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[Complications and adverse events in continuous peripheral regional anesthesia Results of investigations on 3,491 catheters.]
[Article in German]
Neuburger M, Breitbarth J, Reisig F, Lang D, Buttner J.
Abteilung fur Anasthesie, BG Unfallklinik, Murnau.
INTRODUCTION: Over a period of 36 months we prospectively documented infectious, neurological and other complications or adverse events occurring during 3,491 peripheral regional anesthesias via a catheter using computer-based data recording.METHODS: The investigation included 936 axillar plexus catheters, 473 interscalene plexus catheters, 125 vertical infraclavicular plexus catheters, 74 catheters with psoas compartment blocks, 900 femoral nerve catheters, 964 sciatic nerve catheters and 19 catheters in other localizations. The regional anesthesia catheters were inserted under sterile circumstances (hood, facemask, sterile gloves and coat, surgical disinfection and sterile covering of the placement site) and under peripheral nerve stimulation.RESULTS: 3,070 (87.9%) of the regional anesthesias via catheter, were carried out without any complications. Inflammation (two out of three criteria: redness at insertion site, pain on palpation or swelling) was found in 146 patients (4.2% of all cases). Infections (two out of the criteria: CRP elevation, pus on the insertion site, fever, leucocytosis, necessary antibiotic treatment with exclusion of other possible causes) appeared in 2.4% of all cases (83 patients). In 29 patients (0.8%) we observed severe infections (surgical intervention necessary e.g. abscess incision). Risk factors for inflammation or infections included duration of catheter therapy, cervical localization of the catheter and the experience of the anesthesiologist (p<0.05). Bacterial species most frequently found were Staphylococcus aureus (54%) and Staphylococcus epidermidis (38%). In 0.3% (9 patients) we found short lasting neurological deficits and in 6 patients (0.2%) we recorded a nerve lesion that lasted more than 6 weeks. Other complications occurred in 4.2% of all cases.DISCUSSION: Special complications such as infections in peripheral catheter regional anesthesia are rare but can pose severe problems. A close postoperative supervision of all regional catheters has to be ensured under careful consideration of the risk factors for infections and the accompanying symptoms.
PMID: 16193317 [PubMed - as supplied by publisher]
Comment on:
[Anesthesia in the univentricular heart. Between scylla and charybdis]
[Article in German]
Heller AR, Ragaller M, Litz RJ.
Publication Types:
PMID: 15870989 [PubMed - indexed for MEDLINE]
Comment on:
Assessment of neuromuscular blockade using acceleromyography should be performed before emergence from anesthesia.
Dubois PE, Gourdin MJ, Jamart J.
Publication Types:
PMID: 16192562 [PubMed - indexed for MEDLINE]
Comment on:
Is anesthetic-related mortality a statistical illness?
Levy WJ.
Publication Types:
PMID: 16192555 [PubMed - indexed for MEDLINE]
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Infraclavicular brachial plexus block versus humeral approach: comparison of anesthetic time and efficacy.
Minville V, Amathieu R, Luc N, Gris C, Fourcade O, Samii K, Benhamou D.
Department of Anesthesiology and Intensive Care, Toulouse University Hospital, Paul Sabatier University, Toulouse, France. vincentminville@yahoo.fr
Most upper arm regional anesthesia techniques are successful and differences in efficacy should not dictate the choice of technique. In the present study, we compared humeral block (HB) and infraclavicular brachial plexus block (ICB) using anesthetic time (i.e., duration of the procedure + onset time) as the primary outcome measure. The block was successful when a complete sensory block was obtained in the four major nerves of the arm, and the time to complete block was recorded. Patients undergoing orthopedic surgery of the upper limb were included in a prospective randomized study and received ICB (group I, n = 60 patients) or HB (group H, n = 60 patients). Total anesthetic time was 19.5 min (95% confidence interval [CI], 17.4-21.6 min) for ICB and 20.8 min (95% CI, 18.7--22.9 min) for HB (not significant). Time to perform the block was 4.5 min (95% CI, 4-5 min) for ICB and 9.8 min (95% CI, 8.9--10.7 min) for HB (P < 0.05). The onset time was 15 min (95% CI, 13-17 min) for ICB and 11 min (95% CI, 9--13 min) for HB (P < 0.05). The success rate was 92% for ICB and 95% for HB (not significant). One self-limited vascular puncture was made in each group. HB had a faster onset time but ICB using a double-stimulation technique was faster to perform. Anesthetic time was similar with the two techniques. IMPLICATIONS: We have compared infraclavicular brachial plexus block (ICB) with humeral block. Efficacy and anesthetic time were not significantly different, although time to perform the block was shorter with the ICB.
Publication Types:
PMID: 16192544 [PubMed - indexed for MEDLINE]
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Patient preferences for anesthesia outcomes associated with cesarean delivery.
Carvalho B, Cohen SE, Lipman SS, Fuller A, Mathusamy AD, Macario A.
Department of Anesthesia, H3580, Stanford University School of Medicine, Stanford, California 94305, USA. bcarvalho@stanford.edu
When deciding on neuraxial medication (e.g., spinal opioids) for cesarean delivery (CS) under regional anesthesia, anesthesiologists make treatment decisions that "trade off" relieving pain with the potential for increased risk of side effects. No previous studies have examined obstetric patients' anesthesia preferences. Researchers administered 100 written surveys to pregnant women attending our institutions' expectant parent class. We determined patients' preferences for importance of specific intraoperative and postoperative anesthesia outcomes using priority ranking and relative value scales. We also explored patients' fears, concerns, and tolerance regarding CS and analgesics. Eighty-two of 100 surveys were returned and analyzed. Pain during and after CS was the greatest concern followed by vomiting, nausea, cramping, pruritus, and shivering. Ranking and relative value scores were closely correlated (R2 = 0.7). Patients would tolerate a visual analog pain score (0-100 mm) of 56 +/- 22 before exposing their baby to the potential effects of analgesics they receive. In contrast to previous general surgical population surveys that found nausea and vomiting as primary concerns, we found pain during and after CS as parturients' most important concern. Common side effects such as pruritus and shivering caused only moderate concern. This information should be used to guide anesthetic choices, e.g., inclusion of spinal opioids given in adequate doses. IMPLICATIONS: Medical care can be improved by incorporating patients' preferences into medical decision making. We surveyed obstetric patients to determine their preferences regarding potential cesarean delivery anesthesia outcomes. Unlike general surgical patients who rate nausea and vomiting highest, parturients considered pain during and after cesarean delivery the most important concern.
PMID: 16192541 [PubMed - indexed for MEDLINE]
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Emergency preparedness for biological and chemical incidents: a survey of anesthesiology residency programs in the United States.
Candiotti KA, Kamat A, Barach P, Nhuch F, Lubarsky D, Birnbach DJ.
Department of Anesthesiology, Perioperative Medicine and Pain Management, University of Miami School of Medicine/Jackson Memorial Hospital, R-C370, 1611 NW 12th Ave., Miami, Florida 33101, USA. kcandiotti@miami.edu
We surveyed health care professionals about their preparations to manage the clinical problems associated with patients exposed to hazardous substances, including weapons of mass destruction (WMD). Training for WMD is considered a key part of public health policy and preparedness. Although such events are rare, when they do occur, they can cause mass casualties. In many models of mass casualty management, anesthesiology personnel are responsible for treating patients immediately on arrival at the hospital. We studied the extent of training offered to anesthesiology personnel in the use of WMD protective gear and patient management in United States (US) anesthesiology residency programs. Information was obtained via an online survey to all program directors and chair persons of anesthesiology programs. We polled all of the 135 US anesthesiology programs of which 90 (67%) responded. Only 37% had any form of training, and many of them did not repeat training after initial sessions. Twenty-eight percent of programs east of the Mississippi River reported some form of training whereas only 17% of programs west of it reported training available. The majority of anesthesia residency programs in the US that responded to our survey provided little or no training in the management of patients exposed to WMD. IMPLICATIONS: In an attack involving weapons of mass destruction or toxic chemicals, anesthesiologists will provide care. Our survey of United States anesthesiology residency programs demonstrated that there is limited training of residents regarding the anesthetic management of patients injured by weapons of mass destruction. This has serious public health implications.
