About Entrez
Text Version
Entrez PubMed
Overview
Help |
FAQ
Tutorial
New/Noteworthy
E-Utilities
PubMed Services
Journals Database
MeSH Database
Single Citation Matcher
Batch Citation Matcher
Clinical Queries
Special Queries
LinkOut
My NCBI
Related Resources
Order Documents
NLM Mobile
NLM Catalog
NLM Gateway
TOXNET
Consumer Health
Clinical Alerts
ClinicalTrials.gov
PubMed Central
|
|
| Display Show |
 |
A common error and other problems when comparing the same concentration of levobupivacaine and another local anesthetic.
Rosenberg PH.
PMID: 16223410 [PubMed - in process]
-
Desflurane anaesthesia increases sister chromatid exchanges in human lymphocytes.
Akin A, Ugur F, Ozkul Y, Esmaoglu A, Gunes I, Ergul H.
Department of Anaesthesiology, Erciyes University School of Medicine, Kayseri, Turkey.
Background: We investigated genotoxic effects of desflurane on the frequency of sister chromatid exchange (SCE) in peripheral blood lymphocytes of patients during and after anaesthesia. Methods: Fifteen female patients, ASA classification I-II, aged 26-54 years, undergoing elective surgery were enroled in this study. Anaesthesia was induced by injection of thiopental 5-7 mg/kg and fentanyl 1 microg/kg. Vecuronium 0.1 mg/kg was given to facilitate tracheal intubation. Anaesthesia was maintained with desflurane 5-6% in an oxygen/air mixture (FiO(2) 0.3). N(2)O was not used for any patient. Using a heparinized syringe, venous blood was collected in patients before anaesthesia. Additional venous blood samples were taken from all patients at 60 and 120 min after the initiation of anaesthesia. Post-operative blood samples were taken and first, third, seventh and twelfth day samples were coded. Results: Number of SCEs per cell at 60 and 120 min were significantly higher than the number of SCEs per cell before anaesthesia. In addition, number of SCEs per cell at 1, 3 and 7th post-operative days were significantly higher than pre-operative levels (P < 0.05). There was no difference between pre-operative number of SCEs per cell and 12th post-operative day levels (P > 0.05). Conclusion: In the present study, because exposure to desflurane increased sister chromatid exchange in human lymphocytes in our group of patients, we conclude that this agent may be capable of producing genetic damage.
PMID: 16223406 [PubMed - in process]
-
The effect of adding intrathecal magnesium sulphate to bupivacaine-fentanyl spinal anaesthesia.
Ozalevli M, Cetin TO, Unlugenc H, Guler T, Isik G.
Department of Anaesthesiology, Faculty of Medicine, Cukurova University, Adana, Turkey.
Background: The addition of intrathecal (IT) magnesium to spinal fentanyl prolongs the duration of spinal analgesia for vaginal delivery. In this prospective, randomized, double-blind, controlled study, we investigated the effect of adding IT magnesium sulphate to bupivacaine-fentanyl spinal anaesthesia. Methods: One hundred and two ASA I or II adult patients undergoing lower extremity surgery were recruited. They were randomly allocated to receive 1.0 ml of preservative-free 0.9% sodium chloride (group S) or 50 mg of magnesium sulphate 5% (1.0 ml) (group M) following 10 mg of bupivacaine 0.5% plus 25 microg of fentanyl intrathecally. We recorded the following: onset and duration of sensory block, the highest level of sensory block, the time to reach the highest dermatomal level of sensory block and to complete motor block recovery and the duration of spinal anaesthesia. Results: Magnesium caused a delay in the onset of both sensory and motor blockade. The highest level of sensory block was significantly lower in group M than in group S at 5, 10 and 15 min (P < 0.001). The median time to reach the highest dermatomal level of sensory block was 17 min in group M and 13 min in group S (P < 0.05). The mean degree of motor block was also lower in group M at 5, 10 and 15 min (P < 0.001). The median duration of spinal anaesthesia was longer in group M (P < 0.001). Conclusion: In patients undergoing lower extremity surgery, the addition of IT magnesium sulphate (50 mg) to spinal anaesthesia induced by bupivacaine and fentanyl significantly delayed the onset of both sensory and motor blockade, but also prolonged the period of anaesthesia without additional side-effects.
PMID: 16223399 [PubMed - in process]
-
A comparison of the vertical infraclavicular and axillary approaches for brachial plexus anaesthesia.
Rettig HC, Gielen MJ, Boersma E, Klein J.
Department of Anaesthesia, Ikazia Hospital, Rotterdam, the Netherlands.
Background: This prospective, randomized study compared the efficacy of the vertical infraclavicular and axillary approaches using a single injection blockade of the brachial plexus. The primary endpoint was complete blockade in dermatomes C5-Th1, while secondary endpoints included onset time, motor block, block performance time, surgical success rate, patient satisfaction, and side-effects/complications. Methods: Sixty patients, American Society of Anesthesiologists physical status I or II, scheduled for surgery of the forearm or hand received either a vertical infraclavicular (n = 30) or an axillary block (n = 30). A single injection of 0.5 ml/kg ropivacaine 7.5 mg/ml was made after electrolocalization of nerve fibres corresponding to the median nerve at maximum 0.5 mA (2 Hz, 0.1 ms). Onset and distribution of analgesia and motor block were assessed at 5, 10, 15, 20, 30 and 60 min after the local anaesthetic injection. A complete block was defined as analgesia in all dermatomes (C5-Th1) at 60 min post-injection. Results: The vertical infraclavicular approach provided complete blockade in 29 patients (97%) and the axillary approach in 23 patients (77%). Analgesia in C5-C6 dermatomes and corresponding motor block occurred significantly more frequently in the vertical infraclavicular approach, which also had the shortest onset time. Block procedure was quicker in the axillary approach. Side-effects were similar in both groups, and there were no permanent sequelae. Patient satisfaction was equally high in both groups. Conclusion: The vertical infraclavicular approach provides a more complete block than the axillary approach when using a single injection technique and equal volumes/doses of local anaesthetic.
PMID: 16223397 [PubMed - in process]
-
Plasma lidocaine levels and risks after liposuction with tumescent anaesthesia.
Nordstrom H, Stange K.
Nordstrom Medical Clinic and Department of Anesthesiology and Intensive Care, Karolinska University Hospital in Solna, Stockholm, Sweden.
Background: It is common today to use tumescent anaesthesia with large doses of lidocaine for liposuction. The purpose of the present study was to evaluate lidocaine plasma levels and objective and subjective symptoms during 20 h after tumescent anaesthesia with approximately 35 mg per kg bodyweight of lidocaine for abdominal liposuction. Methods: Three litres of buffered solution of 0.08% lidocaine with epinephrine was infiltrated subcutaneously over the abdomen in eight female patients during monitored intravenous (i.v.) light sedation. Plasma levels of lidocaine and signs of subjective and objective symptoms were recorded every 3 h for 20 h after liposuction. Results: Lidocaine 33.2 +/- 1.8 mg/kg was given at a rate of 116 +/- 11 ml/min. Peak plasma levels (2.3 +/- 0.63 microg/ml) of lidocaine occurred after 5-17 h. No correlation was found between peak levels and dose per kg bodyweight or total amount of lidocaine infiltrated. One patient experienced tinnitus after 14 h when a plasma level of 3.3 microg/ml was recorded. Conclusion: Doses of lidocaine up to 35 mg/kg were sufficient for abdominal liposuction using the tumescent technique and gave no fluid overload or toxic symptoms in eight patients, but with this dose there is still a risk of subjective symptoms in association with the peak level of lidocaine that may appear after discharge.
