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255. FORUM Prediction of difficult laryngoscopy in obese patients by ultrasound quantification of anterior neck soft tissue.

Author

Ezri, T., Gewurtz, G., Sessler, D. I., Medalion, B., Szumuk, P., Hagberg, C., and Susmallian, S.

Subjects
LARYNGOSCOPY, OBESITY, NECK, INTUBATION
Abstract

In 50 morbidly obese patients, we quantified the soft tissue of the neck from the skin to the anterior aspect of the trachea at the vocal cords using ultrasound. Thyromental distance, mouth opening, limited neck mobility, modified Mallampati score, abnormal upper teeth, neck circumference and sleep apnoea were assessed as predictors of difficult laryngoscopy. Of the nine (18%) cases of difficult laryngoscopy, seven (78%) had a history of obstructive sleep apnoea, compared with two of the 41 patients (5%) in whom laryngoscopy was easy ( p < 0.001). Patients in whom laryngoscopy was difficult had more pretracheal soft tissue (mean (SD) 28 (2.7) mm vs. 17.5 (1.8) mm; p < 0.001) and a greater neck circumference (50 (3.8) vs. 43.5 (2.2) cm; p < 0.001). None of the other predictors correlated with difficult laryngoscopy. We conclude that an abundance of pretracheal soft tissue at the level of the vocal cords is a good predictor of difficult laryngoscopy in obese patients. [ABSTRACT FROM AUTHOR]

Published
2003
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274. The long-term consequences of anaesthetic management.

Author

Sessler, D. I.

Subjects
ANESTHESIA, ANALGESIA, CANCER invasiveness, MYOCARDIAL infarction, MORTALITY, ADRENERGIC beta blockers, PREVENTION
Abstract

The article focuses on the long-term consequences of anaesthetic management. Topics discussed include two articles published in the periodical "New England Journal of Medicine" related to surgical site infection, impact of regional analgesia to preserve effective defenses against tumour progression and link of perioperative beta-blocker administration to myocardial infarction and mortality.

Published
2014
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275. Pethidine and Skin Warming to Prevent Shivering during Endovascular Cooling

Author

Leslie, K., Williams, D., Irwin, K., Bjorksten, A. R., and Sessler, D. I.

Abstract

We tested the efficacy of pethidine and cutaneous warming to prevent shivering during percutaneous cooling in unanaesthetized patients. Ten patients scheduled for cranial neurosurgery received pethidine infusion and skin warming. The Setpoint™ internal heat-exchanging catheter was inserted and cooling to 33.5°C was started. Clonidine and chlorpromazine were given as “rescue medication” to treat shivering. General anaesthesia was planned to be induced after cooling was complete. Rewarming was initiated at dural closure. Three patients successfully completed the protocol, cooling to 33.8°C at a median rate of 3.6 (range: 3.4-3.8) °C/h. Two patients cooled to 33.8°C but required treatment for shivering (cooling rate: 2.9 [2.8-3.1] °C/h). Four patients failed to cool adequately because of refractory shivering (cooling rate: 2.0 [1.5-2.9] °C/h). One patient did not shiver and yet failed to cool adequately (cooling rate: 0.76 °C/h). Rewarming was at a rate of 2.6 (1.2-4.3) °C/h. There were no significant complications arising from catheter placement. The combination of skin warming and pethidine was not reliable enough to be recommended for use during endovascular cooling in unanaesthetized patients.

Published
2004
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276. Supplemental oxygen does not reduce postoperative nausea and vomiting after thyroidectomy.

Author

Joris, J L, Poth, N J, Djamadar, A M, Sessler, D I, Hamoir, E E, Defêchereux, T R, Meurisse, M R, and Lamy, M L

Abstract

Supplemental intra-operative oxygen 80% halves the incidence of nausea and vomiting after open and laparoscopic abdominal surgery, perhaps by ameliorating intestinal ischaemia associated with abdominal surgery. It is unlikely that thyroid surgery compromises intestinal perfusion. We therefore tested the hypothesis that supplemental perioperative oxygen does not reduce the risk of postoperative nausea and vomiting (PONV) after thyroidectomy.

Published
2003
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277. Esmolol prevents movement and attenuates the BIS response to orotracheal intubation.

Author

Menigaux, C, Guignard, B, Adam, F, Sessler, D I, Joly, V, and Chauvin, M

Abstract

Beta-adrenergic agonists enhance behavioural and electroencephalographic arousal reactions. We explored whether adding esmolol, a short-acting beta(1)-adrenoceptor antagonist, to propofol anaesthesia modified the bispectral index (BIS) during induction of anaesthesia and orotracheal intubation.

