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Comment on:
Pk value does depend on the fineness of the observer scale.
Weber Jensen E, Rodriguez B, Litvan H.
Publication Types:
PMID: 15752419 [PubMed - indexed for MEDLINE]
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Intrathecal fentanyl added to hyperbaric ropivacaine for transurethral resection of the prostate.
Yegin A, Sanli S, Hadimioglu N, Akbas M, Karsli B.
Department of Anesthesiology, Akdeniz University Medical Faculty, 07070 Antalya, Turkey. ayegin@akdeniz.edu.tr
BACKGROUND: Our purpose was to evaluate the effect of intrathecal fentanyl 25 microg added to 18 mg of 6 mg ml(-1) hyperbaric ropivacaine on the characteristics of subarachnoid block and postoperative pain relief in patients undergoing TURP surgery. METHODS: The patients were randomly assigned into two groups: Group S (saline group, n=16) received 3 ml of 18 mg hyperbaric ropivacaine + 0.5 ml saline--in total, a 3.5-ml volume intrathecally; and Group F (fentanyl group, n=15) received 3 ml of 18 mg hyperbaric ropivacaine + 0.5 ml of 25 microg fentanyl--in total, a 3.5-ml volume intrathecally. In both groups the onset and recovery times of the sensory block, degree and recovery times of the motor block and side-effects were recorded and statistically compared. RESULTS: There was no significant difference between the groups in achieving the highest level of sensory block, and in the times taken to reach the peak level. Regression to L1 was significantly prolonged in the fentanyl group compared with the saline group (P=0.004). Times to the first feeling of pain and the first analgesic requirement were significantly prolonged in the fentanyl group compared with the saline group (P=0.011 and P=0.016, respectively). The frequency of pruritus was significantly higher in the fentanyl group compared with the saline group (P=0.022). CONCLUSION: Addition of fentanyl 25 microg to hyperbaric ropivacaine 18 mg for spinal anesthesia in patients undergoing TURP may significantly improve the quality and prolong the duration of analgesia, without causing a substantial increase in the frequency of major side-effects.
Publication Types:
PMID: 15752409 [PubMed - indexed for MEDLINE]
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Pharmacokinetics of 0.5% levobupivacaine following ilioinguinal-iliohypogastric nerve blockade in children.
Ala-Kokko TI, Raiha E, Karinen J, Kiviluoma K, Alahuhta S.
Department of Anaesthesiology, University of Oulu, FIN-90029 Oulu, Finland. tak@cc.oulu.fi
BACKGROUND: Bupivacaine (2 mg kg(-1)) has been recommended for blockade of the ilioinguinal and iliohypogastric nerves in paediatric patients undergoing inguinal surgery. We determined the plasma concentrations of levobupivacaine following ilioinguinal-iliohypogastric block. METHODS: Twenty children scheduled for elective surgery for inguinal surgery received 2 mg kg(-1) of 0.5% levobupivacaine. Surgical anaesthesia was maintained with mask inhalation of oxygen, nitrous oxide and sevoflurane. Venous blood samples were drawn at regular intervals up to 2 h and plasma was separated. Total venous plasma concentrations were determined by gas chromatography. Bupivacaine concentrations from a study with a similar protocol were used as historical controls for comparison. RESULTS: The groups were similar with respect to age, weight and dosage of local anaesthetic. The initial distribution half-time (Talpha), the peak plasma concentration (Cmax) achieved, the time to the peak plasma concentration were similar (Tmax), and the mean areas under the concentration time curve (AUC) were similar between the two local anaesthetics. CONCLUSIONS: Levobupivacaine and bupivacaine are equally absorbed to similar maximum concentrations.
Publication Types:
PMID: 15752408 [PubMed - indexed for MEDLINE]
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Rapid fluid infusion therapy decreases the plasma concentration of continuously infused propofol.
Adachi YU, Satomoto M, Higuchi H, Watanabe K.
Medical Clinic of Hamamatsu Base, Japan Air Self Defense Force, Hamamatsu city, Shizuoka 432-8551, Japan. yuadachi@poppy.ocn
BACKGROUND: Rapid fluid infusion therapy to treat hypovolemia in anesthetized patients is a common practical regimen in daily clinical settings. This study investigated the effect of large volume loading on the plasma concentration of propofol (Cp), hemodynamic parameters, hemoglobin concentration (Hb), hematocrit value (Ht) and the bispectral index (BIS). METHODS: Sixty patients were administered propofol using a target-controlled infusion technique. We studied two independent groups. Half of the patients (group F, n = 30) were administered fentanyl, and the other half (group E, n = 30) epidural administration of mepivacaine for analgesia. After achieving a pseudo-steady state of propofol anesthesia, baseline values of blood pressure, heart rate, Hb, Ht, cardiac output, Cp and BIS were measured, and 10 ml/kg Ringer's solution was infused over 15 min. RESULTS: In group F, Cp was significantly decreased from 2.24 (0.69) [mean (SD)] to 2.07 (0.61) microg/ml and in group E from 2.02 (0.98) to 1.75 (0.51) microg/ml immediately after infusion (P < 0.05). The significant reduction lasted until 30 min in group F, whereas, Cp quickly recovered in group E. Cardiac output was increased only in group F. The dilution ratio demonstrated the prolonged diluting effect in group E and the significant correlation with the rate of decrease in Cp (P < 0.0003, R = 0.21). The BIS value showed no significant change immediately after infusion. CONCLUSION: Large volume loading decreased Cp without a significant change in BIS values. The effect of infusion therapy on the depth of anesthesia might be small and usually negligible during propofol anesthesia.
Publication Types:
PMID: 15752398 [PubMed - indexed for MEDLINE]
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Dose-response relationship of rocuronium: a comparison of electromyographic vs. acceleromyographic-derived values.
Kopman AF, Chin WA, Moe J.
