Anaesthetic Department, Royal Devon and Exeter Hospital, Barrack Road, Exeter
EX2 5DW, UK. davo.kitson@virgin.net
Day-case surgery is increasing in popularity and more patients with multiple
medical problems are being considered as suitable for this approach. However,
the current recommendations exclude morbidly obese patients (body mass index
> 35 kg.m(-2)). We present a review of 258 morbidly obese patients who
have received treatment in our day-surgery unit. Our experience does not show
any significant increase in unplanned admission rates or postoperative complications.
In conclusion, we feel that morbid obesity alone should not be an exclusion
criterion for day-case surgery.
PMID: 11703247, UI: 21560092
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Anaesthesia 2001 Nov;56(11):1103-6
Monitoring of irrigation fluid absorption during percutaneous nephrolithotripsy:
the use of 1% ethanol as a marker.
Malhotra SK, Khaitan A, Goswami AK, Gill KD, Dutta A
Department of Anaesthesiology, Postgraduate Institute of Medical Education
and Research, Chandigarh-160012, India. drskmalhotra@yahoo.com
This study was performed in 32 ASA I patients undergoing percutaneous nephrolithotripsy
under general anaesthesia, using absorption of 1% ethanol as a marker to monitor
irrigation fluid absorption. Various parameters of fluid absorption were studied
and compared, including irrigation fluid volume, irrigation time, total volume
of irrigation fluid absorbed and the rate of irrigation. The amount of irrigant
used vs. the volume absorbed and the volume absorbed vs. total irrigation
time were observed. Fluid absorption occurred in 78% of patients, and 28%
absorbed volumes in excess of 1 l. The mean volume of fluid absorbed was 696.7
ml. The maximum fluid absorption was observed when the irrigation fluid volume,
total irrigation time and irrigation rate exceeded 10 l, 30 min and 200 ml.min(-1),
respectively. In conclusion, this study has shown 1% ethanol to be a safe,
simple and cost-effective marker of fluid absorption during percutaneous nephrolithotripsy
associated with minimal adverse effects.
PMID: 11703245, UI: 21560090
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Anaesthesia 2001 Nov;56(11):1090-7
Rapid sequence induction: a national survey of practice.
Morris J, Cook TM
Specialist Registrar and Consultant, Department of Anaesthesia, Royal United
Hospital, Combe Park, Bath BA1 3NG, UK.
We performed a national postal survey exploring anaesthetists' practice in
rapid sequence induction. All respondents used pre-oxygenation, although the
technique employed, and its reliability, varied. Thiopental and succinylcholine,
given after waiting for signs of loss of consciousness, were the most widely
used drugs for rapid sequence induction. Propofol and rocuronium were used
by more than a third of respondents, and most respondents (75%) also routinely
administered an opioid. Cricoid pressure was used universally but the practice
of its application varied widely. The commonest aids used if intubation was
difficult were the gum elastic bougie, the long laryngoscope blade and the
laryngeal mask. After failed intubation, approximately half of respondents
would maintain the supine position. Failure to intubate at rapid sequence
intubation had been seen by 45% of respondents but harm was uncommon. In contrast,
28% had seen regurgitation, which frequently led to considerable harm and
to three deaths. In spite of this, practice of a failed intubation drill was
uncommon (15%) and anaesthetic assistants were rarely known to practice application
of cricoid pressure. Consultants were less likely than trainees to use rocuronium
as a muscle relaxant, and more likely to choose morphine if administering
an opioid. They were less likely to practice a failed intubation drill. Other
aspects of practice varied little between grades. This survey suggests that
many anaesthetists do not follow best practice when performing a rapid sequence
induction.
PMID: 11703243, UI: 21560088
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Anaesthesia 2001 Nov;56(11):1059-68
Pharmacological actions and therapeutic uses of cannabis and cannabinoids.
Kumar RN, Chambers WA, Pertwee RG
Anaesthesia & Pain Management, Department of Anaesthesia, Grampian University
Hospitals, Aberdeen AB25 2ZN, UK.
This review highlights the pharmacology, pharmacokinetics, pharmacological
actions, therapeutic uses and adverse effects of cannabinoids. The effect
of cannabinoids on anaesthesia is mentioned briefly. Important advances have
taken place in cannabinoid research over the last few years and have led to
the discovery of novel ligands. The possible clinical applications of these
ligands and the direction of future research are discussed.
