None.

 

 

 

ACTA ANAESTHESIOLOGICA SCANDINAVICA - TOP

Oral naproxen but not oral paracetamol reduces the need for rescue analgesic after adenoidectomy in children
R. Korpela, J. Silvola, E. Laakso, O. A. Meretoja
Acta Anaesthesiologica Scandinavica 2007; 51 (6), 726–730.

Background: Our aim was to show the efficacy of naproxen and paracetamol with and without pethidine on pain and nausea and vomiting after adenoidectomy. The primary outcome was the requirement of rescue analgesic for post-operative pain and the secondary outcome was post-operative nausea and vomiting (PONV).
Methods: A randomized, double-blind, placebo-controlled study design was used. Thirty minutes before anaesthesia induction, patients (n = 180) received either a single oral dose analgesic (naproxen 10 mg/kg or paracetamol 20 mg/kg) or a placebo. Half of the children received pethidine 1 mg/kg intravenously (i.v.) at the induction of anaesthesia. Post-operative pain was evaluated using an objective behavioural pain scale (OPS 0–9) and rescue medication, i.v. fentanyl 1 μg/kg, was administered if the child suffered from moderate or severe pain (OPS ≥ 4).
Results: When pethidine was not used, 83% of the children in the naproxen group vs. 97% in the other two groups required rescue fentanyl (P < 0.05). The use of pethidine reduced the incidence of fentanyl requirement by 30% and the number of fentanyl doses by 50% (P < 0.001). It also equalized the effects of naproxen, paracetamol and the placebo making the pain model invalid for this kind of study. The drawback associated with better analgesia was a doubling of the incidence of PONV (P < 0.001).
Conclusions: Oral naproxen (10 mg/kg), but not oral paracetamol (20 mg/kg), reduces the need for rescue analgesic after adenoidectomy in children. The sensitivity of the pain model is crucial for these types of studies.

BRITISH JOURNAL OF ANAESTHESIA - TOP

Removal of the laryngeal tube in children: anaesthetized compared with awake
J. Lee, J. Kim, S. Kim, C. Kim, T. Yoon and H. Kim
British Journal of Anaesthesia 2007 98(6):802-805

Background: Laryngeal tube (LT) is a useful airway device in children, but there is no objective evidence that removal of LT in awake state is better than in anaesthetized state. So, we compared the incidence of respiratory adverse events after the removal of LT, either under anaesthesia or on awakening.
Methods: Seventy healthy children between 1 and 12 yr of age were enrolled in this study. Anaesthesia was induced and maintained with sevoflurane. After induction of anaesthesia, patients were randomized into two groups: removal of LT in anaesthetized state (Group A: 2% sevoflurane) and in awake state (Group B). During and within 1 min of the removal of LT, airway complications such as upper airway obstruction, cough, vomiting, teeth clenching, hypersalivation, desaturation <90%, and laryngospasm were recorded.
Results: Cough (37.1 vs 2.9%), hypersalivation (28.6 vs 5.7%), desaturation (20 vs 0%), and LT dislocation during emergence relating to the patient's movement (26.5 vs 0%) occurred more frequently in Group B (P < 0.05). Upper airway obstruction occurred more frequently (68.6 vs 31.4%) in Group A, and it was easily resolved by chin or jaw lifting.
Conclusion: LT removal in anaesthetized state reduced cough, hypersalivation, and prevented tube displacement and hypoxia. Upper airway obstruction in the anaesthetized state should be predicted and managed with chin or jaw lifting.

CANADIAN JOURNAL OF ANESTHESIA - TOP

Effect of short-term postoperative celecoxib administration on patient outcome after outpatient laparoscopic surgery
Paul F. White, PhD MD FANZCA, Ozlem Sacan, MD, Burcu Tufanogullari, MD, Matthew Eng, Nina Nuangchamnong and Babatunde Ogunnaike, MD
Canadian Journal of Anesthesia 54:342-348 (2007)

