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Items 1 - 42 of 42 |
One page. |
The anesthetic management of a case of tracheal necrosis.
Dereeper E, Karler C, Roman A, Cadiere GB, Urbain F, Sosnowski M.
Department of Anesthesiology, CHU Saint-Pierre, Universite Libre de Bruxelles, Brussels, Belgium. etienne_dereeper@stpierre-bru.be <etienne_dereeper@stpierre-bru.be>
A 63-yr-old female patient developed a tracheal necrosis after esophageal resection with gastric interposition. We report the anesthetic management of this patient undergoing tracheal repair focusing on an original airway management and ventilation strategy.
Publication Types:
PMID: 15728086 [PubMed - indexed for MEDLINE]
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Epidural hematoma unrelated to combined spinal-epidural anesthesia in a patient with ankylosing spondylitis receiving aspirin after total hip replacement.
Hyderally HA.
Mount Sinai Medical Center, 1 Gustave Levy Place, New York, New York 10029, USA. hhyderally@nj.rr.com
Although rare, major complications after spinal and epidural anesthesia do occur. The safety of spinal and epidural anesthesia has been well established. This is a report of an epidural hematoma in a patient with ankylosing spondylitis who received aspirin for thromboprophylaxis after total hip replacement that was unrelated to the combined spinal-epidural anesthetic. Most epidural hematomas are spontaneous and idiopathic.
Publication Types:
PMID: 15728083 [PubMed - indexed for MEDLINE]
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Cardiac arrest during neuraxial anesthesia: frequency and predisposing factors associated with survival.
Kopp SL, Horlocker TT, Warner ME, Hebl JR, Vachon CA, Schroeder DR, Gould AB Jr, Sprung J.
Department of Anesthesiology, Mayo Clinic, 200 First St. S.W., Rochester, MN 55905, USA. kopp.sandra@mayo.edu
The frequency and predisposing factors associated with cardiac arrest during neuraxial anesthesia remain undefined, and the survival outcome data are contradictory. In this retrospective study, we evaluated the frequency of cardiac arrest, as well as the association of preexisting medical conditions and periarrest events with survival after cardiac arrest during neuraxial anesthesia between 1983 and 2002. To assess whether survival after cardiac arrest differs for patients who arrest during neuraxial versus general anesthesia, data were also obtained for patients who experienced cardiac arrest under general anesthesia during similar surgical procedures during the same time interval. Over the 20-yr study period at the Mayo Clinic, there were 26 cardiac arrests during neuraxial blockade and 29 during general anesthesia. The overall frequency of cardiac arrest during neuraxial anesthesia for 1988 to 2002 was 1.8 per 10,000 patients, with more arrests in patients receiving spinal versus epidural anesthesia (2.9 versus 0.9 per 10,000; P = 0.041). In 14 (54%) of the 26 patients who arrested during a neuraxial technique, the anesthetic contributed directly to the arrest (high sympathectomy or respiratory depression after sedative administration), whereas in 12 (46%) patients, the arrest was associated with a specific surgical event (cementing of joint components, spermatic cord manipulation, reaming of the femur, and rupture of amniotic membranes). Patients who arrested during general anesthesia had a higher ASA classification than those who arrested during a neuraxial block (P = 0.031). Hospital survival was significantly improved for patients who arrested during neuraxial anesthesia versus general anesthesia (65% vs 31%; P = 0.013). The association of improved survival with neuraxial anesthesia remained statistically significant after adjusting for all patient/procedural characteristics, with the exception of ASA classification and emergency procedures. We conclude that a cardiac arrest during neuraxial anesthesia is associated with an equal or better likelihood of survival than a cardiac arrest during general anesthesia.
PMID: 15728079 [PubMed - indexed for MEDLINE]
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A retrospective comparison of costs for regional and general anesthesia techniques.
Schuster M, Gottschalk A, Berger J, Standl T.
Department of Anesthesiology, University Hospital Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany. m.schuster@uke.uni-hamburg.de
In this retrospective study, we compared the costs for three different regional anesthesia techniques with the costs of general anesthesia (GA). A total of 1587 anesthesia cases which were performed for orthopedic and trauma patients over a 1-yr period in a tertiary level, university hospital setting were analyzed. The anesthesia technique-related costs were determined calculating case-specific costs for personnel, supplies, and drugs. The techniques were compared on the basis of anesthesia costs and surgical procedure duration. As a result, we found that the costs per surgical minute largely depend on the surgical procedure duration. Based on the regression function, the cost advantage of spinal anesthesia over GA can be estimated to be 13% for a 50-min case, 9% for a 100-min case, and 5% for a 200-min case. The cost disadvantage of brachial plexus anesthesia over GA can be estimated to be 19% for a 50-min case, 8% in a 100-min case, and 1% for a 200-min case. We found no difference in costs between epidural and GA. We concluded that cost comparisons of anesthesia techniques largely depend on the surgical duration of the cases studied. Even in a teaching hospital setting, spinal anesthesia has economic advantages over GA. Especially for short cases, brachial plexus block is more expensive in this setting.
PMID: 15728069 [PubMed - indexed for MEDLINE]
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Testing the reliability of a new ultrasonic cardiac output monitor, the USCOM, by using aortic flowprobes in anesthetized dogs.
Critchley LA, Peng ZY, Fok BS, Lee A, Phillips RA.
Department of Anesthesia and Intensive Care, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong, China. hcritchley@cuhk.edu.hk
We have used an animal model to test the reliability of a new portable continuous-wave Doppler ultrasonic cardiac output monitor, the USCOM. In six anesthetized dogs, cardiac output was measured with a high-precision transit time ultrasonic flowprobe placed on the ascending aorta. The dogs' cardiac output was increased with a dopamine infusion (0-15 microg x kg(-1) x min(-1)). Simultaneous flowprobe and USCOM cardiac output measurements were made. Up to 64 pairs of readings were collected from each dog. Data were compared by using the Bland and Altman plot method and Lin's concordance correlation coefficient. A total of 319 sets of paired readings were collected. The mean (+/-sd) cardiac output was 2.62 +/- 1.04 L/min, and readings ranged from 0.79 to 5.73 L/min. The mean bias between the 2 sets of readings was -0.0l L/min, with limits of agreement (95% confidence intervals) of -0.34 to 0.31 L/min. This represents a +/-13% error. In five of six dogs, there was a high degree of concordance, or agreement, between the 2 methods, with coefficients >0.9. The USCOM provided reliable measurements of cardiac output over a wide range of values. Clinical trials are needed to validate the device in humans.
PMID: 15728064 [PubMed - indexed for MEDLINE]
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The short-acting beta1-adrenoceptor antagonists esmolol and landiolol suppress the bispectral index response to tracheal intubation during sevoflurane anesthesia.
Oda Y, Nishikawa K, Hase I, Asada A.