[Is the use of tumescence anesthesia in general anesthesia contraindicated]?Anaesthesist.
2001 May;50(5):363-4].
[Article in German]
Grassegger A, Haussler R
Publication Types:
Letter
PMID: 11702332, UI: 21559354
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Anaesthesist 2001 Oct;50(10):792
[Is it safe and cost effective...Danaparoid (Orgaran) as an anticoagulant
for mechanical autotransfusion with Cell Saver 5 (Hemonetics),Anaesthesist
(2001) 50:26-31].
[Article in German]
Lorentz A
Publication Types:
Letter
PMID: 11702330, UI: 21559352
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Anaesthesist 2001 Oct;50(10):767-71
[The hereditary motor-sensory neuropathy Charcot-Marie-Tooth disease: anesthesiologic
management--case report with literature review].
[Article in German]
Ginz HF, Ummenhofer WC, Erb T, Urwyler A
Departement Anasthesie, Kantonsspital Basel, Universitatskliniken, 4031 Basel,
Schweiz. hginz@uhbs.ch
A 53-year-old woman diagnosed as having hereditary motor-sensory neuropathy
Charcot-Marie-Tooth (CMT) disease Type 2, underwent inguinal hernia surgery.
In this patient CMT disease was manifested as distal muscle weakness and wasting.
Anaesthetic experience with patients who have CMT disease is limited. Association
to malignant hyperthermia is very unlikely although there is one case report
that shows that there could be a relationship. We describe a total intravenous
anaesthesia (TIVA) protocol with propofol and alfentanil without any muscle
relaxants after fiberoptic intubation. The patient made an uneventful recovery
and was discharged from the hospital on the fourth postoperative day. TIVA
was a safe technique in this patient and should be considered as an alternative
for patients presenting with CMT disease.
PMID: 11702326, UI: 21559348
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Anaesthesist 2001 Oct;50(10):757-66
[Propofol-remifentanil versus sevoflurane-remifentanil for anesthesia for
pediatric procedures in infants, children and adolescents].
[Article in German]
Schmidt J, Fechner J, Fritsch B, Schmitz B, Carbon R, Rosch W, Albrecht
S
INTRODUCTION: The aim of this study was to compare total intravenous anaesthesia
(TIVA) using propofol and remifentanil (P/R-group) and balanced anaesthesia
(BA) using sevoflurane and remifentanil (S/R-group) for paediatric surgery.
PATIENTS AND METHODS: A total of 120 patients aged 6 months to 16 years scheduled
for elective minor lower abdominal surgery were randomly assigned to receive
either propofol (5-10 mg/kg/h) and remifentanil (0.125-1.0 microgram/kg/min)
or sevoflurane (1.0-1.5 MAC) and remifentanil (0.125-1.0 microgram/kg/min).
Perioperative haemodynamics as well as recovery and discharge times, PONV
and side-effects were studied. The patients vigilance, comfort and pain intensity
were assessed postoperatively using the objective pain discomfort scale, the
Steward post-anaesthetic recovery score and a visual analogue scale. RESULTS:
Postoperative recovery (9.0 vs 11.6 min) and extubation times (11.8 vs. 15.0
min) as well as the time taken until a Steward post-anaesthetic recovery score
> 3/4 (15.2 vs. 21.4 min) was reached were significantly shorter in the
P/R-group. However, the length of time until discharge to the ward, postoperative
comfort, pain intensity and analgesic requirements as well as PONV were comparable
in both groups. CONCLUSIONS: With regards to the investigated parameters,
TIVA with propofol and remifentanil is equally effective as BA with sevoflurane
and remifentanil in paediatric patients. However, considering the selected
dosing regimen, recovery times were significantly shorter for children after
TIVA.
Publication Types:
Clinical trial
Randomized controlled trial
PMID: 11702325, UI: 21559347
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Anesth Analg 2001 Dec;93(6):1417-21, table of contents
The frequency of perioperative vision loss.
