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Comparison of two different techniques for brachial plexus block: infraclavicular versus axillary technique.
Ertug Z, Yegin A, Ertem S, Sahin N, Hadimioglu N, Dosemeci L, Erman M.
Department of Anesthesiology and Reanimation, Akdeniz University Medical Faculty, Antalya, Turkey. zekiertug@akdeniz.edu.tr
BACKGROUND: Brachial plexus block via the axillary approach is problematic in patients with limited arm mobility. In such cases, the infraclavicular approach may be a valuable alternative. The purpose of our study was to compare axillary and infraclavicular techniques for brachial plexus block in patients undergoing arm or forearm surgery. METHODS: After institutional approval and informed consent were obtained, 30 patients (ASA physical status I or II) scheduled for forearm and hand surgery under brachial plexus anesthesia were included in the study. Patients were randomly allocated into two groups. Brachial plexus block was performed via the axillary approach in the Group A patients and via the infraclavicular approach in the Group I patients using a peripheral nerve stimulator. All blocks were performed with a total dose of 40 ml 0.375% bupivacaine. RESULTS: In each nerve territory (radial, ulnar, median, and musculocutaneous), the mean values of the degree and the duration of the sensory block and motor block were not significantly different between the two groups (P > 0.05). Inadvertent vessel puncture was significantly more frequent in the axillary approach (P < 0.05). CONCLUSION: Brachial plexus block performed via the infraclavicular approach is as safe and effective as the axillary approach. Infraclavicular approach may be preferred to the axillary approach when the upper arm mobility is impaired or not desired.
Publication Types:
PMID: 16045668 [PubMed - indexed for MEDLINE]
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Infraclavicular block causes less discomfort than axillary block in ambulatory patients.
Koscielniak-Nielsen ZJ, Rasmussen H, Hesselbjerg L, Nielsen TP, Gurkan Y.
Department of Anesthesia and Operative Services, Center of Head and Orthopedics, Copenhagen University Hospital, Rigshospitalet, Denmark. zjkn@rh.dk
BACKGROUND: This randomized study was designed to compare discomfort caused by axillary or infraclavicular blocks in ambulatory patients. We identified which of the three block components, needle passes, local anesthetic (LA) injections, and electrical stimulations, is most painful and quantified pain intensity on a visual analog scale (VAS 0-100). We also assessed onset and quality of analgesia, adverse events and patients' acceptance. METHODS: Eighty patients were studied. In axillary group-A, four LA injections were made after stimulating median, musculocutaneous, ulnar and radial nerves. In infraclavicular group-I, the whole LA volume was injected after stimulating median or ulnar or radial nerves. Patients were ready for surgery when they had analgesia/anesthesia distal to the elbow. RESULTS: Median intensity of block discomfort was 22 in A group and 10 in I group (P < 0.01). There was no difference in distribution of the most painful block components between the groups. Block performance times were 4 min in I group and 7 min in A group (P < 0.01). Block onset times were 18 min in A group and 20 min in I group (NS). There was one block failure in I group. Three patients in A group and five in I group required supplementary blocks (NS). Transient adverse events occurred in 14 A-group and two I-group patients (P<0.01). Thirty-seven I-group and 33 A-group patients were satisfied with the block (NS). CONCLUSIONS: Infraclavicular block by single injection caused less discomfort and fewer adverse events than axillary block by multiple injections. Block effectiveness, onset time and patients' acceptance were similar.
PMID: 16045667 [PubMed - indexed for MEDLINE]
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Single-shot spinal block for labour analgesia in multiparous parturients*.
Viitanen H, Viitanen M, Heikkila M.
Department of Anaesthesiology, Central Hospital of Seinajoki, Seinajoka, Finland. hanna.viitanen@epshp.fi
BACKGROUND: Intrathecal analgesia (ITA) is effective in late, rapidly progressing labour. In 1998, our hospital implemented the use of single-shot spinal block for pain relief in multiparous parturients. As part of a quality assurance programme, we assessed the analgesic efficacy, obstetric and neonatal outcomes and maternal satisfaction after this form of analgesia now in routine use in our labour ward. METHODS: Two hundred and twenty-nine consecutive multiparous parturients presenting for vaginal delivery and requesting analgesia were asked to participate in this prospective study. All parturients received our standard ITA: 2.5 mg bupivacaine (1 ml) + 25 microg fentanyl (0.5 ml) inserted via the L2-3 or L3-4 interspace. Routine monitoring included maternal vital signs, uterine contraction and fetal heart rate tracing. Pain scores (visual analogue scale (VAS) 0-10), sensory levels, motor block, side-effects and maternal satisfaction were recorded. Satisfactory analgesia was defined as a decrease in pain scores to three or less within 20 min after injection. The number of parturients requesting additional analgesia and the duration of spinal block (time from injection until request for additional medication after satisfactory analgesia had worn off) were recorded. RESULTS: Two hundred and nine parturients were included in the study. Satisfactory analgesia was achieved in 153 (73%) parturients. Fifty-five (26%) women requested additional analgesia: 38 (18%) because of unsatisfactory analgesia and 17 (8%) because analgesia ended before delivery. The duration of spinal block was 101 +/- 34 min. Pruritus occurred in 64%, fetal bradycardia in 7% and hypotension in 2% of deliveries. Pain relief was rated excellent by 65%, moderate by 20% and inadequate by 14% of the parturients. One hundred and sixty-nine (81%) women stated that they would like to have spinal analgesia again for pain relief during delivery. CONCLUSION: The majority of multiparous parturients found ITA adequate for pain relief during delivery. However, modifications are required in terms of improved timing, reliability and duration of analgesia.
