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Comment on:
Epidural test dose. How to be sure it is safe?
Tsui BC.
Publication Types:
PMID: 16223418 [PubMed - indexed for MEDLINE]
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Dextrose 5% in water: fluid medium for maintaining electrical stimulation of peripheral nerves during stimulating catheter placement.
Tsui BC, Kropelin B, Ganapathy S, Finucane B.
Department of Anesthesiology and Pain Medicine, University of Alberta Hospital, Edmonton, Alberta, Canada. btsui@ualberta.ca
It is well documented that a higher electrical current is required to elicit a motor response following a normal saline (NS) injection during the placement of stimulating catheters for peripheral nerve block. We present three cases of continuous brachial plexus catheter placement in which Dextrose 5% in water (D5W) was used to dilate the perineural space instead of NS. Three brachial plexus blocks (two interscalene and one axillary) were performed in three different patients for pain relief. In each case, an insulated needle was advanced towards the brachial plexus. A corresponding motor response was elicited with a current less than 0.5 mA after needle repositioning. A stimulating catheter was advanced with ease after 3-5 ml of D5W was injected to dilate the perineural space. A corresponding motor response was maintained when the current applied to the stimulating catheter was less than 0.5 mA. Local anesthetic was then injected and the motor response immediately ceased. All blocks were successful and provided excellent pain relief with the continuous infusion of local anesthetics.
Publication Types:
PMID: 16223407 [PubMed - indexed for MEDLINE]
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Comparison of the effect of ketamine added to bupivacaine and ropivacaine, on stress hormone levels and the duration of caudal analgesia.
Akbas M, Titiz TA, Ertugrul F, Akbas H, Melikoglu M.
Department of Anaesthesiology, Akdeniz University Medical Faculty, Antalya, Turkey. akbasmert@akdeniz.edu.tr
BACKGROUND: The aim of this study was to compare bupivacaine 0.25% and ropivacaine 0.2%, singly and in combination with ketamine, for caudal administration in children. Duration of analgesia, the need for other analgesics and the stress response were measured. METHODS: Eighty children were randomized into four groups of twenty. The bupivacaine group received bupivacaine 0.25% and the ketamine/bupivacaine group received bupivacaine 0.25% plus 0.5 mg/kg ketamine. The ropivacaine group received ropivacaine 0.2%, and the ketamine/ropivacaine group received ropivacaine 0.2% plus 0.5 mg/kg ketamine. The duration of analgesia and analgesic requirements were recorded for each group, as were peri-operative and post-operative concentrations of the stress hormones insulin, glucose and cortisol. RESULTS: Ketamine, added to either bupivacaine or ropivacaine for caudal analgesia, gave a longer duration of analgesia (P < 0.05) than bupivacaine or ropivacaine alone. In all groups, blood insulin concentration was increased, and cortisol concentration reduced. Glucose concentration was significantly increased in all groups (P < 0.05). CONCLUSIONS: Ketamine can safely be added to ropivacaine 0.2% or bupivacaine 0.25% for caudal anesthesia in order to prolong duration of analgesia and reduce the need for additional analgesics. Stress hormone levels are partially attenuated.
Publication Types:
PMID: 16223400 [PubMed - indexed for MEDLINE]
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Intrathecal clonidine does not reduce post-spinal shivering.
Jeon YT, Jeon YS, Kim YC, Bahk JH, Do SH, Lim YJ.
Department of Anesthesiology, Seoul National University Bundang Hospital, Seognam, Seoul, South Korea.
BACKGROUND: After general or epidural anesthesia, clonidine is known to be effective in suppressing established shivering. The aim of this study was to assess the preventive effect of intrathecal clonidine on post-spinal shivering compared with intravenous (i.v.) clonidine. METHODS: One hundred and fifty patients scheduled for orthopedic surgery were randomly allocated into three groups to receive either 1 microg/kg clonidine i.v. (IV group) or the same volume of isotonic saline (control and IT groups) at 5 min before spinal anesthesia. Spinal anesthesia was performed with 12-15 mg hyperbaric bupivacaine 0.5% plus either 1 ml of saline (control and IV groups) or 150 microg clonidine (IT group). Shivering was evaluated for a period of 90 min and graded as none, mild, moderate, and severe. RESULTS: Twenty patients (40%) in the control group and 17 patients (34%) in the IT group showed shivering compared with four (8%) in the IV group. Patients with moderate-to-severe shivering were only seen in the control and IT group, and the maximal intensity of shivering was not different between the two groups. Patients in the IV group were significantly more sedated than the other groups. CONCLUSIONS: The intrathecal administration of clonidine 150 microg fails to prevent post-spinal shivering; by contrast, we have confirmed that i.v. clonidine 1 microg/kg is an effective method to prevent shivering in patients undergoing spinal anesthesia for orthopedic surgery.
Publication Types:
PMID: 16223398 [PubMed - indexed for MEDLINE]
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A comparison of two double-injection techniques for peribulbar block analgesia: infero-temporal plus supero-medial vs. infero-temporal plus medial-percaruncular.
van den Berg AA.
Department of Anesthesiology, Oregon Health & Sciences University, Portland, OR 97239-3908, USA. antonvdb2000@yahoo.com
BACKGROUND: Combinations of infero-temporal and either supero-nasal ('inferior-superior') or medial percaruncular ('inferior-medial') injections are popular double-injection techniques for establishing peribulbar block analgesia. This study compared the efficacy of these two techniques in achieving ocular and lid akinesia. METHODS: One hundred patients were randomized to receive inferior-superior or inferior-medial injections in a study in which injectate, injectate volumes, 5-min ocular akinesia scoring (0-8), lid scoring (0-2) and supplemental injection protocols were standardized. The numbers of supplemental injections required at each observation period and the total volume of injectate required to produce ocular and lid akinesia were compared. RESULTS: The two test groups were demographically similar. The inferior-medial combination achieved greater ocular akinesia than the inferior-superior combination 5 min after the initial injections (mean score +/- standard deviation of 1.74 +/- 1.86 vs. 2.66 +/- 2.39; P < 0.05), with a reduced requirement for supplementary injections (3 vs. 23 supplementary injections; P < 0.025). The inferior-superior technique achieved greater lid akinesia at 5 min than the inferior-medial technique (mean score +/- standard deviation of 0.7 +/- 0.9 vs. 0.3 +/- 0.58; P < 0.005). A medial subconjunctival hemorrhage occurred in one patient in the inferior-medial group. CONCLUSION: Compared with the inferior-superior technique, the inferior-medial combination achieved more rapid ocular akinesia with less need for supplementation, but induced less efficient lid akinesia and had a propensity to cause iatrogenic subconjunctival hemorrhage. The latter complication is considered by our surgeons to be a contraindication to the inferior-medial technique in patients undergoing trabeculectomy.
