bluuebunny/crossref_metadata_2025_split huggingface dataset:
Non-invasive Assessment of the Microcirculation in Critically Ill Patients
Authors: Nanas S. , Gerovasili V. , Renieris P. , Angelopoulos E. , Poriazi M. , Kritikos K. , Siafaka A. , Baraboutis I. , Zervakis D. , Markaki V. , Routsi C. , Roussos C. 
Published: January 2019

Sepsis is associated with abnormalities of muscle tissue oxygenation and of microvascular function. We investigated whether the technique of near-infrared spectroscopy can evaluate such abnormalities in critically ill patients and compared near-infrared spectroscopy-derived indices of critically ill patients with those of healthy volunteers. We studied 41 patients (mean age 58±22 years) and 15 healthy volunteers (mean age 49±13 years). Patients were classified into one of three groups: systemic inflammatory response syndrome (SIRS) (n=21), severe sepsis (n=8) and septic shock (n=12). Near-infrared spectroscopy was used to continuously measure thenar muscle oxygen saturation before, during and after a three-minute occlusion of the brachial artery via pneumatic cuff. Oxygen saturation was significantly lower in patients with SIRS, severe sepsis or septic shock than in healthy volunteers. Oxygen consumption rate during stagnant ischaemia was significantly lower in patients with SIRS (23.9±7.7%/minute, P <0.001), severe sepsis (16.9±3.4%/minute, P <0.001) or septic shock (14.8±6%/minute, P <0.001) than in healthy volunteers (35.5±10.6%/minute). Furthermore, oxygen consumption rate was significantly lower in patients with septic shock than patients with SIRS. Reperfusion rate was significantly lower in patients with SIRS (336±141%/minute, P <0.001), severe sepsis (257±150%/minute, P <0.001) or septic shock (146±101%/minute, P <0.001) than in healthy volunteers (713±223%/minute) and significantly lower in the septic shock than in the SIRS group. Near-infrared spectroscopy can detect tissue oxygenation deficits and impaired microvascular reactivity in critically ill patients, as well as discriminate among groups with different disease severity.
Comparison of Equipotent Doses of Ropivacaine-fentanyl and Bupivacaine-fentanyl in Spinal Anaesthesia for Lower Abdominal Surgery
Authors: Koltka K. , Uludag E. , Senturk M. , Yavru A. , Karadeniz M. , Sengul T. , Ozyalcin S. 
Published: January 2019

The aim of this randomised, double-blind study was to compare equipotent doses of plain ropivacaine and bupivacaine (19.5 mg and 13 mg respectively), both with fentanyl 20 μg, for spinal anaesthesia in lower abdominal surgery. After written informed consent had been obtained, 52 ASA I to II male patients scheduled for lower abdominal surgery were randomly assigned to receive intrathecal plain ropivacaine 19.5 mg with fentanyl 20 μg (group R, n=26) or plain bupivacaine 13 mg with fentanyl 20 μg (group B, n=26) in 3 ml. The level and duration of sensory block, intensity and duration of motor block, time to mobilise and patient satisfaction were recorded. All patients achieved sensory block to T10 or higher. The level of sensory block was significantly higher in group B (T4 [T3 to T7] vs T7 [T4 to T9], P <0.05). There was no difference in the onset time of motor block. The duration of motor block (Bromage score >0) was shorter in group R (139±39 minutes vs group B 182±46 minutes, P <0.05). The duration and intensity of complete motor block (Bromage score=3) were also shorter in group R (90±25 minutes vs 130±40 minutes, P <0.05). We conclude that plain ropivacaine 19.5 mg plus fentanyl 20 μg is associated with a lower level of sensory block and a shorter duration of motor block when compared to bupivacaine 13 mg plus fentanyl 20 μg for spinal anaesthesia in lower abdominal surgery.
Thyroid Storm Presenting as Intra-abdominal Sepsis with Multi-organ Failure Requiring Intensive Care
Authors: Karanikolas M. , Velissaris D. , Karamouzos V. , Filos K. S. 
Published: January 2019