Purpose: Non-opioid analgesics are increasingly used as part of a multimodal regimen for pain management. This prospective, randomized, double-blinded, placebo-controlled study was designed to evaluate the effect of short-term postoperative administration of celecoxib on pain management and recovery outcomes following laparoscopic surgery.
Methods: Eighty consenting ASA I–III outpatients undergoing laparoscopic surgery were randomly assigned to one of two treatment groups: Control (placebo) or Celecoxib (celecoxib, 400 mg·day–1). The initial dose (celecoxib 400 mg or placebo po) was administered in the recovery room, and celecoxib 200 mg (or a placebo) po bid was continued for three additional days after surgery. Postoperative pain scores and the need for opioid- containing analgesics were recorded at specific intervals in the recovery room. Follow-up evaluations were performed at 24 hr, 48 hr, 72 hr and seven days and one month after surgery to assess post-discharge pain, analgesic requirements, complications, quality of recovery, and resumption of normal activities, as well as patient satisfaction with their pain management.
Results: Celecoxib reduced mean pain scores and the need for analgesics at 24 hr and 48 hr postoperatively. Patient satisfaction with their postoperative pain management was also higher in the Celecoxib group (94 ± 8 vs 80 ± 25, P < 0.05). Quality of recovery scores were significantly higher in the Celecoxib group on the first and second postoperative days (17 ± 1 vs 15 ± 2, and 18 ± 1 vs 16 ± 2, respectively). Finally, bowel function recovered an average of one day earlier and patients resumed activities of daily living two days earlier in the Celecoxib group (P < 0.05).
Conclusion: Short-term administration of celecoxib, 400 mg·day–1 po, decreased postoperative pain and the need for opioid-containing analgesic medication, leading to an improved quality of recovery after outpatient laparoscopic surgery.

Haloperidol is as effective as ondansetron for preventing postoperative nausea and vomiting
Yi Lee, MD, Po K. Wang, MD, Hsien Y. Lai, PhD, Yao L. Yang, MD, Chin C. Chu, MD and Jhi J. Wang, PhD
Canadian Journal of Anesthesia 54:349-354 (2007)

Purpose: Recent warnings regarding the safety of droperidol have limited use of this drug as an antiemetic. Haloperidol, a butyrophenone derivative similar to droperidol, has not been rigorously evaluated as an antiemetic. The aim of this study was to compare the prophylactic antiemetic efficacy of haloperidol vs ondansetron for the prevention of postoperative nausea and vomiting (PONV) after general anesthesia.
Methods: Ninety non-smoking female patients were eligible to participate in this randomized double-blinded study. Approximately 30 min before the end of surgery, patients were randomly assigned to receive either haloperidol 2 mg iv, or ondansetron 4 mg iv, respectively. The incidence of PONV, average pain and sedation scores, recovery times, and changes of the rate-corrected QT (QTc) interval were observed postoperatively.
Results: The proportion of patients who experienced PONV in the first 24 hr was similar in the two groups (28% and 26% for haloperidol and ondansetron groups, respectively). The incidence of PONV was significantly less in both groups than predicted according to the patients’ underlying risks (53% for the haloperidol group, P = 0.016; 51% for the ondansetron group, P = 0.015). Pain scores, sedation scores, and recovery times were similar in the two groups, and no prolongation of the QTc interval was observed in either group.
Conclusions: Haloperidol 2 mg iv given 30 min before the end of surgery is effective in preventing PONV, with efficacy comparable to ondansetron 4 mg iv for the first 24 hr after general anesthesia.

A patient information booklet about anesthesiology improves preoperative patient education
Angela Cheung, BSc, Barry A. Finegan, FRCPC, Clint Torok-Both, FRCPC, Niamh Donnelly-Warner, FRCPC and Jelka Lujic, MD
Canadian Journal of Anesthesia 54:355-360 (2007)

