Analysis of the Clinical Variables Associated with Recrudescence after Malignant Hyperthermia Reactions.
Burkman, James M. M.D. ; Posner, Karen L. Ph.D. ; Domino, Karen B. M.D., M.P.H. 
Anesthesiology. 106(5):901-906, May 2007.

Clinical Investigations

Abstract:
Background: Some patients develop recrudescence after a malignant hyperthermia (MH) reaction, but it is not clear which patients are at risk. The authors analyzed clinical variables associated with recrudescence after a clinical MH episode.
Methods: Data were obtained from Adverse Metabolic Reaction to Anesthesia reports in the North American Malignant Hyperthermia Registry. Patients who underwent general anesthesia and with an MH clinical grading score of 20 or greater, indicating a likely MH reaction, were included in this analysis. Patient characteristics, anesthetic agents, MH reaction clinical details, and postoperative outcomes were compared in the recrudescence and no recrudescence groups using chi-square tests and Z tests for categorical variables and the Student t test for continuous variables. Associations of clinical variables with recrudescence were assessed with univariate and multivariate logistic regression.
Results: Of 308 patients, 63 (20%) had recrudescence. The mean time from initial reaction to recrudescence was 13 h (SD = 13 h). Patients with recrudescence were more likely to have a muscular body type (P < 0.01), malignant hyperthermia score of 35 or greater (P < 0.01), a temperature increase (P < 0.01), and more than 150 min from induction to adverse reaction (P < 0.05). Muscular body type, a temperature increase, and a longer time from induction to initial malignant hyperthermia reaction were associated with recrudescence on multivariate logistic regression analysis.
Conclusions: Recrudescence occurred in 20% of patients. Muscular body types had a higher rate of recrudescence, perhaps associated with increased muscle mass. The risk of recrudescence increased as time from induction to the initial MH reaction increased, perhaps as a result of greater muscle exposure to triggering agents.

Early Reversal of Profound Rocuronium-induced Neuromuscular Blockade by Sugammadex in a Randomized Multicenter Study: Efficacy, Safety, and Pharmacokinetics.
Sparr, Harald J. M.D. ; Vermeyen, Karel M. M.D. ; Beaufort, Anton M. M.D. ; Rietbergen, Henk M.Sc. ; Proost, Johannes H. Pharm.D. ; Saldien, Vera M.D. ; Velik-Salchner, Corinna M.D. ; Wierda, J Mark K. H. M.D. 
Anesthesiology. 106(5):935-943, May 2007.

Clinical Investigations

Abstract:
Background: Sugammadex reverses the neuromuscular blocking effects of rocuronium by chemical encapsulation. The efficacy, safety, and pharmacokinetics of sugammadex for reversal of profound rocuronium-induced neuromuscular blockade were evaluated.
Methods: Ninety-eight male adult patients were randomly assigned to receive sugammadex (1, 2, 4, 6, or 8 mg/kg) or placebo at 3, 5, or 15 min after 0.6 mg/kg rocuronium. Patients were anesthetized with propofol and fentanyl. The primary endpoint of the study was the time to achieve a recovery of train-of-four ratio to 0.9. Neuromuscular blockade was measured using acceleromyography. Concentrations of rocuronium and sugammadex were determined in venous blood and urine samples. A population pharmacokinetic model using NONMEM (GloboMax LLC, Hanover, MD) was applied.
Results: The mean time to recovery of the train-of-four ratio to 0.9 after dosing at 3, 5, and 15 min decreased from 52.1, 51.7, and 35.6 min, respectively, after administration of placebo to 1.8, 1.5, and 1.4 min, respectively, after 8 mg/kg sugammadex. Sugammadex was safe and well tolerated. However, 20.4% of patients showed signs of inadequate anesthesia after its administration. The median cumulative excretion of rocuronium in the urine over 24 h was 26% in the placebo group and increased to 58-74% after 4-8 mg/kg sugammadex. The mean plasma clearances of sugammadex and rocuronium were 0.084 and 0.26 l/min, respectively.
Conclusions: In male subjects, sugammadex safely reversed profound neuromuscular blockade induced by 0.6 mg/kg rocuronium in a dose-dependent manner. Sugammadex enhanced the renal excretion of rocuronium, and its clearance is approximately one third that of rocuronium.

