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1.
BJA Educ ; 23(5): 162-171, 2023 May.
Article in English | MEDLINE | ID: mdl-37124170
2.
Acta Anaesthesiol Scand ; 62(3): 293-303, 2018 Mar.
Article in English | MEDLINE | ID: mdl-29159929

ABSTRACT

BACKGROUND: Preclinical evidence suggests that general anesthetics can dose dependently induce neurodegeneration in the developing brains of animals which can be reliably determined by measurement of blood S100ß, but this correlation remains unclear in humans. We hypothesized that S100ß would not be increased in cord arterial blood of fetuses exposed briefly to general anesthetics during a C-section, compared with epidural anesthesia. METHODS: A prospective observational clinical study comparatively measured changes of brain damage biomarker S100ß ratio of umbilical artery over vein (changes after fetus circulation) immediately after delivery under C-section with either epidural or general anesthesia. Newborn blood gas measurements, APGAR scores, and maternal well-being were also compared. RESULTS: Compared with epidural anesthesia, general anesthesia resulted in the lower S100ß ratio of umbilical artery over the vein (medium 2.64 [quartiles 1.39, 3.45] vs. medium 1.59 [quartiles 0.88, 2.01], P = 0.031), without changing the S100ß level in the vein of the mother. There was no significant difference between general and epidural anesthesia when comparing other maternal and newborn parameters. CONCLUSION: S100ß levels in newborn after C-section is lower with general anesthesia than epidural anesthesia, with unclear mechanisms.


Subject(s)
Anesthesia, Epidural , Anesthesia, General , Anesthesia, Obstetrical , Cesarean Section , S100 Calcium Binding Protein beta Subunit/blood , Adult , Apgar Score , Female , Humans , Infant, Newborn , Male , Pregnancy , Prospective Studies
3.
J Clin Anesth ; 12(4): 283-7, 2000 Jun.
Article in English | MEDLINE | ID: mdl-10960199

ABSTRACT

STUDY OBJECTIVE: To investigate the efficacy of warmed, humidified inspired oxygen (O(2)) for the treatment of mildly hypothermic postoperative patients. DESIGN: Prospective, randomized, unblinded clinical trial. SETTING: Postanesthesia care unit in a tertiary care hospital. PATIENTS AND INTERVENTIONS: 30 ASA physical status I, II, and III patients following intraabdominal surgical procedures were randomly assigned to receive either routine O(2) therapy (control group, n = 15), or warmed (42 degrees C) humidified O(2) (treatment group, n = 15) for the initial 90 postoperative minutes. MEASUREMENTS: Core (tympanic) temperature, dry mouth score and shivering score. MAIN RESULTS: Tympanic temperature was similar in both groups on admission ( approximately 35.8 degrees C). Rewarming rate in the first postoperative hour was greater in the treatment group (0.7 +/- 0.1 degrees C. hr(-1)) compared to the control group (0.4 +/- 0.1 degrees C. hr(-1)) (p = 0.03). Patients receiving the warmed, humidified O(2) had a lower incidence of dry mouth compared to the control group (p = 0.03). The incidence of shivering was low and similar in both groups. CONCLUSIONS: Warming and humidifying inspired O(2) hastens recovery from hypothermia in postoperative patients.


Subject(s)
Oxygen Inhalation Therapy , Rewarming/methods , Female , Humans , Humidity , Male , Middle Aged , Postoperative Period , Prospective Studies , Shivering , Temperature , Time Factors , Xerostomia
4.
J Am Diet Assoc ; 100(7): 777-83, 2000 Jul.
Article in English | MEDLINE | ID: mdl-10916515

