Anesthesia & Analgesia

March 2004

Table of Content

CARDIOVASCULAR ANESTHESIA:

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The Incidence and Prediction of Automatically Detected Intraoperative Cardiovascular Events in Noncardiac Surgery

Rainer Röhrig, Axel Junger, Bernd Hartmann, Joachim Klasen, Lorenzo Quinzio, Andreas Jost, Matthias Benson, and Gunter Hempelmann

Anesth Analg 2004 98: 569-577.

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Prophylactic Treatment with Desmopressin Does Not Reduce Postoperative Bleeding After Coronary Surgery in Patients Treated with Aspirin Before Surgery

Hilde Pleym, Roar Stenseth, Alexander Wahba, Lise Bjella, Arve Tromsdal, Asbjørn Karevold, and Ola Dale

Anesth Analg 2004 98: 578-584.

 

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The Association of Patent Foramen Ovale and Atrial Fibrillation After Coronary Artery Bypass Graft Surgery

George Djaiani, Barbara Phillips-Bute, Mihai Podgoreanu, Robert H. Messier, Joseph P. Mathew, Fiona Clements, and Mark F. Newman

Anesth Analg 2004 98: 585-589.

 

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Treatment of Hypoxemia During One-Lung Ventilation Using Intravenous Almitrine

Nicolas Dalibon, Marc Moutafis, Ngai Liu, Jean-Dominique Law-Koune, Stéphanie Monsel, and Marc Fischler

Anesth Analg 2004 98: 590-594.

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Amplification by Hyperoxia of Coronary Vasodilation Induced by Propofol

Alexandre Ouattara, Gilles Boccara, Patrick Lecomte, Rachid Souktani, Philippe Le Cosquer, Stéphane Mouren, Pierre Coriat, and Bruno Riou

Anesth Analg 2004 98: 595-603.

 

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The Effects of a Polymerized Bovine-Derived Hemoglobin Solution in a Rabbit Model of Arterial Thrombosis and Bleeding

Emmanuel Marret, Philippe Bonnin, Elisabeth Mazoyer, Bruno Riou, Ted Jacobs, Pierre Coriat, and Charles-Marc Samama

Anesth Analg 2004 98: 604-610.

PEDIATRIC ANESTHESIA:

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Clinical Evaluation of the Effects of Signal Integrity and Saturation on Data Availability and Accuracy of Masimo SET® and Nellcor N-395 Oximeters in Children

Frederick A. Robertson and George M. Hoffman

Anesth Analg 2004 98: 617-622.

 

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Continuous Psoas Compartment Blocks After Major Orthopedic Surgery in Children: A Prospective Computed Tomographic Scan and Clinical Studies

C. Dadure, O. Raux, P. Gaudard, M. Sagintaah, R. Troncin, A. Rochette, and X. Capdevila

Anesth Analg 2004 98: 623-628.

AMBULATORY ANESTHESIA:

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Comparison of Recovery Profile After Ambulatory Anesthesia with Propofol, Isoflurane, Sevoflurane and Desflurane: A Systematic Review

Anil Gupta, Tracey Stierer, Rhonda Zuckerman, Neal Sakima, Stephen D. Parker, and Lee A. Fleisher

Anesth Analg 2004 98: 632-641.

 

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The Influence of Ambulation Time on the Incidence of Transient Neurologic Symptoms After Lidocaine Spinal Anesthesia

Martti Silvanto, Pekka Tarkkila, Marja-Leena Mäkelä, and Per H. Rosenberg

Anesth Analg 2004 98: 642-646.

ANESTHETIC PHARMACOLOGY:

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Attenuation of Gap-Junction-Mediated Signaling Facilitated Anesthetic Effect of Sevoflurane in the Central Nervous System of Rats

Eiji Masaki, Masahito Kawamura, and Fusao Kato

Anesth Analg 2004 98: 647-652.

 

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Functional Inhibition by Methadone of N-Methyl-D-Aspartate Receptors Expressed in Xenopus Oocytes: Stereospecific and Subunit Effects

Robert J. Callahan, John D. Au, Matthias Paul, Canhui Liu, and C. Spencer Yost

Anesth Analg 2004 98: 653-659.

 

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The Effects of Hexanol on G{alpha}i Subunits of Heterotrimeric G Proteins

John Streiff, David O. Warner, Elena Klimtchuk, William J. Perkins, Kristofer Jones, and Keith A. Jones

Anesth Analg 2004 98: 660-7.

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Peroxynitrite Decreases Rabbit Tissue Factor Activity In Vitro

Vance G. Nielsen and John P. Crow

Anesth Analg 2004 98: 668-671.

 

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Local Anesthetic Properties of a Novel Derivative, N-Methyl Doxepin, Versus Doxepin and Bupivacaine

Yukari Sudoh, Elaine Elliott Cahoon, Umberto De Girolami, and Ging Kuo Wang

Anesth Analg 2004 98: 672-676.

 

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Vasodilation Increases the Threshold for Bupivacaine-Induced Convulsions in Rats

Yutaka Oda, Tomoharu Funao, Katsuaki Tanaka, and Akira Asada

Anesth Analg 2004 98: 677-682.

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Pretreatment with Thiopental for Prevention of Pain Associated with Propofol Injection

Anil Agarwal, Mohammad F. Ansari, Devendra Gupta, Ravindra Pandey, Mehdi Raza, Prabhat K. Singh, Shiopriye, Sanjay Dhiraj, and Uttam Singh

Anesth Analg 2004 98: 683-686.

 

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The Pharmacodynamic Effects of a Lower-Lipid Emulsion of Propofol: A Comparison with the Standard Propofol Emulsion

Dajun Song, Mohamed Hamza, Paul F. White, Kevin Klein, Alejandro Recart, and Omeed Khodaparast

Anesth Analg 2004 98: 687-691.

TECHNOLOGY, COMPUTING, AND SIMULATION:

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Narcotrend Index Versus Bispectral Index as Electroencephalogram Measures of Anesthetic Drug Effect During Propofol Anesthesia

Sascha Kreuer, Wolfram Wilhelm, Ulrich Grundmann, Reinhard Larsen, and Jörgen Bruhn

Anesth Analg 2004 98: 692-697.

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Spectral Analysis of Movement Patterns During Anesthesia (Technical Communication)

Steven L. Jinks, Joseph F. Antognini, and Earl Carstens

Anesth Analg 2004 98: 698-702.

PAIN MEDICINE:

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Cost Drivers in Patient-Controlled Epidural Analgesia for Postoperative Pain Management After Major Surgery

Martin Schuster, André Gottschalk, Marc Freitag, and Thomas Standl

Anesth Analg 2004 98: 708-713.

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Dextromethorphan-Associated Epidural Patient-Controlled Analgesia Provides Better Pain- and Analgesics-Sparing Effects than Dextromethorphan-Associated Intravenous Patient-Controlled Analgesia After Bone-Malignancy Resection: A Randomized, Placebo-Controlled, Double-Blinded Study

Avi A. Weinbroum, Benjamin Bender, Alexander Nirkin, Shoshana Chazan, Isaac Meller, and Yehuda Kollender

Anesth Analg 2004 98: 714-722.

 

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Reduction of ß-Endorphin-Containing Immune Cells in Inflamed Paw Tissue Corresponds with a Reduction in Immune-Derived Antinociception: Reversible by Donor Activated Lymphocytes

Siobhan Hermanussen, MyHong Do, and Peter John Cabot

Anesth Analg 2004 98: 723-729.

 

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The Antinociceptive Effect of Transcranial Electrostimulation with Combined Direct and Alternating Current in Freely Moving Rats

 

Vladimir Nekhendzy, Christo P. Fender, M. Frances Davies, Hendrikus J. M. Lemmens, Michael S. Kim, Donna M. Bouley, and Mervyn Maze

Anesth Analg 2004 98: 730-737.

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Intrathecal and Oral Clonidine as Prophylaxis for Postoperative Alcohol Withdrawal Syndrome: A Randomized Double-Blinded Study

I. Dobrydnjov, K. Axelsson, L. Berggren, J. Samarütel, and B. Holmström

Anesth Analg 2004 98: 738-744.

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Decreased Insulin Requirements with Spinal Cord Stimulation in a Patient with Diabetes (Case Report)

Leonardo Kapural, Salim M. Hayek, Michael Stanton-Hicks, and Nagy Mekhail

Anesth Analg 2004 98: 745-746.

ECONOMICS, EDUCATION, AND HEALTH SYSTEMS RESEARCH:

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Is Physician Anesthesia Cost-Effective?

J. P. Abenstein, Kirsten Hall Long, Brian P. McGlinch, and Niki M. Dietz

Anesth Analg 2004 98: 750-757.

NEUROSURGICAL ANESTHESIA:

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Effect of Isoflurane on Neuronal Apoptosis in Rats Subjected to Focal Cerebral Ischemia

Masahiko Kawaguchi, John C. Drummond, Daniel J. Cole, Paul J. Kelly, Mark P. Spurlock, and Piyush M. Patel

Anesth Analg 2004 98: 798-805.

OBSTETRIC ANESTHESIA:

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Combined Spinal-Epidural Anesthesia Using Epidural Volume Extension Leads to Faster Motor Recovery After Elective Cesarean Delivery: A Prospective, Randomized, Double-Blind Study

Eileen Lew, Seow-Woon Yeo, and Easaw Thomas

Anesth Analg 2004 98: 810-814.

 

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Prophylactic Phenylephrine Infusion for Preventing Hypotension During Spinal Anesthesia for Cesarean Delivery

Warwick D. Ngan Kee, Kim S. Khaw, Floria F. Ng, and Bee B. Lee

Anesth Analg 2004 98: 815-821.

REGIONAL ANESTHESIA:

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Continuous Parasacral Sciatic Block: A Radiographic Study

Elisabeth Gaertner, Pablo Lascurain, Cyrille Venet, Xavier Maschino, Alina Zamfir, Radu Lupescu, and Admir Hadzic

Anesth Analg 2004 98: 831-834.

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Adding Dexmedetomidine to Lidocaine for Intravenous Regional Anesthesia

Dilek Memis, Alparslan Turan, Beyhan Karamanlioglu, Zafer Pamukçu, and Imran Kurt

Anesth Analg 2004 98: 835-840.

 

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Intracellular Calcium Increases in Growth Cones Exposed to Tetracaine

Shigeru Saito, Inas A. M. Radwan, Koichi Nishikawa, Hideaki Obata, Tomonori Okamoto, Toshio Kanno, and Fumio Goto

Anesth Analg 2004 98: 841-845.

 

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The Effect of Short-Term Epidural Local Anesthetic Blockade on Urinary Levels of Substance P in Interstitial Cystitis

Andrew Sukiennik, Daniel B. Carr, Iwona Bonney, James E. Marchand, Heinrich Wurm, and Grannum R. Sant

Anesth Analg 2004 98: 846-850.

GENERAL ARTICLES:

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Assessing Residual Neuromuscular Blockade Using Acceleromyography Can Be Deceptive in Postoperative Awake Patients

Christophe Baillard, Sylvie Bourdiau, Philippe Le Toumelin, Farid Ait Kaci, Bruno Riou, Michel Cupa, and C. Marc Samama

Anesth Analg 2004 98: 854-7.

 

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The Intubating Laryngeal Mask Airway Facilitates Tracheal Intubation in the Lateral Position

Ryu Komatsu, Osamu Nagata, Daniel I. Sessler, and Makoto Ozaki

Anesth Analg 2004 98: 858-861.

 

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Assessing Residual Neuromuscular Blockade Using Acceleromyography Can Be Deceptive in Postoperative Awake Patients

Christophe Baillard, MD PhD*, Sylvie Bourdiau, MD*, Philippe Le Toumelin, MD*, Farid Ait Kaci, MD*, Bruno Riou, MD PhD{dagger}, Michel Cupa, MD*, and C. Marc Samama, MD PhD*

*Department of Anesthesiology and Intensive Care, Avicenne Hospital, Bobigny; and {dagger}Department of Emergency Medicine and Surgery, Pitié-Salpêtrière Hospital, Pierre et Marie Curie University, Paris, France

Anesth Analg 2004;98:854-7

 

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Postoperative awake patients may have significant residual neuromuscular block. In awake patients, the results of accelerometry are affected by extra movements to which the thumb may be subject. In this study, we evaluated the repeatability of train-of-four (TOF) ratio using acceleromyography in 253 patients recovering from anesthesia. Immediately after arrival in the postanesthesia care unit, the ulnar nerve was stimulated with TOF stimulation. The evoked response at the thumb was measured by the TOF-Watch apparatus. The current intensity was 30 mA. Two TOF stimulations were applied and recorded at 30-s intervals. A Bland-Altman test was used. The Kappa ({kappa}) test for clinical agreement between the two measurements was also calculated according to the presence or absence of a residual neuromuscular blockade, defined as a TOF ratio <0.9. According to the presence of a residual neuromuscular blockade, the paired TOF ratios were discordant in 61 patients (24%; 95% confidence interval, 21%V27%). The {kappa}test indicated a moderate agreement (k = 0.47). We demonstrated that accelerometry as used in this study is not always accurate. Two isolated acceleromyograph TOF ratios are not an accurate representation of the neuromuscular status of the patient recovering from anesthesia.