Department of Anesthesiology and Intensive Care Medicine, Graduate School of Medicine, Osaka City University, 1-5-7 Asahimachi, Abeno-ku, Osaka 545-8586, Japan. odayou@msic.med.osaka-cu.ac.jp
In this randomized, double-blind, controlled study, we tested the hypothesis that the short-acting beta(1)-adrenoceptor antagonists esmolol and landiolol suppress hemodynamic changes and bispectral index (BIS) increases, both of which are induced by tracheal intubation under general anesthesia with sevoflurane alone. Forty-five patients were randomly assigned to the control, esmolol, and landiolol groups (n = 15 each). Anesthesia was induced with sevoflurane in oxygen, with an end-tidal concentration maintained at 1 minimum alveolar anesthetic concentration (MAC). Infusion of saline (control group), esmolol (bolus of 1 mg/kg and then 0.25 mg x kg(-1) x min(-1); esmolol group), or landiolol (bolus of 0.125 mg/kg and then 0.04 mg x kg(-1) x min(-1); landiolol group) was started 5 min after the induction of anesthesia and was continued throughout the study. Tracheal intubation was performed 12 min after anesthesia induction. There were no differences in overall changes of mean arterial blood pressure among the three groups, whereas, at 1-5 min after tracheal intubation, heart rate increased in all groups but was significantly slower in the esmolol and landiolol groups than in the control group (P < 0.05). BIS was between 96 and 98 for all patients at baseline and decreased during the induction of anesthesia. There were no differences in BIS among the three groups before laryngoscopy (39 +/- 5, 39 +/- 5, and 38 +/- 4 in the control, esmolol, and landiolol groups, respectively). BIS increased significantly in the control group (54 +/- 10; P < 0.05) 1 min after intubation, whereas it remained unchanged in the esmolol and landiolol groups (45 +/- 10 and 41 +/- 6, respectively). In conclusion, the increase in both heart rate and BIS after tracheal intubation under 1 MAC sevoflurane anesthesia was suppressed by the concomitant administration of either esmolol or landiolol.
Publication Types:
- Clinical Trial
- Randomized Controlled Trial
PMID: 15728061 [PubMed - indexed for MEDLINE]
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Epidural ropivacaine anesthesia decreases the bispectral index during the awake phase and sevoflurane general anesthesia.
Ishiyama T, Kashimoto S, Oguchi T, Yamaguchi T, Okuyama K, Kumazawa T.
Department of Anesthesiology, Faculty of Medicine, University of Yamanashi, 1110 Shimokato, Tamaho, Nakakoma, Yamanashi 409-3898, Japan. ishiyama@yamanashi.ac.jp
The sedative effects of epidural anesthesia without volatile and IV anesthetics and quantification of the degree of epidural anesthesia-induced sedation have not been investigated. In the current study we evaluated the effects of epidural anesthesia on the bispectral index (BIS) during the awake phase and during general anesthesia. After placing the epidural catheter, the patients were randomly allocated to 2 groups receiving either 5 mL of epidural saline (group S) or the same volume of 0.75% ropivacaine (group R). The BIS measurements during the awake phase were performed at 7, 12, 13, 14, 22, and 23 min after the epidural injection. General anesthesia was then induced with propofol and vecuronium and maintained with 0.75% sevoflurane. From approximately 10 min after tracheal intubation, the BIS measurements were made at 1-min intervals for 10 min. The BIS during the awake phase was significantly lower in group R than in group S (P < 0.05). The BIS during general anesthesia was significantly lower in group R than in group S (P < 0.0001). Epidural anesthesia decreased the BIS during the awake phase and during general anesthesia. The decrease of the BIS associated with epidural anesthesia was more prominent during general anesthesia than during the awake phase.
Publication Types:
- Clinical Trial
- Randomized Controlled Trial
PMID: 15728060 [PubMed - indexed for MEDLINE]
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Airway reflexes return more rapidly after desflurane anesthesia than after sevoflurane anesthesia.
McKay RE, Large MJ, Balea MC, McKay WR.
Department of Anesthesia and Perioperative Care, University of California, San Francisco, CA 94143-0648, USA. eshimar@anesthesia.ucsf.edu
Patients given a more soluble inhaled anesthetic usually take longer to awaken from anesthesia than do patients given a less soluble anesthetic. In the present study, we tested whether such a delay in awakening was also associated with a delay in restoration of protective airway reflexes. Patients were randomly assigned to receive desflurane (n = 31) or sevoflurane (n = 33) via a laryngeal mask airway. Demographics did not differ between groups. The average minimum alveolar anesthetic concentration fraction for both groups was 0.62, and the mean (+/-sd) minimum alveolar anesthetic concentration hours was 1.00 +/- 0.68 for desflurane versus 0.95 +/- 0.57 for sevoflurane, although more patients given sevoflurane also received regional anesthesia (17 for sevoflurane and 8 for desflurane). The time from stopping anesthetic administration to appropriate response to command was longer after sevoflurane (5.5 +/- 3.1 versus 3.4 +/- 1.9 min; P < 0.01). In addition, the time from first response to command to ability to swallow 20 mL of water without coughing or drooling was longer after sevoflurane. At 2 min after responding to command, all patients given desflurane were able to swallow without coughing or drooling, whereas 55% of patients given sevoflurane coughed and/or drooled (P < 0.001). At 6 min after responding to command, 18% of patients given sevoflurane still could not swallow without coughing or drooling (P < 0.05). We conclude that desflurane allows an earlier return of protective airway reflexes.
Publication Types:
- Clinical Trial
- Randomized Controlled Trial
PMID: 15728054 [PubMed - indexed for MEDLINE]
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Advances in diabetic management: implications for anesthesia.
Ahmed Z, Lockhart CH, Weiner M, Klingensmith G.
Children's Hospital of Michigan, 3901 Beaubien Street, Detroit, MI 48201, USA. zulfiqarahmed@mac.co
The past 20 yr have seen an explosion in advances for the management of Type I diabetes mellitus. Not only new delivery systems, such as the continuous subcutaneous insulin pump, but also better and more stable types of insulin with predictable pharmacokinetics and pharmacodynamics have been developed. An artificial pancreas is now on the horizon. This progress has had a significant impact on modern perioperative care of the diabetic patient.
Publication Types:
PMID: 15728048 [PubMed - indexed for MEDLINE]
Comment in:
Awareness during anesthesia in children: a prospective cohort study.
Davidson AJ, Huang GH, Czarnecki C, Gibson MA, Stewart SA, Jamsen K, Stargatt R.
Department of Anaesthesia and Pain Management, The Royal Children's Hospital, Flemington Rd., Parkville 3052, Victoria, Australia. andrew.davidson@rch.org.au
During routine adult anesthesia, the risk of awareness is 0.1%-0.2%. No recent studies have reported the incidence in children. Altered pharmacology and differing anesthesia techniques suggest that the incidence may differ in children. In this prospective cohort study, we determined the incidence of awareness during anesthesia in children. Eight-hundred-sixty-four children aged 5-12 yr who had undergone general anesthesia at The Royal Children's Hospital were interviewed on 3 occasions to determine the incidence of awareness. The awareness assessment was nested within a larger study of behavior change after anesthesia. Reports of suspected awareness were sent to four independent adjudicators. If they all agreed, a case was classified as true awareness. Twenty-eight reports were generated. There were 7 cases of true awareness, for an incidence of 0.8% (95% confidence interval, 0.3%-1.7%). Only one aware child received neuromuscular blockers, compared with 12% in the nonaware group. No aware child reported distress, and no substantial difference was detected in behavior disturbance between aware (20%) and nonaware (16%) children. The data provide some evidence that, like adults, children are also at risk of intraoperative awareness. Although the cause remains unclear, anesthesiologists should be alerted to the possibility of awareness in children.
