What about chlorides? (Hans Bahlmann, 12 December 2012)
An interesting study which helps us a little bit further on the road but it is confusing that the authors mention in the methods section that they used HES in saline (Voluven), while in the discussion they claim that they used "a medium molecular weight starch in a balanced electrolyte solution".
I suppose it was "unbalanced" saline-based Voluven which was used in the study. That would mean that the colloid group received about 60 mmol of chlorides more that the CLS group which could explain the increased incidence of nausea? So three questions remain:
1. Which solution was used
2. If it was Voluven, what do the authors feel about the chloride difference
3. If it was Voluven, why didn't the authors use a real balanced colloid solution such as Volulyte
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Comment on: Hayes et al. BMC Anesthesiology, 12:15
Endotracheal tube cuff pressure monitoring and control (Musa Muallem, 19 January 2011)
Dear Editor
I do agree fully with the authers of this article that mandatory monitoring of the ET tube cuff pressure is needed.In my experience in this field of fifty years I likewise found that the ET tube cuff pressure exceeded 30 cm of water in about 50% of cases especially if the operation lated over two hours. Anesthesiologist continue to ignore the above important recommendation in many istitutions because they do not have easy access to devices that monitor and control cuff pressure. Intermittant checking of the cuff pressure during anesthesia is not good enough and has a very poor compliance. The cuff pressure should be monitored and controlled at the required level continouessly and automatically without the anesthesiologist having to worry about it. This situation...
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why only dental or renal pain (medha joshi, 12 May 2010)
this is very interesting . if pressure is relieving dental pain then any chronic pain should be relieved. has there been any research in this direction? what made you chose patients only with dental or renal pain? why not migraine.
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Causes of local resistance. (Adrian Woollard, 18 June 2007)
Dear AuthorsI thought your article was well written. We have recently had a similar case of local anaesthetic resistance. It was a patient presenting as an emergency for a caesarean section. The patient had a history of failure of local anaesthetics for dental procedures and dermatological procedures. The spinal also failed despite good practice. We never found a reason for it to fail. Other reasons we suspect would include subarchnoid cysts which although rare in the lumbar regional could explain the aspiration of CSF and the ability to inject 2 mls without detectable resistance. A review article in the BJA could explain where a mutation in the channel would cause resistance to local anaesthetics. It would be interesting to find the incidence of failure to produce a spinal despite the...
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What about chlorides? (Hans Bahlmann, 12 December 2012)
An interesting study which helps us a little bit further on the road but it is confusing that the authors mention in the methods section that they used HES in saline (Voluven), while in the discussion they claim that they used "a medium molecular weight starch in a balanced electrolyte solution".
I suppose it was "unbalanced" saline-based Voluven which was used in the study. That would mean that the colloid group received about 60 mmol of chlorides more that the CLS group which could explain the increased incidence of nausea? So three questions remain:
1. Which solution was used
2. If it was Voluven, what do the authors feel about the chloride difference
3. If it was Voluven, why didn't the authors use a real balanced colloid solution such as Volulyte read full comment
Comment on: Hayes et al. BMC Anesthesiology, 12:15
Endotracheal tube cuff pressure monitoring and control (Musa Muallem, 19 January 2011)
Dear Editor
I do agree fully with the authers of this article that mandatory monitoring of the ET tube cuff pressure is needed.In my experience in this field of fifty years I likewise found that the ET tube cuff pressure exceeded 30 cm of water in about 50% of cases especially if the operation lated over two hours. Anesthesiologist continue to ignore the above important recommendation in many istitutions because they do not have easy access to devices that monitor and control cuff pressure. Intermittant checking of the cuff pressure during anesthesia is not good enough and has a very poor compliance. The cuff pressure should be monitored and controlled at the required level continouessly and automatically without the anesthesiologist having to worry about it. This situation... read full comment
Comment on: Rokamp et al. BMC Anesthesiology, 10:20
why only dental or renal pain (medha joshi, 12 May 2010)
this is very interesting . if pressure is relieving dental pain then any chronic pain should be relieved. has there been any research in this direction? what made you chose patients only with dental or renal pain? why not migraine. read full comment
Comment on: He et al. BMC Anesthesiology, 8:1
Causes of local resistance. (Adrian Woollard, 18 June 2007)
Dear AuthorsI thought your article was well written. We have recently had a similar case of local anaesthetic resistance. It was a patient presenting as an emergency for a caesarean section. The patient had a history of failure of local anaesthetics for dental procedures and dermatological procedures. The spinal also failed despite good practice. We never found a reason for it to fail. Other reasons we suspect would include subarchnoid cysts which although rare in the lumbar regional could explain the aspiration of CSF and the ability to inject 2 mls without detectable resistance. A review article in the BJA could explain where a mutation in the channel would cause resistance to local anaesthetics. It would be interesting to find the incidence of failure to produce a spinal despite the... read full comment
Comment on: Kavlock et al. BMC Anesthesiology, 4:1