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General Anaesthesia (general + anaesthesia)
Selected AbstractsInfluence of neurohumoral blockade on heart rate and blood pressure responses to haemorrhage in isoflurane anaesthetized ratsACTA PHYSIOLOGICA, Issue 3 2000UllmanArticle first published online: 24 DEC 200 Four groups of Sprague,Dawley rats were anaesthetized with isoflurane (ISO) (1.7% end-tidal concentration) in 40% oxygen, and mechanically ventilated. The animals were bled 15 mL kg,1 b.w. from the femoral vein over 10 min, followed by an observation period of 30 min. Ten minutes before haemorrhage each group of animals was pre-treated with intravenous injection/infusion of either: isotonic saline (Group B; CON; n=7), vasopressin V1 -receptor antagonist [d(CH2)5Tyr(Me)AVP; 10 ,g kg,1] (Group C; AVP-a; n=7), the non-selective angiotensin II receptor antagonist saralasin (10 ,g kg,1 min,1) (Group D; SAR; n=7) or hexamethonium (10 mg kg,1) (Group E; HEX; n=7). A separate group of conscious animals were pre-treated with isotonic NaCl and subjected to the same haemorrhage protocol (Group A; AW; n=7). Mean arterial pressure (MAP), heart rate (HR) and blood gases were observed during the experiments. Only pre-treatment with SAR and HEX reduced MAP significantly. The pre-haemorrhage HR was only affected by HEX, which caused a reduction by 17%. The HR was significantly lower at the end of haemorrhage compared with pre-haemorrhage levels in all groups except that group treated with HEX. In that group the HR changed in the opposite direction. The ability to maintain MAP during haemorrhage, and the post-haemorrhage period, was significantly impaired in the groups treated with AVP-a, SAR or HEX compared with the group receiving NaCl. It is concluded that autonomic nervous activity is of major importance for the maintenance of MAP during isoflurane anaesthesia, whereas circulating angiotensin II and vasopressin levels contribute to a much smaller degree in this regard. General anaesthesia in combination with different degrees of neurohumoral blockade impairs the haemodynamic responses to blood loss, seen in conscious individuals. The impairment involves both the early and late phases during haemorrhage, as well as the post-bleeding recovery period. All three neurohumoral systems (autonomic nervous activity, angiotensin II and vasopressin) are of importance for regulating MAP during and after haemorrhage, although the autonomic nervous outflow appears to contribute to a larger extent. [source] R2 The pattern of extraction of first permanent molars: results from three dental hospitalsINTERNATIONAL JOURNAL OF PAEDIATRIC DENTISTRY, Issue 2006S. S. ALBADRI Objective:, To determine and compare the reasons and pattern of extraction of first permanent molars (FPM) in 3 UK dental hospitals. Design:, Data were collected prospectively from 300 children attending Manchester Dental Hospital (MDH), Liverpool Dental Hospital (LDH) and Charles Clifford Dental Hospital, Sheffield (CCDH) who required extractions of at least one FPM. Information recorded included age, FPM extracted, reason for extractions, previous treatment, method of extraction, and whether patients had previous extractions. Result:, The mean age in months was 129 (Std 22.7), 139 (Std 29.4), and 133 (Std 26.8) for MDH, LDH, CCDH respectively. 45% and 48% of children had four FPM extracted at MDH & CCDH, respectively, compared to 25% in LDH. The main reason for extraction (70%) was caries with poor prognosis, followed by caries and compensating extraction (14%). Molar Incisal Hypoplasia was the reason for extraction in 11% of cases. General anaesthesia was the main anaesthetic method used with 77%, 55%, and 47% in MDH, LDH and CCDH, respectively. Local anaesthesia was used in 43% of cases in LDH in comparison to 12% and 22% in MDH and CCDH, respectively. 68% of children had received no previous treatment to the FPM and only 5% had fissure sealants placed. 40% of children had previous extractions. Conclusion:, The children who are attending our hospitals for extractions of FPM tend to be older than the recommended age for achieving maximum space closure. This study highlights the need for extensive prevention programs targeted at those children with high caries risk. [source] Pregabalin and dexamethasone in combination with paracetamol for postoperative pain control after abdominal hysterectomy.ACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 2 2009A randomized clinical trial Background: Multimodal analgesia may be important for optimal postoperative pain treatment and facilitation of early mobilization and recovery. We investigated the analgesic effect of pregabalin and dexamethasone in combination with paracetamol after abdominal hysterectomy. Methods: One hundred and sixteen patients were randomly assigned to either group A (paracetamol+placebo × 2), group B (paracetamol+pregabalin+placebo) or group C (paracetamol+pregabalin+dexamethasone). According to randomization and preoperatively, patients received paracetamol 1000 mg, pregabalin 300 mg, dexamethasone 8 mg or placebo. General anaesthesia was performed. Postoperative pain treatment was paracetamol 1000 mg × 4 and patient-controlled intravenous morphine, 2.5 mg bolus. Nausea was treated with ondansetron. Morphine consumption, pain score (visual analogue scale) at rest and during mobilization, nausea, sedation, dizziness, number of vomits and consumption of ondansetron were recorded 2, 4 and 24 h after the operation. P<0.05 was considered statistically significant. Results: The 24-h morphine consumption and pain score, both at rest and during mobilization, were not significantly different between treatment groups. The mean nausea score (P=0.002) was reduced in group C vs. A. The number of vomits was significantly reduced in both group B (P=0.041) and C (P=0.001) vs. A. Consumption of ondansetron was reduced in group C vs. A and B (P<0.001). Other side effects were not different between groups. Conclusion: Combinations