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Items 1 - 17 of 17 |
One page. |
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Extensive spinal epidural abscess associated with an unremarkable recovery.
Ansari A, Davies DW, Lohn JW, Culpan P, Etherington G.
Department of Orthopaedics, University College Hospital, Grafton Way, London, United Kingdom.
Spinal epidural abscess is a rare complication of epidural catheter insertion, with an incidence reported to be as low as 0.02%, but with a high morbidity and mortality. This reflects the difficulty in diagnosis of the condition, as early symptoms and signs are usually non-specific with late neurological manifestations. We report a case of spinal epidural abscess in a diabetic patient who underwent splenectomy and distal pancreatectomy. Early investigation with magnetic resonance imaging was effective in demonstrating an extensive epidural abscess involving the thoracic spine, with extension to the base of the skull and associated cord compression. Extensive multilevel laminectomies with thorough irrigation and washout of the epidural space were successful in treating this patient and preventing the development of permanent neurological sequelae.
Publication Types:
PMID: 15648996 [PubMed - indexed for MEDLINE]
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Granisetron and ondansetron for prevention of nausea and vomiting in patients undergoing modified radical mastectomy.
Dua N, Bhatnagar S, Mishra S, Singhal AK.
Department of Anesthesiology, Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India.
Modified radical mastectomy is associated with a relatively high incidence of postoperative nausea and vomiting (PONV). This study was undertaken to evaluate the comparative profile and efficacy of ondansetron and granisetron to prevent PONV after modified radical mastectomy. In a randomized, double-blind, placebo-controlled trial, sixty female patients received ondansetron 4 mg, granisetron 1 mg or saline intravenously just before induction of anaesthesia (n = 20 for each group). A standardized general anaesthetic technique was employed. The incidence of PONV and adverse events were recorded for the first 24h postoperatively. The incidence of PONV was 25% with ondansetron, 20% with granisetron and 70% with saline (P < 0.05, Chi-square test with Yates' correction factor). The incidence of adverse events was comparable among the groups. Ondansetron and granisetron are both effective for reducing the incidence of PONV in female patients undergoing modified radical mastectomy.
Publication Types:
- Clinical Trial
- Randomized Controlled Trial
PMID: 15648984 [PubMed - indexed for MEDLINE]
[Involvement of anaesthesiologists in surgery offices: point of view of anaesthesiologists residents from Lyon]
[Article in French]
Rimmele T, Bouvet L, Boselli E.
Publication Types:
PMID: 15661468 [PubMed - indexed for MEDLINE]
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[Iodine allergy: myth or reality?]
[Article in French]
Malinovsky JM, Mertes PM, Demoly P.
Publication Types:
PMID: 15661458 [PubMed - indexed for MEDLINE]
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[Which place for the anaesthesiologist/intensivist in the surgical ward: a folding seat or an orchestra stall?]
[Article in French]
Pinaud M.
Publication Types:
PMID: 15661456 [PubMed - indexed for MEDLINE]
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[Management of a medical disaster or cosmetic actions]
[Article in French]
Clergue F, Bazin G.
Publication Types:
PMID: 15661455 [PubMed - indexed for MEDLINE]
Comment on:
Perioperative analgesia for knee arthroplasty.
Vanarase MY, Pandit HG, Dodd CA, Murray DW, Popat MT.
Publication Types:
PMID: 15779128 [PubMed - indexed for MEDLINE]
Comment on:
Delayed retroperitoneal haematoma after failed lumbar plexus block.
Hsu DT.
Publication Types:
PMID: 15703309 [PubMed - indexed for MEDLINE]
Comment on:
Perioperative analgesia for knee arthroplasty.
Kuhne J.
Publication Types:
PMID: 15703307 [PubMed - indexed for MEDLINE]
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The preoperative administration of ketoprofen improves analgesia after laparoscopic cholecystectomy in comparison with propacetamol or postoperative ketoprofen.
Boccara G, Chaumeron A, Pouzeratte Y, Mann C.