PMID: 15728046 [PubMed - indexed for MEDLINE]
Comment on:
Goldilocks: the pediatric anesthesiologist's dilemma.
Davis PJ.
Publication Types:
PMID: 15728045 [PubMed - indexed for MEDLINE]
Comment on:
Caudal morphine for pain relief in pediatric liver transplantation: did it help?
Mayhew JF.
Publication Types:
PMID: 15673914 [PubMed - indexed for MEDLINE]
Comment on:
Block of the posterior femoral cutaneous nerve.
Chelly JE, Delaunay L.
Publication Types:
PMID: 15673903 [PubMed - indexed for MEDLINE]
-
Airway management in adult patients with deep neck infections: a case series and review of the literature.
Ovassapian A, Tuncbilek M, Weitzel EK, Joshi CW.
Department of Anesthesia and Critical Care, University of Chicago Hospitals, MC 4028, 5841 S. Maryland Avenue, Chicago, IL 60637, USA. aovassap@airway.uchicago.edu
Patients with deep neck infections, especially those with Ludwig's angina, may die as a result of airway management mishaps. Skillful airway management is critical, but a safe method of airway control in these patients is yet to be established. We subjected patients with deep neck infections to fiberoptic tracheal intubation by using topical anesthesia to provide general anesthesia for surgical interventions. Patient characteristics and techniques for intubations were recorded on a special data-collection form. Of the 26 patients, 17 had Ludwig's angina, and 9 had other types of deep neck infections. Three patients were tracheally intubated while in the sitting position, 2 in Fowler's position, and 21 in the supine position with the head up 10 degrees-15 degrees. Tracheal intubations were successful in 25 patients: 19 nasally and 6 orally. After surgery, seven patients were kept tracheally intubated, and five patients had tracheostomies. Complications were limited to three cases of mild epistaxis and four oversedations with transient hypoxemia. Twelve patients remembered part of the procedure, and two considered it unpleasant. Tracheal intubation with a flexible bronchoscope by using topical anesthesia is highly successful in adult patients with deep neck infections. Tracheostomy using local anesthesia is recommended if fiberoptic intubation is not feasible, if the clinician is not skillful in the use of awake fiberoptic intubation, or if intubation attempts have failed.
PMID: 15673898 [PubMed - indexed for MEDLINE]
Comment in:
Spinal 2-chloroprocaine: a comparison with procaine in volunteers.
Gonter AF, Kopacz DJ.
Department of Anesthesiology, Virginia Mason Clinic, 1100 Ninth Avenue, Seattle, WA 98111, USA.
Recent studies using preservative-free 2-chloroprocaine (2-CP) for spinal anesthesia have shown it to be a reliable short-acting drug that provides similar anesthesia to lidocaine. In this randomized, double-blind, crossover study, we compared the characteristics of spinal 2-CP (30 mg) with those of procaine (80 mg) in eight volunteers to determine whether either drug produces spinal anesthetic characteristics ideal for outpatient surgery. By using sensation to pinprick, transcutaneous electrical stimulation, tolerance to thigh tourniquet, and motor blockade as surrogates for surgical efficacy, 2-CP compared similarly to procaine. Peak block height (T9 [range, T6 to T12] versus T6 [T4 to T8]; P = 0.0796), time to two-segment regression (51 +/- 17 min versus 53 +/- 10 min; P = 0.7434), tourniquet time tolerance (37 +/- 16 versus 49 min +/- 17 min; P = 0.1755), and time to return of motor strength (Bromage scale: 54 +/- 23 min versus 55 +/- 44 min, P = 0.9366; return of 90% quadriceps strength: 78 +/- 9 min versus 98 +/- 30 min; P = 0.0721) were all similar. Procaine did produce overall longer sensory blockade (P = 0.0011) and motor blockade at the gastrocnemius (P = 0.0004) and quadriceps (P = 0.0146) muscles. Times until the resolution of sensory blockade (103 +/- 12 min versus 151 +/- 26 min; P = 0.0003), ambulation (103 +/- 12 min versus 151 +/- 26 min; P = 0.0003), and micturition (103 +/- 12 min versus 156 +/- 23 min; P < 0.0001) were all prolonged after procaine. In conclusion, at the doses tested, spinal 2-CP (30 mg) may be a better choice for short outpatient procedures because it provides anesthesia with similar efficacy as procaine (80 mg) but with more rapid fulfillment of discharge criteria.
Publication Types:
- Clinical Trial
- Randomized Controlled Trial
PMID: 15673896 [PubMed - indexed for MEDLINE]
Comment in:
Spinal 2-chloroprocaine: a comparison with small-dose bupivacaine in volunteers.
Yoos JR, Kopacz DJ.
Department of Anesthesiology, Virginia Mason Clinic, 1100 Ninth Avenue, Seattle, WA 98111, USA.
Ambulatory surgery continues to increase nationwide. Because spinal lidocaine is associated with transient neurologic symptoms, many clinicians have switched to small-dose bupivacaine for outpatient spinal anesthesia. However, bupivacaine often produces inadequate surgical anesthesia and has an unpredictable duration. Preservative-free 2-chloroprocaine (2-CP) has reemerged as an alternative for outpatient spinal anesthesia. We designed this double-blind, randomized, crossover, volunteer study to compare 40 mg of 2-CP with small-dose (7.5 mg) bupivacaine with measures of pinprick anesthesia, motor strength, tolerance to tourniquet and electrical stimulation, and simulated discharge criteria. Peak block height (2-CP average T7 [range T3-10]; bupivacaine average T9 [range T4-L1]), regression to L1 (2-CP 64 +/- 10 versus bupivacaine 87 +/- 41 min), and tourniquet tolerance (2-CP 52 +/- 11 versus bupivacaine 60 +/- 27 min) did not differ between drugs (P = 0.15, 0.12, and 0.40, respectively). However, time to simulated discharge (including time to complete block regression, ambulation, and spontaneous voiding) was significantly longer with bupivacaine (2-CP 113 +/- 14, bupivacaine 191 +/- 30 min, P = 0.0009). No subjects reported transient neurologic symptoms or other side effects. We conclude that spinal 2-CP provides adequate duration and density of block for ambulatory surgical procedures, and has significantly faster resolution of block and return to ambulation compared with 7.5 mg of bupivacaine.
Publication Types:
- Clinical Trial
- Randomized Controlled Trial
PMID: 15673895 [PubMed - indexed for MEDLINE]
Comment in:
Spinal 2-chloroprocaine: the effect of added clonidine.
