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Objective: To identify risk factors for complications in patients undergoing gastrointestinal endoscopy under acupuncture anesthesia and to construct a nomogram predictive model. Methods: This retrospective study included 292 patients who underwent gastrointestinal endoscopy under acupuncture anesthesia at the Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine from June 2020 to May 2023. Logistic regression analysis was used to identify risk factors for complications in patients undergoing gastrointestinal endoscopy under acupuncture anesthesia. A nomogram prediction model was constructed using the RMS package of R4.1.2 software based on the independent risk factors identified. The predictive performance of the model was assessed using consistency index (C-index), calibration curve, and receiver operating characteristic (ROC) curve. Results: Seventy-five patients (25.68%) had complications. Body mass index (BMI), history of cardiovascular diseases, fasting time, history of respiratory diseases, and Sedation-Agitation Scale (SAS) score were identified as risk factors for complications. Based on this risk, a nomogram predictive model was constructed. The C-index of the nomogram model was 0.927. Calibration curve showed a good consistency between actual observations and nomogram predictions. The ROC curve area under curve (AUC) was 0.927 (95% CI: 0.895-0.959), indicating a certain predictive value for the occurrence of complications. When the optimal cut-off value was selected, the sensitivity and specificity of the model were 77.0% and 92.0%, respectively, indicating that the predictive model was effective. Conclusions: BMI, history of cardiovascular disease, fasting time, history of respiratory disease, and SAS score are independent risk factors for complications in patients undergoing gastrointestinal endoscopy under acupuncture anesthesia. The constructed nomogram predictive model has a good performance in predicting the occurrence of complications in patients undergoing gastrointestinal endoscopy with under acupuncture anesthesia. [ABSTRACT FROM AUTHOR]

AbstractObjectiveMethodsResultsConclusionTo investigate the effects of combined acupuncture anesthesia and ropivacaine on postoperative analgesia and neuro-related factors in patients undergoing chest surgery.The analgesic drug dosage, postoperative PCIA pressing times, VAS scores at rest and during activity at 6 h (T1), 12 h (T2), 18 h (T3), and 24 h (T4) postoperatively.The analgesic drug dosage and postoperative PCIA pressing times were lower in the observation group than in the control group (p < 0.05). The VAS scores at T1–T4 postoperatively were lower in the observation group than in the control group (p < 0.05). The SAS scores at T1–T4 postoperatively were lower in the observation group than in the control group (p < 0.05). The levels of IL-6 and IL-10 on postoperative day 1 were higher than those on preoperative day 1 in both groups, with a smaller change in the observation group (p < 0.05). The levels of S100β protein on postoperative day 1 were higher than those on preoperative day 1 in both groups, while the BDNF levels were lower, with a smaller change in the observation group (p < 0.05). There was no significant difference in the incidence of adverse reactions between the control group (11.36%) and the observation group (15.56%) (p > 0.05).Combined acupuncture anesthesia and ropivacaine can effectively improve postoperative analgesia and agitation in patients undergoing chest surgery, reduce the dosage of analgesic drugs, regulate the levels of inflammatory factors and neurotrophic factors in patients, and do not increase the risk of adverse reactions related to patients. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the effects of acupuncture anesthesia on the consumption of sedatives and anesthetics, pain, and time consumption in patients undergoing colonoscopy, thus providing evidence that acupuncture anesthesia should be extended to endoscopists and anesthetists., Methods: Four English and four Chinese databases were searched for randomised controlled trials of acupuncture anaesthesia in patients undergoing colonoscopy, published from database inception to 1 March 2023. Outcomes were consumption of sedatives and anaesthetics, pain tolerance, visual analog scale (VAS) score, the meantime consumption of examination, satisfaction, and adverse reactions., Results: Thirty-one randomized controlled trials with a total of 4790 participants were included. Results showed that acupuncture anaesthesia significantly reduced consumption of sedatives and anaesthetics [9 studies, n = 944, standardized mean difference ( SMD ) = －0.82, 95% CI (－1.31, －0.33), P = 0.001], VAS score [9 studies, n = 1790, mean difference ( MD ) = －1.13, 95% CI (－1.70, －0.57), P < 0.001], meantime consumption [21 studies, n = 3799, MD = －2.09, 95% CI (－3.15, －1.03) , P <0.001] and adverse reactions of colonoscopy [7 studies, n = 738, odds ratio ( OR ) = 0.17, 95% CI (0.10, 0.28), P <0.001]. Acupuncture also significantly improved pain tolerance [14 studies, n = 1661, OR = 7.05, 95% CI (3.79, 13.12), P <0.001], while no beneficial effects were found for satisfaction [7 studies, n = 843, SMD = 0.02, 95% CI (－0.38, 0.43), P = 0.91]., Conclusion: Acupuncture has beneficial effects on patients undergoing colonoscopy, particularly in reducing consumption of sedatives and anaesthetics, alleviating pain, shortening the time consumption of examination and preventing adverse events. As an alternative, effective, inexpensive, and accessible approach, acupuncture anaesthesia should be extended to endoscopists and anaesthesiologists.

Copyright of Journal of Acupuncture & Tuina Science is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction: The objective of this retrospective study was to evaluate the effectiveness and safety of acupuncture-assisted anesthesia (AAA) in breast lump excision. Methods: The medical records of all patients who underwent breast lump excision under AAA in combination with electrical stimulation at traditional acupuncture points in 2016 were examined. All of them (n = 17) received electrostimulation (2–4 Hz) using single needles inserted at bilateral LI4 and PC6. They also underwent insertion of four acupuncture needles at the lump site, which were electrically stimulated at 30 Hz frequency. Results: All surgical procedures were successful with minimal use of analgesics and local anesthetic. The median pain score reported was 1/10 (interquartile range (IQR) = 2/10) at the first hour, and slightly increased to 2/10 (IQR = 2/10) between 24 and 48 h of the surgery. No major postoperative adverse events were documented, except for drowsiness in one case. Conclusion: AAA was found to be generally safe and effective for anaesthesia and analgesia in breast lump excision. However, a large-scale randomized controlled study is required to verify the findings. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the effectiveness and safety of acupuncture combined drug anesthesia and simple drug anesthesia in anorectal surgery. Methods: The randomized controlled trials of acupuncture combined with drug anesthesia was evaluated using Cochrane systematic review method. The search scope was China National Knowledge Internet, wanfang database, China Biomedical Literature, Pubmed and Embase. The deadline was December 31, 2018. The randomized controlled trials of acupuncture combined with anesthesia that met the inclusion criteria were selected. In terms of trial quality evaluation, Cochrane risk bias was used for evaluation. Finally, RevMan 5.2 software was used for statistical analysis. Results: This study finally included 15 articles, a total of 1321 patients. The heterogeneity of significant rate was good, and the combined effect amount OR was 3.55 (95% CI [2.06,6.12]). The combined effect quantitative test (Z = 4.57, P <0.00001) showed that there was a statistical significance, indicating that acupuncture combined drug anesthesia was better than simple anesthesia in anorectal surgery. The heterogeneity of adverse reactions was good, and the combined effect test (Z = 8.88, P <0.00001) showed that there was a statistical significance, indicating that the adverse reaction rate of acupuncture combined with drug anesthesia was lower than that of simple drug anesthesia in the anorectal surgery. Conclusion: Compared with simple drug anesthesia, acupuncture combined with drug anesthesia can improve the anesthesia effect and reduce the occurrence of adverse reactions in anorectal surgery. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Acupuncture & Tuina Science is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The purpose of this review is to describe the most commonly used anaesthetics in endodontology, their efficacy and methods of administration both in the maxilla and the mandible. The reasons why local anaesthesia cannot be achieved in all cases as well as the latest advances in anaesthetic techniques are also discussed. [ABSTRACT FROM AUTHOR]

