MedWorm: Anesthesiology

Sugmmadex reverses vecuronium-induced NMB faster than neostigmine

MedWire News - Anesthesiology — Fri, 06 Nov 2009 13:41:46 +0100

Sugammadex provides significantly faster reversal of vecuronium-induced neuromuscular blockade than neostigmine, research results show. (Source: MedWire News - Anesthesiology)

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Acetaminophen May Be Linked To Asthma In Children And Adults

Pain / Anesthetics News From Medical News Today — Fri, 06 Nov 2009 08:00:00 +0100

New research shows that the widely used pain reliever acetaminophen may be associated with an increased risk of asthma and wheezing in both children and adults exposed to the drug. Researchers from the University of British Columbia, Vancouver, BC, Canada, conducted a systematic review and metaanalysis of 19 clinical studies (total subjects=425,140) that compared the risk of asthma or wheezing with acetaminophen exposure. (Source: Pain / Anesthetics News From Medical News Today)

Health Tip: What's Behind Hip Bursitis?

MedicineNet Chronic Pain General — Fri, 06 Nov 2009 07:00:00 +0100

Title: Health Tip: What's Behind Hip Bursitis?Category: Health NewsCreated: 11/6/2009 8:10:00 AMLast Editorial Review: 11/6/2009 (Source: MedicineNet Chronic Pain General)

Osteomyelitis

MedicineNet Chronic Pain General — Fri, 06 Nov 2009 07:00:00 +0100

Title: OsteomyelitisCategory: Diseases and ConditionsCreated: 11/6/2009 5:06:00 PMLast Editorial Review: 11/6/2009 5:06:05 PM (Source: MedicineNet Chronic Pain General)

rFVIIa lessens bleeding after cardiac surgery

MedWire News - Anesthesiology — Fri, 06 Nov 2009 00:00:00 +0100

Recombinant activated factor VII may be beneficial for treating bleeding after cardiac surgery, preliminary research suggests. (Source: MedWire News - Anesthesiology)

PPIs can be used with thienopyridines

MedWire News - Anesthesiology — Fri, 06 Nov 2009 00:00:00 +0100

Clinicians do not need to avoid concomitant use of proton pump inhibitors during percutaneous coronary intervention surgery in acute coronary syndrome patients receiving clopidogrel or prasugrel, study findings indicate. (Source: MedWire News - Anesthesiology)

Stroke volume variation fails to predict fluid responsiveness in abdominal surgery

MedWire News - Anesthesiology — Fri, 06 Nov 2009 00:00:00 +0100

Measuring stroke volume variation using the FloTrac/Vigileo system does not reliably predict fluid responsiveness in patients undergoing major abdominal surgery, researchers report. (Source: MedWire News - Anesthesiology)

Comparison of fibrescope guided intubation via the classic laryngeal mask airway and i-gel in a manikin*

Anaesthesia — Fri, 06 Nov 2009 00:00:00 +0100

We compared the classic laryngeal mask airway and i-gel as adjuncts to fibrescope guided intubation in a manikin. Two methods of intubation were compared with each device: the tracheal tube directly over the fibrescope; and the tracheal tube over an Aintree Intubation Catheter. Thirty-two anaesthetists took part in this randomised crossover study. Each anaesthetist performed two intubations with each method via each device. The mean (SD) time for the first intubation using the tracheal tube over the fibrescope was 43 (24) s with the classic laryngeal mask airway and 22 (9) s with the i-gel (95% CI for the difference 12[ndash]30 s, p < 0.0001). The mean (SD) times for the first intubation when using the Aintree Intubation Catheter was 46 (24) s with the classic laryngeal mask airway and 37 ...

Radiation Therapy Technique Successfully Treats Pain In Patients With Advanced Cancer

Pain / Anesthetics News From Medical News Today — Thu, 05 Nov 2009 08:00:00 +0100

Stereotactic radiosurgery (SRS), a radiation therapy procedure pioneered at the University of Pittsburgh Cancer Institute (UPCI) that precisely delivers a large dose of radiation to tumors, effectively controls pain in patients with cancer that has spread to the spine, according to researchers from UPCI. The results of the research were presented this week during the American Society for Radiation Oncology (ASTRO) annual meeting in Chicago, being held November 1 - 5, 2009. (Source: Pain / Anesthetics News From Medical News Today)

MTRAC verdict: Oxycodone + naloxone in severe pain

NeLM - Pain control — Thu, 05 Nov 2009 00:00:00 +0100

Source: MTRAC Area: Evidence > Drug Specific Reviews The Midlands Therapeutics Review and Advisory Committee (MTRAC) has reviewed the evidence on oxycodone + naloxone combination prolonged release tablets (Targinact®) for the management of severe pain. The Committee concluded that oxycodone/naloxone prolonged-release tablets were suitable for prescribing in primary care for patients with severe opioid responsive pain who have persistent constipation despite standard laxative treatment. The evidence for efficacy and safety is relatively weak, and it has not been compared to the standard first-line treatment of an opioid plus a laxative. Oxycodone is an established strong opioid used for treatment of severe pain, and has the usual adverse effects of this group, includ...