Department of Anaesthesiology and Critical Care, Hospital Saint-Joseph, 75674 Paris, France. gboccara@hopital-saint-joseph.org
BACKGROUND: Non-opioid analgesics, paracetamol and non-steroid anti-inflammatory drugs (NSAIDs) are proposed for pain relief after laparoscopy. We compared perioperative propacetamol (P) and ketoprofen (K) to provide analgesia after laparoscopic cholecystectomy. METHODS: After ethical committee approval, we included 104 ASA I-II patients, without preoperative analgesic drugs, who were scheduled to undergo laparoscopic cholecystectomy. Anaesthesia was standardized using propofol, fentanyl, atracurium, isoflurane and N(2)O 50%. Ketoprofen 100 mg or propacetamol 2 g or a saline drip (a 100-ml unit of saline in 10 min) was infused blindly and randomly. Patients received either ketoprofen (group K1) or propacetamol (group P1) before induction of anaesthesia and saline after surgery, or saline before surgery and ketoprofen (group K2) or propacetamol (group P2) after surgery. Postoperative visual analogue pain scores (VAS 0-100 mm) were recorded during 24 h. If VAS was >30, a second dose (placebo, ketoprofen or propacetamol) was infused. Nalbuphine 0.2 mg kg(-1) i.v. was given as rescue analgesic if VAS was > or =50. RESULTS: Ninety-eight patients were studied The number of patients not requiring the second analgesic was greater in K1 (33.5%) than the others (K2 0%, P1 0%, P2 7.5%). VAS scores were significantly lower in K1 (P=0.001), with less nalbuphine consumption compared with P1. VAS and opioid request were similar in K2 and P2. CONCLUSION: Preoperative administration of ketoprofen improves postoperative analgesia after laparoscopic cholecystectomy compared with its postoperative administration and pre- and postoperative propacetamol.
Publication Types:
- Clinical Trial
- Randomized Controlled Trial
PMID: 15619603 [PubMed - indexed for MEDLINE]
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Tramadol as adjunct to psoas compartment block with levobupivacaine 0.5%: a randomized double-blinded study.
Mannion S, O'Callaghan S, Murphy DB, Shorten GD.
Department of Anaesthesia and Intensive Care, Cork University Hospital, University College Cork, Cork, Ireland. mannionstephen@hotmail.com
BACKGROUND: Tramadol has been administered peripherally to prolong analgesia after brachial plexus and neuraxial blocks. Our aim was to evaluate the systemic and perineural effects of tramadol as an analgesic adjunct to psoas compartment block (PCB) with levobupivacaine. METHODS: In a randomized, prospective, double-blinded trial, 60 patients (ASA I-III), aged 49-88 yr, undergoing primary total hip or knee arthroplasty underwent PCB and subsequent bupivacaine spinal anaesthesia. Patients were randomized into three groups. Each patient received PCB with levobupivacaine 0.5%, 0.4 ml kg(-1). The control group (group L, n=21) received i.v. saline, the systemic tramadol group (group IT, n=19) received i.v. tramadol 1.5 mg kg(-1) and the perineural tramadol group (group T, n=20) received i.v. saline and PCB with tramadol 1.5 mg kg(-1). Postoperatively patients received regular paracetamol 6-hourly and diclofenac sodium 12-hourly. Time to first morphine analgesia, 24-hour morphine consumption, sensory block, pain and sedation scores and haemodynamic parameters were recorded. RESULTS: Time (h) to first morphine analgesia was similar in the three groups [mean (SD)]: group L, 11.2 (6.6); group T, 14.5 (8.0); group IT, 14.6 (6.8); P=0.35. Twenty-four-hour cumulative morphine (mg) consumption was also similar in the three groups [group L, 21.9 (10.1); group T, 19.8 (6.7), group IT, 16.5 (9.5)], as were durations of sensory and motor block. There were no differences in the incidence of adverse effects except that patients in group IT were more sedated at 14 h than group L (P=0.02). CONCLUSION: We conclude that our data do not support a clinically important local anaesthetic or peripheral analgesic effect of tramadol as adjunct to PCB with levobupivacaine 0.5%.
Publication Types:
- Clinical Trial
- Randomized Controlled Trial
PMID: 15608044 [PubMed - indexed for MEDLINE]
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Randomized, double-blind, phase III, controlled trial comparing levobupivacaine 0.25%, ropivacaine 0.25% and bupivacaine 0.25% by the caudal route in children.
Locatelli B, Ingelmo P, Sonzogni V, Zanella A, Gatti V, Spotti A, Di Marco S, Fumagalli R.
