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Biomedical subjects

Brendan T Finucane

Publications and source records attributed to Brendan T Finucane.

12 recordsLinked to original sources
PubMed2006

Declining randomized clinical trials from Canadian anesthesia departments?

PURPOSE: The research productivity was estimated by publications from anesthesiology departments at Canadian universities over a five-year period, and the articles published were classified into several study designs. METHODS: In this observational study, the MEDLINE database was searched for publications listed by anesthesiology departments at Canadian universities as the primary corresponding source from 2000-2004. Abstracts were reviewed and each publication categorized into its respective methodological design. Impact factors of the journals in which the articles appeared were taken into consideration. "Total impact score" was defined as the total number of articles from a particular journal in a particular year multiplied by the impact factor value. Changes in overall publication numbers over the five-year period were compared and analyzed using Pearson correlation coefficients. RESULTS: Total Canadian anesthesia publications remained constant from 2000-2004. In this five-year time frame, the University of Toronto had the highest number of publications (271) followed by the University of Montreal (86), and McGill University (84). These universities conducted primarily randomized controlled trials (RCTs) whereas smaller Canadian universities mainly published case reports, reviews, and cohort studies. The number of RCTs conducted seems to be decreasing whereas the number of case reports and reviews being published are remaining constant over the five-year period. CONCLUSION: Although overall numbers in anesthesia publications do not suggest a significant decline, the number of RCTs decreased during the years 2000-2004. The quality of anesthesia research appears to be comparable to those in other medical specialties, with larger institutions conducting RCTs and smaller institutions publishing more case reports.

Academic Medical Centers↗
PubMed2006

Induced hypotension with epidural/general anesthesia reduces transfusion in radical prostate surgery.

PURPOSE: Radical prostatectomy is associated with substantial blood loss frequently requiring allogeneic blood transfusion. We investigated the efficacy of deliberate hypotension using combined epidural/general anesthesia in reducing allogeneic transfusion requirements in patients undergoing radical prostatectomy. METHODS: In a prospective, randomized, single-blind trial, 102 patients undergoing radical prostatectomy were allocated to either an epidural group (n = 51) or a control group (n = 51). In the epidural group, deliberate hypotension was achieved with a target mean arterial pressure of 55-60 mmHg. The trigger for allogeneic blood transfusion in both groups was a hematocrit value < 0.25. RESULTS: Operative blood loss in the epidural group was significantly less than that in the control group (955 +/- 517 mL vs 1477 +/- 823 mL respectively, P < 0.001). The percentage of patients who reached the threshold trigger for allogenic transfusion was significantly less in the epidural group (8% vs 26%, respectively, P = 0.019) and the number of patients who were actually transfused during hospitalization was also significantly less (P = 0.028). There were no serious adverse events in either group during the study. CONCLUSION: Controlled hypotension using a combined epidural/ general anesthetic technique is associated with significantly less blood loss, and a reduction in the use of allogeneic blood in patients undergoing radical prostatectomy compared to general anesthesia alone.

Aged↗
PubMed2006

Negative arterial to end-tidal carbon dioxide gradient: an additional sign of malignant hyperthermia during desflurane anesthesia.

Widespread use of desflurane anesthesia has changed the clinical presentation of malignant hyperthermia (MH). Delayed onset of MH symptoms has been reported previously. A negative gradient between arterial to end-tidal CO2 ([a-ET]Pco2) was observed during anesthesia in pregnant patients and infants and has been associated with increased CO2 production, increased cardiac output, reduced functional residual capacity, and low lung compliance. The same conditions exist in cases of MH crisis. We describe an unusual case of MH in which a negative value of (a-ET) Pco2 gradient has been used as diagnostic and monitoring tool.

Adult↗
PubMed2005

Prolonged duration of anesthesia in a patient with multiple sclerosis following paravertebral block.

