Ultimo Aggiornamento: 31 Dicembre 2002

J Cardiothorac Vasc Anesth 2001 Dec;15(6):704-9

Comparison of nicardipine versus placebo to control hemodynamic responses during emergence and extubation.

Kovac AL, McKinley C, Tebbe CJ, Williams C

Department of Anesthesiology, University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS 66160-7415, USA. akovac@kumc.edu

OBJECTIVE: To compare 2 different doses of intravenous nicardipine versus placebo to control heart rate and blood pressure responses to emergence and extubation. DESIGN: Prospective, randomized, double-blind, placebo-controlled. SETTING: University hospital, single-institutional. PARTICIPANTS: Forty-five American Society of Anesthesiologists (ASA) class I through III adult patients. INTERVENTIONS: General endotracheal anesthesia was with oxygen and isoflurane and muscle relaxation. At the end of surgery, with at least 2 twitches present by nerve stimulator and end-tidal isoflurane <0.4%, reversal was accomplished with neostigmine and glycopyrrolate. Two minutes post-reversal, the study drug (nicardipine, 0.015 mg/kg; nicardipine, 0.03 mg/kg; or a saline placebo) was given. Heart rate and blood pressure were measured for every minute up to 10 minutes and at 15 minutes postreversal. MEASUREMENTS AND MAIN RESULTS: There were no significant differences among groups in age, gender, ASA class, weight, or heart rate. The nicardipine groups, 0.015 and 0.03 mg/kg, had lower blood pressure values than the placebo group. There was a significant difference in blood pressure among groups, with greater and more consistent attenuation of blood pressure occurring with the larger nicardipine dose. There were no episodes of hypotension or adverse events. CONCLUSIONS: Compared with placebo, both nicardipine doses attenuated blood pressure but not heart rate responses during emergence and extubation. Greater blood pressure control occurred with the larger nicardipine dose of 0.03 mg/kg. Copyright 2001 by W.B. Saunders Company

Publication Types:

• Clinical trial
• Randomized controlled trial

PMID: 11748517, UI: 21615018

J Cardiovasc Pharmacol 2002 Feb;39(2):287-297

Proarrhythmic Effects of Intravenous Quinidine, Amiodarone, d -Sotalol, and Almokalant in the Anesthetized Rabbit Model of Torsade de Pointes.

Farkas A, Lepran I, Papp JG

Department of Pharmacology and Pharmacotherapy, Faculty of Medicine, University of Szeged, Szeged, Hungary.

[Record supplied by publisher]

SUMMARY: The proarrhythmic effects of four antiarrhythmic agents were examined during alpha 1 -adrenoceptor stimulation in chloralose-anesthetized rabbits. Each dose of almokalant (26, 88, and 260 &mgr;g/kg), d -sotalol, quinidine, or amiodarone (each 3, 10, and 30 mg/kg) was infused i.v. over 5 min and there was a 20-min interval between each infusion. d -sotalol and almokalant evoked torsade de pointes (TdP) and other arrhythmics, frequently. The incidences of TdP were 0, 50, and 40% after administering the first, second, and third doses of the nonselective I Kr inhibitor d -sotalol, respectively. Similarly, these values were 20, 40, and 33% after administering the first, second, and third doses, respectively, of the selective I Kr inhibitor almokalant. Quinidine elicited only a few arrhythmics, but not TdP. Quinidine, d -sotalol, and almokalant evoked conduction blocks in a dose-related manner (p < 0.05) and prolonged QT and QT c intervals (p < 0.05). Amiodarone neither prolonged QT and QT c nor evoked ventricular tachyarrhythmias, blocks, or other proarrhythmias. In conclusion, these results show no direct correlation between the occurrence of TdP and the infusion rate or dose of anti-arrhythmics. Furthermore, the lack of TdP with quinidine warns of false-negative results in the applied model.

PMID: 11791015

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Neurosci Lett 2001 Oct 19;312(2):63-6

Electroacupuncture-related changes of NADPH-diaphorase and neuronal nitric oxide synthase in the brainstem of spontaneously hypertensive rats.

Kim YS, Kim C, Kang M, Yoo J, Huh Y

Department of Acupuncture & Moxibustion, College of Oriental Medicine, Kangnam Korean Hospital, Kyung Hee University, #994-5 Daechi 2-dong, Kangnam-gu, Seoul 135-501, South Korea.