Department of Anesthesiology, St. Vincent's Hospital Manhattan, New York City, NY 10011, USA. akopman@nyc.rr.com
BACKGROUND: Acceleromyography (AMG) is being employed with increasing frequency as a research tool. However, there is almost no information available regarding the accuracy of values for drug potency obtained using AMG. This study was an attempt to determine if AMG-derived ED(50/95) values are interchangeable with those measured with a more traditional neuromuscular monitor. METHODS: Thirty adult patients were studied. Anesthesia was induced and maintained with N20, propofol, and supplementation opioid. Tracheal intubation was accomplished without muscle relaxants. Simultaneous ipsilateral AMG and EMG responses to 0.10 Hz stimulation was recorded. Following instrument calibrations, a single dose of rocuronium was administered. The first patient received a bolus of 0.17 mg kg(-1) of rocuronium. Using the Hill equation with a postulated slope of 4.50, the ED(50) was calculated. The second subject received a dose which approximated the calculated ED(50) for patient no. 1. Successive subjects were given a dose based on the running average of the estimated ED(50). RESULTS: The AMG-derived ED50/95 values for rocuronium (0.163 +/- 0.055 and 0.314 +/- 0.105 mg mg(-1)) were virtually identical to those established using EMG (0.159 +/- 0.043 and 0.306 +/- 0.084 mg kg(-1)). While mean peak twitch depression (Delta T1) was the same in both groups for individual subjects Delta T1 differed by +/- 20% (95% confidence interval). DISCUSSION: Acceleromyography-derived twitch heights for individual patients are not necessarily interchangeable with information obtained using electromyography. Nevertheless, acceleromyography appears to be a valid methodology for determining the drug potency when a population rather than an individual subject is being studied.
Publication Types:
PMID: 15752396 [PubMed - indexed for MEDLINE]
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Risk assessment in anaesthesia.
Rollin AM.
Publication Types:
PMID: 16179067 [PubMed - indexed for MEDLINE]
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Obesity: basic science and medical aspects relevant to anaesthetists.
Cheah MH, Kam PC.
Department of Anaesthesia and Intensive Care, Selayang Hospital, Selayang, Selangor, Malaysia.
Obesity is becoming a major public health problem throughout the world. It is now the second leading cause of death in the United States and is associated with significant, potentially life-threatening co-morbidities. Significant advances in the understanding of the physiology of body weight regulation and the pathogenesis of obesity have been achieved. A better understanding of the physiology of appetite control has enabled advances in the medical and surgical treatment of obesity. Visceral or abdominal obesity is associated with an increased risk of cardiovascular disease and type 2 diabetes. Various drugs are used in the treatment of mild obesity but they are associated with adverse effects. Surgery has become an essential part of the treatment of morbid obesity, notwithstanding the potential adverse events that accompany it. An appreciation of these problems is essential to the anaesthetist and intensivist involved in the management of this group of patients.
Publication Types:
PMID: 16179047 [PubMed - indexed for MEDLINE]
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Effects of music on target-controlled infusion of propofol requirements during combined spinal-epidural anaesthesia.
Zhang XW, Fan Y, Manyande A, Tian YK, Yin P.
Department of Anaesthesiology, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China. zlxu@mails.tjmu.edu.cn
The sedative effects of music were evaluated using the bispectral index (BIS) during target-controlled infusion (TCI) propofol. A total of 110 women undergoing hysterectomy were randomly allocated to receive either music or no music. Propofol was administered using target-controlled infusion and the concentration adjusted gradually to achieve an observer's assessment of alertness/sedation (OAA/S) score of 3 intra-operatively. The haemodynamic and bispectral index values during the sedation phase were recorded. Interleukin-6 was evaluated before, immediately after and 1 h following intervention. The music group had a significant reduction in mean (SD) induction time of sedation: 12 (12) min vs. 18 (12) min, p < 0.01; propofol target concentration: 1.6 (0.3) microg.ml(-1) vs. 2.4 (0.4) microg.ml(-1), p < 0.0001; intra-operative amount of propofol: 171 (98) mg vs. 251 (92) mg, p < 0.0001; and significantly higher levels of satisfaction with their peri-operative care: 9.6 (0.6) compared to the control group: 8.1 (1.0), p < 0.0001. No other differences were found. The results show the influence of music on the induction time of sedation, concentration and level of propofol during surgery, and suggest sedative benefits of music.
Publication Types:
PMID: 16179044 [PubMed - indexed for MEDLINE]
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Comparison of xenon-based anaesthesia compared with total intravenous anaesthesia in high risk surgical patients.
Bein B, Turowski P, Renner J, Hanss R, Steinfath M, Scholz J, Tonner PH.
Department of Anaesthesiology and Intensive Care Medicine, University Hospital Schleswig-Holstein, Campus Kiel, Schwanenweg 21, D-24105 Kiel, Germany. bein@anaesthesie.uni-kiel.de
Xenon, a noble gas with anaesthetic and analgesic properties, has gained renewed interest due to its favourable physical properties which allow a rapid emergence from anaesthesia. However, high costs limit its use to a subset of patients who may benefit from xenon, thereby offsetting its costs. To date, there are only limited data available on the performance of xenon in high risk patients. We studied 39 patients with ASA physical status III undergoing aortic surgery. The patients were randomly assigned to either a xenon (Xe, n = 20) or a TIVA (T, n = 19) group. Global cardiac performance and myocardial contractility were assessed using transoesophageal echocardiography, and myocardial cell damage with troponin T and CK-MB. Echocardiographic measurements were made prior to xenon administration, following xenon administration, and after clamping of the abdominal aorta, after declamping and at corresponding time points in the TIVA group. Laboratory values were determined repeatedly for up to 72 h. Data were analysed using two-way anova factoring for time and anaesthetic agent or with ancova comparing linear regression lines. No significant differences were found in global myocardial performance, myocardial contractility or laboratory values at any time during the study period. Mean (SEM) duration of stay on the ICU (xenon: 38 +/- 46 vs. TIVA 25 +/- 15 h) or in hospital (xenon: 14 +/- 12 vs. TIVA 10 +/- 6 days) did not differ significantly between the groups. Although xenon has previously been shown to exert superior haemodynamic stability, we were unable to demonstrate an advantage of xenon-based anaesthesia compared to TIVA in high risk surgical patients.
