About Entrez
NCBI Toolbar
Text Version
Entrez PubMed
Overview
Help |
FAQ
Tutorials
New/Noteworthy
E-Utilities
PubMed Services
Journals Database
MeSH Database
Single Citation Matcher
Batch Citation Matcher
Clinical Queries
Special Queries
LinkOut
My NCBI
Related Resources
Order Documents
NLM Mobile
NLM Catalog
NLM Gateway
TOXNET
Consumer Health
Clinical Alerts
ClinicalTrials.gov
PubMed Central
|
|
| Display Show |
 |
|
|
[Management of the upper airway in spontaneously breathing children A challenge for the anaesthetist.]
[Article in German]
von Ungern-Sternberg BS, Erb TO, Frei FJ.
Departement Anasthesie, Universitatskinderspital beider Basel, UKBB, .
In unconscious, spontaneously breathing and anaesthetised children, a high incidence of partial or complete airway obstruction jeopardizes sufficient oxygenation. In this situation, the most important and efficient manoeuvre is to open up the upper airway. Chin lift, jaw thrust and continuous positive airway pressure (CPAP) are proven and effective methods for opening an obstructed upper airway. In addition to these simple airway manoeuvres, different techniques of body positioning (e.g., lateral positioning or supine position in combination with the "sniffing position") are effective to improve and maintain upper airway patency.
PMID: 16252114 [PubMed - as supplied by publisher]
Thoracotomy in a patient with a history of local anesthetic allergy.
Ng JM.
Publication Types:
PMID: 16244047 [PubMed - in process]
Comment on:
Anesthesiologists must inform their surgical colleagues when there is a risk of an operating room fire.
Sosis MB.
Publication Types:
PMID: 16244046 [PubMed - in process]
Comment on:
Costs are not the only thing we should be concerned with in anesthesia.
Bloomfield EL.
Publication Types:
PMID: 16244042 [PubMed - in process]
Comment on:
Anesthetic depth and long-term mortality.
Stemp LI.
Publication Types:
PMID: 16244035 [PubMed - in process]
-
Report of the 13th annual meeting of the International Society for Anaesthetic Pharmacology.
Keltner JR, Flood P; International Society for Anaesthetic Pharmacology.
Department of Anesthesia University of California, San Francisco, Box 1654, 2255 Post Street, MZ Bldg N PAIN, San Francisco, CA 94143-1654, USA. keltnerj@anesthesia.ucsf.edu
PMID: 16244032 [PubMed - in process]
-
The effects of continuous epidural anesthesia and analgesia on stress response and immune function in patients undergoing radical esophagectomy.
Yokoyama M, Itano Y, Katayama H, Morimatsu H, Takeda Y, Takahashi T, Nagano O, Morita K.
Department of Anesthesiology and Resuscitology, Okayama University Medical School, 2-5-1, Shikata-cho, Okayama City, Okayama 700-8558, Japan. masayoko@cc.okayama-u.ac.jp
We investigated whether perioperative extensive epidural block (C3-L) affects postoperative immune response in patients undergoing radical esophagectomy. Patients undergoing radical esophagectomy were randomly assigned to either general anesthesia with continuous epidural infusion via 2 epidural catheters that was continued for postoperative analgesia (group E, n = 15) or intraoperative general anesthesia and postoperative IV morphine analgesia (group G, n = 15). Plasma levels of stress hormones, cytokines, C-reactive protein (CRP), leukocyte counts, and distribution of lymphocyte subsets were assessed before and after surgery and on postoperative days (PODs) 1 and 3. In comparison with group E, significant increases in plasma epinephrine level at the end of surgery (P < 0.05) and norepinephrine level at the end of surgery (P < 0.01) and on POD1 (P < 0.01) and POD3 (P < 0.01) and significant decrease in cluster of differentiation (CD4/CD8 ratio) at the end of surgery (P < 0.05) were observed in group G. However, there were no significant differences in other variables between groups. In both groups, plasma cortisol, adrenocorticotropic hormone, interleukin (IL)-1beta, IL-6, IL-10, and CRP levels were increased after surgery (each group P < 0.01) and IL-1beta, IL-6, IL-10, and CRP were still increased on POD1 and POD3 (each change, each group P < 0.01). Leukocyte counts were increased on POD1 (each group P < 0.05) and POD3 (each group P < 0.01). The proportion of lymphocytes decreased from the end of surgery to POD3 (each group P < 0.01). The proportion of B cells was increased on POD1 (each group P < 0.01); that of natural killer cells was decreased at POD1 and POD3 (each group P < 0.01). We conclude that tissue damage and inflammation apparently overcome the effects of extensive epidural block on stress response and immune function in radical esophagectomy.
Publication Types:
PMID: 16244024 [PubMed - in process]
-
Small-dose bupivacaine-sufentanil prevents cardiac output modifications after spinal anesthesia.
Asehnoune K, Larousse E, Tadie JM, Minville V, Droupy S, Benhamou D.
Service d'Anesthesie-Reanimation, Hopital de Bicetre, 94275 Le Kremlin Bicetre, France. asehnounekarim@hotmail.com
Spinal injection of small-dose (SD) bupivacaine decreases the likelihood of hypotension compared with large-dose (LD) bupivacaine. We assumed that a SD of bupivacaine could also prevent the decrease in cardiac output (CO). Patients undergoing elective urologic, lower abdominal, or lower limb surgery under spinal anesthesia were included in this prospective randomized study. Spinal injection consisted of 5 mug of sufentanil and either SD (7.5 mg of hyperbaric bupivacaine with glucosemonohydrate 80 mg/mL; n = 19 patients) or LD (12.5 mg of hyperbaric bupivacaine with glucosemonohydrate 80 mg/mL; n = 19 patients). CO (impedance cardiography), arterial blood pressure, and heart rate) were measured at 1 min before performance of spinal block and 2, 10, and 30 min after the intrathecal injection. Sensory level was also assessed at 30 min. CO was higher in the SD group as compared with the LD group from 2 min to 30 min after spinal anesthesia. Moreover, CO increased at 2 min in the SD group and decreased at 10 and 30 min in the LD group compared with baseline value. In conclusion, SD bupivacaine provides successful anesthesia and gives better CO stability than LD.