Warner ME, Warner MA, Garrity JA, MacKenzie RA, Warner DO
Department of Anesthesiology, Mayo Clinic, Rochester, Minnesota 55905, USA.
warner.mary@mayo.edu
The frequency of perioperative vision loss, especially for spinal surgery,
has been increasing recently. We undertook a retrospective study to determine
the frequency of this outcome in a large surgical population receiving general
or central neuraxis regional anesthesia for noncardiac procedures from 1986
to 1998. Specific criteria were used to separate cases in which the surgical
procedure likely directly contributed to the vision loss. Vision loss was
present if any part of the visual field was affected. Initial database screening
found 405 cases of new-onset vision loss or visual changes in 410,189 patients
who underwent 501,342 anesthetics and who survived at least 30 days after
their final procedures. Two hundred sixteen of these patients regained full
vision or acuity within 30 days. Of the 189 patients who developed vision
deficits for longer than 30 days, 185 underwent ophthalmologic or neurologic
procedures in which ocular or cerebral tissues were surgically damaged or
resected. The remaining 4 patients (1 per 125,234 overall; 0.0008%) developed
prolonged vision loss without direct surgical trauma to optic or cerebral
tissues. In this large study population of noncardiac surgical patients, including
those who underwent spinal surgical procedures, the frequency of perioperative
vision loss persisting for longer than 30 days was very small. IMPLICATIONS:
Vision loss and blindness after surgery and anesthesia is a very rare event.
In this study, only one per 125,234 patients undergoing noncardiac surgery
developed vision loss persisting for longer than 30 days.
PMID: 11726416, UI: 21583157
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Anesthesiology 2001 Nov;95(5):1306
Bowel and bladder dysfunction after spinal bupivacaine.
Mardirosoff C, Dumont L
Publication Types:
Letter
PMID: 11685017, UI: 21540571
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Anesthesiology 2001 Nov;95(5):1303-4
Attempted interscalene block procedures.
Bittar DA
Publication Types:
Letter
PMID: 11685014, UI: 21540568
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Anesthesiology 2001 Nov;95(5):1303
Training requirements for peripheral nerve blocks.
Department of Anesthesiology, Medical School Botucatu, Sao Paulo State University,
Universidade Estuadal Paulista, Brazil. ptgv@uol.com.br
PMID: 11685003, UI: 21540557
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Ann Fr Anesth Reanim 2001 Oct;20(8):733-4
[Does a previous blood patch contraindicate spinal anesthesia? Reply by
authors].
[Article in French]
Caultry C, Prudhomme S, Deladriere H
Publication Types:
Letter
PMID: 11695296, UI: 21552647
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Ann Fr Anesth Reanim 2001 Oct;20(8):732-3
[Ketamine and respiratory function].
[Article in French]
Mion G, Tortosa JC, Petitjeans F
Publication Types:
Letter
PMID: 11695295, UI: 21552646
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Ann Fr Anesth Reanim 2001 Oct;20(8):693-8
[Comparison between 1.5% lidocaine with adrenaline and 1.5% plain mepivacaine
in axillary brachial plexus block].
[Article in French]
Kuntz F, Bouaziz H, Bur ML, Boileau S, Merle M, Laxenaire MC
Service d'anesthesie-reanimation chirurgicale, hopital Central, 29, avenue
du Marechal de Lattre-de-Tassigny, 54035 Nancy, France.
OBJECTIVES: To evaluate the distribution of sensory blockade, the onset time
and the duration of the axillary plexus block obtained after the administration
of 40 mL of 1.5% lignocaine with adrenaline or 40 mL of plain 1.5% mepivacaine.
STUDY DESIGN: Prospective, randomised, comparative, double blind study. PATIENTS
AND METHODS: One hundred and fifty five patients undergoing hand surgery were
randomised into two groups: in group L, 73 patients were given 1.5% lignocaine
with 1/200,000 adrenaline and in group M, 82 patients received 1.5% mepivacaine.
The entire volume was injected on the first evoked motor activity obtained
for a current less than 0.5 mA. Sensory and motor block of each of the four
major nerves of the hand and forearm were assessed using light touch and motor
strength respectively. The block was considered complete when all nerves were
anaesthetised (median, radial, musculocutaneous and ulnar). RESULTS: The percentage
of complete sensitive blockade was 22% in group L and 24% in group M. Complete
motor blockade was respectively 27% in group L and 40% in group M. The median
time required to obtain a complete sensory blockade was 18 min for both group.