PMID: 16223395 [PubMed - in process]
-
Randomized double-blind comparison of ropivacaine-fentanyl and bupivacaine-fentanyl for spinal anaesthesia for urological surgery.
Lee YY, Ngan Kee WD, Muchhal K, Chan CK.
Department of Anaesthesiology and Operating Theatre Services, Kwong Wah Hospital, Kowloon, Hong Kong.
Background: Early studies have suggested that ropivacaine causes less motor block than bupivacaine, which might be advantageous in spinal anaesthesia for short procedures. The aim of this study was to compare plain ropivacaine 10 mg and plain bupivacaine 10 mg, both with fentanyl 15 microg, for spinal anaesthesia in urological surgery. Methods: This was a prospective randomized double-blind study. After written informed consent had been obtained, 34 ASA I-III patients scheduled for urological surgery were randomly assigned to receive intrathecal injection of either plain ropivacaine 10 mg with fentanyl 15 microg (ropivacaine group) or plain bupivacaine 10 mg with fentanyl 15 microg (bupivacaine group) using a combined spinal-epidural technique. Results: All patients achieved sensory block to the T10 dermatome or higher at 15 min after intrathecal injection. One patient in the ropivacaine group was excluded because of unexpectedly prolonged surgery. The primary outcome, the duration of motor block, was shorter in the ropivacaine group (median, 126 min; interquartile range, 93-162 min) compared with the bupivacaine group (median, 189 min; interquartile range, 157-234 min; difference between medians, 71 min; 95% confidence interval, 28-109 min; P = 0.003). The duration of complete motor block was also shorter in the ropivacaine group compared with the bupivacaine group. There was no difference in the onset time of motor block. The characteristics of sensory block and the haemodynamic changes were similar between the groups. Conclusion: Plain ropivacaine 10 mg plus fentanyl 15 microg provided similar sensory anaesthesia, but with a shorter duration of motor block, compared with plain bupivacaine 10 mg plus fentanyl 15 microg when used for spinal anaesthesia in urological surgery.
PMID: 16223393 [PubMed - in process]
-
Local anesthesia for functional endoscopic sinus surgery employing small volumes of epinephrine-containing solutions of lidocaine produces profound hypotension.
Yang JJ, Li WY, Jil Q, Wang ZY, Sun J, Wang QP, Li ZQ, Xu JG.
Jinling Hospital, Medical School of Nanjing University, Nanjing, China.
Background: Local anesthetic containing epinephrine is commonly used in many operations for the main purpose of hemostasis. A randomized, controlled, prospective clinical trial was designed to find out hemodynamic changes after local infiltration of different concentrations and/or different dosages of epinephrine during functional endoscopic sinus surgery (FESS) under general anesthesia. Methods: One hundred and eight adult patients undergoing elective FESS under general anesthesia were randomly allocated into four groups. Group I received 2% lidocaine 2 ml with epinephrine (5 microg/ml); group II received 1% lidocaine 4 ml with epinephrine (2.5 microg/ml); group III received 1% lidocaine 4 ml with epinephrine (5 microg/ml); and group IV received 1% lidocaine 4 ml for local infiltration. Heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP) and mean arterial pressure (MAP) were monitored continuously in the radial artery and recorded in 6 min: before infiltration (baseline), 0.5, 1, 1.5, 2, 2.5, 3, 3.5, 4, 5, and 6 min after local infiltration. The lowest blood pressure (BP) in this period was also recorded. Results: Significant hemodynamic changes, particularly a decrease in BP (P < 0.001) with a slight increase in HR (P < 0.001) at approximately 1.5 min and an increase in SBP at approximately 3 min (P < 0.01) after local infiltration, were observed in group I, group II and group III compared with the baseline, but not in group IV. No significant hemodynamic differences were observed between group I, group II and group III at the same time points (P > 0.05). Conclusion: Local infiltration of low-dose epinephrine causes temporary significant hemodynamic changes particularly a marked decrease in BP during FESS under general anesthesia.
PMID: 16223392 [PubMed - in process]
Delivery of 100% nitrous oxide by Ulco Elite 615 anaesthetic machine.
Walpitagama R.
Publication Types:
PMID: 16235501 [PubMed - in process]
New Zealand anaesthesia trainees and implications for the future workforce.
King SY, McGeorge AD.
Christchurch School of Medicine and Health Sciences, University of Otago, New Zealand.
Attempting to ensure an adequate anaesthesia workforce for New Zealand requires many variables to be taken into consideration. The difficulty lies in trying to predict and match the future needs of the population and the future needs of the workforce itself. This paper examines variables that affect anaesthesia trainees' decisions in regard to future work plans which will affect anaesthesia distribution and manpower in New Zealand, particularly in smaller hospitals. It is already apparent that with distribution problems and/or actual shortages, the gaps in workforce availability for any professional group tend to be in the smaller centres. All New Zealand anaesthesia trainees were sent a questionnaire in 2002, with 110 of 138 trainees responding (79.7%). It appears enough specialists are being trained, with 80% indicating a desire to remain in New Zealand and 13% stating Australia as their choice of destination. The influence of student debt or encouragement of overseas training experience did not appear to be important in their decisions. Having a rotation during training to smaller hospitals had a positive effect on attitudes to working in smaller hospitals as specialists. The recruitment of these future specialists into smaller hospitals also depends upon broader lifestyle choices. Selection of smaller hospitals for anaesthesia practice is encouraged by good financial incentives, adequate professional support, including support by junior doctors, access to ongoing professional development and inclusion into a wider rotation with a larger hospital.
PMID: 16235486 [PubMed - in process]
An audit of morphine versus fentanyl as an adjunct to ropivacaine 0.2% for high thoracic epidural analgesia.
Royse CE, Royse AG, Deelen DA.
Department of Pharmacology, University of Melbourne, the Royal Melbourne Hospital, Melbourne, Victoria.
When used as an adjunct to local anaesthetic, opioid administered via the epidural route can improve the quality of analgesia. Reports of respiratory depression associated with epidural morphine use as a sole agent in the 1980s led to an increased use of lipophilic opioids, especially fentanyl. Although fentanyl is commonly used, controversy exists about its efficacy and site of action. It is possible that low-dose morphine may be more effective than fentanyl, without increasing the risk of respiratory depression. A retrospective audit was conducted of 200 consecutive patients undergoing coronary artery bypass surgery who received high thoracic epidural analgesia. One hundred patients who received fentanyl 2 microg/ml with 0.2% ropivacaine, prior to a change in our technique, were audited, followed by 100 patients who received 20 microg/ml morphine with 0.2% ropivacaine. Outcome measures included the incidence of Visual Analogue Score (VAS) > or =4/10; infusion rate adjustments; and side-effects. Patients receiving fentanyl were more likely to experience pain > or =4/10 (P' = 0.002); the infusion rate was higher (P' = 0.024); required more rate adjustments (P' = 0.001); a greater need for noradrenaline (P' = 0.001) and antiemetic drugs (P' = 0.001). There were no significant differences between the groups for sedation scores or the incidence of respiratory depression. This audit suggests morphine 20 microg/ml may be superior to fentanyl 2 microg/ml, as an adjunct to 0.2% ropivacaine. We found a reduced number of infusion interventions and less inadequate patient analgesia.
PMID: 16235484 [PubMed - in process]
Anaesthesia in a disaster zone: a report on the experience of an Australian medical team in Banda Aceh following the 'Boxing Day Tsunami'.
