversely, intrathecal applications of nicotine caused a slight reduction in baseline latency and prevented isoflurane's pronociceptive effect. We conclude that spinal noradrenergic transmission seems to be necessary for isoflurane pronociception to occur. Isoflurane may act by inhibiting tonically active nicotinic receptors that modulate the release of norepinephrine in the spinal cord.
PMID: 15781512 [PubMed - in process]
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The society for ambulatory anesthesia: 19th annual meeting report.
Joshi GP.
BS, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX 75390-9068. girish.joshi@utsouthwestern.ed.
PMID: 15781510 [PubMed - in process]
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Peripheral nerve blocks result in superior recovery profile compared with general anesthesia in outpatient knee arthroscopy.
Hadzic A, Karaca PE, Hobeika P, Unis G, Dermksian J, Yufa M, Claudio R, Vloka JD, Santos AC, Thys DM.
Department of Anesthesiology, St. Luke's-Roosevelt Hospital Center, College of Physicians and Surgeons of Columbia University, 1111 Amsterdam Ave., New York, NY 10025, USA. ah149@columbia.edu
It has been suggested that use of peripheral nerve blocks (PNBs) may have some potential benefits in the outpatient setting. There have been no studies specifically comparing PNBs performed with short-acting local anesthetics with general anesthesia (GA) in patients undergoing outpatient knee surgery. We hypothesized that a combination of lumbar plexus and sciatic blocks using a short-acting local anesthetic will result in shorter time-to-discharge-home as compared with GA. Patients scheduled to undergo knee arthroscopy were randomized to receive a GA (midazolam, fentanyl, propofol, N(2)O/O(2)/desflurane via laryngeal mask airway) or lumbar plexus/sciatic block (PNBs; 2-chloroprocaine). Patients given GA also received an intraarticular injection of 20 mL 0.25% bupivacaine for postoperative pain control. Patients in the PNB group were given midazolam (up to 4 mg) and alfentanil (500-750 microg) before block placement and propofol 30-50 microg . kg(-1) . min(-1) for intraoperative sedation. Relevant perioperative times, postanesthesia care unit bypass rate, severity of pain, and incidence of complications were compared between the two groups. Fifty patients were enrolled in the study; 25 patients each received GA or PNBs. Total operating room time did not differ significantly between the 2 groups (97 +/- 37 versus 91 +/- 42 min). Seventy-two percent of patients receiving PNB met criteria enabling them to bypass Phase I postanesthesia care unit compared with only 24% of those receiving GA (P < 0.002). Time to meet criteria for discharge home (home readiness) and time to actual discharge were significantly shorter for patients given PNBs than for patients given GA (131 +/- 62 versus 205 +/- 94 and 162 +/- 71 versus 226 +/- 96, respectively). Under the conditions of our study, the combination of lumbar plexus and sciatic blocks with 2-chloroprocaine 3% was associated with a superior recovery profile compared with GA in patients having outpatient knee arthroscopy.
PMID: 15781509 [PubMed - in process]
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Recovery after anesthesia for short pediatric oncology procedures: propofol and remifentanil compared with propofol, nitrous oxide, and sevoflurane.
Glaisyer HR, Sury MR.
Department of Anaesthesia, Great Ormond Street Hospital for Children NHS Trust, Great Ormond Street, London, WC1N 3JH, United Kingdom. glaish@gosh.nhs.uk
Anesthesia techniques in children undergoing short painful oncology procedures should allow rapid recovery without side effects. We compared the recovery characteristics of two anesthetic techniques: propofol with sevoflurane and nitrous oxide and a total IV technique using propofol and remifentanil. Twenty-one children, undergoing two similar painful procedures within 2 wk were studied in a single-blind manner within patient comparison. The order of the techniques was randomized. Propofol and remifentanil involved bolus doses of both propofol 3-5 mg/kg and remifentanil 1-4 microg/kg. Propofol with sevoflurane and nitrous oxide involved propofol 3-5 mg/kg with 2%-8% sevoflurane and 70% nitrous oxide. The primary outcome variable was the time taken to achieve recovery discharge criteria; other recovery characteristics were also noted. The mean age of the children was 6.5 yr (range, 2.5-9.8 yr). Nineteen had lymphoblastic leukemia and two had lymphoma. All children had intrathecal chemotherapy and one had bone marrow aspiration. Most procedures lasted <4 min. The mean time to achieve recovery discharge criteria was appreciably shorter after propofol and remifentanil than propofol with sevoflurane and nitrous oxide by nearly 19 min (P = 0.001). All other time comparisons had similar trends and statistical differences. Seven parents expressed a preference for the propofol and remifentanil technique compared with one preferring propofol with sevoflurane and nitrous oxide. Children are apneic during the procedure and require respiratory support from an anesthesiologist. Discharge readiness from the recovery ward was achieved on average 19 min earlier after propofol with remifentanil compared with the combination of propofol, sevoflurane and nitrous oxide. Parents more often preferred propofol with remifentanil.
