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Acta Anaesthesiol Scand 2003 Feb;47(2):226-9
Department of Anesthesia and Intensive Care, Lund University Hospital, Lund Sweden, Department of Anesthesia and Intensive Care, Haukeland University Hospital, Bergen, Norway.
[Medline record in process]
BACKGROUND: Venomous snake bites are uncommon in the Scandinavian countries. Envenomation from exotic snakes do however occur, mostly amongst snake handlers. This case report documents the effects and treatment for envenomation from Hoplocephalus bungaroides, or the Broad-Headed snake, native to eastern and southern Australia. Snakes of the genus Hoplocephalus have previously been described as of 'lesser medical importance' because of their rarity. METHODS: This case report describes the signs, symptoms and management of systemic envenomation in a previously healthy man. RESULTS: The patient developed signs of severe coagulopathy less than an hour after envenomation. There was also biochemical evidence of rhabdomyolysis, and cardiotoxicity. At no time did the patient develop respiratory insufficiency, neurotoxicity or renal failure. The patient was initially managed with i.v. crystalloids, plasma, corticosteroids and antifibrinolytics and by observation in the intensive care unit (ICU). Coagulopathy resolved after causal treatment with monovalent Tiger snake antivenom. CONCLUSION: The patient made good progress and was well on discharge from the ICU 26 h postenvenomation.
PMID: 12631054, UI: 22518052
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Acta Anaesthesiol Scand 2003 Feb;47(2):208-12
Department of Anesthesiology, Kyoto Prefectural University of Medicine, Kyoto, Department of Anesthesiology, Yamanashi Medical University, Yamanashi, Department of Physiology, Kyoto Prefectural University of Medicine, Kyoto, Japan.
BACKGROUND: We previously demonstrated that preoperative blood pressure values affect intraoperative hypothermia during general anesthesia. We hypothesized that increased catecholamine secretion could be responsible for the relationship between preoperative blood pressure and hypothermia. METHODS: To evaluate the effect of preoperative systolic blood pressure (SBP) and plasma catecholamine levels on core temperature during general anesthesia, 40 male patients who were scheduled for open abdominal surgery were allocated to two groups: those whose preoperative SBP was 140 mmHg or greater (high SBP group, n = 20), and those whose SBP was less than 140 mmHg (normal SBP group, n = 20). Anesthesia was maintained with 0.4% isoflurane and opioids. RESULTS: The average age, height, and weight of the patients in the two groups did not differ. Preoperative SBP, mean blood pressure, diastolic blood pressure and heart rate in the high SBP group were significantly higher than those in the normal SBP group. Plasma norepinephrine concentrations in the high SBP group were significantly greater than those in the normal SBP group before and 1 h after the induction of anesthesia. Tympanic membrane temperatures in the normal SBP group started to decline further just after the induction of anesthesia, more so than that in the high SBP group. The vasoconstriction threshold in the normal SBP group was significantly lower than that in the high SBP group. CONCLUSION: These results suggest that the higher levels of preoperative catecholamine secretion contributed to the lesser degree of intraoperative hypothermia observed in the high SBP group.
PMID: 12631051, UI: 22518049
Acta Anaesthesiol Scand 2003 Feb;47(2):174-80
Universitaetsklinik fuer Anaesthesiologie, Universitaetsklinikum Ulm and Klinik fuer Anaesthesie und operative Intensivmedizin, Kreiskrankenhaus, Heidenheim, Germany; and Department of Anaesthesia, McGill University, Montreal, Canada.