Published
2002
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278. Is a Pre-Operative Brain Natriuretic Peptide or N-Terminal Pro–B-Type Natriuretic Peptide Measurement an Independent Predictor of Adverse Cardiovascular Outcomes Within 30 Days of Noncardiac Surgery? A Systematic Review and Meta-Analysis of Observational Studies

Author

Karthikeyan, G, Moncur, RA, Levine, O, Heels-Ansdell, D, Chan, MTV, Alonso-Coello, P, Yusuf, S, Sessler, D, Villar, JC, Berwanger, O, McQueen, M, Mathew, A, Hill, S, Gibson, S, Berry, C, Yeh, HM, and Devereaux, PJ

Subjects
cardiovascular system, cardiovascular diseases, brain natriuretic peptide, perioperative risk, perioperative myocardial infarction
Abstract

Objectives We conducted a systematic review and meta-analysis to determine if pre-operative brain natriuretic peptide (BNP) (i.e., BNP or N-terminal pro-B-type natriuretic peptide [NT-proBNP]) is an independent predictor of 30-day adverse cardiovascular outcomes after noncardiac surgery. Background Pre-operative clinical cardiac risk indices have only modest predictive power. BNP predicts adverse cardiovascular outcomes in a variety of nonsurgical settings and may similarly predict these outcomes in the perioperative setting. Methods We employed 5 search strategies (e. g., searching bibliographic databases), and we included all studies that assessed the independent prognostic value of pre-operative BNP measurement as a predictor of cardiovascular complications after noncardiac surgery. We determined study eligibility and conducted data abstraction independently and in duplicate. We calculated a pooled odds ratio using a random effects model. Results Nine studies met eligibility criteria, and included a total of 3,281 patients, among whom 314 experienced 1 or more perioperative cardiovascular complications. The average proportion of patients with elevated BNP was 24.8% (95% confidence interval [CI]: 20.1 to 30.4%; I-2 = 89%). All studies showed a statistically significant association between an elevated pre-operative BNP level and various cardiovascular outcomes (e. g., a composite of cardiac death and nonfatal myocardial infarction; atrial fibrillation). Data pooled from 7 studies demonstrated an odds ratio (OR) of 19.3 (95% CI: 8.5 to 43.7; I-2 = 58%). The pre-operative BNP measurement was an independent predictor of perioperative cardiovascular events among studies that only considered the outcomes of death, cardiovascular death, or myocardial infarction (OR: 44.2, 95% CI: 7.6 to 257.0, I-2 = 51.6%), and those that included other outcomes (OR: 14.7, 95% CI: 5.7 to 38.2, I-2 = 62.2%); the p value for interaction was 0.28. Conclusions These results suggest that an elevated pre-operative BNP or NT-proBNP measurement is a powerful, independent predictor of cardiovascular events in the first 30 days after noncardiac surgery. (J Am Coll Cardiol 2009; 54: 1599-606) (C) 2009 by the American College of Cardiology Foundation

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279. Circadian changes in the sweating-to-vasoconstriction interthreshold range

Author

Tayefeh, Farzin, Plattner, Olga, Sessler, D. I., Ikeda, Takehiko, and Marder, Danielle

Abstract

Abstract:  Thermoregulatory defenses are characterized by thresholds, the core temperatures triggering each response. Core body temperature is normally maintained within the interthreshold range, temperatures between the sweating and vasoconstriction thresholds that do not trigger autonomic defenses. This range usually spans only some 0.2C, but it remains unknown whether similar precision is maintained during the circadian core temperature cycle of about 0.8C. Accordingly, we evaluated the interthreshold range at four times of the day. We studied ten male volunteers, each at 3 a.m., 8 a.m., 3 p.m., and 8 p.m. At least 12 h elapsed between tests, and the order was randomly assigned. At each study time, volunteers were warmed peripherally until sweating was observed. Skin temperature was subsequently kept constant while core temperature was decreased by central-venous infusion of ice-cold fluid until peripheral vasoconstriction was detected. The volunteers were not permitted to sleep during threshold determinations, although sleep was not otherwise controlled. The core temperature triggering an evaporative water loss of 40 g.m–2h–1 identified the sweating threshold. Similarly, the vasoconstriction threshold was defined by the core temperature triggering the initial decreases in plethysmographic finger tip blood flow. The interthreshold range at 3 a.m. was twice that observed at the other study times (P < 0.05). Our data suggest that autonomic control of body temperature is reduced at 3 a.m., even when sleep is denied. This result contradicts the general perception that circadian variation alters the thermoregulatory target temperature, but not precision of body temperature control.