PMID: 15781506 [PubMed - in process]
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The endoscopically measured effects of airway maneuvers and the lateral position on airway patency in anesthetized children with adenotonsillar hypertrophy.
Arai YC, Fukunaga K, Ueda W, Hamada M, Ikenaga H, Fukushima K.
Department of Anesthesiology, Kochi Medical School, Oko-Cho, Nankoku, Kochi, 783-8505, Japan. arainon@med.kochi-ms.ac.jp
Obstruction of the upper airway is a major challenge for anesthesiologists administering general anesthesia in spontaneously breathing children with adenotonsillar hypertrophy. Lateral positioning is a simple treatment for obstructive sleep apnea. In this study, we examined the effects of body position shifting and common airway maneuvers such as chin lift and jaw thrust on airway patency (stridor score and upper airway dimensions by endoscopy) in anesthetized children scheduled for adenotonsillectomy. Eighteen children aged 1-11 yr were anesthetized with sevoflurane. During spontaneous breathing with 5% sevoflurane and 100% oxygen, upper airway dimensions and stridor score were recorded. After baseline recording, chin lift and jaw thrust were performed in both the supine and the lateral decubitus position. Chin lift, jaw thrust, and lateral position increased the airway dimensions and improved the stridor score. Moreover, lateral positioning enhanced the effects of these airway maneuvers on airway patency. We concluded that lateral positioning combined with airway maneuvers provided better airway patency for anesthetized children with adenotonsillar hypertrophy.
PMID: 15781504 [PubMed - in process]
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Epidural anesthesia for coronary artery bypass surgery compared with general anesthesia alone does not reduce biochemical markers of myocardial damage.
Barrington MJ, Kluger R, Watson R, Scott DA, Harris KJ.
Department of Anaesthesia, St. Vincent's Hospital, Melbourne, PO Box 2900, Fitzroy, Victoria 3065, Australia. Michael.Barrington@svhm.org.au
High thoracic epidural anesthesia/analgesia (HTEA) for coronary artery bypass grafting (CABG) surgery may have myocardial protective effects. In this prospective randomized controlled study, we investigated the effect of HTEA for elective CABG surgery on the release of troponin I, time to tracheal extubation, and analgesia. One-hundred-twenty patients were randomized to a general anesthesia (GA) group or a GA plus HTEA group. The GA group received fentanyl (7-15 microg/kg) and a morphine infusion. The HTEA group received fentanyl (5-7 microg/kg) and an epidural infusion of ropivacaine 0.2% and fentanyl 2 microg/mL until postoperative Day 3. There were no differences in troponin I levels between study groups. The time to tracheal extubation [median (interquartile range)] in the HTEA group was 15 min (10-320 min), compared with 430 min (284-590 min) in the GA group (P < 0.0001). Analgesia was improved in the HTEA group compared with the GA group. Mean arterial blood pressure poststernotomy and systemic vascular resistance in the intensive care unit were lower in the HTEA group. We conclude that HTEA for CABG surgery had no effect on troponin release but improved postoperative analgesia and was associated with a reduced time to extubation.
PMID: 15781499 [PubMed - in process]
Weak Polar Interactions Confer Albumin Binding Site Selectivity for Haloether Anesthetics.
Liu R, Eckenhoff RG.
* Research Fellow, dagger Professor.
