bluuebunny/crossref_metadata_2025_split huggingface dataset:
Gastrointestinal Perfusion in Septic Shock
Authors: van Haren F. M. P. , Sleigh J. W. , Pickkers R , Van Der Hoeven J. G. 
Published: January 2019

Septic shock is characterised by vasodilation, myocardial depression and impaired microcirculatory blood flow, resulting in redistribution of regional blood flow. Animal and human studies have shown that gastrointestinal mucosal blood flow is impaired in septic shock. This is consistent with abnormalities found in many other microcirculatory vascular beds. Gastrointestinal mucosal microcirculatory perfusion deficits have been associated with gut injury and a decrease in gut barrier function, possibly causing augmentation of systemic inflammation and distant organ dysfunction. A range of techniques have been developed and used to quantify these gastrointestinal perfusion abnormalities. The following techniques have been used to study gastrointestinal perfusion in humans: tonometry, laser Doppler flowmetry reflectance spectrophotometry, near-infrared spectroscopy, orthogonal polarisation spectral imaging, indocyanine green clearance, hepatic vein catheterisation and measurements of plasma D-lactate. Although these methods share the ability to predict outcome in septic shock patients, it is important to emphasise that the measurement results are not interchangeable. Different techniques measure different elements of gastrointestinal perfusion. Gastric tonometry is currently the most widely used technique because of its non-invasiveness and ease of use. Despite all the recent advances, the usefulness of gastrointestinal perfusion parameters in clinical decision-making is still limited. Treatment strategies specifically aimed at improving gastrointestinal perfusion have failed to actually correct mucosal perfusion abnormalities and hence not shown to improve important clinical endpoints. Current and future treatment strategies for septic shock should be tested for their effects on gastrointestinal perfusion; to further clarify its exact role in patient management, and to prevent therapies detrimental to gastrointestinal perfusion being implemented.
Efficacy of Risperidone for Prevention of Postoperative Delirium in Cardiac Surgery
Authors: Prakanrattana U. , Prapaitrakool S. 
Published: January 2019

This randomised, double-blinded, placebo-controlled study was primarily aimed to evaluate the potential of risperidone to prevent postoperative delirium following cardiac surgery with cardiopulmonary bypass and the secondary objective was to explore clinical factors associated with postoperative delirium. One-hundred-and-twenty-six adult patients undergoing elective cardiac surgery with cardiopulmonary bypass were randomly assigned to receive either 1 mg of risperidone or placebo sublingually when they regained consciousness. Delirium and other outcomes were assessed. The confusion assessment method for intensive care unit was used to assess postoperative delirium. The incidence of postoperative delirium in the risperidone group was lower than the placebo group (11.1% vs. 31.7% respectively, P=0.009, relative risk=0.35, 95% confidence interval [CI]=0.16-0.77). Other postoperative outcomes were not statistically different between the groups. In exploring the factors associated with delirium, univariate analysis showed many factors were associated with postoperative delirium. However multiple logistic regression analysis showed a lapse of 70 minutes from the time of opening eyes to following commands and postoperative respiratory failure were independent risk factors (P=0.003, odds ratio [OR]=4.57, 95% CI=1.66-12.59 and P=0.038, OR=13.78, 95% CI=1.15-165.18 respectively). A single dose of risperidone administered soon after cardiac surgery with cardiopulmonary bypass reduces the incidence of postoperative delirium. Multiple factors tended to be associated with postoperative delirium, but only the time from opening eyes to following commands and postoperative respiratory failure were independent risk factors in this study.
A Comparison of the Effect of Total Intravenous Anaesthesia with Propofol and Remifentanil and Inhalational Anaesthesia with Isoflurane on the Release of Pro- and Anti-Inflammatory Cytokines in Patients Undergoing Open Cholecystectomy
Authors: Ke J. J. , Zhan J. , Feng X. B. , Wu Y. , Rao Y. , Wang Y. L. 
Published: January 2019