Paix BR, Capps R, Neumeister G, Semple T.
Department of Anaesthesia, Flinders Medical Centre, Adelaide, South Australia.
We report on the experience of a 23-member Australian medical team in Banda Aceh, Indonesia, following the 2004 Boxing Day tsunami. Arriving 13 days after the tsunami that devastated the city, killed 100,000 of its inhabitants and injured thousands more, we carried out 130 surgical procedures in austere conditions over a 12-day period. Most surgery was peripheral, principally for plastic surgical or orthopaedic procedures to lower limb injuries. Intravenous ketamine anaesthesia was the technique of choice, with good surgical conditions and few significant side-effects.
PMID: 16235482 [PubMed - in process]
The frequency of and indications for general anaesthesia in children in Western Australia 2002-2003.
Sims C, Stanley B, Milnes E.
Department of Anaesthesia, Princess Margaret Hospital for Children and Health Information Centre, Department of Health and Institute for Child Health Research, Perth, Western Australia.
We conducted a retrospective database search of the Hospital Morbidity Data System at the Health Department of Western Australia to determine the number of anaesthetics given to children aged 16 years or less in Western Australia over a twelve-month period. Information was also collected to assess the types of surgery for which anaesthesia was being provided, and the categories of hospital in which children were being anaesthetized. We found that 28,522 anaesthetics were given to 24,981 children, and 2,462 (9.9%) children had more than one anaesthetic. Five and a half percent of the children in Western Australia had an anaesthetic during the twelve months studied. The most common types of surgery were ear nose and throat (28% of anaesthetics), general (21%), dental/oral procedures (17%) and orthopaedic (15%). There was a bimodal distribution in the incidence of anaesthesia versus age, with peaks at 4 years and at 16 years. The most common category of hospital that children were anaesthetized in was private metropolitan (40%) followed by tertiary (38%), rural (14%) and public metropolitan (8%). One thousand, seven hundred and seven children aged less than one year were given an anaesthetic. These anaesthetics were most frequently given to children in tertiary hospitals (62%) followed by private metropolitan (30%), public metropolitan (6%) and rural hospitals (2%).
PMID: 16235481 [PubMed - in process]
Anaesthetic mortality rates in Western Australia 1980-2002.
Gibbs N, Rodoreda P.
Western Australian Anaesthesia Mortality Committee, Western Australian Department of Health, East Perth, Western Australia.
The Western Australian Anaesthetic Mortality Committee has collected data since 1980. During this time, reporting of anaesthesia mortality has been mandatory in Western Australia, confidentiality and legal protection have been ensured, consistent definitions and classifications have been used, and reasonable estimates have been available for the number of surgical procedures performed. The data indicate that there was a decrease in anaesthesia-related mortality in the mid 1980s. Since then the rates have been relatively stable, in relation to both population and number of surgical procedures performed. At present, the rates are extremely low (< 1:50, 000 surgical procedures per annum), and similar to rates reported from other Australian states. While these figures are encouraging, their main function is to serve as the baseline for further improvements.
PMID: 16235480 [PubMed - in process]
Cost-effectiveness of basal flow sevoflurane anaesthesia using the Komesaroff vaporizer inside the circle system.
Nandalan SP, Eltringham RJ, Fan QW.
Department of Anaesthesia, Gloucestershire Royal Hospital, Gloucester, UK.
After ethics committee approval, 51 consenting ASA physical status 1 or 2 adult patients were given basal flow sevoflurane anaesthesia using fresh gas flows of 150 to 300 ml x min(-1) oxygen. A Komesaroff vaporizer was placed on the inspiratory limb of the circle system. Basal flows were introduced immediately following intravenous induction of anaesthesia. The vaporizer was set to deliver the maximum concentration until the inspired sevoflurane concentration (FSI) reached 3%. The dial was then adjusted to maintain the FSI at 3%. After every 60 minutes, the circuit was washed out with 100% oxygen at a flow rate of 10 l x min(-1) for one minute. The FSI reached 3% after an average of 8.5 (3.8) [mean (SD)] minutes. The trends in FSI and the expired sevoflurane concentrations were significantly different (P<0.05) between the mechanically ventilated patients (n=21) and the spontaneously ventilating patients (n =30) and demonstrated a more gradual build-up in the former group. The consumption of sevoflurane was found to be 9.2 (2.8) ml x h(-1). This represented a 52.5% cost saving over the clinical application of the Mapleson's ideal fresh gas flow sequence for low-flow anaesthesia.
PMID: 16235479 [PubMed - in process]
Relationship between journal impact factor and levels of evidence in anaesthesia.
Bain CR, Myles PS.
Department of Anaesthesia and Pain Management, Alfred Hospital, and Preventative Medicine, Monash University, Melbourne, Victoria.
Evidence-based medicine uses a hierarchy of publication types according to their vulnerability to bias. A widely used measure of journal "quality" is its impact factor, which describes the citation rate of its publications. We investigated the relationship between impact factor for eight anaesthesia journals and publication type with respect to their level of evidence 1-4 using Spearman rank correlation (rho). There were 1418 original publications during 2001 included in the analysis. The number (%) of publication types according to evidence-based medicine level were: level 1:6 (0.4%), level 2:533 (38%) level 3:329 (23%), level 4:550 (39%). There was no correlation between journal ranking according to impact factor and publication type (rho =-0.03, P=0.25). The correlation between journal rank and the proportion of publications that were randomized trials was -0.35 (P<0.001). The correlation between journal rank and number of publications was 0.65 (P<0.001). The correlation between journal rank and number of level 1 or 2 studies was 0.58 (P<0.001). The overall level of evidence published in anaesthesia journals was high. Journal rank according to impact factor is related to the number of publications, but not the proportion of publications that are evidence-based medicine level 1 or 2.
PMID: 16235472 [PubMed - in process]
Vivian Richard Ebsary, A.M. biomedical engineer, inventor, philanthropist.
O'Brien HD.
Department of Anaesthesia and Intensive Care, Prince of Wales Hospital, Sydney, NSW.
Vivian Ebsary was an inventor, designer and manufacturer of varied pieces of medical equipment, particularly those involving pumps. These included hypothermia machines and the heart-lung cardiopulmonary bypass machines used in Australian and New Zealand hospitals from the mid 1950s until well into the 1970s. Ebsary also designed and manufactured anaesthetic machines, a hyperbaric unit, scoliosis implant equipment, a chairlift and many other devices for use in the general community. This paper presents an overview of his life's involvement with medicine and medical technology in Australia.
Publication Types:
Personal Name as Subject:
PMID: 16018235 [PubMed - indexed for MEDLINE]
The C.O.N. apparatus.
Houghton IT.
Sir John Cass Department of Art, Media and Design, London Metropolitan University.
The C.O.N. apparatus developed in the late 1950s utilised a non-explosive mixture of cyclopropane, nitrogen and oxygen. Its development is described.
Publication Types:
PMID: 16018234 [PubMed - indexed for MEDLINE]
-
Interpleural anaesthesia for mastectomy.
Higgins PC, Ravalia A.
PMID: 16229706 [PubMed - in process]
-
Spina bifida, tethered cord and regional anaesthesia.
Ali L, Stocks GM.
PMID: 16229704 [PubMed - in process]
-
Caesarean section following the Fontan procedure: two different deliveries and different anaesthetic choices in the same patient.
Eid L, Ginosar Y, Elchalal U, Pollak A, Weiniger CF.
