bluuebunny/crossref_metadata_2025_split huggingface dataset:
Adjustment of Anaesthesia Depth Using Bispectral Index Prolongs Seizure Duration in Electroconvulsive Therapy
Authors: Nishihara F. , Saito S. 
Published: January 2019

Electroconvulsive therapy (ECT) under propofol anaesthesia induces relatively shorter seizures compared to barbiturate anaesthesia. Since significant correlation between seizure duration and bispectral index (BIS) value immediately before electrical stimulus has been reported among patients, adjustment of anaesthesia depth as determined by BIS may be effective in obtaining a longer seizure length. In the present study, we examined this hypothesis in those patients whose muscular seizure duration was less than 40s. ECT was prescribed to 20 patients suffering from endogenous depression. General anaesthesia was induced with propofol 1 mg/kg. Succinylcholine chloride 1 mg/kg was then given. The efficacy of electrical stimulation was determined using a tourniquet technique, electromyogram, and electroencephalography. When a patient had a seizure less than 40s in their second ECT treatment, the subsequent treatment was modified such that the electrical stimulus was given after waiting for a higher BIS value (+10-20). Intensity of electrical stimulus and anaesthesia conditions were identical in the two treatments. All 20 patients had longer seizures as determined by the electromyogram and/or electroencephalography when the stimulus was delivered at the higher BIS value. Seizure duration measured by muscle movement was 31±5s when the stimulus was delivered without waiting and 46±10s when delivered after waiting. There was a significant difference in seizure duration between the two treatments (P<0.01). Waiting for a recovery in BIS value before electrical stimulation can prolong seizure duration.
An Evaluation of the Relative Efficacy of an Open Airway, an Oxygen Reservoir and Continuous Positive Airway Pressure 5 cmH2O on the Non-ventilated Lung
Authors: Slimani J. , Russell W. J. , Jurisevic C. 
Published: January 2019

The aim of this study, during one-lung ventilation, was to evaluate if oxygenation could be improved by use of a simple oxygen reservoir or application of 5 cmH2O continuous positive airway pressure (CPAP) to the non-ventilated lung compared with an open airway. Twenty-three patients with lung malignancy, undergoing thoracotomy requiring at least 60 minutes of one-lung ventilation before lung lobe excision, were studied. After routine induction and establishment of one-lung ventilation, the three treatments were applied in turn to the same patient in a sequence selected randomly. The first treatment was repeated as a fourth treatment and these results of the repeated treatment averaged to minimize the effect of slow changes. Arterial oxygenation was measured by an arterial blood gas 15 minutes after the application of each treatment. Twenty patients completed the study. Mean PaO2 (in mmHg) was 210.3 (SD 105.5) in the “OPEN” treatment, 186.0 (SD 109.2) in the “RESERVOIR” treatment, and 240.5 (SD 116.0) in the “CPAP” treatment. This overall difference was not quite significant (P=0.058, paired ANOVA), but comparison of the pairs showed that there was a significant better oxygenation only with the CPAP compared to the reservoir treatments (t=2.52, P=0.021). While the effect on the surgical field was not apparent in most patients, in one patient surgery was impeded during CPAP. Our results show that the use of a reservoir does not give oxygenation better than an open tube, and is less effective than the use of CPAP 5 cmH2O on the non-ventilated lung during one-lung ventilation.
Cost Calculation and Prediction in Adult Intensive Care: A Ground-up Utilization Study
Authors: Moran J. L. , Peisach A. R. , Solomon P. J. , Martin J. 
Published: January 2019

