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[Argatroban Pharmacological properties and anaesthesiological aspects.]
[Article in German]
Kleinschmidt S, Stephan B, Pindur G, Bauer C.
Klinik fur Anaesthesiologie, Intensivmedizin und Schmerztherapie, Universitatsklinikum des Saarlandes, Homburg (Saar).
Argatroban is a direct, selective and reversible active site thrombin inhibitor derived from L-arginine. It is a representative of a new class of antithrombotic drugs which offer inhibition of clot-bound as well as fluid-phase thrombin. Argatroban is characterised by favourable pharmacokinetics (beta-elimination half-time approximately 40-50 min) undergoing hepatic metabolism and mainly biliary excretion. Renal impairment will not result in altered or delayed elimination. For many years, argatroban has been used in Japan and in the United States and is approved by the FDA for anticoagulation in patients with heparin-induced thrombocytopenia (HIT type II). The ease of monitoring with the activated partial thromboplastin time, lack of induction of antibodies and adequate safety in renal failure patients, make this drug a favourable mode therapy in comparison with other anticoagulants such as lepirudin or heparinoids. Since June 2005 argatroban has been approved in Germany for the treatment of patients with HIT type II. The main characteristics of the drug with special considerations for anaesthesiologists and intensive care physicians are presented in this review.
PMID: 16389543 [PubMed - as supplied by publisher]
New Diplomates, American Board of Anesthesiology(R), Fall 2005.
[No authors listed]
PMID: 16394729 [PubMed - as supplied by publisher]
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Interscalene block superior to general anesthesia: a discussion of the conclusions regarding these two anesthesia techniques.
Weber SC, Parise CA, Jain R.
*Sacramento Knee and Sports Medicine, Sacramento, California. webersc@earthlink.net.
PMID: 16394721 [PubMed - in process]
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Interscalene Block Superior to General Anesthesia: A Discussion of the Conclusions Regarding These Two Anesthesia Techniques.
Hadzic A, Williams BA, Unis D, Hobeika P.
*St. Luke's-Roosevelt Hospital Center, College of Physicians and Surgeons of Columbia University, New York, New York. ah149@columbia.edu.
PMID: 16394720 [PubMed - as supplied by publisher]
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Interscalene block superior to general anesthesia.
Reuben SS.
Baystate Medical Center and the Tufts University School of Medicine, Springfield, Massachusetts. scott.reuben@bhs.org.
PMID: 16394719 [PubMed - in process]
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Benefits of Regional Anesthesia over General Anesthesia for Outpatient Rotator Cuff Surgery.
Brown AR.
Columbia University, New York, New York. arb6@columbia.edu.
PMID: 16394718 [PubMed - in process]
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Impact of anesthesia management characteristics on severe morbidity and mortality: are we convinced?
Arbous MS, Meursing AE, van Kleef JW, Grobbee DE.
*Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, and Dutch Association for Anesthesiology, Utrecht, The Netherlands. d.e.grobbee@jc.azu.nl.
PMID: 16394715 [PubMed - in process]
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Impact of anesthesia management characteristics on severe morbidity and mortality: are we convinced?
Bilen-Rosas G, Karanikolas M, Evers A, Avidan M.
*Washington University Medical School, St. Louis, Missouri. bilenrog@msnotes.wustl.edu.
PMID: 16394714 [PubMed - in process]
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Impact of anesthesia management characteristics on severe morbidity and mortality: are we convinced?
Warner MA.
Mayo Clinic, Rochester, Minnesota. warner.mark@mayo.edu.
PMID: 16394713 [PubMed - in process]
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Anesthesia risk factors not proven by case-control study.
Schmidt KA.
Valley Hospital, Ridgewood, New Jersey. kschmidt99@aol.com.
PMID: 16394712 [PubMed - in process]
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Anesthesia management and perioperative mortality.
Avram MJ, Krejcie TC.
*Northwestern University Feinberg School of Medicine, Chicago, Illinois. mja190@northwestern.edu.
PMID: 16394709 [PubMed - in process]
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The Anlet: Anesthesiology's Response to the Needs of the Armed Forces in World War II.
Wright L, Waisel D, Bacon D.