BACKGROUND:: Enflurane and isoflurane are structural isomers with different anesthetic potencies and side effects. It is not clear whether these differences are produced by differing occupancy of common protein binding sites or by occupancy of different sites, but the very similar molecular properties make the latter possibility unlikely. In this study, the authors examined binding site selectivity of these anesthetics in human serum albumin (HSA). METHODS:: Binding of isoflurane and enflurane with HSA was determined with isothermal titration calorimetry. Competition with known ligands (propofol) allowed localization of binding sites within the HSA molecule. Molecular properties of isoflurane and enflurane were calculated. RESULTS:: Isoflurane binds HSA with higher affinity but smaller total enthalpy than enflurane. Enthalpogram analysis suggested that isoflurane bound a single site, whereas enflurane bound two. Competition experiments indicated that enflurane and isoflurane share one binding site, which also binds propofol. The additional enflurane site binds propofol but not isoflurane. Increased salt concentration decreased the affinity for isoflurane but not for enflurane. The dipole moment of isoflurane is higher than that of enflurane, and the isoflurane binding site is more polar. CONCLUSION:: These data indicate two binding sites of different character for the haloether anesthetics on HSA. One site is more polar and prefers isoflurane, presumably because of its larger dipole. The second site prefers the less polar enflurane. Therefore, weak polar interactions confer considerable selectivity, and differences in drug action may arise from occupancy of different protein sites.
PMID: 15791110 [PubMed - as supplied by publisher]
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Does the Amygdala Mediate Anesthetic-induced Amnesia?: Basolateral Amygdala Lesions Block Sevoflurane-induced Amnesia.
Alkire MT, Nathan SV.
* Assistant Professor in Residence, Department of Anesthesiology, dagger Staff Research Associate, Department of Anesthesiology.
BACKGROUND:: Amnesia for aversive events caused by benzodiazepines or propofol depends on the basolateral amygdala (BLA). Whether the amnesia of volatile anesthesia is also mediated through the BLA is unknown. If so, a general principle of anesthetic-induced amnesia may be emerging. Here, using an inhibitory avoidance paradigm, the authors determine whether BLA lesions prevent sevoflurane-induced amnesia. METHODS:: Male Sprague-Dawley rats were separated into two groups: sham-operated controls (n = 22) and rats given bilateral N-methyl-d-aspartate lesions of the BLA (n = 32). After a 1-week recovery, the rats were randomly assigned to be trained during either air or sevoflurane (0.3% inspired, 0.14 minimum alveolar concentration) exposure. Animals learned to remain in the starting safe compartment of a step-through inhibitory avoidance apparatus for 100 consecutive seconds by administering foot shock (0.3 mA) whenever they entered an adjacent shock compartment. Memory was assessed at 24 h. Longer latencies to enter the shock compartment at 24 h imply better memory. RESULTS:: Sham-air (n = 10) animals had a robust memory, with a median retention latency of 507 s (interquartile range, 270-600 s). Sham-sevoflurane (n = 6) animals were amnesic, with a latency of 52 s (27-120 s) (P < 0.01, vs. sham-air). Both the air-exposed (n = 5) and the sevoflurane-exposed (n = 8) animals with BLA lesions showed robust memory, with latencies of 350 s (300-590 s) and 378 s (363-488 s), respectively. The latencies for both did not differ from the performance of the sham-air group and were significantly greater than the latency of the sham-sevoflurane group (both P < 0.01). CONCLUSIONS:: BLA lesions block sevoflurane-induced amnesia. A role for the BLA in mediating anesthetic-induced amnesia may be a general principle of anesthetic action.
PMID: 15791104 [PubMed - as supplied by publisher]
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Tetanic Stimulation of the Peripheral Nerve before Transcranial Electrical Stimulation Can Enlarge Amplitudes of Myogenic Motor Evoked Potentials during General Anesthesia with Neuromuscular Blockade.
Kakimoto M, Kawaguchi M, Yamamoto Y, Inoue S, Horiuchi T, Nakase H, Sakaki T, Furuya H.
* Research Fellow, dagger Assistant Professor, double dagger Instructor, # Professor and Chair, Department of Anesthesiology, section sign Assistant Professor, parallel Professor and Chair, Department of Neurosurgery, Nara Medical University.
BACKGROUND:: Neuromuscular blockade can suppress myogenic motor evoked potentials (MEPs). The authors hypothesized that tetanic stimulation (TS) of the peripheral nerve before transcranial stimulation may enhance myogenic MEPs during neuromuscular blockade. In the current study, the authors evaluated MEP augmentations by TS at different levels of duration, posttetanic interval, neuromuscular blockade, and stimulus intensity. METHODS:: Thirty-two patients undergoing propofol-fentanyl-nitrous oxide anesthesia were examined. Train-of-five stimulation was delivered to C3-C4, and MEPs were recorded from the abductor hallucis muscle. In study 1, TS with a duration of 1, 3, or 5 s was delivered at 50 Hz to the tibial nerve 1, 3, or 5 s (interval) before transcranial stimulation, and the effects of TS on MEP amplitude were evaluated. In study 2, TS-induced MEP augmentations were evaluated at the neuromuscular blockade level (%T1) of 50% or 5%. In study 3, MEP augmentations by TS at stimulus intensities of 0, 5, 25, and 50 mA were evaluated. RESULTS:: The application of TS significantly enlarged the amplitudes of MEPs at the combinations of duration (3, 5 s) and interval (1, 3, 5 s) compared with those without TS. TS-induced MEP augmentations were similarly observed at %T1 of both 50% and 5%. TS-induced MEP augmentations were observed at stimulus intensities of 25 and 50 mA. CONCLUSIONS:: The results indicate that TS of the peripheral nerve before transcranial stimulation can enlarge the amplitude of MEPs during general anesthesia with neuromuscular blockade. TS of the peripheral nerve can be intraoperatively applied as a method to augment myogenic MEP responses.