Scopolamine Prevents Dreams during General Anesthesia.
Toscano, Adelchi M.D. ; Pancaro, Carlo M.D. ; Peduto, Vito Aldo M.D. 
Anesthesiology. 106(5):952-955, May 2007.

Clinical Investigations

Abstract:
Background: Dreaming during anesthesia is not a well-understood phenomenon. Anticholinergic drugs are used in anesthesia as premedication, but their use to decrease the incidence of dreams and psychological adverse reactions after anesthesia is not well established. The authors therefore studied the efficacy of intramuscular atropine and scopolamine for the prevention of dreams during general anesthesia with propofol and nitrous oxide.
Methods: Healthy women undergoing minor gynecologic surgery were randomly assigned to receive 2.5 [mu]g/kg scopolamine or 10 [mu]g/kg atropine intramuscularly (n = 50/group). In both groups, anesthesia was induced and maintained with propofol as a 2.5-mg/kg bolus, followed by 12 mg [middle dot] kg-1 [middle dot] h-1 as a continuous infusion and 70% nitrous oxide in oxygen. Two interviews regarding dreaming activity and characteristics were conducted at 20 min and 6 h after surgery.
Results: None of the patients in the scopolamine group and 47% of the patients in the atropine group reported the occurrence of dreams 20 min after recovery. The results were similar at 6 h: 6% of the scopolamine group and 43% of the atropine group reported dream activity. No differences in sedation or anesthetic requirements were found.
Conclusions: Previous studies in animals and humans suggest that dreams are affected by drugs acting on the central cholinergic system. The current results suggest that intramuscular scopolamine prevents dreams or dream recall in healthy young women undergoing short elective surgery with propofol-nitrous oxide anesthesia.

A Prospective, Randomized Comparison between Ultrasound and Nerve Stimulation Guidance for Multiple Injection Axillary Brachial Plexus Block.
Casati, Andrea M.D. ; Danelli, Giorgio M.D. ; Baciarello, Marco M.D. ; Corradi, Maurizio M.D. ; Leone, Stefania M.D. ; Di Cianni, Simone M.D. ; Fanelli, Guido M.D. 
Anesthesiology. 106(5):992-996, May 2007.

Pain and Regional Anesthesia

Abstract:
Background: This prospective, randomized, blinded study tested the hypothesis that ultrasound guidance can shorten the onset time of axillary brachial plexus block as compared with nerve stimulation guidance when using a multiple injection technique.
Methods: Sixty American Society of Anesthesiology physical status I-III patients receiving axillary brachial plexus block with 20 ml ropivacaine, 0.75%, using a multiple injection technique, were randomly allocated to receive either nerve stimulation (group NS, n = 30), or ultrasound guidance (group US, n = 30) for nerve location. A blinded observer recorded the onset of sensory and motor blocks, the need for general anesthesia (failed block) or greater than 100 [mu]g fentanyl (insufficient block) to complete surgery, procedure-related pain, success rate, and patient satisfaction.
Results: The median (range) number of needle passes was 4 (3-8) in group US and 8 (5-13) in group NS (P = 0.002). The onset of sensory block was shorter in group US (14 +/- 6 min) than in group NS (18 +/- 6 min) (P = 0.01), whereas no differences were observed in onset of motor block (24 +/- 8 min in group US and 25 +/- 8 min in group NS; P = 0.33) and readiness to surgery (26 +/- 8 min in group US and 28 +/- 9 min in group NS; P = 0.48). No failed block was reported in either group. Insufficient block was observed in 1 patient (3%) of group US and 2 patients (6%) of group NS (P = 0.61). Procedure-related pain was reported in 6 patients (20%) of group US and 14 patients (48%) of group NS (P = 0.028); patient acceptance was similarly good in the two groups.
Conclusion: Multiple injection axillary block with ultrasound guidance provided similar success rates and comparable incidence of complication as compared with nerve stimulation guidance.

A Review of Neuraxial Epidural Morbidity: Experience of More Than 8,000 Cases at a Single Teaching Hospital.
Cameron, Christie M. M.B., B.S., F.A.N.Z.C.A. ; Scott, David A. M.B., B.S., Ph.D., F.A.N.Z.C.A., F.F.P.M.A.N.Z.C.A. ; McDonald, Wendy M. B.N. ; Davies, Michael J. M.B., B.S., M.D., F.A.N.Z.C.A. 
Anesthesiology. 106(5):997-1002, May 2007.