The median time required to obtain a complete motor blockade was 17 min in-group
L and 16 min in-group M. The duration of the sensory blockade was not different
for both groups (i.e., 255 +/- 76 min versus 231 +/- 70 min in group L and
M respectively. The duration of the motor blockade was longer in group L compared
to group M (199 +/- 64 min versus 231 +/- 74 min respectively, p < 0.05).
CONCLUSION: Following axillary plexus block, 1.5% mepivacaine improves neither
the extension nor the duration of sensory blockade achieved by 1.5% lignocaine
with adrenaline.
Publication Types:
Clinical trial
Randomized controlled trial
PMID: 11695288, UI: 21552639
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Paediatr Anaesth 2001 Nov;11(6):749-50
Boyle-Davis gags for tonsillectomy.
Vickers G, Anders N, Flanagan P
Publication Types:
Letter
PMID: 11696160, UI: 21553568
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Paediatr Anaesth 2001 Nov;11(6):746
Gaseous induction in the left lateral position for children at risk for
gastric aspiration.
Weidmann C, Lewis IH
Publication Types:
Letter
PMID: 11696157, UI: 21553565
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Paediatr Anaesth 2001 Nov;11(6):725-8
Use of rapacuronium in a child with spinal muscular atrophy.
Stucke AG, Stuth EA
Anesthesia Research Service 151, VA Medical Center, Milwaukee, WI, USA. astucke@mcw.edu
We report the case of an 18-month-old girl with spinal muscular atrophy (SMA)
that received 1 mg x kg(-1) rapacuronium for laryngospasm during induction
of anaesthesia. Within 15 min, we observed some diaphragmatic recovery and,
after emergence from anaesthesia, the child demonstrated adequate respiratory
efforts. However, the child showed diminished strength of the upper extremity
muscles. Since the preoperative workup had revealed bulbar symptoms and laryngeal
function could not be easily assessed, the patient was kept intubated until
upper extremity strength had returned to preoperative levels. Small doses
of midazolam had been given to reduce the patient's anxiety but the patient
was extubated within 5 h without any complications. Train of four (TOF) monitoring
of the right adductor pollicis muscle, performed during anaesthetic recovery,
was equivocal. In SMA, muscle groups are differentially affected so that TOF
responses may be inconclusive and not reflect the state of the upper airway
muscles. To our knowledge, this is the first report of use of a nondepolarizing
neuromuscular blocking agent in a child with SMA.
PMID: 11696151, UI: 21553559
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Paediatr Anaesth 2001 Nov;11(6):695-700
Analgesia for circumcision in a paediatric population: comparison of caudal
bupivacaine alone with bupivacaine plus two doses of clonidine.
Sharpe P, Klein JR, Thompson JP, Rushman SC, Sherwin J, Wandless JG, Fell
D
University Department of Anaesthesia and Pain Management, Leicester Royal
Infirmary, Leicester, UK. ps46@le.ac.uk
BACKGROUND: Clonidine is often used to improve the duration and quality of
analgesia produced by caudal epidural blockade, although the optimum dose
of clonidine with bupivacaine remains uncertain. Methods: We compared the
effect of clonidine, 1 and 2 microg x kg(-1), added to bupivacaine (1.25 mg
x kg(-1)) with that of bupivacaine alone in 75 male children undergoing elective
circumcision. RESULTS: There was a trend towards increasing duration of analgesia
with increasing dose of clonidine [group B (bupivacaine) 280.7 (171.6) min,
C1 (bupivacaine + clonidine 1 microg x kg(-1)) 327.8 (188.3) min and C2 (bupivacaine
+ clonidine 2 microg x kg(-1)) 382.0 (200.6) min], although this difference
was not statistically significant. Mean time to arousal from anaesthesia was
significantly prolonged with clonidine 2 microg kg(-1) (group C2 21.3 (13-36)
min, group C1 14.0 (6-25) min and group B 14.4 (2-32) min. Supplementary analgesic
requirements and incidence of adverse effects were low, with no differences
between the groups. Conclusions: For paediatric circumcision, under general
anaesthesia, the addition of clonidine 2 microg x kg(-1) to low volume (0.5
ml x kg(-1)) caudal anaesthetics has a limited clinical benefit for children
undergoing circumcision.