* Resident in Anesthesiology, double dagger Professor of Anesthesiology and Medical History, Mayo Clinic College of Medicine. dagger Assistant Professor of Anesthesiology, Harvard Medical School.
PMID: 16394704 [PubMed - as supplied by publisher]
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Anesthesiology Physician Scientists in Academic Medicine: A Wake-up Call.
Schwinn DA, Balser JR.
* James B. Duke Professor of Anesthesiology, Professor of Pharmacology/Cancer Biology and Surgery, Program Director for Cardiovascular Genomics, Center for Genomic Medicine, Institute for Genome Science and Policy, Duke University Medical Center. dagger Associate Vice Chancellor for Research, The James Tayloe Gwathmey Professor of Anesthesiology and Pharmacology, Vanderbilt University Medical Center.
PMID: 16394703 [PubMed - as supplied by publisher]
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Comparison of Plastic Single-use and Metal Reusable Laryngoscope Blades for Orotracheal Intubation during Rapid Sequence Induction of Anesthesia.
Amour J, Marmion F, Birenbaum A, Nicolas-Robin A, Coriat P, Riou B, Langeron O.
* Assistant Professor of Anesthesiology, dagger Resident in Anesthesiology, parallel Staff Anesthesiologist, section sign Professor of Anesthesiology and Critical Care and Chairman, Department of Anesthesiology and Critical Care, double dagger Professor of Anesthesiology and Critical Care and Chairman, Department of Emergency Medicine and Surgery.
BACKGROUND:: Plastic single-use laryngoscope blades are inexpensive and carry a lower risk of infection compared with metal reusable blades, but their efficiency during rapid sequence induction remains a matter of debate. The authors therefore compared plastic and metal blades during rapid sequence induction in a prospective randomized trial. METHODS:: Two hundred eighty-four adult patients undergoing general anesthesia requiring rapid sequence induction were randomly assigned on a weekly basis to either plastic single-use or reusable metal blades (cluster randomization). After induction, a 60-s period was allowed to complete intubation. In the case of failed intubation, a second attempt was performed using metal blade. The primary endpoint of the study was the rate of failed intubations, and the secondary endpoint was the incidence of complications (oxygen desaturation, lung aspiration, and oropharynx trauma). RESULTS:: Both groups were similar in their main characteristics, including risk factors for difficult intubation. On the first attempt, the rate of failed intubation was significantly increased in plastic blade group (17 vs. 3%; P < 0.01). In metal blade group, 50% of failed intubations were still difficult after the second attempt. In plastic blade group, all initial failed intubations were successfully intubated using metal blade, with an improvement in Cormack and Lehane grade. There was a significant increase in the complication rate in plastic group (15 vs. 6%; P < 0.05). CONCLUSIONS:: In rapid sequence induction of anesthesia, the plastic laryngoscope blade is less efficient than a metal blade and thus should not be recommended for use in this clinical setting.
PMID: 16394691 [PubMed - as supplied by publisher]
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Maternal and Neonatal Effects of Remifentanil at Induction of General Anesthesia for Cesarean Delivery: A Randomized, Double-blind, Controlled Trial.
Kee WD, Khaw KS, Ma KC, Wong AS, Lee BB, Ng FF.
* Professor, dagger Associate Professor, section sign Technician, parallel Adjunct Associate Professor, # Research Nurse, Department of Anaesthesia and Intensive Care, double dagger Adjunct Tutor, Department of Paediatrics.
BACKGROUND:: Use of remifentanil during general anesthesia for cesarean delivery has been described, but its maternal and neonatal effects have not been investigated by a controlled study. METHODS:: In a randomized, double-blind, controlled study, patients undergoing elective cesarean delivery received an intravenous bolus of 1 mug/kg remifentanil (n = 20) or saline (n = 20) immediately before induction of general anesthesia. The authors compared maternal hemodynamic changes and neonatal condition and measured plasma concentrations of remifentanil. RESULTS:: The maximum increase in systolic arterial pressure from baseline after induction was smaller in the remifentanil group (median, 9 [range, -17 to 31] mmHg) compared with the control group (42 [6-73] mmHg, median difference, 33 mmHg; 95% confidence interval of difference, 23-45 mmHg; P < 0.0001). Maximum recorded values were smaller in the remifentanil group compared with the control group for systolic and mean arterial pressure and maternal heart rate. Apgar scores and time to sustained respiration were similar between groups. Two neonates in the remifentanil group were considered clinically depressed at birth and were given a single dose of naloxone. Remifentanil crossed the placenta with an umbilical venous/maternal arterial concentration ratio of 0.73 (SD, 0.17) and an umbilical arterial/umbilical venous concentration ratio of 0.60 (0.23). CONCLUSIONS:: A single bolus of 1 mug/kg remifentanil effectively attenuated hemodynamic changes after induction and tracheal intubation. However, remifentanil crosses the placenta and may cause mild neonatal depression and thus should be used for clear maternal indications when adequate facilities for neonatal resuscitation are available.
