Local anesthesia for inguinal herniorrhaphy: A survey of fifty patients

Fifty-eight consecutive herniorrhaphies under local anesthesia are analyzed with a consideration of the methods used and the results obtained.Our experience indicates that local anesthesia can be as satisfactory a method as either general or spinal anesthesia, and has certain advantages over these methods.The major disadvantage of local anesthesia is the added demand placed on the operating surgeon.Experience in the use of local anesthesia is the single most important factor for its success.     

A survey of pediatric caudal extradural anesthesia practice

Background:  Caudal extradural blockade is one of the most commonly performed procedures in pediatric anesthesia. However, there is little information available on variations in clinical practice.
Objectives:  To perform a survey of members of the Association of Paediatric Anaesthetists of Great Britain and Ireland who undertake caudal anesthesia.
Methods:  An 'online' World Wide Web questionnaire collected information on various aspects of clinical practice. The survey ran from April to June 2008.
Results:  There were 366 questionnaires completed. The majority of respondents had >5 years of pediatric experience and performed up to ten caudal extradural procedures a month. The commonest device used was a cannula (69.7%) with 68.6% using a 22G device. There was a trend toward the use of a cannula in those anesthetists with <15 years experience, while those with >15 years experience tended to use a needle. Most anesthetists (91.5%) did not believe that there was a significant risk of implantation of dermoid tissue into the caudal extradural space. The majority used a combination of clinical methods to confirm correct placement. Only 27 respondents used ultrasound. The most popular local anesthetics were bupivacaine (43.4%) and levobupivacaine (41.7%). The most common additives were clonidine (42.3%) and ketamine (37.5%). The caudal catheter technique was used by 43.6%. Most anesthetists (74%) wear gloves for a single shot caudal injection.
Conclusions:  This survey provides a snapshot of current practice and acts a useful reference for the development of enhanced techniques and new equipment in the future.     

Regional anesthesia practice in China: a survey

Study objectiveNeuraxial anesthesia has been widely used in China. Recently, Chinese anesthesiologists have applied nerve stimulator and ultrasound guidance for peripheral nerve blocks. Nationwide surveys about regional anesthesia practices in China are lacking. We surveyed Chinese anesthesiologists about regional anesthesia techniques, preference, drug selections, complications, and treatments.DesignA survey was sent to all anesthesiologist members by WeChat. The respondents can choose mobile device or desktop to complete the survey. Each IP address is allowed to complete the survey once.Main resultsA total of 6589 members read invitations. A total of 2654 responses were received with fully completed questionnaires, which represented an overall response rate of 40%. Forty-one percent of the respondents reported that more than 50% of surgeries in their hospitals were done under regional anesthesia. Most of the participants used test dose after epidural catheter insertion. The most common drug for test dose was 3-mL 1.5% lidocaine; 2.6% of the participants reported that they had treated a patient with epidural hematoma after neuraxial anesthesia. Most anesthesiologists (68.2%) performed peripheral nerve blocks as blind procedures based on the knowledge of anatomical landmarks. A majority of hospitals (80%) did not stock Intralipid; 61% of the respondents did not receive peripheral nerve block training.ConclusionsThe current survey can serve as a benchmark for future comparisons and evaluation of regional anesthesia practices in China. This survey revealed potential regional anesthesia safety issues in China.     

Spectral analysis of movement patterns during anesthesia

It remains unclear how anesthetics produce immobility, an end-point used in determining anesthetic potency. Understanding how movement (in response to noxious stimulation) is ablated by anesthetics could be aided by using spectral analysis of the high and low frequency components of complex movement patterns. We therefore applied a spectral analysis to previously published movement data from rats anesthetized with isoflurane and halothane at 0.6, 0.9, and 1.1 minimum alveolar concentration (MAC). We recorded isometric forces of hindlimb movement elicited by noxious mechanical stimulation of the hindpaw. The movement patterns were subjected to spectral analysis to determine force amplitude for each frequency component. When halothane was increased from 0.6 to 0.9 MAC, force amplitude decreased only for the lowest-frequency (<1 Hz) components, in part related to the generally lower high-frequency forces at 0.6 MAC. Between 0.6 and 0.9 MAC isoflurane amplitude was reduced for most frequencies in the 0-10 Hz range. For both halothane and isoflurane at 1.1 MAC, as expected, force amplitude substantially decreased at all frequencies. We conclude that spectral analysis is useful to describe and quantify the effects of anesthetics on complex movement patterns resulting from noxious stimuli applied during anesthesia. IMPLICATIONS: Complex movement can occur when a noxious stimulus is applied to an anesthetized animal. The frequency components of these movement patterns can be described and quantified by spectral analysis, thus providing a useful tool to investigate the immobilizing properties of anesthetics.     

Impact of remifentanil introduction on practice patterns in general anesthesia

Purpose  

The introduction of new medicine can change clinical practice patterns and may affect patient outcomes. In the present study, we investigated whether introduction of remifentanil in Japan affected the practice patterns of anesthesia.     