Publication Types:
Clinical trial
Randomized controlled trial
PMID: 11696146, UI: 21553554
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Paediatr Anaesth 2001 Nov;11(6):691-4
Pressure versus volume-controlled ventilation with a laryngeal mask airway
in paediatric patients.
Keidan I, Berkenstadt H, Segal E, Perel A
Department of Anesthesiology and Intensive Care, Sheba Medical Center, Sackler
School of Medicine, Tel-Aviv University, Israel. keidan@shani.net
BACKGROUND: The utility of positive pressure ventilation with the laryngeal
mask airway (LMA) in children was described previously, but the possibility
of gastric insufflation, related to high peak airway pressure, continues to
be a disadvantage. In this prospective study, inspiratory pressures, air leak
and signs of gastric insufflation were compared between volume-controlled
ventilation (VCV) and pressure-controlled ventilation (PCV) using an LMA.
METHODS: Thirty-two ASA I patients, aged 4.5 +/- 4 years, who were scheduled
for elective procedures under combined general anaesthesia and caudal analgesia,
were enrolled. After inhalation induction and LMA insertion, each patient
was randomly assigned to receive successively PCV and VCV. Peak pressures
(PCV) and tidal volumes (VCV) were changed in order to achieve adequate ventilation
[endtidal CO2 5-5.4 kPa (38-42 mmHg)]. RESULTS: Peak airway pressures were
significantly lower with PCV than VCV (14.1 +/- 1.6 cmH2O versus 16.7 +/-
2.3 cmH2O, P < 0.001). No patient ventilated with PCV required peak pressure
higher than 20 cmH2O compared with six patients ventilated with VCV (P <
0.05). Haemodynamic parameters, expiratory tidal volume and percent of leak
were similar in both ventilatory modes and no signs of gastric insufflation
were detected. CONCLUSIONS: During general anaesthesia in children using an
LMA, PCV offers lower peak inspiratory airway pressures while maintaining
equal ventilation compared with VCV. Although no signs of gastric insufflation
were detected in both groups, the lower pressures might be significant in
patients with reduced chest wall or lung compliance.
Publication Types:
Clinical trial
PMID: 11696145, UI: 21553553
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Paediatr Anaesth 2001 Nov;11(6):685-9
Use of albumin, blood transfusion and intraoperative glucose by APA and
ADARPEF members: a postal survey.
Soderlind M, Salvignol G, Izard P, Lonnqvist PA
Department of Paediatric Anaesthesia, KS/Astrid Lindgrens Children's Hospital,
Stockholm, Sweden.
BACKGROUND AND METHODS: A postal survey was mailed to the members of Association
of Paediatric Anaesthetists of Great Britain and Ireland (APA) (n=187) and
French-Language Society of Paediatric Anaesthesiologists (ADARPEF) (n=220)
to primarily investigate the impact of a recently published Cochrane report
on the clinical use of albumin solutions in paediatric anaesthetic practice.
At the same time, information regarding blood transfusion strategies and the
use of intraoperative glucose containing maintenance solutions was gathered.
RESULTS: The response rate of the survey was 38% and 25% for APA and ADARPEF
members, respectively. Forty-one percent of APA members reported a reduced
use of albumin containing solutions following the publication of the Cochrane
report compared to eight percent in the ADARPEF group (P < 0.0001). Albumin
continues to be the most frequently used plasma expander in premature babies
and neonates, whereas many colleagues use alternative colloids in infants
and older children. A clear difference was observed in the 1-12-year-old age
group between APA members favouring the use of gelatines and ADARPEF members
who instead frequently use hetastarch solutions. ADARPEF members appeared
to have a slightly more restrictive attitude towards blood transfusion and
also reported more widespread use of erythropoetin (56% versus 9%, P <
0.0001) and predilution techniques (40% versus 23%, P < 0.04) compared
with APA members. Regarding intraoperative maintenance solutions, a large
proportion of both APA and ADARPEF members still use high concentrations of
glucose intraoperatively, even in older children.
PMID: 11696144, UI: 21553552
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Paediatr Anaesth 2001 Nov;11(6):657-62
Transoesophageal echocardiographic monitoring during paediatric cardiac
surgery: obtainable information and feasibility in 532 children.