PMID: 16394684 [PubMed - as supplied by publisher]
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This month in anesthesiology.
Henkel G.
PMID: 16394683 [PubMed - in process]
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Anesthesiology Residency Programs for Physician Scientists.
Knight PR, Warltier DC.
*Departments of Anesthesiology and Microbiology and Immunology and the Medical Scientist Training Program, State University of New York at Buffalo, Buffalo, New York. daggerDepartment of Anesthesiology and the Medical Scientist Training Program, Medical College of Wisconsin, Milwaukee, Wisconsin. pknight@buffalo.edu.
PMID: 16394681 [PubMed - as supplied by publisher]
[The "truths" in anaesthesiology and intensive care.]
[Article in French]
Fourcade O, Samii K.
Coordination d'anesthesie et de reanimation, hopital Purpan, place du Docteur-Baylac, TSA 40031 Toulouse, France.
Publication Types:
PMID: 16386873 [PubMed - as supplied by publisher]
[Epidural anaesthesia and lumbar tattoo: what to do?]
[Article in French]
Raynaud L, Mercier FJ, Auroy Y, Benhamou D; et l'equipe SOS ALR.
Departement d'anesthesie-reanimation, hopital Antoine-Beclere, 157, rue de la Porte-de-Trivaux, 92141 Clamart cedex, France; Service d'anesthesie-reanimation, hopital d'instruction des Armees Percy, 101, avenue Henri-Barbusse, BP 406, 91141 Clamart cedex, France.
More and more often, the anaesthesiologist may have to perform lumbar epidural anaesthesia in a patient with a central lumbar tattoo, and this can occur in an urgent obstetric setting. Before managing two uneventful cases of epidural analgesia for labour, we have performed a literature review and noted that no serious complication has been reported. Nonetheless, a needle passed through a tattoo can entrap pigmented tissue fragments (cores) into the epidural or subarachnoid space. This could theoretically induce risk of late neurological complications, related to an inflammatory or granulomatous response to the pigmented cores introduced in these spaces. To avoid this theoretical risk, the anesthesiologist should try to avoid puncturing through the tattoo, either by selecting a different vertebral interspace, or by using a paramedian approach or by finding a pigment free skin spot within the area of the tattoo. When these options cannot be implemented, a superficial skin incision prior to needle insertion should prevent from coring tattoo pigment when entering the skin. Whatever the final choice, the technique to be implemented should be determined as early as the antenatal visit, after informed consent.
PMID: 16386402 [PubMed - as supplied by publisher]
[Air embolism: an unusual complication of endoscopic retrograde cholangiopancreatography]
[Article in French]
Giuly E, Pesenti C, Pernoud N, Bories E, Francon D.
Departement d'anesthesie-reanimation, institut Paoli-Calmettes, 232, boulevard de Sainte-Marguerite, 13273 Marseille cedex 9, France.
We report the case of a 60-year-old-woman with a myeloma who was hospitalized with a cholestasis. An endoscopic retrograde cholangiopancreatography was scheduled under general anaesthesia with oral intubation. As the biliary prothesis was placed an air embolism happened. The symptomatic treatment allowed a complete recovery. This complication is rare. The pathophysiology is not well known, we discuss the possible mechanisms.
Publication Types:
PMID: 16226421 [PubMed - indexed for MEDLINE]
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[Efficiency of secondary posterior trunk single stimulation, low volume infraclavicular plexus block for upper limb surgery]
[Article in French]
Bloc S, Garnier T, Komly B, Leclerc P, Mercadal L, Morel B, Dhonneur G.