Pain and Regional Anesthesia

Abstract:
Background: The true incidence of serious neuraxial complications such as epidural hematoma or abscess after postoperative epidural infusions is still uncertain, in part due to inconsistencies in multicenter data collection.
Methods: Prospective data were collected over 16 yr from the authors' Acute Pain Service, which is based in a large tertiary teaching institution with a nonobstetric general surgical population.
Results: Over this period, 8,210 epidural catheters were inserted for postoperative analgesia and 32 computed tomography or magnetic resonance imaging scans were undertaken to exclude potential neuraxial complications. From these, two spinal hematomas (1:4,105) and six epidural abscesses (1:1,368) were diagnosed. Only one patient required surgical decompression. There were no long-term neurologic sequelae in any patient. In the past 6 yr, the frequency of investigation and diagnosis of epidural abscess has increased. Overall, the combined rate of epidural abscess or hematoma was 1:1,026, (0.1%; 95% confidence interval, 0.04-0.19%) with a need for operative intervention of 1:8,210 (0.01%; 95% confidence interval, 0.0-0.07%).
Conclusions: Spinal hematoma was very rare (< 0.05%). Epidural abscess was also rare (< 0.1%) but remains a potentially serious complication. Early diagnosis, using magnetic resonance imaging in patients with appropriate clinical indicators, before the onset of neurologic signs, enables conservative therapy in many cases and may help to prevent the development of serious neurologic sequelae.

ACTA ANAESTHESIOLOGICA SCANDINAVICA - TOP

Superior anti-emetic efficacy of granisetron-dexamethasone combination in children undergoing middle ear surgery
S. Gombar, J. Kaur, K. Kumar Gombar, A. Dass, A. Singh
Acta Anaesthesiologica Scandinavica 2007; 51 (5), 621–624

Aim: To compare the effectiveness of granisetron and a granisetron–dexamethasone combination for the prevention of post-operative vomiting in children undergoing middle ear surgery.
Methods: Ninety ASA physical status I or II children, aged 3–12 years, were randomly assigned to three groups of 30 each to receive a single dose of placebo (normal saline), granisetron 40 μg/kg or a combination of granisetron 40 μg/kg and dexamethasone 150 μg/kg intravenously after the induction of anaesthesia. Peri-operative anaesthetic care was standardized in all children. Post-operatively, during the first 24 h after anaesthesia, the frequencies of retching and vomiting and the incidence of adverse events were recorded. Rescue anti-emetic was administered if two or more episodes of emesis occurred. Post-operative pain was treated with morphine intravenously, followed by acetaminophen orally.
Results: There were no differences between the treatment groups with regard to demographic data. A complete response (no retching/vomiting and no need for rescue anti-emetic) was achieved in 50%, 80% and 96.67% of children who received saline, granisetron and granisetron–dexamethasone, respectively (P < 0.05). Six children who received placebo and one who received granisetron alone required another rescue anti-emetic. The incidence of adverse events was comparable in the three groups.
Conclusion: The prophylactic granisetron–dexamethasone combination was more effective than granisetron alone in the prevention of post-operative emesis during the first 24 h after anaesthesia in children undergoing middle ear surgery.

BRITISH JOURNAL OF ANAESTHESIA - TOP

Oral clonidine vs midazolam in the prevention of sevoflurane-induced agitation in children. A prospective, randomized, controlled trial
N. Tazeroualti, F. De Groote, S. De Hert, A. De Villé, A. Dierick and P. Van der Linden
British Journal of Anaesthesia 2007 98(5):667-671

Background: This randomized, double-blind study tested the hypothesis that, in comparison with midazolam, premedication with oral clonidine reduces the incidence of emergence agitation in preschool children anaesthetized with sevoflurane.
Methods: Sixty-eight ASA I–II children undergoing circumcision were randomized into three groups to receive different oral premedication given 30 min before anaesthesia: midazolam 0.5 mg kg^-1, clonidine 2 µg kg^-1, and clonidine 4 µg kg^-1. Sevoflurane anaesthesia was administered via a facemask (O2/N2O: 40/60). Analgesia was with penile block (bupivacaine 0.5% 0.3 ml kg^-1) and rectal paracetamol (30 mg kg^-1). During the first postoperative hour, children were evaluated using a modified ‘objective pain scale’.
Results: Only the 4 µg kg^-1 dose of clonidine was associated with a significant reduction in emergence agitation. Fewer children in the clonidine 4 µg kg^-1 group displayed agitation (25%) than in the midazolam group (60%) (P = 0.025). Incidence of hypotension and bradycardia, time to first micturition and first drink did not differ among groups.
Conclusions: In comparison with midazolam, clonidine 4 µg kg^-1 reduced sevoflurane-induced emergence agitation without increasing postoperative side-effects.