Resident, Department of Anaesthesiology and Critical Care, Hadassah Hebrew University Medical Center, POB 12000, Jerusalem, Israel.
Summary The Fontan procedure is performed for patients with a hypoplastic right ventricle, and pregnancies following this palliative surgery are likely to increase. We present a parturient with the Fontan physiology who successfully underwent two consecutive caesarean deliveries; the first under general anaesthesia for emergency surgery and the second under regional anaesthesia for elective surgery. We suggest that pregnancy and delivery do not typically adversely affect maternal cardiac status in these patients. Attention must be paid, however, to fetal loss, prematurity, growth retardation and associated cardiac congenital malformations for which insufficient data exist in the literature in this patient population.
PMID: 16229700 [PubMed - in process]
-
The nuclear power industry as an alternative analogy for safety in anaesthesia and a novel approach for the conceptualisation of safety goals.
Webster CS.
Research Fellow, The Compucology Project, PO Box 25-380, Christchurch, New Zealand and Department of Anaesthesiology, School of Medicine, University of Auckland, Auckland, New Zealand.
Summary Safety practices in health care have not kept pace with the increasing complexity of medical technology. Although anaesthesia is generally considered to be a leader in the improvement of patient safety, more powerful safety strategies must be found and employed. From an analysis of system characteristics, the nuclear power industry is proposed as an alternative analogy for safety in anaesthesia, and a novel diagrammatic approach is developed for the conceptualisation of safety goals. The nuclear power industry has spent vastly more time and money than has health care on the development of safety, and has progressed through significant safety milestones approximately three times more quickly than has anaesthesia. The greatest scope for the improvement of safety in anaesthesia lies in the appropriate re-design of medical systems and the lowering of the threshold for the reporting of incidents to include accident precursors, thus allowing the identification of dangerous systems before accidents occur.
PMID: 16229697 [PubMed - in process]
-
Anaesthetic management of placenta accreta: use of a pre-operative high and low suspicion classification*.
Weiniger CF, Elram T, Ginosar Y, Mankuta D, Weissman C, Ezra Y.
Instructor, Department of Anaesthesia and Critical Care Medicine, Hadassah Hebrew University Medical Centre, Jerusalem, Israel, POB 12000.
Summary Placenta accreta may be suspected prior to surgery, but the actual diagnosis is only confirmed at surgery. This prospective and observational study was performed to assess whether preparations should be made for potential massive blood loss prior to Caesarean surgery in all patients with suspected placenta accreta. Patients were classified as high or low suspicion for placenta accreta based on ultrasonography and clinical factors. Among 28 suspected cases of placenta accreta, diagnosis was confirmed at surgery in 50% (12/17 high and 2/11 low suspicion) cases. Hysterectomy was only performed in the 12 high suspicion patients with placenta accreta (p < 0.001). High suspicion patients required more blood transfusions: mean(SD) 6.5 (7.0) units vs 1.09 (1.1) units, p = 0.017. Anaesthetists should be prepared for major haemorrhage in all cases of suspected placenta accreta, although use of a system to grade level of suspicion may identify those at greater risk.
PMID: 16229692 [PubMed - in process]
-
The effects of ambient music on simulated anaesthesia monitoring.
Sanderson PM, Tosh N, Philp S, Rudie J, Watson MO, Russell WJ.
Professor of Cognitive Engineering and Human Factors, ARC Key Centre for Human Factors and Applied Cognitive Psychology, The University of Queensland, St Lucia, Australia.
Summary We examined the effect of no music, classical music or rock music on simulated patient monitoring. Twenty-four non-anaesthetist participants with high or low levels of musical training were trained to monitor visual and auditory displays of patients' vital signs. In nine anaesthesia test scenarios, participants were asked every 50-70 s whether one of five vital signs was abnormal and the trend of its direction. Abnormality judgements were unaffected by music or musical training. Trend judgements were more accurate when music was playing (p = 0.0004). Musical participants reported trends more accurately (p = 0.004), and non-musical participants tended to benefit more from music than did the musical participants (p = 0.063). Music may provide a pitch and rhythm standard from which participants can judge changes in vital signs from auditory displays. Nonetheless, both groups reported that it was easier to monitor the patient with no music (p = 0.0001), and easier to rely upon the auditory displays with no music (p = 0.014).
PMID: 16229691 [PubMed - in process]
-
Anaesthetic practitioners in the UK: promise, perils and psychology.
Smith AF.
PMID: 16229687 [PubMed - in process]
-
Detachment of swivel connector from breathing circuit.
Tunstill SA, Stoneham J.
Publication Types:
PMID: 16179066 [PubMed - indexed for MEDLINE]
Comment on:
The need for epidural wings.
Russell R.
Publication Types:
PMID: 16179063 [PubMed - indexed for MEDLINE]
-
Failure of a SafeBite bite protector.
Thomas SP, Bamigbade TA.
Publication Types:
PMID: 16179061 [PubMed - indexed for MEDLINE]
-
A novel adjunct to awake carotid endarterectomy.
Townley SA, Ashton W.
Publication Types:
PMID: 16179059 [PubMed - indexed for MEDLINE]
-
Giant cavernous haemangioma of the tongue.
Tasker LJ, Geoghegan J.
Publication Types:
PMID: 16179055 [PubMed - indexed for MEDLINE]
-
Use of remifentanil for tracheal intubation for caesarean section in a patient with suxamethonium apnoea.
Alexander R, Fardell S.
Department of Anaesthetics, Worcestershire Royal Hospital, Charles Hastings Way, Worcester WR5 1DD, UK.
A parturient presented for elective caesarean section with a history of multiple spinal operations and scoliosis and a biochemical diagnosis of suxamethonium apnoea. She declined any attempt at regional anaesthesia. We describe the use of a thiopental/remifentanil technique to relax the larynx and provide rapid and excellent conditions for laryngoscopy and tracheal intubation. The parturient awoke following an uneventful caesarean section with excellent pain relief and no recall. The baby had normal Apgar scores and umbilical blood gas measurements.
Publication Types:
PMID: 16179051 [PubMed - indexed for MEDLINE]
-
Airway management before, during and after extubation: a survey of practice in the United Kingdom and Ireland.
Rassam S, Sandbythomas M, Vaughan RS, Hall JE.
Specialist Registrar, Anaesthetic Department, University Hospital of Wales, Heath Park, Cardiff CF14 4XW, UK.
Summary Complications at extubation remain an important risk factor in anaesthesia. A postal survey was conducted on extubation practice amongst consultant anaesthetists in the United Kingdom and Ireland. The use of short acting drugs encourages anaesthetists to extubate the trachea at lighter levels of anaesthesia. The results show that oxygen (100%) is not routinely administered either before extubation or en route to the recovery area. A trend towards a head up or sitting position at extubation is emerging. However, further research into the use of these positions is required. Airway related complications at extubation are relatively frequent but are usually dealt with by simple basic measures. The role of drugs such as propofol in decreasing the incidence of these complications needs further evaluation. Some of these results give concern for patient safety and for training. The importance of teaching and adherence to continued oxygenation until complete recovery is strongly emphasised. Nerve stimulators should be used continually as standard monitoring throughout the anaesthetic period when muscle-relaxing drugs are part of the anaesthetic technique.
Publication Types:
PMID: 16179045 [PubMed - indexed for MEDLINE]
-
Evaluation of femoral nerve blockade following inguinal paravascular block of Winnie: are there still lessons to be learnt?
Jochum D, O'Neill T, Jabbour H, Diarra PD, Cuignet-Pourel E, Bouaziz H.