PMID: 16045666 [PubMed - indexed for MEDLINE]
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Postpartum neurologic symptoms following single-shot spinal block for labour analgesia.
Viitanen H, Porthan L, Viitanen M, Heula AL, Heikkila M.
Department of Anaesthesiology, Central Hospital of Seinajoki, Seinajoki, Finland. hanna.viitanen@epshp.fi
BACKGROUND: As part of a quality assurance program, we investigated the incidence of postpartum neurologic symptoms in multiparous parturients receiving spinal block for labour analgesia, now in routine use in our labour ward. METHODS: Two hundred and twenty-nine consecutive multiparous parturients presenting for vaginal delivery and requesting spinal analgesia were asked to participate in this prospective study. All parturients received our standard intrathecal analgesia (ITA): 2.5 mg bupivacaine (1 ml) + 25 microg fentanyl (0.5 ml) using a 27-gauge Quincke-type needle. The patients filled in a questionnaire on the first day after delivery and again upon discharge. Complaints typical of neurologic sequelae were noted and a neurologic examination was performed, if necessary. All patients with postdural puncture headache (PDPH) and transient neurologic symptoms (TNSs) were interviewed by telephone 2 weeks after discharge to determine the course of the symptoms. RESULTS: Two hundred and twelve parturients were included in the study. Eighteen (8.5%) parturients complained of PDPH, the severity of which was mild in eight (4%), moderate in seven (3%), and severe in three (1%) patients, respectively. Fifteen (7%) mothers were treated with analgesics or bedrest only. Three (1%) patients were given an epidural blood patch. The paramedian approach was associated with the development of PDPH (P = 0.04). Transient neurologic symptoms were experienced by nine (4.2%) mothers, lasting 1-3 days, mostly presenting as bilateral pain in the buttocks or thighs. One parturient suffered from paraesthesia of the left foot lasting for 3 days. Forty (19%) mothers complained of non-postural headache and 28 (13%) of new-onset back pain. Three mothers (1%) would not want to receive a further spinal block. CONCLUSION: Transient neurologic symptoms (TNSs) after spinal block occurred infrequently. The incidence of PDPH was higher than in the obstetric population in general and calls for re-evaluation of our spinal block methods. Despite the occurrence of neurologic sequelae, patient acceptability was high.
PMID: 16045665 [PubMed - indexed for MEDLINE]
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An unusual cause of difficult intubation in a patient with a large cervical anterior osteophyte: a case report.
Cesur M, Alici HA, Erdem AF.
Department of Anesthesiology and Reanimation, Medical Faculty, Ataturk University, Erzurum, Turkey. mcesur@atauni.edu.tr
This report describes a case in which a large anterior osteophyte on the C2 and C3 vertebrae, due to ankylosing spondylitis, resulted in distortion of the anatomy of the upper airway and difficult intubation. Ankylosing spondylitis (AS) is a progressive inflammatory disease, characterized by stiffening of the joints and ligaments. Stiffness of the cervical spine, atlanto-occipital, temporomandibular and cricoarytenoid joints may cause difficult intubation (1). This report describes a case in which a large anterior osteophyte on the C2 and C3 vertebrae, associated with AS, resulted in distortion of the anatomy of the upper airway and difficult intubation.
Publication Types:
PMID: 15715633 [PubMed - indexed for MEDLINE]
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Continuous lateral popliteal block with stimulating catheters.
Martinez Navas A, Vazquez Gutierrez T, Echevarria Moreno M.
Anaesthesiology Department, Valme Hospital, Seville, Spain. amarnavas@saludalia.com
Foot surgery often induces severe postoperative pain. Sciatic nerve block is a good alternative for its treatment. We report two cases of continuous lateral popliteal sciatic nerve block using two different stimulating catheters. The lateral approach may offer some advantages. Stimulating catheters may be useful to verify correct catheter tip positioning. This technique seem to be easy to use and provided excellent pain relief.