BACKGROUND: The aim of this study was to determine the impact of sevoflurane anaesthesia on metabolic and endocrine responses to lower abdominal surgery. METHODS: A prospective randomized controlled study in 20 patients undergoing abdominal hysterectomy. Patients were randomly assigned to receive either sevoflurane (S) or isoflurane anaesthesia (I). Using a stable isotope dilution technique, endogenous glucose production (EGP) and plasma glucose clearance (GC) were determined pre- and postoperatively (6,6-2H2-glucose). Plasma concentrations of glucose, insulin, cortisol, epinephrine and norepinephrine were measured preoperatively, 5 min after induction of anaesthesia, during surgery and 2 h after the operation. RESULTS: EGP increased in both groups with no intergroup differences (preop. S 12.2 +/- 1.6, I 12.4 +/- 1.6; postop. S 16.3 +/- 1.9*, I 19.0 +/- 3.1* micro mol kg-1 min-1, all values are means +/- SD, *P < 0.05 vs. preop.). Plasma glucose concentration increased and GC decreased in both groups. There were no differences between groups. (Glucose conc. mmol l-1 preop.: S 4.1 +/- 0.3, I 3.9 +/- 0.5; 5 AI S 5.1 +/- 0.6*, I 5.1 +/- 1.0*, postop. S 7.0 +/- 1.0*, I 7.1 +/- 1.4*; * = P < 0.05 vs. preop.; GC ml kg-1min-1 preop. S 3.0 +/- 0.4, I 3.2 +/- 0.4; postop. S 2.4 +/- 0.3*, I 2.7 +/- 0.3*; *=P < 0.05 vs. preop.) Insulin plasma concentrations were unchanged. Cortisol plasma concentrations increased intra- and postoperatively with no changes between the groups. Norepinephrine plasma concentration increased in the S group after induction of anaesthesia. I group norepinephrine was increased 2 h after operation and showed no intergroup differences. CONCLUSION: Sevoflurane, as well as isoflurane, does not prevent the metabolic endocrine responses to surgery.
PMID: 12631046, UI: 22518044
Acta Anaesthesiol Scand 2003 Feb;47(2):165-73
1Department of Anesthesiology, University Hospital of Bern, Bern, 2Department of Anesthesia and Intensive Care, Kantonsspital St. Gallen, Switzerland.
BACKGROUND: Bispectal index (BIS trade mark ) monitoring may reduce drug usage and hasten recovery in propofol and inhalation anesthesia. The faster emergence profile of desflurane may reduce the effect of BIS monitoring on recovery from desflurane compared with propofol. This study compared hypnotic drug usage, recovery, patient satisfaction and incidence of inadequate sedation in BIS monitored and nonmonitored women anesthetized with desflurane or propofol. METHODS: One hundred and sixty patients scheduled for elective gynecological surgery were randomly assigned to desflurane or propofol anesthesia with and without BIS monitoring. Fentanyl, vecuronium and remifentanil were administered according to clinical criteria. The BIS monitor was used in all patients, but the monitor screen was covered in the controls. A BIS level between 45 and 55 was targeted in the BIS monitored patients whereas depth of anesthesia was assessed by clinical criteria in the controls. RESULTS: The mean (SD) desflurane MAC-hours administered with and without BIS were 0.70 (0.15) and 0.76 (0.12), respectively, resulting in extubation times of 6.5 (4.1) and 8.3 (6.1) min. (NS). Bispectal index monitoring was associated with improved patient satisfaction, reduced postoperative nausea and antiemetic drug requirement, and fewer episodes with sustained BIS levels > 60. The mean (SD) propofol infusion rates were 6.0 (1.4) and 6.6 (0.9) mg kg-1h-1 with and without the BIS monitor (P = 0.023), resulting in mean (SD) extubation times of 6.8 (4.6) and 10.5 min (5.9), respectively (P < 0.05). CONCLUSION: Bispectal index monitoring reduced propofol usage and hastened recovery after propofol anesthesia, whereas in desflurane anesthesia it was associated with improved patient satisfaction, probably because of decreased postoperative nausea and fewer episodes of inadequate hypnosis.
PMID: 12631045, UI: 22518043
Acta Anaesthesiol Scand 2003 Feb;47(2):157-64
Departments of Anaesthesiology and Pharmacology, Linkoping University, Linkoping, Sweden.