The aim of the study was to investigate the effects of two anaesthetic techniques (total intravenous technique vs. inhalational technique) on changes in pro- and anti-inflammatory cytokine levels during open cholecystectomy. Forty ASA PS I-II patients undergoing open cholecystectomy were randomly assigned to two groups. Group R received total intravenous anaesthesia with propofol and remifentanil and group F received balanced inhalational anaesthesia with isoflurane. The plasma levels of tumour necrosis factor-α (TNF-α), interleukin IL-6 and interleukin IL-10 were measured during and after surgery. The proinflammatory cytokine levels (TNF-α and IL-6) and the anti-inflammatory cytokine (IL-10) showed a significant increase in their concentrations compared with pre-induction levels in both groups (P <0.05). By the end of anaesthesia and surgery, TNF-α and IL-6 were significantly lower in group R than in group F (P <0.05). At the end of anaesthesia and 12 hours postoperatively, IL-10 levels in group R were higher than in group F (P <0.05). These findings suggest that total intravenous anaesthesia using propofol and remifentanil suppresses the inflammatory response caused by surgery to a greater extent than a balanced inhalation technique using isoflurane.
Assessment of an Unplanned Admission to the Intensive Care Unit as a Global Safety Indicator in Surgical Patients
Authors: Haller G. , Myles P. S. , Langley M. , Stoelwinder J. , Mcneil J. 
Published: January 2019

An unplanned intensive care unit admission within 24 hours of a procedure with an anaesthetist in attendance (UIA) is a recommended clinical indicator. It is designed to identify preventable iatrogenic complications. Often understood as a specific anaesthetic outcome, its value has been repeatedly questioned. Iatrogenic complications however, often result from successive mishaps. In the specific context of an UIA these complications can be related both to anaesthesia and surgery. UIA is therefore probably more a global indicator of the safety of surgical care (anaesthetic and surgical) rather than a specific anaesthetic outcome. Its utility as such is however unknown. The purpose of this study was to assess the value of UIA as a global measure of avoidable iatrogenic complications in surgical patients. Using computerised patient records and medical charts, all patients with an UIA over a study period of five years were identified. The proportion, cause and preventability of iatrogenic complications amongst these patients were assessed. A total of 188 UIA patients were identified by peer reviewers. Of these, 87% to 92% had a complication caused by anaesthesia and/or surgery. Anaesthesia was found to be responsible for 24% to 31% of iatrogenic complications. All other cases related to the combination of anaesthesia and surgery or surgery alone. Of these, 74% to 92% of complications were found to be preventable. Despite intrinsic limitations of the retrospective chart review method, UIA can be considered as a valuable tool to detect avoidable iatrogenic complications related to both surgical and anaesthetic care.
Evaluation of an Oxford Miniature Vaporizer Placed in-Circuit during the Maintenance Phase of Low-Flow Anaesthesia
Authors: Beck A. Ali , Boesel T. , Seppelt I. M. 
Published: January 2019

The aim of the study was to assess Oxford Miniature Vaporizer output when mounted in-circuit during the maintenance phase of anaesthesia, using isoflurane, controlled ventilation and a fresh gas flow rate less than 1 l/min. Twenty patients of ASA Physical Status I and II were recruited from routine general surgical lists. All patients were paralysed and ventilated. An out-of-circuit isoflurane vaporiser was used during the induction period (first 20 to 30 minutes). Anaesthesia was maintained using an Oxford Miniature Vaporizer placed in-circuit, using a fresh gas flow of 500 ml/min. The end-tidal isoflurane concentration was recorded for 90 minutes at five-minute intervals using a sidestream agent analyser. Two groups were compared, with the Oxford Miniature Vaporizer dial setting at either the 0.5 mark (low output setting) or at the 1.0 mark (higher output setting). At a dial setting of 0.5, the Oxford Miniature Vaporizer produced a steady end-tidal isoflurane of 0.63% (95% confidence interval 0.60 to 0.66). However, when the dial was turned to 1.0 the output was almost always excessive and had to be reduced. These findings indicate that a stable, predictable and clinically useful output can be achieved when the Oxford Miniature Vaporizer is positioned in-circuit using low-flow and controlled ventilation.
Analgesic Efficacy using Loss of Resistance to Air Vs. Saline in Combined Spinal Epidural Technique for Labour Analgesia
Authors: Leo S. , Lim Y. , Sia A. T. H. 
Published: January 2019