Multiple simultaneous perineural infusions for postoperative analgesia in adolescents in an outpatient setting
A. Ganesh and G. Cucchiaro
British Journal of Anaesthesia 2007 98(5):687-689

We report a case series of five adolescents who were managed with dual simultaneous perineural infusions after orthopaedic surgery on an outpatient basis. Adolescents undergoing orthopaedic procedures involving more than one extremity or nerve distribution can be managed after operation with multiple catheters. Use of low concentrations of local anaesthetic infusions along with good patient and family education and close follow-up by a dedicated paediatric pain management team can make this feasible in an outpatient setting.

CANADIAN JOURNAL OF ANESTHESIA - TOP

Case series: The McGrath® videolaryngoscope - an initial clinical evaluation
Ben Shippey, BMBS MRCP FRCA, David Ray, MD FRCA and Dermot McKeown, MBChB FRCA
Canadian Journal of Anesthesia 54:307-313 (2007)
 
Purpose: To document tracheal intubation success rates and airway instrumentation times using the newly designed McGrath® videolaryngoscope.
Methods: We prospectively recorded factors associated with difficult tracheal intubation, factors causing actual difficulty in tracheal intubation, as well as complications arising from use of the new McGrath® videolaryngoscope in a series of adult patients with normal preoperative airway examinations. All patients were undergoing scheduled or elective surgery. In the first 75 patients (phase I), experience with airway instrumentation was documented, while in the second 75 patients (phase II), the time required to obtain an optimal view of the larynx was recorded, as well as the time to complete tracheal intubation.
Results: Ninety-eight percent of all tracheal intubations were successful using the McGrath® videolaryngoscope. Cormack and Lehane grade I views were obtained in 143 patients (95%) and grade II views were achieved in six (4%). In phase II, the median time required to obtain an adequate view was 6.3 sec [interquartile range 4.7–8.7 (range 2–26.3)], and to complete tracheal intubation was 24.7 sec [18.5–34.4 (11.4–286)]. Forty-nine (65%) of the tracheal intubations were completed within 30 sec, and 72 (96%) were completed within one minute. No complications were encountered in any patient.
Conclusions: The McGrath® videolaryngoscope is an effective aid to airway management in patients with normal airways, based upon intubation success rates and the ability to rapidly secure the airway. Its potential advantages of convenience and portability warrant further evaluation in comparison with other airway devices and in patients with difficult airways.

PUB MED - TOP

Reference Type: Journal Article
Record Number: 44
Author: Ahonen, J.; Jokela, R.; Uutela, K.; Huiku, M.
Year: 2007
Title: Surgical stress index reflects surgical stress in gynaecological laparoscopic day-case surgery
Journal: Br J Anaesth
Volume: 98
Issue: 4
Pages: 456-61
Date: Apr
Accession Number: 17350969
Abstract: BACKGROUND: Monitoring of analgesia remains a challenge during general anaesthesia. The surgical stress index (SSI) is derived from the photoplethysmographic waveform amplitude and the heart beat-to-beat interval. We evaluated the ability of SSI to measure surgical stress in patients undergoing gynaecological laparoscopy. Our hypothesis was that while keeping State Entropy (SE) at a predetermined level, SSI would be higher in patients receiving a beta-blocking agent (esmolol) than in those receiving an opioid (remifentanil) during laparoscopy. METHODS: Thirty women undergoing gynaecological laparoscopy were assigned randomly to receive esmolol (n = 15) or remifentanil (n = 15). Anaesthesia was induced with propofol and fentanyl and maintained with desflurane and nitrous oxide 50% in oxygen to keep SE at 50(5). The infusion of esmolol or remifentanil was started before laparoscopy and adjusted to keep the systolic blood pressure at -20 to +10% from the preoperative value. RESULTS: During the fentanyl phase, before surgery, both groups behaved similarly, with an increase in SSI after intubation. In the patients receiving esmolol, the SSI reacted to the initial incision (P < 0.05), and remained high after trocar insertion (P < 0.05). In patients receiving remifentanil, it did not react to the initial incision, but increased after trocar insertion (P < 0.05), and it remained lower both after incision (P < 0.05) and after trocar insertion (P < 0.05). CONCLUSION: SSI was higher in patients receiving esmolol. The index seems to reflect the level of surgical stress and may help guide the use of opioids during general anaesthesia.
Notes: 0007-0912 (Print)
Journal Article
Randomized Controlled Trial
URL: Link
Author Address: Department of Anaesthesia and Intensive Care Medicine, Helsinki University Hospital, Helsinki, Finland. jouni.ahonen@fimnet.fi