Published
1998
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281. Abstracts

Author

Crosby, E. T., Halpern, S., Bill, K. M., Flynnn, R. J., Moore, J., Navaneelan, C., Cunningham, A., Yu, P. Y. H., Gamling, D. R., McMorland, G. H., Perreault, C., Guay, J., Gaudreault, P., Hollman, C., Meloche, R., Hackman, T., Sheps, S. B., Murray, W. B., Heiman, P. A., Slinger, P., Triolet, W., Jain, U., Rao, T. L. K., Dasari, M., Pifarre, R., Sullivan, H., Calandra, D., Friesen, R. M., Bjornson, J., Hatton, G., Parlow, J. L., Casey, W. F., Broadman, L. M., Rice, L. J., Dailey, M., Andrews, W. R., Stigi, S., Jendrek, V., Shevde, K., Withington, D. E., Saoud, A. Tazi, Ramsay, J. G., Bilodeau, J., Johnson, D., Mayers, I., Doran, R. J., Wong, P. Y., Mullen, Brendan J., Wigglesworth, D., Byrick, R. J., Kay, J. Colin, Stubbing, J. F., Sweeney, B. P., Dagher, E., Dumont, L., Lagace, G., Chartrand, C., Badner, N. H., Sandier, A. N., Leitch, L., Koren, G., Erian, R. F., Bunegin, L., Shulman, D. L., Burrows, F., O’Sullivan, K., Bouchier, D., Kashin, B. A., Wynands, J. E., Villeneuve, E., Blaise, G., Guerrard, M. J., Buluran, J., Effa, E., Vaghadia, H., Jenkins, L. C., Janisse, T., Scudamore, C. H., Patel, P. M., Mutch, W. A. C., Ruta, T. S., McNeill, B. R., Murkin, J. M., Gelb, A. W., Farrar, J. K., Johnson, G. D., Adams, M. A., Lillicrap, D. P., Lindblad, T., Beattie, W. S., Buckley, D. N., Forrest, J. B., Lessard, M. R., Trépanier, C. A., Baribault, J. P., Brochu, J. G., Brousseau, C. A., Cote, J. J., Denault, P., Whang, P., Moudgil, G. C., Daly, N., Morrison, D. H., Ogilvie, R., Man, J., Ehler, T., Leitch, L. F., Dupuis, J. Y., Martin, R., Tessonnier, J. M., Barry, A. W., Milne, B., Quintin, L., Gillon, J. Y., Pujol, J. F., DeMonte, F., Zhang, C., Hamilton, J. T., Zhou, Y., Plourde, G., Picton, T. W., Kellett, A., Pilato, M. A., Bissonnette, B., Lerman, J., Brown, K. A., Dundee, J. W., Sosis, M., Dillon, F., Stetson, J. B., Voorhees, W. D., Bourland, J. D., Geddes, L. A., Shoenlein, W. E., O’Leary, G., Teasdale, S., Knill, R. L., Rose, E. A., Berko, S. L., Smith, C. E., Sadler, J. M., Bevan, J. C., Donati, F., Bevan, D. R., Tellez, J., Turner, D., Kao, Y. J., Salidivia, V., Roldan, L., Orrego, H., Carmicheal, F. J., Kent, A. P., Parker, C. J. R., Hunter, J. M., Finley, G. A., Goresky, G. V., Klassen, K., McDiarmid, C., Shaffer, E., Vaughan, M., Randolph, J., Szalados, J. E., Lazzell, V. A., Creighton, R. E., Poon, A. O., Mclntyre, B., Douglas, M. J., Swenerton, J. E., Farquharson, D. F., Landry, D., Petit, F., Riegert, D., Koch, J. P., Maggisano, R., Devitt, J. H., Jense, H. G., Dubin, S. A., Silverstein, P. I., Rodriguez, N., Wakefield, M. L., Williams, R., Dubin, S., Smith, J. J., Hofmann, V. C., Jarvis, A. P., Forbes, R. B., Murray, D. J., Dillman, J. B., Dull, D. L., Cohen, M. M., Cameron, C. B., Johnston, R. G., Konopad, E., Jivraj, K., Hunt, D., Eastley, R., Strunin, L., Fairbrass, M. J., Laganiere, S., McGilvery, M., Foster, B., Young, P., Weisel, D., Parra, L., Suarez Isla, B. A., Lopez, J. R., Hall, R. I., Hawwa, R., Kashtan, H., Edelist, G., Mallon, J., Kapala, D., Dhamee, M. Saeed, Reynolds, A. C., Olund, T., Entress, J., Kalbfleisch, J., Bell, S. D., Goldberg, M. E., Bracey, B. J., Goldhill, D. R., Bennett, M. H., Emmott, R. S., Innis, R. F., Yate, P. M., Flynn, P. J., Gill, S. S., Saunders, P. R., Geisecke, A. H., Feldman, J. M., Banner, M. J., Siriwardhana, S. A., Kawas, A., Lipton, J. L., Giesecke, A. H., Doyle, D. J., Volgyesi, G. A., Hillier, S. C., Gallagher, J., Hargaden, K., Hamil, M., Cunningham, A. J., Scott, W. A. C., Sielecka, D., Illing, L. H., Jani, K., Scarr, M., Maltby, J. R., Roy, J., McNulty, S. E., Torjman, M., Carey, C., Bracey, B., Markham, K., Durcan, J., Blackstock, D., DaSilva, C. A., Demars, P. D., Montgomery, C. J., Steward, D. J., Sessler, D. I., Laflamme, P., McDevitt, S., Kamal, G. D., Symreng, T., Tatman, D. J., Durcharme, J., Varin, F., Besner, J. G., Dyck, J. B., Chung, F., Arellano, R., Lim, G., Bailey, D. G., Bayliff, C. D., Cunningham, D. G., Ewen, A., Sheppard, S. D., Mahoney, L. T., Bacon, G. S., Rice, L. R., Newman, K., Loe, W., Toth, M., Pilato, M., Classen, K., McDiamid, C., Burrows, F. A., Irish, C. L., Casey, W., Hauser, G. J., Chan, M. M., Midgley, F. M., Holbrook, P. R., Elliott, M. E., Man, W. K., Finegan, B. A., Clanachan, A. S., Hudson, R. J., Thomson, I. R., Burgess, P. M., Rosenbloom, M., Fisher, J. M., O’Connor, J. P., Ralley, F. E., Robbins, G. R., Moote, C. A., Manninen, P. H., English, M., Farmer, C., Scott, A., White, I. W. C., Biehl, D., Donen, N., Mansfield, J., Cohen, M., Wade, J. G., Woodward, C., Ducharme, J., Gerardi, A., Mijares, A., Code, W. E., Hertz, L., Chung, A., Meier, H. M. R., Lautenschlaeger, E., Seyone, C., Wassef, M. R., Devitt, F. H., Cheng, D. C. H., Dyck, B., Chan, V. W. S., Ferrante, F. M., Arthur, G. R., Rice, L., Annallah, R. H., Etches, R. C., Loulmet, D., Lacombe, P., Hollmann, C., Tanguay, M., Blaise, G. A., Lenis, S. G., Fear, D. W., Lang, S. A., Ha, H. C., Germain, H., Neion, A., Dorian, P., Salter, D., Pollick, C., Cervenko, F., Parlow, J., Pym, J., Nakatsu, K., Elliott, D., Miller, D. R., Martineau, R. J., Ewing, D., Martineau, R. J., Knox, J. W. D., Oxorn, D. C., O’Connor, J. P., Whalley, D. G., Rogers, K. H., Kay, J. C., Mazer, C. D., Belo, S. E., Hew-Wing, P., Hew, E., Tessonier, J. M., Thibault, G., Testaert, E., Chartrand, D., Cusson, J. R., Kuchel, O., Larochelle, P., and Couture, J.