Publication Types:
PMID: 16179039 [PubMed - indexed for MEDLINE]
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Effect of breathing low concentrations of volatile anaesthetic agents on incidence of adverse airway events.
Goodwin N, Strong PJ, Sudhir G, Wilkes AR, Hall JE.
University Hospital of Wales, Heath Park, Cardiff CF14 4XN, Wales, UK.
The effect of breathing 0.1 minimum alveolar concentrations (MAC) of desflurane or isoflurane for three minutes on the incidence of adverse airway events on a subsequent breath of 2 MAC was investigated. Twenty-five volunteers known to develop an adverse airway event to desflurane or isoflurane took part in the study. Each volunteer was exposed to isoflurane and desflurane at least 24 h apart. Volunteers were assessed for adverse airway events while breathing 2 MAC inhalational anaesthetic following breathing 100% O(2) for 3 min. This was repeated with 0.1 MAC inhalational anaesthetic in oxygen instead of 100% O(2). Adverse airway events decreased from 88% to 40% when tests were conducted with desflurane (p = 0.002). With isoflurane, the reduction from 60% to 52% was not statistically significant (p = 0.774). Breathing low concentrations of desflurane decreases the incidence of adverse airway events on subsequent inhalation of higher concentration of desflurane.
Publication Types:
PMID: 16179038 [PubMed - indexed for MEDLINE]
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Awareness hazard using a Tec 6 vaporiser.
Chambers JC, Hough MB.
Publication Types:
PMID: 16115273 [PubMed - indexed for MEDLINE]
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Failure of a flow sensor of a Datex Ohmeda S/5 Aespire.
Snyders S.
Publication Types:
PMID: 16115270 [PubMed - indexed for MEDLINE]
Comment on:
Blame for peri-operative nerve injury.
Eipe N.
Publication Types:
PMID: 16115261 [PubMed - indexed for MEDLINE]
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Faulty Penlon circle absorber.
Bennett MW, Nowicki RW.
Publication Types:
PMID: 16115260 [PubMed - indexed for MEDLINE]
Comment on:
Thoracic paravertebral nerve block, nerve stimulator guidance and the endothoracic fascia.
Lang SA, Saito T.
Publication Types:
PMID: 16115258 [PubMed - indexed for MEDLINE]
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Intra-operative diagnosis of hypopituitarism in a patient undergoing radical nephrectomy.
Pillai P, Spears FD.
Department of Anaesthesia, Austin Hospital, Melbourne, Victoria 3084, Australia.
A 43-year-old woman presented for elective radical nephrectomy. After induction of anaesthesia, she developed hypotension that failed to respond to standard treatment measures. Her core temperature decreased to 34 degrees C in spite of active warming. She required very low concentrations of anaesthetic agents to maintain an adequate depth of anaesthesia for abdominal surgery. After excluding the common causes of hypotension, the possibility of subclinical hypopituitarism was considered and subsequently confirmed.
Publication Types:
PMID: 16115255 [PubMed - indexed for MEDLINE]
[The use of diagnosis-related-groups data for external benchmarking of anesthesia and intensive care services.]
[Article in German]
Schuster M, Kuntz L, Hermening D, Bauer M, Abel K, Goetz AE.
Zentrum fur Anasthesiologie und Intensivmedizin, Universitatsklinikum Hamburg-Eppendorf, Hamburg.
Measurement and assessment of the economic efficiency of clinical departments is still an unresolved, yet important problem in hospital management. Benchmarking with other providers can help to evaluate one's own efficacy in anaesthesia and intensive care services. In this article we describe a method for using the diagnosis-related-groups (DRG) cost breakdown data, to achieve a case mix adjusted comparison of own costs for anaesthesia and intensive care services with the average costs in German hospitals. On the basis of 19,401 cases from 10 different surgical departments, we compared our own costs with the German-wide benchmark. Major factors for profit optimisation are discussed. Special attention is given to the close interaction of surgical, anaesthesiological and intensive care process performance and costs and its impact on benchmarking studies.
PMID: 16177897 [PubMed - as supplied by publisher]
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[Psychological traits, course of surgery and recovery following hernia repair in patients preferring general or local anaesthesia.]
[Article in German]
Mullender A, Melichar G, Schmucker P, Huppe M.
Abteilung fur Anasthesiologie und operative Intensivmedizin, Allgemeines Krankenhaus Wandsbek, Hamburg.
OBJECTIVE: This study addresses two questions concerning open inguinal hernia repair patients: (1) are there differences in psychological traits between patients opting for local vs. general anaesthesia and (2) assuming comparable operations, are there any differences between the two groups during surgery and postoperative recovery?METHODS: A total of 69 male patients aged between 18 and 80 took part in the study. After having been briefed about anaesthesia, they opted for either local (n=40) or general anaesthesia (n=29). In order to determine psychological traits, patients filled out questionnaires before the operation [NEO Five-Factor-Inventory (NEO-FFI) and the Stress Coping Questionnaire (SVF)] and the Anaesthesiological Questionnaire (ANP) after the operation. Data about the surgery (duration of anaesthesia and operation, blood pressure and heart rate) and the convalescence period (time spent in recovery room, length of stay in hospital) were also recorded. The patients' information processing skills were measured preoperatively and postoperatively using the "Trail Making Test".RESULTS: Patients preferring local anaesthesia were significantly older than those who chose general anaesthesia. Therefore two similar age groups were formed by using the method of matched samples (n=2x26). Between these groups no significant differences were found with reference to psychological traits, but markedly extraverted patients favoured local anaesthesia. There were no differences in the duration of anaesthesia and surgery. Local anaesthesia patients spent less time in the recovery room and in hospital than general anaesthesia patients. Postoperatively, the cognitive state and the satisfaction with the anaesthesia were comparable between both groups.CONCLUSION: Psychological traits do not have a significant impact on the choice of either local or general anaesthesia. However, highly extraverted patients prefer local anaesthesia while extreme introverts prefer general anaesthesia. Our findings suggest that local anaesthesia will become more widely adopted for the repair of groin hernia. Future studies should focus on optimising the perioperative care for patients who choose local anaesthesia.