Thyroid storm is a rare but life-threatening condition manifesting with several clinical presentations. Atypical thyroid storm should be part of the differential diagnosis in patients with multiple organ dysfunction of unknown aetiology. In this case report, delayed recognition of thyroid storm in a young female who presented with acute abdomen increased the risk of poor outcome. Prompt initiation of anti-thyroid therapy once the diagnosis of thyroid storm was established, combined with adequate vital organ support using a goal-directed therapy protocol in the intensive care unit resulted in a good outcome.
Repeated Intrathecal Administration of Ropivacaine Causes Neurotoxicity in Rats
Authors: Zhong Z. , Qulian G. , Yuan Z. , Wangyuan Z. , Zhihua S. 
Published: January 2019

Previous studies suggest that ropivacaine causes the least neurotoxicity among local anaesthetics. Most data derive from a single injection of ropivacaine into the subarachnoid space. The histological changes and behavioural effects of repeated intrathecal administration have yet to be studied. We examined the possible neurotoxicity of multiple doses of intrathecal ropivacaine in rats. Rats received 0.12 ml/kg body weight ropivacaine in normal saline at concentrations of 0.25%, 0.5%, 0.75% and 1.0% at 90-minute intervals via an implanted intrathecal catheter (ID 0.12 mm, OD 0.35 mm) for 48 hours. At L3, the spinal cord and posterior roots were examined by light and electron microscopy. We performed in situ TUNEL assay to evaluate apoptosis in the spinal cord. Sensory threshold to noxious stimulation along with behavioural change were also studied. Both 0.75% and 1.0% ropivacaine induced neuronal injury characterised by infiltration of inflammatory cells, vacuolation of myelin sheaths and axons, abnormal morphology of neurons and apoptosis in the spinal cord, mainly in posterior roots and the adjacent posterior white matter. Compared to controls, the percentage of maximum possible effect did not show any significant differences between the rats treated with variable concentrations of ropivacaine or tested with either heat or mechanical stimulation. As expected, the recovery time to normal ambulation was prolonged as the ropivacaine concentration was increased. Ropivacaine can induce neurotoxicity and trigger apoptosis in a dose-dependent manner after repeated intrathecal administration. Although the clinical safety profile of ropivacaine appears favourable compared with other local anaesthetics, it is possible our findings have clinical significance.
Effects of Open Lung Approach Policy on Mechanical Ventilation Duration in Postoperative Patients with Chronic Thromboembolism with Pulmonary Hypertension: A Case-Matched Study
Authors: Imanaka H. , Takeuchi M. , Tachibana K. , Konishi K. , Nishimura M. 
Published: January 2019

Patients with chronic thromboembolism with pulmonary hypertension (CTEPH) often develop severe hypoxaemia after pulmonary thromboendarterectomy. There is reluctance to apply high positive end-expiratory pressure (PEEP) to those patients, whereas high PEEP is important for acute hypoxaemic respiratory failure due to alveolar collapse. Open lung approach (OLA) policy, a combination of recruitment manoeuvre and PEEP titration, may improve oxygenation and lung mechanics in acute hypoxaemic respiratory failure, but the effect of OLA on the outcome is unknown. We designed a case-matched, retrospective study to investigate whether OLA policy improved the outcome of postoperative patients with CTEPH. Among 113 postoperative patients with CTEPH, 40 were chosen before and after the introduction of an OLA policy to create 1:1 ratio of case-match according to gender, age and preoperative total pulmonary resistance index (conventional treatment group vs OLA group). In the OLA group, recruitment manoeuvre was applied and then PEEP was titrated to maintain oxygenation every 12 hours. Gas exchange and duration of mechanical ventilation were compared between the groups. The OLA group showed higher PaO2/FiO2 ratio at 12 hours after the surgery than the conventional group (P=0.0021). In the OLA group, duration of mechanical ventilation was shorter than the conventional treatment group (median, 23.5 hours vs 43 hours, P=0.0064). The OLA group showed lower cardiac index, higher pulmonary artery pressure and higher total pulmonary resistance index after the surgery than the conventional group. The introduction of the OLA policy may have shortened mechanical ventilation duration despite what appeared to be less favorable early postoperative hemodynamics in patients after the surgery for CTEPH.
Caudal Epidural Block in Children: Comparison of Needle Insertion Parallel with Caudal Canal versus Conventional Two-Step Technique
Authors: Shin K.-M. , Park J.-H. , Kil H.-K. , Kang S.-S. , Kim I.-S. , Hong S.-J. , Choi J.-K. 
Published: January 2019

