Motor Lateralization May Be Influenced by Long-Term Piano Playing Practice

Motor lateralization is viewed as anatomical or functional asymmetry of the two sides of the body. Functional motor asymmetry can be influenced by musical practice. This study explored whether piano playing experience modulates motor asymmetry and leads to an altered pattern of hand selection, reflecting an altered handedness. We asked two groups of right-handed participants-piano players and non-piano players-to reach targets in their frontal space with both arms, and we tested the motor performance of each arm on this task and then on an arm preference test. As musical practice can decrease motor asymmetry between arms, we hypothesized that participants with piano playing experience would display less interlimb asymmetry and that this, in turn, would change their arm preference pattern, compared with participants without piano playing experience. We found support for both hypotheses, and we conclude that arm selection (preference) is not biologically fixed, but, rather, can be modulated through long-term piano playing.

Hemodynamic responses and upper airway morbidity following tracheal intubation in patients with hypertension: conventional laryngoscopy versus an intubating laryngeal mask airway

OBJECTIVES

We compared hemodynamic responses and upper airway morbidity following tracheal intubation via conventional laryngoscopy or intubating laryngeal mask airway in hypertensive patients.

METHODS

Forty-two hypertensive patients received a conventional laryngoscopy or were intubated with a intubating laryngeal mask airway. Anesthesia was induced with propofol, fentanyl, and cis-atracurium. Measurements of systolic and diastolic blood pressures, heart rate, rate pressure product, and ST segment changes were made at baseline, preintubation, and every minute for the first 5 min following intubation. The number of intubation attempts, the duration of intubation, and airway complications were recorded.

RESULTS

The intubation time was shorter in the conventional laryngoscopy group than in the intubating laryngeal mask airway group (16.33 ± 10.8 vs. 43.04 ± 19.8 s, respectively) (p<0.001). The systolic and diastolic blood pressures in the intubating laryngeal mask airway group were higher than those in the conventional laryngoscopy group at 1 and 2 min following intubation (p<0.05). The rate pressure product values (heart rate x systolic blood pressure) at 1 and 2 min following intubation in the intubating laryngeal mask airway group (15970.90 ± 3750 and 13936.76 ± 2729, respectively) were higher than those in the conventional laryngoscopy group (13237.61 ± 3413 and 11937.52 ± 3160, respectively) (p<0.05). There were no differences in ST depression or elevation between the groups. The maximum ST changes compared with baseline values were not significant between the groups (conventional laryngoscopy group: 0.328 mm versus intubating laryngeal mask airway group: 0.357 mm; p = 0.754). The number and type of airway complications were similar between the groups.

CONCLUSION

The intense and repeated oropharyngeal and tracheal stimulation resulting from intubating laryngeal mask airway induces greater pressor responses than does stimulation resulting from conventional laryngoscopy in hypertensive patients. As ST changes and upper airway morbidity are similar between the two techniques, conventional laryngoscopy, which is rapid and safe to perform, may be preferred in hypertensive patients with normal airways.

Anesthetic management for cesarean delivery in a woman with Gilles de la Tourette’s syndrome

Gilles de la Tourette's syndrome is a chronic neuropsychiatric disorder with an early childhood onset featuring mainly motor and vocal tics. We present the anesthetic management for cesarean delivery of a 21-year-old pregnant woman with Tourette's syndrome. She had shrugging of the shoulders and sudden, jerky, repetitive, irregular movements of the hands. General anesthesia was given for cesarean delivery. A live male infant weighing 3130 g was delivered. Her perioperative course was uneventful. No complication was observed. The patient and baby were discharged on the 4th postoperative day. It was decided to prescribe haloperidol 5 mg per day after lactation. Anesthesiologists should remember that there are special considerations when managing anesthesia in patients with Tourette's syndrome. The motor tics may lead to technical difficulty in performing regional anesthesia and surgery. Therefore general anesthesia may be appropriate in order to prevent agitation or involuntary movements. If patient movement and agitation can be controlled by sedation, regional block may be attempted. Drugs such as metoclopramide, ondansetron, midazolam and opioids may be used safely for anesthesia in Tourette's syndrome.

Effects of Lidocaine and Prednisolone on Endoscopic Rigid Laryngoscopy

OBJECTIVE/HYPOTHESIS

The aim of this study is to compare the effects of lidocaine and methylprednisolone on postoperative respiratory complications caused by short-term laryngeal surgery by way of rigid laryngoscope under general anesthesia. The effects of these drugs on recovery from anesthesia are also compared.

STUDY DESIGN

One hundred American Society of Anesthesiologists physical status I to II patients over 20 years of age admitted for laryngeal mass, nodule, or polyp were included in this prospective, placebo-controlled, randomized, and double-blinded study.