ABSTRACT

OBJECTIVE: To determine the accuracy of energy intakes estimated with the multiple-pass 24-hour recall method in women by conducting in-person and telephone interviews. Doubly labeled water measurements of total energy expenditure were used for validation. SUBJECTS: Thirty-five weight-stable women (mean age = 30 years, range = 19 to 46 years) participated. DESIGN: Total energy expenditure was measured over a 14-day period using the doubly labeled water method. During this time, 4 multiple-pass 24-hour recalls were obtained from the women (2 in-person, 2 by telephone) who were provided 2-dimensional food models to estimate portion sizes. The Food Intake Analysis System was used to analyze recall data. STATISTICAL ANALYSES: Paired t tests were conducted to examine differences between energy intake estimated from the telephone and in-person interviews. Agreement between the energy intake estimates from the telephone recalls and the in-person recalls was assessed using the technique of Bland and Altman. Paired t tests were used to compare energy intake estimated from the telephone and in-person recalls to total energy expenditure. RESULTS: No significant difference in mean daily energy intake was found between the telephone (2,253 +/- 688 kcal) and in-person (2,173 +/- 656 kcal) interviews (P = .36). However, the mean energy intake from each interview method was significantly lower than total energy expenditure (2,644 +/- 503 kcal) (P = .006 and .001, respectively). APPLICATIONS/CONCLUSIONS: Underreporting of energy intake was widespread in the sample. Although the multiple-pass 24-hour recall method did not generate a group measure of energy intake that was accurate or unbiased, the telephone-administered multiple-pass 24-hour recall was just as effective in estimating energy intake as the recall administered in-person. Dietetics professionals should be aware of the pervasive and serious problem of under-reporting of self-reported food intakes.


Subject(s)
Diet Records , Energy Intake , Energy Metabolism , Interviews as Topic/standards , Adult , Deuterium , Female , Humans , Mental Recall , Middle Aged , Oxygen Isotopes , Reproducibility of Results , Telephone
5.
Anesth Analg ; 90(6): 1396-401, 2000 Jun.
Article in English | MEDLINE | ID: mdl-10825327

ABSTRACT

UNLABELLED: Lumbar sympathetic block (LSB) is used in the management of sympathetically maintained pain states. We characterized cutaneous temperature changes over the lower extremities after LSB. Additionally, we examined the effects of iohexol, a radio-opaque contrast medium, on temperature changes and pain relief. After institutional review board approval and written, informed consent, 28 LSBs were studied in 17 patients. Iohexol or normal saline was injected in a randomized, double-blinded fashion before bupivacaine. Lower extremity cutaneous temperatures were measured. Pain, allodynia, interference with daily function, and perceived pain relief were reported in a subset of 15 LSBs for 1 wk after the block. The distal lower extremity ipsilateral to the LSB had the greatest magnitude (8.7 degrees +/- 0.8 degrees C) and rate (1.1 degrees +/- 0.2 degrees C/min) of temperature change. The great toe temperature was within 3 degrees C of core temperature within 35 min after LSB. There were no differences in temperature change between the groups. The iohexol group had greater relief of pain until the morning of the first postblock day (P = 0.002) and longer perceived relief of pain (P = 0.01). The maximum temperature of the great toe correlated with allodynia relief (P = 0.0007). Thus clinicians should expect ipsilateral toe temperatures to increase to within approximately 3 degrees C of core temperature. Iohexol does not alter the efficacy of LSB and may improve relief of symptoms. The magnitude of temperature change may predict relief of allodynia. IMPLICATIONS: Cutaneous toe temperatures approaching core temperature provide a useful monitor of lumbar sympathetic block and may predict relief of sympathetically maintained pain. Iohexol will not compromise temperature changes or pain relief.


Subject(s)
Anesthesia, Spinal , Autonomic Nerve Block , Complex Regional Pain Syndromes/therapy , Skin Temperature/drug effects , Sympathetic Nervous System/physiopathology , Adult , Complex Regional Pain Syndromes/physiopathology , Complex Regional Pain Syndromes/psychology , Contrast Media/adverse effects , Double-Blind Method , Female , Humans , Iohexol/adverse effects , Leg/physiology , Male , Middle Aged , Pain Measurement/drug effects
6.
Anesth Analg ; 90(4): 938-45, 2000 Apr.
Article in English | MEDLINE | ID: mdl-10735803