The ability of various proxy cost measures, including therapeutic activity scores (TISS and Omega) and cumulative daily severity of illness scores, to predict individual ICU patient costs was assessed in a prospective “ground-up” utilization costing study over a six month period in 1991. Daily activity (TISS and Omega scores) and utilization in consecutive admissions to three adult university associated ICUs was recorded by dedicated data collectors. Cost prediction used linear regression with determination (80%) and validation (20%) data sets. The cohort, 1333 patients, had a mean (SD) age 57.5 (19.4) years, (41% female) and admission APACHE III score of 58 (27). ICU length of stay and mortality were 3.9 (6.1) days and 17.6% respectively. Mean total TISS and Omega scores were 117 (157) and 72 (113) respectively. Mean patient costs per ICU episode (1991 ÄS) were $6801 ($10311), with median costs of $2534, range $106 to $95,602. Dominant cost fractions were nursing 43.3% and overheads 16.9%. Inflation adjusted year 2002 (mean) costs were $9343 ($ AUS). Total costs in survivors were predicted by Omega score, summed APACHE III score and ICU length of stay; determination R2, 0.91; validation 0.88. Omega was the preferred activity score. Without the Omega score, predictors were age, summed APACHE III score and ICU length of stay; determination R2, 0.73; validation 0.73. In non-survivors, predictors were age and ICU length of stay (plus interaction), and Omega score (determination R2, 0.97; validation 0.91). Patient costs may be predicted by a combination of ICU activity indices and severity scores.
Propofol-Induced Hyperamylasaemia in a General Intensive Care Unit
Authors: Nanas S. , Angelopoulos E. , Tsikriki S. , Kritikos K. , Voutsinas E. , Zervakis D. , Kanaloupiti D. , Pratikaki M. , Roussos C. 
Published: January 2019

This study examined the incidence of hyperamylasaemia, in the absence of other plausible causes of pancreatic dysfunction, in intensive care unit (ICU) patients who received propofol. One-hundred-and-seventy-two consecutive patients of a general ICU who stayed for more than 24 hours were studied. Patients with a diagnosis consistent with elevated serum amylase levels at admission were excluded from the study, as were patients who had received medications known to raise serum amylase levels. Forty-four patients 53 ± 20 years of age and median duration of ICU stay of five days (range two to 55) were eligible. Thirty of those, aged 54 ± 21 years and median duration of ICU stay of five days (range two to 27) received continuous infusion of propofol for sedation (maximum dose 45 μg/kg/min). Of the 30 patients who received propofol, 16 (53%) developed hyperamylasaemia (125 to 466 IU/l) after two to nine days of continuous infusion. Liver and kidney function remained normal throughout the observation period. Of the 14 patients who did not receive propofol (aged 51 ± 18 years), only two (14%) developed hyperamylasaemia, a significantly lower incidence (P=0.021). Propofol infusion is associated with biochemical evidence of pancreatic injury. Amylase levels monitoring of propofol-sedated patients is warranted.
Predictors of Outcome of Ruptured Aortic Aneurysms in a Metropolitan Hospital
Authors: Botha J. A. , Tiruvoipati R. , Last G. C. , Somjen G. , Chue W.-L. 
Published: January 2019

The mortality in patients presenting with ruptured abdominal aortic aneurysm remains high. In this study we aimed to assess the outcome and factors predicting the mortality in patients admitted to a teaching hospital with the diagnosis of ruptured abdominal aortic aneurysm. During the study period (July 2001 to July 2007) all patients admitted with a diagnosis of a ruptured abdominal aortic aneurysm were included. There was a total of 62 patients with a mean age of 76 years. The hospital mortality was 32.3% (20 patients). Twelve patients (19.4%) were discharged home, 25 patients (40.3%) were discharged to rehabilitation and five patients (8%) were discharged to other hospitals for further care. There was a significant difference between survivors and non-survivors in age, loss of consciousness at presentation and duration of hospital stay. Logistic regression analysis of these variables suggests the presence of chronic obstructive pulmonary disease (P=0.04, odds ratio 6.7, 95% confidence interval 1.1 to 41.3) and age (P=0.02, odds ratio 1.2, 95% confidence intervals 1.0 to 1.3) to be independently associated with mortality. These results compare favourably with published Australian as well as the international data.
Critical Care of the Patient with Acute Pancreatitis
Authors: Hasibeder W. R. , Torgersen C. , Rieger M. , Dünser M. 
Published: January 2019