Department of Anaesthesiology and Intensive Care Medicine, Private Hospital Group of Center Alsace, Colmar, France.
Lower limb peripheral nerve blocks are used to provide surgical anaesthesia or postoperative analgesia. Anatomical texts imply that femoral and saphenous nerve blocks be evaluated by sensory testing of the skin overlying the anterior aspect of the thigh, and the medial aspect of the foot, respectively. We have mapped the distribution of anaesthesia in 25 adults following femoral nerve blockade, performed using the inguinal paravascular technique of Winnie. There was substantial interindividual variation in the area of anaesthesia. Only the skin overlying the middle third of the medial thigh was consistently blocked in 100% of patients. The distribution of anaesthesia conformed to anatomical text descriptions in 24% of cases. We conclude that demonstration of complete quadriceps paralysis confirms femoral nerve blockade. Failing that, sensory evaluation of a femoral nerve block should involve testing the skin of the middle third of the medial aspect of the thigh. The skin overlying the anteromedial aspect of the middle third of the leg should be evaluated for saphenous nerve block.
Publication Types:
PMID: 16179041 [PubMed - indexed for MEDLINE]
Comment on:
Can't blame ropivacaine.
Zeidan A.
Publication Types:
PMID: 16192564 [PubMed - indexed for MEDLINE]
Comment on:
Difficult intubation in thoracopagus twins in MRI suite.
Szmuk P, Ghelber O, Ezri T.
Publication Types:
PMID: 16192563 [PubMed - indexed for MEDLINE]
-
Chronic intrapleural effusion drainage using an epidural catheter.
Jankovic Z, Stamenkovic D, Abdel-Hadi W.
Publication Types:
PMID: 16192559 [PubMed - indexed for MEDLINE]
Comment on:
Epidural chloroprocaine-standard of care for postpartum bilateral tubal ligation.
Balestrieri PJ.
Publication Types:
PMID: 16192557 [PubMed - indexed for MEDLINE]
Comment on:
Observational studies identify associations, not causality.
Berry AJ.
Publication Types:
PMID: 16192554 [PubMed - indexed for MEDLINE]
Comment on:
Editorial Board reproached for publication of BIS-mortality correlation.
Drummond JC, Patel PM.
Publication Types:
PMID: 16192553 [PubMed - indexed for MEDLINE]
-
Can direct spinal cord injury occur without paresthesia? A report of delayed spinal cord injury after epidural placement in an awake patient.
Tsui BC, Armstrong K.
Department of Anesthesiology and Pain Medicine University of Alberta, 8-120 Clinical Sciences Building, Edmonton, Alberta, Canada T6G 2G3. btsui@ualberta.ca
We discuss the etiology of a delayed spinal cord injury after epidural anesthesia without paresthesia. The description of such a case in an awake, adult patient who underwent a Whipple resection is provided. An epidural was performed at approximately the T8-9 interspace with the patient in the sitting position after 1 mg of midazolam was administered. On the first attempt, a dural puncture occurred. The patient did not report any paresthesia or pain. The needle was withdrawn and a second attempt was made one interspace lower. At this level, the epidural catheter was advanced into the epidural space uneventfully. Postoperatively, the patient suffered decreased motor function in the right leg. Magnetic resonance imaging revealed high signal intensity within the spinal cord, indicating cord edema compatible with direct needle trauma. An extradural fluid collection consistent with a hematoma was also noted. Although it may be impossible to confirm if the spinal cord injury was a result of direct needle trauma, hematoma, or a combination of needle trauma and hematoma, these events clearly raise the important question of whether an awake patient will always report paresthesia secondary to spinal cord trauma. IMPLICATIONS: This case reminds anesthesiologists that we should not simply assume paresthesia will always occur and be reported if a needle encroaches on the spinal cord even in an awake patient.
Publication Types:
PMID: 16192547 [PubMed - indexed for MEDLINE]
-
The anticatabolic effect of neuraxial blockade after hip surgery.
Lattermann R, Belohlavek G, Wittmann S, Fuchtmeier B, Gruber M.
Department of Anesthesia, University of Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany. ralph.lattermann@klinik.uni-regensburg.de
Although the protein-sparing effect of neuraxial blockade after abdominal surgery is well established, its metabolic effect after operations on the lower extremities remains unclear. In this study, we tested the hypothesis that combined spinal and epidural blockade (CSE) inhibits amino acid oxidation after hip surgery. Sixteen patients undergoing hip replacement surgery received either general anesthesia followed by IV patient-controlled analgesia with piritramide (control; n = 8) or CSE using bupivacaine 0.5% for spinal anesthesia and ropivacaine 0.2% with 0.5 microg/mL of sufentanil for postoperative epidural analgesia (CSE; n = 8). Glucose and protein kinetics were assessed by stable isotope tracer technique ([6,6-2H2]glucose, L-[1-13C]leucine) on the day before and one day after surgery. Plasma concentrations of glucose, lactate, free fatty acids, cortisol, glucagon, and insulin were also determined. CSE prevented the increase in plasma glucose concentration during and immediately after the operation (60 min after skin incision: CSE 4.9 +/- 0.7 versus control 6.2 +/- 0.7 mmol/L; P < 0.05; postanesthesia care unit: CSE 5.0 +/- 0.9 versus control 7.3 +/- 1.1 mmol/L; P < 0.05). Intraoperative cortisol plasma concentrations were smaller in the CSE group than in the control group. One day after the operation, however, glucose plasma concentration, glucose production, and glucose clearance were comparable in both groups. CSE inhibited the postoperative increase in leucine oxidation rate (CSE 30 +/- 12 versus control 43 +/- 8 micromol.kg(-1).h(-1); P < 0.05). There were no differences between the groups in protein breakdown, whole body protein synthesis, and plasma concentrations of lactate, free fatty acids, insulin, and glucagon. In conclusion, CSE prevents hyperglycemia during hip surgery and inhibits protein catabolism thereafter. IMPLICATIONS: We studied the effect of combined spinal/epidural blockade (CSE) on protein and glucose metabolism during and after hip surgery. In comparison to general anesthesia followed by intravenous patient-controlled analgesia, CSE inhibits the increase in glucose plasma concentration during surgery and prevents protein loss on the first postoperative day.
Publication Types:
PMID: 16192545 [PubMed - indexed for MEDLINE]
-
Using stimulating catheters for continuous sciatic nerve block shortens onset time of surgical block and minimizes postoperative consumption of pain medication after halux valgus repair as compared with conventional nonstimulating catheters.
Casati A, Fanelli G, Koscielniak-Nielsen Z, Cappelleri G, Aldegheri G, Danelli G, Fuzier R, Singelyn F.