 

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Spectral Analysis of Movement Patterns During Anesthesia

Steven L. Jinks, PhD, Joseph F. Antognini, MD, and Earl Carstens, PhD Department of Anesthesiology and Pain Medicine and the Section of Neurobiology, Physiology and Behavior, University of California, Davis, Davis, California

Anesth Analg 2004;98:698-702

 

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It remains unclear how anesthetics produce immobility, an end-point used in determining anesthetic potency. Understanding how movement (in response to noxious stimulation) is ablated by anesthetics could be aided by using spectral analysis of the high and low frequency components of complex movement patterns. We therefore applied a spectral analysis to previously published movement data from rats anesthetized with isoflurane and halothane at 0.6, 0.9, and 1.1 minimum alveolar concentration (MAC). We recorded isometric forces of hindlimb movement elicited by noxious mechanical stimulation of the hindpaw. The movement patterns were subjected to spectral analysis to determine force amplitude for each frequency component. When halothane was increased from 0.6 to 0.9 MAC, force amplitude decreased only for the lowest-frequency (<1 Hz) components, in part related to the generally lower high-frequency forces at 0.6 MAC. Between 0.6 and 0.9 MAC isoflurane amplitude was reduced for most frequencies in the 0V10 Hz range. For both halothane and isoflurane at 1.1 MAC, as expected, force amplitude substantially decreased at all frequencies. We conclude that spectral analysis is useful to describe and quantify the effects of anesthetics on complex movement patterns resulting from noxious stimuli applied during anesthesia.

 

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Continuous Psoas Compartment Blocks After Major Orthopedic Surgery in Children: A Prospective Computed Tomographic Scan and Clinical Studies

C. Dadure, MD*, O. Raux, MD*, P. Gaudard, MD*, M. Sagintaah, MD , R. Troncin, MD*, A. Rochette, MD*, and X. Capdevila, MD PhD*

Departments of *Anesthesia and Critical Care Medicine and@ Pediatric Radiology, Lapeyronie University Hospital, Montpellier, France

Address correspondence and reprint requests to Christophe Dadure, MD, Département dAnesthésie Réanimation A, H&ocirc;pital Lapeyronie, 371 Avenue du Doyen G. Giraud, 34295 Montpellier, France.

Anesth Analg 2004 98: 623-628.

 

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Femoral shaft or hip surgeries are very painful for children. We conducted both computed tomographic (CT) and clinical prospective studies to define new landmarks in children and to evaluate the effectiveness of continuous psoas compartment blocks (CPCBs) using disposable elastomeric pumps. In a preliminary CT scan study of 20 patients, the plexus depth was correlated to patient age and the optimal point of puncture for CPCB was three-quarters of the distance from the spinous process of L4 to a line parallel to the spinal column passing through the posterior superior iliac spine. In a subsequent prospective series, a CPCB was administered before surgery to 15 children for pain relief after femoral and hip osteotomies. After general anesthesia, a 0.5 mL/kg bolus of a mixture of 1% lidocaine with epinephrine (1/200.000) and 0.5% ropivacaine was injected through the CPCB catheter. After contrast media assessment of the catheter location, a disposable pump (Infusor LV&reg;; Baxter, Paris, France) with 0.2% ropivacaine was connected and pump flow was adjusted to the patients weight (0.2 mg /kg/ h). Postoperative pain was evaluated using a visual analog scale or the Children and Infants Postoperative Pain Score at hour H1, H6, H12, H18, H24, H36, and H48, and in terms of rescue analgesia, adverse events, and motor blocks. All blocks were effective during surgery. Postoperative analgesia was excellent. The median pain scores were 1 for H1 and 0 beginning H6. The motor blockade was minimal before 24 h and absent thereafter. No major adverse event was noted. Parents of 93% of the children were satisfied. We conclude that postoperative analgesia with CPCB is a very effective technique in children after major proximal lower limb orthopedic surgery. The CT scan landmarks described in this study were more medial than the conventional landmarks used in the literature .

 

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Attenuation of Gap-Junction-Mediated Signaling Facilitated Anesthetic Effect of Sevoflurane in the Central Nervous System of Rats

Eiji Masaki, MD PhD*, Masahito Kawamura, MD{dagger}, and Fusao Kato, PhD{ddagger} Section Editor

Departments of *Anesthesiology, {dagger}Pharmacology, and {ddagger}Neuroscience, Jikei University School of Medicine, Tokyo, Japan

Address correspondence and reprint requests to Eiji Masaki, Department of Anesthesiology, Jikei University School of Medicine, 3V25V8, Nishishinbashi Minato-ku, Tokyo 105V8461, Japan.

Anesth Analg 2004;98:647-652

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Accumulating evidence suggests that reduction of intrinsic excitability or synaptic excitation and/or an enhancement of synaptic inhibition underlie the general anesthetic condition. Besides chemical synapse, neurons could communicate with each other by electrical coupling via gap-junctions. We hypothesized that inhibition of cell-to-cell signaling through gap-junction in the central nervous system (CNS) is involved in the anesthetic mechanism of volatile anesthetics. The minimum alveolar concentration (MAC) of sevoflurane was measured after the intracerebroventricular (ICV) or intrathecal (IT) administration of carbenoxolone (CBX), a gap-junction inhibitor, in vivo. The spontaneous oscillation in membrane currents of locus coeruleus neurons that results from electrical coupling between neurons was also recorded from young rat pontine slices by the patch clamp method, and the effect of sevoflurane on this oscillation was examined in vitro. The ICV administration of CBX (125 and 250 µg/rat)

significantly reduced the MAC of sevoflurane dose-dependently, whereas IT injection failed to inhibit the MAC. Sevoflurane at clinically relevant concentrations (0.1V0.5 mM) suppressed the spontaneous oscillation in membrane current concentration-dependently. These suppressions were significant at 0.5 mM with both amplitude and frequency. We suggest that suppression of gap-junction-mediated signaling in the CNS is involved in the anesthetic-induced immobilization by sevoflurane.

 

 

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Reduction of ß-Endorphin-Containing Immune Cells in Inflamed Paw Tissue Corresponds with a Reduction in Immune-Derived Antinociception: Reversible by Donor Activated Lymphocytes

Siobhan Hermanussen, BSc Hons, MyHong Do, BPharm Hons, and Peter John Cabot, PhD

The School of Pharmacy, The University of Queensland, Queensland, Australia

Address correspondence and reprint requests to Peter J. Cabot, PhD, The School of Pharmacy, The University of Queensland, 4072, Queensland, Australia.

Anesth Analg 2004;98:723-729

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The functional integrity of the immune system is essential for peripheral antinociception. Previous studies have demonstrated that immune cells elicit potent antinociception in inflamed tissues and that corticotropin-releasing factor-induced antinociception is significantly inhibited in animals that have undergone cyclosporin A (CsA)-induced immunosuppression. In this study, we examined the effect of a single bolus of CsA on inflammatory nociception. CsA-treated rats had substantially increased nociception compared with nonimmunosuppressed rats, consistent with a reduction in circulating and infiltrating lymphocytes. Furthermore, CsA-treated rats had inhibition of corticotropin-releasing factor-induced immune-derived antinociception, which was dose-dependently reversed by IV injection of concanavalin A-activated donor lymphocytes (1.0V7.0 x 106 cells/0.1 mL). In conclusion, our findings provided further evidence that opioid-containing immune cells are essential for peripheral analgesia. It is evident from these findings that control of inflammatory pain relies heavily on a functioning immune system.

 

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Combined Spinal-Epidural Anesthesia Using Epidural Volume Extension Leads to Faster Motor Recovery After Elective Cesarean Delivery: A Prospective, Randomized, Double-Blind Study

Eileen Lew, MBBS MMed, Seow-Woon Yeo, MBBS MMed, FAMS, and Easaw Thomas, MBBS FANZCA, FAMS Section Editor

From the Department of Anaesthesia (Obstetrics and Gynaecology), KK Womens and Childrens Hospital, Singapore

Anesth Analg 2004;98:810-814

 

b¡еw~pX¾K]CSE^ɡAĥεw~eqXR]EVE^޳NOqLw~Ī`gͲzQϤpqTWjkCbe¤ʡBHBsAڭ̤FEVEkP榸`gªPıMBʪSʤΦyʤOíwʡC62Ҷiܴc{]Un31^0.5%d]9mgϪӥ10 µg¡FCESY0.5%d]5mgϪӥ10 µg«5 minqLw~ɺު`g0.9%Q6.0 mlCCj2.5 minOUժ̧CY]SBP^BwLhPıM}BromageCժıkh]VAS^B̰PıB̰}BromageBʵBPıh10ݬqְϡ]T10^һݪɶMBʪ_CկfH@ơBVASB̰PıBPıhT10һݪɶΰO̧CSBPۦCEVEժfHܹBʫ_}Bromage 0ɶ۸(73 33 min vs. 136 32 min, P < 0.05)CܡGPDzΪ榸`g¬ۤApqժw~eqXRu55%d]qNണѺNc¾KABUϹBʫ_֡C

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Epidural volume extension (EVE) via a combined spinal-epidural (CSE) technique is the enhancement of a small-dose intrathecal block by epidural saline boluses. In this prospective, randomized, double-blind study, we compared the EVE technique with single-shot spinal anesthesia with respect to its sensory and motor block profile and hemodynamic stability. Sixty-two parturients (n = 31 in each group) undergoing elective cesarean deliveries were administered either spinal anesthesia with hyperbaric 0.5% bupivacaine 9 mg and fentanyl 10 µg or CSE comprising intrathecal hyperbaric 0.5% bupivacaine 5 mg with fentanyl 10 µg, followed by 0.9% saline 6.0 mL through the epidural catheter 5 min thereafter. In each group, the lowest systolic blood pressure (SBP), sensory block level to loss of pain from pinprick, and modified Bromage scores were recorded at 2.5-min intervals. The visual analog pain score (VAS), peak sensory block height, highest modified Bromage motor score, time for sensory regression to the tenth thoracic dermatome (T10), and motor block recovery were compared between groups. Both groups were comparable in demographic data, VAS scores, peak sensory block height, time for sensory regression to T10, and lowest SBP recorded. Patients in the EVE group demonstrated significantly faster motor recovery to modified Bromage 0 (73 33 min versus 136 32 min, P < 0.05).

 

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Amplification by Hyperoxia of Coronary Vasodilation Induced by Propofol

Alexandre Ouattara, MD*,{dagger}, Gilles Boccara, MD PhD*,{dagger}, Patrick Lecomte, MD*,{dagger}, Rachid Souktani, PhD*,{dagger}, Philippe Le Cosquer, MD*,{dagger}, Stéphane Mouren, MD PhD*,{dagger}, Pierre Coriat, MD*,{dagger}, and Bruno Riou, MD PhD*,{ddagger}

*Laboratory of Anesthesiology, Université Pierre et Marie Curie, Paris; {dagger}Department of Anesthesiology and Critical Care, Centre Hospitalier Universitaire Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris; {ddagger}Department of Emergency Medicine and Surgery, Centre Hospitalier Universitaire Pitié-Salpêtrière, Paris, France

Anesth Analg 2004;98:595-603

 

ڭ̦bBӭM`ߤ߼ҫFoˤ@Ӱ]GbL(PaO2 = 137 16 mm Hg, n = 12)M(PaO2 = 541 138 mm Hg, n = 12)pUA(10V300 µM)aʯߩMߦ٧@ۤPC񻤾ɫaʯۦY(-13% 7%)Cɲαiaʯߪ@μWjC]wɮqLATPӷP[qDϫaʯߦYAڭ̬sFbLM񱡪pUήC脲]glibenclamide ^0.6 µMMcromakalim 0.5 µMwBzt~ա]Un=6^Ŧ@ΡCC脲wBzϫaʯߦY(-16% 7%)AvTaʯߵαi@ΡCCromakalimwBzhFɲaʯߵαi@ΪWjCbLM񱡪pUA@>100 µMۭCߦ٩ʯCڭ̱oXסGWjαiaʯߪ@ΡC{HήC脲ް_aʯߦY{HCOACromakalimŦwBzhFɲaʯߵαi@ΪWjC񤣼vTߦ٧@ΡC

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@We tested the hypothesis that in vitro coronary and myocardial effects of propofol (10V300 µM) should be significantly modified in an isolated and erythrocyte-perfused rabbit heart model in the absence (PaO2 = 137 16 mm Hg, n = 12) or in the presence (PaO2 = 541 138 mm Hg, n = 12) of hyperoxia. The induction of hyperoxia provoked a significant coronary vasoconstriction (-13% 7%). Propofol induced increased coronary vasodilation in the presence of hyperoxia. Because high oxygen tension has been reported to induce a coronary vasoconstriction mediated by the closure of adenosine triphosphate-sensitive potassium channels, we studied the effects of propofol in 2 additional groups of hearts (n = 6 in each group) pretreated by glibenclamide (0.6 µM) and cromakalim (0.5 µM) in the absence and presence of hyperoxia, respectively. The pretreatment by glibenclamide induced a coronary vasoconstriction (-16% 7%) which did not affect propofol coronary vasodilation. The pretreatment by cromakalim abolished the amplification of propofol coronary vasodilation in the presence of hyperoxia. Propofol induced a significant decrease in myocardial performance for a concentration >100 µM both in the absence and presence of hyperoxia. We conclude that propofol coronary vasodilation is amplified in the presence of hyperoxia. This phenomenon is not explained by the previous coronary vasoconstriction induced by glibenclamide. However, the pretreatment of hearts by cromakalim abolished the amplification of propofol coronary vasodilation in the presence of hyperoxia. The myocardial effects of propofol were not affected by the presence of hyperoxia.