This study compared the technique of inserting the needle for caudal epidural blockade in a single pass parallel to the caudal canal versus the conventional technique of approaching the caudal canal with the needle at a steeper angle. Seventy-five patients, aged 0 to 72 months, scheduled for urological surgery were prospectively enrolled in this study. Patients were randomly divided into two groups: a conventional method group (caudal block performed with conventional needle insertion, n=40) and a new method group (needle inserted into the skin at an angle of 20° and into the caudal space without redirection, n=35). Two anaesthetists (A, B) performed the caudal blocks. For anaesthetist A, the mean time required (standard deviation) to perform needle insertion in the conventional method group was 2.2 (0.8) minutes and in the new method group 1.1 (0.7) minutes (P=0.03). For anaesthetist B the mean time (standard deviation) to perform needle insertion in the conventional method group was 2.1 (1.1) minutes and in the new method group 1.3 (0.8) minutes (P=0.04). Successful block was considered as first pass placement of the needle in the caudal canal confirmed (after placement) by ultrasound imaging, and the absence of a bloody tap. Subcutaneous placement of the needle after the first attempt occurred in two cases in the conventional method group and three cases in the new method group. Bloody tap occurred in four cases, all in the conventional method group and none in the new method group. When required, the second pass was successful in all cases.
Effects of Clonidine on Recovery after Sevoflurane Anaesthesia in Children Undergoing Cataract Surgery
Authors: Ghai B. , Ram J. , Chauhan S. , Wig J. 
Published: January 2019

This trial assessed the effects of two doses of clonidine compared with placebo on the quality and speed of recovery in children premedicated with oral midazolam and anaesthetised with sevoflurane for cataract surgery. One hundred and twenty American Society of Anesthesiologists physical status I to II children (aged one to six years), premedicated with oral midazolam 0.5 mg/kg and undergoing elective unilateral cataract surgery with sevoflurane anaesthesia were studied. Children were randomised to intravenous clonidine 1 μg/kg (group C1, n=39), 2 μg/kg (group C2, n=41) or normal saline (group NS, n=40). Clinically successful sub-Tenon local anaesthesia block was required for a patient to be included in the analysis. The primary outcome was the incidence of postoperative agitation. Postoperative agitation was defined as a Pain Discomfort Score of ≥3 using items 3 to 5 only, which was assessed 15 minutely until discharge. Agitation was observed in 11/40 (27.5%) children in the NS group compared to 2/39 (5.1%) in group C1 and none in group C2 (P <0.001). Rescue medication to treat severe agitation was required in 5/40 (12.5%) in the NS group, 1/39 (2.6%) in group C1 and none in group C2 (P=0.025). Time to meet discharge criteria was significantly shorter in group C1 compared to the other two groups (48.4±14.0 minutes compared to C2 79.5±12.8 minutes and NS 73.1±20.4 minutes, P <0.001). There were no significant effects on blood pressure and heart rate. Intravenous clonidine 1 μg/kg is effective for reducing agitation after sevoflurane anaesthesia and midazolam premedication in children undergoing cataract surgery. Intravenous clonidine 2 μg/kg was also effective and for a longer period, but was associated with a longer time to discharge.
Joseph Clover and the Cobra: A Tale of Snake Envenomation and Attempted Resuscitation with Bellows in London, 1852
Authors: Ball C. 
Published: January 2019