Publication Types:
PMID: 16244022 [PubMed - in process]
-
The efficacy of plethysmographic pulse wave amplitude as an indicator for intravascular injection of epinephrine-containing epidural test dose in anesthetized adults.
Mowafi HA.
Department of Anesthesia, King Fahd University Hospital, PO Box 40081, Al-Khobar 31952, Saudi Arabia. hany_mowafi@hotmail.com
In this study, I evaluated the efficacy of plethysmographic pulse wave amplitude (PPWA) in detecting intravascular injection of a simulated epidural test dose containing 15 microg of epinephrine in adults during either sevoflurane or isoflurane inhaled anesthesia and compared its reliability to the classical heart rate (HR; positive if > or =10 bpm) and systolic blood pressure (SBP; positive if > or =15 mm Hg) criteria. Eighty patients were randomized to receive either 1 mean alveolar anesthetic concentration of sevoflurane or 1 mean alveolar anesthetic concentration of isoflurane (n = 40 for each anesthesia group). Patients in each anesthesia group microg of epinephrine IV or 3 mL of saline IV (n = 20 each). HR, SBP, and PPWA were monitored for 5 min after injection. Injection of the test dose resulted in peak PPWA decrease by 61% +/- 17% and 58% +/- 15% at 61 +/- 12 s and 63 +/- 13 s in the sevoflurane and isoflurane groups, respectively. Positive PPWA criterion, as determined from peak increases during saline administration, was a decrease in PPWA > or =10%. Using this value, the sensitivity, specificity, positive predictive, and negative predictive values of PPWA were 100% in both anesthetic groups. On the contrary, sensitivities of 85% and 95% were obtained based on HR criterion in the sevoflurane and isoflurane patients, respectively, and a sensitivity of 90% was obtained in both anesthesia groups on the basis of SBP criterion. In conclusion, PPWA is a reliable alternative to conventional hemodynamic criteria for detection of an intravascular injection of epidural test dose.
Publication Types:
PMID: 16244021 [PubMed - in process]
-
Administration of local anesthetic through the epidural needle before catheter insertion improves the quality of anesthesia and reduces catheter-related complications.
Cesur M, Alici HA, Erdem AF, Silbir F, Yuksek MS.
Department of Anesthesiology and Reanimation, Ataturk University, Erzurum, Turkey. mcesur@atauni.edu.tr
Epidural catheter placement offers flexibility in block management. However, during epidural catheter insertion, complications such as paresthesia and venous and subarachnoid cannulation may occur, and suboptimal catheter placement can affect the quality of anesthesia. We performed this prospective, randomized, double-blind study to assess the effect of a single-injection dose of local anesthetic (20 mL of 2% lidocaine) through the epidural needle as a priming solution into the epidural space before catheter insertion. We randomized 240 patients into 2 equal groups and measured the quality of anesthesia and the incidence of complications. In the needle group (n = 100), catheters were inserted after injection of a full dose of local anesthetic through the needle. In the catheter group (n = 98), the catheters were inserted immediately after identification of the epidural space. Local anesthetic was then injected via the catheter. We noted the occurrence of paresthesia, inability to advance the catheter, or IV or subarachnoid catheter placement. Sensory and motor block were assessed 20 min after the injection of local anesthetic. Surgery was initiated when adequate sensory loss was confirmed. In the catheter group, the incidence of paresthesia during catheter placement was 31.6% compared with 11% in the needle group (P = 0.00038). IV catheterization occurred in 8.2% versus 2% of patients in the catheter and needle groups, respectively (P = 0.048). More patients in the needle group had excellent surgical conditions than the catheter group (89.6% versus 72.9; P < 0.003). We conclude that giving a single-injection dose via the epidural needle before catheter placement improves the quality of epidural anesthesia and reduces catheter-related complications.
Publication Types:
PMID: 16244020 [PubMed - in process]
-
A comparison of the laryngeal tube and bag-valve mask ventilation by emergency medical technicians: a feasibility study in anesthetized patients.
Kurola JO, Turunen MJ, Laakso JP, Gorski JT, Paakkonen HJ, Silfvast TO.
Department of Anesthesia and Intensive Care, Kuopio University Hospital, PO Box 1777, FIN-70210, Kuopio, Finland. jouni.kurola@kuh.fi
Airway management is of major importance in emergency care. The basic technique for all health care providers is bag-valve mask (BVM) ventilation, which requires skill and may be difficult to perform. Endotracheal intubation, which is the advanced method for securing the airway, is a demanding technique that has been shown to be associated with infrequent success, even when used by experienced paramedical personnel. Therefore, alternative airway devices have been sought. The use of the laryngeal tube (LT) by experienced anesthesia personnel had been studied in anesthetized patients and manikins in emergency medical training. We decided to evaluate the ability of inexperienced firefighter-emergency medical technician students (fire-EMT) to insert the LT or perform BVM in anesthetized patients. Thirty fire-EMTs randomly inserted the LT (n = 15) and performed 1 min of ventilation or used the BVM (n = 15). We found that all students successfully (100%) inserted the LT. Those who inserted the LT on the first attempt (73%) required 48.2 +/- 14.7 s for the insertion. Both the LT and BVM provided adequate oxygenation and ventilation. In this study, we found that inexperienced fire-EMT students inserted LT and performed 1-min ventilation with a reasonable success rate and insertion time in anesthetized patients.
PMID: 16244014 [PubMed - in process]
-
Chemical dependency treatment outcomes of residents in anesthesiology: results of a survey.
Collins GB, McAllister MS, Jensen M, Gooden TA.
