1: Acta Anaesthesiol Scand 2002 Nov;46(10):1279-80 Related Articles, Links

 
Intravenous sedation and general anesthesia for a patient with Gilles de la Tourette's syndrome undergoing dental treatment.

Yoshikawa F, Takagi T, Fukayama H, Miwa Z, Umino M.

Anesthesiology and Clinical Physiology, Department of Oral Restitution, and Developmental Oral Health Science, Division of Oral Health Sciences, Graduate School, Tokyo Medical and Dental University, Tokyo, Japan.

Patients with Gilles de la Tourette's syndrome develop symptoms during childhood. Repetitive various motor tics or speech tics that are spontaneous, aimless, and involuntary are characteristic of the syndrome (1). Patients with the syndrome have been considered to have an aggressive, impulsive, and obsessive character (2) (3). Suicide is one of the mental symptoms of the syndrome. Routine dental treatment with this syndrome can be difficult.

PMID: 12421203 [PubMed - in process]

2: Acta Anaesthesiol Scand 2002 Nov;46(10):1251-60 Related Articles, Links
 
Prospective, randomized cost analysis of anesthesia with remifentanil combined with propofol, desflurane or sevoflurane for otorhinolaryngeal surgery.

Loop T, Priebe HJ.

Department of Anesthesia, University Hospital, Freiburg, Germany.

BACKGROUND: In the era of cost containment, cost analysis should demonstrate the cost-effectiveness of new anesthetic drugs. METHODS: This single-blind, prospective, randomized study compared the costs of three remifentanil (REM)-based anesthetic techniques with a conventional one in 120 patients undergoing otorhinolaryngeal surgery. The patients were randomized (n=30 each group) to either receive a combination of REM with propofol, desflurane or sevoflurane, or a conventional anesthetic with thiopentone, alfentanil, isoflurane and N2O. RESULTS: The costs for anesthetic and nonanesthetic drugs and for disposables were twice as high in the three REM-based groups as in the conventional group (REM/PRO 0.51 euro;/min, REM/DES 0.42 euro;/min, and REM/SEVO 0.41 euro;/min vs. 0.18 euro;/min in the ALF/ISO/N2O group; P<0.05). Wastage of intravenous drugs accounted for up to 40% of total costs. In all REM groups, early recovery was predictably faster and more complete (P<0.05). Patient satisfaction was equally high (90-97%) in all groups, with less nausea in the REM/PRO group. CONCLUSION: This study demonstrates that REM-based anesthetic techniques are more expensive than a conventional technique using alfentanil, isoflurane and N2O. This is the result of higher costs of anesthetic and nonanesthetic drugs and of disposables. The wastage of intravenous drugs contributes considerably to these costs.

PMID: 12421198 [PubMed - in process]

3: Acta Anaesthesiol Scand 2002 Nov;46(10):1242-1250 Related Articles, Links
 
Assessment of the respiratory exchange ratio in mechanically ventilated patients by a standard anaesthetic gas analyser.

Waldau T, Larsen VH, Parbst H, Bonde J.

Department of Anesthesia and Intensive Care Medicine, Herlev Hospital, University of Copenhagen, Herlev, Denmark.

BACKGROUND: The respiratory exchange ratio (R) is the CO2 production divided with O2 consumption. R is an essential factor included in several formulas during routine blood gas analysis. Instant and individual measurement of R may be of particular interest to improve the evaluation of each single patient. A standard anaesthetic gas analyser has been recommended for measurement of R among spontaneously breathing healthy subjects, but there is no experience using this method among mechanically ventilated critically ill patients. This study validates the assessment of R by a Bruel & Kjaer gas analyser (B & K) during positive pressure ventilation of intensive care patients. METHODS: The B & K sampled gas from 11 mechanically ventilated patients over a period of 5 min. The recordings of end-tidal values of O2 and CO2 based on fractions (RF) allowed for calculation of RF by the alveolar equation solved for R. The continuous recordings of corresponding values were depicted into an O2-CO2 diagram. A developed computer program calculated estimates of R as the slope of the regression lines related to the full cycle (Rfull) and the expiratory phase only (Rexp). Corrected values of the full respiratory cycle (Rfull*) were also calculated assuming changes of CO2 and O2 volumes during gas exchange. The different estimates of R were compared with simultaneous measurement of a Deltatrac indirect calorimeter (Rdelta). RESULTS: Ten values of RF were within the expected interval of 0.72 < R < 1.00. For the full respiratory cycles, the mean R-value was 0.94 +/- 0.07 and for the expiratory phase the mean R-value was 0.82 +/- 0.08. The O2-CO2 diagram appeared as a convexo-convex loop during each cycle. The agreement of Rexp and Rdelta (Rexp-Rdelta: 0.01 +/- 0.13) were good. CONCLUSION: This study demonstrates that gas measurements by a standard anaesthetic gas monitor can be used for determination of R, and thereby we present an alternative to R calculation made by the Deltatrac monitor.

