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Sub-Tenon's block in cataract surgery--a comparison of 1% ropivacaine and a mixture of 2% lignocaine and 0.5% bupivacaine.
Koh JW, Cammack R.
Department of Anaesthesia, Concord Repatriation General Hospital, Concord, New South Wales.
Sub-Tenon's block for cataract surgery is an increasingly common technique. While this technique has been successfully applied, the optimal local anaesthetic solution is not known. This study was performed to assess any differences in anaesthesia and oculomotor block between 1% ropivacaine and a 2% lignocaine with 0.5% bupivacaine mixture. The results indicate that there was no difference noted in the clinical effect between the solutions.
Publication Types:
PMID: 16235477 [PubMed - indexed for MEDLINE]
The first synthetic nondepolarizing muscle relaxant--gallamine.
Ball C, Westhorpe R.
Geoffrey Kaye Museum of Anaesthetic History.
Publication Types:
Personal Name as Subject:
PMID: 16235470 [PubMed - indexed for MEDLINE]
[Hypothermia after spinal anaesthesia: implication of morphine?]
[Article in French]
Fischer MO, Dequire PM, Kalem A, Gerard JL, Plaud B.
Departement d'anesthesie-reanimation chirurgicale, Samu, CHU de Cote-de-Nacre, 14000 Caen, France.
Spinal anaesthesia is the gold standard for elective caesarean section. This technique presents several adverse effects. We report a severe case of hypothermia (33.3 degrees C) after spinal administration of bupivacaine (10 mg) and morphine (100 mug) for elective caesarean section. After excluding other causes of hypothermia, this one could be explained by both the own effects of local anaesthesia (i.e. peripheral vasodilatation) and by the central effect of intrathecal morphine. Because hypothermia is not predictable after spinal injection of morphine both monitoring of central temperature and active warming of the patients could be proposed. Naloxone has been proposed in a case of hypothermia related to spinal injection of morphine.
PMID: 16377124 [PubMed - as supplied by publisher]
Seen from the other side: visual experiences during cataract surgery under topical anaesthesia.
Hu K, Scotcher S.
Victoria Eye Unit, Hereford County Hospital, Hereford, HR1 2ER.
PMID: 16373734 [PubMed - in process]
125 years of developments in dentistry, 1880-2005. Part 4: clinical dentistry.
Gelbier S.
Wellcome Trust Centre for the History of Medicine at University College London. s.gelbier@ucl.ac.uk
Publication Types:
PMID: 16288277 [PubMed - indexed for MEDLINE]
Hypotensive epidural anaesthesia in patients with preoperative renal dysfunction undergoing total hip replacement.
Sharrock NE, Beksac B, Flynn E, Go G, Della Valle AG.
Department of Anesthesiology and Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Medical College of Cornell University, 535 East 70th Street, New York, NY 10021, USA.
BACKGROUND: Hypotensive anaesthesia does not impair renal function after surgery in normal patients but there are no reports of hypotensive anaesthesia in patients with chronic renal dysfunction (CRD). METHODS: From a database of 1893 consecutive patients undergoing total hip replacement (THR) under hypotensive epidural anaesthesia (HEA) from 1999 to 2004, 54 patients were identified with CRD (preoperative serum creatinine >/=124 mumol litre(-1)). Fifty matched pairs were identified for patients with normal renal function who have hypertension (n=50) or no hypertension (n=50). Changes in serum creatinine and blood urea nitrogen (BUN) were recorded daily for 3 days. Acute renal failure was defined as an increase in serum creatinine of 44 mumol litre(-1). RESULTS: The mean duration of hypotension (MAP<55 mm Hg) was 94 min (range 35-305 min). The mean age was 71 yr. All patients with a creatinine level of 124 mumol litre(-1) had a creatinine clearance of <40 ml min(-1) 1.73 m(-2) (range: 13-56). Patients with CRD received more crystalloid during surgery (1755 ml) than the other two groups (1435 ml) (P<0.001). Otherwise, all three groups were similar. No patients developed evidence of acute renal dysfunction immediately after or by 24 h after surgery. Three patients with CRD had an increase in creatinine of >44 mumol litre(-1) at 48 and 72 h after surgery in the setting of volume depletion (acute blood loss in two patients and early ileus in one). Renal function subsequently improved. CONCLUSION: HEA, per se, when carefully managed does not appear to predispose patients with CRD to acute renal failure after THR.