BACKGROUND: Propofol is known to interact with the gamma-aminobutyric acidA (GABAA) receptor, however, activating the receptor alone is not sufficient for producing anaesthesia. METHODS: To compare propofol and GABA, their interaction with the GABAA receptor beta subunit and actin were studied in three cellular fractions of cultured rat neurons using Western blot technique. RESULTS: Propofol tyrosine phosphorylated the GABAA receptor beta2 (MW 54 and 56 kDa) and beta3 (MW 57 kDa) subtypes. The increase was shown in both the cytoskeleton (beta2(54) and beta2(56) subtypes) and the cell membrane (beta2(54) and beta3 subtypes). Concurrently the 56 kDa beta2 subtype was reduced in the cytosol. Propofol, but not GABA, also tyrosine phosphorylated actin in the cell membrane and cytoskeletal fraction. Without extracellular calcium available, the amount of actin decreased in the cytoskeleton, but tyrosine phosphorylation was unchanged. GABA caused increased tyrosine phosphorylation of beta2(56) and beta3 subtypes in the membrane and both beta2 subtypes in the cytoskeleton but no cytosolic tyrosine phosphorylation. CONCLUSION: The difference between propofol and GABA at the GABAA receptor was shown to take place in the membrane, where the beta2(54) was increased by propofol and instead the beta2(56) subtype was increased by GABA. Only propofol also tyrosine phosphorylated actin in the cell membrane and cytoskeletal fraction. This interaction between the GABAA receptor and actin might explain the difference between anaesthesia and physiological neuronal inhibition.
PMID: 12631044, UI: 22518042
Acta Anaesthesiol Scand 2003 Feb;47(2):146-152
Department of Anesthesiology and Intensive Care, Aarhus Kommunehospital, Master of Public Health, University of Aarhus, Danish Institute for Health Services, Research and Development, DSI, Copenhagen, Institute of Epidemiology and Social Medicine, Faculty of Health Sciences, University of Aarhus, Denmark.
[Record supplied by publisher]
BACKGROUND: Knowledge of the population using prehospital emergency services is scarce except for selected subgroups. Interventions are often made without evaluation. The aim of this study was (1) to describe mortality, hospitalization and the diagnostic pattern among emergency ambulance users and (2) to evaluate the impact of one mobile emergency care unit (MECU) staffed by an anesthesiologist. DESIGN AND METHODS: A descriptive and quasi-experimental study of consecutive emergency ambulance users during two 3-month periods: before the MECU (Period 1) and after (Period 2). Hospitalization, diagnostic and 0-180-day mortality data were requested from national registers. Diagnoses were according to the International Classification of Diseases (ICD). RESULTS: Periods 1 and 2 included 2950 and 2869 users, respectively. The MECU attended 27.7% in Period 2. Fewer users were brought to hospital in Period 2 (87.9% vs. 93.8%, P < 0.0001), especially MECU users (76.5% MECU users vs. 92.3% other users; P < 0.001). Diagnoses included all main ICD-groups. Overall mortality of all users was 10.2%; no difference between the periods. Cardiovascular and respiratory diseases were among the most frequent and were associated with high mortality. In Period 2 mortality was lower in subgroups: acute myocardial infarction (AMI; n = 177, day 0-180, 13.3% vs. 40.5%, P < 0.001); and respiratory diseases, only short-term mortality (n = 388, day 0-1 mortality, 0.0% vs. 2.4%, P < 0.05). CONCLUSION: The diagnostic pattern among emergency ambulance users included all main groups of diseases. After the MECU fewer were brought to hospital. The overall mortality for all ambulance users was not influenced by the MECU. For the subgroups, especially AMI, mortality was lower after the introduction of the MECU.
PMID: 12631042
Anaesth Intensive Care 2003 Feb;31(1):92-4
Department of Anaesthesia, The Royal Women's Hospital, Melbourne, 132 Grattan Street, Carlton, Vic. 3053.
This report describes a 33-year-old primigravid woman with spinal muscular atrophy Type III (Kugelberg-Welander syndrome). Elective caesarean section was performed at 38 weeks gestation under spinal anaesthesia. The implications of spinal muscular atrophy for anaesthesia for caesarean section are described.