of paracetamol and pregabalin, or paracetamol, pregabalin and dexamethasone did not reduce morphine consumption and pain score compared with paracetamol alone for patients undergoing abdominal hysterectomy. Dexamethasone reduced nausea, vomiting and use of ondansetron. [source] Anaesthesia for magnetoencephalography in children with intractable seizuresPEDIATRIC ANESTHESIA, Issue 9 2003Peter Szmuk MD Summary Background Magnetoencephalography (MEG), a noninvasive technique for evaluation of epileptic patients, records magnetic fields during neuronal electrical activity within the brain. Anaesthesia experience for MEG has not yet been reported. Methods We retrospectively reviewed records of 48 paediatric patients undergoing MEG under anaesthesia. Thirty-one patients (nonprotocol group) were managed according to the anaesthesiologist's discretion. Premedication included oral midazolam, chloral hydrate or fentanyl oralet, intravenous midazolam or inhalational anaesthesia with sevoflurane. Anaesthesia was maintained with propofol, midazolam, fentanyl, alone or in combination. A subsequent protocol group (17 patients) received chloral hydrate as premedication and propofol for maintenance of anaesthesia. Results There was an overall 25% failure of interictal activity and localization on the MEG scan. In the nonprotocol group, 11 scans failed (35.5%). Of these, eight (72.7%) received midazolam orally. Only one failure (5.8%) was recorded in the protocol group in a patient who received chloral hydrate as sedation supplemented by sevoflurane. Conclusions In our experience, midazolam premedication resulted in a high MEG failure rate (73%). Chloral hydrate premedication and propofol maintenance resulted in a lower incidence of MEG failure (5.8%). General anaesthesia with a continuous infusion of propofol or sevoflurane appears acceptable, although, lighter levels of anaesthesia might be required to avoid interference with interictal activity of the brain. [source] Rapid sequence spinal anaesthesia for category-1 urgency caesarean section: a case seriesANAESTHESIA, Issue 7 2010S. M. Kinsella Summary General anaesthesia is the fastest method for anaesthetising a category-1 caesarean section but is associated with increased maternal morbidity and mortality. We describe the ,rapid sequence spinal' to minimise anaesthetic time. This consists of a no-touch spinal technique, consideration of omission of the spinal opioid, limiting spinal attempts, allowing the start of surgery before full establishment of the spinal block, and being prepared for conversion to general anaesthesia if there are delays or problems. We present a case series of 25 rapid sequence spinal anaesthetics for category-1 caesarean section. The mean (SD [range]) decision-delivery interval was 23 (6 [14,41]) min. After excluding cases where there was an identified delay, the median (IQR [range]) time to prepare and perform the spinal was 2 (2,3 [1,7]) min, and time to develop a ,satisfactory' block was 4 (3,5 [2,7]) min. The total time to induce spinal anaesthesia was 8 (7,8 [6,8]) min. There were three pre-operative conversions to general anaesthesia and three women had pain during surgery that did not require treatment. Our data indicate that one might expect to establish anaesthesia in 6,8 min using a rapid sequence spinal. Careful case selection is crucial. While rapid anaesthesia is important, the reduction of the decision-delivery interval also requires attention to other stages in the pre-operative process. [source] 1225: Anaesthesia in cataract surgeryACTA OPHTHALMOLOGICA, Issue 2010P BODROGI I would like to give a review of anaesthetic methods used in cataract surgery. Retrobulbar (RB) anaesthesia via injection provides not only painlessness, but also akinesia and cuts off autonomic reflexes. Although unfortunatelly it has many possible sideeffects, like perforation of the globe, retrobulbar haemorrhage or injury of the optic nerve, it is still widely used. Parabulbar (PB) anaesthesia was introduced to eliminate traumatic sideeffects of RB, but it did not fulfill all expectations. There are also subconjunctival and sub-Tenon anaesthesia, the latter also results in akinesia. Since the introduction of phacoemulsification topical anaesthesia has become current. Due to the gentle surgical technique, if the wound is corneal and there is no severe fluctuation of depth of the anterior chamber, it can provide sufficient anaesthesia. They apply it in form of drops, gel or special sponge. It can be replenished with intracameral Lidocain. Before surgery it is widely used to apply systemic sedatives, which helps to attenuate the patients' angst because of surgery. Supporting attitude of medical crew and positive verbal communication is also beneficial at this task. General anaesthesia is still the only possibility used in cataract surgery of children and other people unable to cooperate. [source] 1226: Techniques and complications of anaesthesia for vitreoretinal surgery and a new technique of local anaesthesiaACTA OPHTHALMOLOGICA, Issue 2010K GOMBOSArticle first published online: 23 SEP 2010 Purpose Since the 1970s, the methods of vitrectomy procedures in ophthalmology have changed due to technical developments. Consequently certain procedures are less painful and less time consuming. On the other hand, due the modern technology more difficult cases can be operated, which may result in increase the time and strain of the operation. Methods General anaesthesia (GA) is one possibility, but it may have lots of side effects, can cause serious life threatening complications, is time consuming, expensive and sometimes to organise general anaesthesia leads to delay of the operation, consequently possibly hindering the proper timing of it. Despite these, the GA seemed to be necessary when a longer procedure planned. Results Using our method we could avoid some of the well-known complications of RBA and PBA. Painless operations were provided and the surgeons were satisfied with the