PMID: 16377652 [PubMed - in process]
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Anaesthesia for brachytherapy--51/2 yr of experience in 1622 procedures.
Benrath J, Kozek-Langenecker S, Hupfl M, Lierz P, Gustorff B.
Klinische Abteilung fur Anasthesie und Allgemeine Intensivmedizin B, Medizinische Universitat Wien, Wahringer Gurtel 18-20, AKH, A-1090 Wien, Austria.
BACKGROUND: Brachytherapy presents the anaesthetist with unique problems. Information on anaesthesia for brachytherapy, however, is limited. The aim of this paper is to report on our experience involving a large number of brachytherapy procedures. METHODS: A retrospective analysis of records of 1622 anaesthetic procedures in 952 patients is presented. Records were analysed in respect of patient data, tumour localization, brachytherapy treatment and the type and duration of anaesthetic procedures. RESULTS: More than one-third of patients were at high risk (ASA III or IV) and 40% were more than 60 yr. Repetitive treatments were performed on half of the patients. Breast cancer was the most common indication. The average duration of anaesthesia for pelvic brachytherapy was more than 3 h, with a high degree of variability. Regional anaesthesia was used in 30% of all cases and was the predominant technique for pelvic brachytherapy. Spinal catheter techniques represented a high proportion of those receiving regional anaesthesia. Complications resulting from regional and general anaesthesia were minor and no serious incidents occurred. CONCLUSIONS: Based on a large number of procedures, this study gives an example of anaesthetic management in brachytherapy. A substantial minority of patients would be considered high risk for surgical intervention. Regional anaesthesia was the principal technique used when dealing with tumours of the lower body.
PMID: 16377650 [PubMed - in process]
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Chemical encapsulation of rocuronium by synthetic cyclodextrin derivatives: reversal of neuromuscular block in anaesthetized Rhesus monkeys.
de Boer HD, van Egmond J, van de Pol F, Bom A, Booij LH.
Department of Anaesthesiology, Radboud University Medical Centre Nijmegen, The Netherlands.
BACKGROUND: At present, reversal of neuromuscular block induced by steroidal neuromuscular blocking agents (NMBAs) is achieved by administration of cholinesterase inhibitors. Chemical encapsulation of steroidal NMBAs, such as rocuronium, by a cyclodextrin is a new concept in neuromuscular block reversal. The present study evaluates the capacity of nine synthetic cyclodextrin derivatives (Org 25288, Org 25289, Org 25467, Org 25168, Org 25169, Org 25555, Org 25166, Org 26142, and Org 25969) to reverse constant neuromuscular block of approximately 90%, induced by rocuronium infusion in the Rhesus monkey, using single twitch stimulation. The ability of these cyclodextrin derivatives to reverse neuromuscular block was compared with the reversal of the same neuromuscular block by the commonly used combination of neostigmine and atropine. METHODS: After a bolus injection of rocuronium, continuous infusion was started to reduce twitch contractions to approximately 10% of baseline values. After a steady state block of at least 10 min the infusion was stopped and the preparation was allowed to recover spontaneously. This process was repeated, but at the time the infusion was stopped, either one of the nine cyclodextrin derivatives or a combination of neostigmine and atropine was given. RESULTS: Recovery with cyclodextrin derivatives Org 26142 and Org 25969 was faster than after a combination of neostigmine and atropine (P<0.05). Injection of these cyclodextrin derivatives did not affect blood pressure or heart rate. Signs of residual block or recurarization were not observed in any of these experiments. In the experiments in which a combination of neostigmine and atropine was given, two animals showed signs of abdominal discomfort as frequently seen after the administration of neostigmine and significant changes in circulatory variables. CONCLUSIONS: Chemical encapsulation or chelation of rocuronium is a new concept in reversing neuromuscular block induced by rocuronium.
PMID: 16377646 [PubMed - in process]
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The effects of continuous epidural analgesia on Doppler velocimetry of uterine arteries during different periods of labour analgesia.
Chen LK, Lin CJ, Huang CH, Wang MH, Lin PL, Lee CN, Sun WZ.
Department of Anesthesiology and Department of Obstetrics and Gynecology, National Taiwan University Hospital, College of Medicine, Taipei, Taiwan.