MTRAC verdict: Duloxetine in pain due to diabetic peripheral neuropathy

NeLM - Pain control — Thu, 05 Nov 2009 00:00:00 +0100

Source: MTRAC Area: Evidence > Drug Specific Reviews The Midlands Therapeutics Review and Advisory Committee (MTRAC) has reviewed the evidence on duloxetine (Cymbalta®) for diabetic peripheral neuropathic pain in adults. The Committee concluded that duloxetine is suitable for primary care prescribing in this situation. It noted that the evidence for benefit was relatively strong, and that a draft NICE guideline recommends it for first-line use. Duloxetine had been assessed in this indication in three placebo-controlled trials, reducing 24-hour pain scores to a significantly greater degree than placebo in all three. There were also benefits in a number of secondary outcomes. Adverse effects including somnolence, dizziness, fatigue, and gastro-intestinal disturb...

Bispectral index during cardiopulmonary resuscitation: a poor indicator of recovery. Two very different cases

Anaesthesia — Thu, 05 Nov 2009 00:00:00 +0100

We report two cases of massive intra-operative bleeding during lung transplantation requiring emergency cardiopulmonary bypass. In both cases the bispectral index dropped to 0, remained low for around 30 and 90 min respectively, and then returned to values consistent with a usual anaesthetic state (around 40). At the time bispectral monitoring provided some reassurance to the medical team about the adequacy of the resuscitation. However, this proved misleading since postoperative neurological recovery was favourable in one case but not in the other. (Source: Anaesthesia)

Protocol for the "Michigan Awareness Control Study": A prospective, randomized, controlled trial comparing electronic alerts based on bispectral index monitoring or minimum alveolar concentration for the prevention of intraoperative awareness

BMC Anesthesiology — Thu, 05 Nov 2009 00:00:00 +0100

Background: The incidence of intraoperative awareness with explicit recall is 1-2/1000 cases in the United States. The Bispectral Index monitor is an electroencephalographic method of assessing anesthetic depth that has been shown in one prospective study to reduce the incidence of awareness in the high-risk population. In the B-Aware trial, the number needed to treat in order to prevent one case of awareness in the high-risk population was 138. Since the number needed to treat and the associated cost of treatment would be much higher in the general population, the efficacy of the Bispectral Index monitor in preventing awareness in all anesthetized patients needs to be clearly established. This is especially true given the findings of the B-Unaware trial, which demonstrated no significant ...

How Safe Are Popular Reflux Drugs?

MedicineNet Chronic Pain General — Wed, 04 Nov 2009 07:00:00 +0100

Title: How Safe Are Popular Reflux Drugs?Category: Health NewsCreated: 11/4/2009 8:10:00 AMLast Editorial Review: 11/4/2009 (Source: MedicineNet Chronic Pain General)

[Is less always more? : Modalities of extended haemodynamic monitoring for single-lung ventilation.]

Der Anaesthesist — Wed, 04 Nov 2009 00:00:00 +0100

Authors: Rex S PMID: 19885648 [PubMed - as supplied by publisher] (Source: Der Anaesthesist)

The effect of pre-emptive use of minimal dose fentanyl on fentanyl-induced coughing

Anaesthesia — Wed, 04 Nov 2009 00:00:00 +0100

We performed a randomised, double-blind study to evaluate the effect of the pre-emptive use of minimal dose intravenous fentanyl (25 [mu]g) on the incidence of cough caused by a larger bolus of intravenous fentanyl. Six hundred patients were randomly assigned to one of three groups to receive either 0.5 ml saline 0.9% 1 min before administration of fentanyl 150 [mu]g (3 ml), or pre-emptive fentanyl 25 [mu]g (0.5 ml) 1 min before administration of fentanyl 125 [mu]g or 150 [mu]g. The incidence of fentanyl-induced cough was significantly lower in both pre-emptive groups (7 (3.5%) for 125 [mu]g fentanyl and 15 (7.5%) for 150 [mu]g fentanyl) than in the saline group (37 (18.5%); p = 0.001). We conclude that pre-emptive use of fentanyl 25 [mu]g, administered 1 min before bolus injection of fent...

