bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Entropy Module® and Bispectral Index® as Guidance for Propofol-Remifentanil Anaesthesia in Combination with Regional Anaesthesia Compared with a Standard Clinical Practice Group
Authors: Ellerkmann R. K. , Soehle M. , Riese G. , Zinserling J. , Wirz S. , Hoeft A. , Bruhn J. 
Published: January 2019

This study was designed to investigate the impact of the Entropy Module® and Bispectral Index® (BIS) monitoring on drug consumption and recovery times compared with standard anaesthetic practice in patients undergoing orthopaedic surgery using a combination of regional and general anaesthesia as performed by an experienced anaesthesiologist. We hypothesised that electroencephalogram monitoring would lead to a lower drug consumption as well as shorter recovery times. With institutional review board approval and written informed consent, 90 adult patients undergoing surgery to the upper or lower extremity received regional anaesthesia for post- and intraoperative pain control and were randomised to receive general anaesthesia by propofol/remifentanil infusion controlled either solely by clinical parameters or by targeting Entropy or BIS values of 50. Recovery times and drug consumption were recorded. Data from 79 patients were analysed. Compared with standard practice, patients with Entropy or BIS monitoring showed a similar propofol consumption (standard practice 101±22 μg/kg/minute, Entropy 106±24 μg/kg/minute, BIS 104±20 μg/kg/minute) and showed similar Aldrete scores (10/10) one minute after extubation: 9.1∓0.3, 9.2±0.6 and 9.3±0.5, respectively. Time points of extubation were 7.3±2.9 minutes, 9.2∓3.9 minutes and 6.8±2.9 minutes, respectively, demonstrating a significant difference between Entropy and BIS (P=0.023). Compared with standard practice, targeting an Entropy or BIS value of 50 did not result in a reduction of propofol consumption during general anaesthesia combined with regional anaesthesia as performed by an experienced anaesthesiologist in orthopaedic patients.
An Overview of Evidence from Systematic Reviews Evaluating Early Enteral Nutrition in Critically Ill Patients: More Convincing Evidence is Needed
Authors: Heighes P. T. , Doig G. S. , Sweetman E. A. , Simpson F. 
Published: January 2019

International quality improvement initiatives such as Fast-Hug bring a focus on improving the delivery of early enteral nutrition to critically ill patients, however surveys demonstrate current practice remains variable. One way to reduce variability in practice is to provide strong evidence to convince clinicians to change. The purpose of this overview was to identify current best evidence supporting the delivery of early enteral nutrition in critical illness. We sought high-quality evidence in the form of systematic reviews containing meta-analyses of randomised controlled trials. Two authors independently identified studies and assessed methodological quality. Data sources included Medline, EMBASE and hand-searching of guideline reference lists. The literature search identified five systematic reviews that summarised 30 clinical trials. These systematic reviews focused on acutely hospitalised patients, critical illness, bums, elective intestinal surgery and pancreatitis. Early enteral nutrition significantly reduced mortality in elective intestinal surgery patients (relative risk 0.41, 95% confidence interval 0.18 to 0.93, P=0.03, I2=0.0%) and significantly reduced infectious complications in acutely ill hospitalised patients (relative risk 0.45, 95% confidence interval 0.3 to 0.66, P=0.00006, heterogeneity P=0.049). Four of five identified systematic reviews had key methodological quality deficiencies. The results of this overview highlight the variability in the evidence regarding the benefits of early enteral nutrition in critically ill patient populations. The inconsistent delivery to critically ill patients may be explained by the lack of convincing evidence. Better evidence may be needed to reduce the irregularity in the provision of early enteral nutrition to critically ill patients.
Comparison of Actual Tidal Volume in Neonatal Lung Model Volume Control Ventilation using Three Ventilators
Authors: Toyama H. , Endo Y. , Ejima Y. , Matsubara M. , Kurosawa S. 
Published: January 2019