Background: Chronic shoulder pain (CSP) is a common disease causing pain and functional limitation, which is highly prevalent and has substantial negative effects on the quality of life. Acupuncture has gained popularity and has been accepted gradually by many countries because it can successfully treat patients with chronic pain, but the specific brain mechanisms under acupuncture treatment for CSP remain unclear. Therefore, in this study, we aimed to 1) compare the clinical effects between acupuncture at the contralateral and ipsilateral Tiaokou (ST 38) point in patients with unilateral shoulder pain and 2) explore how contralateral- and ipsilateralacupuncture modulates the regional homogeneity (ReHo) of patients with CSP. Patients and methods: This was a pilot functional magnetic resonance imaging (fMRI) trial. Twenty-four patients with CSP were recruited and randomized to the contralateral acupuncture group (contra-group) and the ipsilateral acupuncture group (ipsi-group). All patients completed resting-state functional magnetic resonance imaging (fMRI) scans before and after acupuncture treatment. Shoulder pain intensity (visual analog scale [VAS]) and shoulder joint function (Constant-Murley score [CMS]) were used to evaluate clinical efficiency of treatment. ReHo was used to assess resting-state brain activity. Results: We found clinical improvement in decreasing pain intensity and increasing shoulder function in both groups, and the mean objective shoulder functional improvement in contragroup was better than that in ipsi-group (p = 0.010). Interestingly, the brain mechanism of contra-acupuncture at ST 38 was distinguishable from ipsi-acupuncture regarding ReHo values. Conclusion: Anterior cingulate cortex (ACC) may play a direct role in the regulation of brain by the contralateral acupuncture at ST 38 in patients with shoulder pain. On the contrary, the pathway of brainstem-thalamus-cortex may be likely to work in mechanism of acupuncture at ipsilateral ST 38. Significance: Our results indicate that the clinical effects and brain mechanisms are different between the stimulation given at contralateral and ipsilateral acupoints in patients with CSP and imply that the selection of either contralateral or ipsilateral acupuncture therapy to treat some chronic pain conditions is necessary. [ABSTRACT FROM AUTHOR]

Background: Acupuncture therapy plays a pivotal role in pain relief, and increasing evidence demonstrates that mast cells (MCs) may mediate acupuncture analgesia. The present study aims to investigate the role of MCs in acupuncture analgesia using c-kit gene mutant-induced MC-deficient rats. Materials and methods: WsRC-Ws/Ws rats and their wild-type (WT) littermates (WsRC-+/+) were used. The number of MCs in skin of ST36 area was compared in two rats after immunofluorescence labeling. Mechanical withdrawal latency (MWL), mechanical withdrawal threshold (MWT), and thermal withdrawal latency (TWL) were measured on bilateral plantar for pain threshold evaluation before and after each stimulus. Acupuncture- and moxibustion-like stimuli (43°C, 46°C heat, 1 mA electroacupuncture [EA], 3 mA EA, and manual acupuncture [MA]) were applied randomly on different days. Results: Fewer MCs were observed in the skin of ST36 in mutant rats compared to WT rats (P<0.001). For pain thresholds, MWL and MWT were higher in WsRC-Ws/Ws compared to WsRC-+/+ on bilateral paws (P<0.05), but TWL was not different between the two rats (P>0.05). Bilateral MWL and MWT in WsRC-+/+ rats increased significantly after each stimulus compared to baseline (P<0.01, P<0.001). In WsRC-Ws/Ws rats, only noxious stimuli could produce antinociceptive effects for mechanical pain (46°C, 3 mA EA, MA) (P<0.01, P<0.001). Additionally, the net increases in MWL and MWT induced by most stimuli were greater in WT than in mutant rats (P<0.05). For thermal nociception, either high- or low-intensity stimuli could significantly augment TWL in two rats (P<0.001), and the net increases of TWL evoked by most stimuli were to the same extent in two genetic variants. Conclusion: MCs influence the basic mechanical but not thermal pain threshold. MCs participate in acupuncture analgesia in mechanical but not in thermal nociception, in that MC deficiency may attenuate the mechanical analgesia evoked by high-intensity stimuli and eliminate analgesia provoked by low-intensity stimuli. [ABSTRACT FROM AUTHOR]

Acupuncture, as a healing art in traditional Chinese medicine, has been widely used to treat various diseases. In the history of acupuncture anesthesia, in the past decades, mechanisms of acupuncture analgesia has been widely investigated, and in recent years, acupuncture protection on organ functions has attracted great interest. This review summarized the research progress on mechanisms of acupuncture for analgesia and its protection against organ function injury in anesthesia, and its perspective of analgesia, immunomodulation, neuroendocrine regulation and multiple organ protection. The current evidence supports that acupuncture analgesia and its organ protection in anesthesia is associated with the integration of neuroendocrine-immune networks in the level of neurotransmitters, cytokines, hormones, neuronal ensembles, lymphocytes, and endocrine cells. Although the mechanisms of acupuncture analgesia and its organ protection are still not completely understood, basic as well as clinic researches on the mechanisms and applications of acupuncture and related techniques are being carried out.