Davis BR, Kopacz DJ.
Department of Anesthesiology, Virginia Mason Medical Center, 1100 Ninth Avenue, Seattle, WA 98111, USA.
Preservative-free 2-chloroprocaine (2-CP) is being investigated for short-acting spinal anesthesia. Clonidine improves the quality of spinal bupivacaine and ropivacaine, but in traditional doses (1-2 microg/kg) it produces systemic side effects. It has not been studied in combination with 2-CP. In this double-blind, randomized crossover study, we compared spinal 2-CP (30 mg) with and without clonidine (15 microg) in eight volunteers. Pinprick anesthesia, motor strength, tolerance to electrical stimulation and thigh tourniquet, and time to ambulation were assessed. Peak block height was similar between 2-CP (T8 [range, T6 to L2]) and 2-CP with clonidine (T8 [range, T4 to T11]) (P = 0.57). Sensory anesthesia was prolonged with clonidine at L1 (51 +/- 23 min versus 76 +/- 11 min; P = 0.002), as was complete block regression (99 +/- 18 min versus 131 +/- 15 min; P = 0.001). Lower extremity motor blockade was increased with clonidine (return to baseline Bromage score: 65 +/- 13 min versus 79 +/- 19 min, P = 0.004; return to 90% gastrocnemius strength: P = 0.003). Clonidine increased tourniquet tolerance from 33 to 45 min (P = 0.06) and increased time to ambulation, spontaneous voiding, and discharge (99 +/- 18 min versus 131 +/- 15 min for all; P = 0.001). There were no differences in hemodynamic measurements, and no subject reported transient neurologic symptoms. We conclude that small-dose clonidine increases the duration and improves the quality of 2-CP spinal anesthesia without systemic side effects.
Publication Types:
- Clinical Trial
- Randomized Controlled Trial
PMID: 15673894 [PubMed - indexed for MEDLINE]
Comment in:
Spinal 2-chloroprocaine for surgery: an initial 10-month experience.
Yoos JR, Kopacz DJ.
Department of Anesthesiology, Virginia Mason Clinic, 1100 Ninth Avenue, Seattle, WA 98111, USA.
Spinal 2-chloroprocaine (2-CP) is currently being investigated as a short-acting alternative to lidocaine, which frequently causes transient neurologic symptoms (TNS) in surgical patients. TNS has not been reported with 2-CP in volunteers in doses ranging from 30 to 60 mg and appears to provide an excellent level of surgical anesthesia. In this retrospective study, we describe the experience with spinal 2-CP in surgical patients during its first 10 mo of clinical use at our institution. Most patients had ambulatory surgery, including 39 orthopedic, 30 general surgical, 18 gynecologic, and 34 genitourinary procedures. Chloroprocaine 30 or 40 mg, with or without fentanyl (10-20 microg), was the most common (92%) dose combination used. Mean peak block height averaged T6 to T8. The surgical procedure time was 32.3 +/- 18.4 min. Time from placement of the block to the end of the surgical procedure was 53.1 +/- 20.7 min. Times to ambulation and discharge were 155.1 +/- 34.7 min and 207.9 +/- 69.4 min, respectively. 2-CP spinal anesthesia has proven to be a safe and effective alternative to lidocaine and procaine for ambulatory surgical procedures of < or =1 h, with a predictable regression of block height. No patients reported TNS after surgery.
Publication Types:
- Clinical Trial
- Randomized Controlled Trial
PMID: 15673893 [PubMed - indexed for MEDLINE]
-
Cisatracurium-induced neuromuscular blockade is affected by chronic phenytoin or carbamazepine treatment in neurosurgical patients.
Richard A, Girard F, Girard DC, Boudreault D, Chouinard P, Moumdjian R, Bouthilier A, Ruel M, Couture J, Varin F.
Department of Anesthesiology, Centre Hospitalier de l'Universite de Montreal, Hopital Notre-Dame, 1560 Sherbrooke East, Montreal, Quebec, Canada, H2L 4M1.
The effect of chronic anticonvulsant therapy (CAT) on the maintenance and recovery profiles of cisatracurium-induced neuromuscular blockade has not been adequately studied. In this study, we compared the pharmacokinetics and pharmacodynamics of cisatracurium after a prolonged infusion in patients with or without CAT. Thirty patients undergoing intracranial surgery were enrolled in the study: 15 patients under CAT (carbamazepine and phenytoin, Group A) and 15 controls receiving no anticonvulsant therapy (Group C). Anesthesia was standardized and both groups received a bolus of cisatracurium followed by an infusion to maintain a 95% twitch depression. A steady-state was obtained and the infusion was kept constant for 2 additional hours. Neuromuscular blockade was then allowed to spontaneously recover. Blood samples were taken for measurement of cisatracurium plasma concentration during the steady-state period (Cp(ss)95) and at various times during recovery. Demographic and intraoperative data were similar. CAT resulted in faster 25% and 75% recovery of the first twitch. The rate of infusion of cisatracurium needed to maintain a 95% twitch depression at steady-state was 44% faster in Group A (P < 0.001). The clearance of cisatracurium was significantly faster in Group A when compared with Group C (7.12 +/- 1.87 versus 5.72 +/- 0.70 L . kg(-1) . min(-1), P = 0.01). The Cp(ss)95 was also significantly larger in Group A (191 +/- 45 versus 159 +/- 36 ng/mL, P = 0.04). In addition, patients receiving CAT had a 20% increase in the clearance of cisatracurium that, in turn, resulted in a faster recovery of neuromuscular blockade after an infusion of the drug. Also, patients under CAT had a 20% increase in their Cp(ss)95, indicating an increased resistance to the effect of cisatracurium.
PMID: 15673889 [PubMed - indexed for MEDLINE]
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Retrograde submental intubation by pharyngeal loop technique in a patient with faciomaxillary trauma and restricted mouth opening.
Arya VK, Kumar A, Makkar SS, Sharma RK.
Department of Anesthesia & Intensive Care, Post-Graduate Institute of Medical Education and Research, Chandigarh-160012, India. aryavk_99@yahoo.com
Submental intubation is useful for airway management during maxillofacial surgery when both nasal and orotracheal intubation are deemed unsuitable and to avoid a tracheostomy, especially when long-term ventilatory support is not required in the postoperative period. Adequate mouth opening is a prerequisite for all the techniques described for submental intubation, as the initial step is orotracheal intubation. Hence, this procedure has never been reported in a patient with the inability to open the mouth. We describe the technique of retrograde submental intubation with the help of a pharyngeal loop assembly for the first time in a patient with maxillofacial trauma and restricted mouth opening in whom oral and nasal intubations were not possible and tracheostomy was the only alternative. In this case report, with successful retrograde submental intubation, the potential complications associated with a short-term tracheostomy were avoided, as there was no indication for keeping a tracheostomy during the postoperative period.