Publication Types:
PMID: 16223394 [PubMed - indexed for MEDLINE]
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Intra-operative remifentanil might influence pain levels in the immediate post-operative period after major abdominal surgery.
Hansen EG, Duedahl TH, Romsing J, Hilsted KL, Dahl JB.
Department of Anaesthesiology, Herlev University Hospital, Herlev, Denmark.
BACKGROUND: Remifentanil, a widely used analgesic agent in anaesthesia, has a rapid onset and short duration of action. In clinical settings, this requires an appropriate pain strategy to prevent unacceptable pain in the post-operative period. The aim of this study was to investigate whether remifentanil had any impact on post-operative pain and opioid consumption after major abdominal surgery. METHODS: Fifty patients undergoing major abdominal surgery were randomized to receive either remifentanil 0.4 microg/kg/min or placebo intra-operatively, in addition to basic combined general and epidural anaesthesia, in this double-blind study. Patients received patient-controlled analgesia with morphine for 24 h post-operatively. Morphine consumption, assessment of pain at rest and during coughing, side-effects and levels of sensory block were recorded during the first 24 h post-operatively. RESULTS: Twenty-one patients receiving remifentanil and 18 patients receiving placebo completed the study. The median visual analogue scale (VAS) score at rest from 0 to 2 h was significantly increased in the remifentanil group [40 mm (27-61 mm)] vs. placebo [13 mm (3-35 mm)] (P < 0.05). No significant differences in morphine consumption, VAS score during coughing or adverse effects were observed between the groups. CONCLUSION: The results are weak and difficult to interpret. They could indicate that a high dose of remifentanil added to otherwise sufficient combined general and epidural anaesthesia may induce opioid-induced hyperalgesia and/or clinically acute opioid tolerance after major abdominal surgery; however, as no significant differences could be observed between the groups after 2 h post-operatively, the clinical relevance of these observations is questionable.
Publication Types:
PMID: 16223391 [PubMed - indexed for MEDLINE]
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The physics, clinical measurement, and equipment of anaesthetic practice.
Carty SJ.
PMID: 16409373 [PubMed - in process]
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Abstracts presented at the Annual Meeting of the Age Anaesthesia Association in Middlesbrough, May 2005.
[No authors listed]
PMID: 16409372 [PubMed - as supplied by publisher]
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Abstracts presented at the European Society of Regional Anaesthesia (UK & Ireland) Annual Scientific Meeting in Clydebank, Glasgow, on 12-13 May 2005.
[No authors listed]
PMID: 16409371 [PubMed - as supplied by publisher]
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Abstracts presented at the spring meeting of the Association of Cardiothoracic Anaesthetists (ACTA) in Cambridge, July 2005.
[No authors listed]
PMID: 16409370 [PubMed - as supplied by publisher]
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Abstracts presented at the Annual Congress of the Association of Anaesthetists of Great Britain & Ireland in Manchester, September 2005.
[No authors listed]
PMID: 16409369 [PubMed - as supplied by publisher]
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Loose adhesive in anaesthetic circuit.
Fernandes MP, Barker KF.
Publication Types:
PMID: 16409359 [PubMed - in process]
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Autotriggering of pressure support ventilation during general anaesthesia.
Coxon M, Sindhakar S, Hodzovic I.
Publication Types:
PMID: 16409358 [PubMed - in process]
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Anaesthesia for endobronchial brachytherapy.
Brodick PM.
Publication Types:
PMID: 16409353 [PubMed - in process]
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Cardiovascular changes after induction of anaesthesia.
Kinsella J, Anderson K, Harten J.
Publication Types:
PMID: 16409348 [PubMed - in process]
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Reducing the risk of prion transmission in anaesthesia.
Walsh EM.
Publication Types:
PMID: 16409346 [PubMed - in process]
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Obesity and obstetric anaesthesia.
Saravanakumar K, Rao SG, Cooper GM.
Department of Anaesthetics, Birmingham Women's Hospital, Edgbaston, Birmingham B15 2TG, UK. saravankumark@yahoo.com
The prevalence of obesity continues to increase despite preventive strategies. Obese parturients are at increased risk of having either concurrent medical problems or superimposed antenatal diseases such as pre-eclampsia and gestational diabetes. Moreover, they have a tendency to labour abnormally contributing to increased instrumental delivery and Caesarean section. Obesity is a risk factor for anaesthesia related maternal mortality. Morbidly obese women must be considered as high-risk and deserve an anaesthetic consultation during their antenatal care. The significant difficulty in administering epidural analgesia should not preclude their use in labour. A more liberalised use of regional techniques may be a means to further reduce anaesthesia-related maternal mortality in the obese population. The mother's life should not be jeopardised to save a compromised fetus. Prophylactic placement of an epidural catheter when not contraindicated in labouring morbidly obese women would potentially decrease anaesthetic and perinatal complications associated with attempts at emergency provision of regional or general anaesthesia. Early mobilisation, aggressive chest physiotherapy and adequate pain control are essential components of effective postoperative care.
PMID: 16409341 [PubMed - in process]
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A randomised double-blind controlled study evaluating the hypothermic effect of 150 microg morphine during spinal anaesthesia for Caesarean section.
Hui CK, Huang CH, Lin CJ, Lau HP, Chan WH, Yeh HM.
Department of Anaesthesiology, National Taiwan University Hospital, Taipei, Taiwan.