anaesthesia. The serum Lidocain level was lower in cRBA compared with the single dose technique. Moreover the presence of postoperative pain could be reduced by using anaesthesia via cannula. Conclusion The benefits and disadvantages of cRBA will be apparent only by the spread of the new technique, which could also contribute to its improvement. This method means a perspective for postoperative pain relief. Hopefully more widespread use of this method helps continuous regional techniques to find their well deserved place in ophthalmic anaesthesia. [source] Multiple crown-root fractures in primary molars and a suspected subcondylar fracture following trauma: a report of a caseDENTAL TRAUMATOLOGY, Issue 2 2008Zahra Tejani Injuries to the primary dentition are usually luxations and mandibular fractures rarely occur. With trauma sustained to the chin, the posterior primary teeth are at increased risk of trauma and mandibular fractures can occur. The case discussed is of a 4-year-old female who presented 2 weeks following dental trauma with multiple primary molar fractures and a possible subcondylar fracture. The need for a detailed examination is emphasized and the management of the case under general anaesthesia is described. [source] Clinical application of continuous spirometry with a pitot-based flow meter during equine anaesthesiaEQUINE VETERINARY EDUCATION, Issue 7 2010Y. P. S. Moens Summary This report documents the feasibility and clinical information provided by a new method for spirometric monitoring adapted for equine anaesthesia. Monitoring of ventilatory function was done with continuous spirometry during general anaesthesia of client-owned horses presented for various diagnostic and surgical procedures. An anaesthetic monitor with a spirometry unit for human anaesthesia was used. To allow the measurement of large tidal volumes, a remodelled larger version of the pitot tube- based flow sensor was used. This technology provided reliable spirometric data even during prolonged anaesthesia when water condensation accumulated in the anaesthetic circuit and the sensor. In addition to flow and volume measurement and respiratory gas analysis, the continuous display of flow-volume and pressure-volume loops offered visually recognisable information about compliance, airway resistance and integrity of the circuit. Continuous spirometry with this monitoring system was helpful in evaluating the efficacy of spontaneous ventilation, in adjusting intermittent positive pressure ventilation and detecting technical faults in the anaesthetic apparatus and connection with the patient. This adapted spirometry method represents a practical and reliable measuring system for use during equine anaesthesia. The variety of information provides an opportunity to optimise anaesthetic management in this species. [source] Permanent colostomy after small colon prolapse in a parturient mareEQUINE VETERINARY EDUCATION, Issue 5 2010C. A. Espinosa Buschiazzo Summary Small colon prolapse is a possible complication during parturition and diarrhoea. A case diagnosed in a mare during birth labour was reduced by the attending veterinarian at the farm, and referred to the authors for evaluation. After thorough physical examination, blood and peritoneal fluid tests, a ruptured mesocolon was suspected and the mare explored under general anaesthesia by a median celiotomy approach. During the procedure the affected mesocolon-rectum was confirmed and a resection of the intestine elected. After prolapsing the segment of damaged viscera a permanent end colostomy was performed. Fourteen months later and after an uneventful recovery, the mare was in a very good physical condition and waiting to be covered for the next breeding season. [source] Sedation and general anaesthesia of the foalEQUINE VETERINARY EDUCATION, Issue S7 2005S. A. Robertson First page of article [source] Effect of intravenous lidocaine administration on laminar inflammation in the black walnut extract model of laminitisEQUINE VETERINARY JOURNAL, Issue 3 2010J. M. WILLIAMS Summary Reasons for performing study: Laminitis is a serious complication of horses suffering from sepsis/endotoxaemia-related events. Laminitis in horses and organ injury in human sepsis are both reported to involve inflammatory injury to the laminae/organs including early activation of endothelium and leucocytes leading to emigration of neutrophils into the tissue interstitium. In the black walnut extract (BWE) model, systemic inflammatory events coincide with marked increase in laminar mRNA concentrations of inflammatory genes including proinflammatory cytokines (i.e. IL-1,, IL-6), COX-2, chemokines (i.e. IL-8) and endothelial adhesion molecules (i.e. ICAM-1 and E-selectin). In models of human sepsis, i.v. lidocaine has been reported to decrease leucocyte and endothelial activation, and the expression of proinflammatory cytokines and chemokines. Objectives: To evaluate the effect of i.v. lidocaine therapy on the inflammatory processes documented to occur in the BWE model of laminitis. Methods: Twelve horses were administered BWE and treated immediately with either lidocaine (1.3 mg/kg bwt bolus, followed by 0.05 mg/kg bwt/min CRI, n = 6) or saline (n = 6) for 10 h. At 10 h post BWE administration, laminar samples were obtained under general anaesthesia for assessment of proinflammatory gene expression (using RT-qPCR) and leucocyte emigration (via CD13 immunohistochemistry). At 0, 3 and 10 h post BWE administration, skin samples were obtained for assessment of leucocyte emigration (via calprotectin immunohistochemistry). Results: No significant differences between groups were noted for inflammatory gene mRNA concentrations (IL-1,, IL-6, IL-8, COX-2) or for number of leucocytes present within the laminar interstitium or skin dermis. Increased (P<0.05) laminar E-selectin mRNA concentrations were present in the LD group (vs. SAL group). Conclusions: Continuous administration of i.v. lidocaine does not inhibit inflammatory events in