PMID: 12421197 [PubMed - as supplied by publisher]

4: Acta Anaesthesiol Scand 2002 Nov;46(10):1227-35 Related Articles, Links
 
Modulation of the inflammatory response to cardiopulmonary bypass by dopexamine and epidural anesthesia.

Bach F, Grundmann U, Bauer M, Buchinger H, Soltesz S, Graeter T, Larsen R, Silomon M.

Department of Anesthesiology and Critical Care Medicine, and Department of Thoracic and Cardiovascular Surgery, University of Saarland, Homburg/Saarland, Germany.

BACKGROUND: Cardiopulmonary bypass (CPB) induces a systemic inflammatory reaction. Microcirculation-dependent alteration of the gut mucosal barrier with subsequent translocation of endotoxins is a postulated mechanism for this inflammatory response. This study was designed to elucidate whether two different approaches to modulate splanchnic perfusion may influence systemic inflammation to CPB. METHODS: We examined 40 patients scheduled for elective coronary bypass surgery in a prospective, randomized study. One group (DPX) received dopexamine (1 micro g. kg-1. min-1) continuously after induction of anesthesia until 18 h after CPB. The control group (CON) received equal volumes of NaCl 0.9% in a time-matched fashion. In a third group (EPI) a continuous epidural infusion of bupivacaine 0.25% [(body height (cm) - 100). 10-1=ml.h-1] was administered for the whole study period. Procalcitonin (PCT), tumor necrosis factor (TNF-alpha), soluble TNF receptor, human soluble intercellular adhesion molecule-1, C-reactive protein (CRP) and leukocyte count were measured as parameters of inflammation. RESULTS: All parameters significantly increased following CPB. Increases of PCT, TNF-alpha and leukocyte count were significantly attenuated in the DPX and EPI groups at different time points. However, neither splanchnic blood flow nor oxygen delivery and consumption were different when compared with the CON-group. CONCLUSION: These results do suggest that mechanisms other than an improved splanchnic blood flow by DPX and EPI treatment have to be considered for the anti-inflammatory effects.

PMID: 12421195 [PubMed - in process]

5: Acta Anaesthesiol Scand 2002 Nov;46(10):1203-5 Related Articles, Links
 
Mortality among anesthesiologists in Denmark, 1973-95.

Juel K, Husum B, Viby-Mogensen J, Viskum S.

National Institute of Public Health, Department of Anesthesiology, Gentofte University Hospital, Department of Anesthesia and Intensive Care, Rigshospitalet, and Danish Medical Association, Copenhagen, Denmark.

BACKGROUND: Preliminary data from Sweden indicating that anesthesiologists have a high mortality risk has caused a lot of concern in Denmark. The aim of this study therefore was to compare mortality between consultant anesthesiologists and other consultants in Denmark. METHODS: A historical prospective cohort study based on the membership register of the Danish Medical Association from 1973 to 1992. The study population consisted of 6854 consultants who were members of the Association of Medical Specialists, 406 of whom were anesthesiologists. The all-cause mortality between the two groups was compared during the period 1972-95 using Cox's proportional hazard regression model. RESULTS: The study covered approximately 86 000 person-years. A total of 1205 deaths occurred within the period studied, 41 of whom were anesthesiologists. The relative risk for all-cause mortality among the anesthesiologists compared with all the other consultants was 1.0 (95% confidence limit: 0.7-1.4). CONCLUSION: In Denmark there is no evidence of a high mortality risk in consultant anesthesiologists compared with other consultants.