Purpose: Preadmission clinics provide a limited timeframe in which patients can discuss the risks and benefits of various forms of anesthesia. We hypothesized that the provision of a patient information booklet would clarify and reinforce salient perioperative topics related to anesthesia.
Methods: A prospective study was carried out in two phases. In Phase I, anesthesiologists were surveyed to determine the key topics routinely discussed during a preadmission clinic visit. Subsequently, we developed an illustrated booklet highlighting some of the topics identified during the survey. In Phase II, the booklet was evaluated by a questionnaire designed to assess patient knowledge about perioperative issues. This questionnaire was administered to a control group of patients who did not receive the booklet and a study group who received the booklet. Statistical significance was established at P < 0.05.
Results: In Phase I, 65 anesthesiologists completed the survey of their current practice in the preadmission clinic. The survey revealed no uniformity in overall information provision, but indicated that certain issues were routinely discussed with patients. In Phase II, 322 patients were enrolled. Patients in the study groups scored significantly higher on the knowledge assessment questionnaire than did patients in the control group. Both education and country of origin influenced the scores of patients in the control group, but not in the study group.
Conclusion: A simple, illustrated patient information booklet, when appropriately written and illustrated, is an effective means of standardizing the communication of the risks and benefits of anesthesia in a preadmission clinic. A booklet with a focus on plain language usage and simple illustrations appears to be an advantageous educational tool even in culturally diverse populations.

PUB MED - TOP

Title: Sedation analgesia during office-based plastic surgery procedures: comparison of two opioid regimens
Journal: Plast Reconstr Surg
Volume: 119
Issue: 7
Pages: 2263-70
Date: Jun
Accession Number: 17519730

Abstract:
BACKGROUND: The combination of sedative and analgesic drugs is increasingly being used during minimally invasive surgery. The authors compared the clinical efficacy of two different fentanyl regimens, in combination with midazolam, for sedation analgesia in patients undergoing office-based plastic surgery procedures under local anesthesia.
METHODS: One-hundred patients were randomized into two groups of 50 subjects each. Group F1 received a fentanyl bolus of 0.7 microg/kg before infiltration with local anaesthetics; group F2 received the same bolus plus 0.6 microg/kg fentanyl every 45 minutes. All patients received a midazolam bolus of 0.05 mg/kg plus continuous infusion 0.08 mg/kg per hour.
RESULTS: High-quality analgesia was obtained in every group, without significant differences between the two fentanyl regimens. Group F2 was associated with lower intraoperative mean blood pressure and SpO2 values compared with group F1. No differences were detected between the two groups in perioperative side effects or postoperative pain.
CONCLUSION: Higher doses of opioid did not improve the quality of perioperative patient comfort but acted synergistically with the sedative drugs, amplifying the hemodynamic and respiratory side effects.
URL: Link
Author Address: Department of Anesthesiology and Intensive Care, University of Foggia, Foggia, Italy. g.cinnella@unifg.it

REMARKS: THE ABOVE STUDY CONFIRMS THAT AS LONG AS REGIONAL ANESTHETIC TECHNIQUES ARE USED EFFECTIVELY, HIGHER DOSES OF NARCOTICS CAN BE AVOIDED. THIS MAY ALSO DECREASE OPIOID RELATED SIDE EFFECTS NAMELY NAUSEA AND DELAYED BOWEL MOTILITY. THE AUTHORS ALREADY DEMONSTRATED A RESPIRATORY DEPRESSANT EFFECT IN THE HIGHER OPIOID GROUP. (K. BELANI, MD)

Author: Glen, W.; Lenihan, J. P.
Year: 2007
Title: Use of in-office anesthesia during non-surgical radiofrequency collagen denaturation for stress urinary incontinence
Journal: Curr Med Res Opin
Date: Apr 26
Accession Number: 17559728

