Possible effects of anaesthetic management on the 1 yr followed-up risk of herpes zoster after Caesarean deliveries.

BACKGROUND: As general anaesthesia may compromise the immune system, it has been hypothesized that latent varicella-zoster virus is more likely to be reactivated and cause herpes zoster in mothers after Caesarean deliveries under general anaesthesia. Our study was thus aimed at investigating the risk of herpes zoster among women during the first year after Caesarean deliveries under either general or regional anaesthesia. METHODS: Two nationwide population-based data sets were utilized, including the Taiwan birth certificate registry and the Taiwan National Health Insurance Research Dataset. From 2001 to 2003, a total of 162 495 women underwent Caesarean delivery. Among them, 21 454 women received general anaesthesia, whereas 141 041 patients received regional anaesthesia. Each individual was followed for 1 yr to identify the subsequent occurrence of herpes zoster. Cox's proportional hazards regressions were performed for analysis. RESULTS: During the 1 yr follow-up period, 0.46% of the women receiving general anaesthesia experienced an episode of herpes zoster, compared with 0.34% of women receiving regional anaesthesia. In Caesarean deliveries, the use of general anaesthesia compared with regional anaesthesia was independently associated with a 1.29-fold (95% confidence interval=1.04-1.61) increase in the 1 yr risk of herpes zoster, after adjusting for maternal and infant characteristics. CONCLUSIONS: In this series, there was a small increased risk of herpes zoster in the year after Caesarean delivery with general anaesthesia. Future studies are needed to further investigate these findings.

Cardiac arrest during anesthesia in a teaching hospital. A 4 years survey.

METHODS: During the past 4 years, 48 cases of cardiac arrest occurred during anesthesia among a total of 104,600 cases of anesthesia at Mackay Memorial Hospital in Taipei. RESULTS: The incidence of cardiac arrest was thus about 0.046% (48/104,600), with the causative factors being anesthetic related in 21% (10/48) of cases, surgical factors in 19% (9/48) of cases and patient's pathological factors in 60% (29/48) of cases. Of these 48 patients, 34 died and 14 survived after cardiopulmonary resuscitation (CPR). Anesthesia contributed to death in 3 cases of a total of 104,600 cases of anesthesia giving an approximate incidence of 3/100,000. Two of these 3 cases were avoidable.

Children with mucopolysaccharidoses--three cases report.

The mucopolysaccharidoses (MPS) are a group of inherited disorders of metabolism, with widespread, progressive involvement and derangement of many organs and tissues. Because of their disabling nature, frequent surgical intervention for the abnormality entailed is common, and is associated with a high degree of anesthetic risks perioperatively. One of the major hazards which we find clinically is airway difficulty. Multiple factors are present in the mucopolysaccharidoses to make airway management and trachael intubation potentially hazardous. Aside from generalized infiltration and thickening of the soft tissues, the oropharynx may be obstructed by a large tongue with tonsillar hypertrophy. Also, the friable mucosa covering the nasal and oral pharynx renders these structures easily to bleed and edematous. The neck is typically short and immobile, and the cervical spine and tempromandibular joint may have a limited range of movement. From our experience, we have learned not to overlook the propensity of airway difficulty. The uniqueness of their anatomy and extremely sensitive airway often result in failed intubation and bronchospasm even after successful intubation. Recently, in Mackay Memorial Hospital we have encountered in series three pediatric cases with mucopolysaccharidoses (one Hurler and two Hunter syndromes). In this report we would like to share our experiences and to discuss the anesthetic risks and management of the MPS patients.

Prevention of coughing induced by endotracheal tube during emergence from general anesthesia--a comparison between three different regimens of lidocaine filled in the endotracheal tube cuff.

BACKGROUND: "Deep" extubation, administration of intravenous (i.v.) narcotics, i.v. lidocaine and forestalling local spray of lidocaine have been used to help diminish coughing during emergence. However, the respective efficacy of these techniques has not been concluded. Sconzo et al. indicated that endotracheal tube (ETT) cuff might serve as a reservoir for local anesthetic. Alkalizing and warming are two techniques frequently used to increase in the proportion of uncharged drugs available. Matias indicated that alkalization could prompt a 63-fold increase of the rate of diffusion of lidocaine across the ETT cuff. Huang et al. also observed that alkalization together with warming could achieve a 118-fold increase further. However, the in vivo effects of ETT-cuff lidocaine have not been studied. METHODS: Eighty patients of ASA Class I-II undergoing elective surgeries were included. They were randomly assigned into four groups. After tracheal intubation, the ETT cuff was filled with one of the following solutions: normal saline 6 ml (Group A), 4% lidocaine 6 ml at room temperature (Group B), 4% lidocaine 5 ml + 7% sodium bicarbonate 1 ml at room temperature (Group C), and 4% lidocaine 5 ml + 7% sodium bicarbonate 1 ml warmed to 38 degrees C (Group D). Changes of vital signs as well as the times of coughing in the course of extubation and post-extubation complications were recorded. One way ANOVA (SPSS for windows) was used for data analysis. RESULTS: The respective number of coughing per patient in the experimental groups (Group B, C and D) was significantly less than the saline or control group (mean = 9.70, 9.15 and 3.95, respectively, p < 0.05). The incidence of sore throat in Group C and Group D was significantly less than the control group (35% and 25%, respectively, p < 0.05). Regarding the hemodynamic changes, systolic arterial pressure (SAP) and mean arterial pressure (MAP) were higher in Group B and C (p < 0.05) before extubation. CONCLUSIONS: Alkalized and warmed lidocaine prestored in the endotracheal tube (ETT) cuff can greatly reduce ETT-induced coughing and thus promote a smoother emergence from general anesthesia with endotracheal intubation.