This study investigated the effects of acupuncture combined with general anesthesia on postoperative immune and cognitive functions in elderly patients undergoing subtotal gastrectomy. We recruited 96 elderly patients who received anesthesia for subtotal gastrectomy and randomly divided them into control (n=48) and experimental (n=48) groups. The control group received general anesthesia and the experimental group received combined acupuncture and general anesthesia. We measured hemodynamic immediately before and after anesthesia induction, and immune observations before and after surgery. We found no significant differences in mean heart rate (HR), mean oxygen saturation (SpO2), and partial pressure of end-tidal carbon dioxide (PETCO2) in the perioperative period between the two groups. Mean arterial pressure (MAP) was lower in the experimental group than that in the control group (P<0.05). The levels of cluster of differentiation 3 (CD3+), CD4+ and CD4+/CD8+ in both groups were significantly lower after surgery in both groups (P<0.05). We also found some time-points in which the immune markers where significantly higher in the experimental group. In terms of adverse reactions, there were no differences in nausea, vomiting, and hypoxemia between the two groups (P>0.05), but the incidence of delayed recovery and postoperative agitation were significantly lower in the experimental group compared with those in the control group (P<0.05). One day after surgery, the experimental group showed better protection of cognitive function than the control group (P<0.05). Overall, combined acupuncture and general anesthesia in elderly gastric cancer patients receiving subtotal gastrectomy showed more stable hemodynamics and fewer stress responses during surgery. Thus, combined acupuncture and general anesthesia can shorten the recovery time from anesthesia, have less negative effects on immune function and decrease the incidence of postoperative cognitive impairment. [ABSTRACT FROM AUTHOR]

The article offers information on how dentists should handle erotic complications that may develop when a patient is put on anesthesia. It is interesting to note that in the case of sedo anesthesia where diazepam is injected endovenously, the sexual dreams if they occur cannot or should not be recalled. Dentists are advised to maintain professional decorum and relation with their patients. To avoid any implication of sexual impropriety with patients, dentists are advised to ask dental patients to sign a consent form.

Objective: Carboprost is used to prevent postpartum hemorrhage in pregnant patients but is associated with severe nausea and vomiting .This a study was done to compare ondansetron and P6 point acupuncture stimulation for prevention of carboprost induced nausea and vomiting. Methodology: Fifty ASA class I and II full term pregnant patients scheduled for elective cesarean section were randomly allocated into Group-O (n=25) and Group-P (n=25). Subarachnoid block (SAB) was administered in both groups using inj.0.5% hyperbaric bupivacaine in L3-L4 interspace to achieve a level between T4 to T6. Inj.carboprost 250 mcg was given intramuscularly after the delivery of anterior shoulder in both groups. In addition Group-O inj. Ondansetron was given and in Group-P acupuncture was applied at P6 acupoint. Mean arterial pressures were maintained within 20% of baseline. Both groups were observed for nausea and vomiting for two hours postoperatively. Results: Overall incidence of nausea and vomiting was significantly less in Group-P than in Group-O, however, there was no significant difference in incidence of nausea and vomiting among the two groups when considered individually. Conclusion: We conclude that stimulation of P6 point by acupuncture in comparison to ondansetron decreases the overall incidence of carboprost induced nausea and vomiting in the immediate postoperative period. [ABSTRACT FROM AUTHOR]

The article focuses on the historical aspects concerning the significance of postal stamps in celebrating the contribution to cardiac surgery. Topics discussed include features of commemorative stamps issued in Bangladesh to celebrate 30 years of cardiac surgery in the country, aspects of Chinese postage stamp issued in 1975 which features open heart surgery with the use of acupuncture for anesthesia, and contribution of New Zealander cardiac surgeon Sir Brian Barratt-Boyes featured on stamps.

Abstract: Objective: To observe the protective effect of acupuncture-drug compound anesthesia with different frequency electroacupuncture (EA) on stress reaction in patients of pneumonectomy and to explore potential mechanisms. Methods: Eighty patients scheduled for pneumonectomy were randomly divided into four groups, group A, B, C and D, 20 cases in each group. General anesthesia and single lung protective mechanical ventilation were carried out in all the groups. Acupuncture was given at Hòuxī (▪ SI 3), Zhīgōu (▪ TE 6), Nèiguān (▪ PC 6), and Hégŭ (▪ LI 4) 30 min before general anesthesia, and the acupuncture needles were connected with Han''s acupoint nerve stimulator (HANS-200) in all the groups, but the acupuncture needles without needle bodies were pasted on the acupoints and EA was not given in the group A. 2 Hz continuous wave, 100 Hz continuous wave and 2 Hz/100 Hz EA were given in the group B, C and D respectively. The supplementary amount of anesthesia medicine, heart rate (HR) and mean arterial pressure (MAP) during pneumonectomy, and CD+ 4/CDCD+ 8 in venous blood before and one day after the surgery, and the contents of epinephrine (E) and Cortisol (Cor) in plasma after entering the operating room and before turning out the operating room were detected. Results: ▪ During the operation, supplementary amounts of Fentanyl in the group B and C were lower than those in the group A and D (P<0.05, P<0.01). ▪ The MAP in the four groups at tracheal intubation (T1) all were higher than those before anesthesia (T0) (all P<0.01), and the ascending extents in the group B, C and D were lower than that in the group A (all P<0.01); HR at T1 in the group A was higher than that at T0 (P<0.05), while no significant change in the other groups (all P>0.05), and the ascending extents in the group B and D were lower than that in the group A (both P<0.05); MAP and HR at the other moments in all the groups were stable. ▪ CD+ 4/CD+ 8 in the group A after pneumonectomy was lower than that before the surgery (P<0.05), while no significant change in the other groups (all P>0.05). ▪ Contents of E and Cor after the operation were significantly increased in all the groups (all P<0.01), and the ascending extent of E content in the group D was lower than that in the group A (P<0.05); the ascending level of Cor in the group B and D was lower than that in the group A (P<0.01), and in the group B was lower that in the group C and D. Conclusion: Acupuncture-drug compound anesthesia can attenuate the stress reaction so as to protect organs under the condition of less or same narcotic amount and can alleviate the fluctuation of MAP and HR at tracheal intubation and stabilize CD+ 4/CD+ 8 after pneumonectomy. Among them, 2 Hz and 2 Hz/100 Hz EA have better effects. [Copyright &y& Elsevier]

Abstract: Background: Although the use of acupuncture anesthesia for open heart surgery, which was introduced in China four decades ago, has declined in recent years, there is a renewed interest in it in contemporary China due to the escalating medical costs associated with open heart surgery. This study was aimed to determine whether a combined acupuncture–medicine anesthesia (CAMA) strategy reduces early postoperative morbidity and medical costs in patients undergoing open heart operation under cardiopulmonary bypass. Methods: From July 2006 to October 2010, CAMA was applied in 100 patients undergoing open heart surgery in comparison with another 100 patients under the conventional general anesthesia (GA). For all the CAMA patients, an abdominal breathing training program was practiced for the 3 consecutive days prior to operation. About 15 to 20min prior to surgical incision, acupuncture needles were inserted into the bilateral points ZhongFu, LieQue, and XiMen. During operation, patients were kept on spontaneous breathing. Endotracheal intubation was not employed but only prepared as a standby. The narcotic drugs, fentanyl and midazolam, were intravenously injected but in very low doses as compared to GA. Open heart procedures were performed routinely in both groups. Results: Compared with the GA patients, the CAMA patients had a less usage of narcotic drugs (p<0.001), less postoperative pulmonary infection (p<0.05), shorter stay in intensive care unit (p<0.05), and a lower medical cost (P<0.05). Conclusions: A combined acupuncture–medicine anesthesia strategy reduces the postoperative morbidity and medical costs in patients undergoing open heart surgery under cardiopulmonary bypass. [Copyright &y& Elsevier]