METHODS

Patients were randomly allocated to four groups; methylprednisolone 3 mg.kg-1 (group 1), 0.9% saline physiologic 5 mL (group 2), lidocaine 1.5 mg.kg-1 (group 3) intravenously, seven puffs of lidocaine aerosol 10% to oropharyngolaryngeal structures topically (group 4) sprayed. Anesthesia recovery time was calculated. Respiratory system was evaluated using a scoring table during early postoperative period.

RESULTS

Ninety-two cases were suitable for analysis. Recovery time was longer in group 1 (9.8 3+/- 3.79 minutes) than in groups 3 and 4 (7.22 +/- 2.38, 7.50 +/- 2.30 minutes, respectively) (P < .05). Postoperative respiratory complications were lower in groups 3 and 4 than group 2 (P < .05).

CONCLUSIONS

Lidocaine intravenous or topical administration was effective in reducing postoperative respiratory complications after short-term laryngeal surgery by way of rigid laryngoscope. Methylprednisolone prolonged recovery time from anesthesia.

Effects of menstrual cycle on postoperative analgesic requirements, agitation, incidence of nausea and vomiting after gynecological laparoscopy

BACKGROUND

Several studies have suggested that the menstrual cycle has an impact on postoperative nausea and vomiting (PONV). No previous study has evaluated the effect of the menstrual cycle on the incidence of postoperative agitation and analgesic/antiemetic requirements.

METHODS

On the basis of the phase of the menstrual cycle [pre+/-menstrual (Pd 25-6), early follicular phase (Pd 8-12), ovulatory phase (Pd 13-15), and luteal phase (Pd 20-24)], 67 patients enrolled in this blinded, prospective study. Anesthesia was standardized. Fentanyl was given to the patients who had severe pain in the recovery room. The patients who had agitation were given midazolam. When pain intensity was >5 on the Visual Analog Scale, metamizol was administered in the Gynecology Department. A blinded anesthesiologist recorded episodes of PONV in the recovery room, and 2 and 24 h postoperatively.

RESULTS

The opioid requirement and the frequency of agitation were similar in each group. Metamizol consumption was highest in the luteal phase (p < 0.05). The follicular and luteal phases were predictors for vomiting at recovery (p < 0.05 and p < 0.001, respectively). At the postoperative 2nd hour, nausea was higher in the follicular phase than in the other phases (p < 0.05) and the luteal phase was a predictor for retching (p < 0.001). At the postoperative 24th hour, nausea was the common symptom in the luteal phase (p < 0.05). The need for ondansetron was highest in the luteal phase (p < 0.01).

CONCLUSIONS

In conclusion, we suggest that the scheduling of all surgical procedures according to the menstrual phase may serve to reduce the incidence of PONV and metamizol/ondansetron consumption and hospital costs.

Prolonged apnea following succinylcholine administration in undiagnosed acute organophosphate poisoning

Organophosphates (OP) are irreversibly bound to cholinesterase, causing deactivation of acetylcholinesterase. As a result of inhibition of plasma cholinesterase, increased sensitivity to drugs hydrolyzed by this enzyme can occur, e.g. succinylcholine and mivacurium. A case of more prolonged succinylcholine-induced paralysis in a child with undiagnosed acute OP insecticide poisoning is presented. A 7-h period of apnea and paralysis after administration of succinylcholine was attributed to the decreased rate of succinylcholine metabolism resulting from inhibition of pseudocholinesterase by the insecticide. In seven previously reported cases of prolonged succinycholine apnea after OP poisoning, exposure to insecticide was in chronic or subacute form without any obvious symptoms, and the duration of apnea did not extend up to 4 h, whereas in our case with acute, severe poisoning, succinylcholine led to more prolonged muscle paralysis. In the anesthetic management of patients with acute OP poisoning, succinylcholine should be avoided.

Awake tracheal intubation through the intubating laryngeal mask airway in a patient with halo traction

PURPOSE

To report a case of awake tracheal intubation through the intubating laryngeal mask airway (ILMA) in a patient with halo traction.

CLINICAL FEATURES

A 16-yr-old, 40 kg, boy with atlanto-occipital instability and halo traction was scheduled for surgery under general anesthesia. The head of the patient was fixed in a position of flexion and extension was impossible. Cranial magnetic resonance imaging revealed that pharyngeal and laryngeal axes were aligned, but that the oral axis was in an extreme divergent plane. The tongue and oropharynx were anesthetized with 10% lidocaine spray and bilateral superior laryngeal nerve blockade was performed. Under sedation, awake orotracheal intubation via ILMA was successful. Fibreoptic bronchoscopy has been recommended for awake tracheal intubation in such patients. Other techniques, such as use of the Bullard laryngoscope have been described also but awake tracheal intubation through the ILMA in patients with a halo device in situ has seldom been reported in the medical literature.

CONCLUSION

Airway management of patients with cervical spine instability includes adequate preoperative evaluation of the airway and choosing the appropriate intubation technique. We suggest that the ILMA may be an adequate alternative for awake tracheal intubation in patients with an unstable cervical spine and cervical immobilization with a halo device.