PMID: 15673888 [PubMed - indexed for MEDLINE]
-
Small-dose ketamine infusion improves postoperative analgesia and rehabilitation after total knee arthroplasty.
Adam F, Chauvin M, Du Manoir B, Langlois M, Sessler DI, Fletcher D.
Department of Anesthesia and INSERM E-332, Hopital Ambroise Pare, Publique-Hopitaux de Paris, 92100 Boulogne, France.
We designed this study to evaluate the effect of small-dose IV ketamine in combination with continuous femoral nerve block on postoperative pain and rehabilitation after total knee arthroplasty. Continuous femoral nerve block was started with 0.3 mL/kg of 0.75% ropivacaine before surgery and continued in the surgical ward for 48 h with 0.2% ropivacaine at a rate of 0.1 mL . kg(-1) . h(-1). Patients were randomly assigned to receive an initial bolus of 0.5 mg/kg ketamine followed by a continuous infusion of 3 mug . kg(-1) . min(-1) during surgery and 1.5 mug . kg(-1) . min(-1) for 48 h (ketamine group) or an equal volume of saline (control group). Additional postoperative analgesia was provided by patient-controlled IV morphine. Pain scores and morphine consumption were recorded over 48 h. The maximal degree of active knee flexion tolerated was recorded daily until hospital discharge. Follow-up was performed 6 wk and 3 mo after surgery. The ketamine group required significantly less morphine than the control group (45 +/- 20 mg versus 69 +/- 30 mg; P < 0.02). Patients in the ketamine group reached 90 degrees of active knee flexion more rapidly than those in the control group (at 7 [5-11] versus 12 [8-45] days, median [25%-75% interquartile range]; P < 0.03). Outcomes at 6 wk and 3 mo were similar in each group. These results confirm that ketamine is a useful analgesic adjuvant in perioperative multimodal analgesia with a positive impact on early knee mobilization. No patient in either group reported sedation, hallucinations, nightmares, or diplopia, and no differences were noted in the incidence of nausea and vomiting between the two groups.
Publication Types:
- Clinical Trial
- Randomized Controlled Trial
PMID: 15673878 [PubMed - indexed for MEDLINE]
-
The modifying effects of stimulation pattern and propofol plasma concentration on motor-evoked potentials.
Scheufler KM, Reinacher PC, Blumrich W, Zentner J, Priebe HJ.
Abt. Allgemeine Neurochirurgie, Universitatsklinikum Freiburg, Breisacher Strasse 64, D-79106 Freiburg, Germany. scheufle@nz11.ukl.uni-freiburg.de
The quality of intraoperative motor-evoked potentials (MEPs) largely depends on the stimulation pattern and anesthetic technique. Further improvement in intraoperative MEP recording requires exact knowledge of the modifying effects of each of these factors. Accordingly, we designed this study to characterize the modifying effect of different stimulation patterns during different propofol target plasma concentrations (PTPCs) on intraoperatively recorded transcranial electrical MEPs. In 12 patients undergoing craniotomy, stimulation patterns (300-500 V; 100-1000 Hz; 1-5 stimuli) were varied randomly at different PTPCs (2, 4, and 6 microg/mL). Remifentanil was administered unchanged at 0.2 microg . kg(-1) . min(-1). MEPs were recorded from the thenar and hypothenar muscles. Analysis of MEPs was blinded to the PTPC. Three-way analysis of variance revealed significant main effects of increasing stimulation intensity, frequency, and number of stimuli on MEP amplitude (P < 0.05). Maximum MEP amplitudes and recording success rates were observed with three or more stimuli delivered at 1000 Hz and > or =150 V. A significant main effect of PTPC (2 vs 4 and 6 microg/mL) on MEP amplitude was observed at the thenar recording site only (P < 0.05). An amplitude ratio calculated from corresponding MEPs evoked by double and quadruple stimulation proved to be insensitive to changes in PTPC. In conclusion, MEP characteristics varied significantly in response to changes in stimulation pattern and less to changes in PTPC.
Publication Types:
- Clinical Trial
- Randomized Controlled Trial
PMID: 15673873 [PubMed - indexed for MEDLINE]
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Cisatracurium pharmacodynamics in patients with oculopharyngeal muscular dystrophy.
Caron MJ, Girard F, Girard DC, Boudreault D, Brais B, Nassif E, Chouinard P, Ruel M, Duranceau A.
Department of Anesthesiology, Centre Hospitalier de l'Universite de Montreal, Hopital Notre-Dame, 1560 Sherbrooke E., Montreal, Quebec, Canada H2L 4M1.
The pharmacodynamics of muscle relaxants in patients with oculopharyngeal muscular dystrophy (OPMD) have never been studied. We designed this study to compare the pharmacodynamics of cisatracurium in OPMD patients versus a control group. Forty patients were enrolled: 20 OPMD patients requiring general anesthesia for cricopharyngeal myotomy and 20 age-matched controls undergoing an operation of similar duration and expected blood loss. Anesthesia was standardized, and both groups received a bolus of cisatracurium 0.1 mg/kg. Onset time, time to 10% T1 recovery, and the intervals 10%-25% and 25%-75% were calculated for both groups. A subgroup analysis was performed in patients with a more severe form of OPMD. Demographic and intraoperative data were similar. Onset time was significantly longer in OPMD patients compared with the control group (4.6 +/- 1.5 min versus 3.4 +/- 1.0 min; P = 0.001). There was no difference in recovery times or indices between groups, regardless of the severity of the disease. In conclusion, there was no difference in the duration of a cisatracurium-induced neuromuscular block between OPMD patients and a control group. A delayed onset of action of the drug may occur.
Publication Types:
PMID: 15673864 [PubMed - indexed for MEDLINE]
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Dolasetron versus ondansetron for the treatment of postoperative nausea and vomiting.
Meyer TA, Roberson CR, Rajab MH, Davis J, McLeskey CH.
Department of Pharmacy, Scott & White Memorial Hospital, 2401 S. 31st Street, Temple, TX 76508, USA. phatam@swmail.sw.or
The management of postoperative nausea and vomiting (PONV) remains a persistent problem. Despite the use of prophylactic antiemetics, breakthrough nausea and vomiting still frequently occur. There have been no published studies comparing dolasetron and ondansetron for the treatment of PONV. This was a prospective, randomized, double-blind, active-controlled study in adult outpatient surgery patients. We screened 559 consecutive adult surgery patients, with 92 patients randomized to either ondansetron or dolasetron. The objectives of the study were 1) to determine whether treatment of PONV with ondansetron 4 mg IV or dolasetron 12.5 mg IV would result in better outcomes in patients undergoing day surgery and 2) to compare the cost of drugs used for treating PONV. Thirty-three (70%) of 47 patients given ondansetron required rescue medication, compared with 18 (40%) of 45 patients given dolasetron (P < 0.004). Dolasetron was approximately 40% less expensive than ondansetron, and the costs of the study drug plus rescue antiemetics were 30% less in the dolasetron group than in the ondansetron group. Dolasetron provided greater efficacy for antiemetic treatment because of the need for less rescue therapy. Because of the decreased use of rescue antiemetics and acquisition cost at our hospital, costs in the dolasetron group were less than costs in the ondansetron group.