Sloth E, Pedersen J, Olsen KH, Wanscher M, Hansen OK, Sorensen KE
Department of Anaesthesiology and Intensive Care, Aarhus University Hospital,
Denmark. skejes@aau.dk
BACKGROUND: We hypothesized that transoesophageal echocardiography (TOE)
performed by the anaesthesiologists would be beneficial for monitoring purposes
during paediatric cardiac surgery. We present the results for the first 5
years in 532 consecutive children. METHODS: The probe was successfully inserted
in 99% of cases and remained in the oesophagus for 211 min on average (range
10-555 min). RESULTS: Insignificant valve leak, single- or biventricular failure
and volume depletion were the most common new findings due to TOE. Changes
in inotropic strategy and volume replacement were the most frequent interventions.
In 45% of the cases, new information was disclosed and, in a total of 8% of
cases, decisive information was provided. Except for tracheal extubation in
one child who was uneventfully reintubated, no severe complications were identified.
CONCLUSIONS: These data stress the safety and ease of performing TOE in children
undergoing cardiac surgery. There is evidence for benefit from TOE findings
to potentially enhance the therapeutic basis.
Publication Types:
Clinical trial
PMID: 11696140, UI: 21553548
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Paediatr Anaesth 2001 Nov;11(6):651-5
Downfolding of the epiglottis induced by the laryngeal mask airway in children:
a comparison between two insertion techniques.
Tsujimura Y
Department of Anaesthesia, Yamada Red Cross Hospital, Misono-mura, Watarai-gun,
Mie, Japan. GHD02235@nifty.ne.jp
BACKGROUND: The purpose of this study was to compare the incidence of the
downfolding of the epiglottis in children during insertion of the laryngeal
mask airway (LMATM) using the standard technique and an alternative technique
with the cuff partially inflated. METHODS: Eighty paediatric patients were
randomized into two groups and were anaesthetized using the LMA inserted with
one of the two techniques. RESULTS: There was no difference in the successful
rate of insertion, fibreoptic findings and the lowest intraoperative SpO2
between the two groups. CONCLUSIONS: The partially inflated cuff insertion
technique does not increase the incidence of the downfolding of the epiglottis
in children and would be an acceptable alternative to the standard technique.
Publication Types:
Clinical trial
PMID: 11696139, UI: 21553547
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Reg Anesth Pain Med 2001 Nov-Dec;26(6):595-6
Old stamps: an ancestor of midhumeral canal block.
Gentili ME, Enel D, Estebe JP
Publication Types:
Historical article
Letter
PMID: 11707808, UI: 21564529
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Reg Anesth Pain Med 2001 Nov-Dec;26(6):589-90
A new stimulating catheter for continuous peripheral nerve blocks.
Copeland SJ, Laxton MA
Publication Types:
Letter
PMID: 11707803, UI: 21564524
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Reg Anesth Pain Med 2001 Nov-Dec;26(6):572-5
Continuous brachial plexus block at the cervical level using a posterior
approach in the management of neuropathic cancer pain.
Vranken JH, van der Vegt MH, Zuurmond WW, Pijl AJ, Dzoljic M
Pain Relief Unit, Academic Medical Center, University of Amsterdam, The Netherlands.
j.h.vranken@amc.uva.nl
BACKGROUND AND OBJECTIVES: Neuropathic cancer pain due to tumor growth near
the brachial plexus is often treated with a combination of nonsteroidal anti-inflammatory
drugs, tricyclic antidepressants, anticonvulsants, and oral or transdermal
opioids. We propose placement of a catheter along the brachial plexus using
a posterior approach for patients not responding to the above-mentioned treatment.
CASE REPORT: We describe 2 patients with neuropathic cancer pain in the arm
and shoulder despite treatment with dexamethasone, amitriptyline, gabapentin,
opioids, and, in 1 patient, oral ketamine. An increase in daily opioid dosage
did not relieve the pain but caused unacceptable side effects of nausea, vomiting,
and sedation. Continuous administration of local anesthetics via a brachial
plexus catheter inserted at the cervical level using a posterior approach
resulted in a markedly improved analgesia and decreased opioid requirement.