Views of obstetric patients who refuse regional anesthesia in cesarean section.

BACKGROUND: Regional anesthesia for cesarean section has gained widespread popularity. However, there are still a good few of obstetric patients who refuse it. This study was to investigate the reasons for refusing regional anesthesia in order to gain some insights into the attitudes and concerns of patients. METHODS: Three hundred and twenty-four obstetric patients scheduled for Cesarean section were interviewed just before entering the operating room. They were asked to give one or two reasons for refusing regional anesthesia. RESULTS: Two hundreds of them refused regional anesthesia. The most frequent reasons were apprehension of witnessing the operation (auditory or visional) (45.42%) and fear of backache following regional anesthesia (14.58%). CONCLUSIONS: Anesthesiologists should be aware of patients' feeling or concern and could be capable and willing to discuss with them the relevant problems.

Dyspnea resulting from phrenic nerve paralysis after interscalene brachial plexus block in an obese male--a case report.

Phrenic nerve paralysis is a common complication in interscalene brachial plexus block. This complication is often ignored by most anesthesiologists because no clinical symptoms occur in patients who have no underlying lung disease. We present a case of an obese male suffering from dyspnea due to phrenic nerve block after interscalene brachial plexus block. The decreased respiratory reserve and direct compressing effect of the abdominal organs on the diaphragm in the supine position are thought to be the risk factors in this obese patient. Also discussed are the incidence, diagnostic methods, clinical presentation and treatments of phrenic nerve paralysis during interscalene brachial plexus block.

Postoperative myocardial infarction in a patient with perioperative ST-depression--a case report.

Often we ignore electrocardiogram (EKG) evidence of ischemia and no adverse events occur. However, once in a while these ischemic episodes will turn into a full-blown myocardial infarction. Therefore, studying perioperative events which tilt the balance over to postoperative myocardial infarction (PMI) can enlighten our knowledge in postoperative myocardial infarction (MI) prevention. We present a case of ST depression in perioperative EKG evolving into postoperative MI. In this paper we attempt to explore various possibilities which could have altered this patient from her ischemic state into an infracted event.

[Comparison of intravenous alfentanil, fentanyl and epidural lidocaine for extracorporeal shock wave lithotripsy].

Due to the development of newer generation of lithotriptor, the anesthesia for extracorporeal shock wave lithotripsy (ESWL) was variable recently. To compare opioid analgesia with epidural lidocaine for their efficacy in pain control, hemodynamic changes, side effects and patient acceptance during ESWL, sixty unpremedicated patients undergoing elective ESWL for upper urinary calculi with second generation Dornier MFL 5000 nonimmersion lithotriptor were randomly assigned equally into one of the following managements: Group E: 1% epidural lidocaine with 1:200000 epinephrine; Group A: 15 micrograms/kg alfentanil initially and 7 micrograms/kg on demand intravenously; Group F: 4 micrograms/kg fentanyl initially and 2 micrograms/kg on demand intravenously. Significant hypotension and bradycardia occurred in Gp.E as compared to baseline value (p < 0.05). Early respiratory depression was observed in both Gp. A and Gp. F, but Gp. A showed significantly shorter period (2 to 5 minutes) as compared to Gp.F (2 to 15 minutes). Under the insufflation of oxygen by nasal cannula, mean PaCO2 increased maximally to 50 mmHg, but no arterial oxygen desaturation (< 90%) was noted in Gp.A and Gp.F. The incidence of post-ESWL nausea was higher in Gp.F (p < 0.05), shivering and delayed recovery time were the main disturbing problems in Gp.E (p < 0.01). Although five-point verbal pain scale was significantly higher in Gp.A and Gp.F (at 30 to 45 minutes during ESWL) as compared to Gp.E, acceptance among patients was high throughout the course. We conclude that different anesthetic plans should be determined on different lithotriptors settings and patient's physical condition.(ABSTRACT TRUNCATED AT 250 WORDS)