We immobilized elk with either isoflurane to produce general anesthesia (control), 0.01 mg/kg carfentanil plus 0.1 mg/kg xylazine, or 0.25 mg/kg butorphanol plus 0.4 mg/kg azaperone plus 0.15 mg/kg medetomidine (BAM) and measured the bispectral index (BIS). The carfentanil-xylazine BIS (70.4 ± 1.4) and the BAM BIS (60.2 ± 1.5) were higher than the control BIS (47.2 ± 4.1; P ≤ 0.001). These data indicate that opioids produce neuroleptanalgesia and not general anesthesia or sedation, which explains observed elk responses to these drugs. [ABSTRACT FROM AUTHOR]

Abstract: Purpose: This investigation examined the effect of inflammation produced by intravesical zymosan during the neonatal period on spinal dorsal horn neuronal responses to urinary bladder distension (UBD) as adults. Methods: Female rat pups (P14–P16) were treated with intravesical zymosan or with anesthesia-only. These groups of rats were subdivided forming four groups: half received intravesical zymosan as adults and half received anesthesia-only. One day later, rats were anesthetized, the spinal cord was transected at a cervical level and extracellular single-unit recordings of L6-S1 dorsal horn neurons were obtained. Neurons were classified as Type I—inhibited by heterotopic noxious conditioning stimuli (HNCS) or as Type II – not inhibited by HNCS – and were characterized for Spontaneous Activity and responses to graded UBD (20–60mm Hg). Results: 227 spinal dorsal horn neurons excited by UBD were characterized. In rats treated as neonates with anesthesia-only, Type II neurons demonstrated increased spontaneous and UBD-evoked activity following adult intravesical zymosan treatment whereas Type I neurons demonstrated decreased spontaneous and UBD-evoked activity relative to controls. In rats treated as neonates with intravesical zymosan, the spontaneous and UBD-evoked activity of both Type I and Type II neurons increased following adult intravesical zymosan treatment relative to controls. Conclusions: Neonatal bladder inflammation alters subsequent effects of acute bladder inflammation on spinal dorsal horn neurons excited by UBD such that overall there is greater sensory neuron activation. This may explain the visceral hypersensitivity noted in this model system and suggest that impaired inhibitory systems may be responsible. [Copyright &y& Elsevier]

The article presents a case study of a 59-year-old lidocaine allergic women patient, who undergoes acupuncture anesthesia and surgical dental procedures for complicated dental extraction. The study indicates that these procedures are successful because acupuncture points are a practical application based on the selection of points along the meridians. It recommends acupuncture anesthesia as an alternative anesthesia for complicated extractions in lidocaine allergic patient.

Abstract: Objectives: The aim of this experimental study was to investigate if perturbation of somatosensory function would change corticomotor excitability of the tongue musculature in relation to a novel tongue training task. Materials and methods: Sixteen healthy volunteers participated in two randomized and double-blind sessions separated by two weeks, in which topical anaesthetics or placebo cream were applied to the tongue during a standardized tongue training task. Corticomotor excitability was assessed by changes in motor evoked potentials (MEPs) in the tongue musculature evoked by transcranial magnetic stimulation (TMS) before and after training. Results: The success rate of the training task increased in both sessions (relative increase: topical anaesthetics=53±53%; placebo=50±48%; P =0.713). The MEP amplitudes increased with stimulation intensity (P <0.026) in both sessions and there were significantly higher MEP amplitudes on the contralateral tongue muscle compared to the ipsilateral tongue (P <0.019). There were no differences in MEP amplitudes between the topical anaesthetic and placebo session and there were no main effects of the tongue training task. However, there were significant correlations between increases in success rate and facilitation of the MEP amplitudes in the tongue muscles. Conclusion: Topical anaesthesia has no major effects on corticomotor excitability of tongue musculature and there appears to be a strong individual variation in the effects of a tongue training task on MEP amplitudes. [Copyright &y& Elsevier]

Background: Although many investigators previously reported the sympathovagal effect of spinal anaesthesia, there is no information about the sympathovagal effects of supplementation with fentanyl. The aim of this study was to evaluate the sympathovagal effects of intrathecal or intravenous fentanyl added to spinal anaesthesia. Methods: One hundred and twenty patients undergoing elective transurethral surgery under spinal anaesthesia were randomly allocated to receive intrathecally either isobaric bupivacaine alone (Group B), bupivacaine supplemented with intrathecal (Group Ft) or with intravenous fentanyl (Group Fv). Heart rate variability was estimated using the MemCalc method (Tarawa, Suwa Trust, Japan) before and after spinal anaesthesia. Results: In all groups, spinal anaesthesia significantly decreased low frequency/high frequency (LF/HF) as a marker of sympathovagal balance. However, patients in Group B with a low block height developed a marked increase in LF/HF after spinal anaesthesia, which was attenuated in Group Ft. Meanwhile, intravenous fentanyl did not attenuate this response. Conclusion: We conclude that sympathetic activation observed in patients with a low block height was attenuated by intrathecal fentanyl but not by intravenous fentanyl. [ABSTRACT FROM AUTHOR]

Abstract: Arginine vasopressin (AVP) has been proven to be involved in the process of pain regulation. This communication was designed to investigate the effect of AVP on acupuncture analgesia in the rat model. The results showed that intraventricular injection (icv) of AVP could enhance acupuncture analgesia in a dose-dependent manner, whereas icv of anti-AVP serum decreased acupuncture analgesia. However, neither intrathecal (ith) nor intravenous injection (iv) of AVP or anti-AVP serum could influence acupuncture analgesia. Electrical acupuncture of “Zusanli” points (St. 36) decreased AVP concentration in the hypothalamic paraventricular nucleus (PVN), and increased AVP concentration in the hypothalamic supraoptic nucleus (SON), periaqueductial gray (PAG), caudate nucleus (CdN) and raphe magnus nucleus (RMN), but did not change AVP concentration in the pituitary, spinal cord and plasma. The effect of AVP on acupuncture analgesia was partly reversed by pretreatment with naloxone, an opiate receptor antagonist. These data suggested that AVP in the brain played a role in the process of acupuncture analgesia in combination with the endogenous opiate peptide system. [Copyright &y& Elsevier]