We studied the hypothermic effect of adding 150 microg morphine during spinal anaesthesia in 60 parturients scheduled for elective caesarean section. All the parturients received intrathecal injection of a solution containing 150 mug morphine or normal saline in addition to 10-12 mg hyperbaric bupivacaine 0.5%. In both groups, a significant decrease in body temperature was noted. There was no difference in the area under the curve for temperature against time for the two groups; however, the maximum decrease in temperature from baseline was significantly larger after morphine than after saline injection (mean (SD) 1.11 (0.61) degrees C vs 0.76 (0.39) degrees C, respectively; p = 0.01) and the time to nadir temperature was significantly longer (59.5 (17.6) min vs 50.4 (15.9) min, respectively; p = 0.047). The lowest temperature observed in the morphine group was 34.3 degrees C. We conclude that intrathecal injection of 150 microg morphine intensified the intra-operative hypothermic effect of bupivacaine spinal anaesthesia for caesarean section.
PMID: 16409339 [PubMed - in process]
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Effect of an anaesthesia department led critical care outreach and acute pain service on postoperative serious adverse events.
Story DA, Shelton AC, Poustie SJ, Colin-Thome NJ, McIntyre RE, McNicol PL.
Department of Anaesthesia, The University of Melbourne, Austin Health, Melbourne, Victoria, Australia. David.Story@austin.org.au
We examined whether a combined critical care outreach and acute pain service comprising both medical and nursing staff from the Department of Anaesthesia would decrease the incidence of postoperative serious adverse events in a hospital with an established Medical Emergency Team. We called this combined service IMPACT: Inpatient Management of acute Pain and Advice on Clinical Treatment. We conducted a prospective, before-and-after trial with a baseline phase (319 patients) of standard acute pain management followed by the IMPACT phase (271 patients), during which the IMPACT team systematically reviewed high-risk postoperative patients for the first three days after their return to the general wards. The incidence of serious adverse events decreased from 23 events per 100 patients to 16 events per 100 patients. The 30-day mortality decreased from 9% to 3%, p = 0.004. An acute pain service providing critical care outreach may improve postoperative outcome but the workload is considerable.
PMID: 16409338 [PubMed - in process]
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Radiation exposure of trainee anaesthetists.
Ismail S, Khan FA, Sultan N, Naqvi M.
Department of Anaesthesia, Aga Khan University, Karachi, Pakistan.
This prospective study was conducted to determine the level of radiation exposure of trainee anaesthetists working in urology, orthopaedics and radiology environments. Anaesthetists wore lithium fluoride thermoluminescent dosimeter (TLD) badges over a 6-month period. The position of badges was standardised at the collar site (TLD1) and at waist level (TLD2). Area specific dosimeters were used and exchanged between anaesthetists. Of a total of 723 procedures, anaesthetists were exposed to radiation in 33% of procedures in orthopaedics, 30% in urology and 39% in radiology. The mean (SD) exposure time to radiation per case was significantly greater in orthopaedics than in urology (9.2 (4) min vs. 4.2 (2) min). The radiation exposure per case was highest in radiology (19.2 (22) min). The net combined exposure over a 6-month period was 0.2177 mSv in urology, 0.4265 mSv in orthopaedics and 3.8457 mSv in radiology. The combined exposure was less than the 20 mSv recommended as the maximum exposure per year. Our data does not support the need for routine dosimetric monitoring of anaesthetists working in the above settings.
PMID: 16409335 [PubMed - in process]
[The speciality of anesthesia outside western medicine With special consideration of personal experience in the Democratic Republic of the Congo and Mongolia.]
[Article in German]
Dunser M, Baelani I, Ganbold L.
Klinik fur Anasthesie, Medizinische Universitat, Innsbruck, Osterreich.
During the last decades anesthesia has developed into a wide ranging speciality in western countries, whereas in most developing and newly industrializing nations it still focuses on its core discipline, the perioperative care of the surgical patient. Poor socioeconomic status and inadequate financing of health systems result in a high burden of disease, a high rate of self-financing of healthcare costs by the patients, as well as insufficient personnel, infrastructural and material equipment of most healthcare facilities. Important limiting factors for anesthesia are low educational standards and a widespread lack of oxygen and medical gas supplies, as well as locally serviceable medical equipment. Studies evaluating the status of anesthesia in developing and newly industrializing nations in detail are urgently needed in order to provide aid on national and international as well as institutional and private levels for the development of anesthesia in poor countries.
PMID: 16425039 [PubMed - as supplied by publisher]
Comment on:
Could an epidural hematoma after neuraxial blockade really be idiopathic?
Marcou TA, Mignon A, Ozier Y.
Publication Types:
PMID: 16368861 [PubMed - indexed for MEDLINE]
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Partial sensory and motor deficit of ipsilateral lower limb after continuous interscalene brachial plexus block.
Faust A, Fournier R, Hagon O, Hoffmeyer P, Gamulin Z.
Division of Anesthesiology, University Hospitals of Geneva, Switzerland. alexandre.faust@hcuge.ch
We describe a partial sensory and motor block of the ipsilateral lower limb after interscalene infusion. After and injection of 20 mL of ropivacaine through the needle, the catheter was advanced 5 cm, and an infusion of ropivacaine 0.2% 5 mL/h commenced. Six hours later, the patient reported a left sensory and motor hemisyndrome, which resolved after the infusion was discontinued. Cervical computed tomography showed the tip of the catheter close to the intervertebral foramen at the C7-T1 level and several intravertebral paramedullar air bubbles. We conclude that the neurological symptoms were caused by an injection of local anesthetic via an interscalene catheter placed in proximity to the epidural space. To avoid this complication, we recommend advancing the catheter no more than 2-3 cm and performing frequent neurological evaluation of patients.
Publication Types:
PMID: 16368845 [PubMed - indexed for MEDLINE]
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The effect of age on the systemic absorption and systemic disposition of ropivacaine after epidural administration.
Simon MJ, Veering BT, Vletter AA, Stienstra R, van Kleef JW, Burm AG.