either the laminae or skin in the horse administered black walnut extract. Potential relevance: This work questions the use of continuous i.v. administration of lidocaine as an effective anti-inflammatory therapy for systemic inflammation. [source] Influence of general anaesthesia on the pharmacokinetics of intravenous fentanyl and its primary metabolite in horsesEQUINE VETERINARY JOURNAL, Issue 1 2007S. M. THOMASY Summary Reasons for performing study: In order to evaluate its potential as an adjunct to inhalant anaesthesia in horses, the pharmacokinetics of fentanyl must first be determined. Objectives: To describe the pharmacokinetics of fentanyl and its metabolite, N-[1-(2-phenethyl-4-piperidinyl)maloanilinic acid (PMA), after i.v. administration of a single dose to horses that were awake in Treatment 1 and anaesthetised with isoflurane in Treatment 2. Methods: A balanced crossover design was used (n = 4/group). During Treatment 1, horses received a single dose of fentanyl (4 ,g/kg bwt, i.v.) and during Treatment 2, they were anaesthetised with isoflurane and maintained at 1.2 × minimum alveolar anaesthetic concentration. After a 30 min equilibration period, a single dose of fentanyl (4 ,g/kg bwt, i.v.) was administered to each horse. Plasma fentanyl and PMA concentrations were measured at various time points using liquid chromatography-mass spectrometry. Results: Anaesthesia with isoflurane significantly decreased mean fentanyl clearance (P < 0.05). The fentanyl elimination half-life, in awake and anaesthetised horses, was 1 h and volume of distribution at steady state was 0.37 and 0.26 l/kg bwt, respectively. Anaesthesia with isoflurane also significantly decreased PMA apparent clearance and volume of distribution. The elimination half-life of PMA was 2 and 1.5 h in awake and anaesthetised horses, respectively. Conclusions and potential relevance: Pharmacokinetics of fentanyl and PMA in horses were substantially altered in horses anaesthetised with isoflurane. These pharmacokinetic parameters provide information necessary for determination of suitable fentanyl loading and infusion doses in awake and isoflurane-anaesthetised horses. [source] Effects of unilateral laser-assisted ventriculocordectomy in horses with laryngeal hemiplegiaEQUINE VETERINARY JOURNAL, Issue 6 2006P. ROBINSON Summary Reasons for performing study: Recent studies have evaluated surgical techniques aimed at reducing noise and improving airway function in horses with recurrent laryngeal neuropathy (RLN). These techniques require general anaesthesia and are invasive. A minimally invasive transnasal surgical technique for treatment of RLN that may be employed in the standing, sedated horse would be advantageous. Objective: To determine whether unilateral laser-assisted ventriculocordectomy (LVC) improves upper airway function and reduces noise during inhalation in exercising horses with laryngeal hemiplegia (LH). Methods: Six Standardbred horses were used; respiratory sound and inspiratory transupper airway pressure (Pui) measured before and after induction of LH, and 60, 90 and 120 days after LVC. Inspiratory sound level (SL) and the sound intensities of formants 1, 2 and 3 (F1, F2 and F3, respectively), were measured using computer-based sound analysis programmes. In addition, upper airway endoscopy was performed at each time interval, at rest and during treadmill exercise. Results: In LH-affected horses, Pui, SL and the sound intensity of F2 and F3 were increased significantly from baseline values. At 60 days after LVC, Pui and SL had returned to baseline, and F2 and F3 values had improved partially compared to LH values. At 90 and 120 days, however, SL increased again to LH levels. Conclusions: LVC decreases LH-associated airway obstruction by 60 days after surgery, and reduces inspiratory noise but not as effectively as bilateral ventriculocordectomy. Potential relevance: LVC may be recommended as a treatment of LH, where reduction of upper airway obstruction and respiratory noise is desired and the owner wishes to avoid risks associated with a laryngotomy incision or general anaesthesia. [source] Standing oral extraction of cheek teeth in 100 horses (1998-2003)EQUINE VETERINARY JOURNAL, Issue 2 2005P. M. DIXON Summary Reasons for performing study: Extraction of cheek teeth (CT) by the conventional repulsion technique requires general anaesthesia and carries a high rate of post operative complications. Consequently, an alternative method of extraction, i.e. orally in standing horses, was evaluated. Hypothesis: The need for and risks of general anaesthesia could be avoided and post extraction sequelae reduced by performing extractions orally in standing horses. Methods: One hundred mainly younger horses (median age 8, range 2-18 years) with firmly attached CT that required extraction because of apical infections, displacements, diastemata, idiopathic fractures and the presence of supernumerary CT had the affected teeth (n = 111) extracted orally under standing sedation. Follow-up information was obtained for all cases, a median of 16 months later. Results: Oral extraction was successful in 89 horses and unsuccessful in 11 due to damage to the CT clinical crown (n = 9) during extraction, for behavioural reasons (n = 1) and because the apex of a partly extracted CT fell back into the alveolus following sectioning (n = 1). Predispositions to extraction-related CT fractures were present in 5 of the 9 cases, i.e. advanced dental caries (n = 2) and pre-existing ,idiopathic' fractures (n = 3). The iatrogenically fractured CT were later repulsed under standing sedation (n = 3) and under general anaesthesia (n = 6). Eighty-one of the remaining 89 horses had successful oral CT extraction with no or minimal intra- or post operative complications occurring. Post operative complications in the other 8 cases included post extraction alveolar sequestration (n = 3), alveolar sequestration and localised osteomyelitis (n = 1), localised osteomyelitis (n = 1), incorporation