Publication Types:
PMID: 15715632 [PubMed - indexed for MEDLINE]
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Comparison of recovery properties of desflurane and sevoflurane according to gender differences.
Tercan E, Kotanoglu MS, Yildiz K, Dogru K, Boyaci A.
Department of Anaesthesiology and Reanimation, Erciyes University Medical Faculty, Kayseri, Turkey. etercan@erciyes.edu.tr
BACKGROUND: The aim of this study was to investigate the recovery properties of desflurane and sevoflurane in patients undergoing elective surgery, according to the gender differences. METHODS: In the study, 160 ASA class I-II patients aged between 20 and 60 years were included. The patients were assigned into two groups according to their gender, and these groups were randomly divided into two groups according to a selected volatile anaesthetic agent. Intraoperative bispectral index, time of postoperative achievement for end-tidal concentrations of volatile agents to decline 50% (ET-AA%50), time for extubation, time for eye opening and orientation, and time for bispectral index values to reach control values were recorded. Aldrete scores and error points of a delayed memory recall test were determined. Results: Desflurane groups had a shorter ET-AA%50 time, extubation and eye-opening time in male and female patients compared to the sevoflurane groups, and these results were statistically significant (P < 0.05). In both the desflurane and sevoflurane groups, ET-AA%50 time, extubation and eye-opening time were shorter in male patients than in female patients, and these results were also statistically significant (P < 0.05). There were no significant differences among the groups in terms of Aldrete scores and error points of delayed memory recall test (P > 0.05). Conclusion: In conclusion, early recovery time was shorter in male patients compared to female patients in both the desflurane and sevoflurane groups. Additionally, in the desflurane groups it was shorter in the sevoflurane groups for both genders.
Publication Types:
PMID: 15715628 [PubMed - indexed for MEDLINE]
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Multimodal approach to rapid discharge after endoscopic thoracic sympathectomy.
Cruvinel MG, Duarte JB, Castro CH, Costa JR, Kux P.
Department of Anesthesiology, Mater Dei Hospital, Belo Horizonte, Brazil. marcoscruvinel@uai.com.br
BACKGROUND: After a large experience (more than 10 years) with bilateral endoscopic thoracic sympathectomy (ETS) surgery on an outpatient basis, we studied prospectively a multimodal approach to rapid discharge patients undergoing this procedure. METHODS: One hundred and seventeen consecutive patients, aged 13-60 years, ASA physical status I or II, undergoing outpatient ETS under general anaesthesia were enrolled in this study. All patients were managed using a predefined multimodal clinical care protocol consisting of a general balanced anaesthesia. Basic demographic information was collected from each patient. Duration of surgery and anaesthesia and times to PACU and home discharge were recorded as well as intraoperative and postoperative complications like nausea and vomiting. RESULTS: Surgery took 41.4 +/- 22.1 min and anaesthesia lasted 63 +/- 21.5 min. Time between induction of anaesthesia and beginning of surgery and end of surgery to extubation was 15.0 +/- 2.0 and 7.2 +/- 3.1 min, respectively. It took 4.9 +/- 1.5 min from extubation to OR discharge. Time from PACU arrival to discharge was 12.8 +/- 6.3 min. Time of hospital stay was 132 +/- 18 min. No patient experienced vomiting and two had nausea, representing an incidence of 1.7%. The only anaesthetic cause for hospital admission was a severe allergic reaction. CONCLUSION: Multimodal management to rapid discharge after ETS surgery did result in a short time to patient discharge. We confirm that endoscopic thoracic sympathectomy can be performed safely on an outpatient basis with brief postoperative hospital care and a low rate of complications.
Publication Types:
PMID: 15715627 [PubMed - indexed for MEDLINE]
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Fit and seal characteristics of a new paediatric tracheal tube with high volume-low pressure polyurethane cuff.
Dullenkopf A, Gerber AC, Weiss M.
Department of Anaesthesia, University Children's Hospital Zurich, Zurich, Switzerland.
BACKGROUND: To evaluate a new paediatric tracheal tube (Microcuff, Weinheim, Germany) with an ultrathin high volume-low pressure polyurethane cuff. METHODS: With approval of the Hospital Ethics Committee tracheas of children undergoing general anaesthesia were intubated using a Microcuff tube. Tube sizes were selected according to: internal diameter (mm) = age/4 + 3.5 in children aged > or = 2 years. In newborns (> or = 3 kg) < or = 1 year, ID 3.0-mm tubes, and in children from 1 to 2 years, internal diameter 3.5-mm tubes were used. Tubes were classified too large if no air leakage was obtained at an airway pressure of 20 cm H2O with the cuff not inflated. Sealing pressure was assessed by auscultation. Post-extubation croup requiring therapy was noted. RESULTS: Five-hundred children were studied. In eight children the tubes were too large. Sealing pressure was 9.7 +/- 2.5 cm H2O (4-20). In two patients postextubation croup required singular short-term therapy. CONCLUSIONS: Microcuff paediatric tracheal tubes provided tracheal sealing with cuff pressures considerably lower than usually accepted. The rate of tube exchange was very low (1.6%), as was the rate of airway morbidity (croup requiring therapy; 0.4%).