Department of Anesthesiology, Leiden University Medical Center, Leiden, The Netherlands. M.J.G.Simon@lumc.nl
Knowledge about the systemic absorption and disposition of ropivacaine after epidural administration is important in regard to its clinical profile and the risk of systemic toxicity. We investigated the influence of age on the pharmacokinetics of ropivacaine 1.0% after epidural administration, using a stable-isotope method. Twenty-four patients were enrolled in 1 of 3 groups according to age (group 1: 18-40 yr; group 2: 41-60 yr; group 3: > or =61 yr). Patients received 150 mg ropivacaine hydrochloride epidurally. After 25 min, patients received 50 mL 0.44 mg/mL deuterium-labeled ropivacaine (D3-ropivacaine) IV. Arterial blood samples were collected up to 24 h after epidural administration. Total plasma concentrations of ropivacaine and D3-ropivacaine were determined using liquid chromatography mass spectrometry. In the oldest patients, elimination half-life was significantly longer (ratio of the geometric means 0.60; 95% confidence interval, 0.37-0.99) and clearance was significantly decreased (mean difference, 194 mL/min; 95% confidence interval, 18-370 mL/min) compared with the youngest patients. The systemic absorption was biphasic. Absorption kinetics for ropivacaine (fractions absorbed: (F1, F2) and half-lives: (t(1/2),a1), t(1/2),a2) during the fast and slow absorption process: 0.27 +/- 0.08 and 0.77 +/- 0.12, respectively; 10.7 +/- 5.2 min and 248 +/- 64 min, respectively) were in the same range as for other long-acting local anesthetics. F1 was on average 0.11 (95% confidence interval, 0.002-0.22) higher in the youngest compared with the middle age group. Observed age-dependent pharmacokinetic differences do not likely influence the risk of systemic toxicity in the elderly after a single epidural dose of ropivacaine.
PMID: 16368843 [PubMed - indexed for MEDLINE]
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Continuous positive airway pressure breathing increases the spread of sensory blockade after low-thoracic epidural injection of lidocaine.
Visser WA, Gielen MJ, Giele JL.
Department of Anesthesiology, Intensive Care and Pain Management, Amphia Hospital, Breda, The Netherlands. avisser@amphia.nl
Factors affecting the distribution of sensory blockade after epidural injection of local anesthetics remain incompletely clarified. To evaluate if increasing intrathoracic pressure affects the spread of thoracic epidural anesthesia, we randomized 20 patients who received an epidural catheter at the T7-8 or T8-9 intervertebral space into 2 groups. The control group (n = 10) received an epidural test dose of 4 mL lidocaine 2% during spontaneous breathing at ambient pressure. The continuous positive airway pressure (n = 10) group received the same epidural test dose but during spontaneous respiration with 7.5 cm H2O continuous positive airway pressure. The groups were comparable with respect to demographic variables. Fifteen minutes after the conclusion of the epidural injection, the sensory block ranged from from T4 [median, interquartile range 2.75 segments] to T11 (interquartile range 3.5 segments) in the control group and from T5 (interquartile range 2.25 segments) to L2 (IQR 2.25 segments) in the continuous positive airway pressure group (P = 0.005 for the caudal border). The total number of segments blocked was 7 (median, interquartile range 2.25) in the control group and 11 (interquartile range 3.5) in the continuous positive airway pressure group (P = 0.004). The number of segments blocked caudad to the injection site was 3 (median, interquartile range 3.5) in the control group and 6 (interquartile range 2.25) in the continuous positive airway pressure group (P = 0.005). We conclude that continuous positive airway pressure increases the spread of sensory blockade in thoracic epidural anesthesia, primarily by a more caudad extension of sensory blockade.
Publication Types:
PMID: 16368841 [PubMed - indexed for MEDLINE]
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Dexamethasone added to lidocaine prolongs axillary brachial plexus blockade.
Movafegh A, Razazian M, Hajimaohamadi F, Meysamie A.
Department of Anesthesiology and Critical Care, Dr. Ali Shariati Hospital, Tehran, Iran. movafegh@sina.tums.ac.ir
Different additives have been used to prolong regional blockade. We designed a prospective, randomized, double-blind study to evaluate the effect of dexamethasone added to lidocaine on the onset and duration of axillary brachial plexus block. Sixty patients scheduled for elective hand and forearm surgery under axillary brachial plexus block were randomly allocated to receive either 34 mL lidocaine 1.5% with 2 mL of isotonic saline chloride (control group, n = 30) or 34 mL lidocaine 1.5% with 2 mL of dexamethasone (8 mg) (dexamethasone group, n = 30). Neither epinephrine nor bicarbonate was added to the treatment mixture. We used a nerve stimulator and multiple stimulations technique in all of the patients. After performance of the block, sensory and motor blockade of radial, median, musculocutaneous, and ulnar nerves were recorded at 5, 15, and 30 min. The onset time of the sensory and motor blockade was defined as the time between last injection and the total abolition of the pinprick response and complete paralysis. The duration of sensory and motor blocks were considered as the time interval between the administration of the local anesthetic and the first postoperative pain and complete recovery of motor functions. Sixteen patients were excluded because of unsuccessful blockade. The duration of surgery and the onset times of sensory and motor block were similar in the two groups. The duration of sensory (242 +/- 76 versus 98 +/- 33 min) and motor (310 +/- 81 versus 130 +/- 31 min) blockade were significantly longer in the dexamethasone than in the control group (P < 0.01). We conclude that the addition of dexamethasone to lidocaine 1.5% solution in axillary brachial plexus block prolongs the duration of sensory and motor blockade.
Publication Types:
PMID: 16368840 [PubMed - indexed for MEDLINE]
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Does continuous peripheral nerve block provide superior pain control to opioids? A meta-analysis.
Richman JM, Liu SS, Courpas G, Wong R, Rowlingson AJ, McGready J, Cohen SR, Wu CL.
Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins University, Baltimore, Maryland, USA. jrichma1@jhmi.edu
Although most randomized clinical trials conclude that the addition of continuous peripheral nerve blockade (CPNB) decreases postoperative pain and opioid-related side effects when compared with opioids, studies have included relatively small numbers of patients and the majority failed to show statistical significance during all time periods for reduced pain or side effects. We identified studies primarily by searching Ovid Medline (1966-May 21, 2004) for terms related to postoperative analgesia with CPNB and opioids. Each article from the final search was reviewed and data were extracted from tables, text, or extrapolated from figures as needed. Nineteen articles, enrolling 603 patients, met all inclusion criteria. Inclusion criteria were a clearly defined anesthetic technique (combined general/regional anesthesia, general anesthesia alone, peripheral nerve block), randomized trial, adult patient population (> or =18 yr old), CPNB (or analgesia) used postoperatively (intrapleural catheters were deemed not to be classified as a peripheral nerve catheter), and opioids administered for postoperative analgesia in groups not receiving peripheral nerve block. Perineural analgesia provided better postoperative analgesia compared with opioids (P < 0.001). This effect was seen for all time periods measured for both mean visual analog scale and maximum visual analog scale at 24 h (P < 0.001), 48 h (P < 0.001), and 72 h (mean visual analog scale only) (P < 0.001) postoperatively. Perineural catheters provided superior analgesia to opioids for all catheter locations and time periods (P < 0.05). Nausea/vomiting, sedation, and pruritus all occurred more commonly with opioid analgesia (P < 0.001). A reduction in opioid use was noted with perineural analgesia (P < 0.001). CPNB analgesia, regardless of catheter location, provided superior postoperative analgesia and fewer opioid-related side effects when compared with opioid analgesia.
Publication Types:
PMID: 16368838 [PubMed - indexed for MEDLINE]
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The efficacy and safety of intravenous emulsified isoflurane in rats.
Zhou JX, Luo NF, Liang XM, Liu J.
Intensive Care Unit, Bejing Tiantan Hospital, Capital University of Medical Sciences, Bejing, China.
Although direct IV injection of liquid volatile anesthetics is usually lethal, anesthesia using emulsified halothane and isoflurane without adverse effects has been safely induced in animals. We identified the safe concentration of emulsified volatile anesthetic preparations and determined the dose-response relationship of IV emulsified isoflurane and propofol in rats. Liquid/gas partition coefficients of desflurane, sevoflurane, isoflurane, enflurane, and halothane in 20% and 30% Intralipid were measured and used to calculate their saturated concentrations. Unsaturated emulsified isoflurane was prepared by adding liquid isoflurane to 30% Intralipid. The loss of forepaw righting reflex was taken as induction of anesthesia, and disappearance of electrocardiogram was taken as death. The median effective induction dose (ED50) and median lethal dose (LD50) of emulsified isoflurane were 0.072 and 0.216 mL/kg liquid isoflurane, respectively. The ED50 and LD50 of propofol were 5.89 mg/kg and 18.19 mg/kg, respectively. Time to return of forepaw righting reflex after injection of emulsified isoflurane (38 +/- 18 s) was significantly shorter than with propofol (101 +/- 62 s; P < 0.05). Anesthesia was successfully induced in rats by IV emulsified isoflurane with a comparable safety index and certain safety factor as propofol. Recovery of anesthesia after IV emulsified isoflurane was faster than with propofol.
PMID: 16368817 [PubMed - indexed for MEDLINE]
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Total knee arthroplasty as an overnight-stay procedure using continuous femoral nerve blocks at home: a prospective feasibility study.
Ilfeld BM, Gearen PF, Enneking FK, Berry LF, Spadoni EH, George SZ, Vandenborne K.
Department of Anesthesiology, PUniversity of Florida, Gainesville, Florida, USA. bilfeld@ulf.edu
The average duration of hospitalization after total knee arthroplasty (TKA) in the United States is 4-5 days. In this two-phase study we investigated the feasibility of converting TKA into an overnight-stay procedure using a continuous femoral nerve block provided at home through postoperative day 4. Nine of 10 patients met discharge criteria and were discharged home the day after surgery. Pain was well controlled, opioid requirements and sleep disturbances were minimal, and patient satisfaction was high. Additional research is required to replicate these results in a controlled trial, define the appropriate subset of patients, and assess the incidence of complications associated with this practice before its mainstream use.
PMID: 16368810 [PubMed - indexed for MEDLINE]
Dental anxiety, distress at induction and postoperative morbidity in children undergoing tooth extraction using general anaesthesia.
Hosey MT, Macpherson LM, Adair P, Tochel C, Burnside G, Pine C.
1Senior Lecturer/Honorary Consultant in Paediatric Dentistry, University of Glasgow Dental School, 378 Sauchiehall Street, Glasgow, G2 3JZ.
Objective To report on the prevalence of postoperative morbidity in children undergoing tooth extraction under chair dental general anaesthetic (CDGA) in relation to pre-operative dental anxiety and anaesthetic induction distress.Design A prospective national study.Setting Twenty-five Scottish DGA centres in 2001.Subjects and method Four hundred and seven children (mean age 6.6 years; range: 2.3 to 14.8 years; 52% male). Before CDGA, the Modified Child Dental Anxiety (MCDAS) and Modified Dental Anxiety (MDAS) Scales were completed for children and accompanying adult respectively; the latter also returned a morbidity questionnaire 24 hours and one week post-operatively. Anaesthetic induction distress was scored immediately before CDGA induction using the Children's Hospital of Eastern Ontario Pain Scale (CHEOPS).Results The mean MCDAS score was 24.2 (population norm 18.2); 21% of adults were anxious. Forty-two per cent of children had induction distress; this related to their MCDAS scores (r= 0.43, p<0.001, Pearson Product Moment Correlation Coefficient). Morbidity at 24 hours and seven days was 63% and 24% respectively; this related to MCDAS scores (r= 0.15, p=0.029 and r= 0.17, p= 0.009, Pearson Product Moment Correlation Coefficient) and to induction distress (chi(2)= 7.14, p= 0.007 and chi(2)= 11.70, p= 0.001).Conclusion The majority of children suffered next day morbidity and many still had symptoms a week later. Most children were dentally anxious; this related to induction distress and postoperative morbidity.
PMID: 16415835 [PubMed - in process]
Anaesthetic management of thoracopagus twins with complex cyanotic heart disease for cardiac assessment: special considerations related to ventilation and cross-circulation.