PMID: 16175344 [PubMed - as supplied by publisher]
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[The role of anesthesiology in fast track concepts in colonic surgery.]
[Article in German]
Hensel M, Schwenk W, Bloch A, Raue W, Stracke S, Volk T, V Heymann C, Muller JM, Kox WJ, Spies C.
Klinik fur Anasthesiologie und operative Intensivmedizin, Campus Charite Mitte, Universitatsmedizin, Berlin.
In the present study the "fast-track rehabilitation" protocol of the Charite university hospital for patients undergoing elective colonic resection is described. The underlying principles, clinical pathways and outcome data from 208 patients are shown. Particularly anesthesiological aspects of this multimodal approach, such as modified preoperative and postoperative fluid management, changed guidelines for preoperative fasting, effective analgetic therapy using epidural analgesia and avoiding high systemic doses of opioids, use of short-acting anesthetic agents, and maintenance of normothermia as well as normovolemia are presented and discussed. In comparison to outcome data before "fast-track rehabilitation" was established, the duration of postoperative hospital stay has been reduced from 12 to 5 days, the number of general complications (pneumonia, duodenal ulcer bleeding, urinary tract infection, cerebral, cardiac and renal dysfunction) decreased from 20% to 7%, whereas surgical complications remained constant at 17% (8% wound infections, 3% anastomotic insufficiency).
PMID: 16175343 [PubMed - as supplied by publisher]
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[Myocardial infarction in a 21-year-old ASA I patient after arthroscopic surgery of the knee under general anaesthesia.]
[Article in German]
Fippel A, Veit C, Weber U, Hoitz J.
Abteilung X (Anasthesiologie, Intensiv- und Notfallmedizin), Bundeswehrkrankenhaus, Hamburg.
Myocardial ischemia is a major complication in the perioperative period, mostly in patients with high cardiac risks. After non-cardiac surgery myocardial infarction was observed in 5.6% of patients with coronary heart disease, the rate in patients with no cardiac diseases was 0.1-0.7%. We present the case of a 21-year-old ASA I male patient who underwent surgery to reconstruct the cruciate ligament of the knee. General anaesthesia was performed in combination with a femoral nerve block. After surgery the patient suffered from myocardial infarctions on the day of surgery and the 6th day after surgery. After resuscitation, thrombolysis and percutaneous transluminal coronary angioplasty (PTCA), an intraaortic balloon pump had to be temporarily implanted due to persistent cardiogenic shock.
PMID: 16172852 [PubMed - as supplied by publisher]
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[Airway management for one-lung ventilation]
[Article in German]
Motsch J, Wiedemann K, Roggenbach J.
Klinik fur Anaesthesiologie, Universitatsklinikum Heidelberg. johann.motsch@thoraxklinik-heidelberg.de
The progress in sophisticated and complex operating methods for intrathoracic procedures demands reliable lung separation with the possibility of one-lung ventilation. Patients with thoracic traumas and pulmonary emergencies can confront any anaesthesiologist with the need for lung separating procedures. This review describes the contemporary procedures for lung separation. The special aspects of difficult airway management during one-lung ventilation and the indications for one-lung ventilation are described in detail. The pathophysiological changes during one-lung ventilation and strategies to avoid hypoxemia and to preserve adequate oxygenation are discussed.
Publication Types:
PMID: 15933878 [PubMed - indexed for MEDLINE]
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[A lot of smoke but no fire?]
[Article in German]
Gervais HW.
Klinik fur Anaesthesiologie, Klinikum der Johannes Gutenberg-Universitat, Mainz. gervais@anaesthesie.klinik.uni-mainz.de
PMID: 15912335 [PubMed - indexed for MEDLINE]
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[Influence of gender on propofol consumption and recovery times]
[Article in German]
Wilhelm W, Buchinger H, Biedler A, Altmann S, Larsen R, Kreuer S.
Klinik fur Anasthesiologie und operative Intensivmedizin, St.-Marien-Hospital, Lunen. wolfram.wilhelm@smh-online.de
INTRODUCTION: We investigated gender differences of drug consumption and recovery times for propofol-remifentanil anaesthesia. METHODS: Adult patients scheduled for minor orthopaedic surgery were randomised to receive a propofol-remifentanil anaesthesia controlled either by EEG monitoring (Narcotrend or BIS) or solely by clinical parameters. Anaesthesia was induced with remifentanil 0.4 microg/kg/min and a propofol target-controlled infusion (TCI) at 3.5 microg/ml. After intubation remifentanil was reduced to 0.2 microg/kg/min whereas propofol TCI was adjusted according to clinical parameters or to the following EEG target values: during maintenance to "D(0)" (Narcotrend) or "50" (BIS), 15 min before the end of surgery to "C(1)" (Narcotrend) or "60" (BIS). Recovery times were recorded and average normalised propofol consumption was calculated from induction and maintenance doses. RESULTS: A total of 60 male and 60 female patients completed the study. Gender differences were observed for recovery times (with standard practice) and for propofol consumption (with BIS monitoring). In the standard protocol group, propofol consumption was nearly identical for male and female patients whereas recovery times were significantly longer in the male group. In both EEG-guided groups propofol consumption was less for male patients while recovery times were slightly longer. In the group of female patients higher propofol TCI concentrations had to be used to reach the same BIS or Narcotrend values. CONCLUSION: With propofol-remifentanil anaesthesia, gender has impact on recovery times and propofol consumption. If the same amounts of propofol are applied, males awake later, with BIS or Narcotrend monitoring males receive less propofol for comparable EEG effects.