Publication Types:
PMID: 15715626 [PubMed - indexed for MEDLINE]
[Anonymous critical incident reporting system in anaesthesiology Results after 18 months.]
[Article in German]
Hubler M, Mollemann A, Eberlein-Gonska M, Regner M, Koch T.
Klinik und Poliklinik fur Anasthesiologie und Intensivtherapie, Universitatsklinikum Carl Gustav Carus, Technische Universitat, Dresden.
Two years ago we implemented a reporting system for critical incidents in the Department of Anaesthesiology and Intensive Care of the University Hospital Dresden. During the first 18 months 162 anonymous reports were registered. The most common errors involved airway and ventilation management, followed by errors in fluid and cardio-vascular management. The main causes were distraction, lack of experience, specific training and communication deficits. The confidence in the anonymity of the reporting system was very high. Following the analysis of the reports, several modifications were initiated, e.g. specific training programs or definition of standards. Over time, a change in the relative distribution of reported errors was observed. The article discusses the different kinds of errors and possible countermeasures. It also strengthens several aspects which are important to consider during the initial phase of a local critical incident reporting system.
PMID: 16270216 [PubMed - as supplied by publisher]
[Anaesthesia for a non cardiac surgery in a patient with an Eisenmenger syndrome. Interest of a non invasive haemodynamic monitoring.]
[Article in French]
Guye ML, Schoeffler M, Chouquer R, Muchada R.
Departement d'anesthesie-reanimation, clinique mutualiste Eugene-Andre, 107, rue Trarieux, 69424 Lyon, France.
Patients with an Eisenmenger syndrome have an instuble hemodynamic status. During a general anaesthesia, the intracardiac shunt has to maintain the correct orientation and volume, adapted to each patient, in such a condition, to avoid the risk of hypoxemia and cardiac failure. The haemodynamic monitoring with a Swan Ganz catheter could be useful. But it is necessary to evaluate the advantage and the risks when the technique is used in these pathological circumstances. Moreover, when the cardiac output is measured with the thermodilution technique, the right-left intra cardiac shunt volume, is not taking into account. The continuous haemodynamic monitoring, with a simplified transoesophageal echo-Doppler system, as it was done in this case, allows appreciate the real quantitative variations of the shunt. In this way the more adequate calculation of some others haemodynamic parameters, over all the total systemic vascular resistances, allows a more precise therapeutic approach.
PMID: 16269233 [PubMed - as supplied by publisher]
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[Anaesthesia and critical care for scheduled infrarenal abdominal aortic aneurysm surgery.]
[Article in French]
Marret E, Lembert N, Bonnet F.
Departement d'anesthesie-reanimation, hopital Tenon, 4, rue de la Chine, 75970 Paris cedex 20, France.
Objectives. - Patient scheduled for infrarenal abdominal aortic aneurysm surgery carries a high risk of cardiac or respiratory comorbidity. To outline the perioperative management for these patients. Methods. - Review of the literature using MesH Terms "abdominal aortic aneurysm", "anesthesia", "analgesia" "critical care" and/or "surgery" in Medline database. Results. - Cardiac preoperative evaluation and management have recently been reviewed. Intermediate and high-risk patients should undergo non-invasive cardiac testing to decide between a preoperative medical strategy (using betablocker+/-statin and aspirin) and an interventional strategy (coronary angioplasty or cardiac surgery). Perioperative myocardial ischaemia should also be investigated by clinical, electrocardiographic and biologic monitoring such as plasmatic troponin Ic dosage. Specific score could also assess the respiratory failure risk preoperatively. Epidural analgesia decreases this risk. There is no evidence that a pharmacological treatment decreases the incidence of acute renal failure after aortic surgery. Endovascular repair is actually recommended for older, higher-risk patients or patients with a hostile abdomen or other technical factors that may complicate standard open repair.
PMID: 16269231 [PubMed - as supplied by publisher]
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[National survey in France about continuing medical education among anaesthesiologists.]
[Article in French]
Kua V, Belii A, Pontone S, Beydon L; pour le College francais des anesthesistes-reanimateurs (Cfar).
Departement d'anesthesie, CHU d'Angers, 4, rue Larrey, 49933 Angers cedex 9, France.