Alcohol and Drug Recovery Center, Department of Psychiatry and Psychology, Cleveland Clinic Foundation/P48, 9500 Euclid Avenue, Cleveland, OH 44195, USA. colling@ccf.org
Substance abuse is a potentially lethal occupational hazard confronting anesthesiology residents. We present the results of a survey sent to all United States anesthesiology training programs regarding experience with and outcomes of chemically dependent residents from 1991 to 2001. The response rate was 66%. Eighty percent reported experience with impaired residents and 19% reported at least one pretreatment fatality. Despite this familiarity, few programs required pre-employment drug testing or used substance abuse screening tools during interviews. The majority of impaired residents attempted reentry into anesthesiology after treatment. Only 46% of these were successful in completion of anesthesiology residency. Eventually, 40% of residents who underwent treatment and returned to medical training entered another specialty. The mortality rate for the remaining anesthesiology residents was 9%. Long-term outcome was reported for 93% of all treated residents. Of these, 56% were successful in some specialty of medicine at the end of the survey period. We hypothesize that specialty change afforded substantial improvement in the overall success rate and avoided significant mortality. Redirection of rehabilitated residents into lower-risk specialties may allow a larger number to achieve successful medical careers.
PMID: 16244010 [PubMed - in process]
-
Multimodal analgesia with gabapentin and local anesthetics prevents acute and chronic pain after breast surgery for cancer.
Fassoulaki A, Triga A, Melemeni A, Sarantopoulos C.
Department of Anesthesiology, Aretaieion Hospital, Medical School, University of Athens, Athens, Greece. afassou1@otenet.gr
We evaluated the effect of multimodal analgesia on acute and chronic pain after breast surgery for cancer. Fifty patients scheduled for breast cancer surgery were blindly randomized to receive gabapentin, eutectic mixture of local anesthetics cream, and ropivacaine in the wound or three placebos. Pain (visual analog scale) and analgesics were recorded in the postanesthesia care unit (PACU) 3, 6, and 9 h and 8 days after surgery. Three and 6 mo later, patients were assessed for chronic pain. The treatment group consumed less paracetamol in the PACU (469 versus 991 mg; P < 0.002) and less Lonalgal (1.0 versus 4.4 tablets; P = 0.003) than the controls, exhibited lower visual analog scale scores at rest in the PACU (P = 0.001) and on postoperative Days 1, 3, and 5 (P = 0.040, P = 0.015, and P = 0.045, respectively), and after movement in the PACU (P = 0.001) and on postoperative Days 2, 4, and 8 (P = 0.028, P = 0.007, and P = 0.032, respectively). Three and 6 mo after surgery, 18 of 22 (82%) and 12 of 21 (57%) of the controls reported chronic pain versus 10 of 22 (45%) and 6 of 20 (30%) in the treatment group (P = 0.028 and P = 0.424, respectively); 5 of 22 and 4 of 21 of the controls required analgesics versus 0 of 22 and 0 of 20 of those treated (P = 0.048 and P = 0.107, respectively). Multimodal analgesia reduced acute and chronic pain after breast surgery for cancer.
Publication Types:
PMID: 16244006 [PubMed - in process]
-
Reducing the incidence of surgical fires: supplying nasal cannulae with sub-100% O2 gas mixtures from anesthesia machines.
Lampotang S, Gravenstein N, Paulus DA, Gravenstein D.
Department of Anesthesiology, PO Box 100254, Gainesville, FL 32610-0254, USA. slampotang@anest.ufl.edu
In June 2003, the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) recommended: "As a general policy, use air or FiO2 at < or =30% for open delivery (consistent with patient needs)" to prevent surgical fires. One way to interpret JCAHO's recommendation is that 100% O2 should not be indiscriminately used, and anesthesia providers should have the ability, consistent with patient needs and their clinical judgment, to deliver sub-100% O2 with nasal cannulae. An auxiliary O2 flowmeter has a barbed outlet connector that offers a convenient means to connect a cannula to an anesthesia machine and is routinely used for open delivery of 100% O2. The auxiliary O2 flowmeter provides only 100% O2 and thus does not allow titration of the O2 concentration to patient needs and may increase the risk of surgical fires. This report clarifies the JCAHO recommendation and describes different means of addressing it that are based primarily on using the anesthesia machine to blend a sub-100% O2 gas mixture and delivering it via a nasal cannula. The options presented depend on the model and manufacturer of the anesthesia machine and allow delivery via nasal cannula of O2 concentrations that range from 21% to 100%.
PMID: 16244002 [PubMed - in process]
-
Spatial memory performance 2 weeks after general anesthesia in adult rats.
Crosby C, Culley DJ, Baxter MG, Yukhananov R, Crosby G.
Department of Physiology, Harvard University, Cambridge, MA, USA. gcrosby@zeus.bwh.harvard.edu
We have previously demonstrated that general anesthesia with 1.2% isoflurane-70% nitrous oxide impairs acquisition of a radial arm maze task in both young and aged rats when testing begins 2 days after anesthesia and in aged rats when testing begins 2 wk later. We designed this study to examine whether postanesthesia learning impairment is persistent in young rats. Six-month-old rats were randomized to anesthesia for 2 h with 1.2% isoflurane-70% nitrous oxide, 1.8% isoflurane, or a control group that received 30% oxygen (n = 10 per group). Rats recovered for 2 wk and were then tested daily on a radial arm maze for 14 days. There were no differences between the controls and anesthesia groups in number of correct choices to first error or time to complete the maze. There was no main effect of group in terms of total number of errors (P > 0.05) but the group by day interaction was significant (P < 0.05), reflecting improved performance in the 1.2% isoflurane-70% nitrous oxide group relative to controls during the later days of testing (P < 0.005). Hence, in adult rats, previous general anesthesia is not associated with impaired learning 2 wk later. In fact, previous 1.2% isoflurane-70% nitrous oxide improves maze performance 2 wk later.
PMID: 16243999 [PubMed - in process]
-
The effects of anesthetics and ethanol on alpha2 adrenoceptor subtypes expressed with G protein-coupled inwardly rectifying potassium channels in Xenopus oocytes.