Publication Types:
PMID: 15864506 [PubMed - indexed for MEDLINE]
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[Incidence of transmission of pathogens in intensive care units. Results of the SIR 3 study]
[Article in German]
Barwolff S, Grundmann H, Schwab F, Tami A, Behnke M, Geffers C, Halle E, Gobel U, Schiller R, Jonas D, Klare I, Weist K, Witte W, Dinger E, Beilecke K, Ruden H, Gastmeier P.
Institut fur Hygiene und Umweltmedizin, Charite, Universitatsmedizin, Berlin.
The objective of this study was to determine the incidence of episodes of transmission of nosocomial pathogens and of those pathogens leading to nosocomial infections. Over a period of 18 months all patients from 5 intensive care units (ICUs) who stayed for more than 2 days were included in this study. Surveillance of nosocomial infections was carried out and all isolates of 10 of the most frequent pathogens in ICUs (indicator pathogens) were collected and typed. A total of 28,498 patient days and 431 nosocomial infections were observed (incidence density 15.1 per 1,000 patient days), among them 278 caused by 1 of the selected indicator pathogens. A total of 141 episodes of transmissions were identified, corresponding to an incidence of episodes of transmission of 5.0 per 1,000 patient days and 41 nosocomial infections were transmission-associated, corresponding to 14.5% of all nosocomial infections. The data of this study demonstrate that even in ICUs with average nosocomial infection rates, some nosocomial infections could be avoided.
PMID: 15809853 [PubMed - indexed for MEDLINE]
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[Open heart tricuspid valve replacement in a heroin addict Anaesthesiological management]
[Article in German]
Kozian A, Schilling T, Tiede T, Huth C, Hachenberg T.
Klinik fur Anasthesiologie und Intensivtherapie, Otto-von-Guericke-Universitat, Magdeburg. Alf.Kozian@medizin.uni-magdeburg.de
A 24-year-old female with a history of former heroin addiction underwent open heart surgery for a mechanical tricuspid valve replacement. Anaesthesiological management included a thoracic epidural catheter at the Th(2)/Th(3) segments and balanced general anaesthesia (remifentanil, desflurane/propofol). Additionally, clonidine (2 microg*kg(-1)*h(-1)) was continuously administered. Pain therapy was achieved using 0.375% ropivacaine via a thoracic epidural catheter (4 ml*h(-1)) and metamizole (4 x 1 g/day) intravenously. With this concept we were able to achieve an appropriate anaesthesia and analgesia and the operation was carried out without complications.
Publication Types:
PMID: 15770462 [PubMed - indexed for MEDLINE]
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[Postoperative cognitive dysfunction]
[Article in German]
Engelhard K, Werner C.
Klinik fur Anasthesiologie, Johannes Gutenberg-Universitat, Mainz. engelhak@uni-mainz.de
Postoperative cognitive dysfunction is a severe and life-threatening complication after an operation. The mobilisation of the patient is difficult and, therefore, the stay of the patient in the hospital is extended and the resulting immobilisation is associated with further complications (e.g. decubitus, pneumonia, or thrombosis). The genesis of the postoperative cognitive dysfunction has different causes and the highest risk factors are the age of the patient and the character and the duration of the operation. Preexisting diseases, like diabetes mellitus, heart failure, depression or alcohol excess are high risk factors as well as the use of anticholinergic drugs. A specific therapy for this cognitive dysfunction is unknown and, therefore, preventive measures should be used in patients with a preexisting high risk.
Publication Types:
PMID: 15747140 [PubMed - indexed for MEDLINE]
Influence of changing work patterns on training in anaesthesia: an analysis of activity in a UK teaching hospital from 1996 to 2004.
Underwood SM, McIndoe AK.
Sir Humphry Davy Department of Anaesthesia, Bristol Royal Infirmary, Marlborough Street, Bristol BS2 8HW, UK.
BACKGROUND: We aimed to assess the influence of reduced working hours on training in a UK teaching hospital as the specialist registrar grade was introduced in 1996, the New Deal was implemented in 2001 and the Working Time Directive (WTD) took effect for doctors in training in 2004. METHODS: We analysed data from operating theatres in our hospital looking at grade of anaesthetist, time of day, emergency category, and specialty for more than 50 000 cases. RESULTS: Although direct supervision of trainees increased from 32 to 37 to 47%, senior house officer (SHO) and specialist registrar (SpR) caseload reduced by 20 and 21%, respectively, while that of the consultants rose. CONCLUSIONS: The reduction in total operating theatre cases for our trainees was evident across the epochs analysed, case numbers fell after introduction of the New Deal as well as more recently following the WTD, particularly for SHOs who are now doing a larger proportion of their work at night. SHOs and SpRs are doing more obstetric cases than in previous times but these are regional and not general anaesthetics.
PMID: 16169892 [PubMed - in process]
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Why do women wake up faster than men from propofol anaesthesia?
Hoymork SC, Raeder J.
Department of Anaesthesia, Ullevaal University Hospital, N-0407 Oslo, Norway.
BACKGROUND: It has repeatedly been shown that female patients wake up faster from propofol anaesthesia than male patients. The reason for this is not clear. It is possible that female patients have a more rapid decline in plasma propofol concentration after termination of an infusion, or there could be gender differences in the sensitivity to propofol, making women wake up at higher concentrations. We tested the hypothesis that women wake up faster because of a more rapid decline in plasma propofol. METHODS: Sixty adult patients (30 female and 30 male; ASA I or II) undergoing lower limb surgery under regional anaesthesia, were enrolled in an open study. Propofol was given as the only hypnotic drug, administered by the plasma target control system (TCI) Diprifusor((R)), titrated to bispectral index (BIS) values of 40-60. Blood samples for propofol measurements were taken just before the propofol infusion was stopped and when the patients woke up. RESULTS: The female patients woke up faster than the male patients (5.6 vs 8.2 min, P=0.003). The plasma propofol concentration declined more rapidly in the women (P=0.02). An additional significant finding was that the TCI algorithm had a better fit for the women than for the men, with a median prediction error (MDPE) of 2% in the female patients compared with 40% in the male patients (P<0.001). At emergence the men had a significantly higher measured propofol concentration than the women (P=0.05). CONCLUSION: The female patients had a more rapid decline in plasma propofol at the end of infusion. Gender differences in pharmacokinetics could explain the faster emergence for female patients after propofol anaesthesia, and gender differences in propofol sensitivity may also be present.