Study design: The aim of this study was to assess how French anaesthesiologists perform continuing medical education (CME). Methods. - A 73 items survey was mailed to 1,000 anaesthesiologists (11% of anaesthesiologists population) of geographic, gender and institution representative of national anaesthesiologist demography. A second mail was sent to non-responders, 6 weeks later. Results. - The answer rate was 40.8% and the sample of responders appeared to match the French anaesthesiologist population. Seventy-two percent of surveyed anaesthesiologists were affiliated to the French society of anaesthesia-intensive care and 24% to other medical societies. Attendance to French congresses was 81% and miscellaneous congresses were equally appreciated in terms of quality. Only 17% of surveyed anaesthesiologists attended international congresses. Multi-thematic congresses were preferred by 67%. The annual time devoted to congresses was 6 days (median) with additional 4 days (median) reserved for practical courses. French medical journals and international journals had a reading rate of 89 and 37%, respectively. For 61% of responders CME was funded by institutional grants. Internet CME use was found in 73% of anaesthesiologists. Time and money were the two most frequent reasons invoked for CME restriction. Conclusion. - CME is a broadly shared activity, which still remains focussed on national resources.
PMID: 16269228 [PubMed - as supplied by publisher]
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[Tumescent local anaesthesia for mastectomy: lidocaine plasma concentration.]
[Article in French]
Sleth JC, Lavie M, Mion P, Saizy C, Servais R.
Polyclinique Saint-Roch, 43, rue du Faubourg Saint-Jaumes, 34967 Montpellier cedex 02, France.
Publication Types:
PMID: 16256296 [PubMed - as supplied by publisher]
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[Pregnant woman anaesthetic management in gynaecologic laparoscopic surgery at the maternity hospital of Clermont-Ferrand.]
[Article in French]
Colomb S, Bonnin M, Bolandard F, Lenglet Y, Duband P, Roman H, Canis M, Bazin JE.
Departement d'anesthesie-reanimation, polyclinique, Hotel-Dieu, CHU de Clermont-Ferrand, 63001 Clermont-Ferrand, France.
Objective. - To evaluate the anaesthetic management intended for pregnant women in the field of non obstetric and gynaecologic laparoscopic surgery. Study design. - Retrospective and monocentric investigation. Patients and methods. - Analysis of the anaesthetic and obstetric files from 27 pregnant women operated on in the establishment, between January 2001 and July 2004. Results. - 27 female patients involved in the study. The mean pregnancy term was 15 weeks when laparoscopic surgery was performed, though a single patient was at 30 weeks. The average duration of the surgery was 61 minutes, of which 28 minutes were dedicated to pneumoperitoneum. Twenty-four patients underwent general anaesthesia, the three others underwent locoregional anaesthesia. During the perioperative period no surgical, anaesthetic or obstetric complications were observed. Conclusion. - Laparoscopic surgery during pregnancy requires double skilled management, both in anaesthesiology and obstetrics. On haemodynamics and breathing, pneumoperitoneum does not induce any additional effects when compared to operations without pregnancy. Except with delivery cases, anaesthetic support in laparoscopic surgery intended for pregnant women eventually does not generate any specific problems, but requires the same rigorous management as the one usually following surgery for pregnant patients.
PMID: 16256295 [PubMed - as supplied by publisher]
Assessment of pulse transit time to indicate cardiovascular changes during obstetric spinal anaesthesia{dagger}
Sharwood-Smith G, Bruce J, Drummond G.
Department of Anaesthesia, Critical Care and Pain Medicine, Royal Infirmary of Edinburgh, Edinburgh EH16 4SU, UK.
BACKGROUND: Pulse transit time (PTT) measurement may provide rapidly available beat-to-beat cardiovascular information when conditions change quickly and routine invasive arterial pressure measurement is not justified, for example during obstetric spinal anaesthesia. Method. We obtained ethics approval for an observational study of PTT during the onset of spinal anaesthesia in patients having elective or urgent Caesarean section. PTT was measured as the difference in time between the peak of the ECG R wave and the upstroke of the toe plethysmograph. Arterial pressure was measured by non-invasive sphygmomanometry. RESULTS: We analysed data from 58 normotensive patients and 15 patients with pregnancy-induced hypertension (PIH). PTT increased with the onset of spinal anaesthesia as arterial pressure decreased. An increase of 20% in PTT was 74% sensitive and 70% specific in indicating a decrease in mean arterial pressure of more than 10%. Changes in PTT were related to changes in mean arterial pressure (r(2)=0.55, P<0.0001). Arterial pressure changes were greater and PTT increased significantly more quickly in the normotensive patients than in the patients with hypertension [median, quartiles: 32 (14, 56) ms min(-1) compared with 7 (6, 18) ms min(-1); P<0.01, Mann-Whitney U-test]. However, the relationship between PTT and arterial pressure was similar for the normotensive patients and the patients with PIH. CONCLUSION: PTT measurement gave a beat-to-beat indication of arterial pressure during spinal anaesthesia, and could be developed to allow prediction of the onset of hypotension.