Reference Type: Journal Article
Record Number: 15
Author: Marsh, F.; Thewlis, J.; Duffy, S.
Year: 2007
Title: Randomized controlled trial comparing Thermachoice III* in the outpatient versus daycase setting
Journal: Fertil Steril
Volume: 87
Issue: 3
Pages: 642-50
Date: Mar
Accession Number: 17109859
Abstract: OBJECTIVE: To evaluate outpatient versus daycase Thermachoice III endometrial ablation. DESIGN: Randomized, controlled trial. SETTING: Large United Kingdom teaching hospital. PATIENT(S): Seventy-three women with menorrhagia. INTERVENTION(S): In the outpatient cohort (n = 39), women took ibuprofen 800 mg the evening before, and 1 hour before, performing Thermachoice III. Intraoperatively, they were offered "rescue analgesia" in the form of inhaled nitrous oxide. Postoperatively, women were offered oral tramadol 50-100mg. Neither local anesthetic nor IV sedation was used. In the daycase cohort (n = 34), women underwent a general anesthetic, i.e., propofol and inhalation gases. Intraoperatively, intravenous fentanyl 100 microg and rectal diclofenac 100 mg were administered. MAIN OUTCOME MEASURE(S): Main outcome measures included overall discomfort following Thermachoice III; intraoperative pain scores and a need for rescue analgesia during outpatient Thermachoice III; nausea and vomiting rates; and total time in hospital and the need for an overnight stay. RESULT(S): Eighty-seven percent (n = 34) of women in the outpatient cohort completed the full 8-minute treatment. The remaining five women requested the procedure be stopped because of pain. The mean intraoperative pain scores for the outpatient cohort remained below 45 mm (range, 0-100 mm) for every stage of treatment. The majority (64%) of women from the outpatient cohort required no rescue analgesia whatsoever. There was no significant difference between the overall mean pain score following Thermachoice III for either the outpatient (59 mm; range, 0-100 mm) or daycase (53 mm; range, 0-100 mm) cohorts. However, women from both cohorts reported wide ranges of pain scores (0-100 mm). There was no significant difference between the Likert -style descriptions of overall discomfort between the two groups, with the majority of women rating the pain as none to moderate. The presence of severe dysmenorrhea was statistically significantly correlated with higher overall visual analogue-style pain scores and Likert-style descriptions of discomfort. Significantly fewer women in the outpatient group experienced nausea (13% versus 65% in the daycase group) or vomiting (0 versus 24% in the daycase group), or required postoperative antiemetics (0 versus 56% in the daycase group). The mean total time spent in hospital was significantly shorter for the outpatient cohort at 1 hour and 40 minutes, versus 8 hours 12 minutes for the daycase group. CONCLUSION(S): Outpatient Thermachoice III could be performed in the majority (87%) of women, and was associated with similar overall pain scores as daycase Thermachoice III, however, the range was wide. Outpatient Thermachoice III was associated with significantly less nausea, vomiting, need for antiemetics, and time spent in hospital than was the daycase procedure.
Notes: 1556-5653 (Electronic)
Journal Article
Randomized Controlled Trial
URL: Link
Author Address: Academic Department of Obstetrics and Gynaecology, St. James's University Hospital, Leeds, Yorkshire, United Kingdom. medfm@leeds.ac.uk