PMID: 12635403, UI: 22523280
Anaesth Intensive Care 2003 Feb;31(1):63-8
Departments of Anaesthesia and Pain Management, The Royal Melbourne Hospital and The Alfred Hospital, Melbourne, Victoria.
Awareness during anaesthesia is uncommon (approximately 0.1%), but causes significant anxiety, dissatisfaction and morbidity for patients. Several electroencephalographic monitors hold promise as monitors for awareness. We therefore conducted a survey to evaluate patients' knowledge of and attitudes towards awareness and monitors of anaesthetic depth. Two hundred consenting, preoperative patients completed a seven-item questionnaire. The median number of previous operations was 2 (inter-quartile range, 1-5). Thirteen patients reported an experience which they thought might be awareness (2% of operations performed on the cohort). Only 56% of patients had heard about awareness before and many (35%) of these had heard about it in the media. Many (35%) were uncertain about what might cause awareness. Many (42.5%) were anxious about awareness: female sex and not having heard about awareness before were significant predictors of anxiety. Nevertheless only 34% were willing to pay for a proven awareness monitor if they were at low risk and only 50% if they were at high risk. Perceived risk and a previous awareness experience were significant predictors of willingness to pay for awareness monitoring.
PMID: 12635398, UI: 22523275
Anaesth Intensive Care 2003 Feb;31(1):58-62
Department of Anaesthesia, Princess Margaret Hospital for Children and Department of Public Health, The University of Western Australia, GPO Box D184, Perth, W.A. 6840.
Anaesthetic machines are prepared for use with patients who are susceptible to malignant hyperpyrexia (MH) by flushing with oxygen at 10 l/min for ten minutes to reduce the anaesthetic concentration to 1 part per million (ppm) or less. Anaesthetic workstations are now often used in place of traditional machines. Workstations have greater internal complexity, and it is not known if they can be made safe for susceptible patients by flushing with oxygen. We used a high sensitivity infrared gas analyser to measure the washout of isoflurane from five Datex-Ohmeda workstations. Measurements were then repeated with a patient breathing circuit. Isoflurane washout occurred in an exponential manner. The time to reach a concentration of 1 ppm at the fresh gas outlet was 17 +/- 7 minutes, and all machines had reached less than 2 ppm by ten minutes. The washout of isoflurane from the machine and patient breathing circuit was much slower than from the machine alone, with a concentration less than 2 ppm reached only after 30 minutes. We conclude that the Datex-Ohmeda workstation can be prepared for use in MH susceptible patients by flushing with oxygen at 10 l/min for ten minutes. Flushing of the patient breathing system is not straightforward, and we recommend using a clean T-piece circuit. If the circle system and ventilator are required for anaesthesia, we suggest using new breathing hoses, rebreathing bag and soda lime cartridge, and ventilating an artificial lung for 30 minutes with a fresh gas flow rate of 10 l/min and tidal volume of 1 litre.
PMID: 12635397, UI: 22523274
Anaesth Intensive Care 2003 Feb;31(1):3
PMID: 12635387, UI: 22523264
Anaesthesia 2003 Mar;58(3):275-7
Department of Anaesthesia, Critical Care, and Pain Management, Royal Infirmary of Edinburgh, UK.