CONCLUSION: Continuous brachial plexus block should be considered in patients
with severe neuropathic cancer pain in the arm and shoulder. To achieve sufficient
pain relief for prolonged periods of time, a catheter was inserted to block
the brachial plexus using a posterior approach. This technique may be a valuable
alternative to the interscalene approach because of the improved fixation
of the catheter in the muscle sheet of the trapezius, splenius cervicus, and
levator scapulae muscles, and the decreased likelihood of catheter dislodgment
during neck movements.
PMID: 11707798, UI: 21564519
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Reg Anesth Pain Med 2001 Nov-Dec;26(6):558-64
Santayana's prophecy fulfilled.
Winnie AP, Nader AM
Department of Anesthesiology and Pain Management, Cook County Hospital, Chicago,
Illinois 60612, USA.
Publication Types:
Historical article
PMID: 11707796, UI: 21564517
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Reg Anesth Pain Med 2001 Nov-Dec;26(6):518-22
Vibration sense testing with a 128-Hz tuning fork as a tool to determine
recovery from epidural neuraxial block.
Schulz-Stubner S, Zingel E, Rossaint R
Klinik fur Anasthesiologie am Universitatsklinikum der RWTH Aachen, Aachen,
Germany. Schust@t-online.de
BACKGROUND AND OBJECTIVES: Vibration sense testing using a 128-Hz tuning
fork is a commonly used test in the diagnosis of dorsal horn dysfunction and
polyneuropathy. In this open, prospective study, we tested the hypothesis
that vibration sense testing is a sensitive and specific method to assess
recovery from epidural block. METHODS: Recovery from epidural block was evaluated
in 81 patients undergoing cesarean delivery or vein stripping by comparing
the use of a 128-Hz tuning fork with the results of conventional evaluation
of block recovery. Conventional block recovery testing included Bromage-Score,
formal muscle power testing according to the British Medical Research Council,
pinprick testing, and warm/cold testing. Epidural blocks were performed by
the same anesthesiologist using ropivacaine and sufentanil via an epidural
catheter. After obtaining baseline values, an epidural anesthetic was performed
and patients were tested every 30 minutes until complete recovery from the
block was documented with all examined methods. Statistical analysis was performed
to compare the results of the different methods to the time at which baseline
values of vibration sense were reached. RESULTS: At the time vibration sense
testing returned to baseline, there was no residual motor block according
to the Bromage Score in 100% of the patients and no residual block for foot
flexion and extension. Twelve percent of the patients showed a minimal lack
of strength in the quadriceps muscle and 11% had residual sensory anesthesia
to pinprick below L5/S1. CONCLUSIONS: Based on our observations, recovery
of vibration sense corresponds with recovery of motor block after epidural
anesthesia and may serve as an easy means of documenting recovery with a single
test before discharge.
Publication Types:
Clinical trial
PMID: 11707789, UI: 21564510
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Reg Anesth Pain Med 2001 Nov-Dec;26(6):507-11
Anatomic considerations in relation to the maxillary nerve block.
Singh B, Srivastava SK, Dang R
Department of Anesthesiology, Lady Hardinge Medical College & Associated
Hospitals, New Delhi, India. bali@ndf.vsnl.net.in
BACKGROUND AND OBJECTIVES: To determine the length of the needle that should
be used to reach the maxillary nerve after the lateral pterygoid plate has
been contacted. METHODS: The study was conducted on patients and skulls. Patient
study: The distances from skin at the midpoint of lower border of zygomatic
arch to lateral pterygoid plate and to the point where a paresthesia in the
distribution of maxillary nerve was obtained were measured in 75 patients.
Osteologic study: The distance from the midpoint of lower border of zygomatic
arch to lateral pterygoid plate and to a probe inserted from the orbital aspect
through the inferior orbital fissure and pterygopalatine fossa into the foramen
rotundum (representing maxillary nerve) was measured in 120 skulls. RESULTS:
Patient study: The distance to the point where paraesthesia occurred was more
than that to the lateral pterygoid plate by 0.21 cm on the right side and
0.22 cm on the left side. Osteologic study: The distance to the probe in the
pterygopalatine fossa was more than the distance to lateral pterygoid plate
by 0.13 cm on the right side and 0.14 cm on the left side. CONCLUSIONS: The
needle should not be advanced by more than approximately 0.25 cm beyond the
distance to the pterygoid plate while performing maxillary nerve block by
the lateral extraoral approach.