Reference Type: Journal Article
Record Number: 35
Author: Cooter, R. D.; Rudkin, G. E.; Gardiner, S. E.
Year: 2007
Title: Day Case Breast Augmentation Under Paravertebral Blockade: A Prospective Study of 100 Consecutive Patients
Journal: Aesthetic Plast Surg
Date: May 5
Accession Number: 17486400
Abstract: BACKGROUND: An increasing trend toward day surgery management requires plastic surgeons not only to be cognizant of block techniques, but also to assess their safety and efficacy objectively. Paravertebral block offers benefits by enhancing surgical anesthesia and postoperative analgesia. This study aimed to assess the safety and efficacy of paravertebral block for day patients undergoing submuscular breast augmentation. The primary outcome measure was the rate of block failure. The secondary outcome measures included recovery room stay, pain management, and block complications. On the basis of a literature review and audit results, the study objective also aimed to propose safe guidelines for ambulatory paravertebral block patients undergoing breast surgery. METHODS: A total of 100 patients undergoing 172 single-level paravertebral blocks (72 bilateral blocks) and sedation for submuscular breast augmentation were studied prospectively. A single-injection paravertebral block was performed at the T4 level using a loss of resistance technique. Surgical, anesthetic, and recovery room details were recorded. Analyses were performed to determine the association between recovery room times, body mass index, pain scores, and requirements for opioids, antiemetics, and vasopressors. RESULTS: The findings showed that 87% of the blocks were successful for surgical anesthesia and 94% of the blocks were successful for postoperative analgesia. The pain score for 74% of the subjects was 3 or less. Antiemetics were given for 10% of the patients with significantly longer recovery room times. Vasopressors were required for 6% of the patients. A surgically caused pneumothorax resulted in the only unplanned admission. CONCLUSION: The study findings suggest that paravertebral block is a safe and effective technique for day case submuscular breast augmentation.
Notes: 0364-216X (Print)
Journal article
URL: Link
Author Address: Waverley House Plastic Surgery Centre, Level 1, Waverley House, 360 South Terrace, Adelaide, SA, 5000, Australia, rdcooter@plasticsurgeryadelaide.com.

Reference Type: Journal Article
Record Number: 47
Author: Goulson, D. T.
Year: 2007
Title: Anesthesia for outpatient gynecologic surgery
Journal: Curr Opin Anaesthesiol
Volume: 20
Issue: 3
Pages: 195-200
Date: Jun
Accession Number: 17479020
Abstract: PURPOSE OF REVIEW: Anesthesia care for patients undergoing ambulatory gynecologic surgery has improved incrementally over the past few years. Emphasis has evolved beyond the safe provision of care, because this has largely been achieved. Comfort, speed, and efficiency have taken on new importance. RECENT FINDINGS: Many changes relate to improvements in non-narcotic analgesic techniques and use of various supralaryngeal airways, such as the ProSeal LMA. Also, use of depth of anesthesia monitors and administration of potent short-acting beta-blockers and narcotics to control hemodynamic variables are examples of new anesthesia developments well applied to ambulatory gynecologic cases. Finally, anesthesia care is changing in some instances because surgical techniques are advancing, such as hysteroscopy, and can now be done in an office with little or no anesthesia. SUMMARY: Local anesthetic use in gynecologic laparoscopy appears to improve postoperative pain control modestly, especially when given into the peritoneal cavity. Supralaryngeal airways, such as ProSeal LMA, appear to provide effective ventilation in laparoscopy, although their ability to protect against aspiration is unclear. The speed and comfort of emergence, recovery, and discharge may be improved by consciousness monitoring during general anesthesia and by drugs intended to modulate hemodynamics.
Notes: 0952-7907 (Print)
Journal Article
URL: Link
Author Address: Department of Anesthesiology, University of Kentucky, Lexington, Kentucky, USA.

Reference Type: Journal Article
Record Number: 48
Author: Zeitels, S. M.; Burns, J. A.
Year: 2007
Title: Office-based laryngeal laser surgery with local anesthesia
Journal: Curr Opin Otolaryngol Head Neck Surg
Volume: 15
Issue: 3
Pages: 141-7
Date: Jun
Accession Number: 17483680
Abstract: PURPOSE OF REVIEW: Office-based laryngeal laser surgery was created recently and is emerging as a reliable and practical method of treating a number of laryngeal lesions. This style of minimally invasive surgery is becoming increasingly popular in the United States and abroad. RECENT FINDINGS: Fiber-based lasers and distal-chip flexible endoscopy have facilitated a new style of surgery. Epithelial diseases such as dysplasia and papillomatosis are well suited for treatment. Although the initial angiolytic laser used was a 585-nm pulsed-dye laser, the 532-nm pulsed-potassium-titanyl-phosphate laser has been demonstrated to be more effective. The 2013-nm Thulium laser shows promise as an office-based laser that simulates the properties of the carbon dioxide laser. SUMMARY: Evolving technologies to enhance laryngoscopic imaging and lasers along with socioeconomic forces should lead to increasing numbers of laryngeal procedures being performed in the office with local anesthesia.
Notes: 1068-9508 (Print)
Journal Article
URL: Link
Author Address: Department of Surgery, Harvard Medical School, Center for Laryngeal Surgery and Voice Rehabilitation, Massachusetts General Hospital, Boston, Massachusetts, USA.