PMID: 12638568, UI: 22525039
Anesth Analg 2003 Mar;96(3):911
Publication Types:
PMID: 12598291, UI: 22486056
Anesth Analg 2003 Mar;96(3):874-80, table of contents
Department of Anesthesiology, Loyola University Medical Center, Maywood, Illinois 60153, USA. wjellis@lumc.edu
Spinal anesthesia has numerous advantages over general anesthesia for patients undergoing lumbar laminectomy and microdisk surgery. In this study, we evaluated the addition of epidural clonidine and/or bupivacaine, injected at the incision site, on postoperative outcome variables in patients undergoing lower spine procedures using spinal anesthesia. One hundred twenty patients having lumbar spine surgery received bupivacaine spinal anesthesia supplemented by 150 microg of epidural clonidine with or without incisional bupivacaine, epidural placebo plus incisional bupivacaine, or placebo with incisional saline. Demographic data, intraoperative hemodynamics, blood loss, pain, nausea, urinary retention, hospital discharge, and other variables were compared by using either analysis of variance or chi(2) analysis. Demographics were similar. IV fluids, blood loss, incidence of intraoperative bradycardia, and hypotension were not different among groups. Postanesthesia care unit pain scores were lower and demand for analgesics was less in patients who received both the clonidine and subcutaneous bupivacaine. Patients who received epidural clonidine also had improved postoperative hemodynamics. Hospital discharge, urinary retention, and other variables were not different. We conclude that epidural clonidine as a supplement to spinal anesthesia produced no perioperative complications and improved postoperative pain and hemodynamic stability in patients undergoing lower spine procedures. IMPLICATIONS: Spinal anesthesia with supplemental epidural clonidine in combination with incision site subcutaneous bupivacaine was evaluated both intra- and postoperatively and compared with spinal anesthesia alone for lower lumbar spine procedures. Both epidural clonidine and subcutaneous incisional bupivacaine, added to spinal anesthesia for lumbar spine surgery, improves pain relief and reduces the need for postoperative opioids with their associated side effects.
PMID: 12598277, UI: 22486042
Anesth Analg 2003 Mar;96(3):868-73, table of contents
Department of Anesthesiology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois 60611, USA. radhasukhani@yahoo.com
Clinical use of the sciatic nerve block (SNB) has been limited by technical difficulties in performing the block using standard approaches, substantial patient discomfort during the procedure, or the need for two injections to block the tibial and peroneal nerves. In this report, we describe a single-injection method for SNB using an infragluteal-parabiceps approach, where the nerve is located along the lateral border of the biceps femoris muscle. SNB was performed in the prone or lateral decubitus position. The needle was positioned (average depth, 56 +/- 15 mm) to the point where plantar flexion (53%) or inversion (45%) of the ipsilateral foot was obtained at < or =0.4 mA. Levobupivacaine 0.625% with epinephrine (1:200:000) was administered at a dose of 0.4 mL/kg. The procedure was completed in 6 +/- 3 min. Discomfort during block placement was treated with fentanyl 50-100 microg in 24% of patients. Complete sensory loss and motor paralysis occurred in 92% of subjects at a median time of 10 (range, 5-25) min after injection. Compared with plantar flexion, foot inversion was associated with a more frequent incidence (86% versus 100%), and shorter latency for both sensory loss and motor paralysis of the peroneal, tibial, and sural nerves. There were no immediate or delayed complications. We conclude that the infragluteal-parabiceps approach to SNB is reliable, efficient, safe, and well tolerated by patients. IMPLICATIONS: Sciatic nerve block using the infragluteal-parabiceps approach produces sensory loss and motor paralysis after a single 0.4 mL/kg injection of levobupivacaine 0.625% with epinephrine (1:200,000) in >90% of patients. The approach is reliable, uses consistent soft-tissue landmarks, is not typically painful, and does not produce significant complications.