Abstract: The purpose of this study was to evaluate both, clinically and with electroencephalographic (EEG) recordings, the effect of gold wire implants in acupuncture points in dogs with uncontrolled idiopathic epileptic seizures. Fifteen dogs with such diagnosis were enrolled in the study. A first EEG recording was performed in all dogs under anaesthesia with xylazine (1mg/kg) and propofol (6mg/kg) before the treatment protocol, and a second EEG was performed 15 weeks later. Relative frequency power, intrahemispheric coherence available through EEG, number of seizures and seizure severity were compared before and after treatment using a Wilcoxon signed-rank test. There were no significant statistical differences before and after treatment in relative power or in intrahemispheric coherence in the EEG recording. However, there was a significant mean difference in seizure frequency and seizure severity between control and treatment periods. After treatment, nine of the 15 dogs (60%) had at least a 50% reduction in seizures frequency during the 15 weeks established as follow-up of this treatment. [Copyright &y& Elsevier]

Abstract: Study Objective: There is a high rate of relapse among anesthesia residents attempting to re-enter clinical anesthesia training programs after completing treatment for opioid addiction. Individuals may return to clinical practice after a short period of treatment only to relapse into active addiction, and for the opioid addicted anesthesia resident, this often results in death. The objective of this study was to determine weather or not a period of time away from clinical practice after treatment would reduce the rate of relapse by allowing the individual to concentrate on recovery in the critical first year after treatment, during which the majority of relapses occur. Design: 5 residents identified as being addicted to a controlled substance were removed from residency training and offered treatment. Prior to returning to residency training they were required to complete a post-treatment program involving no less than 12 months of work in the anesthesia simulator, followed by a graded re-introduction into the clinical practice of anesthesia. Setting: Academic anesthesia practice in a large teaching hospital. Results: Of the 5 residents who participated in the program, 3 (60%) successfully completed their residency program and their 5 year monitoring contract, and entered the anesthesia workforce as attending anesthesiologists. Conclusions: The treatment of addicted physicians can be successful, and return of the highly motivated individual to the clinical practice of Anesthesiology is a realistic goal, but this reintroduction must be undertaken in a careful, stepwise fashion. A full understanding of the disease process, the potential for relapse, and the implications of too rapid a return to practice must be taken into careful consideration. [Copyright &y& Elsevier]

Abstract: Anaesthetists should be aware that there is good evidence that sedation can harm patients. Some authorities believe that patients’ protective reflexes are impaired at any level of sedation. Sedation merges into anaesthesia in a continuum of loss of consciousness. All anaesthetists should understand the definition of ‘conscious sedation’, and be aware of the concepts of ‘deep sedation’ and ‘monitored anaesthesia care’, which are prevalent in the USA. This paper discusses, in particular, dental sedation guidelines and, more generally, safe sedation practice for other procedures in which sedation is given. [Copyright &y& Elsevier]

Acupuncture anesthesia has been practiced in China since about 1960. In Japan, Hyodo reported 30 cases of acupuncture anesthesia in 1972. However, from around 1980, the direction of acupuncture investigations turned from anesthesia to analgesia. Acupuncture analgesia is presently considered a way to activate the body's endogenous analgesic system. Recently, with the rise of acupuncture as one of the most well known CAM therapies, acupuncture or moxibustion treatment has been reported for both acute and chronic pain. Even so, few clinical reports and original articles have been reported in Japan. This review illustrates how acupuncture is being used in Japan for acute pain such as surgical operations, post-operative pain (POP), neuropathic pain, pain associated with teeth extractions and after the extraction of impacted wisdom teeth. [ABSTRACT FROM AUTHOR]

Abstract: Introduction: In vivo small animal imaging of the dopaminergic system is of great interest for basic and applied neurosciences, especially in transgenic mice. Small animal SPECT is particularly attractive because of its superior spatial resolution and tracer availability. We investigated the kinetics of the commercial dopamine D2 receptor (DZR) ligand [123I]IBZM in mice as a prerequisite for an appropriate design of translational SPECT imaging between mice and humans. Methods: Cerebral kinetics of [123I]IBZM under isoflurane anaesthesia were assessed by autoradiography in mice sacrificed at 30, 60, 120 and 200 min after iv injection. To explore the possible effects of isoflurane anaesthesia, an additional mice group was only anaesthetized for 20 min before being sacrificed at 140 min (putative time of single-scan SPECT analysis). Results: Maximum [123I]IBZM uptake in the striatum (D2R-rich; 10.5±2.7 %ID/g) and cerebellum (D2R-devoid; 2.4±0.7 %ID/g) was observed at 30 min after injection. Thereafter, [123I]IBZM uptake decreased slowly in striatum and rapidly in the cerebellum (200 min: 5.3±1.9 and 0.4±0.2 %ID/g, respectively). The striatum-to-cerebellum (S/C) [123I]IBZM uptake ratio increased from 4.6±1.2 at 30 min to 11.6±2.6 at 120 min. The S/C ratio at 200 min was highly variable (17.8±10.1), possibly indicating pseudo-equilibration in some animals. In mice, which were only anaesthetized between 120 and 140 min, a higher S/C ratio of 17.0±5.1 was observed. Conclusions: The present study suggests that [123I]IBZM is a suitable ligand for D2R-SPECT in mice. Although a single-scan analysis may be a pragmatic semi-quantitative approach, tracer kinetic analyses on dynamic SPECT data should be pursued. The interfering effects of isoflurane anaesthesia need to be considered. [Copyright &y& Elsevier]

Abstract: In a previous study, we showed that electroacupuncture (EA) applied to the SI-6 point on the contralateral forelimb produces long-lasting and powerful analgesia in pain caused by ankle sprain in a rat model. To investigate the underlying mechanism of EA analgesia, the present study tested the effects of various antagonists on known endogenous analgesic systems in this model. Ankle sprain was induced in anesthetized rats by overextending their right ankle with repeated forceful plantar flexion and inversion of the foot. When rats developed pain behaviors (a reduction in weight-bearing of the affected hind limb), EA was applied to the SI-6 point on the contralateral forelimb for 30min under halothane anesthesia. EA significantly improved the weight-bearing capacity of the affected hind limb for 2h, suggesting an analgesic effect. The α-adrenoceptor antagonist phentolamine (2mg/kg, i.p. or 30μg, i.t.) completely blocked the EA-induced analgesia, whereas naloxone (1mg/kg, i.p.) failed to block the effect. These results suggest that EA-induced analgesia is mediated by α-adrenoceptor mechanisms. Further experiments showed that intrathecal administration of yohimbine, an α2-adrenergic antagonist, reduced the EA-induced analgesia in a dose-dependent manner, whereas terazosin, an α1-adrenergic antagonist, did not produce any effect. These data suggest that the analgesic effect of EA in ankle sprain pain is, at least in part, mediated by spinal α2-adrenoceptor mechanisms. [Copyright &y& Elsevier]

