1: Anaesthesia 2002 Nov;57(11):1114-9 Related Articles, Links

 
 
Anaesthesia for cardioversion: a comparison of sevoflurane and propofol.

Karthikeyan S, Balachandran S, Cort J, Cross MH, Parsloe M.

Yorkshire Heart Centre, Leeds General Infirmary, UK.

This study compared the induction time, haemodynamic changes, recovery characteristics and patient satisfaction for sevoflurane and propofol when used as the main anaesthetic agents for cardioversion. Sixty-one unpremedicated patients scheduled for elective cardioversion were anaesthetised with either inhaled sevoflurane 8% or an intravenous propofol target-controlled infusion set at 6 microg.ml(-1).There was no significant difference in induction time between the two groups: mean (SD) = 90.1(40) s in the sevoflurane group vs. 83.7(35) s in the propofol group. Mean (SD) time to recovery was significantly shorter in the sevoflurane group than in the propofol group: 318 (127) s vs.738 (355) s, respectively, p < 0.001. At recovery, the patients in the propofol group had significantly lower systolic and diastolic blood pressures than those in the sevoflurane group, p < 0.001. The incidence of complications was low in both groups, with similar patient satisfaction expressed after the procedure. We conclude that sevoflurane is a suitable choice for anaesthesia for cardioversion and may provide greater haemodynamic stability than a target-controlled infusion of propofol.

PMID: 12428638 [PubMed - in process]

2: Anaesthesist 2002 Nov;51(11):931-7 Related Articles, Links
 
[Ultrasound in local anaesthesia. Part I: technical developments and background]

[Article in German]

Kapral S, Marhofer P, Grau T.

Klinik fur Anaesthesie und Allgemeine Intensivmedizin, Universitat Wien.

The localisation of the nerve to be blocked is one of the special challenges in local anaesthesia. Since the first time local anaesthesia procedures were carried out approximately 100 years ago, the basic limitations of this method have always been the unsatisfactory success rate and the specific risks involved. Even by variation of the access route to the various nerves and use of different identification methods, no ideal blockade technique has been found which allows a 100% success rate and at the same time reduces the risks to a minimum. The clinical introduction of various aids, such as nerve stimulation or Doppler sonography, have brought no statistically significant advantages despite showing clear improvements. In recent years there has been a trend towards local anaesthesia in perioperative care due to the proven advantages and range of possibilities. Several working groups have developed methods for the sonographic identification of nerves or the epidural space and to an exact placing of needles or catheters from the information obtained. In this way the application of catheters and the injection of local anaesthetic agents can be carried out in an accurate and controlled manner. Although sonography is a procedure which has been used in local anaesthesia for over 10 years, there are at present only few practising local anaesthetists who can use this method. However, interest in this method is growing especially due to the aspect of quality assurance. Organising committees have established that this method will be the future direction. Perhaps even the prediction of Alon P. Winnie for ultrasound-guided local anaesthesia will become true: "Sooner or later someone will make a sufficiently close examination of the anatomy involved, so that exact techniques will be developed."

PMID: 12434270 [PubMed - in process]

3: Anaesthesist 2002 Nov;51(11):922-4 Related Articles, Links
 
[A case of total spinal anaesthesia in pre-hospital emergency care]

[Article in German]

Kunde M, Thierbach A.

Klinik fur Anasthesiologie, Klinikum der Johannes Gutenberg-Universitat, Mainz.

We report on a very rare case of pre-hospital total spinal anaesthesia. In addition to initial management, other possible complications of paravertebral injections are discussed. The identification of symptoms and an immediately initiated life-saving therapy can avoid the necessity of introducing extensive diagnostic and therapeutic procedures. Patients who are adequately treated usually return to their former state of health. Specific medical training of physicians using paravertebral infiltration techniques is mandatory to treat side-effects appropriately. Immediate personal and instrumental measures must be taken for granted to prevent an adverse outcome.

PMID: 12434267 [PubMed - in process]

4: Anaesthesist 2002 Nov;51(11):890-6 Related Articles, Links
 
[The patients' perception of the anaesthetist in a Swiss university hospital]

[Article in German]

Kindler CH, Harms C, Alber C.

Dep. Anasthesie, Universitatskliniken Basel.

