Perioperative blood glucose management in patients undergoing tumor hepatectomy.

Study Objective: To determine whether our institutional insulin management (modified Atlanta) protocol is efficient and safe in controlling blood glucose levels in the perioperative period in surgical patients undergoing tumor hepatectomy.

Design: Retrospective study.

Setting: Large community hospital.

Development and performance of a two-step desflurane-O(2)/N(2)O fresh gas flow sequence.

Study Objective: To determine if the previously described single-step O(2)/N(2)O fresh gas flow (FGF) sequence could be combined with a simple desflurane vaporizer (F(D)) sequence to maintain the end-expired desflurane (F(A)des) at 4.5% with the anesthesia delivery unit machine (ADU Anesthesia Machine(R); General Electric, Helsinki, Finland).

Design: Prospective randomized clinical study.

Muscle relaxation does not influence venous oxygen saturation during cardiopulmonary bypass.

Study Objective: To examine whether the omission of neuromuscular blocking drugs during cardiopulmonary bypass (CPB) is associated with increased anesthetic requirements, higher frequency of intraoperative movements, and lower venous oxygen saturation (SvO(2)).

Design: Prospective, randomized study.

Setting: Large community hospital.

Preinduction glycemia and body mass index are important predictors of perioperative insulin management in patients undergoing cardiac surgery.

Study Objective: To investigate whether preinduction glucose is an important predictor for perioperative insulin management in patients undergoing cardiac surgery.

Design: Prospective cohort study.

Setting: Large community hospital.

Postoperative residual paralysis in outpatients versus inpatients.

Postoperative residual paralysis is an important complication of the use of neuromuscular blocking drugs. In this prospective study, the incidence of residual paralysis detected as a train-of-four response <90% was less frequent in surgical outpatients (38%) than inpatients (47%) (P = 0.001).

Intraoperative severity assessment of coronary artery stenosis in patients at risk: the role of transesophageal echocardiography.

A 71-yr-old male was scheduled for infrarenal abdominal aortic aneurysm repair. Although he had only minor clinical predictors for increased perioperative cardiovascular risk with >4 estimated metabolic equivalents for activities, intraoperative transesophageal echocardiography revealed an abnormal maximal-to-prestenotic blood flow velocity ratio in the left main coronary artery. Postoperatively, a severe distal left main coronary artery stenosis was confirmed with coronary angiography.

Large bolus dose vs. continuous infusion of cisatracurium during hypothermic cardiopulmonary bypass surgery.

Background And Objective: We investigated whether a high bolus dose of cisatracurium (8x ED95) given at induction can provide muscle relaxation for the major part of a cardiac procedure with hypothermic cardiopulmonary bypass, avoid important postoperative residual curarization and cause no waste of product.

Methods: Twenty patients were randomly assigned either to Group 1 (n = 10) or Group 2 (n = 10). Those in Group 1 were given cisatracurium in a high bolus dose (0.

Implications of the use of neuromuscular transmission monitoring on immediate postoperative extubation in off-pump coronary artery bypass surgery.

Background And Objective: When continuous infusions of neuromuscular blocking drugs are administered during lengthy interventions and no routine antagonism of their effects is applied, there is a dramatic incidence of residual curarization. We have examined whether the use of neuromuscular transmission monitoring results in differences in the incidence of postoperative residual curarization, the use of antagonist agents, and the endotracheal extubation rate and outcome after continuous infusion of rocuronium in patients undergoing off-pump coronary artery bypass surgery.

Methods: Twenty patients were assigned to group 1 (n = 10, non-blinded neuromuscular transmission monitoring) or group 2 (n = 10, blinded neuromuscular transmission monitoring).

Effect of N2O on sevoflurane vaporizer settings during minimal- and low-flow anesthesia.

Background: Uptake of a second gas of a delivered gas mixture decreases the amount of carrier gas and potent inhaled anesthetic leaving the circle system through the pop-off valve. The authors hypothesized that the vaporizer settings required to maintain constant end-expired sevoflurane concentration (Etsevo) during minimal-flow anesthesia (MFA, fresh gas flow of 0.5 l/min) or low-flow anesthesia (LFA, fresh gas flow of 1 l/min) would be lower when sevoflurane is used in oxygen-nitrous oxide than in oxygen.

Air-oxygen mixtures in circle systems.

Study Objective: To determine the effect of different air-O(2) mixtures and fresh gas flows (FGF) on the relationship between the delivered (F(Del)O(2)) and inspired O(2) fraction (FIO(2)) in a circle system.

Study Design: Randomized clinical study.

Setting: Large teaching hospital.

The ADU vaporizing unit: a new vaporizer.

Unlabelled: We determined the performance of the vaporizer of the ADU machine (Anesthesia Delivery Unit; Datex-Ohmeda, Helsinki, Finland). The effects of carrier gas composition (oxygen, oxygen/N(2)O mixture, and air) and fresh gas flow (0.2 to 10 L/min) on vaporizer performance were examined with variable concentrations of isoflurane, sevoflurane, and desflurane across the whole range of each vaporizer's output.

The analgesic efficacy of tramadol is impaired by concurrent administration of ondansetron.

Tramadol has weak opioid properties, and an analgesic effect that is mediated mainly by inhibition of the reuptake of norepinephrine and serotonin (5-hydroxytryptamine [5-HT]) and facilitation of 5-HT release (1,2) at the spinal cord. Because 5-HT3 receptors play a key role in pain transmission at the spinal level (3), the 5-HT3 antagonist ondansetron may decrease the efficacy of tramadol, as suggested in an abstract by Maroof et al. In that study, a small dose of 1 mg/kg tramadol was administered along with ondansetron 0.

Maintaining sevoflurane anesthesia during low-flow anesthesia using a single vaporizer setting change after overpressure induction.

Study Objective: A sevoflurane vaporizer dial setting of 1.9% was previously found to maintain the end-expired sevoflurane concentration (Et(sevo)) at 1.3% during maintenance of anesthesia for procedures up to one hour with an O(2) FGF of 1 L/min.

Dose requirements of infusions of cisatracurium or rocuronium during hypothermic cardiopulmonary bypass.

We investigated the influence of mild hypothermic cardiopulmonary bypass (CPB) on the dose requirements of cisatracurium or rocuronium used as a continuous infusion. We studied eight patients given cisatracurium and nine given rocuronium. They were ASA class III and IV and scheduled for elective coronary artery bypass grafting.

Coasting after overpressure induction with sevoflurane.

Study Objective: To evaluate the clinical feasibility of using a coasting technique to temporarily maintain anesthesia after overpressure induction with sevoflurane.

Study Design: Prospective clinical study.

Setting: Large teaching hospital.

Catheter entrapment by atrial suture during minimally invasive port-access cardiac surgery.

Purpose: The port-access approach allows surgeons to perform heart operations through small intercostal openings, or "ports". This technique requires new skills for anesthesiologists. A pulmonary artery venting (PAV) catheter and, in some cases, a coronary sinus catheter (for administration of retrograde cardioplegia) are positioned with the aid of fluoroscopy and transesophageal echography (TEE).