ABSTRACT

UNLABELLED: We tested the hypotheses that accuracy and precision of available temperature monitoring methods are different between spinal anesthesia (SA) and general anesthesia (GA), and that patients receiving SA are at equal risk for hypothermia as those receiving GA. Patients scheduled for radical retropubic prostatectomy were enrolled. Either GA (n = 16) or SA (n = 16) was given according to patient and clinician preference. Temperatures were monitored with thermocouple probes at the tympanic membrane, axilla, rectum, and forehead skin surface. Tympanic temperatures were also measured with an infrared device, and forehead skin temperatures were monitored with two brands of liquid crystal thermometer strips. Accuracy and precision of these monitoring methods were determined by using tympanic membrane temperature, measured by thermocouple, as the reference core temperature (T(c)). At the end of surgery, T(c) was similar between SA (35.0 +/- 0.1 degrees C) and GA (35.2 +/- 0.1 degrees C) (P = 0.44). Accuracy and precision of each temperature monitoring method were similar between SA and GA. Rectal temperature monitoring offered the greatest combination of accuracy and precision. All other methods underestimated T(c). These findings suggest that patients receiving SA or GA are at equal and significant risk for hypothermia, and should have their temperatures carefully monitored, recognizing that most monitoring methods underestimate T(c). IMPLICATIONS: Body temperature should be monitored during spinal anesthesia because patients are at significant risk for hypothermia. Rectal temperature is a valid method of measuring core temperature, whereas other methods tend to underestimate true core temperature.


Subject(s)
Anesthesia, General , Anesthesia, Spinal , Body Temperature , Monitoring, Physiologic/methods , Humans , Male , Middle Aged , Prostatectomy
7.
J Clin Anesth ; 12(7): 525-30, 2000 Nov.
Article in English | MEDLINE | ID: mdl-11137413

ABSTRACT

STUDY OBJECTIVE: To investigate if paravertebral lumbar sympathetic ganglion block and lumbar epidural anesthesia result in comparable cutaneous temperature changes in the lower extremity. DESIGN: Nonrandomized comparison study. SETTING: Operating rooms and pain clinic procedure rooms in a tertiary care hospital. PATIENTS AND INTERVENTIONS: 18 patients undergoing lumbar sympathetic ganglion blocks for the diagnosis and/or treatment of chronic pain, and 13 patients undergoing lumbar epidural anesthesia for radical prostatectomy. MEASUREMENTS: Cutaneous temperatures were measured over the great toe, calf, and thigh in all patients. Mean maximum temperature (Tmax), rate of change of skin temperature (from 5% to 95% of maximum temperature change), and mean time to 1 degrees C increase, and 50% and 95% of maximum temperature change for each group were compared. Temperature changes for the epidural and lumbar sympathetic block patients were compared. MAIN RESULTS: Epidural and lumbar sympathetic block resulted in similar Tmax (34.1 +/- 0.2 and 33.8 +/- 0.9 degrees C, respectively, mean +/- SEM; p = 0.18) and rate of temperature change (0.64 +/- 0.09 and 0.49 +/- 0.07 degrees C/min; p = 0.2) in the great toe. The onset of cutaneous temperature change after lumbar sympathetic block was slower than after epidural anesthesia (1 degrees C increase: 17 and 11 min, respectively, 50% of Tmax: 25 and 17 min, respectively, and 95% of Tmax: 40 and 31 min, respectively; p < 0.05 for each). CONCLUSIONS: The similar rate and magnitude of cutaneous temperature change in the distal lower extremity suggests the degree of sympathetic blockade is similar with lumbar sympathetic blockade and epidural anesthesia. Either technique should provide adequate sympathectomy for treating sympathetically maintained pain once the diagnosis has been confirmed using selective sympathetic blockade.


Subject(s)
Anesthesia, Epidural , Autonomic Nerve Block , Skin Temperature , Adult , Aged , Female , Ganglia, Sympathetic , Humans , Lumbar Vertebrae , Male , Middle Aged , Prostatectomy , Skin/blood supply
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