Canadian Journal of Anesthesia/Journal canadien d anesthésie

Aubin, Patrice; Vischoff, Daniel; Haig, Margaret; Villeneuve, Edith; Charest, Jean; Lallier, Michel; Di Lorenzo, Maria

doi: 10.1007/bf03013133pmid: 10522585

PurposeTo describe the anesthetic and ventilatory management of an infant with diffuse pulmonary bullous lesions.Clinical FeaturesFour successive operations were scheduled for an infant with diffuse pulmonary bullous lesions. At the age of seven weeks, conventional positive pressure ventilation during laparotomy for intestinal occlusion led to arterial desaturation. This was corrected by returning to spontaneous respiration and deep inhalation anesthesia with halothane. Based on our ICU experience and due to a potential impaired oxygenation during conventional ventilation, we chose high-frequency oscillatory ventilation (HFOV) for bilateral sequential thoracotomies for bullectomies at the age of five months. We elected the same ventilatory mode for laparotomy for intestinal obstruction secondary to a polyp at the age of six months. This ventilatory mode was combined with total intravenous anesthesia and epidural analgesia and provided optimal oxygenation and ventilation as well as vital signs stability.ConclusionHigh frequency oscillatory ventilation is a safe technique that may be used in the operating room in cases where conventional ventilation failed to provide satisfactory gas exchange.

Fujii, Yoshitaka; Saitoh, Yuhji; Tanaka, Hiroyoshi; Toyooka, Hidenori

doi: 10.1007/bf03013138pmid: 10522590

PurposeTo compare the efficacy of ramosetron with granisetron for the prevention of postoperative nausea and vomiting (PONV) after laparoscopic cholecystectomy.MethodsIn a randomized, double-blind study, 80 female inpatients received 3 mg granisetron or 0.3 mg ramosetroniv (n=40 of each) at the completion of surgery The standardized anesthetic included isoflurane and nitrous oxide in oxygen.ResultsComplete response, defined as no PONV during the first 24 hr (0–24 hr) after anesthesia was 85% with granisetron and 93% with ramosetron, respectively (P=0.241); the corresponding incidence during the next 24 hr (24–48 hr) after anesthesia was 63% and 90% (P=0.004). No clinically important adverse events due to the study drug were observed in any of the groups.ConclusionRamosetron was more effective than granisetron for prevention of PONV during 0–48 hr after anesthesia for laparoscopic cholecystectomy.

Karski, Jacek M.; Mathieu, Maryse; Cheng, Davy; Carroll, Jo; Scott, Gerald J.

doi: 10.1007/bf03013135pmid: 10522587

PurposeTen percent of our cardiac surgical patients have preoperative anemia. Anemia diagnosed before scheduled cardiac surgery is a strong predictor of the need for homologous blood transfusion (RBC) perioperatively but the cause of this preoperative anemia is not known. The purpose of this study was to evaluate the etiology of preoperative anemia.MethodsSeventy-five consecutive anemic cardiosurgical patients (Hb = < 120 g·L−1 the day before surgery) were studied prospectively. All had multiple diagnostic blood tests done in the preoperative period to diagnose the cause of the anemia and subsequently underwent non-emergency cardiac surgery. Anesthesia and RBC transfusion were standardized according to the protocol. Data in respect to operation, RBC and other blood product transfusion during operation and hospital stay were recorded.ResultsHospital-acquired anemia was present in 37.3% of anemic patients (hemoglobin decrease during hospitalization before surgery ≥9 g·l−1). The second most common diagnosis was iron deficiency anemia (29.3% patients) followed by anemia of chronic renal disease (10.7% patients). When coronary angiography was performed close to operation time, patients had a higher decrease in hemoglobin concentration during hospitalization — suggesting that blood loss during angiography was, in part, responsible for anemia. Seventy-five percent of anemic patients were transfused with RBC perioperatively compared with our overall transfusion rate of 30% of cardiac surgery patients.ConclusionsIn the majority of patients, preoperative anemia is potentially preventable. Investigation and treatment of anemia before cardiac surgery should be a priority in preparing the patient for surgery.

Dob, Daryl P.; Bailey, Paul M.

doi: 10.1007/bf03013142pmid: N/A

Lavin, Patrick A.; Henderson, Cynthia L.; Vaghadia, Himat

doi: 10.1007/bf03013128pmid: 10522580

PurposeChloroprocaine should be an ideal agent for intravenous regional anesthesia (IVRA) because of its rapid onset and ester hydrolysis. Raising the pH of local anesthetics may increase the speed of onset and the intensity of nerve blocks. We compared plain and alkalinized 2-chloroprocaine 0.5% with lidocaine for IVRA.MethodsIn twoseparate double-blind studies, 78 patients scheduled for daycare hand surgery were randomized to receive 40 mL plain 2-chloroprocaine 0.5%, alkalinized 2-chloroprocaine 0.5% or lidocaine 0.5% for IVRA. Time to sensory and motor block, need for supplemental analgesia, and side effects were compared.ResultsThere was no difference in time to sensory or motor block in either group. Patients who received plain chloroprocaine required more supplemental opioid and had a higher incidence of metallic taste and of hives than patients who received lidocaine (P < 0.05). Comparing alkalinized chloroprocaine with lidocaine, there was no difference found with respect to opioid supplementation, CNS side effects, or incidence of hives.ConclusionIn conclusion, alkalinized chloroprocaine was found to be an effective agent for IVRA but no benefit over lidocaine was detected. Plain chloroprocaine for IVRA produced more minor side effects than lidocaine.