Hara K, Yamakura T, Sata T, Harris RA.
Department of Anesthesiology, University of Occupational and Environmental Health, School of Medicine, 1-1, Iseigaoka, Yahatanishiku, Kitakyushu, 807-8555, Japan. kojihara@med.uoeh-u.ac.jp
A wide range of physiological effects are mediated by alpha2-adrenoceptors (ARs) through their association with G protein-coupled inwardly rectifying potassium (GIRK) channels. Although alpha2-ARs are divided into three subtypes (alpha2A-C), a pharmacological distinction among the subtypes is difficult to establish because of the lack of a selective agonist and antagonist; therefore, little is known about the effects of anesthetics on the alpha2-AR subtypes. We expressed each subtype together with GIRK1/GIRK2 subunits in Xenopus oocytes and observed alpha2-AR-mediated GIRK1/GIRK2 currents to test the effects of ethanol, halothane, and several IV anesthetics at clinical concentrations. UK 14,304, a selective alpha2-AR agonist, evoked GIRK1/GIRK2 currents in every subtype. None of the IV anesthetics, which included pentobarbital, propofol, ketamine, and alphaxalone, influenced UK 14,304-evoked potassium currents in any of the receptor subtypes. Ethanol enhanced the UK 14,304-evoked potassium currents, whereas halothane inhibited the currents. However, these effects were not significantly different from those on the baseline-GIRK1/GIRK2 current, suggesting that neither ethanol nor halothane acts directly on the alpha2-AR subtypes. Although none of the drugs examined had any effect on the alpha2-ARs, the physiological actions of the alpha2-ARs mediated by the GIRK1/GIRK2 channels may be affected by ethanol and halothane.
PMID: 16243998 [PubMed - in process]
-
Rocuronium versus succinylcholine for rapid sequence induction of anesthesia and endotracheal intubation: a prospective, randomized trial in emergent cases.
Sluga M, Ummenhofer W, Studer W, Siegemund M, Marsch SC.
Department of Anesthesia, Krankenhaus Thusis, Switzerland.
When anesthesia is induced with propofol in elective cases, endotracheal intubation conditions are not different between succinylcholine and rocuronium approximately 60 s after the injection of the neuromuscular relaxant. In the present study, we investigated whether, in emergent cases, endotracheal intubation conditions obtained at the actual moment of intubation under succinylcholine differ from those obtained 60 s after the injection of rocuronium. One-hundred-eighty adult patients requiring rapid sequence induction of anesthesia for emergent surgery received propofol (1.5 mg/kg) and either rocuronium (0.6 mg/kg; endotracheal intubation 60 s after injection) or succinylcholine (1 mg/kg; endotracheal intubation as soon as possible). The time from beginning of the induction until completion of the intubation was shorter after the administration of succinylcholine than after rocuronium (median time 95 s versus 130 s; P < 0.0001). Endotracheal intubation conditions, rated with a 9-point scale, were better after succinylcholine administration than after rocuronium (8.6 +/- 1.1 versus 8.0 +/- 1.5; P < 0.001). There was no significant difference in patients with poor intubation conditions (7 versus 12) or in patients with failed first intubation attempt (4 versus 5) between the groups. We conclude that during rapid sequence induction of anesthesia in emergent cases, succinylcholine allows for a more rapid endotracheal intubation sequence and creates superior intubation conditions compared with rocuronium.
Publication Types:
PMID: 16243994 [PubMed - in process]
-
Total shoulder arthroplasty as an outpatient procedure using ambulatory perineural local anesthetic infusion: a pilot feasibility study.
Ilfeld BM, Wright TW, Enneking FK, Mace JA, Shuster JJ, Spadoni EH, Chmielewski TL, Vandenborne K.
Department of Anesthesiology, P.O. Box 100254, 1600 SW Archer Rd., Gainesville, FL 32610-0254, USA. bilfeld@ufl.edu
We investigated the feasibility of converting total shoulder arthroplasty (TSA) into an outpatient procedure using ambulatory interscalene perineural ropivacaine infusion. Of the patients of the first phase (n = 8) who were required to remain hospitalized for at least 1 postoperative night, 5 met discharge criteria in the recovery room. Of the subsequent patients of the second phase (n = 6), all met discharge criteria in the recovery room after surgery, and 5 were discharged directly home. For all patients, postoperative pain was well controlled, oral opioid requirements and sleep disturbances were minimal, range-of-motion consistently reached or exceeded the surgeon's expectations, and patient satisfaction was high. These results suggest that TSA may be performed on an outpatient basis using perineural local anesthetic infusion. Additional research is required to define the appropriate subset of patients and assess the incidence of complications associated with this practice before its mainstream use.
PMID: 16243987 [PubMed - in process]
-
Reactive oxygen species as mediators of cardiac injury and protection: the relevance to anesthesia practice.
Kevin LG, Novalija E, Stowe DF.
Anesthesiology Research Laboratories, 8701 Watertown Plank Road, Medical College of Wisconsin, Milwaukee, WI 53226, USA.
Reactive oxygen species (ROS) are central to cardiac ischemic and reperfusion injury. They contribute to myocardial stunning, infarction and apoptosis, and possibly to the genesis of arrhythmias. Multiple laboratory studies and clinical trials have evaluated the use of scavengers of ROS to protect the heart from the effects of ischemia and reperfusion. Generally, studies in animal models have shown such effects. Clinical trials have also shown protective effects of scavengers, but whether this protection confers meaningful clinical benefits is uncertain. Several IV anesthetic drugs act as ROS scavengers. In contrast, volatile anesthetics have recently been demonstrated to generate ROS in the heart, most likely because of inhibitory effects on cardiac mitochondria. ROS are involved in the signaling cascade for cardioprotection induced by brief exposure to a volatile anesthetic (termed "anesthetic preconditioning"). ROS, therefore, although injurious in large quantities, can have a paradoxical protective effect within the heart. In this review we provide background information on ROS formation and elimination relevant to anesthetic and adjuvant drugs with particular reference to the heart. The sources of ROS, the means by which they induce cardiac injury or activate protective signaling pathways, the results of clinical studies evaluating ROS scavengers, and the effects of anesthetic drugs on ROS are each discussed.