In neonates, small changes in tidal volumes (VT) may lead to complications. Previous studies have shown a significant difference between ventilator-measured tidal volume and tidal volume delivered (actual VT). We evaluated the accuracy of three different ventilators to deliver small VT during volume-controlled ventilation. We tested Servo 300, 840 ventilator and Evita 4 Neoflow ventilators with lung models simulating normal and injured neonatal lung compliance models. Gas volume delivered from the ventilator into the test circuit (VTV) and actual VT to the test lung were measured using Ventrak respiration monitors at set VT (30 ml). The gas volume increase of the breathing circuit was then calculated. Tidal volumes of the SV300 and PB840 in both lung models were similar to the set VT and the actual tidal volumes in the injured model (20.7 ml and 19.8 ml, respectively) were significantly less than that in the normal model (27.4 ml and 23.4 ml). PB840 with circuit compliance compensation could not improve the actual VT. VTV of the EV4N in the normal and the injured models (37.8 ml and 46.6 ml) were markedly increased compared with set VT, and actual VT were similar to set VT in the normal and injured model (30.2 ml and 31.9 ml, respectively). EV4N measuring VT close to the lung could match actual VT to almost the same value as the set VT, however the gas volume of the breathing circuit was increased. If an accurate value for the patient's actual VT is needed, this VT must be measured by a sensor located between the Y-piece and the tracheal tube.
Anti-Emetic Doses of Dexamethasone Suppress Cortisol Response in Laparoscopic Cholecystectomy
Authors: Cowie B. S. , Allen K. J. , Said S. A. , Inder W. J. 
Published: January 2019

The efficacy of dexamethasone alone or in combination with a serotonergic antagonist to prevent nausea and vomiting in laparoscopic cholecystectomy is well established, but few data exist regarding its effects on perioperative cortisol and glucose levels. Fourteen non-diabetic subjects having elective laparoscopic choleycystectomy and standardised general anaesthesia were randomised to receive 8 mg of intravenous dexamethasone and tropisetron or tropisetron alone. Plasma cortisol and glucose were measured preinduction, at five and 24 hours postoperatively. There was no difference in plasma cortisol at five hours postoperatively in patients who received dexamethasone, but by 24 hours there was marked suppression compared to the control group (P <0.005) to less than 5% of the preoperative value. There was a small but statistically significant elevation in blood glucose at 24 hours (P <0.01) in the dexamethasone-treated group. In patients undergoing laparoscopic cholecystectomy, an anti-emetic dose of dexamethasone (8 mg) markedly suppresses plasma cortisol at 24 hours and causes a minor elevation in blood glucose.
The use of Drotrecogin Alfa in Severe Falciparum Malaria
Authors: Robak O. , Bojic A. , Locker G. J. , Laczika K. , Ramharter M. , Staudinger T. 
Published: January 2019

We report the case of a 55-year-old male European who became septic after he returned from a four-week holiday to Uganda. Soon after, he was diagnosed with severe falciparum malaria and developed multi-organ failure. Due to the worsening condition of the patient, drotrecogin alfa (activated) was started, soon after which the patient's condition significantly improved. He returned home on day 36 after admission, without neurologic sequelae. Looking at those few cases of severe forms of malaria where drotrecogin alfa (activated) was successfully used, it should at least be considered for administration in patients with severe falciparum malaria with disseminated intravascular coagulation and cerebral involvement who do not respond to or deteriorate during standard treatment.
The Utility of Procalcitonin in Diagnosis of H1N1 Influenza in Intensive Care Patients
Authors: Hammond N. E. , Corley A. , Fraser J. F. 
Published: January 2019

Procalcitonin (PCT) has been reported to differentiate between bacterial and viral causes of respiratory tract infections. We aimed to assess its ability to discriminate between viral and bacterial infection during the H1N1 pandemic of 2009. The design of this study was a retrospective single centre case series review. Subjects were 17 adult patients admitted to the intensive care unit with suspected or confirmed isolated H1N1 influenza infection, from whom a PCT level was assessed within 24 hours of admission. All patients were admitted during the H1N1 pandemic in Queensland from 6 July 2009 to 2 August 2009. The relationship between PCT levels and H1N1 status was measured by a Wilcoxon rank sum test. Patients were proven to have isolated H1N1 infection as judged by Polymerase Chain Reaction, with no bacterial super-infection. Of this number, 37% had a PCT <1 μg/l, and 63% of patients had an indeterminate PCT between 1 and 10 μg/l. The demographics of all 17 patients were mean age 48.2 years (SD 13.6 years); 59% female; mean Acute Physiological and Chronic Health Evaluation II score 20.3 (SD 5.8); mean intensive care unit 477.5 hours (SD 330.0 hours); 82% of cases required mechanical ventilation; 24% of cases required extracorporeal membrane oxygenation and 94% of cases were alive at intensive care unit discharge. PCT was neither sensitive nor specific in determining isolated H1N1 infection in this series of patients. The use of PCT to assist in isolation triage of patients suspected of infection with H1N1 influenza in the intensive care unit should be made with caution. A larger study may be required.
Rohrer's Constant, K2, as a Factor of Determining Inspiratory Resistance of Common Adult Endotracheal Tubes
Authors: Flevari A. G. , Maniatis N. , Kremiotis T. E. , Siempos I. , Betrosian A. P. , Roussos C. , Douzinas E. , Armaganidis A. 
Published: January 2019