PMID: 12421191 [PubMed - in process]

6: Acta Anaesthesiol Scand 2002 Nov;46(10):1200-2 Related Articles, Links
 
Mortality of anesthesiologists, pediatricians, and other specialists in Norway.

Aasland OG.

The Research Institute, The Norwegian Medical Association and Center for Health Administration, University of Oslo,Oslo, Norway.

BACKGROUND: Following sensational media reports, particularly from Sweden, there has been discussion in Scandinavia during the last couple of years about whether anesthesiologists have shorter life spans than other medical specialists. METHODS: Survival analysis (Cox regression) from the master file of the Norwegian Medical Association was used to compare anesthesiologists with pediatricians and other specialists. Data was taken from 10 367 specialists, 533 anesthesiologists, 488 pediatricians, and 9325 other specialists, with Norwegian citizenship. These comprised 574 065 man-years, of which 171 190 were lived after achieving specialty. CONCLUSION: No differences in mortality were found between the three groups.

PMID: 12421190 [PubMed - in process]

7: Acta Anaesthesiol Scand 2002 Nov;46(10):1196-9 Related Articles, Links
 
Mortality among Finnish anesthesiologists from 1984-2000.

Ohtonen P, Alahuhta S.

Departments of Surgery and Anaesthesiology, Oulu University Hospital, Finland.

BACKGROUND: Previous studies have suggested increased mortality among anesthesiologists. We report age-standardized mortality rates and causes of death among Finnish anesthesiologists. METHODS: Data covering the deaths of all medical specialists during 1984-2000 were obtained and analyzed. There were 799 deaths, of which 18 involved anesthesiologists. The causes of deaths of these anesthesiologists were obtained from the database of Statistics Finland. RESULTS: The age-standardized mortality rate (SR) for the male anesthesiologists was 33.9 years (per 1000), and that for the other male specialists was 84.6 years. The SR for the female anesthesiologists was 45.4 years, and that for the other female specialists was 77.3 years. The mean age at death among the anesthesiologists was 63.0 years (SD 11.0), while the mean age at death among the other specialists was 68.6 years (SD 14.7). The age structures of the anesthesiologists and other specialists were different, with the anesthesiologists being younger. CONCLUSION: The different age distributions of the anesthesiologists and other specialists caused the difference in age at death. The SR values for the anesthesiologists are clearly lower than those for other specialists. Thus, the present findings do not show increased mortality among Finnish anesthesiologists.

PMID: 12421189 [PubMed - in process]

8: Acta Anaesthesiol Scand 2002 Nov;46(10):1187-95 Related Articles, Links
 
Mortality rates among Swedish physicians: a population-based nationwide study with special reference to anesthesiologists.

Svardsudd K, Wedel H, Gordh T.

Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology Sections, and Department of Surgical Sciences, Section of Anesthesiology, University Hospital, Uppsala, and Nordic School of Public Health, Gothenburg, Sweden.

BACKGROUND: Recent studies both in the UK and in the USA have indicated a higher mortality rate among anesthesiologists than among other physicians. We therefore decided to investigate the situation in Sweden during the years 1993-99. METHODS: All 26 086 doctors in Sweden with a specialist licence in 1993, including those who were retired or who received one until 1999, were identified in official records and followed up regarding survival until 1999; generating approximately 179 300 person-years. RESULTS: Overall, 893 deaths occurred during the 7-year follow up. Mean age at death was 72.9 years in the whole population, the lowest being 64.1 years among the anesthesiologists and the highest 77.0 among the pediatricians. However, there were large differences in the age and sex distribution among the specialities. For this reason a series of proportional hazard regression analyses (Cox's) of the mortality rates in the various speciality groups were performed, taking into account the influence of age and gender differences. After this procedure anesthesiologists had a 46% higher mortality rate and pediatricians a 24% lower mortality rate than other specialist groups; both deviations being statistically significant. All other specialities had a mortality risk within the expected range. Anesthesiologists tended to have higher rates than other specialists for most underlying causes of death. CONCLUSION: Anesthesiologists have a higher mortality rate than other specialities. The cause is so far unknown. However, it is unlikely to be caused by obvious confounders such as age, gender, or smoking habits. Other factors linked to occupational exposure should be investigated.