Publication Types:
Clinical trial
Multicenter study
PMID: 11707787, UI: 21564508
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Reg Anesth Pain Med 2001 Nov-Dec;26(6):504-6
A paravenous approach for the saphenous nerve block.
De Mey JC, Deruyck LJ, Cammu G, De Baerdemaeker LE, Mortier EP
St Lucas Hospital, Ghent, Belgium. jeanclaude.demey@rug.ac.be
BACKGROUND AND OBJECTIVES: This study assesses a paravenous approach for
saphenous nerve block at approximately the level of the tibial tuberosity,
and compares it with the conventional technique of blind subcutaneous infiltration
between the tibial tuberosity and the gastrocnemius muscle. METHODS: In dissections
of 5 cadavers, the saphenous nerve was found very close to the saphenous vein
bilaterally. Subsequently, in 20 volunteers, a bilateral saphenous nerve block
was performed with 5 mL mepivacaine on each side. Randomly assigned, the block
was performed by blind subcutaneous injection using a 23-gauge needle of 2.5
cm on one side and by a paravenous subcutaneous approach on the other. RESULTS:
The paravenous approach produced a saphenous nerve block in all 20 volunteers
whereas the blind subcutaneous approach was successful in only 6 (33%) (P
<.05). Seven volunteers had a painless minor hematoma at the paravenous
site and 2 had a hematoma at the classical site. CONCLUSION: The saphenous
nerve can be blocked effectively by a paravenous approach using only 5 mL
of local anesthetic solution. This approach is advantageous because of its
easily identifiable landmark.
Publication Types:
Clinical trial
Randomized controlled trial
PMID: 11707786, UI: 21564507
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Reg Anesth Pain Med 2001 Nov-Dec;26(6):499-503
Axillary brachial plexus block using peripheral nerve stimulator: a comparison
between double- and triple-injection techniques.
Sia S, Lepri A, Ponzecchi P
Department of Anesthesiology, Centro Traumatologico Ortopedico, Azienda Ospedaliera
Careggi, Firenze, Italy. salvsia@tin.it
BACKGROUND AND OBJECTIVES: The multiple-injection technique for axillary
block, in which the main 4 nerves of the plexus are located by a nerve stimulator
and separately injected, has been shown to produce a high success rate. However,
this technique may prove to be more difficult and time-consuming than other
methods. Therefore, a simplified technique, with a reduced number of injections,
might be desirable. A comparison between 2- and 3-injection techniques was
made in the present double-blind study. METHODS: One hundred patients were
randomly allocated to 2 groups. In group 3N, the radial, median, and musculocutaneous
nerves were located by a nerve stimulator and injections made. In group 2N,
the radial and median nerves were located and injections made. Forty milliliters
of local anesthetic was used. RESULTS: A greater success rate for anesthetizing
the musculocutaneous nerve was found in group 3N (98% v 80%; P <.005).
No differences between the groups were found in the success rate for blocking
the radial, median, and ulnar nerves. The rate of complete block (all the
sensory areas distal to the elbow) was 90% in group 3N and 76% in group 2N.
The time to perform the block was shorter in group 2N (5 +/- 1 v 6 +/- 1 minutes;
P <.001). CONCLUSIONS: The 2-injection technique offers a success rate
in blocking the 3 nerves innervating the hand similar to that obtained with
the 3-injection technique. The latter approach should be considered when the
musculocutaneous nerve distribution is involved in the surgical area.
Publication Types:
Clinical trial
Randomized controlled trial
PMID: 11707785, UI: 21564506
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Reg Anesth Pain Med 2001 Nov-Dec;26(6):495-8
Axillary plexus block using multiple nerve stimulation: a European view.
TUTTO
IL MATERIALE CONTENUTO IN QUESTO SITO E' STATO REPERITO IN RETE. GLI AUTORI
NON SI ASSUMONO RESPONSABILITA' PER
DANNI A TERZI DERIVATI DA USO IMPROPRIO O ILLEGALE DELLE INFORMAZIONI
RIPORTATE O DA ERRORI RELATIVI AL LORO CONTENUTO.