BACKGROUND: The transient effects of epidural bupivacaine 0.25-0.5% on the Doppler velocimetry of umbilical and uterine arteries had been reported, but the effects of continuous lower dose epidural bupivacaine (0.05-0.1%) infusion for labour analgesia have never been reported. In this study, we evaluated the effects of continuous epidural bupivacaine 0.075% on the Doppler velocimetry of uterine arteries. METHODS: Twenty pregnant women for labour analgesia received continuous epidural bupivacaine 0.075% infusion. We used a 4-MHz continuous-wave Doppler probe (Multigon 500A) with a 200 Hz thump filter to detect uterine blood flow velocity. We recorded the velocimetry data for uterine relaxation and contraction during five time periods: pre-epidural insertion, 1, 2, and 4 h post-epidural infusion, and after delivery of fetus. RESULTS: Our data showed that the velocimetric indices of uterine vascular resistance were significantly increased 1, 2, and 4 h after epidural infusion when compared with the pre-epidural level; these returned to the baseline after delivery. CONCLUSION: Continuous epidural analgesia with bupivacaine 0.075% increases the resistance of uterine artery and therefore possibly reduces the uterine blood flow.
PMID: 16377645 [PubMed - in process]
Images in Anesthesia: Transesophageal echocardiography images of anomalous circumflex coronary artery.
Wong SS, Shenderey A, Laflamme C.
PMID: 16371616 [PubMed - in process]
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A multi source feedback program for anesthesiologists: [Un programme de retroaction multisources pour les anesthesiologistes].
Lockyer JM, Violato C, Fidler H.
Continuing Medical Education and Professional Development, Faculty of Medicine, University of Calgary, 3330 Hospital Drive N.W., Calgary, Alberta, T2N 4N1, Canada. lockyer@ucalgary.ca.
PURPOSE: To assess the feasibility, validity, and reliability of a multi source feedback program for anesthesiologists. METHODS: Surveys with 11, 19, 29 and 29 items were developed for patients, coworkers, medical colleagues and self, respectively, using five-point scales with an 'unable to assess' category. The items addressed communication skills, professionalism, collegiality, continuing professional development and collaboration. Each anesthesiologist was assessed by eight medical colleagues, eight coworkers, and 30 patients. Feasibility was assessed by response rates for each instrument. Validity was assessed by rating profiles, the percentage of participants unable to assess the physician for each item, and exploratory factor analyses to determine which items grouped together into scales. Cronbach's alpha and generalizability coefficient analyses assessed reliability. RESULTS: One hundred and eighty-six physicians participated. The mean number and percentage return rate of respondents per physician was 17.7 (56.2%) for patients, 7.8 (95.1%) for coworkers, and 7.8 (94.6%) for medical colleagues. The mean ratings ranged from four to five for each item on each scale. There were relatively few items with high percentages of 'unable to assess'. The factor analyses revealed a two-factor solution for the patient, a two-factor solution for the coworker and a three-factor solution for the medical colleague survey, accounting for at least 70% of the variance. All instruments had a high internal consistency reliability (Cronbach's alpha > 0.95). The generalizability coefficients were 0.65 for patients, 0.56 for coworkers and 0.69 for peers. CONCLUSION: It is feasible to develop multi source feedback instruments for anesthesiologists that are valid and reliable.
PMID: 16371607 [PubMed - in process]
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Evidence-based decision making: current challenges and a new feature in the Canadian Journal of Anesthesia/La prise de decision fondee sur les preuves : les defis actuels et une nouvelle chronique dans le Journal canadien d'anesthesie.
Cheng DC, Choi PT.
Department of Anesthesia and Perioperative Medicine, London Health Sciences Centre, 339 Windermere Road, London, Ontario N6A 5A5, Canada. davy.cheng@lhsc.on.ca.
PMID: 16371603 [PubMed - in process]
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Canadian Journal of Anesthesia: 2006 and beyond/Le Journal canadien d'anesthesie : 2006 et au dela.
Miller DR.
Editor-in-Chief, Canadian Journal of Anesthesia, Department of Anesthesia, The Ottawa Hospital, General Campus, Room 2600, 501 Smyth Road, Ottawa, Ontario K1H 8L6, Canada. dmiller@ottawahospital.on.ca.
PMID: 16371602 [PubMed - in process]
Hemodynamic effects of bupropion in anesthetized dogs.