 

 

NeAΪǪLfHwΥh[ïण֫aߤNXqProphylactic Treatment with Desmopressin Does Not Reduce Postoperative Bleeding After Coronary Surgery in Patients Treated with Aspirin Before Surgery

Hilde Pleym, MD*, Roar Stenseth, MD PhD*, Alexander Wahba, MD PhD{dagger}, Lise Bjella, MD*, Arve Tromsdal, MD{dagger}, Asbjørn Karevold, MD{dagger}, and Ola Dale, MD PhD*,{ddagger}

Departments of *Anesthesiology and {dagger}Cardiothoracic Surgery, St. Olav University Hospital; and {ddagger}Department of Circulation and Medical Imaging, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway

Anesth Analg 2004;98:578-584

 

HuXޥ[Хh[㦳SʡAi֫aʯ߷fN]CABG^XqC@AΪǪLbŦNpO\vTsܡANe2餺AΪǪLpO\঳jl`Cڭ̦bAΪǪL75160 mgܳNe@ѦӦCABGNfHh[NXqvTCse¤ʡBHBBwӡBոC100үfHGաC@զbijJիܨxᵹh[0.3 µg/kgAt@իhw]0.9%ͲzQ^CON16pɤXqCh[եXq]зǮt^606]237^mLAӲլ601 (301) mL(P = 0.93)ALt]95%iH϶107X117 mL^CסGh[ä֪AΪǪLܳNe@ѯfHCABGNXqC

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The synthetic vasopressin analog desmopressin has hemostatic properties and may reduce postoperative bleeding after coronary artery bypass grafting (CABG). A study on the effects of recent aspirin ingestion on platelet function in cardiac surgery showed a greater impairment of platelet function in patients treated with aspirin <2 days before the operation. We evaluated the effects of desmopressin on postoperative bleeding in CABG patients who were treated with aspirin 75 or 160 mg until the day before surgery. The study was a prospective, randomized, double-blinded, placebo-controlled, parallel group trial. One-hundred patients were included and divided into two groups. One group received desmopressin 0.3 µg/kg and the other received placebo (0.9% NaCl) after the neutralization of heparin with protamine sulfate. Postoperative blood loss was recorded for 16 h. The mean (SD) bleeding was 606 (237) mL in the desmopressin group and 601 (301) mL in the placebo group (P = 0.93), representing no significant difference (95% confidence interval, -107 to 117 mL). We conclude that desmopressin does not reduce postoperative bleeding in CABG patients treated with aspirin until the day before surgery.

 

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Peroxynitrite Decreases Rabbit Tissue Factor Activity In Vitro

Vance G,Nielsen,MD,*and John P.Crow,PhD*.

Department of *Anesthesiology . Pharmacology/Toxicology, Biochemistry and Molecular Genetics,The Center for Free Radical Biology, The University of Alabama at Birmingham

Anesth Analg 2004;98:668-671.

 

´]ƬO餺ް_Ͳzʾ@حnCLƨȵvQ]OONO-^lಣͮƴ(NO)MWƪ(O2-)AiHb~CH´]ƪʡCbxpzʦA`ҾɭPfA]AΨLƨȵvQΦCӥBAߨxpzʦA`j餤´]ƬۭCCڭ̱߲´]ƼSbLƨȵvQiϨ䬡ʭCCLƨȵvQiHSIN1]3-morpholinosydnonimine^͡A SIN1iHΦƴMWƪC߸´]ƤObUCGH37J|90(Cn=8 )G0mM SIN-1, 5mM SIN-1, 5mM SIN-1 M 2000 U/mLHնWƪ[酶]hSOD1^A2000 U/mLHնWƪ[酶]hSOD1^CMNo´]˥[JHߤAΦuʴyOϴw微ΦʤOǡAw´]ƪʡC´]ƼSbSIN1䬡ʭCF48HCPLTդ۩ʮt(P<0.01)CLXնGL۩ʮtCڭ̪׬OA߲´]ƳQLƨȵvQҧAܹLƨȵvQbxŦpzʦA`ҾɭPfҰ_쪺@Τ~sC

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Tissue factor (TF) is a primary initiator of physiological coagulation in vivo.Peroxynitrite (OONO-),a molecule formed nitric oxide (NO) and superoxide (O2-),decreases human TF activity in vitro. Coagulopathy has been associated with hepatoenteric ischemia-reperfusion@ known to involve formation of OONO-. Further , circulating TF activity decreases in rabbits after hepatoenteric ischemia-reperfusion.We hypothesized that exposure of rabbit TF to OONO- would result in a decrease in activity. OONO- generation was performed with 3-morpholinosydnonimine(SIN-1),a molecule that produces both nitric oxide and superoxide .Rabbit brain TF was incubated at 37C for 90 min with 1)0mM SIN-1, 2)5mM SIN-1, 3) 5mM SIN-1 and 2000 U/mL recombinant human superoxide@ dismutase (hSOD1),or 4)2000 U/mL hSOD1(n=8 per condition ) .TF activity was assessed by addition of TF samples to human plasma and measuring clot formation kinetics with a thrombelastograph. TF exposure to SIN-1 resulted in a 48%decrease in activity that was significantly different from the other three conditions (P<0.01). There were no significantly differences between the other conditions .We conclude that rabbit TF is inhibited by OONO-,and further investigation to determine the role of OONO- in coagulopathies associated with hepatoenteric ischemia-reperfusion is warranted.

 

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Pretreatment with Thiopental for Prevention of Pain Associated with Propofol Injection

Anil Agarwal, MD, Mohammad F. Ansari, MD, Devendra Gupta, MD, Ravindra Pandey, MD, Mehdi Raza, MD, Prabhat K. Singh, MD, Shiopriye, MBBS, Sanjay Dhiraj, MD, and Uttam Singh, PhD*

Departments of Anesthesia and *Biostatistics, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India

Anesth Analg 2004;98:683-686

 

y`ghoͲv28%V90%A֯khҸեΪkܦhAĪGUCڭ̤F_R߫Aw`gQu0.25 mg/kgA0.5 mg/kgΧQhd]40 mgwy`ghĪGC124Ҧ~w̡AASA IVIIšAܴNAH|աAC31HCIw`ͲzQAII 2%Qhd]40 mgAIIIQu0.25 mg/kgAIVQu0.5 mg/kgCUw`ħ}2 mLAPɤk_Rߦ^y1CR߶}`gyCkhĥΥ|kA`gɵLh0ALh1A׵h2A׵h3CͲzQ 24ұw̡]77%^DD`ghAIIBIIIBIVO12 ҡ]39%^B10 ]32%^M 1 ҡ]3%^]P < 0.05^CQu0.5 mg/kgwy`gh̦ġCڭ̱˱`Ww`Qu0.5 mg/kgAPɤk_Rߦ^y1Aӹwy`ghC

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Propofol causes pain on IV injection in 28%V90% of patients. A number of techniques have been tried to minimize propofol-induced pain, with variable results. We compared the efficacy of pretreatment with thiopental 0.25 mg/kg and 0.5 mg/kg and lidocaine 40 mg after venous occlusion for prevention of propofol-induced pain. One-hundred-twenty-four adult patients, ASA physical status IVII, undergoing elective surgery were randomly assigned into 4 groups of 31 each. Group I received normal saline, group II received lidocaine 2% (40 mg), and groups III and IV received thiopental 0.25 mg/kg and 0.5 mg/kg, respectively. All pretreatment drugs were made in 2 mL and were accompanied by manual venous occlusion for 1 min. Propofol was administered after release of venous occlusion. Pain was assessed with a four-point scale: 0 = no pain, 1 = mild pain, 2 = moderate pain, and 3 = severe pain at the time of propofol injection. Twenty-four patients (77%) complained of pain in the group pretreated with normal saline as compared with 12 (39%), 10 (32%), and 1 (3%) in the groups pretreated with lidocaine 40 mg, thiopental 0.25 mg/kg, and thiopental 0.5 mg/kg, respectively (P < 0.05). Thiopental 0.5 mg/kg was the most effective treatment. We therefore suggest routine pretreatment with thiopental 0.5 mg/kg along with venous occlusion for 1 min for prevention of pain associated with propofol injection.

 

Qhd]Rߧ¾K[Jdexmedetomidine

Adding Dexmedetomidine to Lidocaine for Intravenous Regional Anesthesia

Dilek Memis, MD*, Alparslan Turan, MD*, Beyhan Karamanlioglu, MD*, Zafer Pamukçu, MD*, and Imran Kurt, MD{dagger}

Departments of *Anaesthesiology and {dagger}Biostatistics, Trakya University Medical Faculty, Edirne, Turkey

Anesth Analg 2004;98:835-840

 

Dexmedetomidine{alpha}-2ǤW骺ܩʬOi֩w8hC㦳hïֹF90%¾KĥζqCQhd]Rߧ¾K[JDexmedetomidineįC[BʩMPı_ĩMɶA¾KqANMNyʤOǰѼƥHγNMNkhMRpC30ҤⳡNwH2զRߧ¾KCӲլ0.5%Qhd]40 mL[1 mL iQ ( L, n = 15). լ 0.5%Qhd]40 mL[0.5 µg/kg dexmedetomidine (LD, n = 15)COPıMBʪ_ĩM_ɶγ¾KqCΤaeMΫ@ 5, 10, 15, 20, M40 minOyʤOǰѼơBakhBRMhĪϥαpCQa30 min, M2, 4, 6, 12, 24 hOyʤOǰѼơBkhMRƭȡBnDĤ@hĪɶBhĪϥαpΤ}CbLDշPıMBʪ_ĮɶYuAPıMBʫ_ɶAa@ɶA¾KqCNMQa30 min, M 2, 4, and 6 hALDժVASۧCLաCLDճNMNhĪnDqCLաCĤ@nDhĪɶLD۩CסGIVRAɦbQhd][Jdexmedetomidineണ¾KqMNhĪGo|ް_}

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@Dexmedetomidine is approximately 8 times more selective toward the {alpha}-2-adrenoceptors than clonidine. It decreases anesthetic requirements by up to 90% and induces analgesia in patients. We designed this study to evaluate the effect of dexmedetomidine when added to lidocaine in IV regional anesthesia (IVRA). We investigated onset and duration of sensory and motor blocks, the quality of the anesthesia, intraoperative-postoperative hemodynamic variables, and intraoperative-postoperative pain and sedation. Thirty patients undergoing hand surgery were randomly assigned to 2 groups to receive IVRA They received 40 mL of 0.5% lidocaine and either 1 mL of isotonic saline (group L, n = 15) or 0.5 µg/kg dexmedetomidine (group LD, n = 15). Sensory and motor block onset and recovery times and anesthesia quality were noted. Before and after the tourniquet application at 5, 10, 15, 20, and 40 min, hemodynamic variables, tourniquet pain and sedation, and analgesic use were recorded. After the tourniquet deflation, at 30 min, and 2, 4, 6, 12, and 24 h, hemodynamic variables, pain and sedation values, time to first analgesic requirement, analgesic use, and side effects were noted. Shortened sensory and motor block onset times, prolonged sensory and motor block recovery times, prolonged tolerance for the tourniquet, and improved quality of anesthesia were found in group LD. Visual analog scale scores were significantly less in group LD in the intraoperative period and 30 min, and 2, 4, and 6 h after tourniquet release. Intra-postoperative analgesic requirements were significantly less in group LD. Time to first analgesic requirements was significantly longer in group LD in the postoperative period. We conclude that the addition of 0.5 µg/kg dexmedetomidine to lidocaine for IVRA improves quality of anesthesia and perioperative analgesia without causing side effects.

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Decreased Insulin Requirements with Spinal Cord Stimulation in a Patient with Diabetes

Leonardo Kapural, MD PhD, Salim M. Hayek, MD PhD, Michael Stanton-Hicks, MB BS, and Nagy Mekhail, MD PhD

Department of Pain Management, The Cleveland Clinic Foundation, Cleveland, Ohio

Address correspondence and reprint requests to Leonardo Kapural, MD, PhD, Pain Management Center, The Cleveland Clinic Foundation, 9500 Euclid Ave. Desk C25, Cleveland, OH 44195.

Anesth Analg 2004;98:745-746

 

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We describe a case of type-2 diabetes mellitus with significant improvement in blood glucose control and significant decrease in insulin requirements after initiation of spinal cord stimulation. We believe that spinal cord stimulation may provide additional beneficial effects in patients with chronic pain and diabetes.