Abstract:
OBJECTIVE: Clinical trials have demonstrated the safety and efficacy of non-surgical, transurethral radiofrequency (RF) collagen denaturation for treating female stress urinary incontinence (SUI) due to hypermobility. Women in those trials were anesthetized using intravenous conscious sedation. This multicenter trial aimed to demonstrate the feasibility, safety, and efficacy of an oral sedation and local anesthetic regimen in performing RF collagen denaturation.
DESIGN AND METHODS: This single-arm study enrolled 33 women, each diagnosed with SUI due to hypermobility, at three United States sites (private physician offices). All women were pretreated with an oral sedative (diazepam) and antibiotic (quinolone) and underwent a bilateral peri-urethral block using 10 cc total of 2% lidocaine. Non-surgical, transurethral RF collagen denaturation was then performed.
MAIN OUTCOME MEASURES: The feasibility of the in-office anesthetic regimen was determined based on the number of RF collagen denaturation treatments completed without conversion to intravenous conscious sedation. To assess the patients subjective level of pain, a visual analog scale (VAS) (0 = no pain; 10 = terrible pain) was completed by each patient immediately before discharge.
RESULTS: The in-office anesthetic regimen allowed for treatment completion in all patients (100% feasibility). On the VAS, 42% of the women rated their pain as 0; the mean pain score was 1.4 (SD 1.8). One woman (3% prevalence) experienced two clinically minor adverse events not conclusively related to the anesthetic regimen; both resolved spontaneously without treatment.
CONCLUSIONS: The results of this trial were similar to those of larger, sham-controlled studies using intravenous conscious sedation and showed non-surgical RF collagen denaturation to be feasible, safe, and effective when performed using in-office anesthesia.
Notes: 1473-4877 (Electronic)
Journal article
URL: Link

REMARKS: ANOTHER STUDY DONE IN AN OFFICE PRACTICE EMPHASIZING THE VALUE OF A REGIONAL ANESTHETIC TECHNIQUE IN MINIMIZING THE NEED FOR INTRAVENOUS SEDATION. (K. BELANI, MD).

Author: Ho, C.
Year: 2007
Title: An audit of the value of pre-operative electrocardiograms before surgery (general anaesthetic) in a day surgery unit
Journal: Scott Med J
Volume: 52
Issue: 2
Pages: 28-30
Date: May
Accession Number: 17536639
Keywords: Adult
*Ambulatory Surgical Procedures
*Anesthesia, General
*Electrocardiography
Female
Humans
Male
Middle Aged
Patient Selection
Preoperative Care/*methods
Prospective Studies
Risk Assessment/methods

Abstract:
BACKGROUND: As the population presenting for day-case surgery and anaesthesia increases, so does the challenge of adequate pre-operative assessment. The resting 12-lead electrocardiogram (ECG) is relatively insensitive and frequently normal even in the presence of severe coronary artery disease but it is quick, easy to perform and frequently requested, thus its value in day-case surgery remains unproven.
AIMS: To assess whether patients at Day Surgery Unit, Gartnavel General Hospital who fit the ECG criteria get an immediate ECG and also to review whether abnormal ECG results leads to any change in the patient's management.
METHODS: A prospective audit was performed on all patients coming in for noncardiac day-case surgery over a 3-week period between February 2006 and March 2006. Patient notes were reviewed before their surgery.
RESULTS: 60 patients presenting for day-case surgery over this period should have had an ECG done but only 24 were referred. A significant abnormality was noted in 12.5% of ECGs. None of these patients had their surgery postponed or management changed. No adverse events occurred in patients proceeding to surgery and there were no cases of peri-operative cardiovascular complications or admissions to hospital.
CONCLUSION: The finding of ECG abnormalities did not prevent the patient proceeding directly to anaesthesia and surgery. Furthermore, they did not predict intra-operative, postoperative complications or hospital admission following the procedure. The ECG is of limited value in the risk stratification of patients selected for day-case surgery.
Notes: 0036-9330 (Print)
Journal Article
URL: Link
Author Address: Faculty of Medicine, Wolfson Medical School Building, University Avenue, University of Glasgow, G12 8QQ. 0206524H@student.gla.ac.uk

REMARKS: AN INTERESTING STUDY THAT SUGGESTS THAT ONE SHOULD ORDER TESTS BASED UPON NEED. (K.BELANI, MD).

Reference Type: Journal Article
Record Number: 4
Author: Hu, P.; Harmon, D.; Frizelle, H.
Year: 2007
Title: Ultrasound guidance for ilioinguinal/iliohypogastric nerve block: a pilot study
Journal: Ir J Med Sci
Volume: 176
Issue: 2
Pages: 111-5
Date: Jul-Sep
Accession Number: 17570011