OBJECTIVES. The role or recognition of the anaesthetist as an independent medical specialist has been the subject of many studies. Since most of this work was performed in English speaking countries, only few data are available for Germany, Austria, or Switzerland. The goal of this study was to determine how much knowledge patients had of the training and activities of anaesthetists. The study included patients ( n=685) who underwent elective operations in all surgical subspecialties at the University Hospital of Basel. METHODS. The data were collected using a questionnaire distributed at the end of the preoperative visit, which included 14 different questions examining the role of the anaesthetist. RESULTS. Surprisingly, and in contrast to previous studies, almost all patients (99%) knew that the anaesthetist is a qualified physician. In addition, 75% of the patients were aware that the anaesthetist is also engaged in activities outside the operating room; these percentages compare favourably with previous results. However, when asked about the specifics of these activities or about how long it takes to train an anaesthetist, the Swiss patients knew little more than patients from other countries. Only one fifth of all patients estimated the duration of postgraduate training correctly and 45% thought that the anaesthesia team worked under the supervision of the surgical team. Previous anaesthetic experiences as well as additional informational material such as a booklet or videofilm did not improve the patients' knowledge with respect to the training or activities of anaesthetists. DISCUSSION. Since other even more elaborate and expensive methods such as large exhibitions, national anaesthesia days, or increased coverage on radio and television also failed to enhance patients' knowledge, the focus is once again on the relationship between the patient and anaesthetist. If we wish to improve the role and recognition of anaesthetists for patients and/or the public, the anaesthetist must be visible for the patients as a true physician in the pre- and postoperative period. To improve this important patient-anaesthetist relationship, we have begun a training program in communication skills for all physicians in our department.

PMID: 12434262 [PubMed - in process]

5: Reg Anesth Pain Med 2002 Nov-Dec;27(6):623-4 Related Articles, Links
 
An anesthetic "Bug" at PubMed.

Eldor J.

Theoretical Medicine Institute, Jerusalem, Israel.

PMID: 12430120 [PubMed - in process]

6: Reg Anesth Pain Med 2002 Nov-Dec;27(6):622-3 Related Articles, Links
 
Clinical hypnosis instead of drug-based sedation for procedures under regional anesthesia.

Schulz-Stubner S.

Department of Anesthesia, The University of Iowa, Iowa City, Iowa.

PMID: 12430119 [PubMed - in process]

7: Reg Anesth Pain Med 2002 Nov-Dec;27(6):612-7 Related Articles, Links
 
Postherniorrhaphy urinary retention-effect of local, regional, and general anesthesia: A review.

Jensen P, Mikkelsen T, Kehlet H.

Department of Surgical Gastroenterology 435, University of Copenhagen, Hvidovre Hospital, Hvidovre, Denmark.

Background and Objectives: Postherniorrhaphy urinary retention (UR) may depend on the anesthetic technique. We therefore reviewed available published studies of UR in relation to anesthetic technique. METHODS: A Medline-based search (1966-November 2001) revealed 70 nonrandomized and 2 randomized studies. RESULTS: The incidence of UR was lower with local anesthesia (LA) (33 in 8,991 patients, 0.37%, 95% confidence interval [CI] 0.24%-0.49%) compared with regional anesthesia (RA) (150 in 6,191 patients, 2.42%, 95% CI 2.04%-2.81%) and general anesthesia (GA) (344 in 11,471 patients, 3.00%, 95% CI 2.69%-3.31%). CONCLUSION: The low incidence of UR with LA is in accordance with the inhibitory effects of RA and GA on bladder function. Data from newer short-acting techniques of GA and RA are required to define the optimal anesthetic for inguinal herniorrhaphy. Reg Anesth Pain Med 2002;27:612-617.

PMID: 12430114 [PubMed - in process]

8: Reg Anesth Pain Med 2002 Nov-Dec;27(6):595-9 Related Articles, Links
 
Comparison of anesthetic effect between 0.375% ropivacaine versus 0.5% lidocaine in forearm intravenous regional anesthesia.

Peng PW, Coleman MM, McCartney CJ, Krone S, Chan VW, Kaszas Z, Vucemilo I.

Department of Anesthesia, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada.