Publication Types:
PMID: 16243980 [PubMed - in process]
Initial injection pressure for dental local anesthesia: effects on pain and anxiety.
Kudo M.
Department of Dental Anesthesiology, School of Dentistry, Health Sciences University of Hokkaido, Japan. masaluge@hoku-iryo-u.ac.jp
This study quantitatively assessed injection pressure, pain, and anxiety at the start of injection of a local anesthetic into the oral mucosa, and confirmed the relationship between injection pressure and pain, as well as between injection pressure and anxiety. Twenty-eight healthy men were selected as subjects and a 0.5-inch (12 mm) 30-gauge disposable needle attached to a computer-controlled local anesthetic delivery system (the Wand) was used. A 0.5 mL volume of local anesthetic solution was injected submucosally at a speed of either 30 or 160 s/mL. Three seconds after the start of local anesthetic injection, injection pressure was measured and pain and anxiety were assessed. Injection pressure was measured continuously in real time by using an invasive sphygmomanometer and analytical software, and pain was assessed on the Visual Analogue Scale and anxiety on the Faces Anxiety Scale. A significant correlation was evident between injection pressure and pain (rs = .579, P = .00124) and between intensity of injection pressure and state anxiety (rs = .479, P = .00979). It is therefore recommended that local anesthetic be injected under low pressure (less than 306 mm Hg) to minimize pain and anxiety among dental patients.
Publication Types:
PMID: 16252739 [PubMed - indexed for MEDLINE]
Office-based anesthesia: requirements for patient safety.
Bridenbaugh PO.
Cincinnati Medical Center, Ohio, USA.
PMID: 16252737 [PubMed - indexed for MEDLINE]
Effect of Transarterial Axillary Block versus General Anesthesia on Paresthesiae 1 Year after Hand Surgery.
Brull R, McCartney CJ, Chan VW, Abbas S, Nova H, von Schroeder H, Katz J.
*Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada. colin.mccartney@uhn.on.ca.
PMID: 16249694 [PubMed - in process]
-
Interaction between Anesthetic Molecules and Their Binding Sites Must Be Far More Complex.
Ishikawa S.
Tokyo Medical and Dental University, School of Medicine, Tokyo, Japan. ishikawa.mane@tmd.ac.jp.
PMID: 16249691 [PubMed - in process]
-
Interaction between Anesthetic Molecules and Their Binding Sites Must Be Far More Complex.
Liu R, Eckenhoff RG.
*University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania. roderic.eckenhoff@uphs.upenn.edu.
PMID: 16249690 [PubMed - in process]
-
Pharmacogenetics of Anesthetic and Analgesic Agents: CYP2D6 Genetic Variations.
Stamer UM, Stuber F.
daggerUniversity of Bonn, Bonn, Germany. ulrike.stamer@ukb.uni-bonn.de.
PMID: 16249687 [PubMed - as supplied by publisher]
-
Successful Resuscitation after Cardiovascular Collapse following Accidental Intravenous Infusion of Levobupivacaine during General Anesthesia.
Salomaki TE, Laurila PA, Ville J.
* Deputy Chief Anesthesiologist, dagger Chief Anesthesiologist, Department of Anesthesiology, Oulu University Hospital, Oulu, Finland. double dagger Professor of Physiology, University of Tampere, Department of Clinical Neurophysiology, Tampere University Hospital, Tampere, Finland.
PMID: 16249685 [PubMed - as supplied by publisher]
-
Efficacy of Postoperative Patient-controlled and Continuous Infusion Epidural Analgesia versus Intravenous Patient-controlled Analgesia with Opioids: A Meta-analysis.
Wu CL, Cohen SR, Richman JM, Rowlingson AJ, Courpas GE, Cheung K, Lin EE, Liu SS.
* Associate Professor, double dagger Assistant Professor, section sign Research Associate, parallel Senior Instructor, # Medical Student, Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins University, Baltimore, Maryland. dagger Medical Student, Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania. ** Clinical Professor, Department of Anesthesiology, Virginia Mason Medical Center, University of Washington, Seattle, Washington.
The authors performed a meta-analysis and found that epidural analgesia overall provided superior postoperative analgesia compared with intravenous patient-controlled analgesia. For all types of surgery and pain assessments, all forms of epidural analgesia (both continuous epidural infusion and patient-controlled epidural analgesia) provided significantly superior postoperative analgesia compared with intravenous patient-controlled analgesia, with the exception of hydrophilic opioid-only epidural regimens. Continuous epidural infusion provided statistically significantly superior analgesia versus patient-controlled epidural analgesia for overall pain, pain at rest, and pain with activity; however, patients receiving continuous epidural infusion had a significantly higher incidence of nausea-vomiting and motor block but lower incidence of pruritus. In summary, almost without exception, epidural analgesia, regardless of analgesic agent, epidural regimen, and type and time of pain assessment, provided superior postoperative analgesia compared to intravenous patient-controlled analgesia.
PMID: 16249683 [PubMed - as supplied by publisher]
-
What Is the Driving Performance of Ambulatory Surgical Patients after General Anesthesia?
Chung F, Kayumov L, Sinclair DR, Edward R, Moller HJ, Shapiro CM.
* Professor, Department of Anesthesia, dagger Assistant Professor, parallel Staff Psychiatrist, # Professor, Department of Psychiatry, section sign Clinical Research Fellow, Toronto Western Hospital, University of Toronto. double dagger Assistant Professor, Department of Anesthesiology, Jackson Memorial Hospital, University of Miami, Miami, Florida.