Acute pancreatitis is an inflammatory process of the pancreas with variable involvement of regional tissues and remote organs. This review gives a comprehensive overview of the aetiology, pathophysiology, diagnosis and therapy of acute pancreatitis relevant to the intensivist. Recent international guidelines on the management of acute pancreatitis are summarised. Eighty percent of acute pancreatitis episodes are related either to gallstones or to alcohol abuse. Independent of its aetiology, the pathophysiologic hallmark of acute pancreatitis is the premature activation of trypsin, which leads to massive pancreas inflammation, systemic overproduction of pro-inflammatory mediators and ultimately remote organ dysfunction. All guidelines agree that the diagnosis of acute pancreatitis should include clinical symptoms, increased serum amylase or lipase levels and/or characteristic findings on computed tomography. Endoscopic retrograde cholangiopancreatography is recommended as a causative therapy in patients with acute cholangitis or a strong suspicion of gallstones. All guidelines underline the importance of vigorous fluid resuscitation and supplemental oxygen therapy and prefer enteral over parenteral nutrition, with the majority favouring the nasojejunal route. In view of lacking scientific evidence, antibiotic prophylaxis to prevent infection of pancreatic necroses is discouraged by most guidelines. Computed tomography-guided fine needle aspiration is the technique of choice to differentiate between sterile and infected pancreas necrosis. While sterile pancreatic necrosis should be managed conservatively, infected pancreatic necrosis requires debridement and drainage supplemented by antibiotic therapy. Surgical necrosectomy is the traditional approach, but less invasive techniques (retroperitoneal or laparoscopic necrosectomy, computed tomography-guided percutaneous catheter drainage) may be equally effective.
A Randomised, Double-blind Comparison of Three Different Volumes of Hypobaric Intrathecal Bupivacaine for Orthopaedic Surgery
Authors: Imbelloni L. E. , Gouveia M. A. , Vieira E. M. , Cordeiro J. A. 
Published: January 2019

This study was designed to evaluate different doses of hypobaric 0.15% bupivacaine administered to achieve unilateral orthopaedic surgery under subarachnoid block. Using a randomised, double-blinded protocol, 150 ASA I to II patients scheduled for elective unilateral orthopaedic surgery were allocated to received a subarachnoid block with hypobaric bupivacaine 0.15% 4.5 mg (3 ml) (Group 1), 6.0 mg (4 ml) (Group 2) or 7.5 mg (5 ml) (Group 3). Measurements included cardiovascular and haemodynamic stability, incidence of unilateral anaesthesia, time to recover from motor block, postoperative urinary retention, transitory neurological symptoms and postdural puncture headache. There was a dose-dependent increase in the duration of the block, from 1:55±00:20 hours (4.5 mg) to 2:15±00:22 hours (6.0 mg) and 3:15±00:31 hours (7.5 mg). The sensory block in the operated limb was significantly higher than that in the non-operated limb at all times. The increasing dose resulted in an increase of the motor block score. Seventy percent of patients had unilateral block. It was concluded that the spinal anaesthesia in all groups was suitable for single limb orthopaedic surgery. The smallest dose (4.5 mg) of hypobaric 0.15% bupivacaine resulted in more unilateral blocks, with narrower distribution and shorter duration.
The Pulmonary Artery Catheter Sleeve – Protective or Infective?
Authors: Corcoran T. B. , Grape S. , Duff O. , Perry P L. , Murray R. 
Published: January 2019

The use of sterile plastic sleeves to protect pulmonary artery catheters (PAC) may decrease infection risk. The catheter may require manipulation but contamination of the sleeve risks inoculating organisms into the patients. We sought to determine whether the sleeve remains sterile and for how long. We conducted a prospective observational study to culture the components of the PAC in a critically ill population. Upon removal we cultured 1) the PAC tip, 2) the PAC introducer exit site, 3) the PAC introducer hub and 4) a sterile irrigant solution which ran down the inside of the protective sleeve. Demographic, catheter and disease variables were also collected. There were 102 PAC episodes amounting to 3952 catheter hours with a mean duration of catheterisation of 39.1 (24.2) hours. There were 17 positive culture results, of which six were positive sleeve fluid cultures. In three of these patients the exit site was culture positive, and the same organism was isolated as within the sleeve. No patient had a positive blood culture. There was no difference between those with and without a positive sleeve culture in terms of demographic or disease variables. The protective sleeve of the pulmonary artery catheter does not remain sterile and should not be considered as a sterile barrier. We believe that manipulating the PAC within the sleeve carries the risk of inoculating the patient with pathogenic organisms. The duration of sterility remains to be determined.
Outcome of Patients Receiving High Dose Vasopressor Therapy: A Retrospective Cohort Study
Authors: Jenkins C. R. , Gomersall C. D. , Leung P. , Joynt G. M. 
Published: January 2019