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The Association of Patent Foramen Ovale and Atrial Fibrillation After Coronary Artery

Bypass Graft Surgery

George Djaiani, MD DEAA, FRCA*, Barbara Phillips-Bute, PhD*, Mihai Podgoreanu, MD*, Robert H. Messier, MD{dagger}, Joseph P. Mathew, MD*, Fiona Clements, MD*, and Mark F. Newman, MD*

Departments of *Anesthesiology and {dagger}Cardiac Surgery, Duke University Medical Center, Durham, North Carolina

Anesth Analg 2004;98:585-589


CABG(AF)ofvAW[F귽ӡCsFCABGfHZե(PFO)Mжjʯ߽FPNAFofvYC1008CABGNfHANqLgDWn߰ʹϩTO_жjʷlAʴNX|AFoͱpCGܡGN124(12.3%)ֵoAFCAFfHh~ѪfHANe`񦳥RʤߤOIܥvANɶAN|ɶCPFO72 (7.1%)Aжjʯ߽F23(2.3%)C NAFfH ֵoPFO 14(19.4%)Aֵoжjʯ߽F8(34.8%)CLogistic^kRPFO (Xv[OR], 1.95; 1.007V3.778; P = 0.047), ~(OR, 1.03; 1.015V1.053; P = 0.0004)ΥRʤ߰Iv(OR, 2.55; 1.671V3.900; P < 0.0001)ONoAFC

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Atrial fibrillation (AF) is associated with considerable morbidity and increased resource utilization after coronary artery bypass graft surgery. In this study, we sought to determine whether patent foramen ovale (PFO) and atrial septal aneurysm are associated with an increased risk of postoperative AF in this patient population. We performed a database study on 1008 patients undergoing primary coronary artery bypass graft surgery. All patients were assessed for the development of postoperative AF from the day of surgery to hospital discharge. Atrial septal defects were identified during comprehensive intraoperative transesophageal echocardiographic examination. Postoperative AF was present in 124 (12.3%) patients. Patients with AF were significantly older and had a more frequent incidence of preoperative congestive heart failure, longer cross-clamp time, and prolonged hospital length of stay. PFO was present in 72 (7.1%) and atrial septal aneurysm in 23 (2.3%) patients. In these patients, postoperative AF was present in 14 (19.4%) patients with PFO and 8 (34.8%) patients with atrial septal aneurysm. Multivariate logistic regression analysis identified that PFO (odds ratio [OR], 1.95; 1.007V3.778; P = 0.047), age (OR, 1.03; 1.015V1.053; P = 0.0004), and history of congestive heart failure (OR, 2.55; 1.671V3.900; P < 0.0001) were predictive of postoperative AF.

 

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The Effects of a Polymerized Bovine-Derived Hemoglobin Solution in a Rabbit Model of Arterial Thrombosis and Bleeding

Emmanuel Marret, MD*, Philippe Bonnin, MD PhD{dagger}, Elisabeth Mazoyer, MD{ddagger}, Bruno Riou, MD PhD*,, Ted Jacobs, MD||, Pierre Coriat, MD*, and Charles-Marc Samama, MD PhD

Departments of *Anesthesiology and Critical Care and Emergency Medicine and Surgery, Hôpital Pitié-Salpêtrière, Paris, France; {dagger}Department of Functional Investigations and {ddagger}Laboratory of Hematology, Hôpital Lariboisière, Paris, France; ||Biopure Corporation, Cambridge, Massachusetts; and ¶Department of Anesthesiology, Hôpital Avicenne, Bobigny, France

Anesth Analg 2004;98:604-610

HJլ¦(HBOCs)㦳X\`ΩNγж˫ӭMNΫ~AMӨ譱vT`JsCsEXJ(HBOC-201)AGMͲzQʯߦΦMX媺vTC«A30uFoltsҫaߡASV`ʯߨûs60%UAëإ߰ʯʷlˡAIJogʦΦ]gʦy [CFRs])AbpCFRs¦ȫAʪHTաAC10u(n = 10)GͲzQ(Ӳ)AAMHBOC-201աCqLHUШӤϬMĪ@ΡGPɴCFRsƩMզXɶCGܡGMHBOC-201@άۦACFRsC (Oq71A61)Xɶ۩(q8898sM81102sF P < 0.05)CͲzQCFRsΥXɶLۼvTCסGHBOC-201M@άۦAiְʯߦΦvéXɶC

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Hemoglobin-based oxygen carriers (HBOCs) have been developed primarily for their oxygenating function and possible use as an alternative to red blood cells during surgery or after major trauma. However, their effect on hemostasis has not been studied extensively. We compared the effects on hemostasis of bovine-derived hemoglobin solution (HBOC-201) with gelatin solution and saline infusion in an experimental model of arterial thrombosis and bleeding. After anesthesia, the Folts model was constructed in 30 rabbits. The common carotid artery was exposed, and a 60% stenosis was induced. A compression injury of the artery was then produced, which triggered a series of cyclic episodes of thrombosis (cyclic flow reductions [CFRs]). After the number of baseline CFRs was counted, animals were assigned randomly to one of three groups (n = 10 each): saline (control), gelatin, or HBOC-201 solution. The effect of studied solutions was observed by recording the number of CFRs during another period and was compared with that of saline. Ear immersion bleeding time was recorded after each CFR period. Gelatin and HBOC-201 had similar effects, manifested by significantly decreased CFRs (from median of 7 to 1 and 6 to 1, respectively) and significantly lengthened bleeding time (from 88 to 98 s and 81 to 102 s, respectively; P < 0.05). Saline infusion had no significant effect on CFRs or bleeding time. HBOC-201 and gelatin had similar effects marked by a reduction in the arterial thrombosis rate and increased bleeding time in rabbits.

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Comparison of Recovery Profile After Ambulatory Anesthesia with Propofol, Isoflurane, Sevoflurane and Desflurane: A Systematic Review

Anil Gupta, MD FRCA, PhD*,{dagger}, Tracey Stierer, MD*, Rhonda Zuckerman, MD*, Neal Sakima, MD*, Stephen D. Parker, MD*, and Lee A. Fleisher, MD* Section Editor

*Department of Anesthesiology and Critical Care, and the Division of Ambulatory Surgery, Johns Hopkins Medical Institutions, Baltimore, Maryland and the {dagger}Division for Ambulatory Surgery, Department of Anesthesiology, University Hospital, Örebro, Sweden

Anesth Analg 2004;98:632-641


tΩʦ^Us|س¾K޳NN_ĬMֵogCϥηjanesthesiaMupNAåB_H]>19^HӹAy^yAqLPubMed]19662002~6MEDLINEWƮwCĤGB˯ϥ yBatBCtMatNӵCz@58gפi̫RCGܡGb_ĬAyMtŨStFatŪ_Ĭn֩yMtšAӤCtŤS֩󲧬tšCtũMCtŤ5wVOLptAӨL¾KStCbߡBæRBYhMX|ߡBæRoͲv譱yu󲧬tš]P<0.05^C\hlJ¾KժfHPyլۤݭnRġCסGP¾K_ĬɶtjAӧlJʳ¾KeuCƤoͲv譱y֡AרOX|ߩMæRC

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In this systematic review we focused on postoperative recovery and complications using four different anesthetic techniques. The database MEDLINE was searched via PubMed (1966 to June 2002) using the search words "anesthesia" and with ambulatory surgical procedures limited to randomized controlled trials in adults (>19 yr), in the English language, and in humans. A second search strategy was used combining two of the words "propofol," "isoflurane," "sevoflurane," or "desflurane". Screening and data extraction produced 58 articles that were included in the final meta-analysis. No differences were found between propofol and isoflurane in early recovery. However, early recovery was faster with desflurane compared with propofol and isoflurane and with sevoflurane compared with isoflurane. A minor difference was found in home readiness between sevoflurane and isoflurane (5 min) but not among the other anesthetics. Nausea, vomiting, headache, and postdischarge nausea and vomiting incidence were in favor of propofol compared with isoflurane (P < 0.05). A larger number of patients in the inhaled anesthesia groups required antiemetics compared with the propofol group. We conclude that the differences in early recovery times among the different anesthetics were small and in favor of the inhaled anesthetics. The incidence of side effects, specifically postoperative nausea and vomiting, was less frequent with propofol.

 

Fଥ\ʧNХҰDФѥVĨbZӭMFG鲧cMȳ쪺

Functional Inhibition by Methadone of N-Methyl-D-Aspartate Receptors Expressed in Xenopus Oocytes: Stereospecific and Subunit Effects

Robert J. Callahan, BS*, John D. Au, BS*, Matthias Paul, MD DEAA{dagger}, Canhui Liu, PhD*, and C. Spencer Yost, MD*

*Department of Anesthesia and Perioperative Care, University of California, San Francisco, California; and {dagger}Department of Anesthesiology and Intensive Care, University of Cologne, Cologne, Germany

Anesth Analg 2004;98:653-659


Fଡ]Methadone^O@ئbCʯkhvϥζVӶVhjĪhġC@̦b@qͲz]ƧZӭM^ҩ㦳NХҰDФѥVĨFC~۬FଦbL@׽dҦNMDAȫCo@׻PĪʤOǬsɪ{ɦĿ@׬ۤ@PCۤӨAܰاoǥ\lqDһݿ@׬O{ɨϥο@8-16CNR1/2AMNR1/2BȫƦXF଩Mܰت@θNR1/2CMNR1/2DȫƦX󬰱ӷPCb~۬FଦsbpUA̤jNMDAEqyۼWjA50%̤jʪNMDA@קܤjAoFଳqLDvCMFପ鲧cb\hȫܤF̤pܩʡAR(-)FହNR1/2AƦX馳׿ܩʡCoǵGѤFFଧNMDA鬡ʪi@BơAIJz@άOqLMNMDA@P_@ΡC

]W@Ķ@@ա^

Methadone is a strong opioid analgesic that is finding increasing use in chronic pain therapeutics. We explored its reported efficacy for inhibiting N-methyl-D-aspartate (NMDA) receptors in a functional electrophysiologic assay (Xenopus laevis oocyte expression). Racemic methadone inhibited all subtypes of rat NMDA receptors with derived 50% inhibitory concentrations in the low micromolar range. These concentrations overlap with clinically achievable concentrations reported in pharmacokinetic studies. In contrast, morphine inhibited these functional ion channels only at 8V16 times larger concentrations. The NR1/2A and NR1/2B subtype combinations were in general significantly more sensitive to inhibition by methadone and morphine compared with the NR1/2C and NR1/2D subtypes. In the presence of racemic methadone, the maximum NMDA-stimulated currents were markedly decreased, but the NMDA concentration producing 50% of maximal activation was altered only slightly, indicating that methadone blocks by a noncompetitive mechanism. Although stereoisomers of methadone showed minimal stereoselectivity in most subtypes, R(-) methadone was highly selective in its inhibition of the NR1/2A combination. These results provide further functional data describing the NMDA receptor inhibitory actions of methadone and support the hypothesis that methadone acts through both opioid and NMDA receptor mechanisms.

 

slͪN-Ұh{Ph{Md]@¾KįSʪ

Local Anesthetic Properties of a Novel Derivative, N-Methyl Doxepin, Versus Doxepin and Bupivacaine

Yukari Sudoh, MD*, Elaine Elliott Cahoon, BS*, Umberto De Girolami, MD{dagger}, and Ging Kuo Wang, PhD*

*Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Womens Hospital; and {dagger}Department of Pathology, Brigham and Womens Hospital and Childrens Hospital and Harvard Medical School, Boston, Massachusetts

Anesth Analg 2004;98:672-676


bUؤTܧ{ĤAh{M̴L]OĪġC@̦XF@sƦXN-Ұh{ìs䧽¾K@ίSʡCjgA2.5A5.0A10mM N-Ұh{Mh{糧PıABʥHεhıĪGûP0.5%d]@FqLqXNUհiFӭMӵN-Ұh{Mh{NalqDpCGܡGN-Ұh{ް_gɶh{]ҦpAb10mMɤOO7.4pɩM5.3pɡ^C@̵o{bUؿ@ױpU\৹_ɶۮtAF2.5mM@ץ~ɶ]ۮtC0.5%d]]15.4mM^ɶ]1.5pɡ^֩N-Ұh{Mh{CN-Ұh{Mh{ObNalqDAN-Ұh{MvC_h{CסGN-Ұh{O@bNalqDBO@ħ¾KC

]@Ķ@@ա^

Among various tricyclic antidepressants, doxepin and amitriptyline are also long-acting local anesthetics. We synthesized a new compound, N-methyl doxepin, and investigated whether this derivative possesses local anesthetic properties. N-methyl doxepin and doxepin were tested in a rat sciatic nerve model at 2.5, 5.0, and 10 mM. Proprioceptive, motor, and nociceptive blockade were evaluated and compared with those induced by 0.5% bupivacaine. Block of Na+ channels by N-methyl doxepin and doxepin was assessed in cultured pituitary tumor cells under voltage clamp conditions. N-methyl doxepin elicited complete nociceptive blockade that generally lasted longer than that caused by doxepin (e.g., approximately 7.4 h versus 5.3 h at 10 mM). Significant differences were observed for full recovery of function at all concentrations and for the duration of complete blockade except at 2.5 mM. Bupivacaine at 0.5% (15.4 mM) was less effective in producing complete blockade (approximately 1.5 h) than N-methyl doxepin and doxepin. Both doxepin and N-methyl doxepin were potent Na+ channel blockers, although N-methyl doxepin displayed a slower wash-in rate. No morphological alterations were detected in cross-sectioned sciatic nerve specimens with these three drugs. We conclude that N-methyl doxepin is a potent Na+ channel blocker and a long-acting local anesthetic for rat sciatic nerve blockade.