BACKGROUND:: Ambulatory surgical patients are advised to refrain from driving for 24 h postoperatively. However, currently there is no strong evidence to show that driving skills and alertness have resumed in patients by 24 h after general anesthesia. The purpose of this study was to determine whether impaired driver alertness had been restored to normal by 2 and 24 h after general anesthesia in patients who underwent ambulatory surgery. METHODS:: Twenty patients who underwent left knee arthroscopic surgery were studied. Their driving simulation performance, electroencephalographically verified parameters of sleepiness, subjective assessment of sleepiness, fatigue, alertness, and pain were measured preoperatively and 2 and 24 h postoperatively. The same measurements were performed in a matched control group of 20 healthy individuals. RESULTS:: Preoperatively, patients had significantly higher attention lapses and lower alertness levels versus normal controls. Significantly impaired driving skills and alertness, including longer reaction time, higher occurrence of attention lapses, and microsleep intrusions, were found 2 h postoperatively versus preoperatively. No significantly differences were found in any driving performance parameters or electroencephalographically verified parameters 24 h postoperatively versus preoperatively. CONCLUSIONS:: Patients showed lower alertness levels and impaired driving skills preoperatively and 2 h postoperatively. Based on driving simulation performance and subjective assessments, patients are safe to drive 24 h after general anesthesia.
PMID: 16249668 [PubMed - as supplied by publisher]
-
Investigation of Implicit Memory during Isoflurane Anesthesia for Elective Surgery Using the Process Dissociation Procedure.
Iselin-Chaves IA, Willems SJ, Jermann FC, Forster A, Adam SR, Van der Linden M.
* Staff Anesthesiologist, section sign Associate Professor, Division of Anesthesiology, University Hospital of Geneva. dagger Psychologist, Neuropsychology Unit, University of Liege, Liege, Belgium. double dagger Psychologist, parallel Professor, Cognitive Psychopathology and Neuropsychology Unit, University of Geneva.
BACKGROUND:: This prospective study evaluated memory function during general anesthesia for elective surgery and its relation to depth of hypnotic state. The authors also compared memory function in anesthetized and nonanesthetized subjects. METHODS:: Words were played for 70 min via headphones to 48 patients (aged 18-70 yr) after induction of general anesthesia for elective surgery. Patients were unpremedicated, and the anesthetic regimen was free. The Bispectral Index (BIS) was recorded throughout the study. Within 36 h after the word presentation, memory was assessed using an auditory word stem completion test with inclusion and exclusion instructions. Memory performance and the contribution of explicit and implicit memory were calculated using the process dissociation procedure. The authors applied the same memory task to a control group of nonanesthetized subjects. RESULTS:: Forty-seven patients received isoflurane, and one patient received propofol for anesthesia. The mean (+/- SD) BIS was 49 +/- 9. There was evidence of memory for words presented during light (BIS 61-80) and adequate anesthesia (BIS 41-60) but not during deep anesthesia (BIS 21-40). The process dissociation procedure showed a significant implicit memory contribution but not reliable explicit memory contribution (mean explicit memory scores 0.05 +/- 0.14, 0.04 +/- 0.09, and 0.05 +/- 0.14; mean automatic influence scores 0.14 +/- 0.12, 0.17 +/- 0.17, and 0.18 +/- 0.21 at BIS 21-40, 41-60, and 61-80, respectively). Compared with anesthetized patients, the memory performance of nonanesthetized subjects was better, with a higher contribution by explicit memory and a comparable contribution by implicit memory. CONCLUSION:: During general anesthesia for elective surgery, implicit memory persists even in adequate hypnotic states, to a comparable degree as in nonanesthetized subjects.
PMID: 16249665 [PubMed - as supplied by publisher]
-
Does Memory Priming during Anesthesia Matter?
Andrade J.
Department of Physiology, University of Sheffield, Sheffield, United Kingdom. j.andrade@sheffield.ac.uk.
PMID: 16249662 [PubMed - in process]
-
This month in anesthesiology.
Henkel G.
PMID: 16249661 [PubMed - in process]
-
The ED50 and ED95 of intrathecal isobaric bupivacaine with opioids for cesarean delivery.
Carvalho B, Durbin M, Drover DR, Cohen SE, Ginosar Y, Riley ET.
Department of Anesthesia, Stanford University School of Medicine, California 94305, USA. bcarvalho@stanford.edu
BACKGROUND: The ideal intrathecal isobaric bupivacaine dose for cesarean delivery anesthesia is uncertain. While small doses (5-9 mg) of bupivacaine may reduce side effects such as hypotension, they potentially increase spinal anesthetic failures. This study determined the ED50 and ED95 of intrathecal isobaric bupivacaine (with adjuvant opioids) for cesarean delivery. METHODS: After institutional review board approval and written informed consent were obtained, 48 parturients undergoing elective cesarean delivery under combined spinal-epidural anesthesia were enrolled in this double-blind, randomized, dose-ranging study. Patients received a 5-, 6-, 7-, 8-, 9-, 10-, 11-, or 12-mg intrathecal isobaric bupivacaine dose with 10 microg fentanyl and 200 microg morphine. Overall anesthetic success was recorded when no intraoperative epidural supplement was required during the cesarean delivery. ED50 and ED95 values for overall anesthetic success were determined using a logistic regression model. RESULTS: ED50 and ED95 values for overall anesthetic success were 7.25 and 13.0 mg, respectively. No advantages for low doses could be demonstrated with regard to hypotension, nausea, vomiting, pruritus, or maternal satisfaction, although this study was underpowered to detect significant differences in secondary outcome variables. CONCLUSIONS: The ED50 and ED95 values (7.25 and 13.0 mg, respectively) for intrathecal isobaric bupivacaine in this circumstance are similar to values the authors determined recently for hyperbaric bupivacaine using similar methodology. These ED50 and ED95 values are significantly higher than those advocated in previous reports in which success was claimed using lower intrathecal bupivacaine doses. The current study used stricter criteria to define "successful" anesthesia and support the use of larger bupivacaine doses to ensure adequate patient comfort.
