[Experience of an interdisciplinary anesthesiology and nursing team for providing anesthesia outside the operating room]

OBJECTIVE

To report on the creation and development of an interdisciplinary anesthesiology and nursing team to provide anesthesia outside the operating room.

MATERIAL AND METHODS

We describe the creation of an interdisciplinary team and preanesthesia evaluation protocols for using nurses specializing in anesthesia for procedures outside the operating room. We analyzed the anesthetic procedures performed outside the operating room, the rate of suspensions due to failure of the procedure, and their impact on the rate of associated complications, from October 2006 to October 2007.

RESULTS

Since the start of the project, 586 procedures outside the operating room have been performed. No suspensions or delays were observed that were due to comorbidity not detected in the preanesthesia evaluation carried out by the nurses. The incidences of complications and inadequate sedations were comparable to those reported for other similar interdisciplinary groups in this area.

CONCLUSIONS

The creation of an interdisciplinary team of anesthesiologists and specialized nurses for providing anesthesia outside the operating room optimizes resources and improves routine clinical practice. It has allowed for universal preanesthesia evaluation, improved the distribution of resources, and proven a stimulus to the care-giving process.

Levobupivacaine plus fentanyl versus racemic bupivacaine plus fentanyl in epidural anaesthesia for lower limb surgery

BACKGROUND

To compare the anaesthetic epidural effects of levobupivacaine plus fentanyl versus bupivacaine plus fentanyl in patients undergoing lower limb surgery.

METHODS

A single blind, randomised, prospective, multicentre study was designed to compare both therapies. The study was conducted in 10 tertiary hospitals. A total of 96 patients who were ASA I or II, who required at least a 24-hour-stay in the hospital and who were subjected to surgery of lower limbs with epidural anaesthesia were enrolled in this study. Treatments were administered at a dosage of 1.2 ml per metamera,including a test dose (3 mL) and the dose of fentanyl (100 mg). Patients were then randomly allocated to receive either Levobupivacaine (n = 49) or bupivacaine (N.= 47). The primary endpoint was sensory blockade (SB) duration. Secondary evaluations included motor blockade (MB), post-surgery analgesic medication usage, safety and the investigator global evaluation.

RESULTS

SB duration was similar for both interventions: 195 min (165-205) in the bupivacaine group versus 170 min (140-185) in the levobupivicaine group (log-rank test, P=0.884). However, the lack of MB as evaluated by the modified Bromage scale was significantly higher in the levobupivacaine group than in the bupivacaine group (39% vs 13%, P=0.017). Although no significant differences in MB duration were observed between the groups, a trend was observed in the levobupivacaine group, which had a lesser MB (P=0.093). Investigator satisfaction was high and was assessed to a similar extent for both interventions. Forty-one adverse events were detected in 28 patients, with no differences between groups: 15 (33%) with bupivacaine and 13 (27%) with levobupivacaine, P=0.516.

CONCLUSION

Although both interventions showed similar anaesthetic effects, a higher proportion of patients receiving levobupivacaine lacked MB.

[Transient neurological syndrome after spinal hyperbaric bupivacaine: a new case]

A 47-year-old woman underwent hysteroscopy and removal of an endometrial polyp because of irregular, acyclic bleeding of 6 months' duration. The procedure was carried out under spinal anesthesia. No adverse events occurred during puncture or surgery, or in the immediate postoperative recovery period. Recovery from the sensory and motor block was normal. Twenty-four hours after surgery gluteal and lower limb pain and paresthesia developed, with no sensory or motor deficit. The symptoms suggested transient neurological syndrome. This syndrome has been defined by pain in the lower limbs, buttocks, thighs and calves after uncomplicated spinal anesthesia and full recovery from the sensorimotor block during the immediate postoperative period (first 24 hours). The condition is self-limiting and does not leave permanent neurological sequelae. Recent studies have demonstrated biochemical and anatomical changes that provide a structural basis for this clinical entity. According to this literature, transient neurological syndrome might be a mild expression of local anesthetic toxicity. Recent findings show that the initial injury to the nerve cell membrane, induced by high concentrations of local anesthetic could lead to permanent neuronal damage.

Hypoxia regulates avian cardiac Arnt and HIF-1alpha mRNA expression

The aryl hydrocarbon receptor nuclear translocator (Arnt) and hypoxia-inducible factor (HIF)-1alpha mediate cellular responses to hypoxia. We investigated the ability of hypoxia to regulate Arnt and HIF-1alpha mRNA in the heart in vivo. We cloned avian Arnt, developed an in vivo model of chronic cardiac hypoxia, and measured expression of cardiac Arnt and HIF-1alpha mRNA by quantitative RT-PCR. Chronic hypoxic exposure (24 h to 15% O(2)) of day 9 chick embryos resulted in a 30-fold increase in covalent binding of (3)H-misonidazole, a hypoxic tissue marker, to cardiac tissue, and a 2-fold induction of cardiac inducible nitric oxide synthase mRNA, compared to normoxic controls. In this same model, cardiac Arnt mRNA expression decreased by 35%, while HIF-1alpha mRNA expression increased 400%. These data suggest that regulation of Arnt and HIF-1alpha mRNA expression may contribute to the physiological responses of the heart during prolonged hypoxia.

[Ropivacaine]

This paper describes the pharmacological, pharmacokinetic and pharmacodynamic features of ropivacaine on both an experimental and clinical level. Ropivacaine is an amide-type local anesthetic whose chemical structure is related to that of mepivacaine and bupivacaine and whose duration of effect falls between the two. Ropivacaine is a less potent effector of motor blockade than bupivacaine, and its toxic effects on the central nervous system and myocardial tissue is likewise less. Ropivacaine has been employed for epidural anesthesia and analgesia (including through a caudal approach), for peripheral motor blockade, for local infiltration (in gel form), and for intravenous regional anesthesia in ophthalmologic surgery involving peri- and retrobulbar blockade. Subarachnoid use has not yet been accepted in Spain, although phase IV clinical trials of this application have begun. Concentrations of 2 mg/ml (0.2%) and 7.5 mg/ml (0.75%) and 10 mg/ml (1%) are available in Spain.

Thiohydrazone copper(II) complexes. The relationship between redox properties and superoxide dismutase mimetic activity

The redox behaviour of copper(II) complexes with the open chain ligand, benzilbisthiosemicarbazone, and the macrocyclic one [3,4,10,11-tetraphenyl-1,2,5,8,9,12,13-octaazacyclotetradeca-7,14- dithione- 2,4,9,11-tetraene] has been explored by cyclic voltammetry. The half-wave potential values for the copper(II)/copper(I) redox couple and the spectral data obtained on dimethylsulfoxide (DMSO) solution agree with the superoxide dismutase (SOD)-mimetic activity of the complexes. The macrocyclic complexes show more positive reduction potential and more activity than the open chain derivatives. From our results it follows that the structure and conformation of ligand has influence on the redox potential of central atom in coordination compound. The changes in the coordination sphere are connected with the change of biological function of compounds represented by SOD-mimic activity. In addition, the L1H6 derivatives show quasireversible waves associated to Cu(II)/Cu(III) process.