The aim of the study was to calculate the in vitro inspiratory resistance (RETT) of adult endotracheal tubes (ETT), via the end-inspiratory occlusion method, and to apply this method in vivo in order to estimate RETT value in real time. By plotting RETT over inspiratory flow (V) and calculating Rohrer's coefficients of linear and nonlinear resistance, K1 and K2 respectively, we determined the resistive behaviour of each ETT. Peak and plateau pressures were recorded at both proximal and distal sites of the ETT after applying a three-second occlusion under constant flow. Distal pressure was obtained via an intraluminal catheter. RETT was calculated as (Ppeak – Pplateau)/(V;), at both sites. RETT value resulted from the difference Rproximal - Rdistal. Graph RETT over (V;) was plotted and Rohrer's constants were calculated by the method of least squares. For ETTs with inner diameter 9.0, 8.5, 8.0, 7.5, 7.0 and 6.5 mm, K2 was 2.42, 3.05, 4.65, 6.01, 9.17 and 12.80 cmH2O/l/s, respectively. The intraluminal catheter increased RETT No.7.0 by an average of 49%. Finally, ten patients with partially obstructed ETTs were tested and K2 in vivo constants found to be higher than their corresponding in vitro values (P value 0.00012). Therefore, knowing the performing size of an ETT may help the clinicians identify ETT obstruction and deal with weaning problems.
Retrospective Audit of Blood Transfusion and Comparison with Haemoglobin Concentration in Patients Undergoing Elective Primary and Revision Lower Limb Arthroplasty
Authors: Evans S. , O'Loughlin E. , Bruce J. 
Published: January 2019

We retrospectively audited the incidence of blood transfusion and related this to preoperative haemoglobin levels in 181 patients undergoing lower limb arthroplasty over a six-month period. This included 102 primary total knee replacements, 52 primary total hip replacements, 11 revision total knee replacements and 16 revision total hip replacements. The overall incidence of transfusion was 16.0%. The incidence in primary arthroplasty was 11% (9.8% for total knee replacements and 13.5% for total hip replacements), and in revision surgery was 44.4% (27.3% for total knee replacements and 56.3% for total hip replacements). Combining data for primary total knee replacements and primary total hip replacements, a preoperative haemoglobin threshold of 120 g/l divided patients into high and low risk groups for transfusion. Below or equal to this threshold the incidence of transfusion was 47.7%; above this threshold the incidence was 7.2%. We suggest that patients having primary lower limb arthroplasty with a preoperative haemoglobin of 120 g/l or less should undergo investigation of their anaemia and optimisation of erythropoeisis.
Concurrent Intracardiac Metastasis in a Patient with Intestinal Perforation
Authors: Lee C. T. , Farrell S. , Silbert B. S. 
Published: January 2019

The administration of anaesthesia to subjects with intracardiac lesions poses the potential for cardiac complications. Cardiac metastases should be identified in susceptible cases and transthoracic echocardiography performed to elucidate the nature of the cardiac lesions. We describe a case of an intracardiac metastasis in a 65-year-old subject with a small bowel tumour leading to intestinal perforation and presenting for surgical treatment. Oncological assessment of the situation, in conjunction with the anaesthetic risks, led to abandonment of surgery and palliative treatment.
Comparison of the Effect-Site Concentrations of Remifentanil for Streamlined Liner of the Pharynx Airway (SLIPA™) versus Laryngeal Mask Airway Softseal™ insertion during Target-Controlled Infusion of Propofol
Authors: Kim S. H. , Choi E. M. , Chang C. H. , Kim H. K. , Chung M. H. , Choi Y. R. 
Published: January 2019