of alveolar packing material into alveolar granulation tissue (n = 1), and nasal discharge due to continued intranasal presence of purulent food material (n = 1) and to ongoing sinusitis (n = 1). The above sequelae were treated successfully in all cases, with general anaesthesia required in just one case. Following oral extraction, significantly (P<0.001) fewer post operative problems developed in 54 horses with apically infected CT in comparison with 71 previous cases that had repulsion of apically infected CT at our clinic. Conclusions and potential relevance: Oral extraction of cheek teeth is a successful technique in the majority of younger horses with firmly attached CT and greatly reduces the post operative sequelae, compared with CT repulsion. Additionally, the costs and risks of general anaesthesia are avoided. Further experience and refinement in the described protocol could potentially increase the success of this procedure and also reduce the incidence of post operative sequelae. [source] Rapid detoxification from opioid dependence under general anaesthesia versus standard methadone tapering: abstinence rates and withdrawal distress experiencesADDICTION BIOLOGY, Issue 3 2003PAUL KRABBE The aim of this work was to study abstinence rates and withdrawal effects of rapid detoxification of opioid-dependents under general anaesthesia (RD-GA) compared to standard methadone tapering (SMT) using a prospective clinical trial with a follow-up of 3 months, as a preliminary study at the Novadic addiction centre in St Oedenrode and St Joseph Hospital in Veghel, the Netherlands. Thirty opioid-dependent patients took part. Outcome measures included urine toxicology screening for opiates to determine abstinence and presence of objective and subjective opioid withdrawal distress symptoms. Statistically significant differences in abstinence rate between RD-GA and SMT were present after one (RD-GA 100% vs. SMT 40%, p <0.01) and 2 months (RD-GA 93% vs. SMT 33%, p <0.01). After 3 months the difference in abstinence was still substantial, but no longer statistically significant (RD-GA 67% vs. SMT 33%, p =0.14). Objective and subjective withdrawal symptoms showed largely identical outcomes and were equally low in the two groups for those who remained in the study. There was a considerably higher percentage of abstinence in the RD-GA group after 1, 2 and 3 months of follow-up accompanied by relatively mild withdrawal symptoms of shorter duration. However, if one completes SMT the data suggest a greater chance of staying clean in the long term than those completing RD-GA. [source] Intraoperative microrecording under general anaesthesia with bispectral analysis monitoring in a case of deep brain stimulation surgery for Parkinson's diseaseEUROPEAN JOURNAL OF NEUROLOGY, Issue 8 2008P. Duque No abstract is available for this article. [source] Surgical treatment of acne inversa (hidradenitis suppurativa): a 20-year experienceEXPERIMENTAL DERMATOLOGY, Issue 6 2006Wolfgang Hartschuh Acne inversa (AI) is caused by follicular hyperkeratosis in intertriginous areas rich in apocrine glands followed by occlusion and rupture of the follicle and inflammation. Sinus tracts, scarring and often contraction with limitation in mobility may occur. There is a world-wide consensus that in chronic disease surgical removal of all involved tissue as early as possible is the most effective treatment modality. The aim of this study is to demonstrate our operative strategy, including postoperative wound care and prevention, the results and pitfalls in the treatment of AI. The operations are increasingly performed in tumescence anaesthesia, followed by secondary healing. Only removal of extended skin areas in the inguino-genital and ano-perineal regions demand general anaesthesia. In axillary regions, all hair-bearing skin including the sweat glands is removed to obtain a hair-free, dry skin area. In the other regions with ill-defined hair and apocrine gland areas, only involved indurated skin is excised. For early limited disease with fluctuant abscesses, unroofing instead of mere incision and drainage is a good first option. Professional wound care with shaving and stretching of the wound margins is very important to avoid premature wound closure. Locally applied disinfectant soaps and 2% triclosane ointments are effective in pre- and postoperative skin care. Follow-up evaluation and collaboration among surgeons and dermatologists and an improved insight in the pathogenesis of AI are mandatory for the successful long-term management of patients afflicted with this complex and debilitating disease. [source] The changes in neuromuscular excitability with normobaric hyperoxia in humansEXPERIMENTAL PHYSIOLOGY, Issue 1 2010Christelle Brerro-Saby Based on previous observations in hyperbaric hyperoxia, we hypothesized that normobaric hyperoxia, often used during general anaesthesia and resuscitation, might also induce a neuromuscular excitability. In heathy volunteers, we studied the consequences of a 50 min period of pure oxygen breathing on the neuromuscular conduction time (CT), the amplitude of the compound evoked muscle potential (M-wave), the latency and amplitude of the Hoffman reflex (H reflex) and the electromyographic tonic vibratory response (TVR) of the flexor digitorum superficialis muscle to explore the proprioceptive reflex loop. Hyperoxia-induced oxidative stress was measured by the changes in blood markers of lipid peroxidation (thiobarbituric acid reactive substances, TBARS) and antioxidant response (reduced ascorbic acid, RAA). During hyperoxia, the M-wave amplitude increased, both CT and H reflex latency were shortened, and the H reflex amplitude increased. By contrast, TVR significantly decreased. Concomitantly, an oxidative stress was assessed by increased TBARS and decreased RAA levels. This study shows the existence of dual effects of hyperoxia, which facilitates the muscle membrane excitability, nerve conduction and spinal reflexes, but reduces