PMID: 12598276, UI: 22486041
Anesth Analg 2003 Mar;96(3):862-7, table of contents
Department of Anesthesiology, Rikshospitalet University Hospital, Oslo, Norway. oivind.klaastad@rikshospitalet.no
Partly based on magnetic resonance imaging studies, the "plumb-bob" approach for brachial plexus block was designed to minimize the risk of pneumothorax. Nevertheless, the risk of pneumothorax has remained a concern. We analyzed magnetic resonance images from 10 volunteers to determine whether the risk of pneumothorax was decreased with this method. The recommended initial needle direction is anteroposterior through the junction between the lateral-most part of the sternocleidomastoid muscle and the superior edge of the clavicle. If the initial placement is not successful, the brachial plexus may be sought in sectors 20 degrees -30 degrees cephalad or caudad to the anteroposterior line in a sagittal plane through the insertion point. We found that the anteroposterior line reached the pleura in 6 of 10 volunteers without prior contact with the subclavian artery or the brachial plexus, but always with contact with the subclavian vein. To reach the middle of the brachial plexus, a mean cephalad redirection of the simulated needle by 21 degrees was required (range from 41 degrees cephalad to 15 degrees caudad in one case). We conclude that the risk of contacting the pleura and the subclavian vessels may be reduced by initially directing the needle 45 degrees cephalad instead of anteroposterior. If the brachial plexus is not contacted, the angle should be gradually reduced. IMPLICATIONS: In magnetic resonance images of volunteers, simulated needle passes with the "plumb-bob" approach to the supraclavicular brachial plexus block were analyzed for precision and risk profile. To avoid needle contact with the lung, the subclavian vein, and the subclavian artery, our results suggest a change in the method's initial needle direction.
PMID: 12598275, UI: 22486040
Anesth Analg 2003 Mar;96(3):859-61, table of contents
Department of Anesthesia University Hospital Antwerp, Edegem, Belgium. marcel.vercauteren@uza.be
IMPLICATIONS: This case report describes an allergic reaction attributed to colloid administration before a semi-urgent cesarean delivery. The most challenging part of this event was related to the anesthetic and obstetric treatment options to avoid further compromise of both mother and fetus.
PMID: 12598274, UI: 22486039
Anesth Analg 2003 Mar;96(3):852-8, table of contents
Department of Anesthesiology, Intensive Care Medicine, and Pain Therapy, Johann Wolfgang Goethe-University Hospital, Frankfurt, Germany.
Worldwide, long-acting bupivacaine is the most popular local anesthetic for spinal anesthesia in parturients undergoing elective cesarean delivery. With advances in surgical techniques, e.g., the Misgav Ladach method, and shorter duration of surgery, the local anesthetic mepivacaine, with an intermediate duration of action, may be a reasonable alternative. Our aim in the present study was to evaluate the effects of 2% hyperbaric mepivacaine alone, or combined with either intrathecal fentanyl (5 and 10 microg), or sufentanil (2.5 and 5 microg), on sensory, motor, and analgesic block characteristics, hemodynamic variables, and neonatal outcome in a randomized, prospective, and double-blinded study (n = 100, 20 parturients per group, singleton pregnancy, >37 wk of gestation). No parturient experienced intraoperative pain. The average duration of motor block Bromage 3 in all groups was 68 min, and resolution time to Bromage 0 was 118 min. Maximal cephalad sensory block level was T3-6 and could be established within 6 min. Complete analgesia was significantly prolonged in all groups receiving intrathecal opioids, yet, with sufentanil 5 microg, even the duration of effective analgesia was significantly extended. Neonatal outcome was not affected by intrathecal opioid administration. In conclusion, 2% hyperbaric mepivacaine is a feasible local anesthetic for spinal anesthesia in parturients undergoing elective cesarean delivery, particularly with short duration of surgery. IMPLICATIONS: Sensory, motor, and analgesic block characteristics of the local anesthetic mepivacaine alone or combined with intrathecal opioids were studied in parturients undergoing elective cesarean delivery in a randomized, double-blinded clinical trial. Mepivacaine was found to be an acceptable local anesthetic for spinal anesthesia in parturients undergoing cesarean delivery. In combination with sufentanil 5 microg, complete and effective analgesia were significantly prolonged.
PMID: 12598273, UI: 22486038
Anesth Analg 2003 Mar;96(3):839-46, table of contents
Department of Anesthesiology-Resuscitology, Yamaguchi University School of Medicine, Japan.