Identification of the epidural space is often performed using the loss of resistance technique to either air or saline. We sought to investigate if the medium used affected the quality of analgesia obtained by parturients who received labour epidurals. We conducted a retrospective audit of labour epidurals performed on nulliparous parturients in our institution from May 2003 to March 2005. All epidural catheters were inserted by senior obstetric anaesthetists using a combined spinal epidural technique. The following information was recorded: parturients’ demographic data, loss of resistance technique used, type and amount of local anaesthetic solution administered, complications encountered during procedure, pre-block and post-block pain scores, incidence of breakthrough pain requiring supplemental medication and post-block side-effects. Data from 2848 patients were collected and analysed; 56% of patients made up the saline group and 44% the air group. Patients in both groups had similar demographic profiles and similar incidences of complications and post-block side-effects. However, patients in the air group had a higher incidence of recurrent breakthrough pain P=0.023). We also identified three other factors that were associated with an increased incidence of recurrent breakthrough pain; administration of pre-block oxytocin, sitting position of the parturient during the procedure and the use of intrathecal bupivacaine for induction of analgesia. Our findings suggest that a loss of resistance to air is associated with a higher incidence of recurrent breakthrough pain among parturients who received combined spinal epidural analgesia for labour than a loss of resistance to saline.
View of the Larynx Obtained using the Miller Blade and Paraglossal Approach, Compared to that with the Macintosh Blade
Authors: Achen B. , Terblanche O. C. , Finucane B. T. 
Published: January 2019

The purpose of this study was to determine if laryngoscopy using a Miller blade with a paraglossal approach would yield an improved view of the larynx compared to that obtained with a Macintosh blade using the standard approach. One-hundred and sixty-one patients, scheduled for elective surgery requiring tracheal intubation, voluntarily participated in this study. Patients were randomly assigned to one of the two groups (Miller vs. Macintosh). A standard general anaesthetic was administered. Comparisons were made of the percentage of the vocal cords visible at laryngoscopy. The view of the airway was also graded using the Cormack and Lehane scale. Statistical analysis using Fisher's exact test was performed. A P value <0.05 was considered statistically significant. The time required to complete intubation and complications if any, were also recorded. Laryngoscopy using the Miller blade allowed 100% of the vocal cords to be viewed in 78%> of cases, whereas this was achievable in only 53% with the Macintosh blade (P=0.0014). The Miller blade enabled greater than 25% of the vocal cords to be seen in 95% of the cases, whereas this was achievable in only 80% with the Macintosh laryngoscope (P=0.003). A grade 1 Cormack and Lehane view of the larynx was obtained in 96.5% of cases in the Miller group compared with 85% in the Macintosh group (P=0.02). Direct laryngoscopy using the Miller blade and paraglossal approach, afforded a much-improved view of the larynx in the majority of cases. For this reason trainees should learn laryngoscopy using both blades.
Effect of Open-Chest Surgery in the Lateral Position on Blood Propofol Concentration during Target-Controlled Infusion of Propofol
Authors: Tan L. H. , Cokis C. J. , Weightman W. M. , Manopas A. R. , Paech M. J. , Nazir H. S. , Hackett L. P. 
Published: January 2019

Our research hypothesis was that single lung ventilation during thoracic surgery in the lateral position increases the blood concentration of propofol during target-controlled infusion. Thirty adult patients in two tertiary referral hospitals undergoing open-chest surgery were studied. Anaesthesia was induced and maintained with propofol using a Diprifusor (Graseby 3500) computer-controlled pump set to deliver a blood concentration of 4 μg.ml-1. Blood samples were taken with the patient positioned in 1) the supine position 20 minutes after induction (supine); 2) the lateral position just prior to one-lung ventilation (lateral); 3) the lateral position five minutes after commencing one-lung ventilation (OLV5) and 4) the lateral position 20 minutes after commencing one-lung ventilation (OLV20). Propofol concentrations were determined by high performance liquid chromatography. The target-controlled infusion target level was maintained at 4 μg.ml-1 during the study period for all cases. The mean (SD) propofol blood concentration (μg.ml-1) at each stage was 5.5 (1.5) supine, 5.3 (1.1) lateral, 5.3 (1.2) OLV5 and 5.1 (1.2) OLV20. Repeated measures ANOVA showed an F value 1.9, lambda 5.5 and P value 0.15. Post hoc analysis did not identify a significant difference between the sample times. During target-controlled infusion of propofol, mean blood propofol concentrations did not change significantly from those obtained with the patient supine after up to 50 minutes in the lateral position during thoracic surgery, or 20 minutes after commencing one-lung ventilation.
Comparison of Intensive Care Outcome Prediction Models Based on Admission Scores With those Based on 24-Hour Data
Authors: Duke G. J. , Piercy M. , Digiantomasso D. , Green J. V. 
Published: January 2019