PMID: 12421188 [PubMed - in process]

9: Acta Anaesthesiol Scand 2002 Nov;46(10):1185-6 Related Articles, Links
 
Do anesthesiologists die younger?

Ekbom A.

Unit of Clinical Epidemiology, Department of Medicine, Karolinska Hospital, Stockholm, Sweden, Department of Epidemiology, Harvard School of Public Health, Boston.

PMID: 12421187 [PubMed - in process]

10: Anaesth Intensive Care 2002 Oct;30(5):699 Related Articles, Links

Different intradermal skin testing response to atracurium and cisatracurium after an anaphylactoid reaction during general anaesthesia.

Soetens F, Smolders F.

Publication Types:
PMID: 12413274 [PubMed - in process]

11: Anaesth Intensive Care 2002 Oct;30(5):647-59 Related Articles, Links

Airway management on placental support (AMPS)--the anaesthetic perspective.

Collins DW, Downs CS, Katz SG, Gatt SP, Marsland C, Abrahams N, Turner RJ.

Department of Anaesthesia, Sydney Children's Hospital Randwick, NSW, Australia.

Neonatal airway obstruction has been reported to have a high mortality. Antenatal diagnosis of this condition is now possible. Anaesthetic and surgical techniques have been developed that allow neonatal airway obstruction to be managed at delivery, while the fetus remains oxygenated via the placental circulation. Three case studies are presented, and the anaesthetic issues for mother and fetus/neonate are discussed with reference to previously published cases of airway management on placental support. In particular, techniques for uterine relaxation and maintenance of placental circulation are explored. The history of these procedures and issues of planning and logistics are also discussed.

PMID: 12413268 [PubMed - in process]

12: Anaesth Intensive Care 2002 Oct;30(5):633-40 Related Articles, Links

The ASA Physical Status Classification: inter-observer consistency. American Society of Anesthesiologists.

Mak PH, Campbell RC, Irwin MG; American Society of Anesthesiologists.

Department of Anaesthesiology, Queen Mary Hospital, University of Hong Kong, Hong Kong.

The American Society of Anesthesiologists (ASA) physical status classification system has previously been shown to be inconsistently applied by anaesthetists. One hundred and sixty questionnaires were sent out to all specialist anaesthetists in Hong Kong. Ten hypothetical patients, identical to those of a similar study undertaken 20 years ago, each with different types and degrees ofphysical disability were described. Respondents were asked about their country of training and type of anaesthetic practice and to assign an ASA classification status for each patient. Ninety-seven questionnaires were returned (61%) after two mailings. Agreement for each patient within groups, between groups and overall comparisons were made. Percentage of agreement was between 31 to 85%. Overall correlation was only fair in all groups (Kappa indices: 0.21-0.4). We found that the current pattern of inter-observer inconsistency of classification was similar to that 20 years ago and exaggerated between locally and overseas trained specialists (P<0.05). The validity of the ASA system, its usefulness and the need for a new, more precise scoring system is discussed.

PMID: 12413266 [PubMed - in process]

13: Anaesth Intensive Care 2002 Oct;30(5):597-602 Related Articles, Links

Genotoxicity of waste anaesthetic gases.

Bozkurt G, Memis D, Karabogaz G, Pamukcu Z, Ture M, Karamanlioglu B, Gunday I, Algunes C.

Department of Medical Genetics, Medical Faculty, Trakya University, Edime, Turkey.