 

CײžPзǪžĮĤ

The Pharmacodynamic Effects of a Lower-Lipid Emulsion of Propofol: A Comparison with the Standard Propofol Emulsion

Dajun Song, MD PhD, Mohamed Hamza, MD, Paul F. White, PhD MD, Kevin Klein, MD, Alejandro Recart, MD, and Omeed Khodaparast, MS

From the Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center at Dallas, Dallas, Texas

Anesth Analg 2004;98:687-691


XXCײž]Ampofol^At1%A5%oH0.6%ZCסC@HBs63WdEfH¾KΧCײžβž(Diprivan)_ĮɶBɩMɪ@ήĪGCRߪ`gΪӥ0.1gg/kg]Ϊӥ1gg/kg^M2mg/kgAϥΤ@iո`tv`RߺAtvb120-200ggEkg-1Emin-1COUϮgɶM`gɶAåB`gɯkh{סAɳtסANyʤOǪܤƥHWơACɶMw_ɶCGAmpofolMDiprivanb_ĮɶAɳtסA¾KһݪqAWơAyʤOǫСA_ХHαw̪N׳S㪺tC`gɯkhoͲvAmpofolհDiprivanա]26%M6%APq0.05rCסGAmpofolb¾KʯPDiprivanۦPA`gkhoͲv̡C

]@Ķ@@ա^

Using a randomized, double-blind protocol design, we compared a new lower-lipid emulsion of propofol (Ampofol®) containing propofol 1%, soybean oil 5%, and egg lecithin 0.6% with the most commonly used formulation of propofol (Diprivan®) with respect to onset of action and recovery profiles, as well as intraoperative efficacy, when administered for induction and maintenance of general anesthesia as part of a "balanced" anesthetic technique in 63 healthy outpatients. Anesthesia was induced with sufentanil 0.1 µg/kg (or fentanyl 1 µg/kg) and propofol 2 mg/kg IV and maintained with a variable-rate propofol infusion, 120V200 µg E kg-1 E min-1. Onset times to loss of the eyelash reflex and dropping a syringe were recorded. Severity of pain on injection, speed of induction, intraoperative hemodynamic variables, and electroencephalographic bispectral index values were assessed. Recovery times to opening eyes and orientation were noted. The results demonstrated that there were no significant differences between Ampofol® and Diprivan® with respect to onset times, speed of induction, anesthetic dose requirements, bispectral index values, hemodynamic variables, recovery variables, or patient satisfaction. However, the incidence of pain on injection was more frequent in the Ampofol® group (26% versus 6%, P < 0.05). We conclude that Ampofol® is equipotent to Diprivan® with respect to its anesthetic properties but was associated with a more frequent incidence of mild pain on injection.

jNfHw~۱h]PCEA^vNkhOΤ

Cost Drivers in Patient-Controlled Epidural Analgesia for Postoperative Pain Management After Major Surgery

Martin Schuster, MD, MA, André Gottschalk, MD, Marc Freitag, MD, and Thomas Standl, MD Section Editor

Department of Anesthesiology, University Hospital Hamburg-Eppendorf, Hamburg, Germany

Anesth Analg 2004;98:708-713


@̦^UʬsF350ҤjNPCEAvNkh]]ABݳBNBMΥ~NfH^ġB{MkCNĤ@ѩMĤTѪkhO1623M916]ıdA0-100^C¯fH{4.92.2ѡAfH5.23.1ѡAΥ~fH4.52.8ѡCw~Ī`gĩMĪVXG`qb¯fH707507mlAfH770576mlAΥ~fH593456mlPCEAvL{`Oά447218/ҡ]1ӳ1^C䤤51%ȤHOA20%ĶOA15%PCEAMƶOA13%ɺ޸mJOΡCھڳoǶOΩMֶOΪiʡAijϥPCEApOΡCѩϥPCEAOΥDnOĶOMȤHXAҥHӦҼ{PCEAʴùwTwL~|C

]ء@Ķ@@ա^

In this retrospective study, we determined efficiency, treatment length, and resource use for postoperative pain management with patient-controlled epidural analgesia (PCEA) in 350 consecutive patients undergoing major abdominal, thoracic, gynecological, or orthopedic surgery. Average pain scores on a visual analog scale were 16 23 and 9 16 (visual analog scale range, 0 to 100) on postoperative Days 1 and 3, respectively, and were similar among groups. The treatment length was 4.9 2.2 days in general surgical, 5.2 3.1 days in gynecological, and 4.5 2.8 days in orthopedic patients. The total volumes of the mixture of local anesthetic and opioid received epidurally were 707 507 mL, 770 576 mL, and 593 456 mL in the general surgical, gynecological, and orthopedic groups, respectively. The average total costs for all groups for the full treatment course with PCEA were 447 218 per case (1 equals approximately US$1). Fifty-one percent of these costs were staff costs, 20% were costs for the applied drugs, 15% were costs for PCEA pumps and pump material, and 13% were costs for the initial catheter insertion. In the light of these costs and the availability of less costly alternatives, measurements for cost containment by using PCEA are recommended. Because treatment length is the main cost driver both for drug and staff costs, close monitoring of treatment length and a predefined migration path to alternative techniques after PCEA should be considered.

 

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The Antinociceptive Effect of Transcranial Electrostimulation with Combined Direct and Alternating Current in Freely Moving Rats

Vladimir Nekhendzy, MD*, Christo P. Fender, BA*, M. Frances Davies, PhD*, Hendrikus J. M. Lemmens, MD, PhD*, Michael S. Kim, MD*, Donna M. Bouley, DVM, PhD{dagger}, and Mervyn Maze, MBChB, FRCP, FRCA{ddagger}

Departments of *Anesthesiology and {dagger}Comparative Medicine, Stanford University School of Medicine, Stanford, California, and the {ddagger}Department of Anaesthetics and Intensive Care, Imperial College, London and Chelsea and Westminster NHS Hospital Trust, London, UK

Anesth Analg 2004;98:730-737


ڳɸg`qE]TES^iHo㪺h@ΡAϳNeĪζq֡Cѩʤ{ɹӹMTESh@ΪʪATES{ΨCoǫDMwʪƥiHTESqmֽɡAbHΪUبELkΩpC礤A@̱ĥΨEΦP{ɬۦsʪҫAҹTESܶˮ`@ΡCܶˮ`@γqLqMBۥѬʶ裡BOˮ`EHȨӵC2.25mATESֳͧtBBWv̿ʡ]40-60Hz^ܶˮ`@,iF̤j50%CסGjgTES㦳ܶˮ`@ΡCoا@ΪSIܤjY֤PıgbgTESɪܶˮ`@Τ_n@ΡC

]ء@Ķ@@ա^

Transcranial electrostimulation (TES) has been reported to elicit significant analgesia, allowing a substantial reduction of intraoperative opioids. Acceptance of TES into clinical practice is hampered by lack of controlled clinical trials and inconclusive animal data regarding the TES antinociceptive action. This inconclusive data may be explained, in part, by failure in rat experiments to simulate the variables used in humans when TES electrodes are positioned on the skin. In this study we validated the TES antinociceptive effect in a novel animal model of cutaneously administered TES, when the stimulating conditions mimic the ones used in clinical practice. The antinociceptive effect was assessed by measuring nociceptive thresholds in the tail-flick and hot-plate latency tests in awake, unrestrained male rats. Data were analyzed by analysis of variance and mixed-effects population modeling. The administration of TES at 2.25 mA produced an almost immediate, sustained, frequency-dependent (40V60 Hz) antinociceptive effect, reaching approximately 50% of the maximal possible value. We conclude that an antinociceptive effect of cutaneously administered TES can be demonstrated in the rat. Some characteristics of the effect suggest an important role of the sensory nerves of the rats scalp in mediating the TES antinociceptive response.

 

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Is Physician Anesthesia Cost-Effective?

J. P. Abenstein, MSEE MD*, Kirsten Hall Long, PhD{dagger}, Brian P. McGlinch, MD*, and Niki M. Dietz, MD* Section Editor

*Department of Anesthesiology and {dagger}Division of Health Care Policy and Research, Mayo Clinic, Rochester, Minnesota

Anesth Analg 2004;98:750-757


¾K@ӳ̦ijDOGb¾Ku@O_DDZM~¾Kvv¾K㦳įqH@̽լd¾KIOΨӵ䦨CQΤI¾KOΪլdƩMsGAإ߰_@دSwҦӤv¾KPDv¾K@اg١CįqvwqG¾KvWoؼҦaӪwةRW[]YO/ةRW[[$/YLS]^CGv¾KiHCA[JOIC~w̦įqv-$2,601/YLSA[JOIѦ~w̹wįqv-$4,410/YLSC@ΦhӷPRįqvdb-$4,410 $38,778/YLSCGϬMwItOMw`vD`TCoؤR䴩v¾KҦѤFgپǪҾڡC

]z`@Ķ@@ա^

One of the most controversial issues in anesthesia is whether nonmedically directed nurse anesthetists are relatively more cost-effective than anesthesiologists in the provision of anesthesia care. We electronically surveyed anesthesia practices throughout the United States to estimate the range in anesthesia professional costs from the payer perspective. Using this survey data on anesthesia reimbursement and published outcomes studies, we developed an ad hoc model to estimate the cost-effectiveness of physician-directed anesthesia relative to a nonmedically directed nurse anesthetist model of care from the payer perspective. Cost-effectiveness ratios were defined as the ratio of incremental costs associated with physician anesthesia relative to the estimated incremental life expectancy gains with this model of care (i.e., dollars per year of life saved [$/YLS]). Reference case results suggest that physician anesthesia is cost saving with an estimated incremental cost-effectiveness ratio of -$2,601/YLS for a younger privately insured patient and an estimated cost-effectiveness ratio of -$4,410/YLS for an elderly Medicare insured patient. Cost-effectiveness ratios ranged from -$4,410 to $38,778/YLS in univariate and multivariate sensitivity analyses across payer types. Results were most sensitive to assumed differences in reimbursement (commercial conversion factors) and to mortality rate assumptions by provider type. This analysis offers economic evidence in support of the physician anesthesia model of care.

 

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Prophylactic Phenylephrine Infusion for Preventing Hypotension During Spinal Anesthesia for Cesarean Delivery

Warwick D. Ngan Kee, MBChB MD, FANZCA, Kim S. Khaw, MBBS FRCA, Floria F. Ng, RN BASc, and Bee B. Lee, MBBS FANZCA

Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong, China

Anesth Analg 2004;98:815-821


b@Hӹ礤A@̬sF帡NwʨϥέfǤWקK¾Kް_C@ΡCbT`īHYϥέfǤW100gg/min]n=26^3CbLXeCq@AYʯߦY]SAP^C󥿱`KfǤW100gg/minCӲա]n=24^bSAPp󥿱`80%ɵfǤW100ggCPӲլۤ`gfǤW֧CoͲv]6/26]23%^FӲլ21/24]88%^FP<0.0001^APɤ]U{ס]̧CSAP106mmHg,iʴT׬95X111mmHg;Ӳլ80mmHg,73X93mmHgFP<0.0001^C߲v]ӲպC]P<0.0001^CխfǤWq]1260gg; 1010--1640gg^jӲա]450ggA300--750ggFP<0.0001^AaMApgarۦCCէ@ӭL઺aPH<7.2CסG¾KU帡fHwʨϥέfǤWi²BwBĦaNC

]z`@Ķ@@ա^

In a randomized, double-blinded, controlled trial, we investigated the prophylactic infusion of IV phenylephrine for the prevention of hypotension during spinal anesthesia for cesarean delivery. Immediately after intrathecal injection, phenylephrine was infused at 100 µg/min (n = 26) for 3 min. From that point until delivery, phenylephrine was infused at 100 µg/min whenever systolic arterial blood pressure (SAP), measured each minute, was less than baseline. A control group (n = 24) received IV bolus phenylephrine 100 µg after each measurement of SAP <80% of baseline. Phenylephrine infusion decreased the incidence (6 [23%] of 26 versus 21 [88%] of 24; P < 0.0001), frequency, and magnitude (median minimum SAP, 106 mm Hg; interquartile range, 95V111 mm Hg; versus median, 80 mm Hg; range, 73V93 mm Hg; P < 0.0001) of hypotension compared with control. Heart rate was significantly slower over time in the infusion group compared with the control group (P < 0.0001). Despite a large total dose of phenylephrine administered to the infusion group compared with the control group (median, 1260 µg; interquartile range, 1010V1640 µg; versus median, 450 µg; interquartile range, 300V750 µg; P < 0.0001), umbilical cord blood gases and Apgar scores were similar. One patient in each group had umbilical arterial pH <7.2. Prophylactic phenylephrine infusion is a simple, safe, and effective method of maintaining arterial blood pressure during spinal anesthesia for cesarean delivery.