PMID: 16169889 [PubMed - in process]
Comment on:
CEMACH report: oesophageal intubation.
Heath M.
Publication Types:
PMID: 16076928 [PubMed - indexed for MEDLINE]
Comment on:
Aspiration and death associated with the use of the laryngeal mask airway.
Cook C, Gande AR.
Publication Types:
PMID: 16076925 [PubMed - indexed for MEDLINE]
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The effects of halothane and isoflurane on cardiovascular function in laterally recumbent horses.
Raisis AL, Blissitt KJ, Henley W, Rogers K, Adams V, Young LE.
Department of Equine Clinical Studies, Animal Health Trust, Lanwades Park, Newmarket, Suffolk, UK.
BACKGROUND: Experimental studies in adult horses have shown that general anaesthesia maintained with isoflurane is associated with less depression of cardiovascular function compared with halothane anaesthesia. Adverse effects of intermittent positive-pressure ventilation (IPPV) have also been demonstrated. Nevertheless, the haemodynamic effects of these agents and the effects of differing modes of ventilation have not been assessed during clinical anaesthesia in horses undergoing surgery. METHODS: The haemodynamic effects of isoflurane or halothane anaesthesia during spontaneous or IPPV were studied non-invasively in 32 laterally recumbent horses undergoing elective surgery. Indices of cardiac function and measurements of femoral arterial blood flow and resistance were recorded using transoesophageal and transcutaneous Doppler echocardiography, respectively. Arterial pressure was measured directly using a facial artery catheter. RESULTS: Cardiac index (CI) was significantly higher during isoflurane anaesthesia than during halothane anaesthesia and was also higher during spontaneous ventilation with isoflurane. CI decreased significantly over time and an inverse relationship was observed between CI and mean arterial pressure (MAP). Horses with higher MAP had a significantly lower CI. During isoflurane anaesthesia, femoral arterial blood flow was significantly higher in both pelvic limbs compared with halothane anaesthesia, and flow in the lower limb was significantly higher during spontaneous ventilation than during IPPV. No significant change in femoral blood flow was observed over time. CONCLUSION: The effects of anaesthetics and mode of ventilation on cardiovascular function recorded under surgical conditions in horses are similar to those reported under experimental conditions. However, in contrast with previous experimental studies, CI progressively decreased over time regardless of agent used or mode of ventilation employed.
PMID: 15980042 [PubMed - indexed for MEDLINE]
Evidence Based Resource in Anaesthesia and Analgesia, 2nd edition : M. Tramer (ed.). BMJ Books: London, UK, 2003, 208 pp; indexed, illustrated ISBN: 0-7279-1786-2; Price pound30.00.
Found P.
London, UK.
PMID: 16174325 [PubMed - in process]
Unexpected aortic dissection detected by transoesophageal echocardiography in the operating theatre at the beginning of cardiac surgery.
Varela JA, Hortal FJ, Zaballos M, Riesgo MJ.
Publication Types:
PMID: 16045148 [PubMed - indexed for MEDLINE]
Nausea and vomiting after cataract surgery: does neostigmine have an emetic effect?
Frizelle HP, Curran E, Twomey C, MacAdoo J, Shorten G.
Publication Types:
PMID: 16045147 [PubMed - indexed for MEDLINE]
Partial liquid ventilation in acute salt water-induced lung injury.
Schober P, Seidel D, Kalb R, Obal D, Pakulla MA, Loer SA.
University of Dusseldorf, Department of Anaesthesiology, Dusseldorf, Germany.
BACKGROUND AND OBJECTIVES: Salt-water aspiration results in pulmonary oedema and hypoxia. We tested the hypothesis that partial liquid ventilation has beneficial effects on gas exchange and rate of survival in acute and extended salt water-induced lung injury. METHODS: Anaesthetized, ventilated rats (tidal volume 6 mL kg(-1), PEEP 5 cmH2O) received a tracheal salt-water instillation (3%, 8 mL kg(-1) body weight) and were randomly assigned to three groups (n = 10 per group). While lungs of Group 1 were gas-ventilated, lungs of Group 2 received a single perfluorocarbon instillation (30 min after the injury, 5 mL kg(-1) perfluorocarbon) and lungs of Group 3 received an additional continuous perfluorocarbon application into the treachea (5 mL kg(-1) h(-1)) Arterial blood gases were measured with an intravascular blood gas sensor. RESULTS: Salt-water instillation resulted in a marked decrease in PaO2 values within 30 min (from 432 +/- 65 to 83 +/- 40 mmHg, FiO2 = 1.0, P < 0.01). Arterial oxygenation improved in all three groups irrespective of treatment. We observed no significant differences between groups in peak PaO2 and PaCO2 values. CONCLUSIONS: Our results suggest that partial liquid ventilation has no additional beneficial effects on gas exchange after life-threatening salt water-induced lung injury when compared to conventional gas ventilation with positive end-expiratory pressure.
PMID: 16045144 [PubMed - indexed for MEDLINE]
Effects of mivacurium on the diaphragm evaluated by cervical magnetic stimulation of the phrenic nerves.
Hinz J, Auer P, Moerer O, Neumann P, Crozier TA.