The aim of this study was to determine the hospital survival of patients receiving high doses of catecholamines. A retrospective observational study was conducted in a 22-bed multidisciplinary adult intensive care unit of a tertiary referral university hospital. All patients (n = 64) receiving >100 μg/min of adrenaline or noradrenaline or adrenaline and noradrenaline combined over a one-year period were studied to determine survival to intensive care unit and hospital discharge. Four patients survived to intensive care unit discharge and hospital discharge (6.25%, 95% CI 0.3 to 12.2%). Survival was 3.3% (95% CI 0 to 7.9%) in the subgroup of 60 patients who received >100 μg/min noradrenaline and 3.6% (95% CI 0 to 8.6%) in the 55 patients who received >2 μg/kg/min noradrenaline. None of the 32 patients who received >200 μg/min noradrenaline survived. We conclude that the survival of patients requiring high doses of catecholamines is poor, but the use of such doses is probably not futile. It remains for individual clinicians, patients and their surrogates to decide whether use of high doses of vasopressor is appropriate, given the low probability of survival.
Equivalent Metabolic Acidosis with Four Colloids and Saline on Ex Vivo Haemodilution
Authors: Morgan T. J. , Vellaichamy M. , Cowley D. M. , Weier S. L. , Venkatesh B. , Jonest M. A. 
Published: January 2019

Colloid infusions can cause metabolic acidosis. Mechanisms and relative severity with different colloids are incompletely understood. We compared haemodilution acid-base effects of 4% albumin, 3.5% polygeline, 4% succinylated gelatin (all weak acid colloids, strong ion difference 12 mEq/l, 17.6 mEq/l and 34 mEq/l respectively), 6% hetastarch (non-weak acid colloid, strong ion difference zero) and 0.9% saline (crystalloid, strong ion difference zero). Gelatin weak acid properties were tracked via the strong ion gap. Four-step ex vivo dilutions of pre-oxygenated human venous blood were performed to a final [Hb] near 50% baseline. With each fluid, base excess fell to approximately −13 mEq/l. Base excess/[Hb] relationships across dilution were linear and direct (R2 ≥0.96), slopes and intercepts closely resembling saline. Baseline strong ion gap was −0.3 (2.1) mEq/l. Post-dilution increases occurred in three groups: small with saline, hetastarch and albumin (to 3.5 (02) mEq/l, 4.3 (0.3) mEq/l, 3.3 (1.4) mEq/l respectively), intermediate with polygeline (to 12.2 (0.9) mEq/l) and greatest with succinylated gelatin (to 20.8 (1.4) mEq/l). We conclude that, despite colloid weak acid activity ranging from zero (hydroxyethyl starch) to greater than that of albumin with both gelatin preparations, ex vivo dilution causes a metabolic acidosis of identical severity to saline in each case. This uniformity reflects modifications to the albumin and gelatin saline vehicles, in part aimed at pH correction. By proportionally increasing the strong ion difference, these modifications counter deviations from pure saline effects caused by colloid weak acid activity. Extrapolation in vivo requires further investigation.
Ease of Proseal Laryngeal Mask Airway Insertion and its Fibreoptic view after Placement using Gum Elastic Bougie: A Comparison with Conventional Techniques
Authors: Taneja S. , Agarwal M. , Dali J. S. , Agrawal G. 
Published: January 2019

The Proseal Laryngeal Mask Airway (PLMA) is routinely inserted by the digital and introducer tool techniques but a newer Gum Elastic Bougie (GEB) guided insertion technique has been described. The aims and objectives were to compare the ease of PLMA insertion and fibreoptic view of PLMA after placement using GEB and conventional techniques. Ninety-six ASA I or II patients of either gender, aged 18 to 60 years, scheduled for elective surgery under general anaesthesia in the supine position were included in this study. Following induction of anaesthesia, a PLMA was inserted using a GEB, introducer tool or digital technique in Groups G, I and D respectively (n=32). Correct placement of the PLMA was confirmed by using clinical tests along with fibreoptic assessment. Ease of PLMA insertion was assessed by the number of attempts, time taken and number of patients requiring lateral approach for insertion. The fibreoptic view of PLMA placement through the airway tube was graded on a scale from 4 (best view) to 1 (worst view). GEB-guided PLMA insertion was more successful both after the first attempt (G 100%, I 69%, D 72%, P <0.01) and after two attempts (G 100%, I 78%, D 84%, P <0.05). Time taken for successful placement was significantly shorter in the GEB-guided group after two attempts (G 22∓2 seconds, I 31.9±18.8 seconds, D 29.5±18.6 seconds, P <0.05). The fibreoptic view through the airway tube was significantly better in the GEB-guided group (P <0.01). Incidence of trauma was significantly less in the GEB-guided group (P <0.05).
Perioperative Mortality Risk Score using Pre- and Post-operative Risk Factors in Older Patients
Authors: Story D. A. , Fink M. , Leslie K. , Myles P. S. , Yap S.-J. , Beavis V. , Kerridge R. K. , Mcnicol P. L. 
Published: January 2019