 

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Intracellular Calcium Increases in Growth Cones Exposed to Tetracaine

Shigeru Saito, MD, Inas A. M. Radwan, MD, Koichi Nishikawa, MD, Hideaki Obata, MD, Tomonori Okamoto, MD, Toshio Kanno, MD, and Fumio Goto, MD

From the Department of Anesthesiology, Gunma University Graduate School of Medicine, Maebashi, Japan

Anesth Analg 2004;98:841-845


Ĺ令Mbͪgrʧ@ΧwɡC@̬sad]bͪ@IhL{O_ް_Ca2+@פɰCͪ@Sad]AqLfura2/AMwCa2+@סAo{ad]]12mM^ް_ͪ@ӭMCa2+@פɰ]P<0.01^. Ca2+Iq~PVӭMGܯgCbLCa2+i򤤡Aad]@Ωͪ@ACa2+@תW[ܤpAɭPFͪ@IhCNi2+(100Um;@Ca2+)MBAPTA-AM(5Um; ӭMCa2+gX)12mMad]ɭPͪ@IhCסGad]]>1Mm^ Pɤް_ͪ@IhMCa2+@׼W[Aoز{HiOWߵoͪC

]@Ķ@@ա^

Neurotoxicity of local anesthetics has been reported for both matured and growing neurons. In the present study, we examined if tetracaine increases Ca2+ concentration during growth cone collapse. Intracellular Ca2+ concentration was measured by fura 2/AM after exposure to tetracaine. Tetracaine (1V2 mM) induced increases in intra-growth cone Ca2+ concentration (P < 0.01). The Ca2+ hot spot was expanded into the neurite from the periphery towards the cell body. When tetracaine was applied to growth cones in Ca2+ free media, the increase was minor. However, tetracaine induced growth cone collapse even in the culture media, which did not contain Ca2+. Ni2+ (100 µM; a general Ca2+ channel inhibitor) and BAPTA-AM (5 µM; intracellular Ca2+ chelator) could not inhibit growth cone collapse induced by 1V2 mM tetracaine. Tetracaine (>1 mM) induces collapse and Ca2+ increase at growth cones simultaneously; however, these two

phenomena might be provoked independently.

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The Intubating Laryngeal Mask Airway Facilitates Tracheal Intubation in the Lateral Position

Ryu Komatsu, MD*, Osamu Nagata, MD*, Daniel I. Sessler, MD{dagger}, and Makoto Ozaki, MD*

*Department of Anesthesiology, Tokyo Womens Medical University, Tokyo, Japan, and the {dagger}Outcomes ResearchTM Institute and Departments of Anesthesiology and Pharmacology, University of Louisville, Louisville, Kentucky

Anesth Analg 2004;98:858-861


Mצ޴ުx{רSgLtΪAצ줸NɮDܧx|ް_MIGC@̽լdnmJ]ILMA^O_UDѭ奿`w̪޴ޡAצMallampati3AYZ5cmCqL\vMޮɶӵoا޳NO_@Nצw̧xޮɪɱϱICܬ50AұyնLXN]צ^M50ҨLN]צ^A¾KɥĬMӥCyդNw̳¾KɫeΥkצAޤ]ĥΦP˪AӲջɩMާĥΥצCէϥLIMAAOުɶMݭnվ㴡ިҼƩM覡CϥMann-Whitney U , Fishers exact test,X2ΫDStudents t έpRCGGկfH@뱡pMDqpۦFצձif{׵yj]5.1G4.6cm^Fծ޴ޮɶ۪]25s^Aަ\v]@ˡ]96H^CסGYϦbצAILMAѤFNަ\vMޮɶ]<1min^C

]@Ķ@@ա^

Although the difficulty of tracheal intubation in the lateral position has not been systematically evaluated, airway loss during surgery in a laterally positioned patient may have hazardous consequences. We explored whether the intubating laryngeal mask airway (ILMA) facilitates tracheal intubation in patients with normal airway anatomy, i.e., Mallampati grade <=3 and thyromental distance >=5 cm, positioned in the lateral position. We evaluated whether this technique can be used as a rescue when the airway is lost during the middle of surgery in laterally positioned patients with respect to success rate and intubation time. Anesthesia was induced with propofol, fentanyl, and vecuronium in 50 patients undergoing spine surgery for lumbar disk herniation (Lateral) and 50 undergoing other surgical procedures (Supine). Patients having disk surgery (Lateral) were positioned on their right or left sides before induction of general anesthesia, and intubation was performed in that position. Patients in the control group (Supine) were anesthetized in supine position, and intubation was performed in that position. Intubation was performed blindly via an ILMA in both groups. The time required for intubation and number and types of adjusting maneuvers used were recorded. Data were compared by the Mann-Whitney U test, Fishers exact test, {chi}2 test, or unpaired Students t-test, as appropriate. Data presented as mean (SD). Demographic and airway measures were similar in the two groups, except for mouth opening, which was slightly wider in patients in the lateral position: 5.1 (0.9) versus 4.6 (0.7) cm. The time required for intubation was similar in each group ({approx}25 s), as was intubation success (96%). We conclude that blind intubation via an ILMA offers a frequent success rate and a clinically acceptable intubation time (<1 min) even in the lateral position.

DŦNNߦިƥ󪺵oͲvΦ۰˥Xv

The Incidence and Prediction of Automatically Detected Intraoperative Cardiovascular Events in Noncardiac Surgery

Rainer Röhrig, Dr. med., Axel Junger, PD Dr. med., MBA (FIT), Bernd Hartmann, Dr. med., Joachim Klasen, Dr. med., Lorenzo Quinzio, Dr. med., Andreas Jost, Matthias Benson, Dr. med. habil., and Gunter Hempelmann, Prof. Dr. med. Dr. h.c. Section Editor

Anesth Analg 2004;98:569-577
@

sOXqOҪتӵN۰˥Xߦިƥ(CVE)58A458WiDŦNw̪wҫCڭ̨ϥέ׭q᪺ŦMI(RCRI)HASAŨӵ¾KMICHڭ̫إߤFطsҫCqLql¾KOtΨӵo{CVEsCϥ޿^kӫإߤ@ӽM@²檺ҫCϥήշǩMORӵwҫǽTʡCb(n = 29,437)5249Ww(17.8%)Mҹꪺ(n = 29,021) 5031Ww(17.3%)ܤ֦@CVECCVEM|fv۬(2.1% 1.0%; P < 0.01)CsҫܤFܦnOOAժ̤u@Sxu(AUC)UnO0.709 M 0.707CASA(AUC 0.647)M RCRI (AUC 0.620)ѪR׮t@ǡCOطsҫMASA ARCRIOv٤CªASAũM RCRIAXΩwNCVEo͡C

] Ķ i ա^

The objective of this study was to evaluate prognostic models for quality assurance purposes in predicting automatically detected intraoperative cardiovascular events (CVE) in 58,458 patients undergoing noncardiac surgery. To this end, we assessed the performance of two established models for risk assessment in anesthesia, the Revised Cardiac Risk Index (RCRI) and the ASA physical status classification. We then developed two new models. CVEs were detected from the database of an electronic anesthesia record-keeping system. Logistic regression was used to build a complex and a simple predictive model. Performance of the prognostic models was assessed using analysis of discrimination and calibration. In 5249 patients (17.8%) of the evaluation (n = 29,437) and 5031 patients (17.3%) of the validation cohorts (n = 29,021), a minimum of one CVE was detected. CVEs were associated with significantly more frequent hospital mortality (2.1% versus 1.0%; P < 0.01). The new models demonstrated good discriminative power, with an area under the receiver operating characteristic curve (AUC) of 0.709 and 0.707 respectively. Discrimination of the ASA classification (AUC 0.647) and the RCRI (AUC 0.620) were less. Neither the two new models nor ASA classification nor the RCRI showed acceptable calibration. ASA classification and the RCRI alone both proved unsuitable for the prediction of intraoperative CVEs.

 

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Treatment of Hypoxemia During One-Lung Ventilation Using Intravenous Almitrine

Nicolas Dalibon, MD, Marc Moutafis, MD, Ngai Liu, MD, Jean-Dominique Law-Koune, MD, Stéphanie Monsel, MD, and Marc Fischler, MD

From the Department of Anesthesiology, Hôpital Foch, Université Paris-Ouest, Suresnes, France

Anesth Analg 2004;98:590-594

ڭ̨ϥγoHe¤ʬsӵRߨϥβmKT嗪Ӫvͳq(OLV) ɪCgĪGC28Ww̨ϥβAΪӥAwwAϥĺ޶i͹jNCϥέDWnYӵŦơCOLV SpO2@ Τp95%]lJ0.6^w̳QǤJsCϥΦwAmKT嗪 (12 µg E kg-1 E min-1 10 min 4 µg E kg-1 E min-1) SpO2 F90%ΧC90%]ưbs~^C28Ww̤18HQǤJsdA䤤9HmKT嗪A8HwvCmKT嗪դ@ӡAwդ6Hפv(P < 0.05)CmKT嗪դ8HAwդ1Hv(SpO2 O >=95% b OLV) (P < 0.01)Cs߲vAʯAŦƳSܡCOڭ̥ub@bw̤o{DʯߦyCmKT嗪iHΨӪvͳqɪCgC

] Ķ i ա^

We performed this prospective randomized double-blinded study to assess the ability of almitrine to treat hypoxemia during one-lung ventilation (OLV). Twenty-

eight patients were anesthetized with propofol, sufentanil, and atracurium; lung separation was achieved with a double-lumen tube. A transesophageal Doppler probe was inserted to evaluate cardiac index. If SpO2 was equal to or decreased to <95% during OLV (inspired fraction of oxygen of 0.6), patients were included in the study and received a placebo or almit- rine (12 µg E kg-1 E min-1 for 10 min followed by 4 µg E kg-1 E min-1) infusion until SpO2 reached 90% or decreased to <90% (exclusion from the study). Eighteen of the 28 patients were included and received either almitrine (n = 9) or a placebo (n = 9). Treatment was discontinued in 1 patient in the almitrine group and 6 in the placebo group (P < 0.05). Treatment was successful (SpO2 remaining >=95% during OLV) in 8 patients in the almitrine group and 1 in the placebo group (P < 0.01). Heart rate, arterial blood pressure, and cardiac index did not change throughout the study, but we could obtain an adequate aortic blood flow signal in only half of the patients. Almitrine could be used to treat hypoxemia during OLV.


pϥMasimo SET® and Nellcor N-395pHXMMתƷǽTʩMĩʪ{ɵ

Clinical Evaluation of the Effects of Signal Integrity and Saturation on Data Availability and Accuracy of Masimo SET® and Nellcor N-395 Oximeters in Children

Frederick A. Robertson, MD, and George M. Hoffman, MD Section Editor

From the Department of Pediatric Anesthesiology, Childrens Hospital of Wisconsin, and the Department of Anesthesiology, Medical College of Wisconsin, Milwaukee, Wisconsin

Anesth Analg 2004;98:617-622
@

߷ipsyӤФF޳NAn٥iHC˥XvCѩ󴣰HBzMƪtk̲׸ƦP@ΡAڭ̤FbPHXM񹡩MפUNellcor N-395, Masimo SET®, and GE Solar 8000pƳiAHҵoMwCb27w̤@@i޳NARɶMƪYA˴wMHҵoAqLHXM SpO2ӶiĵhCSolar 8000Lӷs֦ưkCMasimos LoSIQ]Hq^ҵoNellcors MOT/PS]B/߷i˴^F֪ơCSHҵoQܪɭԡA̤bTʩMt譱StOCMӡAػwbSIQ, MOT, ΧCgpU|cơCػiHIDHAOL̤PtkyFPGC]AbCSIQMCUNellcor N-395 M Masimob{ɤWOPAMѪGE Solar 8000p]PC

] Ķ i ա^

Pulse oximetry manufacturers have introduced technologies that claim improved detection of hypoxemic events. Because improvements in signal processing and data rejection algorithms may differentially affect data reporting, we compared the data reporting and signal heuristic performance and agreement among the Nellcor N-395, Masimo SET®, and GE Solar 8000 oximeters under a spectrum of conditions of signal integrity and arterial oxygen saturations. A blinded side-by-side comparison of technologies was performed in 27 patients, and data were analyzed for time of data availability, measures of agreement and signal heuristics, and warnings stratified by signal integrity and SpO2. The Solar 8000 had less total data dropout than either of the new technologies. Masimos LoSIQ (signal quality) heuristic rejected less data than Nellcors MOT/PS (motion/pulse search) flag. When no signal heuristic was displayed, there was little difference in precision and bias between the two newer technologies; however, agreement between devices deteriorated in the presence of SIQ, MOT, or hypoxemia. Both newer devices flagged questionable data, but their use of different rejection algorithms resulted in different probabilities of presenting data. Therefore, with poor SIQ or during hypoxemia, the Nellcor N-395 and Masimo oximeters are not clinically equivalent to each other or to the older Solar 8000 oximeter

 

樫ɶQhd]«@LʯggoͪvT

The Influence of Ambulation Time on the Incidence of Transient Neurologic Symptoms After Lidocaine Spinal Anesthesia

Martti Silvanto, MD*, Pekka Tarkkila, MD, PhD{ddagger}, Marja-Leena Mäkelä, MD{dagger}, and Per H. Rosenberg, MD, PhD