PMID: 16192534 [PubMed - indexed for MEDLINE]
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A simulation-based acute skills performance assessment for anesthesia training.
Murray DJ, Boulet JR, Kras JF, McAllister JD, Cox TE.
Washington University Clinical Simulation Center, Washington University School of Medicine, St. Louis, Missouri 63110, USA. murrayd@notes.wustl.edu
In an earlier study, trained raters provided reliable scores for a simulation-based anesthesia acute care skill assessment. In this study, we used this acute care skill evaluation to measure the performance of student nurse anesthetists and resident physician trainees. The performance of these trainees was analyzed to provide data about acute care skill acquisition during training. Group comparisons provided information about the validity of the simulated exercises. A set of six simulation-based acute care exercises was used to evaluate 43 anesthesia trainees (28 residents [12 junior and 16 senior] and 15 student nurse anesthetists). Six raters scored the participants on each exercise using either a detailed checklist, key-action items, or a global rating. Trainees with the most education and clinical experience (i.e., senior residents) received higher scores on the simulation scenarios, providing some evidence to support the validity of the multi-scenario assessment. Trainees varied markedly in ability depending on the content of the exercise. In general, anesthesia providers demonstrated similar aptitude in managing each of the six simulated events. Most participants effectively managed ventricular tachycardia, but postoperative events such as anaphylaxis and stroke were more difficult for all trainees to promptly recognize and treat. Training programs could use a simulation-based multiple encounter evaluation to measure provider skill in acute care. IMPLICATIONS: A trainee's skill in managing critical events can be assessed using a multiple scenario simulation-based performance evaluation.
PMID: 16192533 [PubMed - indexed for MEDLINE]
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The feasibility of sharing simulation-based evaluation scenarios in anesthesiology.
Berkenstadt H, Kantor GS, Yusim Y, Gafni N, Perel A, Ezri T, Ziv A.
The Israel Center for Medical Simulation, Department of Anesthesiology and Intensive Care, Sheba Medical Center, Tel Hashomer, Israel. berken@netvision.net.il
We prospectively assessed the feasibility of international sharing of simulation-based evaluation tools despite differences in language, education, and anesthesia practice, in an Israeli study, using validated scenarios from a multi-institutional United States (US) study. Thirty-one Israeli junior anesthesia residents performed four simulation scenarios. Training sessions were videotaped and performance was assessed using two validated scoring systems (Long and Short Forms) by two independent raters. Subjects scored from 37 to 95 (70 +/- 12) of 108 possible points with the "Long Form" and "Short Form" scores ranging from 18 to 35 (28.2 +/- 4.5) of 40 possible points. Scores >70% of the maximal score were achieved by 61% of participants in comparison to only 5% in the original US study. The scenarios were rated as very realistic by 80% of the participants (grade 4 on a 1-4 scale). Reliability of the original assessment tools was demonstrated by internal consistencies of 0.66 for the Long and 0.75 for the Short Form (Cronbach alpha statistic). Values in the original study were 0.72-0.76 for the Long and 0.71-0.75 for the Short Form. The reliability did not change when a revised Israeli version of the scoring was used. Interrater reliability measured by Pearson correlation was 0.91 for the Long and 0.96 for the Short Form (P < 0.01). The high scores for plausibility given to the scenarios and the similar reliability of the original assessment tool support the feasibility of using simulation-based evaluation tools, developed in the US, in Israel. The higher scores achieved by Israeli residents may be related to the fact that most Israeli residents are immigrants with previous training in anesthesia. IMPLICATIONS: Simulation-based assessment tools developed in a multi-institutional study in the United States can be used in Israel despite the differences in language, education, and medical system.
PMID: 16192523 [PubMed - indexed for MEDLINE]
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The effect of anesthesia by diethyl ether or isoflurane on activity of cytochrome P450 2E1 and P450 reductases in rat liver.
Plate AY, Crankshaw DL, Gallaher DD.
Department of Food Science and Nutrition, University of Minnesota, 1334 Eckles Ave, St. Paul, Minnesota 55108, USA.
In this study we sought to determine whether exposure to the anesthetics diethyl ether and isoflurane influences the activity of hepatic cytochrome P450 2E1 and P450 reductases in the rat. Rats were fed a purified diet for 6 wk before anesthesia with 1 of 3 anesthetics: carbon dioxide, diethyl ether, or isoflurane. Cytochrome P450 2E1 and P450 reductases were measured in liver microsomes. No significant differences in enzyme activities were found among the groups. These results indicate that diethyl ether and isoflurane can be used to kill rats without inducing P450 enzymes. IMPLICATIONS: Rats were anesthetized with ether, isoflurane, or carbon dioxide and liver P450 enzymes were quantified by spectrophotometry. Based on the results of this study, rats can be anesthetized with isoflurane or diethyl ether for a short period without a change in the activity of P450 enzymes.
PMID: 16192521 [PubMed - indexed for MEDLINE]
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Inhibitory effects of intravenous anesthetics on mast cell function.
Fujimoto T, Nishiyama T, Hanaoka K.
Department of Anesthesiology, Graduate School of Medicine, The University of Tokyo, Japan. tfujimot@highway.ne.jp
Mast cells play a protective role in the inflammation and auto-tissue injury. The impairment of mast cell function may influence defense against infection. We investigated the effect of four IV anesthetics (thiopental, midazolam, ketamine, and propofol) on the chemotaxis and exocytosis of mast cells. Canine mast cell chemotaxis was measured by the Boyden's blindwell chamber technique using 100 microg/mL of substance P as a stimulator. We measured mast cell exocytosis by measuring released histamine from mast cells using substance P or gamma-monomeric IgG-mediated crosslinking as a stimulator. Thiopental, midazolam, and propofol exerted a dose-dependent inhibitory effect on mast cell chemotaxis. Ketamine, midazolam, and propofol had a dose-dependent inhibitory effect on mast cell exocytosis. In conclusion, midazolam and propofol inhibited both chemotaxis and exocytosis of mast cells, while thiopental only inhibited chemotaxis, and ketamine only inhibited exocytosis. IMPLICATIONS: Mast cells play an important role in the antibacterial host-defense mechanism. Thiopental, midazolam, and propofol exerted a dose-dependent inhibitory effect on mast cell chemotaxis. Ketamine, midazolam, and propofol had a dose-dependent inhibitory effect on mast cell exocytosis. The impairment of mast cell function by IV anesthetics may influence the defense against infection.
PMID: 16192519 [PubMed - indexed for MEDLINE]
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Species-specific differences in response to anesthetics and other modulators by the K2P channel TRESK.
Keshavaprasad B, Liu C, Au JD, Kindler CH, Cotten JF, Yost CS.
Department of Anesthesia and Perioperative Care, University of California San Francisco, 513 Parnassus Ave., Room S-261, Box 0542, San Francisco, California 94143, USA.