University of Gottingen, Department of Anaesthesiology, Emergency and Intensive Care Medicine, Gottingen, Germany. mail@josehinz.de
BACKGROUND AND OBJECTIVE: Non-depolarizing neuromuscular blocking agents have differential effects on the diaphragm and skeletal muscles. We employed a new method to study the effects of mivacurium on the diaphragm and compared the results obtained with this method with published data. METHODS: Anaesthesia was induced and maintained with propofol and alfentanil and the trachea was intubated after topical anaesthesia. Contractions of the diaphragm were induced by cervical magnetic stimulation of the phrenic nerves and quantified by measuring airway pressure responses. The neuromuscular effects on skeletal muscles were measured by acceleromyography of the adductor pollicis muscle. Mivacurium (0.15 mg kg(-1)) was injected and neuromuscular responses were recorded until the effects had waned. RESULTS: Eleven male and 10 female patients (ASA I-II; 57 +/- 16 yr; 78 +/- 13 kg; mean +/- standard deviation) participated. Median maximal reduction of twitch response was less (P < 0.05) for the diaphragm (89%) than for the adductor pollicis (100%). Time to 25% recovery was shorter for the diaphragm than for the adductor pollicis (8.8 +/- 2.2 min vs. 22.6 +/- 5.0 min, P < 0.05). The difference between the recovery index of the diaphragm (7.3 min (3.6-18.4)) and the adductor pollicis (8.2 min (4.4-20.9) (median (range)) just missed our chosen level of statistical significance (P = 0.06). The recovery time to train-of-four 0.8 was shorter for the diaphragm (median and 95% confidence interval 25.1 +/- 10.2 min) than for the adductor pollicis (median and 95% confidence interval 37.5 +/- 9.4 min, P < 0.05). CONCLUSIONS: The duration of the clinical effect of mivacurium on the diaphragm is markedly shorter than on the adductor pollicis muscles but there was only a small difference in the recovery index of the two muscles. These effects and the time courses determined with the new method closely resemble the results obtained with different methods in other studies.
Publication Types:
PMID: 16045143 [PubMed - indexed for MEDLINE]
A comparison of lidocaine 2% with levobupivacaine 0.75% for sub-Tenon's block.
McLure HA, Kumar CM, Ahmed S, Patel A.
St James's University Hospital, Leeds, UK.
BACKGROUND AND OBJECTIVE: To compare the onset of action, and quality of block, of lidocaine 2% with levobupivacaine 0.75% for sub-Tenon's block in patients undergoing cataract surgery. METHODS: We performed a two-centre trial in 91 patients who were randomized to receive 4 mL of lidocaine 2% (n = 44) or levobupivacaine 0.75% (n = 47) for sub-Tenon's block, both with hyaluronidase 15 IUmL(-1). Onset of akinesia was assessed every 2 min for 10 min. Numbers of patients requiring supplementary injections to achieve clinically satisfactory akinesia or rescue analgesia were recorded. Data were analyzed with Fisher's exact test, U-test and t-test where appropriate. Results were considered significant when P < 0.05. RESULTS: The speed of onset was statistically significantly faster for lidocaine compared to levobupivacaine (3.02 vs. 5.06 min, P < 0.001). There was no statistical difference in number of patients requiring a supplementary injection of local anaesthetic (levobupivacaine 3 vs. lidocaine 0, P = 0.24), rescue analgesia with topical tetracaine (levobupivacaine 0 vs. lidocaine 2, P = 0.5), or ocular akinesia scores at the completion of surgery (lidocaine 1.4 vs. levobupivacaine 1.6, P = 0.12). Pain scores measured by a verbal analogue scale were not significantly different for injection, perioperatively or postoperatively. CONCLUSIONS: Both agents produce a rapid onset of anaesthesia when used for sub-Tenon's block. The difference between the two agents, although statistically significant, is not clinically important.
Publication Types:
PMID: 16045137 [PubMed - indexed for MEDLINE]
Nateglinide, a non-sulfonylurea rapid insulin secretagogue, increases pancreatic islet blood flow in rats.
Iwase M, Nakamura U, Uchizono Y, Nohara S, Sasaki N, Sonoki K, Iida M.
Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Maidashi 3-1-1, Higashi-ku, Fukuoka 812-8582, Japan. iwase@intmed2.med.kyushu-u.ac.jp
We studied whether the rapid hypoglycemic action of nateglinide is associated with an increase in islet blood flow. Islet blood flow was measured using the two-colour microsphere method. Orally administered nateglinide with glucose acutely increased islet blood flow to levels greater than those after glucose alone or tolbutamide with glucose in conscious Sprague-Dawley rats (percent increase at 10 min after oral administration; nateglinide+glucose, 125+/-25%; glucose, 33+/-11%, p<0.001; tolbutamide+glucose, 42+/-23%, p<0.01). Nateglinide administered with non-metabolisable 3-O-methylglucose also increased islet blood flow (61+/-17%). The stimulated islet blood flow significantly correlated with serum insulin levels. N(G)-monomethyl-L-arginine, a nitric oxide synthase inhibitor, completely inhibited the increase in islet blood flow induced by nateglinide with glucose. Intravenously administered nateglinide did not significantly affect the already increased islet blood flow in diabetic Otsuka Long-Evans Tokushima Fatty rats. Our results indicated that nateglinide acutely increased islet blood flow at least in part through a nitric oxide-dependent mechanism.
PMID: 16023099 [PubMed - indexed for MEDLINE]
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Anesthesia considerations in carbohydrate-deficient glycoprotein syndrome type I.
Meaudre E, Meyrieux V, Suprano I, Camboulives J, Paut O.
Publication Types:
PMID: 16176328 [PubMed - in process]
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Aerophagia and anesthesia: an unusual cause of ventilatory insufficiency in a neonate.
Lalwani K.
Department of Anesthesiology, Oregon Health and Science University, Portland, OR 97239, USA. lalwanik@ohsu.edu
We describe a healthy neonate with abdominal distention, inadequate ventilation, and delayed extubation during anesthesia for minor surgery. Following rectal decompression and successful extubation, extreme abdominal distention recurred postoperatively after ingestion of clear fluids. We elicited a history of frequent and excessive flatus from the parents, and abdominal radiography revealed distended loops of small bowel with small lung volumes suggestive of aerophagia. The differential diagnosis of aerophagia is reviewed, the anesthetic implications discussed, and relevant literature pertaining to this condition summarized.