The impact of computerised physician order entry on prescribing practices in a cardiothoracic intensive care unit*

Anaesthesia — Wed, 04 Nov 2009 00:00:00 +0100

This prospective, time series, cross-sectional study was designed to compare the quality of handwritten vs computerised prescriptions in a tertiary 25-bedded cardiothoracic intensive care unit. A total of 14 721 prescriptions for 613 patients were analysed over three periods of investigation: 7 months before; and 5 and 12 months after implementation of a clinical information system with computerised physician order entry capability. Errors in prescribing were common. Only (53%) of handwritten charts analysed had all immediate administration drugs prescribed correctly. Errors included omission of route 81 (8.0%), date of prescription 78 (7.7%), and time to be given 255 (25.2%), and 119 (11.7%) had no dose or an incorrect dose prescribed. All errors of completeness were abolished following i...

Monitoring of haemostasis in liver transplantation: comparison of laboratory based and point of care tests

Anaesthesia — Wed, 04 Nov 2009 00:00:00 +0100

During orthotopic liver transplanatation haemostasis is often disturbed and coagulation monitoring is mandatory. We compared the results obtained by whole blood prothrombin time and activated partial thromboplastin time assays (Hemochron®) and thrombelastometry (ROTEM® 05) with laboratory coagulation assays (prothrombin time, activated partial prothrombin time, fibrinogen, and platelet count) in samples obtained during orthotopic liver transplantations. Determination of prothrombin time and activated partial prothrombin time using the Hemochron device showed good correlation with laboratory coagulation assays (r = 0.912, p < 0.001, and r = 0.794, p < 0.001). Maximum clot firmness as determined by thrombelastometry correlated well with platelet count (r = 0.779, p < 0.001) and, to a lesse...

HLA-DR expression and differential trafficking of monocyte subsets following low to intermediate risk surgery*

Anaesthesia — Wed, 04 Nov 2009 00:00:00 +0100

Reduced HLA-DR expression on monocytes has been suggested as a predictive marker of immunosuppression following very high risk surgery, but there are few reports in lower risk surgery. In 32 patients undergoing low to intermediate risk surgery, blood samples were analysed by flow cytometry for HLA-DR expression and numbers in both CD14high and CD14lowCD16+ monocyte subsets. The numbers of CD14high monocytes increased at 24 h (mean (SD), 5.0 (2.2) vs 7.6 (3.9) × 105 cells.ml[minus]1; p < 0.01) while CD14lowCD16+ monocytes decreased (0.68 (0.36) vs 0.44 (0.36) × 105 cells.ml[minus]1; p < 0.01). HLA-DR expression was significantly reduced in both subsets by 24 h (mean (SD) fluorescent intensity 440 (310) vs 160 (130) for CD14high and 1000 (410) vs 560 (380) for CD14lowCD16+ subsets; p < 0.0...

APA national audit of pediatric opioid infusions

Pediatric Anesthesia — Wed, 04 Nov 2009 00:00:00 +0100

Conclusions: The overall incidence of 1 : 10 000 of serious harm with opioid infusion techniques in children is comparable to the risks with pediatric epidural infusions and central blocks identified by two recent UK national audits (1,2). Avoidable factors were identified including prescription and pump programming errors, use of concurrent sedatives or opioids by different routes and overgenerous dosing in infants. Early respiratory depression in patients with specific risk factors, such as young age, neurodevelopmental, respiratory, or cardiac comorbidities, who are receiving nurse-controlled analgesia or continuous opioid infusion suggests that closer monitoring for at least 2 h is needed for these cases. As a result of this audit, we can provide parents with better information on rela...

Restless Legs May Vary by Race and Gender

MedicineNet Chronic Pain General — Tue, 03 Nov 2009 07:00:00 +0100

Title: Restless Legs May Vary by Race and GenderCategory: Health NewsCreated: 11/2/2009 2:10:00 PMLast Editorial Review: 11/3/2009 (Source: MedicineNet Chronic Pain General)

Clinical review: Pain management and sedation for children in the emergency department

NeLM - Pain control — Mon, 02 Nov 2009 00:00:00 +0100

Source: BMJ Area: News The authors of this review article provide an overview of published evidence to help clinicians assess, manage, and minimise pain in children presenting to hospital. The following questions are addressed: . How is acute pain best assessed in children? . What is the role of non-pharmacological methods in paediatric pain relief? . What is the best initial choice of analgesic drug? . How can procedures be carried out without causing further pain? . Which topical anaesthetics are available for cannulation and venepuncture? . What are the topical, local, or regional anaesthesia options for wounds and injuries? . Does procedural sedation have a role in painful emergency procedures in children? (Source: NeLM - Pain contro...