BACKGROUND:: Continuous intrathecal labor analgesia produces rapid analgesia or anesthesia and allows substantial flexibility in medication choice. The US Food and Drug Administration, in 1992, removed intrathecal microcatheters (27–32 gauge) from clinical use after reports of neurologic injury in nonobstetric patients. This study examined the safety and efficacy of a 28-gauge intrathecal catheter for labor analgesia in a prospective, randomized, multicenter trial. METHODS:: Laboring patients were randomly assigned to continuous intrathecal analgesia with a 28-gauge catheter (n = 329) or continuous epidural analgesia with a 20-gauge catheter (n = 100), using bupivacaine and sufentanil. The primary outcome was the incidence of neurologic complications, as determined by masked neurologic examinations at 24 and 48 h postpartum, plus telephone follow-up at 7–10 and 30 days after delivery. The secondary outcomes included adequacy of labor analgesia, maternal satisfaction, and neonatal status. RESULTS:: No patient had a permanent neurologic change. The continuous intrathecal analgesia patients had better early analgesia, less motor blockade, more pruritus, and higher maternal satisfaction with pain relief at 24 h postpartum. The intrathecal catheter was significantly more difficult to remove. There were no significant differences between the two groups in neonatal status, post–dural puncture headache, hemodynamic stability, or obstetric outcomes. CONCLUSIONS:: Providing intrathecal labor analgesia with sufentanil and bupivacaine via a 28-gauge catheter has an incidence of neurologic complication less than 1%, and produces better initial pain relief and higher maternal satisfaction, but is associated with more technical difficulties and catheter failures compared with epidural analgesia. [ABSTRACT FROM AUTHOR]

Abstract: Depending on their pharmacology and the ways they are used, illicit drugs can lead to a wide range of medical and surgical problems. The drug-using patient requiring surgery or pain relief needs special attention in order to avoid interactions and complications, especially as most of these patients will be using more than one drug. In order to raise awareness, we review the different drugs, their clinical effects and the problems which may be encountered. [Copyright &y& Elsevier]

Abstract: Study Objective: To investigate whether placement, and use of stimulating catheters for interscalene brachial plexus blocks improves short-term postoperative analgesia. Design: Controlled, prospective, randomized, pilot study. Setting: University hospital. Patients: 60 patients undergoing shoulder surgery. Interventions and Main Measurements: The brachial plexus was identified using a stimulating needle. In conventional catheter group 1 (CC 1), local anesthetic (LA) was injected through the needle and catheters were advanced blindly thereafter. In catheter group 2 (CC 2), catheters were blindly inserted and LA was injected through the catheter. In the stimulating catheter group (SC), LA was injected only after catheter tip location was confirmed by nerve stimulation. Time required to perform the block, pain intensity at rest, and dynamic pain (defined movement: lifting of arm; numeric rating scale, 0-10), patient satisfaction (verbal rating scale, Likert scale), and plasma concentrations of ropivacaine were measured. Main Results: Patients in the SC group had significantly decreased pain scores. The median block performance time was 6 minutes in CC 1 (CI 25%-75%: 4-8 min), 11 minutes in CC 2 (CI 25%-75%: 7-13 min), and 12 minutes in SC (CI 25%-75%: 10-24 min). Patient satisfaction and plasma concentrations of ropivacaine did not differ among the groups. Conclusions: Stimulating catheters for interscalene plexus blocks improve postoperative analgesia at rest in patients undergoing shoulder surgery. [Copyright &y& Elsevier]

Abstract: Study Objective: To evaluate stressors and coping strategies for stress in a sample of anesthesiologists working at a university hospital. Design: Cross-sectional study via survey instrument. Setting: University department of anesthesiology and critical care at a 1305-bed hospital. Participants: 135 anesthesia specialists and specialist trainees of anesthesia. Measurements and Main Results: A total of 135 self-reporting questionnaires used to assess sociodemographic data, workload, task demands, stress-coping strategies, physical health, emotional well-being, and working conditions, were distributed. Of these, 89 questionnaires were completed and returned, for a response rate of 65.9%: 33 (37.1%) female anesthesiologists and 56 (62.9%) male anesthesiologists. The burden of task-related stressors and of communication possibilities was assessed differently by male and female anesthesiologists. Female anesthesiologists more frequently reported higher concentration demands (P = 0.013) and limited possibilities to control work (P = 0.009) than did their male colleagues. Work at intensive care units (P = 0.001) was particularly demanding and burdensome for female anesthesiologists. Combined evaluation of various stress-coping strategies did not show significant differences between the genders. Generally, anesthesiologists had more confidence in their own personal capabilities and resources and in their social–particularly family–support outside the workplace, than in their social support from colleagues and superiors. Conclusions: Task-related stressors and communication possibilities differed between male and female anesthesiologists in our institution. Female anesthesiologists felt that they had less control over their work. [Copyright &y& Elsevier]

Abstract: Our knowledge of the function of the auditory nervous system is based upon a wealth of data obtained, for the most part, in anaesthetised animals. More recently, it has been generally acknowledged that factors such as attention profoundly modulate the activity of sensory systems and this can take place at many levels of processing. Imaging studies, in particular, have revealed the greater activation of auditory areas and areas outside of sensory processing areas when attending to a stimulus. We present here a brief review of the consequences of such non-passive listening and go on to describe some of the experiments we are conducting to investigate them. In imaging studies, using fMRI, we can demonstrate the activation of attention networks that are non-specific to the sensory modality as well as greater and different activation of the areas of the supra-temporal plane that includes primary and secondary auditory areas. The profuse descending connections of the auditory system seem likely to be part of the mechanisms subserving attention to sound. These are generally thought to be largely inactivated by anaesthesia. However, we have been able to demonstrate that even in an anaesthetised preparation, removing the descending control from the cortex leads to quite profound changes in the temporal patterns of activation by sounds in thalamus and inferior colliculus. Some of these effects seem to be specific to the ear of stimulation and affect interaural processing. To bridge these observations we are developing an awake behaving preparation involving freely moving animals in which it will be possible to investigate the effects of consciousness (by contrasting awake and anaesthetized), passive and active listening. [Copyright &y& Elsevier]