TRESK (TWIK-related spinal cord K+ channel) is the most recently characterized member of the tandem-pore domain potassium channel (K2P) family. Human TRESK is potently activated by halothane, isoflurane, sevoflurane, and desflurane, making it the most sensitive volatile anesthetic-activated K2P channel yet described. Herein, we compare the anesthetic sensitivity and pharmacologic modulation of rodent versions of TRESK to their human orthologue. Currents passed by mouse and rat TRESK were enhanced by isoflurane at clinical concentrations but with significantly lower efficacy than human TRESK. Unlike human TRESK, the rodent TRESKs are strongly inhibited by acidic extracellular pH in the physiologic range. Zinc inhibited currents passed by both rodent TRESK in the low micromolar range but was without effect on human TRESK. Enantiomers of isoflurane that have stereoselective anesthetic potency in vivo produced stereospecific enhancement of the rodent TRESKs in vitro. Amide local anesthetics inhibited the rodent TRESKs at almost 10-fold smaller concentrations than that which inhibit human TRESK. These results identified interspecies differences and similarities in the pharmacology of TRESK. Further characterization of TRESK expression patterns is needed to understand their role in anesthetic mechanisms. IMPLICATIONS: Mouse and rat TRESK (TWIK-related spinal cord K+ channel) have different pharmacologic responses compared with human TRESK. In particular, we found stereospecific differences in response to isoflurane by the rodent TRESKs but not by human TRESK. TRESK may be a target site for the mechanism of action of volatile anesthetics.
PMID: 16192517 [PubMed - indexed for MEDLINE]
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Optimal end-tidal sevoflurane concentration for the removal of the laryngeal mask airway in anesthetized adults.
Shim YH, Shin CS, Chang CH, Shin YS.
Department of Anesthesiology and Pain Medicine and Anesthesia and Pain Research Institute, Yonsei University College of Medicine, CPO Box 1217, Seoul 120-752, Korea.
Sevoflurane provides smooth and rapid emergence from anesthesia and can be used when the removal of a laryngeal mask airway (LMA) is required in anesthetized patients. We sought to determine the optimal end-tidal concentrations of sevoflurane required for the removal of LMA in anesthetized adults. We studied 35 adults, aged 22-64 years old with an ASA physical status I or II, who were undergoing perineal surgery. General anesthesia was induced with thiopental, and the LMA was then inserted. Anesthesia was maintained with sevoflurane, oxygen, and air. After the surgery, the target concentration was maintained for at least 10 min, and then the LMA was removed. Each target concentration at the time of removal was predetermined by the Dixon up-down method (with 0.1% as a step size) starting at 1.7% end-tidal concentration of sevoflurane. The LMA removal was considered successful when there was no coughing, clenching of teeth, or gross purposeful movements during or within 1 min after removal and also if there was no breath holding, laryngospasm, or desaturation after removal. The end-tidal concentration of sevoflurane to achieve successful LMA removal in 50% of adults was 0.99% +/- 0.09% (mean +/- SD) and in 95% of adults was 1.18% (95% confidence limits, 1.07%-1.79%). In conclusion, we have determined that LMA removal in 50% and 95% of anesthetized adults can be safely accomplished without coughing, moving, or any other airway complications at 0.99% and 1.18% end-tidal concentrations of sevoflurane. IMPLICATIONS: Because the removal of the laryngeal mask airway (LMA) in the anesthetized state is required in some clinical situations, we sought to determine the end-tidal concentration of sevoflurane to safely remove the LMA in anesthetized adults.
PMID: 16192515 [PubMed - indexed for MEDLINE]
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Sub-Tenon's anesthetic administration for cataract surgery: how much stays in?
Patton N, Malik TY, Aslam TM.
Department of Ophthalmology, Princess Margaret Hospital, Dunfermline, Fife, United Kingdom. niallpatton@yahoo.co.uk
We performed a prospective, randomized trial assessing the "remaining" volume of anesthetic solution that stays within the sub-Tenon's space after administration of 2 different volumes: 3 mL and 5 mL. The remaining volume correlated with motor block (r = 0.72; P < 0.001). The volume lost through the incision as a percentage of total volume injected was similar in both groups, suggesting sub-Tenon's space is not limited to a finite injected volume less than 5 mL and may be capable of receiving larger volumes of anesthetic to improve motor block. IMPLICATIONS: The volume of anesthetic solution remaining within sub-Tenon's space correlates with motor block. The amount of volume lost as a percentage of total administered is independent of the volume injected, suggesting sub-Tenon's space is not limited to a finite injected volume less than 5 mL and may be capable of receiving larger volumes of anesthetic to improve motor block.
Publication Types:
PMID: 16192511 [PubMed - indexed for MEDLINE]
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Increased progesterone production during the luteal phase of menstruation may decrease anesthetic requirement.
Erden V, Yangin Z, Erkalp K, Delatioglu H, Bahceci F, Seyhan A.
Department of Anesthesiology, SSK Vakif Gureba Hospital, Istanbul, Turkey.
Besides having important hormonal effects, progesterone has depressant and hypnotic effects on the brain. In this study, we compared women in the follicular phase with low progesterone levels and in the luteal phase with high progesterone levels regarding their anesthetic requirements. Twenty patients with menstrual cycle days from 1 to 10 (follicular group) and 20 patients with menstrual cycle days from 18 to 24 (luteal group) were included in the study. Anesthesia was induced with fentanyl and thiopental; relaxation was secured with rocuronium, and anesthesia was maintained with a mixture of nitrous oxide 2 L/min and oxygen 2 L/min plus sevoflurane. The delivered sevoflurane concentration was adjusted to sustain a constant bispectral index value that averaged 46 in both groups. To determine the progesterone levels, blood samples were taken from all patients before surgery. We found that progesterone levels were 0.86 +/- 0.30 ng/mL in the follicular group and 7.48 +/- 3.86 ng/mL in the luteal group. The minimum alveolar anesthetic concentration (MAC)-hour (MAC-h) value of sevoflurane in the follicular group (1.55 +/- 0.18 MAC-h) was significantly larger than in the luteal group (1.3 +/- 0.13 MAC-h) (P < 0.0001). The sevoflurane requirements were larger in the follicular group during the maintenance phase of anesthesia. In conclusion, high progesterone levels during the luteal phase might be the cause of decreased anesthetic requirement. IMPLICATIONS: The aim of this study was to determine the effect of high progesterone levels on anesthetic requirement. We measured progesterone levels before surgery and calculated the sevoflurane dose (MAC-h) required to maintain a constant bispectral index value. The dose of sevoflurane correlated inversely with serum progesterone concentrations.
PMID: 16192510 [PubMed - indexed for MEDLINE]
Comment on:
Identifying and evaluating predictors of a difficult airway: the importance of not excluding the really interesting patients.
Kristensen MS.
Publication Types:
PMID: 16116028 [PubMed - indexed for MEDLINE]
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Masseter spasticity successfully treated with neuroablations of the bilateral mandibular nerves for a patient with progressive bulbar palsy.
Fujiwara Y, Oguri K, Shimada Y.
Publication Types:
PMID: 16116026 [PubMed - indexed for MEDLINE]
Comment on:
Timing of acupuncture stimulation.
Bagley WP.
Publication Types:
PMID: 16116025 [PubMed - indexed for MEDLINE]
Comment on:
Plasma bupivacaine concentrations are too low to explain reduced vecuronium requirement with an epidural.
Donati F, Fortier LP.
Publication Types:
PMID: 16116022 [PubMed - indexed for MEDLINE]
Comment on:
Seizures after a Bier block with clonidine and lidocaine: is clonidine really the culprit?