Editorial Board

European Journal of Pain — Sun, 01 Nov 2009 00:00:00 +0100

(Source: European Journal of Pain)

Redistribution of Tissue Blood Flow After Stellate Ganglion Block in the Rabbit

Regional Anesthesia and Pain Medicine — Sun, 01 Nov 2009 00:00:00 +0100

Conclusions: These results indicate that lower limb and visceral blood flow as well as blood flow on the nonblock side are redistributed to the block side after SGB. Redistribution from peripheral tissue may have a more important role than that of visceral blood flow redistribution after SGB. (C)2009 American Society of Regional Anesthesia and Pain Medicine (Source: Regional Anesthesia and Pain Medicine)

Less Urinary Tract Infection by Earlier Removal of Bladder Catheter in Surgical Patients Receiving Thoracic Epidural Analgesia

Regional Anesthesia and Pain Medicine — Sun, 01 Nov 2009 00:00:00 +0100

Conclusions: Leaving the bladder catheter as long as the epidural analgesia is maintained results in a higher incidence of UTI and prolonged hospital stay. Removal of the bladder catheter on the morning after surgery does not lead to higher rate of catheterizations. (C)2009 American Society of Regional Anesthesia and Pain Medicine (Source: Regional Anesthesia and Pain Medicine)

Preliminary Results of the Australasian Regional Anaesthesia Collaboration: A Prospective Audit of More Than 7000 Peripheral Nerve and Plexus Blocks for Neurologic and Other Complications

Regional Anesthesia and Pain Medicine — Sun, 01 Nov 2009 00:00:00 +0100

Conclusions: These results indicate that the incidence of serious complications after peripheral nerve blockade is uncommon and that the origin of neurologic symptoms/signs in the postoperative period is most likely to be unrelated to nerve blockade. (C)2009 American Society of Regional Anesthesia and Pain Medicine (Source: Regional Anesthesia and Pain Medicine)

Ultrasound in Regional Anesthesia: Where Should the "Focus" Be Set?

Regional Anesthesia and Pain Medicine — Sun, 01 Nov 2009 00:00:00 +0100

No abstract available (Source: Regional Anesthesia and Pain Medicine)

Effect of neck movement on endotracheal tube position.

Canadian Journal of Anaesthesia — Sat, 31 Oct 2009 00:00:00 +0100

Authors: Rai E PMID: 19882197 [PubMed - as supplied by publisher] (Source: Canadian Journal of Anaesthesia)

Persistency and pathway of isoflurane-induced inhibition of superoxide production by neutrophils.

Canadian Journal of Anaesthesia — Sat, 31 Oct 2009 00:00:00 +0100

CONCLUSIONS: Isoflurane administration caused prolonged (from 24 to 48 hr) decreases in agonist-induced SOP by neutrophils. This effect involved inhibition at site(s) in the signalling pathway upstream from protein kinase C. The current findings suggest that the intraoperative use of isoflurane may result in an extended impairment to the antibacterial host defense mechanism and that neutrophil inhibition may play a role in the delayed tissue protection afforded by treatment with volatile anesthetics. PMID: 19882198 [PubMed - as supplied by publisher] (Source: Canadian Journal of Anaesthesia)

Comparison of a single-use GlideScope((R)) Cobalt videolaryngoscope with a conventional GlideScope((R)) for orotracheal intubation.

Canadian Journal of Anaesthesia — Sat, 31 Oct 2009 00:00:00 +0100

CONCLUSIONS: The GlideScope((R)) Cobalt has similar performance characteristics compared with the conventional GlideScope((R)) videolaryngoscope when used for orotracheal intubation. The two devices can likely be used interchangeably. (ClinicalTrials.gov number, NCT00459797.). PMID: 19882199 [PubMed - as supplied by publisher] (Source: Canadian Journal of Anaesthesia)

Better Drug Emerges for Steroid-Induced Bone Loss

MedicineNet Chronic Pain General — Fri, 30 Oct 2009 07:00:00 +0100

Title: Better Drug Emerges for Steroid-Induced Bone LossCategory: Health NewsCreated: 10/29/2009 12:10:00 PMLast Editorial Review: 10/30/2009 (Source: MedicineNet Chronic Pain General)

Study Eases Arthritis Drug Cancer Fears

MedicineNet Chronic Pain General — Fri, 30 Oct 2009 07:00:00 +0100

Title: Study Eases Arthritis Drug Cancer FearsCategory: Health NewsCreated: 10/30/2009 10:05:00 AMLast Editorial Review: 10/30/2009 10:05:56 AM (Source: MedicineNet Chronic Pain General)

[Wernicke's encephalopathy presenting as unexplained coma with hyperlactatemia.]