Published
1989
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282. Nitrous oxide decreases shivering threshold in rabbits less than isoflurane.

Author

Imamura, M, Matsukawa, T, Ozaki, M, Sessler, D I, Nishiyama, T, Okuyama, K, and Kumazawa, T

Abstract

Comparable minimum alveolar concentration (MAC) fractions of volatile anaesthetics produce similar thermoregulatory impairment. Nitrous oxide, however, decreases the vasoconstriction threshold less than sevoflurane or isoflurane. We tested the hypothesis that nitrous oxide also decreases shivering threshold less than isoflurane alone or in combination.

Published
2003

286. Nitrous oxide does not produce a clinically important sparing effect during closed-loop delivered propofol-remifentanil anaesthesia guided by the bispectral index: a randomized multicentre study†‡

Author

Liu, N., Le Guen, M., Boichut, N., Genty, A., Hérail, T., Schmartz, D., Khefif, G., Landais, A., Bussac, J. J., Charmeau, A., Baars, J., Rehberg, B., Tricoche, S., Chazot, T., Sessler, D. I., Fischler, M., Struys, M. M. R. F., Liu, N., Le Guen, M., Boichut, N., Genty, A., Hérail, T., Schmartz, D., Khefif, G., Landais, A., Bussac, J. J., Charmeau, A., Baars, J., Rehberg, B., Tricoche, S., Chazot, T., Sessler, D. I., Fischler, M., and Struys, M. M. R. F.