This study was designed to determine the optimal dose of remifentanil required for the successful insertion of Streamlined Liner of the Pharynx Airway (SLIPA™) and to compare it to that required for laryngeal mask airway (LMA) insertion in patients receiving a propofol infusion at a standard effect-site concentration. Fifty-eight patients scheduled to undergo general anaesthesia were randomly assigned to either the SLIPA (n=29) or LMA (n=29) group. All patients were premedicated with midazolam 0.05 mg.kg-1 and glycopyrrolate 0.004 mg.kg-1 intramuscularly. After the administration of lignocaine 1 mg.kg-1 intravenously, a propofol infusion was started at an effect-site concentration of 3.5 μg.ml-1 with a remifentanil infusion without a neuromuscular blocking agent. The remifentanil dose was determined by the modified up-and-down method starting in each group at 4 ng.ml-1. Six minutes after induction, the airway device was inserted. Airway device insertion was classified as ‘success’ or ‘failure’ based on patient response. From the isotonic regression analysis and bootstrap distribution, the EC50 of remifentanil for SLIPA and LMA were 0.93 ng.ml-1 (95% confidence interval [CI] 0.81 to 1.50 ng.ml-1) and 1.36 ng.ml-1 (95% CI 1.19 to 2.06 ng.ml-1) respectively, and the EC95 for SLIPA and LMA insertions were 1.90 ng.ml-1 (95% CI 1.39 to 1.95) and 2.43 ng.ml-1 (95% CI 1.80 to 2.46 ng.ml-1) respectively. Using the 83% CIs from the bootstrap distribution, EC50 for SLIPA was significantly less than that of LMA (0.83 to 1.23 vs 1.26 to 2.00, respectively) (P <0.05). These findings suggest that the insertion of SLIPA needs about a 32% lower depth of anaesthesia than LMA insertion.
Effectiveness of the Streamlined Liner of the Pharynx Airway (SLIPA™) in Allowing Positive Pressure Ventilation during Gynaecological Laparoscopic Surgery
Authors: Hong S. J. , Ko K. M. , Park J. H. , Kim I. S. , Hwang S. M. , Shin K. M. , Yoon Y. J. , Kang S. S. 
Published: January 2019

The aim of this study was to assess whether the Streamlined Liner of the Pharynx Airway (SLIPA™) performed as well as an endotracheal tube for positive pressure ventilation in gynaecological laparoscopic surgery in the Trendelenburg position. Forty patients (American Society of Anesthesiologists physical status I to III) were randomly divided into two groups: SLIPA (n=20) or endotracheal tube group (n=20). Lung mechanics and severity of postoperative sore throat were assessed in both groups. In the SLIPA group, the oropharyngeal leak pressure was also measured. There were no significant differences between groups in the lung mechanics. In the SLIPA group, oropharyngeal leak pressure and peak inspiratory pressure increased significantly after gas insufflation compared to 10 minutes after patient positioning in the lithotomy position (P <0.05). The difference between oropharyngeal leak pressure and peak inspiratory pressure (approximately 10 cmH2O throughout the procedure) remained suitable for airway maintenance. The incidence of sore throat was similar in both groups but the severity was less in the SLIPA group 24 hours after surgery (P <0.05). There were no other complications such as regurgitation noted in either group. In the study population, the SLIPA performed as well as an endotracheal tube in allowing positive pressure ventilation without gas leak during gynaecological laparoscopy. The way in which the SLIPA increases its resistance to gas leak as the inspiratory pressure rises may account for this.
The Efficacy of Ultrasound-Guided Transversus Abdominis Plane Block in Patients Undergoing Hysterectomy
Authors: Atim A. , Bilgin F. , Kilickaya O. , Purtuloglu T. , Alanbay I. , Orhan M. E. , Kurt E. 
Published: January 2019