Publication Types:
PMID: 16129987 [PubMed - indexed for MEDLINE]
-
Effect of lateral positioning on upper airway size and morphology in sedated children.
Litman RS, Wake N, Chan LM, McDonough JM, Sin S, Mahboubi S, Arens R.
University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania 19104, USA. litmanr@email.chop.edu
BACKGROUND: Lateral positioning decreases upper airway obstruction in paralyzed, anesthetized adults and in individuals with sleep apnea during sleep. The authors hypothesized that lateral positioning increases upper airway cross-sectional area and total upper airway volume when compared with the supine position in sedated, spontaneously breathing children. METHODS: Children aged 2-12 yr requiring magnetic resonance imaging examination of the head or neck region using deep sedation with propofol were studied. Exclusion criteria included any type of anatomical or neurologic entity that could influence upper airway shape or size. T1 axial scans of the upper airway were obtained in the supine and lateral positions, with the head and neck axes maintained neutral. Using software based on fuzzy connectedness segmentation (3D-VIEWNIX; Medical Imaging Processing Group, University of Pennsylvania, Philadelphia, PA), the magnetic resonance images were processed and segmented to render a three-dimensional reconstruction of the upper airway. Total airway volumes and cross-sectional areas were computed between the nasal vomer and the vocal cords. Two-way paired t tests were used to compare airway sizes between supine and lateral positions. RESULTS: Sixteen of 17 children analyzed had increases in upper airway total volume. The total airway volume (mean +/- SD) was 6.0 +/- 2.9 ml in the supine position and 8.7 +/- 2.5 ml in the lateral position (P < 0.001). All noncartilaginous areas of the upper airway increased in area in the lateral compared with the supine position. The region between the tip of the epiglottis and vocal cords demonstrated the greatest relative percent change. CONCLUSIONS: The upper airway of a sedated, spontaneously breathing child widens in the lateral position. The region between the tip of the epiglottis and the vocal cords demonstrates the greatest relative percent increase in size.
PMID: 16129971 [PubMed - indexed for MEDLINE]
Central apnoea after balanced general anaesthesia that included dexmedetomidine.
Ho AM, Chen S, Karmakar MK.
Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Shatin, NT, Hong Kong SAR, PRC. hoamh@hotmail.com
Dexmedetomidine is an alpha(2)-adrenoreceptor agonist that, in spite of its potent sedative, amnesic, and analgesic properties, has minimal respiratory depressant effect. Even at doses adequate for general anaesthesia, it does not cause central apnoea. Thus, it has been claimed that "combining alpha(2)-agonists with opiate narcotics or non-steroidal anti-inflammatory drugs can enhance the analgesic efficacy without increasing the respiratory depressant effect of the latter" and "the combination of alpha(2)-adrenoceptor agonists with opioids does not lead to further ventilatory depression". We present a case of central apnoea after general anaesthesia that included opioids and dexmedetomidine, and remind the readers that in susceptible patients, dexmedetomidine may cause life-threatening respiratory depression through potentiation of co-administered central nervous system depressants.
PMID: 16243902 [PubMed - in process]
Anesthetic management of bronchopleurocutaneous fistula - an alternate approach.
Govindarajan R, Mathur A, Aransohn J, Saweris W, Ghosh B, Sathyamoorthy MK.
PMID: 16251571 [PubMed - in process]
-
Images in Anesthesia: Congenital tracheal stenosis in a boy with Rubinstein-Taybi syndrome.
Magillo P, Della Rocca M, Campus R, Bava E, Rossi GA, Dodero P.
PMID: 16251568 [PubMed - in process]
-
Anesthetic management of the parturient with relapsing polychondritis: [Anesthesie d'une parturiente atteinte de polychondrite chronique atrophiante].
Douglas MJ, Ensworth S.
Department of Anesthesia, B.C. Women's Hospital, 4500 Oak Street, Vancouver, B.C. V6H 3N1, Canada. jdouglas@cw.bc.ca.
PURPOSE: To present the anesthetic management of a parturient with relapsing polychondritis (RP) and to discuss the anesthetic implications of RP. CLINICAL FEATURES: A 28-yr-old primiparous woman with known RP, spondyloarthropathy and fibromyalgia presented for urgent Cesarean delivery for breech presentation and prodromal labour. Her pregnancy had been complicated by a hospital admission for an exacerbation of her RP as manifested by hoarseness, increased pain and tenderness of her left ear and nasal bridge cartilages, sinusitis with bloody nasal discharge and increased pain and tenderness of the anterior tracheal rings. Epidural anesthesia was administered for the Cesarean delivery. Her intraoperative and postoperative course was uneventful. Close cooperation among obstetricians, anesthesiologists and rheumatologists resulted in a successful outcome. CONCLUSION: Relapsing polychondritis is a syndrome with important anesthetic implications. Multidisciplinary cooperation is essential in managing these high risk parturients.
PMID: 16251564 [PubMed - as supplied by publisher]
-
Hypobaric spinal anesthesia with 0.2% tetracaine for total joint hip arthroplasy: [La rachianesthesie hypobare avec de la tetracaine a 0,2 % pour l'arthroplastie totale de hanche].
Kim JA, Ahn HJ.
Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 135-710, 50 Ilwon-dong, Kangnam-ku, Seoul, Korea. hjahn@smc.samsung.co.kr.