The Industrial Revolution saw the creation of many new jobs, but probably none more curious than that of zookeeper. The London Zoological Gardens, established for members in 1828, was opened to the general public in 1847. In 1852 the “Head Keeper in the Serpent Room”, Edward Horatio Girling, spent a night farewelling a friend departing for Australia. He arrived at work in an inebriated state and was bitten on the face by a cobra that he was handling in a less than sensible manner. He was taken by cab to University College Hospital where he was resuscitated by a number of doctors, including Joseph Clover, then the resident medical officer to the hospital and later to become the leading anaesthetist in London. Clover recorded this event in his diary along with the resuscitation method used. The patient eventually died but his treatment created a flurry of correspondence in the medical and lay press. Interestingly, the attempted resuscitation was with bellows, which had been abandoned by the Royal Humane Society twenty years earlier. Clover records other cases of resuscitation with bellows at University College Hospital during his time as a resident medical officer there (1848 to 1853). There is a casebook belonging to Joseph Clover in the Geoffrey Kaye Museum, in Melbourne. This story is one of the many interesting stories uncovered during a study of this book and Clover's other personal papers.
Validation of the Postoperative Nausea and Vomiting Intensity Score in Gynaecological Patients
Authors: Allen M. L. , Leslie K. , Jansen N. 
Published: January 2019

The Postoperative Nausea and Vomiting (PONV) Intensity Scale was developed to distinguish trivial from clinically important PONV perioperatively and has been validated in a general surgical population. This study aimed to assess the scale in gynaecological surgery patients. Seventy-three patients undergoing gynaecological surgery were included. Interviews occurred at four and 24 hours postoperatively. Measurements included the PONV Intensity Scale, nausea and pain visual analogue scale, antiemetic use and complications related to PONV. Ten patients (14%) had a clinically significant PONV Intensity Scale score, 42 (58%) reported nausea and 15 (21%) reported vomiting during the study. At 24 hours, 80% of patients with a clinically significant score at four hours had received antiemetics vs 18% of those without a clinically significant score (P=0.001). Of patients with a clinically significant score at 24 hours, 71% had suffered a complication vs 11% of those without a clinically significant score (P <0.0001). The median nausea visual analogue scale scores at four hours were 69 mm (interquartile range 69 to 76 mm) in patients with a clinically significant score vs 0 mm (0 to 9 mm) in patients without a clinically significant score (mean difference 56 mm, 95% confidence interval 41 to 72 mm, P <0.0001). The PONV Intensity Scale is a valid, responsive and practically useful instrument in distinguishing trivial from clinically significant PONV. The rate of clinically important PONV is considerably lower than the rate of any PONV symptoms perioperatively.
Speeding Dantrolene Preparation for Treating Malignant Hyperthermia
Authors: Kugler Y. , Russell W. J. 
Published: January 2019

Dantrolene is known to have a low solubility in water. Studies have demonstrated that it dissolves more rapidly in warm water. However, the overall benefit of warming has not been measured. This study evaluated the overall time benefit of warming. The first step was to measure how long it took to warm the 10 ml plastic ampoules of sterile water from ambient temperature (20°C) to 45°C. We found that when immersed in a water bath held at 45°C, this required a minimum of seven minutes. Therefore the ampoules used for the study were kept immersed in a water bath held at 45°C for at least 10 minutes. It took an average of 82.6 seconds to draw 60 ml (six ampoules) of water into a 60 ml syringe. Squirting the water into the dantrolene vial and mixing until dissolved took 102.8 seconds (SD 8.3) for the warmed water and 129.0 seconds (SD 14.6) for the ambient temperature water (P=0.009). Redrawing the dantrolene solution into the syringe took an average of 32 seconds for the warmed water and 35.2 seconds for the ambient temperature water. After the redrawing phase the average temperature of the warmed solution was 32.2°C. The average total preparation time for the warmed solution was 217.4 seconds (SD 20.0) and for the ambient temperature preparation was 243.0 seconds (SD 11.7) (P=0.038). Thus the time difference in preparation was about 256 seconds, which is the time that could be saved in preparing the standard dose of 10 vials of dantrolene using water at 45°C. However, as it required about seven minutes to initially warm the sterile ampoules, there would be a net increase, not decrease in the time required. These findings indicate that warming is of no benefit in speeding dantrolene preparation.
Intensive Care Medicine Trainees’ Perception of Professionalism: A Qualitative Study
Authors: van Mook W. N. K. A. , de Grave W. S. , Gorter S. L. , Zwaveling J. H. , Schuwirth L. W. , van der Vleuten P. M. 
Published: January 2019