We compared the performance of six outcome prediction models - three based on 24-hour data and three based on admission-only data - in a metropolitan university-affiliated teaching hospital with a 10-bed intensive care unit. The Acute Physiology and Chronic Health Evaluation models, version II (APACHE II) and version III-J, and the Simplified Acute Physiology Score version II (SAPS II) are based on 24-hour data and were compared with the Mortality Prediction Model version II and the SAPS version III using international and Australian coefficients (SAPS IIIA). Data were collected prospectively according to the standard methodologies for each model. Calibration and discrimination for each model were assessed by the standardised mortality ratio, area under the receiver operating characteristic plot and Hosmer-Lemeshow contingency tables and chi-squared statistics (C10 and H10). Predetermined criteria were area under the receiver operating characteristic plot >0.8, standardised mortality ratio 95% confidence interval includes 1.0, and C10 and H10 P values >0.05. Between October 1, 2005 and December 31, 2007, 1843 consecutive admissions were screened and after the standard exclusions, 1741 were included in the analysis. The SAAPS II and SAPS IIIA models fulfilled and the APACHE II model failed all criteria. The other models satisfied the discrimination criterion but significantly over-predicted mortality risk and require recalibration. Outcome prediction models based on admission-only data compared favourably to those based on 24-hour data.
Efficacy of Low Dose Levobupivacaine (0.1%) for Axillary Plexus Block using Multiple Nerve Stimulation
Authors: Zhao X. , Wang Y.-W. , Chen H. , Zhang Z. , You X.-M. , Luo K. , Jin Y.-J. 
Published: January 2019

The purpose of this study was to investigate if low doses of levobupivacaine (0.1%) produce complete sensory blockade in preoperative axillary brachial plexus block and to compare the effect of different doses of levobupivacaine on sensory and motor blockade. A total of 110 patients scheduled for elective forearm or hand surgery were randomly allocated to receive 36 ml or 72 ml of levobupivacaine 0.1% or 36 ml of levobupivacaine 0.25%. In each group, volumes were equally distributed in the four nerve territories. In all patients, the sensory and motor block was assessed at five, 10, 20 and 30 minutes after the placement of axillary block. Complete sensory block was obtained in 94.4% of patients receiving 36 ml of levobupivacaine 0.1%, 92.1% of those receiving 72 ml of levobupivacaine 0.1%, and 97.1% of those receiving 36 ml of levobupivacaine 0.25%. There was no significant difference either in the onset of the sensory and motor block or duration of the sensory and motor block. This study demonstrates that 36 ml of levobupivacaine 0.1% (36 mg) is as effective as higher doses and volumes in axillary brachial plexus blockade.
Effect of the Mode of Administration of Inhaled Anaesthetics on the Interpretation of the FA/FI Curve – a GasMan® Simulation
Authors: Van Zundert T. , Hendrickx J. , Brebels A. , De Cooman S. , Gatt S. , De Wolf A. 
Published: January 2019