The aim of this study was to investigate the electroacupuncture-related changes of nicotinamide adenine dinucleotide phosphate-diaphorase (NADPH-d) and neuronal nitric oxide synthase (nNOS) in the brainstem of spontaneously hypertensive rats (SHR). We evaluated the changes of NADPH-d-positive neurons using a histochemical method and the changes of nNOS-positive neurons using an immunohistochemical method. The staining intensities of NADPH-d-positive neurons and nNOS-positive neurons were assessed in a quantitative fashion using a microdensitometrical method based on optical density by means of an image analyzer. The optical density of NADPH-d-positive neurons and nNOS-positive neurons of the Shinsu (BL23) and Choksamni (ST36) electroacupuncture groups were significantly decreased in most brainstem areas as compared to the normal and arbitrary groups, with the exception of the optical density of NADPH-d positive neurons in the prepositus nucleus as compared to the arbitrary group. The present results demonstrated that electroacupuncture changes the activity in the NO system in the brainstem of SHR and the site where electroacupuncture is administered is of importance for this effect.

PMID: 11595335, UI: 21479959

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Reg Anesth Pain Med 2002 Jan-Feb;27(1):113-4

Walking spinal anesthesia for cesarean delivery-have we walked too far?

Velickovic IA, Leicht CH

Department of Anesthesiology, The Western Pennsylvania Hospital, Pittsburgh, Pennsylvania.

[Medline record in process]

PMID: 11799522, UI: 21657660

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Reg Anesth Pain Med 2002 Jan-Feb;27(1):112-3

Oral anticoagulants and regional anesthesia for joint replacement surgery.

L'E Orme RM

Department of Anaesthesia, Kettering General Hospital, Kettering, United Kingdom.

[Medline record in process]

PMID: 11799520, UI: 21657658

Reg Anesth Pain Med 2002 Jan-Feb;27(1):77-89

Ultrasound in the practice of brachial plexus anesthesia.

De Andres J, Sala-Blanch X

Department of Anesthesia, Valencia University Medical School, Pain Management Center, Department of Anesthesiology and Critical Care, Valencia University General Hospital (J.D.) and the Servicio de Anestesiologia y Reanimacion, Hospital Clinic de Barcelona, Universidad de Barcelona (X.S-B.), Barcelona, Spain.

[Record supplied by publisher]

PMID: 11799509

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Reg Anesth Pain Med 2002 Jan-Feb;27(1):37-42

Infraclavicular block with lateral approach and nerve stimulation: Extent of anesthesia and adverse effects.

Jandard C, Gentili ME, Girard F, Ecoffey C, Heck M, Laxenaire MC, Bouaziz H

Service d'Anesthesie-Reanimation, Hopital Central (C.J., M.H., M.C.L., H.B.), Nancy, Cedex; Centre Medico Chirurgical Saint-Vincent (M.E.G.), Saint-Gregoire, France.

[Medline record in process]

BACKGROUND AND OBJECTIVES: The infraclavicular approach to the brachial plexus is little used despite theoretical advantages of the technique. Using a vertical paracoracoid approach, we assessed the extent of the sensory block and the incidence of adverse effects. METHODS: After obtaining informed consent, 100 patients undergoing surgical procedures distal to the elbow were evaluated. The block was performed using a peripheral nerve stimulator. The puncture site was located in the infraclavicular fossa; the direction of the insulated needle was perpendicular to the skin. Motor response was sought in the hand or wrist at </= 0.6 mA. A total of 40 mL of 1.5% mepivacaine was administered as a single injection. The sensory block was evaluated every 5 minutes for 30 minutes before surgery in the cutaneous distribution of terminal branches of the brachial plexus. RESULTS: When one considers the cutaneous distributions of the median, ulnar, radial, and musculocutaneous nerves, the success rate was 89% for surgery without need for additional peripheral nerve blocks or general anesthesia. In contrast, cutaneous areas innervated by the axillary and medial cutaneous nerves were rarely anesthetized. We were unable to demonstrate a correlation between the intensity of the stimulation and the success of the block. On the other hand, a correlation was found between tourniquet sensation and the absence of anesthesia of the medial cutaneous nerve of the arm. Local anesthetic toxicity, Horner's syndrome, and vascular puncture were respectively observed in 1%, 4%, and 5% of cases. The depth of the needle introduction was correlated with the body mass index (P <.001; r =.63). CONCLUSION: Single injection infraclavicular block, using a vertical paracoracoid approach, appears suitable for surgery distal to the elbow. Selective anesthesia of the medial cutaneous nerve is useful in improving tolerance of the tourniquet. Reg Anesth Pain Med 2002;27:37-42.