Anaesthesia and Intensive Care Department, Ospedali Riuniti di Bergamo, Largo Barozzi 1, 24100 Bergamo, Italy.
BACKGROUND: The rationale for replacing racemic bupivacaine with the s-enantiomers levobupivacaine and ropivacaine is to provide a wider margin of safety with the same analgesic efficacy and less postoperative motor block. In a randomized, double-blind, phase III, controlled trial we compared the caudal administration of levobupivacaine 0.25% and ropivacaine 0.25% with bupivacaine 0.25% in children. METHODS: Ninety-nine ASA I-II children less than 10 yr old scheduled for elective sub-umbilical surgery were randomized to receive caudal block with bupivacaine 0.25%, ropivacaine 0.25% or levobupivacaine 0.25%. The primary outcome of the study was the clinical efficacy of the caudal block during the operation. Secondary outcome measures were analgesic onset time, pain relief after the operation and residual motor blockade. RESULTS: The proportion of children with effective analgesia during the operation was similar among groups. There were no significant differences in the analgesic onset time of the caudal block. Bupivacaine produced a significant incidence of residual motor block compared with levobupivacaine or ropivacaine at wake-up (P<0.01). There were no significant differences in the number of patients receiving rescue analgesia after surgery. However, analgesic block lasted significantly longer in patients receiving bupivacaine (P=0.03). CONCLUSION: During sub-umbilical surgery, caudal levobupivacaine, ropivacaine and bupivacaine provided comparable analgesic efficacy. Bupivacaine produced a higher incidence of residual motor blockade and a longer analgesic block than ropivacaine and levobupivacaine.
Publication Types:
- Clinical Trial
- Clinical Trial, Phase III
- Randomized Controlled Trial
PMID: 15608043 [PubMed - indexed for MEDLINE]
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Yet another venous air embolism!
Chakravarthy M.
Publication Types:
PMID: 15578492 [PubMed - indexed for MEDLINE]
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Case 5--2004: Transesophageal echocardiography-guided insertion of a pulmonary artery catheter.
Tempe DK, Datt V, Banerjee A, Goel S, Arora D, Tomar AS, Shanewise JS, DiNardo JA.
Department of Anaesthesiology, G.B. Pant Hospital, New Delhi, India. tempedeepak@hotmail.com
Publication Types:
- Case Reports
- Clinical Conference
PMID: 15578482 [PubMed - indexed for MEDLINE]
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Measurement of cardiac output before and after cardiopulmonary bypass: Comparison among aortic transit-time ultrasound, thermodilution, and noninvasive partial CO2 rebreathing.
Botero M, Kirby D, Lobato EB, Staples ED, Gravenstein N.
Department of Anesthesiology, University of Florida College of Medicine and the Gainesville Veterans Affairs Medical Center, Gainesville, FL, USA. botero@anest1.anest.ufl.edu
OBJECTIVES: A noninvasive continuous cardiac output system (NICO) has been developed recently. NICO uses a ratio of the change in the end-tidal carbon dioxide partial pressure and carbon dioxide elimination in response to a brief period of partial rebreathing to measure CO. The aim of this study was to compare the agreement among NICO, bolus (TDCO), and continuous thermodilution (CCO), with transit-time flowmetry of the ascending aorta using an ultrasonic flow probe (UFP) before and after cardiopulmonary bypass (CPB). DESIGN: Prospective, observational human study. SETTING: Veterans Affairs Medical Center Hospital. PARTICIPANTS: Sixty-eight patients. METHODS: Matched sets of CO measurements between NICO, TDCO, CCO, and UFP were collected in 68 patients undergoing elective CABG at specific time periods before and after separation from CPB. After anesthetic induction, all patients had an NICO sensor attached between the endotracheal tube and the breathing circuit, a PAC floated into the pulmonary artery for TDCO and CCO monitoring, and a UFP positioned on the ascending aorta and used for the reference CO. Bland-Altman analysis was used to compare the agreement among the different methods. MEASUREMENTS AND MAIN RESULTS: Bland-Altman analysis of CO measurements before CPB yielded a bias, precision, and percent error of 0.04 L/min +/- 1.07 L/min (44.8%) for NICO, 0.18 L/min +/- 1.01 L/min (41.7%) for TDCO, and 0.29 L/min +/- 1.40 L/min (57.5%) for CCO compared with simultaneous UFP CO measurements, respectively. After separation from CPB (average 29 mins), bias, precision, and percent error were -0.46 L/min +/- 1.06 L/min (37.3%) for NICO, 0.35 L/min +/- 1.39 L/min (46.1%) for TDCO, and 0.36 L/min +/- 1.96 L/min (64.7%) for CCO compared with UFP CO measurements, respectively. CONCLUSIONS: Before initiation of CPB, the accuracy for all 3 techniques was similar. After separation from CPB, the tendency was for NICO to underestimate CO and for TDCO and CCO to overestimate it. NICO offers an alternative to invasive CO measurement.