PMID: 16176321 [PubMed - in process]
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Prevention of aspiration under general anesthesia by use of the size 2 1/2 ProSeal laryngeal mask airway in a 6-year-old boy: a case report.
Goldmann K, Jakob C.
Department of Anaesthesia, Philipps University Marburg, Marburg, Germany. kaigoldmann1@aol.com
We report a case where use of the size 2 1/2 ProSeal laryngeal mask airway helped to prevent pulmonary aspiration of regurgitated gastric fluid. We describe the management of this case and discuss the potential advantages of this modified laryngeal mask airway for supraglottic airway management in pediatric patients.
PMID: 16176318 [PubMed - in process]
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Tracheoesophageal fistula and associated congenital heart disease: implications for anesthetic management and survival.
Diaz LK, Akpek EA, Dinavahi R, Andropoulos DB.
Division of Pediatric Cardiovascular Anesthesiology, Baylor College of Medicine, Texas Children's Hospital, TX 77030, USA. lkdiaz@bcm.tmc.edu
BACKGROUND: Infants with tracheoesophageal fistula (TEF) and/or esophageal atresia (EA) frequently have other associated congenital anomalies which can have a significant impact on their anesthetic care and survival to discharge. METHODS: A medical record review and retrospective data analysis were performed in a university affiliated children's hospital of all infants undergoing TEF/EA repair between January 1998 and July 2004. The incidence of intraoperative complications during the TEF repair and overall survival to hospital discharge was compared in two groups of infants: 26 patients with TEF/EA and coexisting congenital heart disease (CHD), and 27 patients with TEF/EA and no CHD. RESULTS: The overall incidence of intraoperative critical events during repair of TEF/EA was significantly higher in infants with associated cardiac pathology (P = 0.003). Six of 53 infants died during hospitalization (overall mortality, 11.3%) and all had associated cardiac pathology. In comparison with nonductal-dependent lesions, the presence of a ductal-dependent cardiac lesion appeared to significantly increase patient mortality (57% vs. 10%, P = 0.028). CONCLUSIONS: Low birth weight (<1500 g) and associated cardiac pathology were found to be independent predictors of mortality in infants undergoing surgery for TEF/EA repair. The presence of a ductal-dependent cardiac lesion further increased the risk of morbidity and mortality, in addition to necessitating special anesthesia considerations.
PMID: 16176315 [PubMed - in process]
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The comparative effect of single dose mivacurium during sevoflurane or propofol anesthesia in children.
Hadimioglu N, Ertugrul F, Ertug Z, Yegin A, Karaguzel G, Erman M.
Department of Anaesthesiology and Intensive Care, Akdeniz University, Antalya, Turkey. necmiyehadimioglu@hotmail.com
BACKGROUND: We aimed to randomly compare intubating conditions, recovery characteristics and neuromuscular effects of single dose of mivacurium (0.2 mg.kg(-1)) during sevoflurane vs. propofol anesthesia in 60 healthy children, undergoing inguinal surgery. METHODS: All children were randomly allocated to receive 2 mg.kg(-1) propofol iv or sevoflurane 8% inspired concentration for induction of anesthesia. Anaesthesia was maintained with 66% nitrous oxide in oxygen and 100-120 microg.kg(-1) propofol or sevoflurane approximately 2-3% inspired concentration with controlled ventilation. The ulnar nerve was stimulated at the wrist by a train-of four (TOF) stimulus every 20 s and neuromuscular function was measured at the adductor pollicis. When the response to TOF was stable, 0.2 mg.kg(-1) mivacurium was given. The trachea was intubated successfully at the first attempt in all patients. RESULTS: Onset time following a single dose of mivacurium was shorter in the sevoflurane group (2.99 min), than in the propofol group (4.42 min). The times to 25, 50, 75, and 90% recovery were significantly longer in the sevoflurane group (13.1, 15.7, 18.6, and 21.2 min, respectively) than in the propofol group (11.4, 13.2, 14.4, and 17.2 min respectively). TOF ratios of 50, 70, and 90% were significantly occurred later in sevoflurane group than propofol group. CONCLUSIONS: Our results indicate that when compared with propofol group, the sevoflurane group had an accelerated onset and a delayed recovery of neuromuscular block induced by mivacurium in children.
PMID: 16176313 [PubMed - in process]
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Facilitating coping behavior in children prior to dental general anesthesia: a randomized controlled trial.
Campbell C, Hosey MT, McHugh S.
Glasgow Dental Hospital and School, University of Glasgow, Glasgow, UK. caroline.campbell@northglasgow.scot.nhs.uk
BACKGROUND: The aim of this study was to establish the efficacy of two different preparation packages, a paper-based cartoon and an interactive computer, at facilitating coping behavior in children undergoing dental general anesthetic (DGA) tooth extraction. METHOD: A total of 198 children were allocated randomly to computer, cartoon or control groups. A Visual Analog Scale (VAS) and Modified Child Dental Anxiety Scale (MCDAS) were used to compare preoperative anxiety levels between the three study groups. Blinded observers then scored behavior at both anesthesia induction and upon recovery using a VAS for each (0 = coped/no distress and 10 = no coping/high distress). RESULTS: The children's median age was 5 (range 3-10) years, 57% were boys, a median of seven teeth were extracted (range 1-20). Preoperative anxiety was similar for all preparation groups; with 24% of all children categorized 'phobic' using MCDAS. The median induction (coping) VAS level for both the computer and the cartoon groups was '1' (range 0-10), compared with the control group level of '3' (range 0-10). The median recovery (coping) VAS levels were: computer group: 0 (range 0-10), cartoon group: 4 (range 0-10) and control group: 2.5 (range 0-10). The Mann-Whitney U-test showed that the computer group coped significantly better than the control group at induction (P = 0.014) and significantly better than the cartoon group upon recovery (P = 0.016). The statistical power for detecting differences between groups (computer/cartoon versus control) was calculated to be 90%, based on pilot study data. CONCLUSIONS: The computer preparation package facilitated coping behavior in children undergoing DGA induction.
PMID: 16176310 [PubMed - in process]
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