The mechanisms for delayed onset paraplegia after transient spinal cord ischemia are not fully understood. We investigated whether apoptotic motor neuron death is involved in its development. Spinal cord ischemia was induced for 15 min by occlusion of the abdominal aorta in rabbits. At 8, 24, or 48 h after reperfusion, hind limb motor function was assessed, and the lumbar spinal cord was examined morphologically (hematoxylin-eosin and terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate-biotin nick-end labeling staining) and biochemically (breakdown products of alpha-fodrin and patterns of DNA changes). At each time point, 14 rabbits were studied (7 for histopathology and 7 for biochemical analysis). Six rabbits served as sham controls. Delayed motor dysfunction developed in two thirds of the rabbits. The motor neurons in the rabbits with motor dysfunction (not paraplegia) showed swelling and a finely granular dispersed Nissl substance. In paraplegic rabbits, destruction of the gray matter and prominent inflammatory cell infiltration were observed. No apoptotic motor neuron was found in any rabbit. There was neither detectable increase in a caspase-3-mediated breakdown product of alpha-fodrin, nor DNA laddering in any rabbit. The results suggest that apoptosis has a negligible role in the pathophysiology of delayed paraplegia in the spinal cord ischemia model examined. IMPLICATIONS: Although the possibility of apoptotic motor neuron death cannot be completely excluded, delayed onset paraplegia after transient spinal cord ischemia is largely associated with necrotic cell death.
PMID: 12598271, UI: 22486036
Anesth Analg 2003 Mar;96(3):796-801, table of contents
Department of Anesthesiology, University Hospital Center, Charleroi, Belgium. mira.dernedde@chu-charleroi.fr
In this randomized study, we evaluated the quality of postoperative analgesia and the incidence of side effects of continuous thoracic epidural levobupivacaine 15 mg/h in 2 different concentrations: 0.5%, 3 mL/h (n = 33) or 0.15%, 10 mL/h (n = 27). The following variables were registered within 48 h: sensory block, pain scores, rescue morphine consumption, motor blockade, hemodynamics, sedation, nausea and vomiting, and patient satisfaction. The two groups were similar with regard to demographics, cephalad level of sensory block, quality of analgesia, morphine consumption, side effects, and high satisfaction rate. Motor blockade was weaker in the 0.5% group (P = 0.025), with a significantly increased hemodynamic stability, compared with the 0.15% group (P = 0.004). In conclusion, the same dose of levobupivacaine provides an equal quality of analgesia in small- or large-volume continuous epidural infusion and decreases the incidence of motor blockade and hemodynamic repercussions. This is in accordance with the assumption that the total dose of local anesthetics determines the spread and quality of analgesia. IMPLICATIONS: We demonstrated that a large concentration/small volume of levobupivacaine given as a continuous thoracic epidural infusion provided an equal quality of postoperative analgesia as a small-concentration/large-volume infusion and induced less motor blockade and fewer hemodynamic repercussions.
PMID: 12598265, UI: 22486030
Anesth Analg 2003 Mar;96(3):789-95, table of contents
Post-Anesthesia Care Unit, Tel Aviv Sourasky Medical Center, and the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. draviw@tasmc.health.gov.il
It is a common clinical observation that postoperative pain may be resistant to morphine. The analgesic potentials of ketamine have also been well documented. In this study, we evaluated the effects of postoperative coadministration of small doses of ketamine and morphine on pain intensity, SpO(2), and subjectively rated variables in surgical patients who underwent standardized general anesthesia and complained of pain (> or =6 of 10 on a visual analog scale [VAS]) despite >0.1 mg/kg of i.v. morphine administration within 30 min. Patients randomly received up to three boluses of 30 microg/kg of morphine plus saline (MS; n = 114) or 15 microg/kg of morphine plus 250 microg/kg of ketamine (MK; n = 131) within 10 min in a double-blinded manner. The MS group's pain VAS scores were 5.5 +/- 1.18 and 3.8 +/- 0.9 after 10 and 120 min, respectively, after 2.52 +/- 0.56 injections, versus the MK group's VAS scores of 2.94 +/- 1.28 and 1.47 +/- 0.65, respectively (P < 0.001), after 1.35 +/- 0.56 injections (P < 0.001). The 10-min level of wakefulness (1-10 VAS) in the MS group was significantly (P < 0.001) less (6.1 +/- 1.5) than the MK group's (8.37 +/- 1.19). SpO(2) decreased by 0.26% in the MS group but increased by 1.71% in the MK patients at the 10-min time point (P < 0.001). Thirty MS versus nine MK patients (P < 0.001) experienced nausea/vomiting; nine MK patients sustained a 2-min light-headed sensation, and one patient had a weird dream after the second drug injection. IMPLICATIONS: A small-dose ketamine and morphine regimen interrupted severe postoperative pain that was not relieved previously by morphine. Ketamine reduced morphine consumption and provided rapid and sustained improvement in morphine analgesia and in subjective feelings of well-being, without unacceptable side effects.