Hopital prive Claude-Galien, 20, route de Boussy, 91480 Quincy-sous-Senart, France. francanest@aol.com
OBJECTIVES: To assess the efficiency of a posterior secondary trunk single stimulation, low volume (30 ml 1.5% mepivacaine) infraclavicular brachial plexus block (ICB) technique. STUDY DESIGN: Prospective study. PATIENTS AND METHODS: One hundred consecutive patients scheduled for hand, forearm or elbow surgery were included. ICB was placed using a single stimulation technique. 30 ml 1.5% mepivacaine was injected when an evoked distal radial motor type response was elicited for 0.3-0.6 mA intensity current. Based upon both sensory and motor distribution ICB, characteristics and performance were assessed. RESULTS: No patient required general anesthesia conversion. Success rate was 92%. 8 patients required a total amount of 10 complementary distal troncular blocks. No specific complication of ICB technique was accoutered. All patients completed full neurological recovery from ICB 24 hours after surgery. CONCLUSION: 30 ml mepivacaine 1.5% ICB is suitable for upper limb surgery.
PMID: 16115744 [PubMed - indexed for MEDLINE]
A survey of local anaesthetic use among general dental practitioners in the UK attending postgraduate courses on pain control.
Corbett IP, Ramacciato JC, Groppo FC, Meechan JG.
University of Newcastle upon Tyne, Framlington Place, Newcastle upon Tyne NE2 4BW. i.p.corbett@ncl.ac.uk
OBJECTIVE: The aim of this study was to identify which local anaesthetic solutions were used by general dental practitioners in the United Kingdom and to determine selection criteria. In addition, differences in anaesthetic choice between recent graduates (< or = 5 years) and more experienced practitioners were investigated. MATERIAL AND METHODS: Five hundred and six general dental practitioners attending postgraduate courses on pain control in dentistry completed a questionnaire. Participants were asked to indicate year and place of qualification, anaesthetic solutions available in their surgeries and criteria used in the choice of anaesthetic. In addition, the respondents were asked to indicate choice of local anaesthetic in a number of common medical conditions. Questionnaires were distributed and collected immediately prior to the start of the course presentation and participants were not asked to indicate whether the selection decisions were teaching, experience or evidence based. Data were analysed by using the Chi-square test. RESULTS: Lidocaine with epinephrine was the most widely available solution among this group of practitioners (94%), the second most common solution was prilocaine with felypressin (74%). The majority of practitioners had two or more solutions available. Practitioners who qualified within the last five years (14%) were more likely to have articaine available, the most recently introduced local anaesthetic into the UK (p = 0.04, one degree of freedom). Common medical conditions lead to a modification in anaesthetic selection: the use of prilocaine/felypressin increases in the majority of circumstances, although it is avoided in pregnant females by recent graduates. CONCLUSIONS: Lidocaine/epinephrine continues to be the most common anaesthetic solution used by this group of UK general practitioners. The primary criterion for selection of an anaesthetic agent was perceived efficacy. Prilocaine/felypressin is commonly selected as an alternative solution in the presence of common medical conditions.
PMID: 16395370 [PubMed - in process]
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Local anaesthetic use among GDPs.
Coulthard P.
ObjectiveThe aim of this study was to identify which local anaesthetic solutions were used by general dental practitioners in the United Kingdom and to determine selection criteria. In addition, differences in anaesthetic choice between recent graduates (</=5 years) and more experienced practitioners were investigated.Material and methodsFive hundred and six general dental practitioners attending postgraduate courses on pain control in dentistry completed a questionnaire. Participants were asked to indicate year and place of qualification, anaesthetic solutions available in their surgeries and criteria used in the choice of anaesthetic. In addition, the respondents were asked to indicate choice of local anaesthetic in a number of common medical conditions. Questionnaires were distributed and collected immediately prior to the start of the course presentation and participants were not asked to indicate whether the selection decisions were teaching, experience or evidence based. Data were analysed by using the Chi-square test.ResultsLidocaine with epinephrine was the most widely available solution among this group of practitioners (94%), the second most common solution was prilocaine with felypressin (74%). The majority of practitioners had two or more solutions available. Practitioners who qualified within the last five years (14%) were more likely to have articaine available, the most recently introduced local anaesthetic into the UK (p = 0.04, one degree of freedom). Common medical conditions lead to a modification in anaesthetic selection: the use of prilocaine/felypressin increases in the majority of circumstances, although it is avoided in pregnant females by recent graduates.ConclusionsLidocaine/epinephrine continues to be the most common anaesthetic solution used by this group of UK general practitioners. The primary criterion for selection of an anaesthetic agent was perceived efficacy. Prilocaine/felypressin is commonly selected as an alternative solution in the presence of common medical conditions.