Datta S, Pai U, Bridenbaugh PO, Walia A.
Publication Types:
PMID: 16116019 [PubMed - indexed for MEDLINE]
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Loose--but not lost---tooth.
Lee BB, Jiang N.
Publication Types:
PMID: 16116016 [PubMed - indexed for MEDLINE]
Comment on:
Direction of the J-tip of a guidewire during subclavian approach.
Bahk JH, Ryu HG, Jeon YT.
Publication Types:
PMID: 16116015 [PubMed - indexed for MEDLINE]
Erratum in:
- Anesth Analg. 2005 Oct;101(4):1011.
Cervical spine motion: a fluoroscopic comparison during intubation with lighted stylet, GlideScope, and Macintosh laryngoscope.
Turkstra TP, Craen RA, Pelz DM, Gelb AW.
Department of Anesthesia and Perioperative Medicine, University of Western Ontario, 339 Windermere Road, London, Ontario, Canada N6A 5A5. ttukstra@uwo.ca [corrected]
The question of which is the optimum technique to intubate the trachea in a patient who may have a cervical(C)-spine injury remains unresolved. We compared, using fluoroscopic video, C-spine motion during intubation for Macintosh 3 blade, GlideScope, and Intubating Lighted Stylet, popularly known as the Lightwand or Trachlight. Thirty-six healthy patients were randomized to participate in a crossover trial of either Lightwand or GlideScope to Macintosh laryngoscopy, with in-line stabilization. C-spine motion was examined at the Occiput-C1 junction, C1-2 junction, C2-5 motion segment, and C5-thoracic motion segment during manual ventilation via bag-mask, laryngoscopy, and intubation. Time to intubate was also measured. C-spine motion during bag-mask ventilation was 82% less at the four motion segments studied than during Macintosh laryngoscopy (P < 0.001). C-spine motion using the Lightwand was less than during Macintosh laryngoscopy, averaging 57% less at the four motion segments studied (P < 0.03). There was no significant difference in time to intubate between the Lightwand and the Macintosh blade. C-spine motion was reduced 50% at the C2-5 segment using the GlideScope (P < 0.04) but unchanged at the other segments. Laryngoscopy with GlideScope took 62% longer than with the Macintosh blade (P < 0.01). Thus, the Lightwand (Intubating Lighted Stylet) is associated with reduced C-spine movement during endotracheal intubation compared with the Macintosh laryngoscope.
Publication Types:
PMID: 16116013 [PubMed - indexed for MEDLINE]
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Ultrasound-guided infraclavicular versus supraclavicular block.
Arcand G, Williams SR, Chouinard P, Boudreault D, Harris P, Ruel M, Girard F.
Department of Anesthesiology, CHUM, Hopital Notre-Dame, 1560 Sherbrooke east, Montreal, Quebec, Canada H2L 4M1.
In this prospective study we compared ultrasound-guided (USG) infraclavicular and supraclavicular blocks for performance time and quality of block. We hypothesized that the infraclavicular approach would result in shorter performance times with a quality of block similar to that of the supraclavicular approach. Eighty patients were randomized into two equal groups: Group I (infraclavicular) and Group S (supraclavicular). All blocks were performed using ultrasound visualization with a 7.5-MHz linear probe and neurostimulation. The anesthetic mixture consisted of 0.5 mL/kg of bupivacaine 0.5% and lidocaine hydrocarbonate 2% (1:3 vol.) with epinephrine 1:200,000. Sensory block, motor block, and supplementation rates were evaluated for the musculocutaneous, median, radial, and ulnar nerves. Surgical anesthesia without supplementation was achieved in 80% of patients in group I compared with 87% in Group S (P = 0.39). Supplementation rates were significantly different only for the radial territory: 18% in Group I versus 0% in group S (P = 0.006). Block performance times were not different between groups (4.0 min in Group I versus 4.65 min in Group S; P = 0.43). Technique-related pain scores were not different between groups (I: 2.0; S: 2.0; P = 1.00). We conclude that USG infraclavicular block is at least as rapidly executed as USG supraclavicular block and produces a similar degree of surgical anesthesia without supplementation.
Publication Types:
PMID: 16116009 [PubMed - indexed for MEDLINE]
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Determining the plasma concentration of ketamine that enhances epidural bupivacaine-and-morphine-induced analgesia.
Suzuki M, Kinoshita T, Kikutani T, Yokoyama K, Inagi T, Sugimoto K, Haraguchi S, Hisayoshi T, Shimada Y.
Department of Anesthesiology, Second Hospital Nippon Medical School, Kanagawa 211-8533, Japan. manzo@nms.ac.jp
N-methyl-D-aspartate (NMDA) receptor antagonists enhance opioid-induced analgesia. The plasma concentration of ketamine, an NMDA receptor antagonist that enhances epidural morphine-and-bupivacaine-induced analgesia, is not known. We examined 24 patients with lung carcinoma or metastatic lung tumor who underwent video-assisted thoracic surgery in a placebo-controlled, double-blind manner 4 h after emergence from anesthesia. The morphine + ketamine group (n = 8) and morphine + placebo group (n = 8) received 5 mL volume of 2.5 mg morphine and 0.25% bupivacaine and the placebo + ketamine group (n = 8) received 5 mL volume of saline and 0.25% bupivacaine epidurally at the end of skin closure. Four hours after this anesthesia, in the morphine + ketamine and placebo + ketamine groups, ketamine was administered to successively maintain a stable plasma ketamine concentration of 0, 10, 20, 30, 40, and 50 ng/mL by a target-controlled infusion device, and patients assessed the levels of pain at rest, pain on coughing, somnolence (drowsiness), and nausea using a 100-mm visual analog scale (VAS). In the morphine + placebo group, a placebo (saline) was similarly administered instead of ketamine. In the morphine + ketamine group, the VAS scores for pain at rest and pain on coughing significantly decreased on ketamine administration at a plasma concentration of 20 ng/mL or larger compared with the respective baseline VAS scores (P < 0.05 each). In the placebo + ketamine group, the VAS scores for pain at rest and pain on coughing did not significantly change at any plasma concentration of ketamine as compared to the morphine + placebo group. In the morphine + ketamine group, a plasma concentration of ketamine larger than 20 ng/mL did not further reduce VAS scores for pain at rest and pain on coughing. The VAS scores for drowsiness were comparable among the three groups at any plasma concentration of ketamine. Ketamine at a plasma concentration of 20 ng/mL or larger may enhance epidural morphine-and-bupivacaine-induced analgesia. As an adjunct with epidural morphine-and-bupivacaine and considering the safety of small doses, the minimal plasma concentration of ketamine given IV may be approximately 20 ng/mL.
Publication Types:
PMID: 16115991 [PubMed - indexed for MEDLINE]
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Different conditions that could result in the bispectral index indicating an incorrect hypnotic state.
Dahaba AA.
Department of Anaesthesiology and Intensive Care Medicine, Graz Medical University, Auenbruggerplatz 29, A-8036 Graz, Austria. ashraf.dahaba@meduni-graz.at
Since its introduction in 1996, the Bispectral Index (BIS) has gained increasing popularity in daily anesthesia practice. However, numerous reports have been appearing in the literature of paradoxical BIS changes and inaccurate readings. The purpose of this review is to assess the utility of BIS monitoring through examining the various published reports of all BIS values not coinciding with a clinically judged sedative-hypnotic state, whether arising from an underlying pathophysiology of electroencephalographic (EEG) cerebral function or because of shortcomings in the performance and design of the BIS monitor. High electromyographic activity and electric device interference could create subtle artifact signal pollution without their necessarily being displayed as artifacts. This would be misinterpreted by the BIS algorithm as EEG activity and assigned a spuriously increased BIS value. Numerous clinical conditions that have a direct effect on EEG cerebral function could also directly influence the BIS value.