PMID: 11799503, UI: 21657641

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Reg Anesth Pain Med 2002 Jan-Feb;27(1):23-30

Intrathecal opioids versus epidural local anesthetics for labor analgesia: A meta-analysis.

Bucklin BA, Chestnut DH, Hawkins JL

Department of Anesthesiology, University of Nebraska Medical Center (B.A.B.), Omaha, Nebraska.

[Medline record in process]

BACKGROUND AND OBJECTIVES: Some anesthesiologists contend that intrathecal opioid administration has advantages over conventional epidural techniques during labor. Randomized clinical trials comparing analgesia and obstetric outcome using single-injection intrathecal opioids versus epidural local anesthetics suggest that intrathecal opioids provide comparable analgesia with few serious side effects. This meta-analysis compared the analgesic efficacy, side effects, and obstetric outcome of single-injection intrathecal opioid techniques versus epidural local anesthetics in laboring women. METHODS: Relevant clinical studies were identified using electronic and manual searches of the literature covering the period from 1989 to 2000. Searches used the following descriptors: intrathecal analgesia, spinal opioids, epidural analgesia, epidural local anesthetics, and analgesia for labor. Data were extracted from 7 randomized clinical trials comparing analgesic measures, incidence of motor block, pruritus, nausea, hypotension, mode of delivery, and/or Apgar scores. RESULTS: Combined test results indicated comparable analgesic efficacy 15 to 20 minutes after injection with single-injection intrathecal opioid administration. Intrathecal opioid injections were associated with a greater incidence of pruritus (odds ratio, 14.01; 99% confidence interval, 6.9 to 28.3), but there was no difference in the incidence of nausea or in the method of delivery. CONCLUSIONS: Published studies suggest that intrathecal opioids provide comparable early labor analgesia when compared with epidural local anesthetics. Intrathecal opioid administration results in a greater incidence of pruritus. The choice of technique does not appear to affect the method of delivery. Reg Anesth Pain Med 2002;27:23-30.

PMID: 11799501, UI: 21657639

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Reg Anesth Pain Med 2002 Jan-Feb;27(1):9-14

Regional anesthesia and pain medicine: Residency training-the year 2000.

Kopacz DJ, Neal JM

Department of Anesthesiology, Virginia Mason Medical Center, Seattle, Washington.

[Medline record in process]

BACKGROUND AND OBJECTIVES: A survey of anesthesiology training programs in 1980 reported the use of a regional anesthetic technique in 21.3% of cases. A similar survey of anesthesiology training programs in 1990 reported that the use of regional anesthetic techniques had increased to 29.8%. Over the ensuing 10 years, additional changes have occurred in the field of anesthesiology and its United States residency training programs. This manuscript reports the impact these changes have had on the use of regional anesthesia techniques in residency training programs in the year 2000. METHODS: Blinded cumulative data about regional anesthetic techniques performed by anesthesiology residents were obtained from all annual training report forms submitted to the Residency Review Committee for Anesthesiology. Exposure to obstetric (OB) anesthesia, pain management, and a resident's year-in-training were analyzed as independent factors expected to influence the use of regional anesthesia. RESULTS: Anesthesiology trainees used a regional anesthesia technique in 30.2% of cases in the year 2000. This represents an insignificant change from 1990 and a marked slowing in the growth of regional anesthesia techniques compared with the 1980 to 1990 period. The use of regional anesthesia remains strongly correlated with a resident's exposure to OB anesthesia and pain consultations. Variability in exposure to regional anesthesia techniques among individual residents has decreased. CONCLUSIONS: Anesthesiology training programs now appear to provide a satisfactory exposure to regional anesthesia for a majority of resident trainees, although 40% of residents may still be deficient in nerve block anesthesia. The growth in the use of regional anesthesia during residency has plateaued over the past decade, but the discrepancy between individual resident experience has improved. Reg Anesth Pain Med 2002;27:9-14.

PMID: 11799499, UI: 21657637

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Reg Anesth Pain Med 2002 Jan-Feb;27(1):6-8

Perioperative epidural analgesia and nutrition after upper abdominal surgery: Unraveling the mechanisms of protein conservation.

Carli F, Schricker T

Department of Anesthesia, McGill University Health Centre, Royal Victoria Hospital, Montreal, Quebec, Canada.

[Medline record in process]

PMID: 11799498, UI: 21657636