PMID: 16257996 [PubMed - as supplied by publisher]
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Evaluation of costs and effects of epidural analgesia and patient-controlled intravenous analgesia after major abdominal surgery.
Bartha E, Carlsson P, Kalman S.
Department of Anaesthesiology, Linkoping University Hospital, Linkoping, Sweden.
BACKGROUND: The outcome of different treatment strategies for postoperative pain has been an issue of controversy. Apart from efficacy and effectiveness a policy decision should also consider cost-effectiveness. Since economic analyses on postoperative pain treatment are rare we developed a decision model in a pilot cost-effectiveness analysis (CEA) comparing epidural analgesia (EDA) and patient-controlled intravenous analgesia (PCIA) after major abdominal surgery in routine care. METHODS: Using a decision-tree model, treatment with EDA (ropivacaine and morphine) was compared with PCIA (morphine). Effects and costs of treatment were established. The number of pain-free days at rest (pain intensity <30 using visual analogue scale 1-100 mm) was the primary measure of effect. An incremental cost-effectiveness ratio (ICER) was calculated as the difference in direct costs divided by the difference in effect. A database on 644 patients collected for the purpose of quality control during the period of 1997 to 1999 was the main data source. Sensitivity analysis was used to test uncertain data. RESULTS: EDA was more effective in terms of pain-free days but more expensive. The additional cost for each pain-free day was 5652 Euros. CONCLUSION: It is a judgement of value if the additional cost is reasonable. When the cost of around 55 000 Euros per gained life-year with full health for other interventions is debated, our result indicates poor cost-effectiveness for EDA. Before any conclusion can be drawn concerning policy recommendations the difference in costs has to be related to other outcome measures as length of hospital stay, morbidity and mortality are required.
PMID: 16257994 [PubMed - as supplied by publisher]
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Functional hyperemic response in the rat visual cortex under halothane anesthesia.
Schulte ML, Hudetz AG.
Department of Anesthesiology, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226, USA.
To establish a model for functional hyperemia in the rat visual cortex, cortical blood flow responses to flash stimulation were measured with the laser Doppler flow (LDF) technique at various levels of halothane anesthesia. The concentration-dependent effect of halothane on arterial pressure and its consequent effect on the hyperemic response were also investigated. Using a stroboscopic light source, 10 flashes at 1min intervals were delivered to the left eye of 12 Sprague-Dawley rats. LDF responses were measured bilaterally in the monocular primary visual cortex (V1M) at steady state halothane concentrations between 0.4 and 1.4%. In six rats, methoxamine (MX) was infused to prevent halothane-induced hypotension; the remaining rats did not receive MX. In all rats, LDF response to flash commenced within 1s and peaked at 2.5s in the contralateral V1M, but not in ipsilateral V1M. The maximum LDF response was 25% at 0.5% halothane and 12% at 1.4% halothane. In rats without MX infusion, mean arterial pressure (MAP) fell from 138 to 90mmHg when halothane increased from 0.4 to 1.4%. MX infusion prevented the hypotension, but did not influence the LDF response, suggesting that the halothane's effect was direct rather than pressure-mediated. We demonstrate for the first time, a robust functional hyperemic response to discrete flash stimuli in the primary visual cortex of halothane-anesthetized albino rats that can be measured with LDF over a wide range of halothane concentrations and is not fully suppressed at surgical levels of halothane anesthesia.
PMID: 16256270 [PubMed - as supplied by publisher]
Comment on:
The lower the indications, the higher the complications.
Boezaart AP, Rosenquist RW.
Publication Types:
PMID: 16032601 [PubMed - indexed for MEDLINE]
Comment on:
Continuous sciatic nerve block and total-knee arthroplasty.
Sciard D, Lam N, Hussain M.
Publication Types:
PMID: 16032598 [PubMed - indexed for MEDLINE]
Comment on:
Sciatic nerve block for total-knee replacement: is it really necessary in all patients?
Levesque S, Delbos A.
Publication Types:
PMID: 16032596 [PubMed - indexed for MEDLINE]
Comment on:
Bier block with steroid for CRPS: was bier block performed correctly?
Stevens DS.
Publication Types:
PMID: 16032595 [PubMed - indexed for MEDLINE]
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Use of stellate ganglion block to salvage an ischemic hand caused by the extravasation of vasopressors.
Tran de QH, Finlayson RJ.
Department of Anesthesia, Montreal General Hospital Site, McGill University Health Center, Quebec, Canada.