Publication Types:
PMID: 16115989 [PubMed - indexed for MEDLINE]
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Evaluation of a closed-loop muscle relaxation control system.
Eleveld DJ, Proost JH, Wierda JM.
Research Group for Experimental Anesthesiology and Clinical Pharmacology, PO Box 30001, 9700 RB Groningen, The Netherlands. d.j.eleveld@anest.azg.nl
Automatic muscle relaxation control may reduce anesthesiologists' workload freeing them for other patient care requirements. In this report we describe a muscle relaxation controller designed for routine clinical application using rocuronium and the train-of-four count. A muscle relaxation monitor (TOF Watch SX) was connected to a laptop computer running a controller algorithm program that communicates with a syringe pump to form a closed-loop muscle relaxation system. The control algorithm uses proportional-integral and lookup table components and is designed to avoid the usability restrictions of existing controllers. The controller is optimized using an objective method to avoid the uncertainties of ''hand-crafted'' controller algorithms. Controller target was train-of-four count 1 or 2 and controller performance was evaluated in 15 patients. During 39 hours of closed-loop control, 96.1% of all twitches recorded were in the target range. Average rocuronium infusion rate was 0.36 mg.kg(-1).h(-1) (sd 0.18 mg.kg(-1).h(-1)). We show that the controller remains useful even in the presence of disturbances that can arise in routine clinical conditions. The muscle relaxation controller maintained the target train-of-four count values and may serve as a basis for the design of hardware and user interfaces for closed-loop muscle relaxation control in clinical conditions.
PMID: 16115988 [PubMed - indexed for MEDLINE]
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Continuous monitoring of cerebral oxygen saturation in elderly patients undergoing major abdominal surgery minimizes brain exposure to potential hypoxia.
Casati A, Fanelli G, Pietropaoli P, Proietti R, Tufano R, Danelli G, Fierro G, De Cosmo G, Servillo G.
Department of Anesthesiology, Azienda Ospedaliera di Parma, Via Gramsci 14, 43100 Parma, Italy. acasati@ao.pr.it
Elderly patients are more prone than younger patients to develop cerebral desaturation because of the reduced physiologic reserve that accompanies aging. To evaluate whether monitoring cerebral oxygen saturation (rSO(2)) minimizes intraoperative cerebral desaturation, we prospectively monitored rSO(2) in 122 elderly patients undergoing major abdominal surgery with general anesthesia. Patients were randomly allocated to an intervention group (the monitor was visible and rSO(2) was maintained at > or =75% of preinduction values; n = 56) or a control group (the monitor was blinded and anesthesia was managed routinely; n = 66). Cerebral desaturation (rSO(2) reduction <75% of baseline) was observed in 11 patients of the treatment group (20%) and 15 patients of the control group (23%) (P = 0.82). Mean (95% confidence intervals) values of mean rSO(2) were higher (66% [64%-68%]) and the area under the curve below 75% of baseline (AUCrSO2(2)< 75% of baseline) was lower (0.4 min% [0.1-0.8 min%]) in patients of the treatment group than in patients of the control group (61% [59%-63%] and 80 min% [2-144 min%], respectively; P = 0.002 and P = 0.017). When considering only patients developing intraoperative cerebral desaturation, a lower Mini Mental State Elimination (MMSE) score was observed at the seventh postoperative day in the control group (26 [25-30]) than in the treatment group (28 [26-30]) (P = 0.02), with a significant correlation between the AUCrSO(2) < 75% of baseline and postoperative decrease in MMSE score from preoperative values (r(2)= 0.25, P = 0.01). Patients of the control group with intraoperative cerebral desaturation also experienced a longer time to postanesthesia care unit (PACU) discharge (47 min [13-56 min]) and longer hospital stay (24 days [7-53] days) compared with patients of the treatment group (25 min [15-35 min] and 10 days [7-23 days], respectively; P = 0.01 and P = 0.007). Using rSO(2) monitoring to manage anesthesia in elderly patients undergoing major abdominal surgery reduces the potential exposure of the brain to hypoxia; this might be associated with decreased effects on cognitive function and shorter PACU and hospital stay.
Publication Types:
PMID: 16115985 [PubMed - indexed for MEDLINE]
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Magnesium sulfate pretreatment reduces myoclonus after etomidate.
Guler A, Satilmis T, Akinci SB, Celebioglu B, Kanbak M.
Department of Anesthesiology and Reanimation, Hacettepe University, Sihhiye Ankara, Turkey 06100. ayguncuhadar@hotmail.com
Myoclonic movements and pain on injection are common problems during induction of anesthesia with etomidate. We investigated the influence of pretreatment with magnesium and two doses of ketamine on the incidence of etomidate-induced myoclonus and pain. A prospective double-blind study was performed on 100 ASA physical status I-III patients who were randomized into 4 groups according to the pretreatment drug: ketamine 0.2 mg/kg, ketamine 0.5 mg/kg, magnesium sulfate (Mg) 2.48 mmol, or normal saline. Ninety seconds after the pretreatment, anesthesia was induced with etomidate 0.2 mg/kg. Vecuronium 0.1 mg/kg was used as the muscle relaxant. An anesthesiologist, blinded to group allocation, recorded the myoclonic movements, pain, and sedation on a scale between 0-3. Nineteen of the 25 patients receiving Mg (76%) did not have myoclonic movements after the administration of etomidate, whereas 18 patients (72%) in the ketamine 0.5 mg/kg, 16 patients (64%) in the ketamine 0.2 mg/kg, and 18 patients (72%) in the control group experienced myoclonic movements (P < 0.05). We conclude that Mg 2.48 mmol administered 90 s before the induction of anesthesia with etomidate is effective in reducing the severity of etomidate-induced myoclonic muscle movements and that ketamine does not reduce the incidence of myoclonic movements.
Publication Types:
PMID: 16115978 [PubMed - indexed for MEDLINE]
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Prolonged injection time and light smoking decrease the incidence of fentanyl-induced cough.
Lin JA, Yeh CC, Lee MS, Wu CT, Lin SL, Wong CS.
Department of Anesthesiology, Tri-Service General Hospital and National Defense Medical Center, National Defense University, #325 Chenggung Road Section 2, Neihu 114, Taipei, Taiwan, Republic of China.
We designed this study to evaluate the effect of injection time and smoking on fentanyl-induced cough. Four-hundred-fifty ASA class I-II patients, aged 18-80 yr and weighing 40-90 kg, scheduled for elective surgery were included. All patients received fentanyl (100 microg for patients weighing 40-69 kg and 150 microg for patients weighing 70-90 kg for clinical convenience) via the proximal port of a peripheral IV line on the forearm. Patients were randomly assigned to 3 groups of 150 patients each. Patients in Group I received fentanyl injection over 2 s, whereas for patients in Groups II and III the fentanyl was injected at a constant rate over 15 s and 30 s, respectively. We recorded the number of coughs of each patient during and 30 s after fentanyl injection. The incidence of cough was 18% in group I, 8% in Group II, and 1.3% in Group III, significantly less (P < 0.05) with a longer injection time. Current smokers had a less frequent incidence of cough than nonsmokers; however, this effect was only significant in light smokers (<10 cigarettes per day or <10 smoking years or <10 pack-years). In conclusion, a longer injection time reduces the incidence of fentanyl-induced cough, and light smoking may be a protective factor against fentanyl-induced cough.