Paganelli MO, Tanus-Santos JE, Sabha M, do Prado JF, Chaud MV, Martins LC, Moreno H Jr.
Cardiovascular Pharmacology and Hypertension Division, Department of Pharmacology, Faculty of Medical Sciences, State University of Campinas (UNICAMP), CP 6111, 13083-970, Campinas, SP, Brazil.
Bupropion is a non-nicotinic drug used in smoking cessation therapy. However, its acute effects remain unclear. In this study, we investigated the effects of bupropion on hemodynamic parameters in pentobarbital-anesthetized mongrel dogs. Bupropion administered either in bolus injections (3 or 6 mg/kg, i.v.) or in cumulative doses of 0.01, 0.1, 1, 3 and 10 mg/kg showed, in both studies, a significant increase of mean pulmonary arterial pressure and pulmonary vascular resistance index. These results show that bupropion can elevate the pulmonary pressure. Further investigations should be done to test this effect in smokers with chronic obstructive pulmonary disease.
PMID: 16376873 [PubMed - in process]
Comment on:
Caudal block.
Ghai B, Bala I, Bhardwaj N.
Publication Types:
PMID: 16176325 [PubMed - indexed for MEDLINE]
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Comment on:
Sedation for MRI.
Mayhew J.
Publication Types:
PMID: 16176323 [PubMed - indexed for MEDLINE]
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The upper airway in Weaver syndrome.
Crawford MW, Rohan D.
Department of Anesthesia, The Hospital for Sick Children, University of Toronto, Ontario, Canada. mark.crawford@sickkids.ca
Weaver syndrome is a rare disorder of unknown etiology characterized by skeletal overgrowth, distinctive craniofacial and digital abnormalities, and advanced bone age. The prime anesthetic problem reported in children with Weaver syndrome is difficulty with tracheal intubation, resulting in part from relative micrognathia, short neck, and an anterior and cephalad position of the larynx. In this report, the authors describe their experience with two children diagnosed with Weaver syndrome who presented for dental surgery. Contrary to previous reports, tracheal intubation was accomplished with relative ease, suggesting that difficulty in intubation in Weaver syndrome may be age-related, diminishing with advancing age and growth of the mandible, as has been reported for other micrognathic syndromes such as Pierre Robin sequence.
Publication Types:
PMID: 16176320 [PubMed - indexed for MEDLINE]
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Central venous catheterization in infants and children--small caliber audio-Doppler probe versus ultrasound scanner.
Arai T, Yamashita M.
Department of Anesthesiology, Ibaraki Children's Hospital, Futaba-dai Mito, Japan. tsmarai@nifty.com
BACKGROUND: Ultrasound guidance for cannulation of the internal jugular vein has been shown to increase the success rate and reduce the incidence of complications in infants and children. We compared the use of a small caliber audio-Doppler probe with an ultrasound scanner for cannulation of a central venous (CV) line via the right internal jugular vein in infants and children. METHODS: Fifty-two infants and 29 children scheduled for open-heart surgery were enrolled. Cannulation was guided using a small caliber audio-Doppler probe (the AU group, n = 42), or an ultrasound scanner image (the US group, n = 39). Ultimate success rate, success rate at the first attempt, success rate within 5 min, and complications were compared for the two groups. RESULTS: In children (>12 months), both methods were equally efficient. But in infants (<12 months), success rate at the first attempt using audio-Doppler was worse than the rate using an ultrasound scanner and there were more complications when audio-Doppler was used. CONCLUSIONS: We conclude that application of both the audio-Doppler and the ultrasound scanner is useful in children over 1 year of age for access to the internal jugular vein. However, in infants and neonates, the ultrasound scanner would be more useful than the audio-Doppler.
Publication Types:
PMID: 16176314 [PubMed - indexed for MEDLINE]
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A comparison of three methods for estimating appropriate tracheal tube depth in children.
Mariano ER, Ramamoorthy C, Chu LF, Chen M, Hammer GB.