Publication Types:
PMID: 15578466 [PubMed - indexed for MEDLINE]
Comment in:
Transcranial Doppler emboli count predicts rise in creatinine after coronary artery bypass graft surgery.
Sreeram GM, Grocott HP, White WD, Newman MF, Stafford-Smith M.
Department of Anesthesiology, Duke Heart Center, Duke University Medical Center, Durham, NC, USA. sreer001@mc.duke.edu
OBJECTIVE: To examine the correlation between transcranial Doppler ultrasonography-detected emboli during coronary artery bypass graft surgery with cardiopulmonary bypass and renal dysfunction as determined by the postoperative change in creatinine. DESIGN: Retrospective review of data from the anesthesia and cardiothoracic surgery databases. SETTING: Tertiary care university hospital. PARTICIPANTS: Two hundred eighty-six patients undergoing coronary artery bypass graft surgery. INTERVENTIONS: Transcranial Doppler ultrasonography of the right middle cerebral artery was performed after induction of general anesthesia through completion of the operation. Doppler signals were recorded and emboli counts determined using an automated counting system. MEASUREMENTS AND MAIN RESULTS: Renal dysfunction was assessed as the change in creatinine from the preoperative value to the maximum postoperative value (Delta-Cr). There was a significant (p = 0.0003) univariate correlation between postoperative change in creatinine and total number of Doppler-detected emboli. The effect of total number of emboli remained significant (p = 0.0038) in the multivariable analysis after adjustment for covariables (age, sex, number of grafts, left ventricular ejection fraction, hypertension, history of congestive heart failure, diabetes, cardiopulmonary bypass time, preoperative creatinine, and maximum postoperative creatinine). CONCLUSIONS: Increased numbers of Doppler-detected emboli during coronary artery bypass graft surgery are associated with postoperative renal dysfunction.
PMID: 15578463 [PubMed - indexed for MEDLINE]
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Changes of expression of glial cell line-derived neurotrophic factor and its receptor in dorsal root ganglions and spinal dorsal horn during electroacupuncture treatment in neuropathic pain rats.
Dong ZQ, Ma F, Xie H, Wang YQ, Wu GC.
Department of Integrative Medicine and Neurobiology, Institute of Acupuncture Research, Shanghai Medical College, Fudan University, P.O. Box 291, 138 Yi Xue Yuan Road, Shanghai 200032, China.
Injury to the nervous system occasionally leads to intense and persistent neuropathic pain, which is resistant to conventional analgesic methods. It was reported that electroacupuncture (EA) had potent analgesic effect on neuropathic pain by activating various endogenous transmitters such as the opioid peptides. Glial cell line-derived neurotrophic factor (GDNF) has been hypothesized to play an important role in modulation of nociceptive signals especially during neuropathic pain state. Using immunohistochemistry, Western blot, and RT-PCR analysis techniques, the present study observed the effects of EA on the expression of GDNF and GDNF family receptor alpha-1 (GFRalpha-1, the high-affinity receptor of GDNF) in neuropathic pain rats. The results showed that both protein and mRNA levels of GDNF and GFRalpha-1 in the dorsal root ganglions (DRG), as well as GDNF protein in the spinal dorsal horn, were significantly increased after chronic constriction injury (CCI) of the rats' sciatic nerve and could be further enhanced by EA treatment. The present data demonstrated that EA could activate endogenous GDNF and GFRalpha-1 system of neuropathic pain rats and this might underlie the effectiveness of EA in the treatment of neuropathic pain.
PMID: 15698937 [PubMed - indexed for MEDLINE]
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