BACKGROUND AND AIM: The possibility of a potential mutagenic or carcinogenic action of chronic exposure to low concentrations of inhalational anaesthetics has been previously studied, with conflicting results. The purpose of this study was to assess whether occupational exposure to waste anaesthetic gases increases genotoxic risk. We examined peripheral lymphocytes from anaesthetists for both sister chromatid exchange (SCE) and for cells with high-frequency SCEs (HFCs). METHOD: A group of 16 non-smoking anaesthetists with occupational exposure to anaesthetic gases and a sex- and age-matched group matched 16 non-smoking matched physicians without occupational exposure to anaesthetic gases were studied. The participants were also selected on the basis of similar responses to a questionnaire assessing risk of genotoxicity relating to other aspects of life. RESULT: SCEs, and HFC percentages obtained from the exposed anaesthetists (6.6+/-2.4 and 12.2+/-15.9) were greater but not statistically significantly so than in the reference group (5.2+/-1.6 and 5.9+/-10.0). CONCLUSION: This study does not support the existence of an association between occupational exposure to waste anaesthetic gases and an increase in SCEs in lymphocytes. The nature of our anaesthesia practice suggests exposure was likely to be low. It should be noted that some anaesthetic gases produce lesions that can be efficiently repaired in mitogen-stimulated lymphocytes in vitro but not in circulating lymphocytes.

PMID: 12413259 [PubMed - in process]

14: Can J Anaesth 2002 Nov;49(9):993-6 Related Articles, Links
 
Canadian Anesthesiologists' Society Gold Medal / La Medaille d'Or de la Societe canadienne des anesthesiologistes.

Byrick RJ.

Toronto, Ontario.

PMID: 12419732 [PubMed - in process]

15: Can J Anaesth 2002 Nov;49(9):978-85 Related Articles, Links
 
Similar long-term cardiovascular effects of propofol or isoflurane anesthesia during ischemia/ reperfusion in dogs: [Effets cardiovasculaires prolonges similaires de l'anesthesie au propofol ou a l'isoflurane pendant l'ischemie/reperfusion chez les chiens].

Thompson K, Wisenberg G, Sykes J, Thompson RT.

Imaging Division, Lawson Health Research Institute. the Division of Cardiology, Faculty of Medicine and Dentistry, University of Western Ontario. St. Joseph's Health Care, London, Canada.

PURPOSE: To compare the long-term functional and metabolic effects of propofol or isoflurane general anesthesia in a canine model of ischemia/reperfusion. METHODS: Using magnetic resonance (MR) techniques, we monitored both regional metabolism ((31)P MR spectroscopy) and systolic function of the heart ((1)H MR imaging) throughout a two-hour occlusion of the left anterior descending coronary artery and ten days of reperfusion. Twenty-two beagles were randomized into isoflurane and propofol general anesthesia groups (n = 10, n = 12 respectively). Contrast-enhanced MR imaging was used to measure infarct size (% of left ventricle that was necrotic) and coronary blood flow was determined using radioactively labelled microspheres. RESULTS: Cardiac metabolism, as monitored by intracellular pH and high-energy phosphate ratios, was not significantly different between the two groups throughout the protocol. Relative to propofol, isoflurane reduced the depression of left ventricular ejection fraction (EF) during the ischemic period [isoflurane 68.5% +/- 4.2%, propofol 58.3% +/- 2.0% of baseline (B); P = 0.04], propofol increased the recovery of EF at day three (isoflurane 63.9% +/- 4.3%, propofol 74.0% +/- 2.5% of B; P = 0.05). By day ten, EF in both groups was similar. Infarct sizes were also similar at day ten (isoflurane 15.7% +/- 3.0%, propofol 13.2% +/- 2.2%). Normalizing these by the region at risk (volume of tissue with low blood flow during the occlusion) to assess infarct ratios was also not significant (isoflurane 0.58% +/- 0.08%, propofol 0.54% +/- 0.07%). CONCLUSIONS: There were no significant differences between the two anesthetic groups at day ten, suggesting that any apparent dissimilarities in early cardiovascular effects were short-term only. These results indicate that isoflurane and propofol produce equivalent long-term cardiovascular effects following ischemia/reperfusion.

PMID: 12419729 [PubMed - in process]

16: Can J Anaesth 2002 Nov;49(9):958-62 Related Articles, Links
 
The anesthetic management of ventricular septal defect (VSD) repair in a child with mitochondrial cytopathy : [La demarche anesthesique adoptee pendant la reparation d'une communication interventriculaire (CIV) chez une enfant presentant une cytopathie mitochondriale].

Farag E, Argalious M, Narouze S, DeBoer GE, Tome J.

Sections of Pediatrics and Congenital Heart Disease Anesthesia, The Cleveland Clinic Foundation, Cleveland, Ohio, USA.