PMID: 15791101 [PubMed - as supplied by publisher]
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Anesthesia, amnesia, and the amygdala: reducing the fear of intraoperative awareness.
Antognini JF, Carstens EE.
* University of California, Davis, California. jfantognini@ucdavis.edu.
PMID: 15791096 [PubMed - in process]
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This month in anesthesiology.
Henkel G.
PMID: 15791095 [PubMed - in process]
[Interest of naloxone infusion on analgesia and respiratory depression after spinal anaesthesia with morphine]
[Article in French]
N'Guyen L, Minville V, Chassery C, Pourrut JC, Samii K.
Publication Types:
PMID: 15501635 [PubMed - indexed for MEDLINE]
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[Regional anaesthesia for labor adn delivery in a parturient with neuropathy with liability to pressure palsy (tomaculous neuropathy)]
[Article in French]
Berdai S, Benhamou D; Equipe SOS-ALR.
Departement d'anesthesie-reanimation, hopital de Bicetre, 78, rue du General-Leclerc, 94270 Le Kremlin-Bicetre, France.
Tomaculous neuropathy (or hereditary neuropathy with liability to pressure palsy [HNLPP]) is a rare and hereditary disease which incidence has probably been underestimated. It is characterised by demyelination resulting in numbness and weakness after nerve pressure, injury or stretch. Despite a well-documented genetic pathophysiologic mechanism, implications for anaesthesia in patients with HNLPP are only speculative and the use of regional anaesthesia is debatable. We report here the case of a patient with HNLPP who was followed during two consecutive pregnancies in the same hospital and for whom an expert of the SOS-RA hotline service was consulted before each delivery. For the first delivery, epidural analgesia was performed for labour pain control but a caesarean section was necessary because of failure to progress (0.0625% bupivacaine with 0.2 microg/ml sufentanil for labour then 2% lidocaine with adrenaline for surgery). Two years later, the patient was again seen for a preanaesthetic visit because elective Caesarean section was planned. Spinal anaesthesia using hyperbaric bupivacaine and sufentanil was used. Both deliveries were uneventful and there were no neurologic complaints in the postpartum periods.
Publication Types:
PMID: 15501632 [PubMed - indexed for MEDLINE]
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[Clinical applications of intravenous anaesthetics pharmacology: the example of hypnotics and opioids]
[Article in French]
Lagneau F, Tod M, Marty J.
Service d'anesthesie-reanimation, hopital Beaujon, 100, boulevard du General-Leclerc, 92118 Clichy, France. franck.lagneau@bjn.ap-hop-paris.fr
OBJECTIVE: To review the general principles of pharmacokinetics and pharmacodynamics models by focusing on intravenous anaesthetics (hypnotics and opioids). DATA SOURCES: Medline references, lectures from the French congress of anaesthesiology and intensive care medicine, abstracts. DATA SYNTHESIS: Pharmacokinetic and pharmacodynamic modelling allows simple estimation of becoming of anaesthetic drugs in the body, instead of classical pharmacologic approach. However, pharmacokinetic as well as pharmacodynamic parameters are often considered as resulting from complex mathematic approaches and remain then poorly used in practice by physicians. The aim of this article is to simply expose concepts underlying PK-PD models building and to explain significance of the main PK-PD parameters (first-order rate constants, k(e0), T(1/2)k(e0), T(peak), context-sensitive half-time, context-sensitive decrement times). Clinical consequences for using intravenous anaesthetic drugs (hypnotics and opioids) are exposed either during bolus injection or continuous infusion, when injected alone or co-administered.