Publication Types:
PMID: 16115973 [PubMed - indexed for MEDLINE]
Society for obstetric anesthesia and perinatology. Palm desert, california. May 4-7, 2005.
Zakowski M.
Cedars-Sinai Medical Center, Los Angeles, California. mark.zakowski@cshs.org.
PMID: 16192804 [PubMed - in process]
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Leroy D. Vandam, M.D.: An Anesthesia Journey (DVD).
Bacon DR.
Mayo Clinic, Rochester, Minnesota. bacon.douglas@mayo.edu.
PMID: 16192803 [PubMed - in process]
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What's Old in Obstetric Anesthesia?
Tsen LC.
Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts. ltsen@zeus.bwh.harvard.edu.
PMID: 16192799 [PubMed - as supplied by publisher]
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What's Old in Obstetric Anesthesia?
Waters JH, Ford P.
*University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania. watejh@upmc.edu.
PMID: 16192798 [PubMed - in process]
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Thalamocortical connection and anesthesia.
Hagihira S, Takashina M, Mori T, Mashimo T.
*Osaka University Graduate School of Medicine, Osaka, Japan. hagihira@masui.med.osaka-u.ac.jp.
PMID: 16192797 [PubMed - in process]
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Thalamocortical connection and anesthesia.
John ER, Prichep LS.
*New York University School of Medicine, New York, New York, and Nathan S. Kline Psychiatric Research Institute, Orangeburg, New York. roy.john@med.nyu.edu.
PMID: 16192796 [PubMed - in process]
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The "anesthetic cascade": fact or fiction?
Antkowiak B.
University of Tuebingen, Tuebingen, Germany. bernd.antkowiak@uni-tuebingen.de.
PMID: 16192794 [PubMed - in process]
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The pulmonary artery catheter in anesthesia practice.
Swan HJ.
* Former Director, Department of Cardiology, Cedars-Sinai Medical Center, Professor of Medicine (Emeritus), Department of Medicine, UCLA, Los Angeles, California.
Catheterization of the heart in man with use of a flow-directed balloon-tipped catheter. By J. H. C. Swan, W. Ganz, J. Forrester, H. Marcus, G. Diamond, and D. Chonette. N Engl J Med 1970; 283:447-51. Reprinted with permission.Pressures in the right side of the heart and pulmonary capillary wedge can be obtained by cardiac catheterization without the aid of fluoroscopy. A No. 5 French double-lumen catheter with a balloon just proximal to the tip is inserted into the right atrium under pressure monitoring. The balloon is then inflated with 0.8 ml of air. The balloon is carried by blood flow through the right side of the heart into the smaller radicles of the pulmonary artery. In this position when the balloon is inflated wedge pressure is obtained. The average time for passage of the catheter from the right atrium to the pulmonary artery was 35 s in the first 100 passages. The frequency of premature beats was minimal, and no other arrhythmias occurred.
PMID: 16192783 [PubMed - in process]
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Dr. Rudolph Matas: Innovator and Pioneer in Anesthesiology.
Hutson LR Jr, Vachon CA.
* Resident, dagger Staff Anesthesiologist..
PMID: 16192782 [PubMed - as supplied by publisher]
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Intraoperative Epidural Analgesia Combined with Ketamine Provides Effective Preventive Analgesia in Patients Undergoing Major Digestive Surgery.
Lavand'homme P, De Kock M, Waterloos H.
* Associate Professor of Anesthesiology, dagger Professor of Anesthesiology, double dagger Research Nurse.
BACKGROUND:: As a broader definition of preemptive analgesia, preventive analgesia aims to prevent the sensitization of central nervous system, hence the development of pathologic pain after tissular injury. To demonstrate benefits from preventive treatment, objective measurement of postoperative pain such as wound hyperalgesia and persistent pain should be evaluated. The current study assessed the role and timing of epidural analgesia in this context. METHODS:: In a randomized, double-blinded trial, 85 patients scheduled to undergo neoplastic colonic resection were included. All the patients received a thoracic epidural catheter, systemic ketamine at a antihyperalgesic dose, and general anesthesia. Continuous infusion of analgesics belonging to the same class was administered by either intravenous or epidural route before incision until 72 h after surgery. Patients were allocated to four groups to receive intraoperative intravenous lidocaine-sufentanil-clonidine or epidural bupivacaine-sufentanil-clonidine followed postoperatively by either intravenous (lidocaine-morphine-clonidine) or epidural (bupivacaine-sufentanil-clonidine) patient-controlled analgesia. Postoperative pain scores (visual analog scale), analgesic consumption, wound area of punctuate hyperalgesia, residual pain, and analgesics needed from 2 weeks until 12 months were recorded. RESULTS:: Analgesic requirements, visual analog scale scores, and area of hyperalgesia were significantly higher in the intravenous treatment group (intravenous-intravenous), and more patients reported residual pain from 2 weeks until 1 yr (28%). Although postoperative pain measurements did not differ, postoperative epidural treatment (intravenous-epidural) was less effective to prevent residual pain at 1 yr (11%; P = 0.2 with intravenous-intravenous group) than intraoperative one (epidural-epidural and epidural-intravenous groups) (0%; P = 0.01 with intravenous-intravenous group). CONCLUSION:: Combined with an antihyperalgesic dose of ketamine, intraoperative epidural analgesia provides effective preventive analgesia after major digestive surgery.
PMID: 16192774 [PubMed - as supplied by publisher]
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Volatile Anesthetics Bind Rat Synaptic Snare Proteins.
Nagele P, Mendel JB, Placzek WJ, Scott BA, D'avignon DA, Crowder CM.
* Adjunct Instructor, Department of Anesthesiology, Washington University School of Medicine. Attending Anesthesiologist, Department of Anesthesiology and General Intensive Care, Medical University of Vienna. dagger Undergraduate Research Assistant, double dagger Senior Research Technician, Department of Anesthesiology, parallel Associate Professor, Department of Anesthesiology and Department of Molecular Biology/Pharmacology, Division of Biology and Biomedical Sciences, Washington University School of Medicine. section sign Director High Resolution NMR Facility, Department of Chemistry, Washington University.
BACKGROUND:: Volatile general anesthetics (VAs) have a number of synaptic actions, one of which is to inhibit excitatory neurotransmitter release; however, no presynaptic VA binding proteins have been identified. Genetic data in Caenorhabditis elegans have led to the hypothesis that a protein that interacts with the presynaptic protein syntaxin 1A is a VA target. Motivated by this hypothesis, the authors measured the ability of syntaxin 1A and proteins that interact with syntaxin to bind to halothane and isoflurane. METHODS:: Recombinant rat syntaxin 1A, SNAP-25B, VAMP2, and the ternary SNARE complex that they form were tested. Binding of VAs to these proteins was detected by F-nuclear magnetic resonance relaxation measurements. Structural alterations in the proteins were examined by circular dichroism and ability to form complexes. RESULTS:: Volatile anesthetics did not bind to VAMP2. At concentrations in the clinical range, VAs did bind to SNAP-25B; however, binding was detected only in preparations containing SNAP-25B homomultimers. VAs also bound at clinical concentrations to both syntaxin and the SNARE complex. Addition of an N-terminal His6 tag to syntaxin abolished its ability to bind VAs despite normal secondary structure and ability to form SNARE complexes; thrombin cleavage of the tag restored VA binding. Thus, the VA binding site(s) has structural requirements and is not simply any alpha-helical bundle. VAs at supraclinical concentrations produced an increase in helicity of the SNARE complex; otherwise, VA binding produced no gross alteration in the stability or secondary structure of the SNARE complex. CONCLUSION:: SNARE proteins are potential synaptic targets of volatile anesthetics.