Annales Francaises d'Anesthesie et de Reanimation — Fri, 30 Oct 2009 00:00:00 +0100

Authors: Faivre A, Lacroix G, Montcriol A, Lafolie T, Meaudre E PMID: 19880270 [PubMed - as supplied by publisher] (Source: Annales Francaises d'Anesthesie et de Reanimation)

Prévention des infections nosocomiales en réanimation (transmission croisée et nouveau-né exclus).

Annales Francaises d'Anesthesie et de Reanimation — Fri, 30 Oct 2009 00:00:00 +0100

Prévention des infections nosocomiales en réanimation (transmission croisée et nouveau-né exclus). Ann Fr Anesth Reanim. 2009 Oct 30; Authors: PMID: 19880271 [PubMed - as supplied by publisher] (Source: Annales Francaises d'Anesthesie et de Reanimation)

Infusion of hypertonic saline/starch during cardiopulmonary bypass reduces fluid overload and may impact cardiac function

Acta Anaesthesiologica Scandinavica — Fri, 30 Oct 2009 00:00:00 +0100

This study aimed to confirm an improvement of cardiopulmonary function by reducing fluid loading during an open-heart surgery. Forty-nine elective CABG patients were randomized to an intraoperative infusion of hypertonic saline/hydroxyethyl starch (HSH group) or Ringer's solution (CT group). Both groups received 1 ml/kg/h of the study solution for 4 h after baseline values were obtained (PICCO® transpulmonary thermodilution technique). Net fluid balance (NFB), hemodynamic and laboratory parameters were measured. NFB was four times higher in the CT group compared with the HSH group during the first 6 h post-operatively. The total fluid gain until the next morning was lower in the HSH group, 2993.9 (938.6) ml, compared with the CT group, 4298.7 (1059.3) ml (P (Source: Acta Anaesthesiologica...

Overdose Deaths in Washington Medicaid Enrollees on the Rise

MedPage Today Pain Management — Thu, 29 Oct 2009 19:39:44 +0100

Medicaid patients in the Washington area made up nearly half of overdose deaths involving prescription opioids, a report from several health and human service agencies in Washington said. (Source: MedPage Today Pain Management)

Surgical treatment of non-insertional achilles tendinitis.

Pain Physician — Thu, 29 Oct 2009 11:54:09 +0100

Authors: Murphy GA Noninsertional Achilles tendinitis is a distinct clinical entity, frequently characterized by swelling, pain, and lower limb dysfunction. This condition can be frustrating to treat, for the patient and the physician alike, as reflected in the various treatments, both conservative and surgical, that have been described. Although many patients with Achilles tendinitis can be successfully treated with nonoperative methods, persistent symptoms require surgical treatment, such as tenotomy, debridement, or repair. PMID: 19857839 [PubMed - in process] (Source: Pain Physician)

Pharmaceutical Society Of Australia Supports Draft National Pain Strategy

Pain / Anesthetics News From Medical News Today — Thu, 29 Oct 2009 10:00:00 +0100

The Pharmaceutical Society of Australia (PSA) has welcomed the release of the initial draft of the National Pain Strategy. PSA National Vice President and the only pharmacy representative on to the National Pain Summit Leaders' Meeting, Dr Lisa Nissen, said that PSA supported the intent of the draft strategy and looked forward to seeing the strategy finalised. (Source: Pain / Anesthetics News From Medical News Today)

Tai Chi May Help Ward Off Knee Pain in Seniors

MedicineNet Chronic Pain General — Thu, 29 Oct 2009 07:00:00 +0100

Title: Tai Chi May Help Ward Off Knee Pain in SeniorsCategory: Health NewsCreated: 10/29/2009 8:10:00 AMLast Editorial Review: 10/29/2009 (Source: MedicineNet Chronic Pain General)

New Clues to How Fish Oils Help Arthritis Patients

MedicineNet Chronic Pain General — Thu, 29 Oct 2009 07:00:00 +0100

Title: New Clues to How Fish Oils Help Arthritis PatientsCategory: Health NewsCreated: 10/28/2009 2:10:00 PMLast Editorial Review: 10/29/2009 (Source: MedicineNet Chronic Pain General)

Takes a Pro to Make Offices Pain-Free

MedicineNet Chronic Pain General — Thu, 29 Oct 2009 07:00:00 +0100

Title: Takes a Pro to Make Offices Pain-FreeCategory: Health NewsCreated: 10/28/2009 12:10:00 PMLast Editorial Review: 10/29/2009 (Source: MedicineNet Chronic Pain General)

[Elderly, loneliness, vulnerability and consent to care.]