Glucose transport across the rat blood-brain barrier during anesthesia

The authors studied blood-brain barrier (BBB) glucose transport kinetics in awake rats and in pentobarbital- and halothane-anesthetized rats, using a 3H2O/14C-D-glucose double-indicator method corrected for cerebral blood flow at glucose concentrations from 1 to 80 mM. At normal glucose concentrations (5 mM), total brain glucose influx was unaltered by pentobarbital. In contrast, halothane attenuated glucose transport capacity from 1.9 to 0.4 mumol/g-min-1 and increased diffusional transport, Km (Michaelis constant) was decreased sixfold, from 12 to 2 mM. Halothane appears to inhibit BBB glucose transport by competing for the glucose carrier and by altering the affinity of the carrier for glucose, perhaps by altering the environment of the carrier or the carrier itself. The finding of halothane-induced increased diffusional transport of glucose across the BBB corroborates earlier reports and more recent evidence that halothane increases the permeability of the BBB to diffusional processes.     

Pediatric anesthesia practice and training in Japan: a survey

BACKGROUND: Pediatric anesthesia in Japan is in the developing stage. The aim of this study was to review pediatric anesthesia training in Japan and to discuss the future prospects for this field. METHODS: We sent questionnaires to assess current pediatric anesthetic practice and training to all 106 university hospitals [UHs; response rate, 66% (70/106)] and all 17 children's hospitals [CHs; response rate, 87.5% (15/17)] in Japan. We also sent questionnaires to assess attitudes towards pediatric anesthetic training, to all 280 representatives of the Japanese Society of Anesthesiologists [JSA; response rate, 57.9% (162/280)]. RESULTS: The hospital survey revealed the number of pediatric anesthesia cases encountered in 15 CHs (25,009 cases) to be almost equivalent to that in 70 UHs (29,031 cases). In 19 of these UHs, there were no newborn surgical cases. Forty-nine UHs reported that no special training program existed for pediatric anesthesia, and only five UHs mandated training at CHs. Sixty-six percent of the representative JSA members considered it premature for pediatric anesthesia to become a subspecialty, but 87% considered experience in pediatric anesthesia mandatory for anesthesia board qualification. CONCLUSIONS: This survey revealed that although pediatric anesthesia training is considered mandatory, university hospitals lack adequate numbers of pediatric cases and children's hospitals suffer from a shortage of staff positions and anesthesiologists, and hence are unable to satisfy this demand. Most representative members of our society consider it too early to subspecialize pediatric anesthesia in Japan.     

Pediatric anesthesia practice in France: a survey of 1,526 anesthesiologists

OBJECTIVES: To assess the individual activity of anaesthetists in paediatric anaesthesia (PA), and collect their wishes about continuing education and recommendations in PA. STUDY DESIGN: Transversal, prospective study. METHODS: A questionnaire of 33 items, sent to 4,360 anaesthetists, spread over 15 health districts, working in a public or private institution. RESULTS: We gathered 1,526 replies (35%) of which 34% university hospitals, 32% public institutions and 31% private institutions. 943 physicians (63%) had no specific structure, and 1,119 (87%) considered a specialized nurse to be essential for PA. 1,127 physicians (74%) had undertaken a specific session during their formation. The practice of PA depends upon age and context. Above 1 year old, the surgery that is performed weekly was ENT (38%), abdominal and urologic surgery (28%). Mask induction was performed by 60% of the physicians in children under 5 years. 63% of the anaesthetists dreaded a laryngospasm during induction. 625 physicians undertook regional anaesthesia in children under 5 years (87% caudal anaesthesia, 48% peripheral nerve blocks). 1,029 physicians (67%) wished for recommendations in PA in children under 12 months. CONCLUSIONS: This survey showed that most of the anaesthetists wished for recommendations in their paediatric anaesthesia practice.     

A survey of labor patient-controlled epidural anesthesia practice in California hospitals

BACKGROUND: Patient-controlled epidural analgesia (PCEA) offers many advantages over continuous epidural infusions for labor analgesia including fewer physician interventions, improved analgesia and satisfaction, and reduced local anesthetic doses. However, anesthesiologists have been slow to adopt this technique, first described in 1988. No previous studies have evaluated specific labor patient-controlled epidural analgesia practices in the United States. The aim of this study was to determine labor epidural and patient-controlled epidural analgesia practices among California hospitals. METHODS: Following institutional review board exemption approval, an online survey was created using freeonlinesurveys.com. An anonymous survey was sent via e-mail to 230 California Society of Anesthesiologists' members chosen at random to represent their hospitals' labor analgesia practices. RESULTS: We received 133 replies from the 230 survey requests sent, a 58% response rate. The median labor epidural rate among the hospitals involved was 65% (range 0-95%). Overall, only 25% of California hospitals use patient-controlled epidural analgesia for analgesia in labor, with greater use among hospitals with dedicated obstetric anesthesia coverage and larger numbers of deliveries. Reasons given for not using patient-controlled epidural analgesia include cost, clinician preference, safety concerns and the inconvenience of change. CONCLUSIONS: Despite the potential advantages of patient-controlled epidural analgesia over continuous epidural infusions for labor analgesia, patient-controlled epidural analgesia has not been widely adopted in California hospitals. Education regarding this technique is needed to encourage its increased use.     