the gain of the proprioceptive reflex loop. The activation of the group IV muscle afferents by hyperoxia and the resulting oxidative stress might explain the TVR depression. [source] Enteric-formulated lactoferrin was more effectively transported into blood circulation from gastrointestinal tract in adult ratsEXPERIMENTAL PHYSIOLOGY, Issue 6 2006Takashi Takeuchi We have previously demonstrated that intestinally infused bovine lactoferrin (bLF) is transported into the blood circulation via the lymphatic pathway, not via the portal circulation. Therefore, in the present study, we further investigated whether intragastrically infused enteric-formulated bLF (EF-bLF) was more efficiently absorbed than bLF from the intestine in adult rats. The rats were randomly divided into three groups: 30 and 300 mg kg,1 non-enteric-formulated bLF (non-EF-bLF) groups and a 30 mg kg,1 EF-bLF group. Thoracic lymph was collected from a thoracic lymph duct under general anaesthesia. Bovine lactoferrin was infused into the stomach or duodenal lumen via a needle for a period of over 1 min in a volume of 1 ml kg,1. The bLF transported into the lymph was assayed quantitatively by double-antibody enzyme-linked immunosorbent assay (ELISA). Following the intragastric administration of bLF, the three groups showed almost the same lymph flow, but the bLF concentration in the lymph fluid in the EF-bLF group increased significantly and peaked 3 h after administration. With intraduodenal administration, the bLF concentration in the lymph fluid of the higher non-EF-bLF group was significantly higher than those of the other groups. The amount of absorbed bLF in the EF-bLF group was, however, about 10 times higher than that in the lower non-EF-bLF group, when it was administered intragastrically. These data show that enteric-formulated bLF is less susceptible to gastric pepsin and is more efficiently absorbed from the intestine than is non-enteric-formulated bLF. [source] Could exercise be a new strategy to revert some patients with atrial fibrillation?INTERNAL MEDICINE JOURNAL, Issue 1 2010P. Gates Abstract Background: This study is the result of the anecdotal observation that a number of patients with atrial fibrillation (AF) had noted reversion to sinus rhythm (SR) with exercise. We aimed to evaluate the potential role of exercise stress test (EST) for the reversion of AF. Methods: Patients with AF who were scheduled to undergo electrical cardioversion (DCR) underwent EST using a modified Bruce protocol. Results: Eighteen patients (16 male); aged 36,74 years (mean 58 years) were studied. Five patients (27.7%) had successful reversion with exercise (group 1). Thirteen patients remained in AF (group 2). No patient who failed to revert with exercise did so spontaneously before DCR 3 h to 7 months later (median 20 days). Comparison between group 1 and group 2 did not reveal any significant difference Conclusion: This small preliminary study suggests that in some patients it may be possible to revert AF to SR with exercise and avoid DCR and concomitant general anaesthesia. The authors suggest that a larger multicentre randomized trial is warranted to confirm or refute these initial results and if correct identify those who might benefit. [source] Scandinavian clinical practice guidelines on general anaesthesia for emergency situationsACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 8 2010A. G. JENSEN Emergency patients need special considerations and the number and severity of complications from general anaesthesia can be higher than during scheduled procedures. Guidelines are therefore needed. The Clinical Practice Committee of the Scandinavian Society of Anaesthesiology and Intensive Care Medicine appointed a working group to develop guidelines based on literature searches to assess evidence, and a consensus meeting was held. Consensus opinion was used in the many topics where high-grade evidence was unavailable. The recommendations include the following: anaesthesia for emergency patients should be given by, or under very close supervision by, experienced anaesthesiologists. Problems with the airway and the circulation must be anticipated. The risk of aspiration must be judged for each patient. Pre-operative gastric emptying is rarely indicated. For pre-oxygenation, either tidal volume breathing for 3 min or eight deep breaths over 60 s and oxygen flow 10 l/min should be used. Pre-oxygenation in the obese patients should be performed in the head-up position. The use of cricoid pressure is not considered mandatory, but can be used on individual judgement. The hypnotic drug has a minor influence on intubation conditions, and should be chosen on other grounds. Ketamine should be considered in haemodynamically compromised patients. Opioids may be used to reduce the stress response following intubation. For optimal intubation conditions, succinylcholine 1,1.5 mg/kg is preferred. Outside the operation room, rapid sequence intubation is also considered the safest method. For all patients, precautions to avoid aspiration and other complications must also be considered at the end of anaesthesia. [source] Exposure to anaesthetic trace gases during general anaesthesia: CobraPLA vs.ACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 7 2010LMA classic Background: To prospectively investigate the performance, sealing capacity and operating room (OR) staff exposure to waste anaesthetic gases during the use of the Cobra perilaryngeal airway (CobraPLA) compared with the laryngeal mask airway classic (LMA). Methods: Sixty patients were randomly assigned to the CobraPLA or the LMA group. Insertion time, number of insertion attempts and airway leak pressures were assessed after induction of anaesthesia. Occupational exposure to nitrous oxide (N2O) and Sevoflurane (SEV) was measured at the anaesthetists' breathing zone and the patients' mouth using a photoacoustic infrared spectrometer. Results: N2O waste gas concentrations differed significantly in the anaesthetist's