Research Institute of Military Medicine and {dagger}Department of Anaesthesia, Central Military Hospital, Helsinki; {ddagger}Department of Anesthesiology and Intensive Care Medicine, Helsinki University Hospital

Anesth Analg 2004;98:642-646

 

Qhd]«@LʯgXg]TNS^|MCw]{«᦭樫iɭPTNSoiCڭ̰]2H񭫪Qhd]50mgΩ`NA樫ɶTNSo͡C120潥`N]ASA1~2^fHQH3աAp樫ա]GroupE^A6pɫ樫ա]Group6h^Mߴ樫ա]GroupL^CbGroupEAfHQ\b«_ᾨ樫]229+/-21Ad135247^CbGroup6hAfHb«קɤj6AӦbGroupLfHקɦܲĤGѦWCҦfHbέpǡB¾KM~ǪЧC`TNSoͲv16HC䤤GroupE3ҡ]7.5H^AGroup6h11ҡ]28H^AGroupL5ҡ]13H^CbεLTNSfHo{tC2HQhd]50mg«᦭樫ëDTNSMI]C

] Ķ i ա^

The cause of transient neurologic symptoms (TNSs) after lidocaine spinal anesthesia remains unclear. It has been proposed that early ambulation after spinal anesthesia contributes to the development of TNSs. We evaluated the influence of ambulation time on the occurrence of TNSs after spinal anesthesia with 50 mg of 2% plain lidocaine for knee arthroscopy. One-hundred-twenty patients undergoing knee arthroscopy (ASA physical status 1V2) were randomized into 3 groups, i.e., early (Group E), 6-h (Group 6-h), or late ambulation (Group L) groups. In Group E, ambulation was allowed as early as possible after regression of spinal block (on average 229 21 min; range, 135V247 min). In Group 6-h, the patients remained in bed for approximately 6 h after the block and in Group L until the next morning. The patient groups were comparable with respect to demographic, anesthetic, and surgical variables. The overall incidence of TNSs was 16%. TNSs occurred in 3 patients of Group E (7.5%), in 11 patients of Group 6-h (28%), and in 5 patients of Group L (13%). No significant differences were detected between the patients with and without TNSs. Early ambulation was not found to be a risk factor for TNSs after spinal anesthesia with 50 mg of 2% lidocaine.

 

vJTEG G{alpha}iȰ򪺼vT

The Effects of Hexanol on G{alpha}i Subunits of Heterotrimeric G Proteins

John Streiff, PhD*, David O. Warner, MD*, Elena Klimtchuk, PhD{dagger}, William J. Perkins, MD*, Kristofer Jones, BS{ddagger}, and Keith A. Jones, MD*

Departments of *Anesthesiology and {dagger}Physiology and Biophysics, {ddagger}Mayo Clinic and Mayo Foundation, Rochester, Minnesota

Anesth Analg 2004;98:660-7

 

AJML¾KįzZѤTCijI]GTP^XJա]GJա^ո`@tCtΪ\CڭFvJTEG G{alpha}iȰ򬡩ʪ@ΡCGTPѦAXG{alpha}IʬO0.029*Pi/G{alpha}I*minAQvJbj10mMB22mM@שҧCΤGʥЪkܤFvJNG{alpha}Iܩʷūױq47.2oC42.5oCAӦb10oCܨGŵcCqLؤoбưM⪩koXvJ]30mM^୰CGG{alpha}IE骺ƶqAoܤFvJɭPFJժEXCMӡAGTPXqDƦٽK̨IӱoG{alpha}ItרäQvJ]30mM^ҼvTC~ѻEXɪͪAXG{alpha}IAڭ̨èSo{b㪺DƦ١Aѩ󤺷[35S]GTP{gamma}SXG{alpha}ItתӾɭPvJɪҰʪG{alpha}Ip~|C

] Ķ i ա^

Alcohols and other anesthetics interfere with the function of a variety of systems regulated by guanosine triphosphate (GTP)-binding proteins (G proteins). We examined the effect of hexanol on the activity of the {alpha}subunit (G{alpha}i1) of heterotrimeric G proteins. The GTP hydrolysis activity of recombinant G{alpha}i1 was 0.029 mole Pi E mole G{alpha}i1-1 E min-1 and was inhibited by hexanol at concentrations larger than 10 mM, with a 50% inhibitory concentration of 22 mM. Circular dichroism spectroscopy revealed that hexanol decreased the denaturation temperature of G{alpha}i1 from 47.2XC to 42.5XC without altering its secondary structure at 10XC. Hexanol (30 mM) reduced the amount of monomeric G{alpha}i1 in solution measured by size-exclusion chromatography, indicating that hexanol caused protein aggregation. However, the rate of GTP{gamma}S binding to G{alpha}i immunoprecipitated from airway smooth muscle membranes was not affected by 30 mM hexanol. Excluding the apparent inhibition of recombinant G{alpha}i1 resulting from aggregation-induced artifact, we found no evidence that the hexanol-induced inhibition of receptor-activated G{alpha}i-coupled pathways in intact airway smooth muscle resulted from direct inhibition of the intrinsic rate of [35S]GTP{gamma}S binding to G{alpha}i.

 

Xijd]o֪

Vasodilation Increases the Threshold for Bupivacaine-Induced Convulsions in Rats

Yutaka Oda, MD PhD, Tomoharu Funao, MD, Katsuaki Tanaka, MD, and Akira Asada, MD PhD

From the Department of Anesthesiology and Intensive Care Medicine, Graduate School of Medicine, Osaka City University, Osaka, Japan

Anesth Analg 2004 98: 677-682

 

d]qL~PMϯgtΪvTFުOC]ަYļW[FRߪ`gd]ϯgtάrʡAGXiĥi୰CoجrʡCڭFӰ]AYXiĭCFMBۥDIlѹd]ϬrʡCSprague-DawleyѹQHӲա]C^Bdaա]N^Mԩա]P^]C12ҡ^CH1mg/kg/mint׵ۥd]ܥX{i/}˩֡C3Hd]PɤOͲzQBda]0.4ug/min^Mԩ]̪510ug/minAH50ug/min^CCժ`gd]ᥭʯɰNաBPզbֵo@ebuCCեd]־q5.8+/-1.5mg/kgAӦbNթMPۤɰ]O7.6+/-1.5mg/kg,p=0.02M8.1+/-1.1mg/kg^CMӡAb3դo@֮ɦߤ`ΫDJյXd]@שθd]@רStCڭ̱oXסAdaMԩFd]ֿnqAävTѥd]ɪ֩һݪߩθ@סC

] Ķ i ա^

Bupivacaine affects the vascular resistance by peripheral and central nervous system (CNS) mechanisms. As vasoconstrictors increase the CNS toxicity of IV bupivacaine, vasodilators may decrease its CNS toxicity. We examined the hypothesis that vasodilators decrease the CNS toxicity of bupivacaine in awake, spontaneously breathing rats. Male Sprague-Dawley rats were randomly divided into control (C), nicardipine (N), and phentolamine (P) groups (n = 12 in each group). Racemic bupivacaine was administered IV at 1 mg/kg/min until tonic/clonic convulsions occurred. Saline, nicardipine (0.4 µg/min), and phentolamine (10 µg/min within 5 min, 50 µg/min thereafter) were simultaneously administered with bupivacaine in groups C, N, and P, respectively. Mean arterial blood pressure was significantly increased by infusion of bupivacaine in group C and was maintained at baseline levels before the onset of convulsions in groups N and P. The convulsive dose of bupivacaine in group C was 5.8 1.5 mg/kg, but was significantly larger in groups N and P (7.6 1.5 and 8.1 1.1 mg/kg, P = 0.02 and 0.001, respectively). However, there were no differences in total or protein-unbound plasma concentration of bupivacaine or in concentration of bupivacaine in the brain at the onset of convulsions among the 3 groups. We conclude that nicardipine and phentolamine increase the cumulative dose but do not affect the threshold plasma or brain concentrations required for bupivacaine-induced convulsions.

 

y¾KθqϺʴ¾KĪ@ΪNarcotrendƻPWƤ

Narcotrend Index Versus Bispectral Index as Electroencephalogram Measures of Anesthetic Drug Effect During Propofol Anesthesia

Sascha Kreuer, MD*, Wolfram Wilhelm, MD DEAA*, Ulrich Grundmann, MD*, Reinhard Larsen, MD*, and Jörgen Bruhn, MD{dagger} Section Editor

*Department of Anesthesiology and Intensive Care Medicine, University of Saarland, Homburg/Saar, Germany, and the {dagger}Department of Anesthesiology and Intensive Care Medicine, University of Bonn, Bonn, Germany

Anesth Analg 2004 98: 692-697

 

Narcotrendʴ(MonitorTechnik, Bad Bramstedt, Germany)lEEGı¾KEEGi۰ʤRC̷sn4.0]Adimensionlessơ]BISơ^Adq100]Ĭ^0Cڭ̤by¾KNarcotrendƤBISʴ¾KĪ@ΡC18ܴڪvʫeCNfHCNeyնةmw~ɺޡAëͲӪ˦mmBIS(version XP; Aspect Medical Systems, Natick, MA)NarcotrendqCC5sO@NarcotrendơBBISȡBy⪺߿@פήǿ@סCHӥΤy⻤ɡA޴ޫw~0.5%d]15mlA45miny⾯q̦W[B2Cbؾqվ㤤Ayǿ@צb2.0 0.4 µg/mL (̧C) 6.3 1.3 µg/mL (̰)iʡCNarcotrendƤBISӹwyǿ@ס]HPKܡ^A̤O0.880.03, 0.850.04CNarcotrendƤBISʴĪ@ΡAke0O0.200.05 min-1 ]Narcotrendơ^B0.160.07 min-1]BIS^.by⪺iʽd򤺡ANarcotrendƤBIS˴EEGʺAܤơC

]PĶ i ա^

The Narcotrend monitor (MonitorTechnik, Bad Bramstedt, Germany) performs an automatic analysis of the electroencephalogram (EEG) during anesthesia based on a visual assessment of the raw EEG. Its newest software version 4.0 includes a dimensionless index that, similar to the bispectral index (BIS), ranges from 100 (awake) to 0. We compared the performance of Narcotrend index and BIS as EEG measures of anesthetic drug effect during propofol anesthesia. Eighteen adult patients scheduled for radical prostatectomy were investigated. An epidural catheter was placed in the lumbar space and electrodes for BIS (version XP; Aspect Medical Systems, Natick, MA) and Narcotrend were positioned as recommended by the manufacturers. Narcotrend index, BIS values, and propofol plasma and effect site concentrations as parallelly simulated by Rugloop software (Department of Anesthesia, Ghent University, Belgium) were automatically recorded in intervals of 5 s. Induction of anesthesia consisted of a fentanyl bolus and a propofol infusion. After endotracheal intubation, patients received 15 mL bupivacaine 0.5% epidurally, and 45 min later propofol dosages were subsequently increased and decreased twice. Simulated propofol effect site concentrations ranged from 2.0 0.4 µg/mL (smallest) to 6.3 1.3 µg/mL (largest) during these subsequent increases and decreases of propofol. In terms of prediction probability (PK) the performance of the Narcotrend index (PK = 0.88 0.03) to predict propofol effect site concentrations was comparable to the BIS (PK = 0.85 0.04). Using the respective EEG index as a measure of drug effect the mean ke0 was calculated as 0.20 0.05 min-1 for Narcotrend index and 0.16 0.07 min-1 for BIS. In the observed propofol concentration range Narcotrend index detected differences in EEG dynamics as well as BIS.

 

cʰ~FNfHDextromethorphanpXw~PCApXRPCAѧnhĪGXX@HBBwӬs

Dextromethorphan-Associated Epidural Patient-Controlled Analgesia Provides Better Pain- and Analgesics-Sparing Effects than Dextromethorphan-Associated Intravenous Patient-Controlled Analgesia After Bone-Malignancy Resection: A Randomized, Placebo-Controlled, Double-Blinded Study

Avi A. Weinbroum, MD*,{ddagger}, Benjamin Bender, MD{dagger}, Alexander Nirkin, MD{dagger}, Shoshana Chazan, RN{ddagger}, Isaac Meller, MD{dagger}, and Yehuda Kollender, MD{dagger}

*Postanesthesia Care Unit, the {ddagger}Acute Pain Service, and the {dagger}National Orthopedic Oncology Unit, Tel Aviv Sourasky Medical Center and the Sackler Faculty Medicine, Tel Aviv University, Tel Aviv, Israel

Anesth Analg 2004 98: 714-722.