Szmuk P, Rabb MF, Curry B, Smith KJ, Lantin-Hermoso MR, Ezri T.
Department of Anesthesiology, Division of Cardiology, University of Texas Medical School at Houston, TX, USA; Outcomes Research Institute, Louisville, KY, USA.
We describe the anaesthetic management of a pair of thoracopagus twins of 14 months of age undergoing complex cardiac evaluation. Synchronous ventilation of the twins, needed for the ECG-gated magnetic resonance imaging-angiography, was achieved through a Carlens (Y) adaptor during procedures and transport. The complex logistical implications are obvious. We also describe the first use of bispectral index monitor for detection of cross-circulation in conjoint twins.
PMID: 16415317 [PubMed - as supplied by publisher]
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Combined use of Bispectral IndexTM and A-LineTM Autoregressive IndexTM to assess anti-nociceptive component of balanced anaesthesia during lumbar arthrodesis.
Bonhomme V, Llabres V, Dewandre PY, Brichant JF, Hans P.
University Department of Anaesthesia and Intensive Care Medicine, CHR de la Citadelle, Liege, Belgium.
BACKGROUND: This study evaluated the A-Line Autoregressive Index (AAI) response to surgical stimulation during lumbar arthrodesis, as an estimate of the anti-nociceptive component of a Bispectral Index (BIS) guided anaesthesia combined with epidural analgesia. METHODS: /B>. An epidural catheter was inserted in 23 patients allocated randomly to receive ropivacaine plus clonidine (Group R) or normal saline (Group S) epidurally. General anaesthesia was induced with propofol, cis-atracurium and a remifentanil infusion that was stopped 3 min after tracheal intubation, and maintained using sevoflurane to keep BIS at 50 (range 40-60). Mean arterial pressure, heart rate, end-tidal sevoflurane, BIS and AAI were analysed from 2 min before to 17 min after surgical incision. RESULTS: While BIS was maintained at 50, AAI significantly increased from a 2 min averaged value of 12 (4) to 21 (7) in Group S within the first 5 min after surgical incision, but did not change in Group R. Maximum AAI values reached during the study period were significantly higher in Group S than in Group R [38 (12) and 27 (10), respectively]. Binary logistic regression analysis allowed the calculation of AAI threshold values above which the probability of predominant nociception over anti-nociception was higher than 95%. At 1 MAC sevoflurane concentration, a 2 min averaged AAI of 35 or an AAI peak value of 62 were associated with such a probability. CONCLUSIONS: During a BIS-guided constant level of hypnosis, AAI response to the onset of surgical stimulation significantly differs according to the analgesic regimen. Further studies are needed to refine the estimation of sensitivity and specificity of this variable in assessing the balance between nociception and anti-nociception during general anaesthesia.
PMID: 16415310 [PubMed - as supplied by publisher]
Erratum in:
- Eur J Anaesthesiol. 2005 Dec;22(12):958. Vincent, S [corrected to Souron, Vincent]; Laurent, D [corrected to Delaunay, Laurent]; Francis, B [corrected to Bonner, Francis].
Sedation with target-controlled propofol infusion during shoulder surgery under interscalene brachial plexus block in the sitting position: report of a series of 140 patients.
Souron V, Delaunay L, Bonner F.
Clinique Generale, Department of Anaesthesiology, Annecy, France. vsouron@club-internet.fr
BACKGROUND AND OBJECTIVE: The aim of this study was to assess target-controlled propofol infusion as a technique of sedation for shoulder surgery under interscalene brachial plexus block in the sitting position and to evaluate the effect of sedation on hypotensive/bradycardic events during this procedure. METHODS: One hundred and forty patients undergoing elective shoulder surgery in the sitting position under interscalene brachial plexus block (with 30 mL of ropivacaine 0.75%) were prospectively enrolled. All patients were premedicated with hydroxyzine 1 mg kg(-1), none received beta-blockers. No patients were given atropine except for the patients who experienced a vasovagal event either during the block procedure or intravenous catheter placement. The target-controlled propofol infusion was started immediately after positioning the patient on the operating table. The initial target concentration was 1 microg mL(-1). The infusion rate was adjusted every 15 min by increasing or decreasing the target concentration by 0.2 microg mL(-1) steps to maintain the patient rousable to verbal commands (score of 3 on Wilson sedation scale). The following parameters were assessed: minimal, maximal, optimal target concentration, respiratory and haemodynamic parameters, total propofol dose, additional alfentanil needs, occurrence of hypotensive/bradycardic events, complications. Results are mean +/- SD. Statistical analysis used t-test and chi2-tests. RESULTS: The optimal propofol target concentration was 0.8 mug mL(-1). No respiratory complications or conversion to general anaesthesia was reported. Two patients experienced transient and inconsequential intraoperative agitation. The incidence of hypotensive/bradycardic events during the procedure was 5.7% (eight patients). CONCLUSION: Target-controlled propofol infusion (0.8-0.9 microg mL(-1)) following hydroxyzine premedication is a safe and effective technique for sedation when combined with interscalene brachial plexus block during shoulder surgery in the sitting position.
PMID: 16225721 [PubMed - indexed for MEDLINE]
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Impairment of sustained attention after major gynaecological surgery.
Dale MT, Naik R, Williams JP, Lloyd AJ, Thompson JP.
Leicester Royal Infirmary, University of Leicester and UHL NHS Trust, Division of Anaesthesia, Critical Care and Pain Management, Department of Cardiovascular Sciences, Leicester, UK.
BACKGROUND AND OBJECTIVES: The sustained attention to response task (SART) test is a sensitive indicator of deficits in sustained attention and is simple to perform. Sustained attention is impaired for a short period after minor surgery under general anaesthesia but the magnitude and duration of this effect after major surgery is unknown. We used the SART test to investigate deficits in sustained attention in patients undergoing major surgery under general anaesthesia. METHODS: The SART test was completed before surgery and at 24, 48 and 72 h postoperatively by 20 ASA I-II female patients (mean age 48.6 yr) undergoing total abdominal hysterectomy under general anaesthesia. It was also completed by 20 age-matched female controls at similar time intervals to evaluate the effect of repeated test performance. RESULTS: There was a significant (P < 0.05) interaction between the groups in number of errors made (a measure of sustained attention deficit). The number of errors decreased in control subjects on repeated performance of the SART test but remained unchanged in patients undergoing total abdominal hysterectomy. The differences between groups remained significant after 72 h (P < 0.05). Patients' overall response times slowed significantly at 24-48 h (P < 0.05), but this recovered by 72 h after surgery. In contrast, overall response times in the control group tended to accelerate on repeated performance of the SART. CONCLUSIONS: The results of this study suggest that 72 h following major surgery patients have deficits in sustained attention compared with controls. Control subjects demonstrated a marked learning effect on repeated test performance compared with patients.