The effects of blood solubility, cardiac output and ventilation on the rise of the alveolar towards the inspired concentration, the FA/FI curve, of an inhaled anaesthetic are often thought to reflect how these factors affect wash-in of the central nervous system compartment and, therefore, speed of induction because If is the partial pressure ultimately attained in the central nervous system (FVRG). These classical FA/FI curves assumed a constant FI. We used GasMan® to examine whether changes in solubility, cardiac output and ventilation affect the relationship between the FA/FI curve and FVRG differently while either FI or FA are kept constant. Using GasMan®, we studied the effects of solubility (desflurane vs isoflurane), cardiac output (5 vs 10 l.min-1) and minute ventilation (4 vs 8 l.min-1) on FA, FI FA/FI. and FVRG with either FI kept constant or FA kept constant (at 1 minimum alveolar concentration). High fresh gas flows were used to avoid rebreathing, so that the delivered concentration matched FI. Despite similar effects on the FA/FI curve, the effects on FVRG differed. With constant FI, lower solubility or higher ventilation results in a higher FVRG and a higher cardiac output results in a lower FVRG With constant FA, solubility has only a minimal effect on FVRG; an increase in cardiac output hastens the rise of FVRG to the same plateau value; and a change in ventilation has minimal effect on FVRG. Despite similar effects on the FA/FI curve, the effects of solubility, cardiac output and ventilation on the FVRG are different when either FI or FA are kept constant. With the FI kept constant, induction of anaesthesia is slower with a higher cardiac output, but with FA kept constant, induction of anaesthesia is faster with a higher cardiac output. The introduction of an end-expired closed-loop feedback administration of inhaled anaesthetics makes this distinction clinically relevant.
Preoperative Estimated Glomerular Filtration Rate and RIFLE-Classified Postoperative Acute Kidney Injury Predict Length of Stay Post-Coronary Bypass Surgery in an Australian Setting
Authors: Moore E. M. , Simpson J. A. , Tobin A. , Santamaria J. 
Published: January 2019

We investigated the influence of preoperative estimated glomerular filtration rate and postoperative acute kidney injury on outcomes after coronary bypass surgery in a local setting, with the focus on length of stay. A retrospective analysis of prospectively collected data for 3302 consecutive patients who underwent coronary artery bypass graft surgery (June 1997 through to January 2007) at St Vincent's Public Hospital, Melbourne, was undertaken. Preoperative estimated glomerular filtration rate was calculated and categorised using US National Kidney Foundation cut-offs for chronic kidney disease (normal function; mild, moderate and severe dysfunction). Postoperative acute kidney injury was categorised using serum creatinine RIFLE criteria (no acute kidney injury, risk, injury and failure). Postoperative intensive care and hospital length of stay was determined. The hazard ratios for time to hospital discharge up to one month decreased (indicating a longer length of stay) as severity of preoperative renal dysfunction category increased when compared to those with normal renal function: mild hazard ratio=1.02 (95% confidence interval: 0.91 to 1.15, P=0.70), moderate 0.87 (0.76 to 1.00, P=0.047), severe 0.47 (0.35 to 0.64, P < 0.001). Hazard ratios also decreased as severity of postoperative acute kidney injury category increased, when compared to those with no acute kidney injury: risk 0.67 (0.58 to 0.77, P <0.001), injury 0.52 (0.41 to 0.65, P <0.001), failure 0.35 (0.20 to 0.60, P <0.001). The increasing severity of preoperative renal dysfunction and postoperative acute kidney injury were associated with increased hospital length of stay. This has implications for resource use, informed consent and case selection.
Hyperbaric Oxygen Therapy in the Treatment of Post Cardiac Surgical Strokes – a Case Series and Review of the Literature
Authors: Gibson A. J. , Davis F. M. 
Published: January 2019

Strokes remain an uncommon but significant complication of cardiac surgery. Cerebral air embolism is the likely aetiology in the majority of cases. Hyperbaric oxygen therapy is the recognised treatment for cerebral air embolism associated with compressed air (SCUBA) diving accidents and is therefore also the standard of care for iatrogenic causes of air embolism. It follows that there is a logic in treating post-cardiac surgical stroke patients with hyperbaric oxygen. The aim of this retrospective review was to examine the outcomes of 12 such patients treated in the Christchurch Hospital hyperbaric unit and to appraise the evidence base for the use of hyperbaric oxygen therapy in this setting. Despite delays of up to 48 hours following surgery before the institution of hyperbaric oxygen therapy, 10 of the 12 patients made a full neurological recovery or were left with mild residual symptoms, with nine returning to their previous level of care. One patient remained hemiplegic and there was one early neurological death. There is a paucity of prospective data in this area, but based on sound pathophysiological principles and clinical experience, we believe that patients suffering a stroke following open cardiac surgery should be considered for hyperbaric oxygen therapy.