We developed a risk score for 30-day postoperative mortality: the Perioperative Mortality risk score. We used a derivation cohort from a previous study of surgical patients aged 70 years or more at three large metropolitan teaching hospitals, using the significant risk factors for 30-day mortality from multivariate analysis. We summed the risk score for each of six factors creating an overall Perioperative Mortality score. We included 1012 patients and the 30-day mortality was 6%. The three preoperative factors and risk scores were (“three A's”): 1) age, years: 70 to 79=1, 80 to 89=3, 90+=6; 2) ASA physical status: ASA I or II=0, ASA III=3, ASA IV=6, ASA V=15; and 3) preoperative albumin <30 g/l=2.5. The three postoperative factors and risk scores were (“three I's”) 1) unplanned intensive care unit admission =4.0; 2) systemic inflammation =3; and 3) acute renal impairment=2.5. Scores and mortality were: <5=1%, 5 to 9.5=7% and ≥10=26%. We also used a preliminary validation cohort of 256 patients from a regional hospital. The area under the receiver operating characteristic curve (C-statistic) for the derivation cohort was 0.80 (95% CI 0.74 to 0.86) similar to the validation C-statistic: 0.79 (95% CI 0.70 to 0.88), P=0.88. The Hosmer-Lemeshow test (P=0.35) indicated good calibration in the validation cohort. The Perioperative Mortality score is straightforward and may assist progressive risk assessment and management during the perioperative period. Risk associated with surgical complexity and urgency could be added to this baseline patient factor Perioperative Mortality score.
Effects of Propofol on Calcium Homeostasis in Human Skeletal Muscle
Authors: Migita T. , Mukaida K. , Hamada H. , Kobayashi M. , Nishino I. , Yuge O. , Kawamoto M. 
Published: January 2019

Malignant hyperthermia is a pharmacogenetic skeletal muscle disorder of intracellular calcium (Ca2+) homeostasis with an autosomal dominant inheritance. The objective of this study was to investigate the safety of propofol by investigating its effects on calcium homeostasis and its effect sites in human skeletal muscles. Muscle specimens were obtained from 10 individuals with predisposition to malignant hyperthermia. In skinned fibre experiments, we measured the effects of propofol on the Ca2+-induced Ca2+ release and the uptake of Ca2+ into the sarcoplasmic reticulum. Ca2+ imaging in primary myotubes was employed to analyse propofol-mediated alternations in the Ca2+ regulation and propofol-induced Ca2+ responses in the presence of Ca2+ channel blocker or Ca2+-induced Ca2+ release inhibitor. Increased Ca2+ release from the sarcoplasmic reticulum and inhibition of Ca2+ uptake into the sarcoplasmic reticulum were not observed with 100 μM propofol. A rise of Ca2+ was not seen under 100 μM propofol and the EC50 value for propofol was 274.7±33.9 μM, which, is higher than the clinical levels for anaesthesia. Propofol-induced Ca2+ responses were remarkably attenuated in the presence of Ca2+ channel blocker or Ca2+-induced Ca2+ release inhibitor compared with the results obtained with caffeine. We conclude firstly that propofol is safe for individuals with predisposition to malignant hyperthermia when it is used within the recommended clinical dosage range, and secondly that its mode of action upon ryanodine receptors is likely to be different from that of caffeine.
Intermittent Positive Airway Pressure to Manage Hypoxia during One-lung Anaesthesia
Authors: Russell W. J. 
Published: January 2019

The effect of intermittent positive airway pressure to the non-ventilated lung was assessed in 10 patients who desaturated during one-lung ventilation. Once their saturation fell below 95% they were given a slow inflation of 2 l/min of oxygen into the non-ventilated lung for two seconds. This was repeated every 10 seconds for five minutes or until the saturation rose to 98%, whichever was sooner. The initial mean SpO2, was 89.3% ±4.2%. All 10 patients had an increase in saturation. The mean saturation following intermittent positive airway pressure was 96.5%±1.6% (P <0.0001). Similarly, the mean oxygen tension rose from 67.2∓12.8 mmHg to 98.9±19.8 mmHg. Intermittent positive airway pressure should be considered for patients who desaturate while undergoing one-lung ventilation.