PMID: 16395368 [PubMed - in process]
Lethal adverse reaction during anaesthetic induction.
Fernandez-Galinski S, Pacrev S, Vela E, Munne MA, Escolano F.
Department of Anaesthesiology, Hospital Universitario del Mar UAB, Barcelona, Spain.
PMID: 16390573 [PubMed - in process]
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Low flow desflurane and sevoflurane anaesthesia in children.
Isik Y, Goksu S, Kocoglu H, Oner U.
University of Gaziantep, Faculty of Medicine, Department of Anesthesiology and Reanimation, Gaziantep, Turkey.
SummaryBackground and objective: Low flow desflurane and sevoflurane anaesthesia were administered to children and compared for haemodynamic response, renal and hepatic function, recovery time and postoperative nausea and vomiting. Methods: Eighty ASA I-II patients aged 5-15 yr were included in the study. Midazolam was given for premedication. Anaesthesia induction was performed with fentanyl, propofol and atracurium. After intubation, the first group received desflurane, oxygen and nitrous oxide at 6 L min-1 and the second sevoflurane, oxygen and nitrous oxide at 6L min-1. Ten minutes after induction the flow was decreased to 1L min-1 in both groups. Haemodynamic parameters, preoperative and postoperative renal and hepatic function, the times of operation and anaesthesia, and early recovery data were recorded. Modified Aldrete scores were noted at the 10th and 30th minutes postoperatively and postoperative nausea, and vomiting were assessed. Results: There were no significant differences in haemodynamic parameters, renal and hepatic functions, postoperative recovery and postoperative nausea and vomiting between groups. The recovery time was shorter in the desflurane group compared to the sevoflurane group. Conclusion: Low flow desflurane and sevoflurane anaesthesia do not adversely affect haemodynamic parameters, hepatic and renal function in children. Desflurane may be preferred when early recovery from anaesthesia is warranted.
PMID: 16390568 [PubMed - in process]
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Vasoconstrictor prostanoids may be involved in reduced coronary reactive hyperemia after ischemia-reperfusion in anesthetized goats.
Climent B, Fernandez N, Sanchez A, Garcia-Villalon AL, Monge L, Dieguez G.
Departamento de Fisiologia, Facultad de Medicina, Universidad Autonoma, Arzobispo Morcillo, 2 28029 Madrid, Spain.
To examine coronary vasodilator reserve after ischemia-reperfusion, reactive hyperemia was determined during reperfusion after partial and total, brief and prolonged ischemia. To this, left circumflex coronary artery flow was electromagnetically measured, and partial (60 min) or total (15 and 60 min) occlusions of this artery were induced, followed in each case by 60-min reperfusion in anesthetized goats untreated and treated with N(W)-nitro-l-arginine methyl ester (l-NAME) or meclofenamate. In untreated and treated animals, coronary flow was decreased during reperfusion after the three types of ischemia. In hyperemic responses to 5- and 10-s coronary occlusions, repayment of debt decreased during reperfusion after the three types of ischemia in untreated animals, and this decrease was not affected by l-NAME. This decrease during reperfusion after partial and total, 60-min ischemia, but not after total, 15-min ischemia, reversed with meclofenamate. Peak hyperemic flow/control flow ratio decreased only during reperfusion after total 60-min occlusion in untreated animals and it was normalized by meclofenamate. These results show that ischemia-reperfusion reduces hyperemic response (vasodilator reserve); this diminution being dependent on duration and severity of ischemia. The hyperemic responses reduction during reperfusion after prolonged ischemia, but not after brief ischemia may be related at least in part to increased production of vasoconstrictor prostanoids.
PMID: 16386731 [PubMed - in process]
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