OBJECTIVE: This case report describes the successful use of early stellate ganglion block to salvage an acutely ischemic hand caused by the extravasation of vasopressors. CASE REPORT: A young man with a gunshot wound to the right inguinal area was brought to the operating room for surgical hemostasis and exploration. After discovery that the central line had been inserted in the proximity of the area of injury (right femoral vein), the vasopressor infusions were changed to a 14-gauge intravenous line inserted in the dorsum of the right hand. When the intravenous line became infiltrated, the hand was found to be swollen, cold, and underperfused. A right stellate ganglion block was immediately performed to overcome the intense peripheral vasoconstriction and, thus, re-establish circulation to the hand. CONCLUSIONS: Stellate ganglion block may prove to be an early measure in the treatment of upper-extremity ischemia caused by vasopressor extravasation.
Publication Types:
PMID: 16032594 [PubMed - indexed for MEDLINE]
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Alberto Gutierrez and the hanging drop.
Aldrete JA, Auad OA, Gutierrez VP, Wright AJ.
Arachnoiditis Foundation, Inc., Birmingham, AL 35243, USA. aldrete@arachnoiditis.com
Publication Types:
Personal Name as Subject:
PMID: 16032593 [PubMed - indexed for MEDLINE]
Comment in:
The musculocutaneous nerve: ultrasound appearance for peripheral nerve block.
Schafhalter-Zoppoth I, Gray AT.
Department of Anesthesia and Perioperative Care, San Francisco General Hospital, University of San Francisco, 94110, USA.
BACKGROUND AND OBJECTIVES: To gain complete anesthesia of the forearm, block of the musculocutaneous nerve is necessary. Variations in its course and position make localization of the musculocutaneous nerve problematic. The aim of the study is to describe the ultrasound appearance of the musculocutaneous nerve in the axilla and to suggest potential areas to target neural block. METHODS: We scanned the axillary regions of 19 volunteers and assessed the size and shape of 34 musculocutaneous nerves at entry into, exit from, and in the center of the coracobrachialis muscle. Furthermore, we measured the depth of the musculocutaneous nerve under the skin surface and its distance from the axillary artery at those 3 measurement points. RESULTS: As it travels through the coracobrachialis muscle, the musculocutaneous nerve changes in shape from oval to flat-oval to triangular. During this course, the musculocutaneous nerve also separates from the axillary artery and becomes more lateral while changing its depth from the surface. The musculocutaneous nerve increases its transverse area along this nerve path. In 2 subjects, the musculocutaneous nerve could not be visualized unilaterally within the course of the coracobrachialis muscle. CONCLUSIONS: Knowledge of its ultrasound appearance facilitates localization and successful block of the musculocutaneous nerve. Because the distance between the musculocutaneous nerve and brachial plexus varies, different locations of musculocutaneous nerve puncture during ultrasound-guided regional anesthesia can be chosen.
PMID: 16032591 [PubMed - indexed for MEDLINE]
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Differential block of N-propyl derivatives of amitriptyline and doxepin for sciatic nerve block in rats.
Gerner P, Luo SH, Zhuang ZY, Djalali AG, Zizza AM, Myers RR, Wang GK.
Pain Research Center, Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston, MA 02115, USA. pgerner@partners.org
BACKGROUND AND OBJECTIVES: The propyl group of ropivacaine ( N -propyl-2',6'-pipecoloxylidide hydrochloride) could be responsible for conferring some sensory selectivity to this drug. Thus, adding a propyl group to experimental local anesthetics (LAs) (e.g., the tricyclic antidepressants amitriptyline and doxepin) to increase sensory selectivity may be useful. We, therefore, synthesized N -propyl amitriptyline and N -propyl doxepin and investigated a potential predominance of sensory/nociceptive block over motor block (differential block) in a rat sciatic nerve block model. In addition, tetrodotoxin (TTX), a naturally occuring Na + channel blocker, was coinjected to investigate whether it increased block duration. METHODS: A 0.2-mL test dose of N -propyl amitriptyline and N -propyl doxepin, at a concentration of 1, 2.5, 5, and 10 mM, (alone or in combination with TTX at a concentration of 20 microM) was injected by the subfascial sciatic nerve approach. Motor function and sensory function (nociception) were evaluated by the force a rat's hind limb produced when pushing against a balance and the reaction to pinch, respectively. RESULTS: N -propyl amitriptyline and N -propyl doxepin demonstrated prolonged block duration, with N -propyl amitriptyline displaying significant differential block at higher concentrations (5 and 10 mM). The combination of either of these drugs with TTX increased the potency as well as the efficacy. Neurotoxicity commenced at concentrations of 5 to 10 mM. CONCLUSIONS: Detailed histopathologic nerve toxicity evaluations are justified to determine whether N -propyl amitriptyline has potential as a more sensory-selective local anesthetic at lower concentrations or as a predominantly sensory-selective neurolytic agent at higher concentrations.