PMID: 16192769 [PubMed - as supplied by publisher]
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Influence of Nociception and Stress-induced Antinociception on Genetic Variation in Isoflurane Anesthetic Potency among Mouse Strains.
Mogil JS, Smith SB, O'reilly MK, Plourde G.
* E.P. Taylor Professor of Pain Studies, dagger Graduate Research Assistant, double dagger Undergraduate Research Assistant, Department of Psychology and Centre for Research on Pain, McGill University, Montreal, Quebec, Canada. section sign Professor, Department of Anesthesia, McGill University Health Centre, Montreal, Quebec, Canada.
BACKGROUND:: Genetic background influences anesthetic potency to suppress motor response to noxious stimulation (minimum alveolar concentration [MAC]) as well as nociceptive sensitivity in unmedicated animals. However, the influence on MAC of baseline sensitivity to the noxious stimuli used to assess MAC has virtually never been studied. The authors assessed room air nociceptive sensitivity and isoflurane MAC in multiple mouse strains. Isoflurane requirement for loss of righting response (MACLORR) was also measured. METHODS:: One outbred and 10 inbred mouse strains were tested for latency to respond (in room air) to a tail clip (either 500 g or 2,000 g). Naive mice of the same 11 strains were tested for isoflurane MAC and MACLORR. To assess the role of opioid-mediated stress-induced antinociception, mice were also tested for nociceptive sensitivity after injection of naloxone (10 mg/kg) or saline. RESULTS:: Robust strain differences were observed for all measures. The authors found that tail-clip latency (using a 500-g or 2,000-g clip, respectively) correlated significantly with MAC (r = -0.76 and -0.58, respectively) but not MACLORR (r = -0.10 and -0.26). Naloxone produced strain-dependent reductions in open air tail-clip latencies, and these reductions were also strongly correlated with MAC (r = -0.67 and -0.71). CONCLUSIONS:: The authors suggest that genetic variability in isoflurane MAC (but not MACLORR) may reflect genetic variability in the underlying sensitivity to the noxious stimulus being used to measure MAC. This variable sensitivity to nociception in the awake state is at least partially mediated by endogenous antinociceptive mechanisms activated by the tail-clip stimulus itself.
PMID: 16192767 [PubMed - as supplied by publisher]
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Prevention of Hypotension during Spinal Anesthesia for Cesarean Delivery: An Effective Technique Using Combination Phenylephrine Infusion and Crystalloid Cohydration.
Kee WD, Khaw KS, Ng FF.
* Professor, dagger Associate Professor, double dagger Research Nurse.
BACKGROUND:: Many methods for preventing hypotension during spinal anesthesia for cesarean delivery have been investigated, but no single technique has proven to be effective and reliable. This randomized study studied the efficacy of combining simultaneous rapid crystalloid infusion (cohydration) with a high-dose phenylephrine infusion. METHODS:: Nonlaboring patients scheduled to undergo elective cesarean delivery received an intravenous infusion of 100 mug/min phenylephrine that was started immediately after spinal injection and titrated to maintain systolic blood pressure near baseline values until uterine incision. In addition, patients received infusion of lactated Ringer's solution that was given either rapidly (group 1, n = 57) or at a minimal maintenance rate (group 0, n = 55). Maternal hemodynamic changes and neonatal condition were compared. RESULTS:: Six patients were excluded from analysis. Only 1 of 53 patients (1.9% [95% confidence interval, 0.3-9.9%]) in group 1 experienced hypotension versus 15 of 53 patients (28.3% [95% confidence interval, 18.0-41.6%]) in group 0 (P = 0.0001). Compared with group 0, patients in group 1 had greater values for the following: serial measurements of systolic blood pressure (P = 0.02), minimum recorded systolic blood pressure (P = 0.0002), and minimum recorded heart rate (P = 0.013). Total phenylephrine consumption was smaller in group 1 compared with group 0 (P = 0.008). Neonatal outcome and maternal side effects were similar between groups. CONCLUSIONS:: Combination of a high-dose phenylephrine infusion and rapid crystalloid cohydration is the first technique to be described that is effective for preventing hypotension during spinal anesthesia for cesarean delivery.
PMID: 16192766 [PubMed - as supplied by publisher]
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This month in anesthesiology.
Henkel G.
PMID: 16192756 [PubMed - in process]
[Prevention of venous thromboembolism following cardiac, vascular or thoracic surgery]
[Article in French]
Piriou V, Rossignol B, Laroche JP, Ffrench P, Lacroix P, Squara P, Sirieix D, D'Attellis N, Samain E.
Service d'anesthesie-reanimation chirurgicale, centre hospitalier Lyon Sud, Pierre-Benite, France.
In the absence of thromboprophylaxis, coronary artery bypass graft surgery (CABG), intrathoracic surgery (thoracotomy or video-assisted thoracoscopy), abdominal aortic surgery and infrainguinal vascular surgery are high-risk surgeries for the development of venous thromboembolic events (VTE). The incidence of VTE following surgery of the intrathoracic aorta, carotid endarterectomy or mediastinoscopy is unknown. Data from the litterature are lacking to draw evidence-based recommandations for venous thromboprophylaxis after these three types of surgeries, and the following guidelines are but experts'opinions (Grade D recommendations). Thromboprophylaxis is recommended after CABG (Grade D), with either subcutaneous (SC) low molecular weight heparin (LMWH) or SC or intravenous (i.v.) unfractioned heparin (UH) (PTT target = 1.1-1.5 time control value) (both grade D). This may be combined with the use of intermittent pneumatic compression device (Grade B). After valve surgery. The anticoagulation recommended to prevent valve thrombosis is sufficient in order to prevent VTE. We recommend thromboprophylaxis with either LMWH or low dose UH to prevent VTE after aortic or lower limbs infrainguinal vascular surgery (both grade B and D). Vitamine K antagonists (VKA) are not recommended in this indication (Grade D). We recommend thromprophylaxis following intrathoracic surgery via thoracotomy or videoassisted thoracoscopy (grade C). Either subcutaneous LMWH or subcutaneous or i.v. low dose UH may be used (Grade C). Efficacy of intermittent pneumatic compression device has been demonstrated in a study (grade C). VKA are not recommended (grade D). No further recommendation regarding the duration of thromboprophylaxis after these three types of surgeries can be made.
Publication Types:
PMID: 16009530 [PubMed - indexed for MEDLINE]
Performance of entropy and Bispectral Index as measures of anaesthesia effect in children of different ages.
Davidson AJ, Huang GH, Rebmann CS, Ellery C.
Department of Anaesthesia and Pain Management, Royal Children's Hospital, Parkville 3052, Australia.