Publication Types:
PMID: 15501628 [PubMed - indexed for MEDLINE]
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[Pollution level during inhalation sedation with a 50%N2O/50%O2 premix: comparison of two administration devices]
[Article in French]
Hennequin M, Onody P.
Groupe d'etudes sur les deficiences, les incapacites et les desavantages en sante orale, equipe d'accueil, faculte de chirurgie dentaire, universite d'Auvergne, CHU de Clermont-Ferrand, 63000 Clermont Ferrand, France. martine.hennequin@u-clermont1.fr
OBJECTIVES: Prefixed equimolar nitrous oxide and oxygen mixture (Kalinox) indications have risen within hospital services both as sedative and analgesic procedures. This study aimed to evaluate the levels of pollution associated with the use of two different systems of administration. STUDY DESIGN: An experimental trial was undertaken in a dental service for anxious patients or those with behavioral problems requiring nitrous oxide/ oxygen sedation for treatment. PATIENTS AND METHODS: Sedation was provided using either a continuous flow system or an on-demand system of administration of Kalinox over two consecutive periods, corresponding to 23 days of administration and 26 days without administration. The gas was administered for 122 patients in 149 procedures. The occupational exposure to nitrous oxide was measured continuously for the two evaluation periods using infrared spectrometry. The Time Weighted Average exposure (TWA) over eight hours was calculated for each system for each day with at least one sedation session. RESULTS: The mean TWA calculated for the two evolution periods was significantly lower with the on-demand system than where compared the continuous flow system (respectively 15.3 +/-23.1 and 32.3 +/-25.1 ppm; p < 0.05). CONCLUSION: The occupational exposure to nitrous oxide generated by the administration of the 50% N2O/ 50%O2 premix during dental care remained within accepted levels in relation to national recommendations for the exposed personnel.
PMID: 15501625 [PubMed - indexed for MEDLINE]
Antagonism of neuromuscular blockade but not muscle relaxation affects depth of anaesthesia.
Vasella FC, Frascarolo P, Spahn DR, Magnusson L.
Department of Anaesthesiology, University Hospital, CHUV BH-10, 1011 Lausanne, Switzerland.
BACKGROUND: Conflicting effects of neuromuscular blocking drugs and anticholinesterases on depth of anaesthesia have been reported. Therefore we evaluated the effect of atracurium and neostigmine on bispectral index (BIS) and middle-latency auditory evoked potentials (AAI). METHODS: We studied 40 patients (ASA I-II) aged 18-69 yr. General anaesthesia consisted of propofol and remifentanil by target-controlled infusion and neuromuscular function was monitored by electromyography. When BIS reached stable values, patients were randomly assigned to one of two groups. Group 1 received atracurium 0.4 mg kg(-1) and, 5 min later, the same volume of NaCl 0.9%; group 2 received saline first and then atracurium. When the first twitch of a train of four reached 10% of control intensity, patients were again randomized: one group (N) received neostigmine 0.04 mg kg(-1) and glycopyrrolate 0.01 mg kg(-1), and the control group (G) received only glycopyrrolate. RESULTS: Injection of atracurium or NaCl 0.9% had no effect on BIS or AAI. After neostigmine-glycopyrrolate, BIS and AAI increased significantly (mean maximal change of BIS 7.1 [SD 7.5], P<0.001; mean maximal change of AAI 9.7 [10.5], P<0.001). When glycopyrrolate was injected alone BIS and AAI also increased (mean maximal change of BIS 2.2 [3.4], P=0.008; mean maximal change of AAI 3.5 [5.7], P=0.012), but this increase was significantly less than in group N (P=0.012 for BIS; P=0.027 for AAI). CONCLUSION: These data suggest that neostigmine alters the state of propofol-remifentanil anaesthesia and may enhance recovery.
PMID: 15778268 [PubMed - as supplied by publisher]
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Correlation of Narcotrend Index, entropy measures, and spectral parameters with calculated propofol effect-site concentrations during induction of propofol-remifentanil anaesthesia.
Grouven U, Beger FA, Schultz B, Schultz A.