Fujii, Yoshitaka; Saitoh, Yuhji; Takahashi, Shinji; Toyooka, Hidenori

doi: 10.1007/bf03013130pmid: 10522582

PurposeHypertensive patients exhibit exaggerated cardiovascular responses to tracheal extubation. This study was undertaken to compare the efficacy of combined diltiazem and lidocaine with each drug alone in suppressing the hemodynamic changes during tracheal extubation.MethodsSixty hypertensive patients (ASA II), defined as systolic blood pressure > 160 mmHg and/or diastolic blood pressure > 95 mmHg (WHO), undergoing elective orthopedic surgery received, in a randomized, double-blind manner, 0.2 mg·kg−1 diltiazem, 1.0 mg·kg−1 lidocaine, or 0.2 mg·kg−1 diltiazem plus 1.0 mg·kg−1 lidocaine (n=20 of each) iv before tracheal extubation. Changes in heart rate (HR), mean arterial pressure (MAP) and ratepressure product (RPP) were measured before and after tracheal extubation.ResultsHemodynamic changes during tracheal extubation were less in patients receiving diltiazem plus lidocaine than in those receiving diltiazem or lidocaine as a sole medicine (RPP; 10322 ±1674 (combined) vs 11532 ±1802 (diltiazem), 15388 ±2050 (lidocaine), mean ±SD, P < 0.05).ConclusionCombined diltiazem and lidocaine is more effective prophylaxis than diltiazem or lidocaine alone for attenuating the cardiovascular responses to tracheal extubation and emergence from anesthesia in hypertensive patients.

Peng, Philip; Claxton, Andrew; Chung, Frances; Chan, Vincent; Miniaci, Anthony; Krishnathas, Ananthan

doi: 10.1007/bf03013124pmid: 10522576

PurposeThe primary objective was to evaluate the analgesic effectiveness of femoral nerve block and ketorolac following ACL reconstruction. The secondary objective was to examine their effects on recovery milestones.MethodsPrior to standard general anesthesia, 90 patients were randomized into three groups of preoperative treatment: 1) femoral nerve block (15 mL bupivacaine 0.5%) and 1 mL normal salineiv (FNB group); 2) placebo femoral nerve block (15 mL normal saline) and 30 mg (1 mL) ketorolaciv (KT group); 3) placebo femoral nerve block (15 mL normal saline) and 1 mL normal salineiv (PL group). Postoperatively, pain was assessed by visual analogue score, demand and consumption of morphine via patient-controlled analgesia pump. The times for patients to tolerate oral fluid, food, sit up, ambulate and void were also noted.ResultsMorphine consumption within one hour, three hours and until POD 1 in the FNB group was lower than the PL group (7 ± 6, 11 ± 9, 27 ± 23 mgvs 13 ± 5, 20 ± 9, 49 ± 28 mg respectively), whereas only that within one hour in the KT group was lower than the PL group. Pain score was lower in FNB and KT groups in the first postoperative hour than in the PL group (P < 0.05). There were no differences among the three groups in the times to meet recovery milestone and discharge criteria.ConclusionFemoral nerve block provides superior analgesia than placebo for ACL reconstruction but was insufficient to facilitate early recovery.

Asai, Takashi

doi: 10.1007/bf03013141pmid: 10522593

Gray, Cavin; Swinhoe, Crispin F.; Myint, Ye; Mason, David

doi: 10.1007/bf03013131pmid: 10522583

PurposeTo determine the accuracy of a target controlled infusion system for ketamine and to assess its suitability for the provision of analgesia when used in conjunction with a propofol infusion in spontaneously breathing patients.MethodsNineteen, adult, ASA I–II patients scheduled for elective surgery were studied. After premedication with 20 mg temazepam an appropriate plasma concentration of ketamine was selected and, when the target controlled infusion (TCI) system indicated that this had been achieved, anesthesia was induced and maintained using a propofol infusion. The plasma ketamine concentration was measured at predetermined intervals and cardiovascular and respiratory parameters recorded at 10 min intervals. Patients were reviewed in recovery and 24 hr postoperatively to assess the adequacy of their recovery and the presence of any undesirable side effects.ResultsThe TCI system had a median performance error against predicted plasma concentrations of 18.9% (SE 2.5%) and a median absolute performance error of 23.3% (SE 2.3%). Divergence was 20.3% (SE 30.1%) and wobble was 12.9% (SE 2.1%). There was a mean decrease in arterial pressure of 6.4% (SD 19.7%) and a mean increase in heart rate of 4.3% (SD 17.4%). Little respiratory depression occurred and all patients made a rapid postoperative recovery with none describing unpleasant dreams or hallucinations.ConclusionThe TCI system provided a clinically acceptable degree of control of the plasma ketamine concentration although some further improvement should be possible by amending the pharmacokinetic model. Clinically the combination with a propofol infusion proved to be a satisfactory anesthetic technique.

Elwood, Thomas; Hutchinson, Elizabeth; Maltby, J. Roger

doi: 10.1007/bf03013140pmid: 10522592