Publication Types:
- Clinical Trial
- Randomized Controlled Trial
PMID: 15673860 [PubMed - indexed for MEDLINE]
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Optimal timing of acustimulation for antiemetic prophylaxis as an adjunct to ondansetron in patients undergoing plastic surgery.
White PF, Hamza MA, Recart A, Coleman JE, Macaluso AR, Cox L, Jaffer O, Song D, Rohrich R.
Department of Anesthesiology & Pain Management, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX 75390-9068, USA. paul.white@utsouthwestern.ed
We designed this study to evaluate the antiemetic efficacy of transcutaneous electrical acupoint stimulation in combination with ondansetron when applied before, after, or both before and after plastic surgery. A randomized, double-blind, sham-controlled study design was used to compare three prophylactic acustimulation treatment schedules: preoperative--an active device was applied for 30 min before and a sham device for 72 h after surgery; postoperative--a sham device was applied for 30 min before and an active device for 72 h after surgery; and perioperative--an active device was applied for 30 min before and 72 h after surgery (n = 35 per group). All patients received a standardized general anesthetic, and ondansetron 4 mg IV was administered at the end of surgery. The incidence of vomiting/retching and the need for rescue antiemetics were determined at specific time intervals for up to 72 h after surgery. Nausea scores were recorded with an 11-point verbal rating scale. Other outcome variables assessed included discharge times (for outpatients), resumption of normal activities of daily living, complete antiemetic response rate, and patient satisfaction with antiemetic therapy and quality of recovery. Perioperative use of the ReliefBand significantly increased complete responses (68%) compared with use of the device before surgery only (43%). Median postoperative nausea scores were significantly reduced in the peri- and postoperative (versus preoperative) treatment groups. Finally, patient satisfaction with the quality of recovery (83 +/- 16 and 85 +/- 13 vs 72 +/- 18) and antiemetic management (96 +/- 9 and 94 +/- 10 vs 86 +/- 13) on an arbitrary scale from 0 = worst to 100 = best was significantly higher in the groups receiving peri- or postoperative (versus preoperative) acustimulation therapy. For patients discharged on the day of surgery, the time to home readiness was significantly reduced (114 +/- 41 min versus 164 +/- 50 min; P < 0.05) when acustimulation was administered perioperatively (versus preoperatively). In conclusion, acustimulation with the ReliefBand was most effective in reducing postoperative nausea and vomiting and improving patients' satisfaction with their antiemetic therapy when it was administered after surgery.
Publication Types:
- Clinical Trial
- Randomized Controlled Trial
PMID: 15673859 [PubMed - indexed for MEDLINE]
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Inadvertent extra-epidural catheter placement in an infant.
Berkowitz D, Kaye RD, Markowitz SD, Cook-Sather SD.
Department of Anesthesia, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.
We report the inadvertent passage of an epidural catheter threaded from the caudal space out of a lumbar intervertebral foramen and into the lower thoracic paravertebral space in an infant. We identified the errant catheter by radiography and removed it without sequelae.
Publication Types:
PMID: 15673858 [PubMed - indexed for MEDLINE]
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The effects of intraabdominally insufflated carbon dioxide on hepatic blood flow during laparoscopic surgery assessed by transesophageal echocardiography.
Meierhenrich R, Gauss A, Vandenesch P, Georgieff M, Poch B, Schutz W.
Department of Anesthesiology, University of Ulm, Steinhovelstrasse 9, 89075 Ulm, Germany. rainer.meierhenrich@medizin.uni-ulm.de
Conflicting results have been published about the effects of carbon dioxide (CO(2)) pneumoperitoneum on splanchnic and liver perfusion. Several experimental studies described a pressure-related reduction in hepatic blood flow, whereas other investigators reported an increase as long as the intraabdominal pressure (IAP) remained less than 16 mm Hg. Our goal in the present study was to investigate the effects of insufflated CO(2) on hepatic blood flow during laparoscopic surgery in healthy adults. Blood flow in the right and middle hepatic veins was assessed in 24 patients undergoing laparoscopic surgery by use of transesophageal Doppler echocardiography. Hepatic venous blood flow was recorded before and after 5, 10, 20, 30, and 40 min of pneumoperitoneum, as well as 1 and 5 min after deflation. Twelve patients undergoing conventional hernia repair served as the control group. The induction of pneumoperitoneum produced a significant increase in blood flow of the right and middle hepatic veins. Five minutes after insufflation of CO(2) the median right hepatic blood flow index increased from 196 mL/min/m(2) (95% confidence interval (CI), 140-261 mL/min/m(2)) to 392 mL/min/m(2) (CI, 263-551 mL/min/m(2)) (P < 0.05) and persisted during maintenance of pneumoperitoneum. In the middle hepatic vein the blood flow index increased from 105 mL/min/m(2) (CI, 71-136 mL/min/m(2)) to 159 mL/min/m(2) (CI, 103-236 mL/min/m(2)) 20 min after insufflation of CO(2). After deflation blood flow returned to baseline values in both hepatic veins. Conversely, in the control group hepatic blood flow remained unchanged over the entire study period. We conclude that induction of CO(2) pneumoperitoneum with an IAP of 12 mm Hg is associated with an increase in hepatic perfusion in healthy adults.
Publication Types:
PMID: 15673853 [PubMed - indexed for MEDLINE]
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Continuous gastric decompression for postoperative nausea and vomiting after coronary revascularization surgery.
Burlacu CL, Healy D, Buggy DJ, Twomey C, Veerasingam D, Tierney A, Moriarty DC.
Department of Anaesthesia & Intensive Care Medicine, Mater Misericordiae Hospital, Eccles Street, Dublin 7, Ireland. crina@ireland.com
Postoperative nausea and vomiting is common after cardiac surgery and may contribute to significant morbidity. Gastric decompression during anesthesia has been used for postoperative nausea and vomiting prophylaxis in shorter duration noncardiac surgery with conflicting results. We tested the hypothesis that gastric decompression during elective coronary revascularization surgery with cardiopulmonary bypass and continued afterwards until tracheal extubation would reduce the incidence of vomiting or retching and nausea. In a prospective, randomized, cohort study, 104 patients with at least 2 Apfel's risk factors for postoperative nausea and vomiting were allocated to receive a gastric tube on free gravity drainage after induction of anesthesia (n = 52) or to a control group (n = 52). The gastric tube was removed simultaneously with tracheal extubation postoperatively. The primary outcome measure was the incidence of vomiting or retching. Secondary outcomes included the incidence and severity of nausea measured on a visual analog scale. The incidence of vomiting or retching was 13.4% in patients with gastric decompression, compared with 11.5% in the control group (P = 0.7). Similarly, there was no statistically significant difference between the two groups in the incidence of nausea (32.7% versus 25.0%, P = 0.6), median severity of nausea on a visual analog scale at 12 h (25; range, 0-55 mm versus 30; range, 0-60 mm, P = 0.4), or antiemetics administration (38.5% versus 28.8%, P = 0.3). Continuous gastric decompression during coronary revascularization surgery and afterwards until tracheal extubation did not reduce the incidence of vomiting or retching or the incidence and severity of nausea in these patients.