The Competency-Based Training program in Intensive Care Medicine in Europe identified 12 competency domains. Professionalism was given a prominence equal to technical ability. However, little information pertaining to fellows’ views on professionalism is available. A nationwide qualitative study was performed. The moderator asked participants to clarify the terms professionalism and professional behaviour, and to explore the questions “How do you learn the mentioned aspects?” and “What ways of learning do you find useful or superfluous?”. Qualitative data analysis software (MAXQDA2007) facilitated analysis using an inductive coding approach. Thirty-five fellows across eight groups participated. The themes most frequently addressed were communication, keeping distance and boundaries, medical knowledge and expertise, respect, teamwork, leadership and organisation and management. Medical knowledge, expertise and technical skills seem to become more tacit when training progresses. Topics can be categorised into themes of workplace-based learning, by gathering practical experience, by following examples and receiving feedback on action, including learning from own and others’ mistakes. Formal teaching courses (e.g. communication) and scheduled sessions addressing professionalism aspects were also valued. The emerging themes considered most relevant for intensivists were adequate communication skills and keeping boundaries with patients and relatives. Professionalism is mainly learned ‘on the job’ from role models in the intensive care unit. Formal teaching courses and sessions addressing professionalism aspects were nevertheless valued, and learning from own and others’ mistakes was considered especially useful. Self-reflection as a starting point for learning professionalism was stressed.
End-of-Life Decisions in Hungarian Intensive Care Units
Authors: Zubek L. , Szabó L. , Diószeghy Cs. , Gál J. , élö G. 
Published: January 2019

The awareness of local practice of end-of-life decisions in accordance with the law and ethical principles is essential for intensive care physicians in all countries. The first step for the required social dialogue is to investigate local practice. We performed the first Hungarian survey with the aim of better understanding local practice in end-of-life decisions in intensive care units. Questionnaires were sent out electronically to 743 members of the Hungarian Society of Anaesthesiology and Intensive Care. Respecting anonymity, we have statistically evaluated 103 replies (response rate 13.8%) and compared the results to data from other European countries. The results show that the practice of intensive care physicians in Hungary is rather paternalistic. Intensive care physicians generally make their decisions alone (3.75/5 points) without considering the opinion of the patient (2.57/5 points), the relatives (2.14/5 points) or other medical staff (2.37/5 points). Furthermore, they prefer not to start a form of treatment rather than to withdraw an ongoing one. Nevertheless, the frequency of end-of-life decisions (3 to 9% of intensive care unit patients) made in Hungarian intensive care units is less than in other European countries. End-of-life decisions are part of medical practice. Since the legal and ethical framework is unclear, practice varies between locations and mostly depends on individual decisions rather than established protocols or guidance. For end-of-life decisions, self-determination must be supported and a dialogue must be established between lawmakers and physicians.
The Clinical Role of Glutamine Supplementation in Patients with Multiple Trauma: A Narrative Review
Authors: Al Balushi R. M. , Cohen J. , Banks M. , Paratz J. D. 
Published: January 2019

Glutamine is considered an essential amino acid during stress and critical illness. Parenteral glutamine supplementation in critically ill patients has been shown to improve survival rate and minimise infectious complications, costs and hospital length-of-stay. However, glutamine supplementation in patients receiving enteral nutrition and the best method of administration are still controversial. The purpose of this article is to provide a narrative review of the current evidence and trials of enteral and parenteral glutamine supplementation in multiple trauma patients. A search in PubMed and EMBASE was conducted and relevant papers that investigated the effect of enteral or parenteral glutamine supplementation in patients with multiple trauma were reviewed. Although recent nutritional guidelines recommend that glutamine supplementation should be considered in these patients, further well-designed trials are required to provide a confirmed conclusion. Due to the inconclusive results of enteral glutamine supplementation trials in patients receiving enteral nutrition, future trials should focus on intravenous glutamine supplementation in patients requiring enteral nutrition and on major clinical outcome measures (e.g. mortality rate, infectious complications).