Department of Anesthesiology and Pain Therapy, Azienda Ospedaliera di Parma, Via Gramsci 14-43100 Parma, Italy. acasati@ao.pr.it
We prospectively tested the hypothesis that the use of a stimulating catheter improves the efficacy of continuous posterior popliteal sciatic nerve block in 100 randomized patients scheduled for elective orthopedic foot surgery. After eliciting a sciatic mediated muscular twitch at < or = 0.5 mA nerve stimulation output, the perineural catheter was advanced 2-4 cm beyond the tip of the introducer either blindly (Group C; n = 50) or stimulating via the catheter (Group S; n = 50). A bolus dose of 25 mL of 1.5% mepivacaine was followed by a postoperative patient-controlled infusion of 0.2% ropivacaine (basal infusion: 3 mL/h; incremental dose: 5 mL; lockout time: 30 min). Propacetamol 2 g IV was administered every 8 h, and opioid rescue analgesia was available if required. Catheter placement required 7 +/- 2 min in Group S and 5 +/- 2 min in Group C (P = 0.056). A significantly shorter onset time of both sensory and motor blocks was noted in Group S. No difference in quality of pain relief at rest and during motion was reported between the groups. Median (range) local anesthetic consumption during the first 48 h after surgery was 239 mL (175-519 mL) and 322 mL (184-508 mL) in Groups S and C, respectively (P = 0.002). Rescue opioid analgesia was required by 12 (25%) and 28 (58%) patients in Groups S and C, respectively (P = 0.002). We conclude that the use of a stimulating catheter results in shorter onset time of posterior popliteal sciatic nerve block, similar pain relief with reduced postoperative consumption of local anesthetic solution, and less rescue opioid consumption. IMPLICATIONS: This prospective, randomized, blind investigation demonstrated that the use of a stimulating catheter for continuous posterior popliteal sciatic nerve block resulted in shorter onset time of sensory and motor blocks and less local anesthetic consumption and need for rescue pain medication after elective orthopedic foot surgery compared with blind catheter advancement.
Publication Types:
PMID: 16192543 [PubMed - indexed for MEDLINE]
-
Does the site of injection distal to the greater trochanter make a difference in lateral sciatic nerve blockade?
Taboada M, Rodriguez J, Del Rio S, Lagunilla J, Carceller J, Alvarez J, Atanassoff PG.
Department of Anesthesiology, Hospital Clinico Universitario de Santiago, Travesia da Choupana s/n, 15706 Santiago de Compostela, Spain. manutabo@mixmail.com
The two components of the sciatic nerve become more distant from one another in their course down the lower limb. This may have clinical implications if a small volume of local anesthetic is used with a single injection technique. In this prospective, randomized, double-blind study, we compared two different injection sites, 20 cm and 30 cm distal to the greater trochanter, in terms of onset time and success rate of sciatic nerve blockade after a single injection of 20 mL of 1.5% mepivacaine. Fifty patients undergoing foot surgery were randomly allocated to receive a lateral sciatic nerve blockade using one of 2 levels: 20 cm distal to the greater trochanter (group proximal; n = 25) and 30 cm distal to the greater trochanter (group distal; n = 25). Twenty milliliters of 1.5% mepivacaine was injected after a flexion plantar response was obtained at <0.5 mA. Time required for onset of sensory and motor blockade of the foot was recorded. Success rate was defined as complete sensory and motor blockade in all sciatic nerve distributions associated with a pain-free surgery. Onset of complete sensory and motor blockade was faster in group proximal (12 +/- 7 min and 15 +/- 8 min, respectively) compared with group distal (19 +/- 9 min and 23 +/- 9 min; P < 0.05). Group proximal also had a more frequent success rate compared with group distal (88% versus 56%, respectively; P < 0.05). It is concluded that in lateral sciatic nerve blockade, a more proximal approach to the sciatic nerve predicts a shorter onset time and more frequent success than a more distal injection site when a single injection and a small volume of local anesthetic is used. IMPLICATIONS: In lateral sciatic nerve blockade, a more proximal approach to the sciatic nerve provides shorter onset times and more frequent success than a more distal injection site when a single injection of 20 mL of mepivacaine 1.5% is used.
Publication Types:
PMID: 16192542 [PubMed - indexed for MEDLINE]
[Abstracts of the 47th National Congress of Anesthesia and Resuscitation, Paris, France, 21-24 September 2005]
[Article in French]
[No authors listed]
Publication Types:
PMID: 16231416 [PubMed - indexed for MEDLINE]
[Spinal anaesthesia for Caesarean section: dose injection speed have an effect on the incidence of hypotension?]
[Article in French]
Bouchnak M, Belhadj N, Chaaoua T, Azaiez W, Hamdi M, Maghrebi H.
Service d'anesthesie-reanimation, centre de maternite et de neonatologie de Tunis, rue Jabel-Lakhdar, 1007 La Rabta, Tunis, Tunisie.
Objective. - To study effect of injection rate on spinal blockade and haemodynamic of spinal bupivacaine for Caesarean section. Study design. - Prospective and randomized. Patients and methods. - Sixty ASA I-II patients scheduled for elective Caesarean section were randomized to receive either fast (20 seconds, group R, n=30) or slow (60 seconds, group L, n=30) spinal injection of 10 mg of hyperbaric bupivacaine 0.5% associated with 25 mug of fentanyl and 100 mug of morphine. Sensory and motor blockade and haemodynamic parameters were recorded. Results. - Profiles of sensory and motor block were similar in both groups. Variations of arterial blood pressure and total dose of ephedrine were not different between R and L groups. However, the number of patient with systolic blood pressure lower than 100 mmHg were significantly lower in L group than in R group (p=0.04). Incidences of adverse effects were similar in both groups. Conclusion. - Result of the present study suggests that a slow rate of injection would induce lower incidence of hypotension induced by spinal bupivacaine for Caesarean section.
PMID: 16226864 [PubMed - as supplied by publisher]
-
Anesthesie d'un enfant atteint d'un DRESS syndrome pour realisation d'une IRM.
Colomb S, Gonzalez D, Dissait F.
Federation d'anesthesie-reanimation-Samu, CHU de Clermont-Ferrand, BP 69, 58, rue Montalembert, 63003 Clermont-Ferrand cedex 01, France.
Publication Types:
PMID: 16226863 [PubMed - as supplied by publisher]
-
[Inadvertent globe perforation during peribulbar anaesthesia and sedation with propofol.]
[Article in French]
Schaack E, Diallo B, Devys JM.
Departement d'anesthesie-reanimation chirurgicale, fondation ophtalmologique Adolphe-de-Rothschild, 25-29, rue Manin, 75019 Paris, France.
Sedation has been used widely for reducing patient anxiety during peribulbar block for ocular surgery. We report the case of a patient in whom a spontaneous move after injection of propofol for peribulbar block resulted in a globe perforation.
PMID: 16226425 [PubMed - as supplied by publisher]
-
[Local anaesthetics for peripheral nerve blocks.]
[Article in French]
Mazoit JX.
Departement d'anesthesie, hopital de Bicetre et laboratoire d'anesthesie UPRES EA3540, faculte de medecine de Bicetre, universite Paris-Sud, 94276 Le Kremlin-Bicetre cedex, France.
PMID: 16226006 [PubMed - as supplied by publisher]
-
[Peripheral regional anesthesia: perioperative cares and monitoring.]
[Article in French]
Beloeil H, Gibert S, Macaire P, Zetlaoui PJ.
Departement d'anesthesie-reanimation, hopital de Bicetre, 48, rue du General-Leclerc, 94270 Le-Kremlin-Bicetre cedex, France.
PMID: 16226005 [PubMed - as supplied by publisher]
-
[Regional anesthesia: which learning?]
[Article in French]
Ripart J; Comite Douleur-ALR de la Sfar.
Departement d'anesthesie-douleur, CHU de Nimes, 5, rue Hoche, 30029 Nimes cedex 09, France.
PMID: 16226004 [PubMed - as supplied by publisher]
Coexisting harlequin and Horner syndromes after high thoracic paravertebral anaesthesia.
Burlacu CL, Buggy DJ.
Department of Anaesthesia, Intensive Care and Pain Medicine, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland.