PURPOSE: To present the anesthetic management for the correction of a ventricular septal defect (VSD) in a patient with multiple acyl CoA dehydrogenase deficiency (glutaric aciduria type II; GAII). A review of the literature about anesthetic management of patients with mitochondrial diseases undergoing cardiopulmonary bypass (CPB) is also included. Clinical features: An 11-yr-old girl with GAII manifested as severe hypoglycemia since she was a newborn and generalized muscle weakness. She underwent open-heart surgery for VSD correction with CPB. The anesthetic management avoided inhalational anesthetics, maintained the blood sugar within normal limits and continued normothermia during CPB in order to avoid the stress of hypothermia for her abnormal mitochondria. The patient tolerated the procedure well and experienced a good recovery. CONCLUSION: The anesthetic management of patients with any mitochondrial disease requires normoglycemia, normothermia and the avoidance of metabolic stress in order to preserve energy production by the diseased mitochondria.

PMID: 12419725 [PubMed - in process]

17: Can J Anaesth 2002 Nov;49(9):954-8 Related Articles, Links
 
Hospital practice more than specialty influences the choice of regional or general anesthesia for Cesarean section : [La pratique hospitaliere influence plus que la specialite dans le choix de l'anesthesie regionale ou generale pour la cesarienne].

Johnson D, Truman C.

Form the Department of Critical Care Medicine, University of Alberta. the Health Service Utilization, Alberta Health and Wellness, Edmonton, Alberta, Canada.

PURPOSE: Describe the influence of specialty certification and practice style upon the anesthetic technique used for Cesarean deliveries. METHODS: Alberta physician claims and hospital abstracts between April 1, 1998 to March 31, 2000 were used to determine the technique of anesthesia (regional or general). The influence of practice (volume of deliveries, geographic location, presence of regional analgesia providers) and specialty (anesthesiologist or family/general practice) is explored by logistic regression. RESULTS: Hospital abstracts of 13,884 Cesarean sections were analyzed. Anesthesiologists performed 76% of the anesthetics: epidural (33%), spinal (45%), and general anesthesia (22%). Comparing only regional and metropolitan hospitals, the percent of general anesthesia performed by anesthesiologists varied between 5% to 50%. After adjusting for other factors, we found, in order of importance, the following determined the use of general anesthesia for Cesarean sections: 1) hospitals with more epidural procedure providers during labour were 3% less likely to have providers choose general anesthesia; 2) larger, regional and metropolitan hospitals were less likely to have providers choose general anesthesia; 3) hospitals with a high volume epidural procedure provider during labour were 64% less likely to have providers choose general anesthesia; 4) anesthesiologists were 32% less likely to choose general anesthesia. CONCLUSION: The overall use of regional anesthesia for Cesarean sections in Alberta is high. The chance of receiving a general anesthetic for a Cesarean delivery varies across the province and was more related to practice environment than specialty.

PMID: 12419724 [PubMed - in process]

18: Can J Anaesth 2002 Nov;49(9):946-50 Related Articles, Links
 
Combined paravertebral lumbar plexus and parasacral sciatic nerve block for reduction of hip fracture in a patient with severe aortic stenosis : [Une anesthesie combinee, paravertebrale du plexus lombaire et parasacree du nerf sciatique, pour la reduction d'une fracture de la hanche chez une patiente souffrant d'une stenose aortique severe].

Ho AM, Karmakar MK.

Department of Anaesthesia and Intensive Care, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, PRC.

PURPOSE: To report the use of a combined paravertebral lumbar plexus and parasacral sciatic nerve block for reduction of hip fracture in an elderly patient with severe aortic stenosis. Clinical features: In an 87-yr-old lady with severe aortic stenosis and fracture of the right trochanter due to a fall, a combined right-sided paravertebral lumbar plexus and parasacral sciatic nerve block was used successfully for operative reduction of the fracture. A moderate amount of phenylephrine was required to maintain adequate systemic blood pressure despite the largely unilateral nature of the blocks. CONCLUSION: Combined paravertebral lumbar plexus and parasacral sciatic nerve block can be a viable alternative to general anesthesia and epidural or spinal block for hip surgery in patients with severe aortic stenosis.