Abstract:
BACKGROUND: Ilioinguinal/iliohypogastric nerve block combined with general anaesthesia facilitates inguinal herniorrhaphy in an ambulatory setting by improving analgesia and reducing opioid requirements. Case reports in children indicate the possibility of colonic puncture and associated morbidity with blind ilioinguinal and iliohypogastric blockade.
AIMS: To investigate the feasibility of ultrasound guided ilioinguinal/iliohypogastric nerve block.
METHODS: Pilot study of four patients where ultrasound imaging was used to identify the ASIS, anterior abdominal muscle layers, the peritoneum and to guide local anaesthetic infiltration in patients undergoing inguinal hernia surgery and appendicectomy.
RESULTS: All patients had successful blocks, without complications. Mean visual analogue scores were 2/10 in the post anaesthesia care unit. Mean opioid consumption was 10 mg of intramuscular morphine in the first 24 h.
CONCLUSIONS: Ultrasound guidance for ilioinguinal and iliohypogastric nerve block in the inguinal region is both feasible and a promising technique.
Notes: 0021-1265 (Print)
Journal Article
URL: Link
Author Address: Department of Anaesthesia, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland, kooliohu@hotmail.com.
REMARKS: ONE WOULD HAVE THOUGHT THAT THE ULTRASOUND WOULD NOT BE OF BENEFIT FOR THE ILIO-INGUINAL AND ILIO-HYPOGASTRIC NERVE BLOCKS - HOWEVER, THE ULTRASOUND CAN BE HELPFUL TO BLOCK THESE SENSORY NERVES AS SHOWN BY THE ABOVE AUTHORS (K. BELANI, MD)

Author: Wax, D. B.; Beilin, Y.; Levin, M.; Chadha, N.; Krol, M.; Reich, D. L.
Year: 2007
Title: The effect of an interactive visual reminder in an anesthesia information management system on timeliness of prophylactic antibiotic administration
Journal: Anesth Analg
Volume: 104
Issue: 6
Pages: 1462-6, table of contents
Date: Jun
Accession Number: 17513642
Keywords: Anesthesia/*methods
Antibiotic Prophylaxis/*methods
Humans
*Management Information Systems
Photic Stimulation/*methods
*Reminder Systems
Surgical Wound Infection/prevention & control
Time Factors

Abstract:
BACKGROUND: To reduce the incidence of surgical site infection, preoperative antibiotics should be administered within 60 min before surgical incision. The purpose of this study was to determine whether adding a visual interactive electronic reminder with a message related to antibiotic administration to our anesthesia information management system would increase compliance with prophylactic antibiotic guidelines.
METHODS: We retrospectively studied electronic anesthesia records of ambulatory and day-of-surgery admission surgical cases in which one of our usual prophylactic antibiotics was administered from June 2004 through December 2005, an interval that includes cases both before and after the February 2005 implementation of the new reminder. Compliance was defined as documented antibiotic administration within 60 min before the surgical procedure starting time. Noncompliant cases were divided into those in which dosing was too early or too late.
RESULTS: Compliance for 4987 cases before and 9478 cases after the reminder was implemented increased from 82.4% to 89.1% (P < 0.01). This increase was found both for attending anesthesiologists assisted by a resident or nurse anesthetist (82.9% before vs 89.1% after, P < 0.01) and for attending anesthesiologists working alone (80.1% before vs 89.3% after, P < 0.01). The improvement in compliance was associated with a decrease in the incidence of antibiotics administered too late (i.e., after surgical incision) (15.2% before vs 8.1% after, P < 0.01), but with no significant change in the incidence of antibiotics administered too early (i.e., more than 60 min before skin incision) (2.4% before vs 2.8% after, P = 0.07).
CONCLUSIONS: The implementation of a visual interactive electronic reminder regarding administration of preoperative antibiotics in an anesthesia information management system was associated with a sustained increase in compliance with surgical prophylactic antibiotic administration timing guidelines.
Notes: 1526-7598 (Electronic)
Comparative Study
Journal Article
URL: Link
Author Address: Department of Anesthesiology, Mount Sinai School of Medicine, New York, NY 10029, USA. david.wax@mssm.edu

REMARKS: NICE DEMONSTRATION BY THE AUTHORS OF DIGITAL SYSTEMS THAT CAN HELP WITH INTRAOPERATIVE COMPLIANCE AND PATIENT SAFETY. (K. BELANI, MD

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