Annales Francaises d'Anesthesie et de Reanimation — Thu, 29 Oct 2009 00:00:00 +0100

Authors: Dourthe C, Cotty E, Bécot-Mahaud S, Bonnin E, Boulanger S, Delcampo MP, Schreiner AS PMID: 19879718 [PubMed - as supplied by publisher] (Source: Annales Francaises d'Anesthesie et de Reanimation)

Tracheal intubation with the AirwayScope videolaryngoscope using straight vs curved reinforced tubes.

Canadian Journal of Anaesthesia — Thu, 29 Oct 2009 00:00:00 +0100

Authors: Minonishi T, Kinoshita H, Tange K, Hatakeyama N, Matsuda N, Azma T, Hatano Y PMID: 19866244 [PubMed - as supplied by publisher] (Source: Canadian Journal of Anaesthesia)

Evidence-based medicine for lung-protective ventilation: the emperors new clothes for doubtful recommendations?

Acta Anaesthesiologica Scandinavica — Thu, 29 Oct 2009 00:00:00 +0100

(Source: Acta Anaesthesiologica Scandinavica)

Infusions of albumin increase free fraction of naproxen in healthy volunteers: a randomized crossover study

Acta Anaesthesiologica Scandinavica — Thu, 29 Oct 2009 00:00:00 +0100

In vitro and in vivo studies have indicated that stabilizers present in pharmaceutical-grade albumin influence the albumin-binding capacity for highly protein-bound drugs. However, the half-life of the stabilizers and the quantitative effect have been difficult to determine. A randomized crossover study including six healthy volunteers was performed. The study subjects received 750 mg of oral naproxen 2 h before the study. They were randomized to receive either 100 ml of 20% albumin or 100 ml of Ringer's acetate solution intravenously. Frequent blood samples were obtained. The experiment was repeated 4 weeks later with the alternate solution. The serum samples were analysed to determine the concentrations of albumin, N-acetyl-dl-tryptophan, caprylate, and naproxen. The free fraction of nap...

Chest physiotherapy with positive expiratory pressure breathing after abdominal and thoracic surgery: a systematic review

Acta Anaesthesiologica Scandinavica — Thu, 29 Oct 2009 00:00:00 +0100

A variety of chest physiotherapy techniques are used following abdominal and thoracic surgery to prevent or reduce post-operative complications. Breathing techniques with a positive expiratory pressure (PEP) are used to increase airway pressure and improve pulmonary function. No systematic review of the effects of PEP in surgery patients has been performed previously. The purpose of this systematic review was to determine the effect of PEP breathing after an open upper abdominal or thoracic surgery. A literature search of randomised-controlled trials (RCT) was performed in five databases. The trials included were systematically reviewed by two independent observers and critically assessed for methodological quality. We selected six RCT evaluating the PEP technique performed with a mechanic...

Unexpected cardiovascular collapse from massive air embolism during endoscopic retrograde cholangiopancreatography

Acta Anaesthesiologica Scandinavica — Thu, 29 Oct 2009 00:00:00 +0100

A 72 year-old woman with cholangiocarcinoma presented for endoscopic retrograde cholangio pancreatography (ERCP) for diagnostic intraductal endoscopy under GETA. During the technically difficult procedure the patient became suddenly hypoxic, hypotensive, bradycardic, and progressed to PEA code (ETCO2 5 mmHg). ACLS was initiated. Transesophageal echo demonstrated massive right heart air accumulation; abdominal X-Ray showed air filled bile ducts. Central access was obtained, a pulmonary artery catheter floated, and 30 ml of air aspirated from the RV. Within 5 minutes pulses returned; the patient was transferred to the ICU. MRI revealed two watershed infarcts in the right frontal lobe. The patient fully recovered and returned a month later for an uneventful ERCP. (Source: Acta Anaesthesiologi...

Remifentanil post-conditioning attenuates cardiac ischemia–reperfusion injury via κ or δ opioid receptor activation

Acta Anaesthesiologica Scandinavica — Thu, 29 Oct 2009 00:00:00 +0100

This study investigates whether remifentanil post-conditioning is also cardioprotective. Remifentanil post-conditioning (5-min infusion at 1, 5, 10 or 20 [mu]g/kg/min) or ischemic post-conditioning (three cycles of a 10 s reperfusion interspersed with a 10 s ischemia) was induced in an open-chest rat heart model of ischemia and reperfusion injury, in the presence or absence of nor-binaltorphimine, naltrindole or CTOP, specific [kappa], [delta] and [mu] opioid receptor antagonists, respectively. The same sequence of experiments was repeated in the isolated heart model using the maximal protective dose of remifentanil from the dose[ndash]response studies. Both ischemic and remifentanil post-conditioning reduced the myocardial infarct size relative to the control group in both models. This ca...