Reference Type: Journal Article
Record Number: 49
Author: Pang, K. P.; Terris, D. J.
Year: 2007
Title: Modified cautery-assisted palatal stiffening operation: New method for treating snoring and mild obstructive sleep apnea
Journal: Otolaryngol Head Neck Surg
Volume: 136
Issue: 5
Pages: 823-6
Date: May
Accession Number: 17478223
Abstract: OBJECTIVE: To assess a new method (modified cautery-assisted palatal stiffening operation [CAPSO]) to treat snoring and mild obstructive sleep apnea (OSA). DESIGN: A prospective, nonrandomized trial. METHODS: Thirteen patients with simple snoring and mild OSA underwent the modified CAPSO under local anaesthesia. All patients had preoperative polysomnography and at 3 months postoperatively. RESULTS: All patients were Friedman stage II and III, with tonsil size 0, 1, or 2. All patients had improvement in their snoring. Eighty-four percent of the patients had improvement in the Epworth Sleepiness Scale, from 12.2 to 8.9. Objective success on the polysomnogram was noted in six out of the eight patients (75%) with mild OSA. The AHI improved from 12.3% to 5.2% (P < 0.05), and the LSAT improved from 88.3% to 92.5% (P < 0.05). CONCLUSION: The modified CAPSO is a simple, low-cost, and effective office-based method to treat snoring and mild obstructive sleep apnea.
Notes: 0194-5998 (Print)
Journal Article
URL: Link
Author Address: Department of Otolaryngology-Head and Neck Surgery, Medical College of Georgia, Augusta, Georgia; Department of Otorhinolaryngology, Pacific Sleep Centre, Tan Tock Seng, Singapore.

Reference Type: Journal Article
Record Number: 50
Author: Lalwani, K.; Kitchin, J.; Lax, P.
Year: 2007
Title: Office-based dental rehabilitation in children with special healthcare needs using a pediatric sedation service model
Journal: J Oral Maxillofac Surg
Volume: 65
Issue: 3
Pages: 427-33
Date: Mar
Accession Number: 17307588
Abstract: PURPOSE: 1) To review our experience with office-based sedation/anesthesia for children with special healthcare needs who underwent dental rehabilitation at our institution. 2) To compare the cost to comparable patients who underwent similar procedures in the operating room. PATIENTS AND METHODS: Retrospective review of patients' medical records and the sedation service database. Group CL: 114 patients who underwent office-based dental rehabilitation (135 procedures). Group OR: 23 patients who underwent dental rehabilitation under general anesthesia in the operating room for cost comparison. Outcomes: 1) Efficacy (procedure completion rate and unplanned admissions); 2) Safety (complications and interventions); 3) Comparison of mean hospital charges billed between groups. RESULTS: Demographics were similar in both groups. The most common specific underlying diagnoses were autism (38%), cerebral palsy/developmental delay (18%) and ADHD (4%) in both groups. Efficacy: procedure completion rate was 98.5% (2 aborted). There was 1 (0.7%) unplanned postanesthetic care unit admission due to an adverse drug event. Safety: 2 (1.5%) patients required invasive airway control. Eighteen (13.3%) patients developed transient hypoxemia. Twenty-three (17%) patients had airway obstruction needing simple intervention, and 1 (0.7%) patient had hypotension. There were no serious complications. Cost: mean total hospital charges were considerably higher in group OR ($6,126), versus group CL ($1,277), even after adjustment for inflation and length of procedure (P<.0001). CONCLUSION: Office-based dental rehabilitation using a pediatric sedation service model in children with special needs is efficient, and can achieve average savings of $4,849 in hospital charges per patient.
Notes: 0278-2391 (Print)
Comparative Study
Evaluation Studies
Journal Article
URL: Link
Author Address: Department of Anesthesiology and Perioperative Medicine, Oregon Health and Science University, Portland, OR 97239, USA. lalwanik@ohsu.edu

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