Department of Anaesthesiology, Klinikum Hannover Oststadt, Hannover Medical School, Hannover, Germany. ugrouven@aol.com
OBJECTIVE: The aim of this study was to compare the EEG parameter Narcotrend Index with the spectral and entropy-based EEG parameters median frequency, 95% spectral edge frequency, burst-compensated 95% spectral edge frequency, spectral entropy, amplitude entropy, and approximate entropy with regard to their ability to describe cerebral anaesthetic drug effects during induction of propofol-remifentanil anaesthesia. METHODS: Three induction schemes were studied with 10 patients each receiving 2 mg propofol/kg/60s (group 1), 4 mg/kg/120s (group 2), and 4 mg/kg/240s (group 3). The EEG was recorded with the EEG monitor Narcotrend. To analyse the relation between drug effect and EEG parameters, Spearman rank correlation of the different EEG parameters with the calculated propofol effect-site concentration was computed. RESULTS: In all groups Narcotrend Index showed the highest correlation with the propofol effect-site concentration and the lowest variability of individual correlation values. Furthermore, only the Narcotrend Index showed a monophasic behaviour over the entire time period analysed. In the group of entropy parameters approximate entropy yielded the best results. Among the spectral parameters the burst-compensated 95% spectral edge frequency had the highest correlation with the propofol effect-site concentration. It was markedly higher than for the standard spectral edge frequency. The correlations of median frequency and amplitude entropy with propofol effect-site concentration were the lowest. CONCLUSIONS. Changes in the propofol effect-site concentration during induction of anaesthesia were best described by the multivariate Narcotrend Index compared to conventional spectral EEG parameters and different entropy measures.
PMID: 15779834 [PubMed - in process]
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Hip replacement, hip seeding, and epidural anaesthesia.
Sharrock NE, Finerty E.
Department of Anesthesiology, Hospital for Special Surgery, New York, NY 10021, USA. sharrockn@hss.edu
PMID: 15781083 [PubMed - in process]
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Do-not-resuscitate orders in the surgical setting.
Truog RD, Waisel DB, Burns JP.
Department of Anesthesia, Children's Hospital Boston, and Harvard Medical School, Boston, MA 02115, USA. Robert.Truog@childrens.harvard.edu
PMID: 15733701 [PubMed - indexed for MEDLINE]
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Anesthesia in a child with deletion 13q syndrome.
Mayhew JF, Fernandez M, Wheaton M.
PMID: 15787931 [PubMed - in process]
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Anesthesia for cleft lip surgery in a child with Seckel syndrome - a case report.
Rajamani A, Kamat V, Murthy J, Hussain SA.
Department of Anaesthesiology and Critical Care, Sri Ramachandra Medical College and Research Institute, Sri Ramachandra Nagar, Chennai, India.
Summary We describe the anesthetic management of a 5-year-old girl diagnosed with Seckel syndrome, for cleft lip surgery. The syndrome is characterized by severe intrauterine and postnatal growth retardation with proportional dwarfism, typical beak-like triangular nose, and mental retardation, accounting for its various synonyms such as bird-headed dwarfism, microcephalic primordial dwarfism, nanocephalic dwarfism and Seckel-type dwarfism.
PMID: 15787928 [PubMed - in process]
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CT-guided lung biopsies in children: anesthesia management and complications.
Bendon AA, Krishnan BS, Korula G.
Department of Anesthesia, Christian Medical College, Vellore, Tamil Nadu, India.
Summary We describe the anesthetic management of three children who underwent CT-guided lung biopsies and the complications associated with the procedure. We discuss the likely causes and recommend steps that would help decrease the risk of these complications during such a procedure.
PMID: 15787924 [PubMed - in process]
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Evaluation of satisfaction level by parents and children following pediatric anesthesia.
Iacobucci T, Federico B, Pintus C, Francisci G.
Department of Anaesthesia and Resuscitation, Catholic University of 'Sacred Heart', Rome, Italy.
Summary Background: Research in the field of patient satisfaction first took place in the 1980s in the USA, and later in Europe, aimed at meeting competitive requirements in the field of health care. Very few studies of this type exist in regard to pediatric anesthesia. Our aim was to develop a rapidly interpretable questionnaire to measure the level of parental satisfaction when their children undergo surgery and provide information on those factors triggering anxiety in these children. Methods: Over a period of 18 months 179 parents of children in pediatric surgery responded to 214 questionnaires designed to investigate principally the emotional/behavioral spheres as well as the comfort provided. Results and conclusions: We found that parents generally expressed a high degree of satisfaction which was good and correlated significantly with environmental comfort and postoperative observations performed by anesthetists and nursing staff. In the children, lack of fear at the moment of being anesthetized, and lack of anxiety on the day preceding surgery, were attributed to the serenity transmitted by the anesthetist and nurses. Significant anxiety resulted from the fear of an unpleasant impact with the operating room.
PMID: 15787923 [PubMed - as supplied by publisher]
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