 

cʰ~F~Nkh@PAݥΤjq¾KġCDextromethorphan]DM^AN-ҰD-ѥVĨܾAwQҩ㦳jjhĪGCcʰ~FfHbзǥ½ƦXw~¾KU]ΩΤDM^~NAڭ̹εw~PCA(PCEA)RPCA(IV-PCA)ӵ@ΡCHl120줸fHANPCEA(ùd]3.2mgϪӥ8ug/)IV-PCA(ܰmg/)AbD[ıkh>=4ɶ}lΪܳN96hCCդU30fHwDM 90mgfA]NeΪܳN2ѡ^@ӡCkh@PɤDiclofenac75mg IM@ɱϡCDMfHPCAϥΤίkhPզwӯfH50HASOON2Ѥ]P<0.01^CPCEAժCpɤ`khjקIV-PCAմp50H(P<0.01)CPCA-DMfHDiclofenacζqPզwӯfH42H(P<0.01)CPCEA-DM7HBIV-PCA-DM11HiƧ@ΡAPCEA-IV-PCA-wզ@44HiƧ@(P<0.01)CΨؤPh޳NfH̦Uɬʮɶ۪ADMfHwդUɮɶu(1.5+-0.8 VS 2.1+-1.1dAP=0.02)C]ADM঳Ħakhôֳ¾KĪζqAؼWj@ΦbPCEAոIV-PCAէC~DMfHUɬʮɶwΪ̦C

]P Ķ i ա^

Pain after bone malignancy surgery is intense and requires large amounts of analgesics. The augmented antinociceptive effects of dextromethorphan (DM), a N-methyl-D-aspartate receptor antagonist, were demonstrated previously. We assessed the use of postoperative patient-controlled epidural analgesia (PCEA) or IV patient-controlled analgesia (PCA) in patients undergoing surgery for bone malignancy under standardized combined general and epidural anesthesia with or without DM. Patients (n = 120) were randomly allocated to receive PCEA (ropivacaine 3.2 mg plus fentanyl 8 µg/dose) or IV-PCA (morphine 2 mg/dose) postoperatively, starting at subjective visual analog scale pain intensity >=4 of 10 for up to 96 h. Placebo or DM 90 mg orally (30 patients/group/set) was given in a double-blinded manner before surgery and for 2 days afterwards. Diclofenac 75 mg IM was available as a rescue drug. DM patients used PCA and rated their pain >50% less than their placebo counterparts in each set, especially during the first 2 postoperative days (P < 0.01). Hourly and overall maximal pain intensity among PCEA patients was ~50% less than in the IV-PCA set (P < 0.01). Diclofenac was used 42% less (P < 0.01) by the PCA-DM patients compared with their placebo counterparts. Seven PCEA-DM and 11 IV-PCA-DM individuals reported having side effects compared with 44 in the PCEA-placebo and the IV-PCA-placebo groups (P < 0.01). Time to first ambulation was similar with both analgesia techniques but shorter among the DM-treated patients compared with the placebo recipients (1.5 0.8 versus 2.1 1.1 days, P = 0.02). Thus, DM afforded better pain control and reduced the demand for analgesics, augmented the PCEA effect versus IV-PCA, and was associated with minimal untoward effects in each analgesia set. DM patients ambulated earlier than placebo recipients.

 

TΤfAi֩wwNs_XXX@HBӬs

Intrathecal and Oral Clonidine as Prophylaxis for Postoperative Alcohol Withdrawal Syndrome: A Randomized Double-Blinded Study

I. Dobrydnjov, MD*, K. Axelsson, MD PhD*, L. Berggren, MD PhD*, J. Samarütel, MD PhD{dagger}, and B. Holmström, MD PhD*

*Departments of Anesthesiology and Intensive Care, Örebro University Hospital, Örebro, Sweden; and {dagger}Tartu University Hospital, Tartu, Estonia Anesth Analg 2004 98: 738-744

 

bsAڭ̵FbNoͰs_Xg(AWS)MI¯fHɥRTΩΤfAi֩wĪGCڭ̰wi֩wNAWSw@ΡC45s̿fH(AJJ>60g/d)AܴgDeCN(TURP)AH3աCҦfHQhd]100mg񭫲GUĪ`gCa(DiazG)Nea10mgfAATi֩w(Cloni/tG)fAwTΥi֩w150ugAfAi֩w(Clonp/oG)i֩w150ugfACs_{ɵe|wзǶE_AWSfHCDiazG12fHX{_gACloni/tG2BClonp/oG1fHX{gCs_{ɵe|wзǶiADiazGե12ӥi֩wե1CDiazGզ2fHX{YĸkCClonp/oGկfH«612hʯפU(P<0.05), DiazGկfHN2472hX{ʤOʰjC`ANeTΩΤfAi֩w150ugiws̿fHoYNAWSC

]PĶ i ա^

@In this study, we evaluated the effect of intrathecal and oral clonidine as supplements to spinal anesthesia with lidocaine in patients at risk of postoperative alcohol withdrawal syndrome (AWS). We hypothesized that clonidine would have a prophylactic effect on postoperative AWS. Forty-five alcohol-dependent patients (daily ethanol intake >60 g) scheduled for transurethral resection of the prostate were double-blindly randomized into three groups. All patients received hyperbaric lidocaine 100 mg intrathecally. The diazepam group (DiazG) was premedicated with diazepam 10 mg orally; the intrathecal clonidine group (Cloni/tG) received a placebo (saline) tablet and clonidine 150 µg intrathecally; and the oral clonidine group (Clonp/oG) received clonidine 150 µg orally. For patients diagnosed with AWS, the Clinical Institute Withdrawal Assessment for Alcohol, revised scale, was used. Twelve patients in the DiazG had symptoms of AWS, compared with two in the Cloni/tG and one in the Clonp/oG. The median Clinical Institute Withdrawal Assessment for Alcohol, revised scale, score was 12 in the DiazG versus 1 in the clonidine-treated groups. Two patients in the DiazG had severe delirium. Patients receiving oral clonidine had a slightly decreased mean arterial blood pressure 6V12 h after spinal anesthesia (P < 0.05); patients in the DiazG had a hyperdynamic circulatory reaction 24V72 h after surgery. In conclusion, preoperative clonidine 150 µg, intrathecally or orally, prevented significant postoperative AWS in ethanol-dependent patients.

Anesth Analg 2004 98: 738-744

 

tŹ什_ʸʦjg`vT

Effect of isoflurane on neuronal apoptosis in rats subjected to focal cerebral ischemia.

Kawaguchi M, Drummond JC, Cole DJ, Kelly PJ, Spurlock MP, Patel PM.

Department of Anesthesiology, VA Medical Center and University of California, San Diego, California, USA.

Anesth Analg 2004 98G 798-805

 

MtťiHֵuȯʦ_ʦʯglˡAOo@O@ĤOëDOܪCg`ik]ʦ뭱nvBXjCoܾ޲tťi֦g`AiLkʦް_g`Cڭ̬sFtŹ什_ʯʦjаOӭM`vTCϥβtų¾KWistar-KyotojHM(n = 40)MtŲ(n = 40)AդjqLϤjʯ70ӧΦ_ʯʦCL{Yūױb37+/- 0.2JCbMղtŰϥΡAjiĬ;btŲաAtų¾Kb1.5 MACCjbA`7pɡB1B4β7ѳB]n=10//I^C뭱nqLĬVϹRӶipCbTӬ۾FAqLTUNELVMK̬VkҹF`ӭMʪcaspase-9Mcaspase-3CA`7pɡB1ѩM4ѲtŲժ뭱npM(P < 0.05)AMӦA`7ѨըõLtOCʦ1ѫMժ`ӭM(TUNEL, caspase-3, M caspase-9 )ƶqh󲧬tŲաAgL4ѩ7Ѫ_AtŲժ`ӭMhMաC7ѫAcaspase-3 M -9ʪgƶqbtŲդh(P < 0.05)CoǸƪtŬOӤOFʦɭP몺oiCtŴ֤Fʦ᦭`oiAOèSʦ_`oiCסGڭ̬sFtŹ什_ʸʦjg`vTCbtų¾KjAʦް_`oͩʦ_ߴqAtŨäʦ᪺g`C

] Ķ i ա^

Although isoflurane can reduce ischemic neuronal injury after short postischemic recovery intervals, this neuroprotective efficacy is not sustained. Neuronal apoptosis can contribute to the gradual increase in infarct size after ischemia. This suggests that isoflurane, although capable of reducing early neuronal death, may not inhibit ischemia-induced apoptosis. We investigated the effects of isoflurane on markers of apoptosis in rats subjected to focal ischemia. Fasted Wistar-Kyoto rats were anesthetized with isoflurane and randomly allocated to awake (n = 40) or isoflurane (n = 40) groups. Animals in both groups were subjected to focal ischemia by filament occlusion of the middle cerebral artery for 70 min. Pericranial temperature was servo-controlled at 37 degrees C +/- 0.2 degrees C throughout the experiment. In the awake group, isoflurane was discontinued and the animals were allowed to awaken. In the isoflurane group, isoflurane anesthesia was maintained at 1.5 MAC (minimum alveolar anesthetic concentration). Animals were killed 7 h, 1 day, 4 days, or 7 days after reperfusion (n = 10/group/time point). The area of cerebral infarction was measured by image analysis in a hematoxylin and eosin stained section. In three adjacent sections, apoptotic neurons were identified by TUNEL staining and immunostaining for active caspase-9 and caspase-3. Infarct size was smaller in the isoflurane group than the awake group 7 h, 1 day, and 4 days after reperfusion (P < 0.05). However, this difference was absent 7 days after reperfusion. The number of apoptotic (TUNEL, caspase-3, and caspase-9 positive) cells 1 day after ischemia was significantly more in the awake versus isoflurane group. After a recovery period of 4 or 7 days, the number of apoptotic cells in the isoflurane group was more than in the awake group. After 7 days, the number of caspase-3 and -9 positive neurons was more in the isoflurane group (P < 0.05). The data indicate that isoflurane delays but does not prevent the development of cerebral infarction caused by ischemia. Isoflurane reduced the development of apoptosis early after ischemia but did not prevent it at later stages of postischemic recovery. IMPLICATIONS: The effect of isoflurane on neuronal apoptosis was investigated in rats subjected to focal cerebral ischemia. In isoflurane-anesthetized animals, ischemia-induced apoptosis occurred during the later stages of postischemic recovery. Isoflurane did not inhibit postischemic neuronal apoptosis.

 

骶PMgG@Xus

Continuous parasacral sciatic block: a radiographic study.

Gaertner E, Lascurain P, Venet C, Maschino X, Zamfir A, Lupescu R, Hadzic A.

*Service dAnesthésie Réanimation Chirurgicale Hôpital de Hautepierre, Strasbourg, France; {dagger}Service dAnesthésie, Clinique des Eaux Claires, Grenoble, France; and {ddagger}Department of Anesthesiology, St. Lukes-Roosevelt Hospital, New York, New York

Anesth Analg 2004 98: 831-834.

 

ʪ骶O¾KɭPF骶PMgCbosAڭ[Fg骶ު`JĪXMw]A骶ު`JIѭmMdαjסCڭ̰OF87WDnUϤNfHAmޫ`J8 mLzguVơAϥXuR`JGGpAPɶiPıMBʪRC`JGXuRܴXGҦɺ(86 ھɺ, e99%)bTѭmCĪ`Jeq21 +/- 3 mLCҦfH骶OTӥDnզ]HgB`gMѫ֯g^FFPıCڭ̱oXסG骶OTӥDnզ\ɭP骶PMgAoֵͨogLpICXuiΩҹɺުmCסG骶OTӥDnզ]HgB`gMѫ֯g^\ɭP骶PMgCXuiΩҹɺުTmC

] Ķ i ա^

Parasacral sciatic blockade results in anesthesia of the entire sacral plexus. In this study we sought to determine the spread of the local anesthetic injected through a parasacral catheter, the anatomical location of the inserted catheters, and the extent and reliability of the blockade. In this study, 87 consecutive patients undergoing major lower limb surgery were enrolled. After placement of the catheter and injection of 8 mL of radio-opaque contrast dye, radiographic images were evaluated for dispersion of the injectate. Sensory and motor evaluations were also performed. Radiographic analysis of the injectates revealed that nearly all catheters (86 catheters, 99%) were in the correct anatomical position. The mean volume of local anesthetic injection was 21 +/- 3 mL. All patients developed a full sensory block of all three major components of the sciatic plexus (tibial, common peroneal, and posterior cutaneous nerve of the thigh). We conclude that the parasacral sciatic block results in frequent success of blockade of all three major components of the sciatic plexus and it has a small risk of complications. Contrast radiography can be used to document the catheter placement.

 

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The effect of short-term epidural local anesthetic blockade on urinary levels of substance P in interstitial cystitis.

Sukiennik A, Carr DB, Bonney I, Marchand JE, Wurm H, Sant GR.

Departments of Anesthesia and Urology, Tufts-New England Medical Center, Boston, Massachusetts 02111, USA.

Anesth Analg 2004 98: 846-850.

 

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We investigated the effect of epidural local anesthetic blockade on urinary substance P levels in five patients suffering from painful flare-ups of interstitial cystitis. Urine was collected in 24-h intervals commencing at the onset of an epidural bolus of 0.25% bupivacaine followed by maintenance epidural infusions of 0.05% bupivacaine. Substance P was measured by radioimmunoassay. After initiation of the epidural infusion, urinary substance P levels increased and then declined in all patients. All patients reported a decrease in pain intensity. We hypothesize that acute release, followed by depletion, of substance P from bladder sensory nerve endings accounts for the transient increase of peptide levels in urine and may contribute to the decrease in pain intensity during a 3-day epidural infusion.