Percutaneous infraclavicular subclavian vein catheterization in critically ill infants and children

The safety and risks of percutaneous infraclavicular subclavian vein catheterization, when performed by nonsurgical staff, were studied prospectively in 100 consecutive patients. The overall success rate was 92% (with one attempt, 45%; with two attempts, 85%). The procedure was performed under emergency conditions in 35% of the patients, with a success rate of 88.6%. The success rate was significantly lower in younger patients. Hemodynamic status, respiratory status, and level of expertise of the individual performing catheterization did not affect success rate. Most of the failures (six of eight) were related to presumed thrombosis from prior cannulation of the superior vena cava. Mean duration of catheterization was 7.5 +/- 5.8 days (+/- SD). Minor complications (n = 24) included hematomas, minor bleeding from subclavian artery puncture, and transient premature ventricular ectopic beats. Major complications (n = 6) were pneumothoraces (n = 4) and catheter-related infection (n = 2). The number of attempts made to catheterize the vessel and the level of expertise of the operator had the greatest effect on complication rates. No mortality was associated with this procedure. We have found percutaneous infraclavicular subclavian vein catheterization to be a rapid alternative to surgical cutdown for venous access during cardiopulmonary resuscitation. Pediatric residents can be trained, under direct supervision, to perform this procedure with a high success rate and a low complication rate.     

Anesthetic and recovery profiles of lidocaine versus mepivacaine for spinal anesthesia in patients undergoing outpatient orthopedic arthroscopic procedures

Study ObjectiveTo compare isobaric lidocaine and mepivacaine in outpatient arthroscopic surgery.DesignProspective, randomized, double-blinded study.SettingAmbulatory surgery center affiliated with an academic tertiary-care hospital.Patients84 adult, ASA physical status 1, 2, and 3 ambulatory patients, age 18-70 years, undergoing arthroscopic knee surgery.InterventionPatients were randomized to receive a combination spinal-epidural anesthetic using 80 mg of either isobaric 2% mepivacaine or isobaric 2% lidocaine. Patients also received a femoral 3-in-1 block with 0.5% bupivacaine applied to the affected extremity.MeasurementsDemographic data and level and duration of the block were recorded. The use of supplemental epidural anesthesia was noted along with frequency of bradycardia, hypotension, and episodes of nausea and vomiting. Duration of block and times to ambulation and voiding were recorded. Delayed variables, including fatigue, difficulty urinating, back pain, and transient neurologic symptoms (TNS) were obtained.Main ResultsNo demographic differences were noted between groups, and surgical duration was similar. Satisfactory anesthesia was achieved in all cases, with no differences noted in hypotension, bradycardia, nausea, or vomiting. Onset of sensory and motor block was similar. Duration of block before epidural supplementation was 94 ± 21 minutes with lidocaine versus 122 ± 23 minutes for mepivacaine (P < 0.011). Times to ambulation and voiding were longer in patients receiving mepivacaine but did not affect PACU stay. Twenty-four and 48-hour recovery was similar with no TNS symptoms reported.ConclusionNo major differences were noted between lidocaine and mepivacaine spinal anesthesia. Time to ambulation and voiding were longer in patients who received mepivacaine as was time to first dose of epidural catheter. Neither group had TNS symptoms. Lidocaine and mepivacaine are both appropriate spinal anesthetics for ambulatory orthopedic lower extremity procedures.     

Inhibition of p38 mitogen-activated protein kinase protects human islets from cryoinjury and improves the yield, viability, and quality of frozen-thawed islets

The development of an optimal islet cryopreservation method will permit transplantation of islets from multiple donors in a single procedure and contribute to alleviation of the islet shortage. In this study, we have improved human islet cryopreservation methods under serum-free conditions using an intracellular-based islet cryopreservation solution (ICS), especially supplemented with a p38 pathway inhibitor (p38IH) to suppress p38 mitogen-activated protein kinase (MAPK) activation. Three different solutions were compared for freezing and thawing of human islets (1) conventional RPMI1640 medium, (2) ICS, and (3) ICS supplemented with a p38IH, SD-282 (ICS-p38IH). Islet cryopreservation with ICS-p38IH significantly improved islet recovery, viability, and quality after thawing of cryopreserved islets. This improvement may allow the use of cryopreserved islets in clinical islet transplantation.     

Nerve anastomosis with glue: comparative histologic study of fibrin and cyanoacrylate glue

The authors report the results of a comparative experimental nerve study, using a biologic tissue glue (fibrin) and a synthetic glue (2-cyanoacrylate) in a rat model. A tension-free repair is necessary with the use of fibrin glue, or gapping may occur, thus limiting the use of the agent in promoting re-neurotization. In addition, the human origin of fibrin and thrombin allow for the possibility of viral transmission. The aim of the study was to verify if the synthetic glue is a viable alternative, or whether it causes cellular and tissue lesions. Their main finding was that the cyanoacrylate causes a foreign-body inflammatory reaction and retractile fibrosis, often reducing the nerve diameter up to two-thirds. Cyanoacrylate glue is thus not recommended for peripheral nerve repair.     

Gabapentin pharmacokinetics and feasibility in cardiac surgery

Canadian Journal of Anesthesia/Journal canadien d'anesthésie -