A patient undergoing left mastectomy and immediate latissimus dorsi breast reconstruction under combined paravertebral block and general anaesthesia developed transient, well-demarcated, right-sided hemifacial erythema and sweating, and left-sided Horner syndrome postoperatively. This 'harlequin' appearance occurs because of a normal or excessive vasodilatory, thermoregulatory response to heat or emotion mediated by an intact sympathetic pathway on the erythematous side, together with relative pallor of the pharmacologically blocked side.
PMID: 16227336 [PubMed - as supplied by publisher]
-
Analgesic and antacid properties of i.m. tramadol given before Caesarean section under general anaesthesia.
Elhakim M, Abd El-Megid W, Metry A, El-Hennawy A, El-Queseny K.
Department of Anaesthesia, Faculty of Medicine, Ain-Sham University, Cairo, Egypt.
BACKGROUND: Intramuscular (i.m.) tramadol increases gastric pH during anaesthesia similar to famotidine. We investigated the antacid analgesic value of a single dose of i.m. tramadol given 1 h before elective Caesarean section performed under general anaesthesia. METHODS: Sixty ASA I parturients undergoing elective Caesarean section were included in a randomized double-blind study. The patients were randomly allocated to receive i.m. tramadol 100 mg (n=30) or famotidine 20 mg (n=30) 1 h before general anaesthesia. RESULTS: At the beginning and the end of anaesthesia, patients receiving tramadol had a median gastric fluid pH of 6.4, which was not significantly different from those treated with famotidine (median 6.3). The infant well-being, as judged by Apgar score, cord blood gas analysis, and neurobehavioural assessment showed no significant difference between the two groups. Nalbuphine consumption in the first 24 h after operation was reduced by 35% in the tramadol group. Pain intensity score on sitting and sedation were significantly greater in famotidine group up to 24 h after surgery. There was no significant difference in incidence and severity of nausea and vomiting between the two groups. CONCLUSION: A single i.m. dose of tramadol is useful pre-treatment to minimize the risk of acid aspiration during operation, and in improving pain relief during 24 h after surgery.
PMID: 16227335 [PubMed - as supplied by publisher]
Effects of systemically applied clonidine on intestinal perfusion and oxygenation in healthy pigs during general anaesthesia and laparotomy.
Vagts DA, Iber T, Roesner JP, Mutz C, Kurzweg V, Harkner C, Bruderlein K, Noldge-Schomburg GF.
Universitat Rostock, Klinik und Poliklinik fur Anasthesiologie und Intensivtherapie, Rostock, Germany.
SummaryBackground and objective: Clonidine, which is used for induction of sympatholysis and prevention or treatment of alcohol withdrawal in anaesthesia and intensive care medicine, may have deleterious effects on intestinal mucosal perfusion. This study was designed to investigate the effects of clonidine on intestinal perfusion and oxygenation. Methods: Following ethical approval 17 anaesthetized, and acutely instrumented pigs were randomly assigned to two groups: eight animals received intravenous clonidine (2 mug kg-1 bolus and 2 mug kg-1 h-1), nine animals served as a control group. Measurement points for systemic and regional haemodynamic and oxygenation parameters were 135 and 315 min after starting the clonidine application. Results: Clonidine elicited systemic haemodynamic changes (median [25-75th interquartile range]): heart rate (106 [91, 126] to 84 [71, 90] beats min-1) cardiac output (147 [123, 193] to 90 [87, 107] mL min-1 kg-1) and mean arterial pressure (77 [72, 93] to 69 [61, 78] mmHg) decreased. Despite systemic haemodynamic changes, the superior mesenteric artery blood flow did not change in the clonidine group. The vascular resistance of the superior mesenteric artery decreased. The small intestinal oxygen supply, the mucosal and the serosal tissue oxygen partial pressure did not change. Conclusions: Systemic sympatholysis induced by intravenously applied clonidine in addition to basic intravenous anaesthesia elicited a decrease in cardiac output and mean arterial pressure. However, regional macrohaemodynamic perfusion was maintained and intestinal oxygenation did not change. Clonidine does not impair intestinal mucosal and serosal oxygenation under physiological conditions.
PMID: 16225726 [PubMed - in process]
Patients' self-evaluation after 4-12 weeks following xenon or propofol anaesthesia: a comparison.
Coburn M, Kunitz O, Baumert JH, Hecker K, Rossaint R.
University Hospital of the RWTH Aachen, Department of Anaesthesiology, Aachen, Germany.
SummaryBackground and objective: The aim of this study was to assess postoperative patients' self-evaluation after xenon anaesthesia compared to total intravenous anaesthesia with propofol. Methods: 160 patients aged 18-60 yr, ASA I-II undergoing elective surgery took part in this randomised-controlled trial. After approval by the local Ethics Committee and as soon as the patients had given their written informed consent, they were randomly allocated to either the xenon (n = 80) or propofol (n = 80) group. In both groups remifentanil was used as opioid. The postoperative patients' self-evaluation was assessed with a double-blind telephone poll. Early spatial orientation, patients' self-evaluation of anaesthesia, choice of the same anaesthesia for future operations and recall of uncomfortable feelings after anaesthesia were determined. Results: 116 Patients were analysed, 63 in the xenon and 53 in the propofol group. The two study groups were comparable with respect to age, weight, height, gender and ASA classification. The two groups indicated similar values in the early spatial orientation at the onset of recovery and thereafter. Patients' self-evaluation of anaesthesia with main emphasis at high marks and repetition of the same anaesthesia if necessary were similar in both groups. Recalls of uncomfortable feelings were comparable but not for postoperative pain and appetite/thirst which appeared with a significantly higher incidence in the xenon group. Conclusions: Patients' self-evaluation and memory of early spatial orientation following xenon anaesthesia are comparable to propofol.
PMID: 16225724 [PubMed - in process]
Prostate anaesthetic block with ropivacaine for urologic surgery.
Niccolai P, Carles M, Lagha K, Raucoules-Aime M.
Princesse Grace Hospital, Department of Anaesthesiology, Monte Carlo, Princedom of Monaco, France.
SummaryBackground and objective: The aim of this study was to evaluate prostate anaesthetic block for haemodynamic tolerance and quality of analgesia during and after transurethral surgery. Methods: Ninety adult males, ASA III/IV, were randomly assigned to receive a prostate anaesthetic block (n = 45) or spinal anaesthesia (n = 45). The main outcome measurement during anaesthesia, surgery and recovery was haemodynamic tolerance (number of hypotensive episodes, heart rate, systolic and mean blood pressures). Other outcome variables were pain scores during anaesthesia, surgery and every 4 h until 24 h after the end of surgery and amount of oral morphine required during the 24-h postoperative period. Results: Sixty-six patients were ASA III and 24 ASA IV. Ongoing cardiovascular therapies were comparable between groups. All surgical procedures were performed under good conditions. For patients receiving prostate anaesthetic block, the blood pressure and heart rate did not change significantly during the study period. For patients receiving spinal anaesthesia, the hypotension rate was 55.6% (n = 25) compared to 0 in the prostate anaesthetic block group (P < 0.001); 25 and 4 patients, respectively, required vascular filling and additional ephedrine administration. In both groups, all pain scores were <40 (100 mm visual analogue scale) during the study period. Oral morphine was given during the postoperative period to two prostate anaesthetic block patients and four who had received spinal anaesthesia (not significant). Conclusion: Transurethral surgery under prostate anaesthetic block is safe and assures adequate analgesia during and after surgery.
PMID: 16225723 [PubMed - in process]
Comparison of the anaesthetic requirement with target-controlled infusion of propofol to insert the laryngeal tube vs. the laryngeal mask.