PMID: 12598264, UI: 22486029
Anesth Analg 2003 Mar;96(3):746-9, table of contents
UMR CNRS 6551 Mort Neuronale, Neuroprotection, Neurotransmission, Universite de Caen, Centre Cyceron, France. abraini@neuro.unicaen.fr
Inhaled anesthetics, including the gaseous anesthetics nitrous oxide and xenon, are thought to act by interacting directly with ion-channel receptors. In contrast, little is known about the mechanism of action of inert gases that show only narcotic potency at high pressures, such as nitrogen or argon. In the present study, we investigated the effects of selective gamma-aminobutyric acid (GABA) receptor antagonists on narcosis produced by nitrogen, argon, and nitrous oxide. Pretreatment with the competitive GABA(A) receptor antagonist gabazine (0.2 nmol) but not the GABA(B) receptor antagonist 2-hydroxysaclofen (10 nmol) increased the nitrogen and argon threshold pressure for loss-of-righting-reflex (P < 0.005) but had no effect on nitrous oxide narcosis. Pretreatment with the GABA(A) benzodiazepine receptor antagonist flumazenil (5 nmol) also increased the narcosis threshold pressure of argon (P < 0.025). Given that neither 2-hydroxysaclofen, gabazine, nor flumazenil at the doses used induced hyperexcitability, our results support a selective antagonism by gabazine and flumazenil of the narcotic action of nitrogen and argon. Some mechanisms of nitrogen and argon narcotic action might be similar to those of clinical inhaled anesthetics. IMPLICATIONS: We studied the effects in the rat of gamma-aminobutyric acid (GABA) receptor antagonists on narcosis induced by nitrogen and argon that act only at high pressures. Our results show that the GABA (A) receptor may play a significant role, suggesting that some mechanisms might be similar to those of clinical inhaled anesthetics.
PMID: 12598256, UI: 22486021
Anesth Analg 2003 Mar;96(3):696-7, table of contents
Department of Anesthesia and Pain Medicine, Seoul National University College of Medicine, Seoul, Korea.
IMPLICATIONS:We report a case of management of ventilation during operative repair of a traumatic left mainstem bronchial disruption in a pediatric patient. With the use of a conventional cuffed endotracheal tube, with the cuff partially in the right mainstem bronchus and partially in the trachea, we successfully managed the case with single-lung ventilation.
PMID: 12598247, UI: 22486012
Anesth Analg 2003 Mar;96(3):683-5, table of contents
Department of Anesthesiology, Taipei-Veterans General Hospital, National Yang-Ming University and National Taiwan University, China.
IMPLICATIONS: We describe a case of massive carbon dioxide embolism with an abrupt decrease in arterial blood pressure and continuous mixed venous oxygen saturation during endoscopic vein harvesting that was immediately diagnosed by intraoperative transesophageal echocardiography.
PMID: 12598243, UI: 22486008
J Cardiothorac Vasc Anesth 2003 Feb;17(1):147-148
PMID: 12635083
J Cardiothorac Vasc Anesth 2003 Feb;17(1):84-6
Wockhardt Heart Institute, Bangalore, Karnataka, India.
PMID: 12635068, UI: 22521176