PMID: 12419722 [PubMed - in process]

19: Can J Anaesth 2002 Nov;49(9):932-5 Related Articles, Links
 
Benzodiazepine premedication may attenuate the stress response in daycase anesthesia: a pilot study : [La premedication avec de la benzodiazepine peut diminuer la reaction de stress en chirurgie d'un jour : une etude pilote].

Duggan M, Dowd N, O'Mara D, Harmon D, Tormey W, Cunningham AJ.

Department of Anaesthesia, and Chemical Pathology, Beaumont Hospital, Dublin, Ireland.

PURPOSE: Patients undergoing daycase surgery suffer from varying degrees of fear and anxiety. There is conflicting evidence in the literature regarding the benefit of benzodiazepine premedication in daycase surgery. We carried out a prospective, double-blind, randomized pilot study investigating the effect of benzodiazepine premedication on the stress response in patients undergoing daycase anesthesia and surgery. METHODS: Group I (n = 16) received diazepam 0.1 mg*kg(-1) orally 60 min preoperatively; Group II (n = 15) received diazepam 0.1 mg*kg(-1) orally 90 min preoperatively; Group III (n = 30) received a placebo. The stress response was measured by analyzing urinary catecholamine and cortisol levels and by scoring anxiety levels using state-trait anxiety inventory (STAI) scores and visual analogue scores (VAS). RESULTS: Anxiety scores (VAS and STAI scores) were not different between groups. We found a statistically significant reduction in urinary cortisol and noradrenaline levels in the groups receiving diazepam vs placebo. DISCUSSION: The reduction in stress hormones following diazepam premedication, in patients undergoing daycase surgery may support the role for benzodiazepine premedication in this setting. However, further studies are warranted to determine the clinical significance of these findings.

PMID: 12419719 [PubMed - in process]

20: Can J Anaesth 2002 Nov;49(9):895-9 Related Articles, Links
 
New opportunities for anesthesia research in Canada/Nouvelles possibilites de recherche en anesthesie au Canada.

Orser BA, Miller DR.

Departments of Anesthesia, University of Toronto and The University of Ottawa, Canada.

PMID: 12419712 [PubMed - in process]

21: Eur J Pharmacol 2002 Nov 15;454(2-3):241-247 Related Articles, Links
 
Oxytocin-induced renin secretion by denervated kidney in anaesthetized rat.

Loichot C, Grima M, De Jong W, Helwig JJ, Imbs JL, Barthelmebs M.

Institut de Pharmacologie, Faculte de Medecine, Universite Louis Pasteur, 11 Rue Humann, 67085 Cedex, Strasbourg, France

The effects of oxytocin on renin secretion by denervated kidney were investigated in vivo, by infusing the peptide directly into the renal artery of anaesthetized rats. Renin secretion was calculated by the renal veno-arterial difference in plasma renin activity multiplied by renal plasma flow. The intra-renal arterial (i.r.a.) infusion of oxytocin (1.5 or 15 ng/kg/min, 10 min) induced a sixfold increase in renin secretion as compared to vehicle-treated controls, without effects on renal blood flow, mean arterial blood pressure, glomerular filtration rate or natriuresis. The effect of oxytocin (1.5 ng/kg/min) was prevented by pretreatment with an oxytocin receptor antagonist, desGly-NH(2),d(CH(2))(5)[D-Tyr(2),Thr(4),Orn(8)]vasotocin] (5.6 &mgr;g/kg bolus i.v. 20 min before oxytocin infusion, followed by 2.8 &mgr;g/kg/min i.r.a.). Nadolol (2.5 mg/kg i.v.), a beta-adrenoceptor antagonist, also blocked the oxytocin-induced increase in renin secretion. These results show that oxytocin is able to stimulate renin release by activating oxytocin receptors but that beta-adrenoceptors also seem to be involved.

PMID: 12421653 [PubMed - as supplied by publisher]

22: J Oral Maxillofac Surg 2002 Nov;60(11):1369-71 Related Articles, Links

Uvular paralysis after dental anesthesia.

Sanchis JM, Penarrocha M.

Department of Oral Medicine and Oral Surgery, University of Valencia Medical and Dental School, Valencia, Spain.

PMID: 12420277 [PubMed - indexed for MEDLINE]