PURPOSE: Hypobaric local anesthetics for total hip replacement (THR) have potential advantages related to body position and differential block. However, the dose requirements of hypobaric local anesthetics for THR have not been clearly established. Therefore, we undertook a dose-response study of hypobaric tetracaine for THR. METHODS: In a randomized, controlled, and double-blinded manner, three groups of 20 patients each undergoing THR received spinal anesthesia using either 10, 12, or 14 mg of 0.2% hypobaric tetracaine in a lateral decubitus position, with the operated side up. Adequate anesthesia was defined as: 1) upper sensory block between T10 and T4; 2) motor block of modified Bromage scale 2 or 3; and 3) time to sensory remission to the L2 level of more than three hours. RESULTS: The number of patients who achieved adequate sensory and motor block levels was similar amongst the three groups. However, all patients who received 14 mg had a sensory remission time to L2 of more than three hours while only 30% of the patients in the 12 mg group and no patient in the 10 mg group had the same remission time. A significant differential block was observed between the non-dependent and the dependent sides, but the degree of differential block was not different between the groups. CONCLUSION: 10 to 14 mg of 0.2% hypobaric tetracaine achieved similar and adequate block levels, but different regression times. To ensure complete sensory block duration for THR, we recommend using 14 mg of 0.2% hypobaric tetracaine.
PMID: 16251562 [PubMed - in process]
-
Local application of volatile anesthetics attenuates the response to a mechanical stimulus in humans: [L'application locale d'anesthesiques volatils diminue la reaction au stimulus mecanique chez les humains].
Fassoulaki A, Skouteri I, Siafaka I, Sarantopoulos C.
57-59 Raftopoulou street, 11744 Athens, Greece. fassoula@aretaieio.uoa.gr.
Purpose: Volatile anesthetics may cause local hyperalgesia and/or analgesia. This double-blind randomized study investigated the effect of these medications when applied locally on the response to a mechanical stimulus.Methods: In experiment 1, standard commercial preparations of halothane 1 mL, isoflurane 1.5 mL and sevoflurane 2.7 mL were randomly applied on the forearm of 30 volunteers for 30 min, after which the response to a mechanical stimulus was recorded. The other forearm received water as control. The next day, the experiment for each anesthetic was repeated in a reverse fashion. Thirty minutes after the application, the response to a standardized mechanical stimulus was recorded. In experiments 2 and 3, the response to the same mechanical stimulus was tested after local applications of 2, 4, and 6 mL of halothane or after a local application of 5 mL sevoflurane respectively.Results: Low doses of the three anesthetics did not alter the response to the mechanical stimulus (F = 3.055, df = 1,174, P = 0.082). Two, 4, and 6 mL of halothane attenuated the response to the mechanical stimulus by 36%, 27% and 29% respectively (F = 9.586, df = 1,114, P = 0.002). Five millilitres of sevoflurane attenuated the response to the mechanical stimulus by 36% (F = 5.111, df = 19, P < 0.001).Conclusion: Low liquid volumes of volatile anesthetics, when applied locally to the skin, did not influence the response to a mechanical stimulus, but higher volumes attenuated this response.
PMID: 16251561 [PubMed - in process]
-
Communication between anesthesiologists, patients and the anesthesia team: a descriptive study of induction and emergence: [Communication entre anesthesiologistes, patients et equipe d'anesthesie : une etude descriptive de l'induction et du retour a la conscience].
Smith AF, Pope C, Goodwin D, Mort M.
Department of Anaesthesia, Royal Lancaster Infirmary, Lancaster LA1 4RP, UK, Andrew.f.smith@mbht.nhs.uk.
PURPOSE: Although the importance of communication skills in anesthetic practice is increasingly recognized, formal communication skills training has hitherto dealt only with limited aspects of this professional activity. We aimed to document and analyze the informally-learned communication that takes place between anesthesia personnel and patients at induction of and emergence from general anesthesia. METHODS: We adopted an ethnographic approach based principally on observation of anesthesia personnel at work in the operating theatres with subsequent analysis of observation transcripts. RESULTS: We noted three main styles of communication on induction, commonly combined in a single induction. In order of frequency, these were: (1) descriptive, where the anesthesiologists explained to the patient what he/she might expect to feel; (2) functional, which seemed designed to help anesthesiologists maintain physiological stability or assess the changing depth of anesthesia and (3) evocative, which referred to images or metaphors. Although the talk we have described is nominally directed at the patient, it also signifies to other members of the anesthetic team how induction is progressing. The team may also contribute to the communication behaviour depending on the context. Communication on emergence usually focused on establishing that the patient was awake. CONCLUSION: Communication at induction and emergence tends to fall into specific patterns with different emphases but similar functions. This communication work is shared across the anesthetic team. Further work could usefully explore the relationship between communication styles and team performance or indicators of patient safety or well-being.
PMID: 16251555 [PubMed - in process]
-
Ethnographic research applied to anesthesia/La recherche ethnographique appliquee a l'anesthesie.
Angus J.
Faculty of Nursing, University of Toronto, 50 St. George Street, Toronto, Ontario M5S 3H4, Canada. jan.angus@utoronto.ca.
PMID: 16251553 [PubMed - in process]
Safety of intravenous sedation administered by the operating oral surgeon: the first 7 years of office practice.
Rodgers SF.
Newburgh Oral Surgery, PC, 4855 Highway 261, Newburgh, IN 47630, USA.
PURPOSE: Outpatient intravenous sedation by properly trained personnel provides a safe, cost-effective means of anesthesia for numerous surgical procedures. The goal of this study was to provide a 7-year summary (December 1994 through November 2001) of anesthesia-related problems that occurred in the practice of a single Midwestern board-certified oral and maxillofacial surgeon. METHODS: The files of intravenous sedation cases from December 1994 through November 2001 were organized retrospectively. RESULTS: A total of 2,889 sedations were performed by the surgeon during the 7-year period. There were 1,743 (about 60.33%) patients in ASA Class I, 1,139 (about 39.43%) in ASA Class II, and 7 (about 0.24%) in ASA Class III. There were a total of 70 patients who had 77 adverse events. Less than 3% of the sedation patients experienced complications. There were no deaths and no patients required emergency transport to a hospital. CONCLUSIONS: The administration of intravenous sedation by the operating surgeon for outpatient oral surgery procedures is safe and results in a low incidence of adverse events. In this series, a number of previously undiagnosed medical problems were discovered. The diagnosis and referral for management of these medical problems improved patient health.
PMID: 16182915 [PubMed - indexed for MEDLINE]
| Display Show |
|
|