ACG: Compound Eases Constipation for Opioid Patients (CME/CE)

MedPage Today Pain Management — Wed, 28 Oct 2009 12:59:25 +0100

SAN DIEGO (MedPage Today) -- An investigational compound increased spontaneous bowel movements for patients with opioid-induced constipation, researchers said here. (Source: MedPage Today Pain Management)

Access to U.S. Burn Centers Varies by Region

MedicineNet Chronic Pain General — Wed, 28 Oct 2009 07:00:00 +0100

Title: Access to U.S. Burn Centers Varies by RegionCategory: Health NewsCreated: 10/27/2009 4:10:00 PMLast Editorial Review: 10/28/2009 (Source: MedicineNet Chronic Pain General)

[Audit on preoperative cardiac evaluation before non-cardiac surgery: The importance of a pocket guide to improve the anaesthesist's adhesion to ACC/AHA guidelines.]

Annales Francaises d'Anesthesie et de Reanimation — Wed, 28 Oct 2009 00:00:00 +0100

DISCUSSION: The use of the pocket reminder concerning the ACC/AHA recommendations significantly reduced both the total number of cardiology referrals, and the number of unjustified referrals. The use of a pocket guide may help in reducing both the cost and the postponement of scheduled surgery. PMID: 19879104 [PubMed - as supplied by publisher] (Source: Annales Francaises d'Anesthesie et de Reanimation)

Ultrasound and peripheral blocks for acute and chronic pain: A review

European Journal of Pain Supplements — Tue, 27 Oct 2009 13:42:25 +0100

Abstract: In the regional anesthesia field we assisted to an increasing study and use of ultrasound imaging for peripheral nerve blocks. This approach has been appreciated for good reliability in terms of clinical outcome of blocks and in terms of safety of the procedure. For this reason, ultrasound guidance is nearing to become the standard of care in regional anesthesia and for postoperative pain management. However, its role in invasive procedures in pain medicine is still discussed. The availability of other imaging techniques and lack of familiarization with ultrasonographic imaging are some of the reasons beneath this discrepancy. However, important steps are being made lately towards the development of safe, available and clinically efficient ultrasound guided techniques for many pr...

Ultrasound and facet blocks: A review

European Journal of Pain Supplements — Tue, 27 Oct 2009 13:42:25 +0100

Abstract: Facet or zygapophysial joints are considered to be common sources of chronic spinal pain. In addition to causing localized spinal pain, facet joints may refer pain to adjacent structures. Cervical facet-joint pain may radiate to the head, neck, and shoulders. Thoracic facets may produce paraspinous mid-back pain with neuralgic characteristics; and lumbar facet joints may refer pain to the back, buttocks, and proximal lower extremities. Because the facet joint is innervated by the medial branches arising from the posterior rami of the spinal nerve at the same level and a level above the joint, LA blocks of these nerves have been advocated for diagnostic and prognostic purposes. Intra-articular l–z joint injection with LA has also been proposed as a method for diagnosing facet-jo...

Ultrasound and pain in children: A review

European Journal of Pain Supplements — Tue, 27 Oct 2009 13:42:25 +0100

Abstract: Ultrasound guidance has been demonstrated to improve block characteristics in children including shorter block performance time, higher success rates, shorter onset time, longer block duration, less volume of local anesthetic agents and visibility of neuraxial structures.Clinical studies in children suggest that ultrasound guidance has some advantages over more traditional nerve stimulation-based techniques for regional block. However, the advantage of ultrasound guidance on safety over traditional has not been adequately demonstrated in children except ilio-inguinal blocks.There are only a limited number of randomized control trails in children comparing ultrasound guided peripheral nerve block with other techniques. Available evidence in children demonstrates that ultrasound gu...

Ultrasound and chronic pain: Innovative approaches

European Journal of Pain Supplements — Tue, 27 Oct 2009 13:42:24 +0100

Abstract: Ultrasound (US) is an increasingly used imaging technique in interventional pain management. It allows the identification of soft tissues, vessels and nerves, without exposing patients and personnel to radiation. Imaging can be performed continuously and the fluid injected is visualized in a real time fashion. Possible applications are nerve blocks of the cervical and lumbar zygapophysial joints, stellate ganglion block, intercostal and paravertebral nerve blocks, inguinal nerve blocks, occipital nerve blocks, blocks of painful stump neuromas, caudal epidural injections and injections of trigger/tender points. Due to direct nerve visualization, US has a potential application for destructive procedures, such as cryoanalgesia, radiofrequency lesions or chemical neurolysis. Limitati...