Department of Anesthesia, University of California at San Diego School of Medicine, San Diego, CA 92103, USA. ermariano@ucsd.edu
BACKGROUND: Estimating appropriate tracheal tube (TT) depth following tracheal intubation in infants and children presents a challenge to anesthesia practitioners. We evaluated three methods commonly used by anesthesiologists to determine which one most reliably results in appropriate positioning. METHODS: After IRB approval, 60 infants and children scheduled for fluoroscopic procedures requiring general anesthesia were enrolled. Patients were randomly assigned to one of three groups: (1) deliberate mainstem intubation with subsequent withdrawal of the TT 2 cm above the carina ('mainstem' method); (2) alignment of the double black line marker near the TT tip at the vocal cords ('marker' method); or (3) placement of the TT at a depth determined by the formula: TT depth (cm) = 3 x TT size (mmID) ('formula' method). TT tip position was determined to be 'appropriate' if located between the sternoclavicular junction (SCJ) and 0.5 cm above the carina as determined by fluoroscopy. Risk ratios were calculated, and data were analysed by the chi-square test accepting statistical significance at P < 0.05. RESULTS: The mainstem method was associated with the highest rate of appropriate TT placement (73%) compared with both the marker method (53%, P = 0.03, RR = 1.56) and the formula method (42%, P = 0.006, RR = 2.016). There was no difference between the marker and formula methods overall (P = 0.2, RR = 1.27). Analysis of age-stratified data demonstrated higher success with the marker method compared with the formula method for patients 3-12 months (P = 0.0056, RR = 4.0). CONCLUSIONS: Deliberate mainstem intubation most reliably results in appropriate TT depth in infants and children.
Publication Types:
PMID: 16176312 [PubMed - indexed for MEDLINE]
Clown doctors as a treatment for preoperative anxiety in children: a randomized, prospective study.
Vagnoli L, Caprilli S, Robiglio A, Messeri A.
Pain Service-Department of Anesthesia and Intensive Care, Anna Meyer Children's Hospital, 50132 Florence, Italy.
BACKGROUND: The induction of anesthesia is one of the most stressful moments for a child who must undergo surgery: it is estimated that 60% of children suffer anxiety in the preoperative period. Preoperative anxiety is characterized by subjective feelings of tension, apprehension, nervousness, and worry. These reactions reflect the child's fear of separation from parents and home environment, as well as of loss of control, unfamiliar routines, surgical instruments, and hospital procedures. High levels of anxiety have been identified as predictors of postoperative troubles that can persist for 6 months after the procedure. Both behavioral and pharmacologic interventions are available to treat preoperative anxiety in children. OBJECTIVE: The aim of this study was to investigate the effects of the presence of clowns on a child's preoperative anxiety during the induction of anesthesia and on the parent who accompanies him/her until he/she is asleep. METHODS: The sample was composed of 40 subjects (5-12 years of age) who had to undergo minor day surgery and were assigned randomly to the clown group (N = 20), in which the children were accompanied in the preoperative room by the clowns and a parent, or the control group (N = 20), in which the children were accompanied by only 1 of his/her parents. The anxiety of the children in the preoperative period was measured through the Modified Yale Preoperative Anxiety Scale instrument (observational behavioral checklist to measure the state anxiety of young children), and the anxiety of the parents was measured with the State-Trait Anxiety Inventory (Y-1/Y-2) instrument (self-report anxiety behavioral instrument that measures trait/baseline and state/situational anxiety in adults). In addition, a questionnaire for health professionals was developed to obtain their opinion about the presence of clowns during the induction of anesthesia, and a self-evaluation form was developed to be filled out by the clowns themselves about their interactions with the child. RESULTS: The clown group was significantly less anxious during the induction of anesthesia compared with the control group. In the control group there was an increased level of anxiety in the induction room in comparison to in the waiting room; in the clown group anxiety was not significantly different in the 2 locations. The questionnaire for health professionals indicated that the clowns were a benefit to the child, but the majority of the staff was opposed to continuing the program because of perceived interference with the procedures of the operating room. The correlation between the scores of the form to self-evaluate the effectiveness of the clowns and of the Modified Yale Preoperative Anxiety Scale is significant for both the waiting room and induction room. CONCLUSIONS: This study shows that the presence of clowns during the induction of anesthesia, together with the child's parents, was an effective intervention for managing children's and parents' anxiety during the preoperative period. We would encourage the promotion of this form of distraction therapy in the treatment of children requiring surgery, but the resistance of medical personnel make it very difficult to insert this program in the activity of the operating room.
Publication Types:
PMID: 16199685 [PubMed - indexed for MEDLINE]
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