The study objective of this prospective, double-blind randomised controlled study was to evaluate the efficacy of ultrasound guided transversus abdominis plane (TAP) block and bupivacaine infiltration of the skin and subcutaneous tissue of the wound in patients undergoing hysterectomy. Patients were randomly allocated to three groups: a control group (n=18) and TAP block group (n=18) received bilateral TAP blocks with saline and bupivacaine respectively, and an infiltration group (n=19) received skin and subcutaneous wound tissue infiltration with bupivacaine at the end of surgery. After surgery patients received patient-controlled intravenous tramadol and were assessed for pain and tramadol consumption at 1, 2, 4, 6 and 24 hours. Both the TAP and infiltration groups had lower movement and rest pain scores than the control group, with lower scores in the TAP group than the infiltration group at 6 and 24 hours. Total tramadol consumption was significantly lower in the TAP group than in the other groups at all time points. We concluded that ultrasound-guided TAP block reduced rest and movement pain after total abdominal hysterectomy and was more effective than superficial wound infiltration for postoperative pain management.
Ondansetron does not Modify Emergence Agitation in Children
Authors: Hoşten T. , Solak M. , Elemen L. , Ozgun M. , Toker K. 
Published: January 2019

In this prospective, placebo-controlled study, we evaluated the effect of prophylactic ondansetron therapy on emergence agitation of children who underwent minor surgery below the umbilicus. Seventy children aged one to six years and American Society of Anesthesiologists physical status I were studied. Children were premedicated with midazolam rectally and were randomly assigned to receive either ondansetron (Group O) or placebo (Group P) in combination with caudal anaesthesia. Children in Group O received intravenous ondansetron (0.1 mg/kg for children weighing <40 kg, 4 mg for children weighing >40 kg) and Group P (n=35) received normal saline 2 ml following anaesthesia induction with sevoflurane. Airway management was provided with LMA-Proseal without muscle relaxation and anaesthesia maintenance was provided with a 60:40 N2O:O2 mixture and sevoflurane. Emergence agitation was evaluated with a ten point scale and pain level was assessed every 10 minutes for the first 30 minutes after admission to the recovery room. There were no significant differences between the placebo and ondansetron groups with respect to demographic, anaesthetic and surgical details. Incidences of emergence agitation in ondansetron and placebo groups were similar (32.4% and 30.3% at 10 minutes respectively). Mean modified Children's Hospital of Eastern Ontario pain scale scores and mean ten-point scale scores and emergence agitation incidences decreased similarly after 10 minutes in both groups. Ready time for discharge was similar between the groups. Agitated patients had significantly increased ready time for discharge compared to non-agitated patients (P=0.001). Prophylactic intravenous ondansetron administration does not reduce emergence agitation comparing to placebo after sevoflurane anaesthesia.
Remifentanil Patient-Controlled Analgesia for Labour: A Complete Audit Cycle
Authors: Buehner U. , Broadbent J. R. , Chesterfield B. 
Published: January 2019

Remifentanil patient-controlled analgesia (PCA) was introduced to a small maternity unit where an extensive epidural service was difficult to provide. This was a new service and the New Zealand College of Midwives had serious doubts about the efficacy and safety of remifentanil, so auditing its use was important. In a two-stage audit, clinical notes of 244 consecutive remifentanil users were studied between January 2008 and November 2009. We developed a questionnaire to assess the parturients’ satisfaction with remifentanil PCA and designed a proforma to evaluate it against four standards of best practice. During the two audit periods, timely commencement of PCA was achieved in 65% and 82% of cases, respectively. A 70% compliance rate with monitoring standards fell to 10% after the withdrawal of supervision by an acute pain team, but improved to 91% following implementation of regular midwifery training sessions and a redesigned partogram and prescription flowchart. Ninety-four percent of women rated remifentanil PCA as excellent, very good or good. Maternal side-effects were nausea, pruritus and drowsiness. A comparison of Apgar scores of consecutive neonates born by normal vaginal delivery to women receiving no analgesia, with those born to women using remifentanil PCA, demonstrated no difference. As a result of our audit, remifentanil PCA is now viewed by our midwives as an effective and safe method when accompanied by 1:1 care and appropriate monitoring. With our input other maternity units have introduced it, especially where epidural service provision is limited, and for patients in whom epidural analgesia is contraindicated.
Patient-Controlled Analgesia Syringe Pumps
Authors: Westhorpe R. N. , Ball C. 
Published: January 2019

The idea of administering repeated small doses of a drug intravenously is not new, but it took many years for the method to become part of the routine clinical management of pain. The traditional practice of administering an opioid in a predetermined dose by intramuscular or subcutaneous injection, and at predetermined minimal intervals, led to usually inadequate and intermittent pain relief. The dosage of opioid was often determined so as to be conservative and ‘safe’, and administration depended on patient request and availability of nursing staff.