Pain in arthritis

European Journal of Pain Supplements — Tue, 27 Oct 2009 13:42:24 +0100

Abstract: Under the term arthritis are grouped a large number of diseases characterized by the occurrence of an inflammatory process within the joints; between the different types of chronic arthritis, rheumatoid arthritis (RA) is the prototypical example. With the increasing importance of early diagnosis and treatment, in the last years several subsets of chronic arthritis have been described, starting from the early arthritis (EAs), term that include all the arthritis of recent onset; within the EAs we recognize the undifferentiated polyarthritis (UPA), that does not fulfill the classification criteria for an established chronic arthritis but that can turn into an established form of chronic arthritis overtime, and the early RA (ERAs), e.g., the arthritis of less than one year of duratio...

Fibromyalgia: From treatment to rehabilitation

European Journal of Pain Supplements — Tue, 27 Oct 2009 13:42:24 +0100

Abstract: Fibromyalgia is a clinical syndrome of chronic widespread pain and reduced pain thresholds to palpation. The pathophysiology remains unknown, but there is increasing evidence that peripheral and central sensitization cause an amplification of sensory impulses that may alter pain perception in fibromyalgia patients. Interventions to treat fibromyalgia should aim at different targets simultaneously in order to reduce peripheral and central sensitization. There are both pharmacologic and non-pharmacologic approaches with evidence for effectiveness in the treatment of fibromyalgia and its associated symptoms. Evidence from randomized trials and meta-analyses shows that partial and short-term improvements in fibromyalgia symptoms can be achieved with low doses of antidepressants and w...

Fibromyalgia: The diagnosis and pharmacologic treatment

European Journal of Pain Supplements — Tue, 27 Oct 2009 13:42:24 +0100

Abstract: Fibromyalgia (FM) is a chronic condition characterized by widespread pain and diffuse tenderness along with a constellation of ancillary symptoms. The 1990 ACR criteria for classification of FM are important in enhancing much the research of FM. FM is part of a spectrum of functional somatic syndromes. FM is not a homogenous condition and several subtypes of FM had been determined. The best strategy for management of FM is to use a multidisciplinary approach to treatment using both pharmacological and non-pharmacological interventions.Tramadol, tricyclic drugs, mixed reuptake inhibitors and anticonvulsants show efficacy in this condition. Recently, three drugs: pregabalin, duloxetine and milnacipran have been approved by the FDA for treatment of FM. (Source: European Journal of P...

Pain and rheumatology: An overview of the problem

European Journal of Pain Supplements — Tue, 27 Oct 2009 13:42:24 +0100

Abstract: Actually pain is a very important health problem, affecting the majority of people, leading to a significant worsening of patients quality of life and being responsible for a large amount of both medical resources’ expenses and indirect costs. Between the different causes of pain, rheumatic conditions are predominant; in fact diseases such as osteoarthritis (OA), rheumatoid arthritis (RA), fibromyalgia (FM) and extra-articular rheumatisms (EARs) are not only frequently observed, but are also invariably associated with pain occurrence. According to the wide range of rheumatic diseases described, pain expression is complex and not univocal, being influenced not only by the underlying disease, but also by other factors. Generally, 3 rhythms of pain presentation are described in rh...

Pain and physical medicine

European Journal of Pain Supplements — Tue, 27 Oct 2009 13:42:24 +0100

Abstract: The first stage of any physical medicine intervention for a patient with pain is an accurate diagnosis. This allows a decision on the proposed therapy to be made according to the clinical picture. Recent classifications of pain allow us to divide pain management treatment into three specific groups, aimed at: (1) cancer pain, (2) pain (acute, sub-acute or chronic) as a symptom of a specific pathology, and (3) chronic non-malignant pain. In this article, we offer a summary of our clinical experience regarding the drafting of rehabilitation plans for patients with pain who have been referred to us. (Source: European Journal of Pain Supplements)

Psychiatry and chronic pain: Examining the interface and designing a structure for a patient-center approach to treatment

European Journal of Pain Supplements — Tue, 27 Oct 2009 13:42:24 +0100

Abstract: Chronic pain disorders require comprehensive care. While interdisciplinary approaches are recommended, the role of the psychiatrist is often misunderstood. Psychiatrists should be involved with the care of patients with chronic pain as early as possible to maximize response to treatment and improvements in quality of life. Psychiatrists offer an expertise that specifically addresses important deficiencies in the care of patients with chronic pain: (1) the lack of a detailed formulation, (2) the lumping of all psychopathology, and (3) the failure to effectively utilize a rehabilitation model of treatment. (Source: European Journal of Pain Supplements)

Spinal cord stimulation: A brief update on mechanisms of action