PMID: 16225719 [PubMed - indexed for MEDLINE]
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Lumbar epidural catheter insertion: the midline vs. the paramedian approach.
Leeda M, Stienstra R, Arbous MS, Dahan A, Th Veering B, Burm AG, Van Kleef JW.
Leiden University Medical Center, Department of Anesthesiology, Leiden, The Netherlands.
BACKGROUND AND OBJECTIVE: The purpose of this study was to compare the characteristics of epidural catheter insertion via the midline or the paramedian approach with regard to ease of catheter insertion, incidence of paraesthesias and efficacy of epidural block. In addition to the type of approach, the prognostic value of Patients characteristics variables with regard to the incidence of paraesthesias was assessed. METHODS: Thirty patients scheduled for surgery under epidural anaesthesia were randomly assigned to one of two groups of 15 patients each. Epidural anaesthesia was performed via a midline or paramedian approach using loss of resistance to saline. Variables measured were: time needed to identify the epidural space, time needed for and ease of epidural catheter insertion and the incidence of paraesthesias. After completion of these observations, epidural anaesthesia was established with 150 mg ropivacaine 1%. Efficacy of the epidural block was assessed by the need for intraoperative analgesics and by the patient on a three-point scale (good/fair/poor). RESULTS: Quality of sensory blockade was adequate in both groups. Catheter insertion was significantly faster using the paramedian approach. The difference between the two approaches with regard to the incidence of paraesthesias was not significant, however, there was a trend towards more paraesthesias in the midline group. In the multivariate analysis, type of approach was an independent significant predictor of paraesthesias and we found a trend towards a higher incidence of paraesthesias in female patients. CONCLUSIONS: Catheter insertion was faster in the paramedian group and we found a trend towards a higher incidence of paraesthesias with the midline approach.
Publication Types:
PMID: 16225718 [PubMed - indexed for MEDLINE]
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Pressure support ventilation during inhalational induction with sevoflurane and remifentanil in adults.
Banchereau F, Herve Y, Quinart A, Cros AM.
Universite Victor Segalen-Bordeaux II, Hopital Pellegrin Enfants, DAR IV, Bordeaux, France. francois.banchereau@chu-bordeaux.fr
BACKGROUND AND OBJECTIVE: The purpose of this prospective randomized study was to assess the value of pressure support ventilation during inhalational induction with sevoflurane in adult patients. METHODS: Thirty-five adult patients, ASA I-II and scheduled for ear nose throat surgery were studied. Vital capacity induction with 8% sevoflurane in 8 L min-1 oxygen was performed. Pressure support ventilation was used in Group 1 with pressure set at 15 cmH2O. In Group 2, patients breathed spontaneously. After 2 min, sevoflurane was set to 3% and remifentanil 1 microg kg(-1) was injected over 2 min followed by an infusion of 0.1 microg kg(-1) min(-1). Two minutes after the end of the bolus, intubation was performed. Bispectral index, oxygen saturation, respiratory rate, end-tidal carbon dioxide, expired tidal volume and expired sevoflurane concentration were recorded every minute. RESULTS: Eighteen patients were included in Group 1 and 17 in Group 2. Saturation, respiratory rate and end-tidal carbon dioxide were similar in the two groups. Expired tidal volume was significantly higher and bispectral index values significantly lower in Group 1. Intubating conditions were better in Group 1. CONCLUSIONS: Pressure support ventilation provides both better ventilation and deeper level of anaesthesia during inhalation induction with sevoflurane.
Publication Types:
PMID: 16225715 [PubMed - indexed for MEDLINE]
Effects of intravenous anesthetics on the activity of glutamate transporter EAAT3 expressed in Xenopus oocytes: Evidence for protein kinase C involvement.
Yun JY, Kim JH, Kim HK, Lim YJ, Do SH, Zuo Z.
Department of Anesthesiology and Clinical Research Institute, Seoul National University Hospital College of Medicine, 28 Yongon-Dong, Chongno-Gu, Seoul, 110-744, South Korea.
We investigated the effects of the intravenous anesthetics, thiopental, etomidate and ketamine, on the activity of one type of glutamate transporters, EAAT3 (excitatory amino acid transporter type 3). Rat EAAT3 was expressed in Xenopus oocytes by injection of its mRNA. Using two-electrode voltage clamp, membrane currents were recorded after the application of l-glutamate (30 muM) in the presence or absence of various concentrations of the anesthetics. Thiopental (0.3-30 muM) and ketamine (3-1000 muM) did not affect EAAT3 activity. Etomidate decreased EAAT3 activity in a concentration-dependent manner (0.10-10 muM). Etomidate at 1 muM significantly decreased the V(max), but not the K(m) of EAAT3 for glutamate. Chelerythrine, a protein kinase C (PKC) inhibitor, significantly decreased EAAT3 activity, however, there were no statistical differences among the chelerythrine, etomidate or chelerythrine plus etomidate groups. Likewise, the combination of staurosporine, another PKC inhibitor, and etomidate did not decrease the responses further compared with staurosporine or etomidate alone. Phorbol-12-myrisate-13-acetate, a PKC activator, abolished etomidate-induced decrease in EAAT3 activity. Since our results showed that thiopental and ketamine did not affect EAAT3 activity significantly, EAAT3 may not be a target for their anesthetic effects. Our results also suggest that etomidate, possibly via PKC, decreased EAAT3 activity at clinically relevant concentrations.