breathing zone (11.7±7.2 p.p.m. in CobraPLA vs. 4.1±4.3 p.p.m. in LMA, P=0.03), whereas no difference could be shown in SEV concentrations. Correct CobraPLA positioning was possible in 28 out of 30 patients (more than one attempt necessary in five patients). Correct positioning of the LMA classic was possible in all 30 patients (more than one attempt in three patients). Peak airway pressure was higher in the CobraPLA group (16±3 vs. 14±2 cmH2O, P=0.01). The average leak pressure of the CobraPLA was 24±4 cmH2O, compared with 20±4 cmH2O of the LMA classic (P<0.001; all values means±SD). Conclusion: Despite higher airway seal pressures, the CobraPLA caused higher intraoperative N2O trace concentrations in the anaesthetists' breathing zone. [source] Effect of epidural dexmedetomidine on intraoperative awareness and post-operative pain after one-lung ventilationACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 6 2010M. ELHAKIM Background: During combined general and regional anaesthesia, it is difficult to use autonomic signs to assess whether wakefulness is suppressed adequately. We compared the effects of a dexmedetomidine,bupivacaine mixture with plain bupivacaine for thoracic epidural anaesthesia on intraoperative awareness and analgesic benefits, when combined with superficial isoflurane anaesthesia (<0.05 maximum alveolar concentration) in patients undergoing thoracic surgery with one-lung ventilation (OLV). Methods: Fifty adult male patients were randomly assigned to receive either epidural dexmedetomidine 1 ,g/kg with bupivacaine 0.5% (group D) or bupivacaine 0.5% alone (group B) after induction of general anaesthesia. Gasometric, haemodynamic and bispectral index values were recorded. Post-operative verbal rating score for pain and observer's assessment of alertness/sedation scale were determined by a blinded observer. Results: Dexmedetomidine reduced the use of supplementary fentanyl during surgery. Patients in group B consumed more analgesics and had higher pain scores after operation than patients of group D. The level of sedation was similar between the two groups in the ICU. Two patients (8%) in group B reported possible intraoperative awareness. There was a limited decrease in PaO2 at OLV in group D compared with group B (P<0.05). Conclusion: In thoracic surgery with OLV, the use of epidural dexmedetomidine decreases the anaesthetic requirements significantly, prevents awareness during anaesthesia and improves intraoperative oxygenation and post-operative analgesia. [source] Suspected allergy to local anaesthetics: follow-up in 135 casesACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 5 2010T. HARBOE Background: Local anaesthetics (LA) are generally considered safe with respect to allergy. However, various clinical reactions steadily occur. Even though most reactions are manifestations of reflexes to perceptive stimuli, uncertainty often remains regarding a possible allergic mechanism. This uncertainty later leads to an avoidance of local anaesthesia and unnecessarily painful interventions, resource-consuming general anaesthesia or even the risk of re-exposure to other yet unidentified allergens. In the present study, follow-up procedures at an allergy clinic were analysed to examine the frequency of identified causative agents and pathogenetic mechanisms and evaluate the strength of the diagnostic conclusions. Method: The medical records of 135 cases with alleged allergic reactions to LA were reviewed. Diagnoses were based on case histories, skin tests, subcutaneous challenge tests and in vitro IgE analyses. Results: Two events (1.5%) were diagnosed as hypersensitivity to LA, articaine,adrenaline and tetracaine,adrenaline, respectively. Ten reactions (7%) were diagnosed as IgE-mediated allergy to other substances including chlorhexidine, latex, triamcinolone and possibly hexaminolevulinate. As challenge testing was not consistently performed with the culprit LA compound, follow-ups were short of definitely refuting hypersensitivity in 61% of the cases. The reported clinical manifestations were in general diagnostically unspecific, but itch and generalised urticaria were most frequent in test-positive cases. Conclusion: Reactions during local anaesthesia are rarely found to be an IgE-mediated LA allergy. Whenever the clinical picture is compatible with allergy, other allergens should also be tested. [source] Pathologic paediatric conditions associated with a compromised airwayINTERNATIONAL JOURNAL OF PAEDIATRIC DENTISTRY, Issue 2 2010SUHER BAKER International Journal of Paediatric Dentistry 2010; 20: 102,111 Purpose., The purpose was to describe pathologic paediatric conditions associated with airway compromise adversely affecting dental treatment with sedation and general anaesthesia. Methods., A review of available literature was completed, identifying pathologic paediatric conditions predisposing to airway compromise. Results., Airway-related deaths are uncommon, but respiratory complication represents the greatest cause of morbidity and mortality during the administration of general anaesthesia. Differences in anatomy and physiology of the paediatric and adult airway contribute to the child's predisposition to rapid development of airway compromise and respiratory failure; juvenile rheumatoid arthritis, cervical spine injury, morbid obesity, and prematurity represent only a few conditions contributing to potential airway compromise of which the paediatric clinician needs to be aware. In all cases, thorough physical examination prior to treatment is mandated to affect a positive treatment outcome. Conclusions., Successful management of children and adolescents with a compromised airway begins with identification of the problem through a detailed medical history and physical examination. Due to the likely fragile nature of many of these patients, and possibility of concomitant medical conditions affecting airway management, dental treatment needs necessitating pharmacological management are best treated