Background and Objectives: Ropivacaine was shown to provide superior postblock analgesia to lidocaine in intravenous regional anesthesia (IVRA) in voluntary studies. The objective of this study was to compare the anesthesia efficacy, postblock analgesia, and local anesthetic-related side effects between ropivacaine and lidocaine when forearm IVRA was used. METHODS: Fifty-one patients undergoing outpatient hand surgery were randomized to receive forearm IVRA with either ropivacaine 0.375% or lidocaine 0.5%. The volume was 0.4 mL/kg up to 25 mL. Sensation to pinching by forceps and motor function was assessed at 5-minute intervals up to 15 minutes. After tourniquet deflation, verbal pain rating score (VRPS) at 15-minute intervals for the first 2 hours and time for first analgesic in the first 24 hours were evaluated. RESULTS: Eleven patients were excluded from the study with 20 patients remaining in each group. Onset time of anesthesia (6.5 +/- 2.9 minutes v 8.0 +/- 4.1 minutes for lidocaine and ropivacaine groups, respectively) and motor block were similar. In the postoperative period, VPRS was significantly lower in the ropivacaine group in the first 60 minutes (median, 0; P <.05) with significantly more patients in the ropivacaine group pain free (VPRS, 0) up to the first 90 minutes (P >.05). More patients in lidocaine group requested analgesic in the first 2 hours postblock, and only patients in the lidocaine group required supplemental IV morphine in the recovery room. Twenty-four hour analgesic consumption was the same. No local anesthetic-related side effects were observed. CONCLUSIONS: We conclude that 0.375% ropivacaine provides effective anesthesia and superior postoperative analgesia compared with 0.5% lidocaine when forearm IVRA is used. Reg Anesth Pain Med 2002;27:595-599.

PMID: 12430111 [PubMed - in process]

9: Reg Anesth Pain Med 2002 Nov-Dec;27(6):587-9 Related Articles, Links
 
Hernia surgery, anesthetic technique, and urinary retention-apples, oranges, and kumquats?

Mulroy MF.

Virginia Mason Medical Center, Seattle, Washington.

PMID: 12430109 [PubMed - in process]

10: Reg Anesth Pain Med 2002 Nov-Dec;27(6):576-80 Related Articles, Links
 
Local anesthetic neurotoxicity: Clinical injury and strategies that may minimize risk.

Drasner K.

Department of Anesthesia and Perioperative Care, University of California, San Francisco, California, 94143.

PMID: 12430107 [PubMed - in process]

11: Reg Anesth Pain Med 2002 Nov-Dec;27(6):568-75 Related Articles, Links
 
Current concepts in resuscitation of patients with local anesthetic cardiac toxicity.

Weinberg GL.

Department of Anesthesiology, University of Illinois College of Medicine, Chicago, Illinois.

PMID: 12430106 [PubMed - in process]

12: Reg Anesth Pain Med 2002 Nov-Dec;27(6):562-7 Related Articles, Links
 
Local anesthetic toxicity-does product labeling reflect actual risk?

Horlocker TT, Wedel DJ.

Department of Anesthesiology, Mayo Clinic, Rochester, Minnesota.

PMID: 12430105 [PubMed - in process]

13: Reg Anesth Pain Med 2002 Nov-Dec;27(6):556-61 Related Articles, Links
 
Systemic toxicity and cardiotoxicity from local anesthetics: Incidence and preventive measures.

Mulroy MF.

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

PMID: 12430104 [PubMed - in process]

14: Reg Anesth Pain Med 2002 Nov-Dec;27(6):545-55 Related Articles, Links
 
Cardiac toxicity of local anesthetics in the intact isolated heart model: A review.

Heavner JE.

Department of Anesthesiology, Texas Tech University Health Sciences Center, Lubbock, Texas.

An editorial in 1979 by George Albright about sudden cardiac arrest after regional anesthesia spawned an era of intense research focusing on what local anesthetics do to the heart and how they do it. The ultimate goal of the research was to bring to the clinician long-acting local anesthetics that are less cardiotoxic than ones available before 1979, bupivacaine and etidocaine, in particular. In this article, I will review results of studies of local anesthetic cardiotoxicity using the intact mammalian heart in vitro published after the Albright editorial through 2001. Reg Anesth Pain Med 2002;27:545-555.

PMID: 12430103 [PubMed - in process]

15: Reg Anesth Pain Med 2002 Nov-Dec;27(6):543-4 Related Articles, Links
 
One hundred years later, I can still make your heart stop and your legs weak: The relationship between regional anesthesia and local anesthetic toxicity.

Horlocker TT, Neal JM.

Mayo Clinic, Rochester, Minnesota, Virginia Mason Medical Center, Seattle, Washington.

PMID: 12430102 [PubMed - in process]