Background: Especially because of improvements in clinical neurologic monitoring, carotid endarterectomy done under local anesthesia has become the technique of choice in several centers. Temporary ipsilateral vocal nerve palsies due to local anesthetics have been described, however. Such complications are most important in situations where there is a pre-existing contralateral paralysis. We therefore examined the effect of local anesthesia on vocal cord function to better understand its possible consequences. Methods: This prospective study included 28 patients undergoing carotid endarterectomy under local anesthesia. Vocal cord function was evaluated before, during, and after surgery (postoperative day 1) using flexible laryngoscopy. Anesthesia was performed by injecting 20 to 40 mL of a mixture of long-acting (ropivacaine) and short-acting (prilocaine) anesthetic. Results: All patients had normal vocal cord function preoperatively. Twelve patients (43%) were found to have intraoperative ipsilateral vocal cord paralysis. It resolved in all cases ≤24 hours. There were no significant differences in operating time or volume or frequency of anesthetic administration in patients with temporary vocal cord paralysis compared with those without. Conclusion: Local anesthesia led to temporary ipsilateral vocal cord paralysis in almost half of these patients. Because pre-existing paralysis is of a relevant frequency (up to 3%), a preoperative evaluation of vocal cord function before carotid endarterectomy under local anesthesia is recommended to avoid intraoperative bilateral paralysis. In patients with preoperative contralateral vocal cord paralysis, surgery under general anesthesia should be considered. [Copyright &y& Elsevier]

Abstract: Study Objective: To compare patient satisfaction with local anesthetic infiltration versus caudal epidural block for anorectal procedures. Design: Randomized controlled trial. Setting: Operating room and postanesthesia care unit (PACU). Patients: 22 adult, ASA physical status I, II, and III patients scheduled for anorectal surgery. Interventions: Patients were randomized to receive either local anesthetic infiltration (LAI) (n = 10) by the surgeon or caudal epidural block (CEB) (n = 12) by the anesthesiologist. Measurements: The primary outcome was patient satisfaction with the anesthetic technique and pain relief 12 hours after the procedure on a 4-point Likert scale. Secondary outcomes included time to first analgesic request, time to reach a PACU discharge score (REACT score) of 10, time to ambulation, time to discharge home, and adverse events. Main Results: More subjects in the CEB group (83.3%) were highly satisfied than in the LAI group (20%; P = 0.003), assessed 12 hours postoperatively by telephone interview. Subjects in the CEB group requested analgesia 423 minutes later (95% confidence interval, 286-560 min) than subjects in the LAI group. Differences in time to reach a REACT score of 10, time to ambulation, and time to discharge home were not statistically significant. Conclusions: Caudal epidural block provides higher patient satisfaction and longer lasting analgesia than LAI without delaying discharge. [Copyright &y& Elsevier]

Background: Submucosal resection is accompanied by significant post-operative pain and discomfort. The aim of this randomized, double-blinded clinical trial was to study the efficacy of a local block anaesthetic, delivered after induction of general anaesthesia, in reducing post-operative pain.Methods: Patients aged 16 years and over who were scheduled for elective submucosal resection were randomly assigned to receive either standardized general anaesthesia, general anaesthesia with local anaesthetic infiltration or general anaesthesia with placebo infiltration. Haemodynamic stability, intra-operative blood loss, post-operative pain (over a seven day follow-up period), analgesics consumption, hospital stay, and the patient's and surgeon's levels of satisfaction were assessed.Results: We found significantly lower results for pack removal pain score, volume of intra-operative blood loss, number of patients suffering from headache, altered dental sensation or nasal pain, number of patients who consumed analgesics, and length of hospital stay, comparing the infiltration group with the general anaesthesia and placebo groups (p<0.05).Conclusion: This clinical trial showed that infiltration with the local anaesthetics fentanyl and clonidine substantially reduced post-operative pain and shortened patients' hospital stay. [ABSTRACT FROM AUTHOR]

BACKGROUND Tumescent local anesthesia is widely used in dermatologic surgery. Minimizing pain associated with injections is crucial to successful surgical procedures. OBJECTIVE This study investigates the pain associated with warm and room temperatures in neutralized or nonneutralized tumescent anesthetic solutions injection. METHODS Thirty-six patients with axilla osmidrosis who underwent local anesthesia for surgery were randomly assigned to three groups. Group A received warm neutral (40°C) and room-temperature neutral (22°C) tumescent injections to each axillary region. Group B received warm neutral (pH 7.35) and warm nonneutral (pH 4.78) tumescent injections on each side of axilla. Group C received warm nonneutral and room-temperature nonneutral tumescent injections on each side of axilla. Pain associated with infiltration of anesthesia was rated on a visual analog scale (VAS). RESULTS A statistically significant decrease ( p < .001) in pain sensation was reported on the warm, neutral injection side (mean rating, 32.7 mm) compared with the room-temperature, neutral injection side (mean rating, 53.3 mm). Patient-reported pain intensity was significantly lower on the side that received warm, neutral tumescent anesthesia (mean rating, 26.8 mm) than on the side receiving warm, nonneutral tumescent anesthesia (mean rating, 44.9 mm; p < .001). The difference in VAS scores between warm neutral (mean rating, 23.9 mm) and room-temperature nonneutral (mean rating, 61.2 mm) was statistically significant ( p < .001). CONCLUSION The warm, neutral tumescent anesthetic preparation effectively suppressed patient pain during dermatologic surgical procedures. [ABSTRACT FROM AUTHOR]

A styloid process (SP) cutter was developed and put into clinical use. The design of components of the ‘styloidectome’ was based on the principles of mechanics. The measurements of the individual parts were determined on the basis of morphological data of the oropharynx from 40 subjects undergoing tonsillectomy under general anaesthesia. Experiments showed that the instrument could be used to transect the SP and excise the amputated bones from the deep tissue space. We used the instrument for the resection of elongated SPs, via an oral approach, in seven in-patients (involving 10 SPs) under general anaesthesia and in two out-patients (involving three SPs) under local anaesthesia. The length of the resected SP ranged from 0.8 to 2.5 cm and the stump of the SP was smooth. The removal lasted only seconds and blood loss was minimal, without any complications. The styloidectome was reliable, easy to use and could be used for the resection of an elongated SP under general or local anaesthesia. [ABSTRACT FROM AUTHOR]

Abstract: Our previous study proved that hypothalamic paraventricular nucleus (PVH) plays an important role in acupuncture analgesia. The effect of acupuncture on the concentrations of arginine vasopressin (AVP), oxytocin (OXT), leucine-enkephaline (L-Ek), β-endorphin (β-Ep) and dynorphinA1–13 (DynA1–13) was investigated in rat PVH. Electrical acupuncture of “Zusanli” points (St. 36) 30min increased the AVP, not OXT, L-Ek, β-Ep and DynA1–13 concentrations in PVH tissue using micropunch and radioimmunoassay, which showed a negative relationship between the pain threshold and AVP concentrations in PVH tissue. Electrical acupuncture could elevate the AVP concentrations in PVH perfuse liquid during acupuncture, and then reduce the AVP concentrations in PVH perfuse liquid after acupuncture. But no change in OXT, L-Ek, β-Ep and DynA1–13 concentrations was detected in PVH perfuse liquid. Electrical acupuncture decreased the number of AVP, not OXT, L-Ek, β-Ep and DynA1–13 immunoreactive cells in PVH using immunocytochemistry. The results suggested that only AVP, not OXT and endogenous opiate peptides in PVH involved acupuncture analgesia in the rat. [Copyright &y& Elsevier]