Thermal balance and tremor patterns during epidural anesthesia

Five healthy, nonpregnant volunteers were studied before and after induction of lumbar epidural anesthesia to determine the cause of central hypothermia during epidural anesthesia. Cutaneous heat loss was measured from 10 area-weighted sites using thermal flux transducers. Oxygen consumption was measured and converted to heat production in watts (W). After a 2-h control period at approximately 20 degrees C, epidural anesthesia was induced by injection of 30-50 ml 3% chloroprocaine. Additional boluses were given to extend the sensory blockade to at least the T5 dermatome. Tremor during epidural anesthesia was compared with normal shivering induced by rapid central venous infusion of approximately 4 l iced saline in six unanesthetized volunteers. Average skin temperature and cutaneous heat loss decreased during the control period, while tympanic membrane temperature remained stable. During the 1st h of epidural blockade, tympanic membrane temperature decreased 1.1 +/- 0.3 degrees C, and average skin temperature increased 0.9 +/- 0.5 degrees C. Cutaneous heat loss increased 16 +/- 6% (15 +/- 5 W), but metabolic heat production increased even more (and was associated with a shivering-like tremor). Tremor during epidural anesthesia and shivering induced by iced saline infusion had similar synchronous waxing-and-waning patterns. No abnormal EMG patterns were detected during epidural anesthesia. We conclude that central hypothermia during the 1st h of epidural anesthesia does not result from heat loss to the environment in excess of metabolic heat production, but results primarily from redistribution of body heat from central to peripheral tissues. Analysis of the tremor patterns suggests that oscillations recorded during epidural anesthesia in nonpregnant individuals is normal thermoregulatory shivering. Shivering occurred sooner and was more intense during iced saline infusion than during epidural anesthesia, despite comparable central hypothermia. The low intensity of shivering during epidural anesthesia, and in some individuals the delay in onset, may result from blockade of afferent cutaneous cold signals.     

Local anesthesia for cesarean section

Local infiltration anesthesia as a primary technique for cesarean section is very rarely used and is not even briefly mentioned in some modern textbooks. Most of our references come from the third world countries where there may be a single operator and a lack of anesthetic personnel, equipment, and supplies. It has been used as recently as 1996 in the United Kingdom (Leeds) and 1999 in India. Admittedly, there are but few indications for this technique in modern anesthetic practice. The indications, 3 techniques, and complications of this method of analgesia have been described. All anesthetic techniques used for cesarean section carry their own special hazards. This particular technique may be useful when general or regional anesthesia is contraindicated. Although there are limitations on the surgical technique-no packs, no retractors, gentleness on the part of the operator, and avoidance of sudden movement-the surgery has been performed successfully on several occasions. Copyright © 2001 by W.B. Saunders Company     

Surgical standby for percutaneous transluminal coronary angioplasty: a survey of patterns of practice

To determine patterns of surgical standby for percutaneous transluminal coronary angioplasty (PTCA), a questionnaire was mailed to 196 US institutions in which PTCA and coronary artery bypass grafting (CABG) are performed regularly. Eighty-nine responses (46%) were received and comprise this report. Of responding institutions, the mean number of hospital beds was 615. In 1987, these institutions performed a mean of 337 PTCAs and 558 open-heart surgical procedures. The rate of emergency CABG for PTCA complications (occlusion, dissection, or coronary perforation) was 4.4% +/- 0.3%, whereas the rate of urgent CABG (within 24 hours) for PTCA failure was 3.7 +/- 0.6%. The incidence of emergency CABG for PTCA complications was higher (5.1% +/- 0.6%) among low-volume PTCA centers (less than 250 cases per year) than at high-volume centers (more than 250 cases per year) (3.7% +/- 0.3%; p less than 0.05). The most common pattern of surgical backup was to maintain an open operating room on standby (57/89, 64%), and the second most common pattern was to make the next open operating room available, allowing operating room access within 1 to 3 hours (21/89, 24%). Nearly a third of institutions (26/89, 29%) maintained a flexible backup arrangement according to PTCA risk. Routine pre-PTCA patient evaluation by surgeon and/or anesthesiologist occurred in 38% (34/89). Fees for standby services were charged by 51% of surgical teams (45/89), 39% of anesthesia teams (35/89), and 38% of operating room facilities (34/89).(ABSTRACT TRUNCATED AT 250 WORDS)