PMID: 16413532 [PubMed - as supplied by publisher]
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Left posterior lateral pharyngeal space injection during ambulatory general anesthesia third molar surgery: a case report.
Vanisky EJ, Almony JS, Wargo AJ, Sniezek JC.
Major, US Army; Chief of Oral and Maxillofacial Surgery, Wuerzburg Army Community Hospital, Wuerzburg, Germany; Formerly, Resident, Oral and Maxillofacial Surgery, Tripler Army Medical Center, HI.
PMID: 16413909 [PubMed - in process]
Comment on:
Fetal pain.
Sites BD.
Publication Types:
PMID: 16403924 [PubMed - indexed for MEDLINE]
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Comment on:
Fetal pain.
Myers LB, Bulich LA, Mizrahi A, Santangelo S.
Publication Types:
PMID: 16403923 [PubMed - indexed for MEDLINE]
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Report on the 4th Scientific Meeting of the Asian Society of Paediatric Anaesthesiologists, September 24-25 2005, in Singapore.
[No authors listed]
PMID: 16409547 [PubMed - as supplied by publisher]
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Anesthesia in an infant with uncorrected tetralogy of Fallot for transanal pull-through for Hirschsprung's disease.
Haack M, Machotta A, Boemke W, Hohne C.
PMID: 16409542 [PubMed - in process]
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Anesthesia in a child with pyruvate dehydrogenase deficiency.
Mayhew JF.
PMID: 16409541 [PubMed - in process]
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Right lung atelectasis during general anesthesia with laryngeal mask airway.
Kucukguclu S, Gokmen N, Ylmaz F.
PMID: 16409540 [PubMed - in process]
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Near-death experience in a boy undergoing uneventful elective surgery under general anesthesia.
Lopez U, Forster A, Annoni JM, Habre W, Iselin-Chaves IA.
Division of Anesthesiology, University Hospital of Geneva, Geneva, Switzerland.
Near-death experience (NDE) is a complex subjective experience, which may include affective elements such as a sense of peacefulness, paranormal components such as a sensation of floating out of the body, and a perception of being in a dark tunnel and seeing a brilliant light. It is usually reported to occur in association with a wide range of life-threatening situations, as for instance, cardiopulmonary resuscitation. We report on an episode of NDE that occurred in a 12-year-old boy who underwent a general anesthesia for an elective uncomplicated surgery. To our knowledge, this is the first case of NDE in a child that has been reported in this context.
PMID: 16409537 [PubMed - in process]
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Anesthesia management in a young child with aromatic l-amino acid decarboxylase deficiency.
Vutskits L, Menache C, Manzano S, Haenggeli CA, Habre W.
Department of Anesthesiology, Pharmacology and Surgical Intensive Care, University Hospital of Geneva, Geneva, Switzerland.
Aromatic l-amino acid decarboxylase (AADC) deficiency is characterized by an almost complete absence of sympathetic autoregulation, because of very low levels of circulating catecholamines. Here, we report the successful management of four consecutive anesthesia procedures in a young child presenting with AADC deficiency. Our experience suggests that, with appropriate anticipation of the potential autonomic disturbances, anesthesia, at least for minor surgical and diagnostic procedures, can be conducted safely in patients with AADC deficiency.
PMID: 16409536 [PubMed - in process]
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Successful anesthetic management of a child with an extensive facial hemangioma and high output cardiac failure for placement of a central venous catheter.
Shroff PK, Martin TW, Schmitz ML.
Assistant Professor of Anesthesiology, Arkansas Children's Hospital, University of Arkansas for Medical Sciences.
A two-and-a-half-year-old female with an extensive facial and lingual hemangioma, associated high output cardiac failure, and a history of difficult intubation presented for central venous catheter (CVC) placement for vincristine chemotherapy. Anesthetic management of this complex case is presented and the complicating medical conditions are discussed.
PMID: 16409535 [PubMed - in process]
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Anesthetic management of pial synangiosis and intracranial hemorrhage with a Fontan circulation.
Subramaniam B, Soriano SG, Michael Scott R, Kussman BD.
Department of Anesthesiology, Perioperative and Pain Medicine, Children's Hospital Boston, Boston, MA, USA.
We report the case of a 11-year-old girl with Moyamoya syndrome, who had undergone staged-repair of tricuspid atresia to a Fontan circulation, scheduled to undergo bilateral pial synangiosis. Surgery for the first hemisphere was complicated by intracranial hemorrhage requiring an emergency craniotomy. The case highlights the importance of understanding Fontan physiology and its interrelationship with the cerebral circulation in the setting of cerebrovascular insufficiency and raised intracranial pressure.
PMID: 16409534 [PubMed - in process]
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Anesthetic implications of Jacobsen syndrome.
Blaine Easley R, Sanders D, McElrath-Schwartz J, Martin J, Mark Redmond J.
Department of Anesthesiology and Critical Care, Johns Hopkins Medical Institute, Baltimore, MD, USA.
Jacobsen syndrome (JS), also known as 11q-syndrome, is a congenital disorder associated with a deletion of the long arm of chromosome 11. Patients with JS characteristically exhibit multiple dysmorphic features, developmental delay, cardiac anomalies, and platelet abnormalities. Anesthetic issues related to the care of patients with JS concern airway management secondary to short neck, abnormal mouth shape and micrognathia/retrognathia, a high incidence of cardiac anomalies, and platelet dysfunction. Importantly, platelet abnormalities affect 95% of reported JS patients and involve platelet number, size and function. Two children with JS who required open heart surgery are presented and anesthetic management issues discussed. These patients represent the first reports regarding the perioperative issues in caring for patients with JS.
PMID: 16409533 [PubMed - in process]
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Torsade de pointes during sevoflurane anesthesia in a child with congenital long QT syndrome.
Saussine M, Massad I, Raczka F, Davy JM, Frapier JM.
Department of Anaesthesiology D, Arnaud de Villeneuve University Hospital, Montpellier, France.
We present a case of congenital long QT syndrome which developed torsade de pointes during sevoflurane anesthesia for implantation of an internal cardioverter-defibrillator. The diagnosis, implications and treatment are discussed.
PMID: 16409532 [PubMed - in process]
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