Abstract

Background Nitrous oxide (N2O) offers both hypnotic and analgesic characteristics. We therefore tested the hypothesis that N2O administration decreases the amount of propofol and remifentanil given by a closed-loop automated controller to maintain a similar bispectral index (BIS). Methods In a randomized multicentre double-blind study, patients undergoing elective surgery were randomly assigned to breathe 60% inspired N2O (N2O group) or 40% oxygen (AIR group). Anaesthesia depth was evaluated by the proportion of time where BIS was within the range of 40-60 (BIS40-60). The primary outcomes were propofol and remifentanil consumption, with reductions of 20% in either being considered clinically important. Results A total of 302 patients were randomized to the N2O group and 299 to the AIR group. At similar BIS40-60 [79 (67-86)% vs 76 (65-85)%], N2O slightly decreased propofol consumption [4.5 (3.7-5.5) vs 4.8 (4.0-5.9) mg kg−1 h−1, P=0.032], but not remifentanil consumption [0.17 (0.12-0.23) vs 0.18 (0.14-0.24) µg kg−1 min−1]. For the subgroups of men, at similar BIS40-60 [80 (72-88)% vs 80 (70-87)%], propofol [4.2 (3.4-5.3) vs 4.4 (3.6-5.4) mg kg−1 h−1] and remifentanil [0.19 (0.13-0.25) vs 0.18 (0.15-0.23) µg kg−1 min−1] consumptions were similar in the N2O vs AIR group, respectively. For the subgroups of women, at similar BIS40-60 [76 (64-84)% vs 72 (62-82)%], propofol [4.7 (4.0-5.8) vs 5.3 (4.5-6.6) mg kg−1 h−1, P=0.004] and remifentanil [0.18 (0.13-0.25) vs 0.20 (0.15-0.27) µg kg−1 min−1, P=0.029] consumptions decreased with the co-administration of N2O. Conclusions With automated drug administration titrated to comparable BIS, N2O only slightly reduced propofol consumption and did not reduce remifentanil consumption. There was a minor gender dependence, but not by a clinically important amount. Clinical trial registration This study was registered at ClinicalTrials.gov, number NCT00547209

287. Ondansetron does not reduce the shivering threshold in healthy volunteers

Author

Komatsu, R., Orhan-Sungur, M., In, J., Podranski, T., Bouillon, T., Lauber, R., Rohrbach, S., Sessler, D., Komatsu, R., Orhan-Sungur, M., In, J., Podranski, T., Bouillon, T., Lauber, R., Rohrbach, S., and Sessler, D.

Abstract

Background. Ondansetron, a serotonin-3 receptor antagonist, reduces postoperative shivering. Drugs that reduce shivering usually impair central thermoregulatory control, and may thus be useful for preventing shivering during induction of therapeutic hypothermia. We determined, therefore, whether ondansetron reduces the major autonomic thermoregulatory response thresholds (triggering core temperatures) in humans. Methods. Control (placebo) and ondansetron infusions at the target plasma concentration of 250 ng ml−1 were studied in healthy volunteers on two different days. Each day, skin and core temperatures were increased to provoke sweating; then reduced to elicit peripheral vasoconstriction and shivering. We determined the core-temperature sweating, vasoconstriction and shivering thresholds after compensating for changes in mean-skin temperature. Data were analysed using t-tests and presented as means (sds); P<0.05 was taken as significant. Results. Ondensetron plasma concentrations were 278 (57), 234 (55) and 243 (58) ng ml−1 at the sweating, vasoconstriction and shivering thresholds, respectively; these corresponded to ≈50 mg of ondansetron which is approximately 10 times the dose used for postoperative nausea and vomiting. Ondansetron did not change the sweating (control 37.4 (0.4)°C, ondansetron 37.6 (0.3)°C, P=0.16), vasoconstriction (37.0 (0.5)°C vs 37.1 (0.3)°C; P=0.70), or shivering threshold (36.3 (0.5)°C vs 36.3 (0.6)°C; P=0.76). No sedation was observed on either study day. Conclusions. Ondansetron appears to have little potential for facilitating induction of therapeutic hypothermia

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