in a controlled setting such as the operating room, where a patent airway can be maintained. [source] Behaviour guidance in dental treatment of patients with autism spectrum disorderINTERNATIONAL JOURNAL OF PAEDIATRIC DENTISTRY, Issue 6 2009CHEEN Y. LOO Background., Autism spectrum disorder (ASD) is a neurodevelopmental disorder categorized into autism, pervasive developmental disorder , not otherwise specified (PDD-NOS) and Asperger syndrome. Aims., To identify factors associated with the behaviour of patients with ASD in a dental setting, use of general anaesthesia (GA), and protective stabilization. Design., The dental charts of 395 patients with ASD patients and 386 unaffected patients were reviewed. The following data were analysed: ASD diagnosis, age, gender, residence, seizure disorder, additional diagnosis (mental retardation, cerebral palsy, self-injurious behaviour or pica), medications, caries prevalence and severity, dental treatment history, behaviour, and behaviour guidance technique(s) used. Results., Within both groups, younger patients were more uncooperative. ASD patients with autism were more uncooperative than patients with PDD-NOS; patients with an additional diagnosis were also more uncooperative. ASD patients with higher caries severity, who were uncooperative or female, were more likely to require GA. Use of protective stabilization was associated with lower caries severity, presence of seizure disorder, uncooperative behaviour, male gender, or residency in a group home/institution. Conclusions., Autism spectrum disorder patients with autism, younger age and an additional diagnosis were more uncooperative. Factors associated with the use of GA and protective stabilization in patients with ASD were also identified. [source] Pulpal status of human primary teeth with physiological root resorptionINTERNATIONAL JOURNAL OF PAEDIATRIC DENTISTRY, Issue 1 2009JOANA MONTEIRO Objective., The overall aim of this study was to determine whether any changes occur in the pulpal structure of human primary teeth in association with physiological root resorption. Methods., The experimental material comprised 64 sound primary molars, obtained from children requiring routine dental extractions under general anaesthesia. Pulp sections were processed for indirect immunofluorescence using combinations of: (i) protein gene product 9.5 (a general neuronal marker); (ii) leucocyte common antigen CD45 (a general immune cell marker); and (iii) Ulex europaeus I lectin (a marker of vascular endothelium). Image analysis was then used to determine the percentage area of staining for each label within both the pulp horn and mid-coronal region. Following measurement of the greatest degree of root resorption in each sample, teeth were subdivided into three groups: those with physiological resorption involving less than one-third, one-third to two-thirds, and more than two-thirds of their root length. Results., Wide variation was evident between different tooth samples with some resorbed teeth showing marked changes in pulpal histology. Decreased innervation density, increased immune cell accumulation, and increased vascularity were evident in some teeth with advanced root resorption. Analysis of pooled data, however, did not reveal any significant differences in mean percentage area of staining for any of these variables according to the three root resorption subgroups (P > 0.05, analysis of variance on transformed data). Conclusions., This investigation has revealed some changes in pulpal status of human primary teeth with physiological root resorption. These were not, however, as profound as one may have anticipated. It is therefore speculated that teeth could retain the potential for sensation, healing, and repair until advanced stages of root resorption. [source] A comparison of paracetamol, ibuprofen or their combination for pain relief following extractions in children under general anaesthesia: a randomized controlled trialINTERNATIONAL JOURNAL OF PAEDIATRIC DENTISTRY, Issue 3 2007GIATH GAZAL Objective., This study was designed to compare the effectiveness of different oral analgesics for relieving pain and distress in children following the extraction of teeth under general anaesthesia (GA). The analgesics included paracetamol alone, ibuprofen alone, and paracetamol and ibuprofen in combination. Methods., Two hundred and one subjects were randomly allocated to one of four groups. Forty-seven children were included in the ibuprofen alone (5 mg kg,1) group, 51 in the paracetamol/ibuprofen combination (15/5 mg kg,1) group, 48 in the high-dose paracetamol (20 mg kg,1) group, and 55 children were included in the usual-dose paracetamol (15 mg kg,1) group (control group). Evaluation of distress for children was made immediately pre-operatively, on recovery from anaesthesia and again after 15 min by using a five-point face scale. Furthermore, each child was observed immediately postoperatively and 15 min postoperatively for signs of pain using the Children's Hospital of Eastern Ontario Pain Scale. Results., There were significant decreases in the mean pain and distress scores for both the ibuprofen alone and paracetamol/ibuprofen combination groups compared to the control group (usual-dose paracetamol) at 15 min postoperatively. Conclusions., This study provides evidence to support the oral administration of ibuprofen alone or in combination with paracetamol for postoperative analgesia in children who are having teeth extracted under GA. [source] Congenital double lower lip: report of a caseINTERNATIONAL JOURNAL OF PAEDIATRIC DENTISTRY, Issue 6 2006M. M. CHIDZONGA Summary., A case of the management of a congenital double lower lip in a 2-week-old female child: is described. The mother stated that the child was having difficulties when suckling and was also worried about the unsightly appearance. The redundant lower lip was excised under general anaesthesia. The child made an uneventful recovery. [source] | |||||||||||||||||||||||||||||||