Publication Types:
- Clinical Trial
- Randomized Controlled Trial
PMID: 15673850 [PubMed - indexed for MEDLINE]
Comment on:
Can epidurography help to predict the extent of epidural blockade?
Marret E, Gibert S, Bonnet F.
Publication Types:
PMID: 15681967 [PubMed - indexed for MEDLINE]
Comment in:
Continuous peripheral nerve blocks at home for treatment of recurrent complex regional pain syndrome I in children.
Dadure C, Motais F, Ricard C, Raux O, Troncin R, Capdevila X.
Department of Anesthesia and Critical Care Medicine, Lapeyronie University Hospital, Montpellier, France. chdadure@yahoo.fr
BACKGROUND: Recurrent complex regional pain syndrome I is not rare in the pediatric population. The authors conducted this study to evaluate the efficacy of continuous peripheral nerve blocks with elastomeric disposable pumps associated with initial Bier blocks for the treatment of recurrent complex regional pain syndrome I in children. METHODS: After parental informed consent, 13 children who did not respond to conventional complex regional pain syndrome treatment were included (mean age, 13 yr; range, 9-16 yr). After general anesthesia, peripheral nerve block was performed using 0.5 ml/kg lidocaine, 1%, with epinephrine and 0.5% ropivacaine injected in the peripheral nerve block catheter. Then, a 20-min Bier block was performed using a tourniquet and 0.2 ml/kg lidocaine, 1%; 3 ml/kg hydroxyethyl starch 130/06; and 5 mg/kg buflomedil injected intravenously. A solution of 0.1 ml . kg . h continuous ropivacaine, 0.2%, was infused through the catheter using an elastomeric pump for 96 h. Need for rescue analgesia, occurrence of side effects, and status of motor and sensory block were recorded at hours 1, 6, 12, 24, 48, 72, and 96. Children and parents completed a satisfaction assessment. All of the children had follow-up visits after 2 months. RESULTS: Postoperative analgesia was excellent. The median pain score was 0 for each period studied. Motor blockade was minimal before 12 h (median, 1) and absent thereafter. One child needed rescue analgesia. All children were able to walk easily after the initial 24-h period (walking score, > 4). Children and parents were all satisfied. Children returned home under parental surveillance beginning in the 24th hour. Neither peripheral nerve block nor Bier block caused side effects. After 2 months, none of the children exhibited any clinical symptom of recurrent complex regional pain syndrome. CONCLUSION: Ambulatory continuous peripheral nerve block associated with an initial Bier block seems to be a significant and novel contribution to treat recurrent pediatric complex regional pain syndrome I. It allows complete pain relief, early mobilization, and rapid return home, representing a psychological advantage for these children.
PMID: 15681955 [PubMed - indexed for MEDLINE]
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Cricoid pressure does not increase the rate of failed intubation by direct laryngoscopy in adults.
Turgeon AF, Nicole PC, Trepanier CA, Marcoux S, Lessard MR.
Department of Anesthesiology, Laval University, Quebec City, Quebec, Canada.
BACKGROUND: Cricoid pressure (CP) is applied during induction of anesthesia to prevent regurgitation of gastric content and pulmonary aspiration. However, it has been suggested that CP makes tracheal intubation more difficult. This double-blind randomized study evaluated the effect of CP on orotracheal intubation by direct laryngoscopy in adults. METHODS: Seven hundred adult patients undergoing general anesthesia for elective surgery were randomly assigned to have a standardized CP (n = 344) or a sham CP (n = 356) during laryngoscopy and intubation. After anesthesia induction and complete muscle relaxation, a 30-s period was allowed to complete intubation with a Macintosh No. 3 laryngoscope blade. The primary endpoint was the rate of failed intubation at 30 s. The secondary endpoints included the intubation time, the Cormack and Lehane grade of laryngoscopic view, and the Intubation Difficulty Scale score. RESULTS: Groups were similar for demographic data and risk factors for difficult intubation. The rates of failed intubation at 30 s were comparable for the two groups: 15 of 344 (4.4%) and 13 of 356 (3.7%) in the CP and sham CP groups, respectively (P = 0.70). The grades of laryngoscopic view and the Intubation Difficulty Scale score were also comparable. Median intubation time was slightly longer in the CP group than in the sham CP group (11.3 and 10.4 s, respectively, P = 0.001). CONCLUSIONS: CP applied by trained personnel does not increase the rate of failed intubation. Hence CP should not be avoided for fear of increasing the difficulty of intubation when its use is indicated.
Publication Types:
- Clinical Trial
- Randomized Controlled Trial
PMID: 15681945 [PubMed - indexed for MEDLINE]
Potential value of adenosine 5'-triphosphate (ATP) and adenosine in anaesthesia and intensive care medicine.
Skrabanja AT, Bouman EA, Dagnelie PC.
Department of Epidemiology, NUTRIM, Maastricht University, Maastricht, The Netherlands.
Extracellular adenosine and adenosine triphosphate (ATP) are involved in biological processes including neurotransmission, muscle contraction, cardiac function, platelet function, vasodilatation, signal transduction and secretion in a variety of cell types. They are released from the cytoplasm of several cell types and interact with specific purinergic receptors which are present on the surface of many cells. This review summarizes the evidence on the potential value and applicability of ATP (not restricted to ATP-MgCl2) and adenosine in the field of anaesthesia and intensive care medicine. It focuses, in particular, on evidence and roles in treatment of acute and chronic pain and in sepsis. Based on the evidence from animal and clinical studies performed during the last 20 years, ATP could provide a valuable addition to the therapeutic options in anaesthesia and intensive care medicine. It may have particular roles in pain management, modulation of haemodynamics and treatment of shock.
PMID: 15722385 [PubMed - as supplied by publisher]
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Checking anaesthetic equipment.
Lake AP, Bugelli G, Jones PA.
Publication Types:
PMID: 15719866 [PubMed - in process]
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A new cardiopulmonary bypass circuit with reduced foreign surface (CorX): initial clinical experience and implications for anaesthesia management.
Bein B, Caliebe D, Scholz J, Steinfath M, Tonner PH, Boening A.
Publication Types:
PMID: 15719863 [PubMed - in process]
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CATALYST - The Medical Memoirs of a World Anaesthetist.
Hatch D.
PMID: 15725333 [PubMed - in process]
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Anesthesia for a child with Alagille syndrome.
Marshall L, Mayhew JF.
Publication Types:
PMID: 15725328 [PubMed - in process]
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Anesthesia for children with Wolf-Hirshhorn syndrome: a report and literature review.
Mohiuddin S, Mayhew JF.
Division of Pediatric Anesthesia and Pain Management, Arkansas Children's Hospital, University of Arkansas for Medical Sciences, Little Rock, AR 72202-3591, USA.