PMID: 16032586 [PubMed - indexed for MEDLINE]
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Clinical evaluation of the lateral sagittal infraclavicular block developed by MRI studies.
Koscielniak-Nielsen ZJ, Rasmussen H, Hesselbjerg L, Gurkan Y, Belhage B.
Department of Anesthesia and Operative Services, University of Copenhagen, Denmark.
BACKGROUND AND OBJECTIVES: Lateral sagittal infraclavicular block by single injection has a faster performance time and causes less discomfort than does axillary block by multiple injections. This prospective, descriptive, multicenter study assessed block effectiveness, onset time, and incidence of adverse events and verified the noninvasive measurements from magnetic resonance imaging (MRI). METHODS: One hundred sixty patients were anesthetized by use of the lateral sagittal infraclavicular block and following the MRI recommendations for needle insertion. Each patient received a mixture that contained equal volumes of ropivacaine 7.5 mg/mL and mepivacaine 20 mg/mL with epinephrine 5 mug/mL, in a total amount that corresponded to 0.5 mL/kg (minimum 30 mL, maximum 50 mL). Block effectiveness (analgesia or anesthesia of all 5 nerves below the elbow after 30 minutes), performance and onset times, needle insertion depth and dorsal angle, twitch type, analgesia of the individual nerves, and incidence of adverse events and complications, as well as patient's acceptance, were recorded. RESULTS: One hundred forty-three patients (91%) had successful blocks, 12 patients required supplementary nerve blocks in the axilla, 3 patients had total failures of blocks (no forearm analgesia at all), and 2 patients were excluded from the assessments. Median block performance time was 4 minutes (range, 2-10 minutes) and the onset time 20 minutes (range, 10-50 minutes). Plexus nerves were found at a mean depth of 53 mm +/- 10 mm and the needle dorsal angle was 23 degrees +/- 9 degrees . Four patients experienced painful paresthesias and 3 patients had accidental punctures of axillary vessels. Signs or symptoms of complications (hematoma, local anesthetic toxicity, pneumothorax, or neuropraxias) were not observed. Only 3 patients would prefer general anesthesia in the future. Finger/wrist extension may be an optimal twitch response (P = .14). CONCLUSIONS: Block effectiveness (91%) and onset time (20 minutes) were satisfactory and comparable to the vertical paracoracoid approach. The low rate of axillary vessel punctures (2%) may be the most important advantage of this block. The needle insertion depth measurements confirmed the MRI findings, but the dorsal angle was steeper than predicted.
Publication Types:
PMID: 16032583 [PubMed - indexed for MEDLINE]
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A comparison of four stimulation patterns in axillary block.
Rodriguez J, Taboada M, Del Rio S, Barcena M, Alvarez J.
Department of Anesthesiology, Hospital Clinico Universitario de Santiago, Spain. jaimerodriguezgarcia@nacom.es
BACKGROUND AND OBJECTIVES: Insufficient spread of the local anesthetic toward the retroarterial region of the neurovascular space may be responsible for inconsistent anesthesia of the upper limb after single-injection axillary block. We hypothesized that injection of the local anesthetic on a single radial-nerve stimulation would produce the same extent of anesthesia as either a single median-nerve stimulation, a double-stimulation technique (radial and musculocutaneous nerves), or a triple-stimulation technique (radial, musculocutaneous, and median nerves). METHODS: One hundred twenty patients were randomly assigned to receive an axillary block by either median-nerve, radial-nerve, radial-nerve plus musculocutaneous-nerve, or triple-nerve stimulation with 40 mL of plain 1.5% mepivacaine. Patients were assessed for sensory block by the pinprick method at 5 and 20 minutes. RESULTS: Radial-nerve stimulation produced more extensive anesthesia than did median-nerve stimulation. The rate of anesthesia at 20 minutes in the median-nerve cutaneous distribution was similar after median-nerve stimulation or radial-nerve stimulation. The ulnar nerve was more frequently blocked at 20 minutes after radial-nerve stimulation than after median-nerve stimulation. Extent of anesthesia at 20 minutes after radial-nerve plus musculocutaneous-nerve stimulation was similar to that produced by triple-nerve stimulation, except for lower rates of anesthesia that corresponded to the median nerve. All of the differences were statistically significant. CONCLUSIONS: Musculocutaneous-nerve stimulation and radial-nerve stimulation play predominant roles in the success of axillary brachial plexus block, although a triple-nerve stimulation technique is still required to produce complete anesthesia of the upper limb.
Publication Types:
PMID: 16032582 [PubMed - indexed for MEDLINE]
Comment on:
Ultrasound imaging of peripheral nerves: a need for a new trend.
Awad IT, Chan V.
Publication Types:
PMID: 16032581 [PubMed - indexed for MEDLINE]
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