PURPOSE: To explore the possibility that the prolonged duration of anesthesia following paravertebral block was related to the presence of multiple sclerosis in a patient undergoing elective inguinal hernia repair. CLINICAL FEATURES: A healthy 33-yr-old female presented for elective inguinal hernia repair. The procedure was performed under general anesthesia and a paravertebral block was performed at the end of the procedure for postoperative pain relief, whilst the patient was still anesthetized. Upon recovering from general anesthesia it was noted that the patient had a flaccid paralysis of both lower extremities. She was also very nauseated and required antiemetics and vasopressors for hypotension. A differential diagnosis of subarachnoid, subdural or epidural spread was considered. The presence of an epidural hematoma was also considered. The block regressed very slowly with full return of function in 12.5 hr. The duration of action of the block was far longer than one would expect following spinal, epidural or subdural spread of a local anesthetic. Urinary catheterization was performed electively to prevent urinary retention. The patient was discharged home late that evening. Prior to discharge she volunteered that she was being investigated for multiple sclerosis. One month later the diagnosis of multiple sclerosis was confirmed. CONCLUSION: In conclusion the extended duration of central neural blockade following paravertebral block, may have been related to an abnormal uptake of local anesthetics into the spinal cord in the presence of demyelination.

Adult↗
PubMed2005

The "BURP" maneuver worsens the glottic view when applied in combination with cricoid pressure.

PURPOSE: The purpose of this study was to determine if the application of a BURP maneuver to the cricoid cartilage would combine the benefits of both the BURP and the Sellick maneuvers, resulting in an improved glottic view and offer the potential of protection against passive gastric regurgitation. METHODS: This was a double-blind, prospective, randomized, crossover trial. Forty-three patients scheduled for elective surgery participated in this study. General anesthesia was induced using fentanyl, propofol and rocuronium. In a random sequence for each case and blinded to the laryngoscopist, one of three maneuvers was carried out. Direct vertical pressure, using 30 newtons, a BURP maneuver with cricoid pressure, or no pressure was applied to the cricoid and the laryngoscopic view was ascertained. A separate laryngoscopy was conducted for each maneuver and the views were graded as good (part of the glottis seen), poor (only the arytenoids were seen) or no view (only the epiglottis was seen). Endotracheal intubation was then performed in each case. RESULTS: The results showed that the combination of the BURP maneuver and cricoid pressure worsened the view obtained at laryngoscopy in 30% of cases (P = 0.007). Cricoid pressure alone worsened the view in 12.5% of cases (P = 0.279). No difference was seen in 65% of cases. All patients but one were intubated easily. CONCLUSION: There is no benefit to routinely applying a modified "BURP" maneuver to the cricoid cartilage during rapid sequence induction of anesthesia.

Adult↗
PubMed2002

Epidural block: technical aspects and complications.

In continuous epidural anaesthesia we rely heavily on the 'test dose' to confirm correct placement of the catheter. This is not always accurate and there are a number of new techniques designed to provide better information about epidural needle and catheter placement. These include: electrical stimulation of the catheter, use of ultrasound and the application of simple geometry. The use of epidurals in patients undergoing coronary artery bypass graft surgery is controversial because of the risk of vertebral canal haematoma. Neurological complications may arise during administration of the block, since the needle or catheter may result in direct nerve trauma. The injection of irritant drugs can also cause neurological damage. We must therefore be meticulous when injecting drugs into the epidural space. The increasing use of anticoagulant therapy in surgical patients and, in particular, the variety of low molecular weight heparins available, may make it difficult to safely perform epidural anaesthesia.

Journal Article↗
PubMedDate not supplied

The public's fears about and perceptions of regional anesthesia.

BACKGROUND AND OBJECTIVES: The public is not well informed about matters relating to regional anesthesia. Previous studies concerning regional anesthesia have involved patients, surgeons, and anesthesiologists. This study is the first in-depth survey of the attitudes of the general public toward a number of commonly perceived fears about regional anesthesia. METHODS: A province-wide telephone survey was conducted in Alberta, Canada. The sample surveyed was representative of the adult population of the province and included an equal balance of urban and rural participants. General and regional anesthesia were defined, a scenario involving major knee surgery was described, and participants were asked to choose between regional and general anesthesia. Respondents were then questioned so their attitudes toward commonly perceived fears associated with regional anesthesia could be assessed. RESULTS: A total of 1,216 people were surveyed. A preference for regional or general anesthesia was not expressed in this scenario. Approximately 27% of respondents were very concerned about permanent paralysis, back injury, perioperative pain, seeing the surgical procedure, and the prospect of a needle in the back. Only 6% of individuals were concerned about headaches. CONCLUSIONS: The public's fears and conceptions about regional anesthesia are greatly distorted. The anesthesia community has not been successful in keeping the public informed about regional anesthesia. Future anesthesia-related educational programs should address the concerns of the public about anesthesia matters, particularly regional anesthesia.

Adult↗