To compare minimum fresh gas flow ( Vmin) requirements and respiratory resistance in the Uniflow and Bain anaesthetic breathing systems used in the Mapleson D mode. Seven pigs, aged 8–12 weeks, anaesthetized for ophthalmic surgery. Anaesthesia was maintained with halothane delivered in oxygen using a (Mapleson D) Bain breathing system. The Vmin that prevented re-breathing was found, and peak inspiratory (PIP) and peak expiratory (PEP) pressures measured. The fresh gas flow ( Vf) was then increased to Vmin + 50%, then Vmin + 100%, and respiratory pressures re-measured. A heat and moisture exchanger (HME) was inserted at the endotracheal tube and the procedure repeated. The breathing system was then exchanged for a Uniflow and the protocol repeated. After final disconnection from the breathing system, the animals’ peak inspiratory and expiratory flows, tidal, and minute volumes (V m) were measured over five respiratory cycles. The Vmin (L minute−1; mL kg−1 minute−1) required to prevent rebreathing in the Uniflow system [8.1(mean) ±1.7 (SD); 332 ± 94] was significantly greater than the Bain system (6.5 ± 1.1; 256 ± 64). At Vmin, PEP with the Uniflow (3.5 ± 0.1 cmH2O) was significantly higher than the Bain system (2 ± 0.7 cmH2O), but PIP values did not differ (Uniflow −0.6 ± 2.1 cmH2O; Bain system −0.2 ± 0.6 cmH2O). With both systems, PEP increased significantly ( p < 0.001) with each increase in Vf: Uniflow system 4.2 ± 0.4 ( Vmin + 50%) and 5.5 ± 0.5 cmH2O ( Vmin + 100%); Bain system 2.8 ± 0.7 ( Vmin + 50%) and 3.5 ± 0.7 cmH2O ( Vmin + 100%). Insertion of the HME did not alter pressures. The mean tidal volume was 6.4 ± 1.6 mL kg−1; mean V m was 184.9 ± 69.8 mL kg−1 and mean respiratory rate was 28 ± 5 breaths minute−1. In one pig breathing with the Uniflow system PEP rose sharply; respiratory and heart rates increased, and ventricular dysrhythmias occurred. When the system was changed and Vf reduced, physiological variables became normal. The study discredited the hypothesis that the two breathing systems behave similarly. Values for Vmin and PEP were higher with the Uniflow system. Increasing Vf increased PEP with both systems. Insertion of an HME did not affect respiratory pressures. The Uniflow used in Mapleson D mode is not suitable for anaesthesia in young spontaneously breathing pigs. [ABSTRACT FROM AUTHOR]

Evaluation of the LMA-ProSeal for positive pressure ventilation (PPV) in the pig. Prospective observational study. Twelve German country pigs, weighing 25–62 kg. Lungs of pigs were mechanically ventilated under general anaesthesia using the LMA-ProSeal. The ease of insertion, number of attempts and total time until placement of the LMA-ProSeal and gastric tube were recorded. Bronchoscopy was performed to determine the position of the LMA-ProSeal and to detect signs of aspiration. Ventilation variables and the leak airway pressure ( Pleak) were measured. An arterial blood gas sample was taken to determine the adequacy of ventilation. The airway was secured in all pigs within 39 ± 19 seconds (27–51). Different sizes of LMA-ProSeal were used; up to 30 kg: size 3, up to 43 kg: size 4; and above 43 kg: size 5. In all but one animal the P-LMA and gastric tube were inserted at the first attempt. In nine animals gastric fluid was drained through the gastric tube. There was no evidence of aspiration in any animal. The mean [±SD (95%CI)] Pleak was 28.8 ± 7.5 cm H2O (24.06–33.60) and normal ventilation was achieved in all animals. The results of this study indicate that the airway of pigs weighing 25–62 kg can be secured safely and reliably with the sizes 3, 4 and 5 LMA-ProSeal. Endotracheal intubation in pigs can be difficult so there is a risk of hypoxemia in the apnoeic animal. With the LMA-ProSeal the airway can be secured rapidly, safely and reliably. Use of the Standard-LMA under PPV can be associated with gas leakage into the stomach and the subsequent risk of gastric distension and regurgitation. Both the ability to drain the stomach and the high Pleak of the LMA-ProSeal could contribute to improved protection against aspiration under PPV. [ABSTRACT FROM AUTHOR]

Background: Ramstedt pyloromyotomy through a right upper quadrant (RUQ) transverse incision has been the traditional treatment for hypertrophic pyloric stenosis. Recently, laparoscopic (LAP) and circumumbilical (UMB) approaches have been introduced as alternative methods to improve cosmesis, but concerns about greater operative times, costs, and complications remain. This study compares the three operative techniques and examines their advantages and complication rates. Study design: We performed a retrospective review of patients undergoing pyloromyotomy at a children’s hospital between January 1997 and June 2003. Results: Two hundred ninety patients underwent pyloromyotomy by LAP (n = 51), RUQ (n = 190), or UMB (n = 49). Complication rate, time to ad libitum feeding, incidence of emesis, and postoperative length of stay did not differ considerably among groups. Two LAP patients were converted to RUQ. Mucosal perforation occurred in three patients each in the RUQ and UMB groups, but none in the LAP group. Operative times were considerably less for LAP (25 ± 9 minutes) than for RUQ (32 ± 9 minutes) and UMB (42 ± 12 minutes) (p &#60; 0.05, ANOVA, Bonferroni). Charges related to operations and anesthesia were considerably greater for UMB (operation: $1,574 ± $433; anesthesia: $731 ± $190) compared with the other two groups (p &#60; 0.05, ANOVA, Bonferroni), but did not differ between LAP (operation: $1,299 ± $311; anesthesia: $586 ± $137) and RUQ (operation: $1,237 ± $411; anesthesia: $578 ± $167). Data are presented as mean ± SD. Conclusions: Advantages of LAP include a shorter mean operative time without higher complications or costs. UMB is associated with the greatest mean operative time and costs. Laparoscopic pyloromyotomy is a safe and effective approach to the treatment of hypertrophic pyloric stenosis. [Copyright &y& Elsevier]

In 1987 Mouret performed the first laparoscopic cholecystectomy, starting a revolution in surgery. For paediatricians it is difficult to appreciate the magnitude of what has occurred in this short period. The development of minimal access techniques represents the most significant change in surgical practice since the introduction of aseptic technique or safe anaesthesia. As with many innovations, rapid change, technical language, and the evangelism of pioneers has left confusion in its wake. [ABSTRACT FROM AUTHOR]