Wolf-Hirshhorn is a rare chromosomal defect syndrome. We present two cases of children diagnosed with Wolf-Hirshhorn syndrome, and discuss the ramifications of anesthesia for these patients.
PMID: 15725327 [PubMed - in process]
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Anesthesia for pediatric renal transplantation with and without epidural analgesia--a review of 7 years experience.
Coupe N, O'Brien M, Gibson P, de Lima J.
University of Sydney, Sydney, New South Wales, Australia.
BACKGROUND: Few objective data exist describing current anesthesia practice for pediatric renal transplantation. We describe here, the experience from an Australian tertiary pediatric center that has continued an active pediatric renal transplantation program after relocation in 1995. Areas of interest include preoperative status, fluid management, hemodynamic stability, perioperative complications, and the use of epidural analgesia. In particular, the influence of perioperative epidural analgesia on hemodynamic stability is addressed. METHODS: A retrospective review of anesthesia records of all patients undergoing pediatric renal transplantation performed at the Children's Hospital at Westmead (CHW), from November 1995 to October 2002 was carried out. RESULTS: Fifty-three pediatric renal transplants were performed in 50 patients. Average age and weight were 10.2 years (range: 1-18 years) and 31.4 kg (range: 9-66 kg), respectively. A total of 14 recipients were less than or equal to 6 years of age. Twenty-four children were recipients of cadaveric transplants, 29 children received kidneys from living related donors. Few children presented with severe anemia (two patients) gross electrolyte abnormalities (three patients) or uncontrolled hypertension. Intraoperatively, all children had central venous pressure monitoring and only four had invasive arterial blood pressure monitoring. Average intraoperative fluid administration was 88 ml x kg(-1) (range: 30-190). Twenty-three children received blood transfusions intraoperatively. Postoperative analgesia was provided using an epidural infusion in 39 patients and an opioid infusion/patient controlled analgesia in the remainder. There was a tendency to greater hemodynamic stability in the group, which received intra-operative epidural analgesia. Half the patients who had epidural analgesia required parenteral opioid supplementation. Five patients had postoperative pulmonary edema. Minor postoperative adverse events included epidural associated motor block (three cases) and opioid related oversedation (one patient). No perioperative mortality or major morbidity was recorded. CONCLUSIONS: Anesthesia for renal transplantation in pediatric patients at CHW is safe and effective using a selected range of drugs and techniques. Pretransplant medical optimization, careful preoperative assessment, adequate monitoring and precise fluid management together with appropriate postoperative analgesia typify the perioperative care of CHW renal transplant recipients.
PMID: 15725320 [PubMed - in process]
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Pediatric sedation in North American children's hospitals: a survey of anesthesia providers.
Lalwani K, Michel M.
Department of Anesthesiology and Perioperative Medicine, Oregon Health and Science University, Portland, OR 97239, USA. lalwanik@ohsu.edu
BACKGROUND: Information about the existence and organization of pediatric sedation services in North America is not available. We conducted a survey to collect this information from anesthesiologists at pediatric institutions and to identify factors perceived as limiting the development of sedation services. METHOD: We electronically mailed a confidential survey about pediatric sedation practice to an attending anesthesiologist involved in pediatric sedation at 116 children's hospitals in the United States and Canada. We identified the institutions using Internet resources. Electronic mailing addresses were obtained from departmental websites, society membership directories and departmental administrators. Our follow-up for nonresponders was by a second e-mail and a telephone call. RESULTS: A total of 54 completed questionnaires were received, a response rate of 47%. Forty-nine (91%) were received from US hospitals, and the remainder from Canadian. Fifty percent of hospitals had a formal pediatric sedation service. Fifty-four percent utilized a 'mobile' provider model. Hospital credentialing for nonanesthesiologist providers varied between 66 and 76% for 'deep' and 'conscious' sedation, respectively. A nurse-physician provider combination was the most common, utilized in 59% of hospitals. Anesthesiologists were the sole sedation providers in 26% of institutions. Propofol was used regularly by nonanesthesiologists for sedation of nonintubated (42%) and intubated (63%) patients. Eighty-seven percent of institutions reported barriers to development of pediatric sedation services. The most common barrier was a shortage of providers, particularly anesthesiologists. CONCLUSIONS: Propofol use by nonanesthesiologists is common. Addressing the shortage of providers, and allocating resources for credentialing providers will encourage further development of pediatric sedation practice.
PMID: 15725318 [PubMed - in process]
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Opening the upper airway--airway maneuvers in pediatric anesthesia.
von Ungern-Sternberg BS, Erb TO, Reber A, Frei FJ.
Division of Anesthesia, Department of Anesthesia, University Children's Hospital, Basel, Switzerland. bvonungern@uhbs.ch
PMID: 15725313 [PubMed - in process]
One shot spinal morphine injection for postthoracotomy pain control in children.
Ioscovich A, Briskin A, Deeb M, Orkin D.
Publication Types:
PMID: 15500504 [PubMed - indexed for MEDLINE]
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Vertical infraclavicular brachial plexus block in children: a preliminary study.
de Jose Maria B, Tielens LK.
Department of Anesthesiology, Hospital Sant Joan de Deu, University Hospital UB, Barcelona, Spain. bdejosemaria@hsjdbcn.org
BACKGROUND: Brachial plexus blockade is a well-established technique in upper limb surgery. Among the infraclavicular approaches, the vertical infraclavicular brachial plexus (VIP) block is easy to perform and has a large spectrum of nerve blockade. The aim of this preliminary study was to determine the ease, effectiveness, safety, and duration of the VIP block in pediatric trauma surgery. METHODS: Fifty-five patients (ASA physical status I and II, age range 5-17 years old) scheduled for upper limb trauma surgery received a VIP block under light general anesthesia, using 0.5 ml x kg(-1) of ropivacaine 0.5%. The number of attempts and time to perform the block, the occurrence of a surgical response, the visual analogue score (VAS) scores, the incidence of complications and the duration of the block were evaluated. RESULTS: The brachial plexus was found easily at the first or second attempt in 85% (47 of 55) of the cases, in 15% (eight of 55) of the cases it was localized after three to four attempts. The mean time to perform the block was 3.35 +/- 3.37 min. Ninety-eight percentage (54 of 55) of the blockades were effective for surgery and in just one case was ineffective. The VAS scores at the end of the procedure in 100% (55 of 55) of the cases were <3. There were no cases with clinical signs of pneumothorax nor inadvertent puncture of major vessels. Two patients developed a Horner's syndrome and in one a mild superficial hematoma at the puncture site occurred. The mean sensory block duration was 8.45 +/- 1.71 h and the mean motor block duration was 6.52 +/- 2.50 h. CONCLUSIONS: In this preliminary study, the VIP block was easy to perform, effective and free of major complications for pediatric trauma surgery. With the doses of ropivacaine we used it was useful for intra- and postoperative analgesia.
Publication Types:
PMID: 15500493 [PubMed - indexed for MEDLINE]
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