Richebe P, Rivalan B, Baudouin L, Sesay M, Sztark F, Cros AM, Maurette P.
Centre Hospitalier et Universitaire de Bordeaux, Departement d'Anesthesie et Reanimation III, Bordeaux Cedex, France.
SummaryBackground and objective: The target effect-site concentration of propofol to insert a laryngeal mask airway was recently reported as almost 5 mug mL-1. The present study aimed to determine the target effect-site concentration with target-controlled infusion of propofol to place classical larnygeal mask airway or current laryngeal tube in adult patients. Methods: We included 40 patients scheduled for short gynaecological and radiological procedures under general anaesthesia in a randomized, double-blind manner using the Dixon's up-and-down statistical method. Monitoring included standard cardiorespiratory monitors, and bispectral index monitoring was used for all patients. Anaesthesia was conducted with a target-controlled infusion system: Diprifusortrade mark. The initial target plasma concentration of propofol was 5 mug mL-1, and was changed stepwise by 0.5 mug mL-1 increments according to Dixon's up-and-down method. Criteria for acceptable insertion were: Muzi's score </=2, and mean arterial blood pressure, heart rate or bispectral index variation <20% the baseline values.Results: Target effect-site concentration of propofol required to insert laryngeal tube was 6.3 +/- 0.3 mug mL-1 with Dixon method and ED50 was 6.1 mug mL-1 (5.9-6.4) with logistic regression method. In the case of larnygeal mask airway they were 7.3 +/- 0.2 mug mL-1 (Dixon method) and 7.3 mug mL-1 (7.1-7.5; with logistic regression) respectively (P < 0.05). ED95 (logistic regression) was 6.8 mug mL-1 (5.9-7.6) for laryngeal tube and 7.7 mug mL-1 (7.3-8.0) for larnygeal mask airway (P < 0.05). Haemodynamic incidents were 55% in the larnygeal mask airway group vs. 30% in the laryngeal tube group (P < 0.05). Conclusions: The target effect-site concentration of propofol for insertion of laryngeal tube was lower than for larnygeal mask airway (P < 0.05), with a consequent reduction of the propofol induced haemodynamic side-effects.
PMID: 16225722 [PubMed - in process]
Reminiscences of the Department of Anesthesia at the Massachusetts General Hospital: A History: R. J. Kitz (ed.). Published privately, 459 pp; indexed, illustrated ISBN: 0-9715376-0-7; Price US$60.00.
Green DW.
London, UK.
PMID: 16223450 [PubMed - in process]
-
Abstracts of the Association of Paediatric Anaesthetists of Great Britain and Ireland, March 2005, Norwich.
[No authors listed]
PMID: 16238578 [PubMed - as supplied by publisher]
-
Anesthesia in Friedreich's ataxia.
Schmitt HJ, Munster T, Heuss D.
PMID: 16238573 [PubMed - in process]
-
Anesthesia for the child with Andersen's Syndrome.
Young DA.
PMID: 16238570 [PubMed - in process]
-
Anesthesia in a patient with chromosome 11;22 translocation: a case report and literature review.
Drum ET, Herlich A, Levine B, Mayhew JF.
Division of Pediatric Anesthesiology, Temple University Children's Medical Center, Temple University School of Medicine, Philadelphia, PA.
Summary Chromosome 11;22 translocation is a rare genetic condition, which results in characteristic features some of which may present problems when these children require surgery and anesthesia. We describe a child with this chromosomal variant who presented for surgery and anesthesia. The case report and review of the literature is presented here.
PMID: 16238561 [PubMed - in process]
-
Addition of clonidine and fentanyl: comparison between three different regional anesthetic techniques in circumcision.
Naja ZA, Ziade FM, Al-Tannir MA, Abi Mansour RM, El-Rajab MA.
Department of Anaesthesia and Pain Medicine, Makassed General Hospital, Beirut, Lebanon.
Summary Background : Several techniques have been used for alleviating postcircumcision pain with regional anesthetics being more effective than systemic opioids. Our aim was to compare the effectiveness of dorsal penile block, ring block (RB) and dorsal penile block associated with RB in reducing postcircumcision pain in children. Methods : We conducted a prospective randomized double-blind clinical trial on 100 boys aged between 1 month and 5 years undergoing elective circumcision. Each 20 ml of local anesthetic mixture contained 9 ml lidocaine 1% without epinephrine, 9 ml bupivacaine 0.5%, 1 ml fentanyl (50 mug.ml(-1)) and 1 ml clonidine (75 mug.ml(-1)). They were allocated to one of three groups: 33 boys were given a RB with 1-1.5 ml (group 1), 32 had a dorsal penile block with 1.5-4 ml (group 2) and 35 had a combined ring and dorsal penile block with 2.5-5 ml of anesthetic mixture based on the child's age. Results : Ninety-one children (91%) completed the clinical trial (three failed blocks and six follow-up losses). The groups were similar with regard to age, weight, height, duration of surgery and hemodynamic status. The average pain scores were significantly higher with a RB compared with the other two groups (P < 0.05) for the first postoperative day. RB children and dorsal penile block children consumed significantly more analgesics for the first six postoperative hours (P < 0.05). The surgeon's satisfaction was significantly higher with the ring + dorsal penile block group (100%) compared with the other two groups (P = 0.032). Conclusion : Dorsal penile block plus RB technique is superior to dorsal penile block alone and RB alone in reducing postcircumcision pain in children.
PMID: 16238558 [PubMed - in process]
-
Preliminary experience with oral dexmedetomidine for procedural and anesthetic premedication.
Zub D, Berkenbosch JW, Tobias JD.
School of Medicine, University of Missouri, Columbia, MO, USA.
Summary Background : Oral premedication is often required in children to provide anxiolysis and lessen the psychological impact of hospitalization and/or procedures. We present our experience with dexmedetomidine as an oral premedicant prior to procedural sedation or anesthetic induction. Methods : We undertook a retrospective review of the anesthesia or sedation service records of patients who received oral dexmedetomidine. Results : The cohort for the study included 13 patients ranging in age from 4 to 14 years. Oral dexmedetomidine (mean dose: 2.6 +/- 0.83 mug.kg(-1); range 1.0-4.2 mug.kg(-1)) was used as premedication prior to anesthesia induction in four patients and prior to intravenous (IV) cannula placement for procedural sedation in nine patients with neurobehavioral problems. Effective sedation was achieved in 11 of 13 patients. The one patient in whom anxiolysis was not achieved received the lowest dose of dexmedetomidine (1 mug.kg(-1)) prior to anesthesia induction. In the other three patients, parental separation and acceptance of the mask was achieved at 20-30 min with a dose of 2.5 mug.kg(-1). When used for procedural sedation, placement of an IV cannula was accomplished without difficulty in seven of eight patients with neurobehavioral disorders and with only mild resistance in the other. No complications were noted and parental satisfaction with the sedation experience was high. Conclusions : These preliminary data suggest that dexmedetomidine may be an effective oral premedicant prior to anesthesia induction or procedural sedation. We found that it was effective even in patients with neurobehavioral disorders in whom previous attempts at sedation had failed.
PMID: 16238552 [PubMed - in process]
-
Abstracts of the XXIV Annual European Society of Regional Anaesthesia (ESRA) Congress, Berlin, Germany, 14-17 September 2005.
[No authors listed]
Publication Types:
PMID: 16112520 [PubMed - indexed for MEDLINE]
| Display Show |
|
|