BACKGROUND: Entropy and Bispectral Indextrade mark (BIStrade mark) have been promoted as EEG-based anaesthesia depth monitors. The EEG changes with brain maturation, but there are limited published data describing the characteristics of entropy in children, and some data suggest that BIS is less reliable in young children. The aim of this study was to compare the performance of entropy as a measure of anaesthetic effect in different age groups. The performance of entropy was compared with BIS. METHODS: Fifty-four children receiving a standard sevoflurane anaesthetic for cardiac catheter studies were enrolled. The entropy and BIS were recorded pre-awakening and at 1.5%, 2% and 2.5% steady-state end-tidal sevoflurane concentrations. For analysis children were divided into four age groups: 0-1 yr, 1-2 yr, 2-4 yr and 4-12 yr. RESULTS: The pre-awakening values were obtained in 46 children. The median pre-awakening values for entropy and BIS varied significantly across ages with the values being lowest in the 0-1 yr age group (response entropy: 45 vs 84, 87 and 89, P=0.003; state entropy: 36 vs 78, 74 and 77, P=0.009; BIS: 56 vs 78, 76.5 and 72, P=0.02). Values were recorded at all three sevoflurane concentrations in 48 children. Compared with older groups, the 0-1 yr age group had the least significant difference in BIS and entropy when compared among different sevoflurane concentrations. The calculated sevoflurane concentrations to achieve mid-scale values of entropy and BIS were highest in the 1-2 yr age group, lower in the 0-1 yr age group and progressively lower in the 2-4 and 4-12 yr age groups. CONCLUSIONS: For both entropy and BIS the measure of anaesthetic effect was significantly different for children aged <1 yr compared with older children. There was no difference in performance of entropy and BIS. Both should be used cautiously in small children.
PMID: 16183678 [PubMed - in process]
Lidocaine 2% with or without glucose 8% for spinal anesthesia for short orthopedic surgery.
Imbelloni LE, Beato L.
PMID: 16189347 [PubMed - in process]
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Regional anesthesia in cardiac surgery and immediate extubation after cardiac surgery: a different view.
Hemmerling T, Choiniere JL, Basile F, Prieto I.
PMID: 16189343 [PubMed - in process]
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Uncomplicated outcome after anesthesia for pediatric patients with Gaucher disease: [Evolution sans complications apres l'anesthesie de patients pediatriques atteints de la maladie de Gaucher].
Ioscovich A, Briskin A, Abrahamov A, Halpern S, Zimran A, Elstein D.
Gaucher Clinic, Shaare Zedek Medical Center, P.O. Box 3235, Jerusalem 91031, Israel. elstein@szmc.org.il.
PURPOSE: The purpose of this retrospective review was to highlight clinical issues relating to anesthetic management in children who present with Gaucher disease-specific features that may impact on anesthetic management and surgical outcome. Previous reports have dealt primarily with neuronopathic forms where neurological dysfunction determined the mode of anesthesia. To date, no series of routine surgeries in pediatric patients with non-neuronopathic Gaucher disease has been published. METHODS: All surgeries performed in children with Gaucher retrospectively analyzed. RESULTS: There were 31 procedures under anesthesia in 15 pediatric patients. Twenty-seven of these (87%) involved either insertion or removal of a central venous catheter. There was no correlation between disease severity and the need for blood transfusion postoperatively [required in only eight cases (25.8%), including a total hip replacement]. No difficult intubations or other airway problems were recorded. Positioning of two patients, because of gibbus and prior to hip replacement, respectively, required special attention. CONCLUSIONS: We record our experience in surgeries in children with mild, non-neuronopathic type I and severe neuronopathic type III Gaucher disease, who had relatively short surgeries under general anesthesia. Attention to hematological parameters in particular can minimize postoperative bleeding, the most serious complication.
PMID: 16189337 [PubMed - in process]
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Anesthetic management of children with Moebius sequence: [Anesthesie chez des enfants atteints du syndrome de Moebius].
Ames WA, Shichor TM, Speakman M, Zuker RM, McCaul C.
Division of Pediatric Anesthesiology, DUMC, Box 3094, Durham, North Carolina 27710, USA. wads@doctors.org.uk.
Background: Moebius sequence is a rare congenital absence of the sixth and seventh cranial nerves, although there may be additional congenital cranial neuropathies. Developmental delay, cardiac and musculoskeletal abnormalities may also co-exist. Oro-facial manifestations include bilateral facial nerve palsy resulting in a mask like facies, drooling, incomplete eye closure, and strabismus secondary to the extra-ocular muscle imbalance. This condition has multiple implications for anesthetic care. METHODS: We reviewed 111 anesthesia records of 46 patients with Moebius sequence for anesthesia technique and related complications. RESULTS: Facial nerve palsy was universally present and bilateral in 44 (93.6%) patients. Thirty-two (68%) had concomitant sixth nerve palsy. Oro-facial and limb abnormalities were present in 16 (35%) and 18 (39%) of patients respectively. Endotracheal intubation, when attempted, was easy in 76 of 106 cases. Tracheal intubation was consistently difficult in seven patients and intubation failure occurred in a single patient only. Statistically significant factors associated with difficult tracheal intubation included structural abnormalities of the mandible and palate and abnormalities of four cranial nerves (IX, X, XI, XII). CONCLUSION: We confirm that tracheal intubation may be difficult in patients with Moebius sequence. We identify disease features that might predict a difficult tracheal intubation and thus allow the anesthesiologist an opportunity to plan accordingly.
PMID: 16189336 [PubMed - in process]
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Images in Anesthesia: Anesthetic implications of persistent left superior vena cava.
Konvicka JJ, Villamaria FJ.
PMID: 16189331 [PubMed - in process]
Changes in bispectral index values during lumbar arthrodesis.
Barrera E, Fernandez-Galinski S, Arbones E, Escolano F, Puig MM.
Publication Types:
PMID: 15918390 [PubMed - indexed for MEDLINE]
Propacetamol and ketoprofen after thyroidectomy.
Fourcade O, Sanchez P, Kern D, Mazoit JX, Minville V, Samii K.
University of Toulouse, Purpan Hospital, Anaesthesia Department, France. fourcade.o@chu-toulouse.fr
BACKGROUND AND OBJECTIVE: The combination of non-opioid analgesic drugs, though widely used, has been rarely evaluated. The aim of this study was to compare the efficacy of propacetamol and the non-steroidal analgesic drug ketoprofen, alone or in combination, on pain relief after thyroid surgery performed using remifentanil. METHODS: Ninety-seven patients were randomly allocated to one of the three groups: propacetamol 2 g (32), ketoprofen 100 mg (33) and propacetamol 2 g + ketoprofen 100 mg (32). Each regimen was administered intravenously (i.v.) 30 min before the end of surgery and then every 6 h. If pain was not relieved, patients received an i.v. bolus of tramadol 100 mg. Tramadol consumption and pain intensity using a visual analogue scale was recorded at 1, 2, 8 and 14 h after the end of surgery. RESULTS: Pain scores were significantly higher with propacetamol compared with ketoprofen 2 h after surgery (35 +/- 3.7, 21 +/- 2.6, respectively; P < 0.01). The number of patients receiving tramadol was higher with propacetamol alone compared with the two other groups, 1 h (14/32, 4/33, 2/32, respectively; P > 0.01) and 2 h (24/32, 6/33, 8/32, respectively; P < 0.01) after surgery. There was no difference between ketoprofen alone and ketoprofen plus propacetamol, and there was no difference between the three groups from the 8th hour onward. CONCLUSIONS: In the immediate postoperative period after thyroid surgery performed using remifentanil, the concomitant use of propacetamol and ketoprofen does not improve analgesia compared with ketoprofen alone.
Publication Types:
PMID: 15918387 [PubMed - indexed for MEDLINE]
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Comment on:
Inadequate anaesthesia in lethal injection for execution.
Weisman RS, Bernstein JN, Weisman RS.
Publication Types:
PMID: 16182888 [PubMed - indexed for MEDLINE]
Comment on:
Inadequate anaesthesia in lethal injection for execution.
Heath MJ, Stanski DR, Pounder DJ.
Publication Types:
PMID: 16182887 [PubMed - indexed for MEDLINE]
Comment on:
Inadequate anaesthesia in lethal injection for execution.
Groner JI.
Publication Types:
PMID: 16182886 [PubMed - indexed for MEDLINE]
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