ARTICLE TITLE: A survey of the practice of thoracic epidural
analgesia in the United Kingdom.
ARTICLE SOURCE: Anaesthesia (England), Oct 1998, 53(10) p1016-22
AUTHOR(S): Romer HC; Russell GN
AUTHOR'S ADDRESS: Department of Anaesthesia, Cardiothoracic
Centre-Liverpool NHS Trust, UK.
PUBLICATION TYPE: JOURNAL ARTICLE
ABSTRACT: A postal survey of the practice of thoracic epidural
analgesia was sent to 275 hospitals in the United Kingdom. Responses
were received from 70% of hospitals. Informed consent is rarely
adequately obtained, with only 28% of respondents mentioning even the
most common complications. Epidural cannulation is most often (60%)
performed following induction of general anaesthesia, rather than in
the awake patient. A test dose of local anaesthetic without
adrenaline is usual. Neither aspirin nor low-dose heparin are
considered a contraindication. The majority of respondents used a
combination of bupivacaine with fentanyl (51%) or diamorphine (40%),
usually administered by continuous infusion. Drugs were frequently
prepared and adjusted by anaesthetic staff. The majority of epidurals
(63%) are nursed in intensive care units postoperatively. Properly
funded pain management teams, at present unusual, would facilitate
ward-based epidural management and release intensive care resource. A
central register of epidural complications is required to provide
valuable evidence for the optimum practice of thoracic epidural
analgesia.
ARTICLE TITLE: ARDS: are we winning at last?
[editorial]
ARTICLE SOURCE: Anaesthesia (England), Sep 1998, 53(9) p831-2
AUTHOR(S): Sair M; Evans TW
PUBLICATION TYPE: EDITORIAL
MB, We *are* winning but don't know why.
ARTICLE TITLE: Postoperative analgesia with intramuscular morphine
at fixed rate versus epidural morphine or sufentanil and bupivacaine
in patients undergoing major abdominal surgery.
ARTICLE SOURCE: Anesth Analg (United States), Dec 1998, 87(6)
p1346-53
AUTHOR(S): Broekema AA; Veen A; Fidler V; Gielen MJ; Hennis PJ
AUTHOR'S ADDRESS: Department of Anesthesiology, University Hospital
Groningen, The Netherlands.
PUBLICATION TYPE: CLINICAL TRIAL; JOURNAL ARTICLE; RANDOMIZED
CONTROLLED TRIAL
ABSTRACT: We assessed the efficacy and side effects of postoperative
analgesia with three different pain regimens in 90 patients
undergoing major abdominal surgery. The patients were randomly
assigned to one of three groups: epidural morphine (EM) or sufentanil
(ES), both combined with bupivacaine, or IM morphine (IM) at fixed
intervals. Before incision, patients in the epidural groups received
sufentanil or morphine in bupivacaine via a thoracic catheter,
followed by a continuous infusion 1 h later. General anesthesia
consisted of N2O/O2 and isoflurane for all groups. Patients in all
groups received IV sufentanil as part of their anesthetic management.
Patients in the IM group received IV sufentanil 1 microg/kg before
incision, and patients in all groups received sufentanil 10 microg
for inadequate analgesia. Postoperatively, the epidural or IM
treatment was continued for > or =5 days. Postoperative analgesia
at rest and during coughing and movement was significantly better in
the epidural groups than in the IM group during the 5 consecutive
days. There were no significant differences between the epidural
groups. The incidence of most side effects was similar in all groups.
We conclude that epidural analgesia provided better pain relief than
IM analgesia, even if the latter was optimized by fixed-dose
administration at fixed intervals and included adjustments on demand.
Epidural sufentanil and morphine, both combined with bupivacaine,
seemed to be equally effective with similar side effects.
IMPLICATIONS: Postoperative analgesia with epidural sufentanil or
morphine and bupivacaine after major abdominal surgery seemed to be
better than the conventional method of IM morphine treatment, despite
optimal administration, i.e., fixed doses at fixed intervals with
regular adjustments. Analgesic efficacy and side effects of epidural
sufentanil and morphine were similar.
MB. The patients knew what route was being used but the observers did
not. ie it is not double blind trial. I suppose that is why there
only "seemed" to be a difference.
ARTICLE TITLE: Two tips for users of Bullard Intubating
Laryngoscope.
ARTICLE SOURCE: Anesth Analg (United States), Nov 1998, 87(5)
p1206-8
AUTHOR(S): Habibi A; Bushell E; Jaffe RA; Giffard RG; Brock-Utne
JG
AUTHOR'S ADDRESS: Department of Anesthesia, Stanford University
Medical Center, California 94305-5640, USA.
PUBLICATION TYPE: JOURNAL ARTICLE
ARTICLE TITLE: Severe, acute meningeal irritative reaction after
epidural blood patch.
ARTICLE SOURCE: Anesth Analg (United States), Nov 1998, 87(5)
p1139-40
AUTHOR(S): Oh J; Camann W
AUTHOR'S ADDRESS: Department of Anesthesia, Brigham and Women's
Hospital, Harvard Medical School, Boston, Massachusetts 02115,
USA.
PUBLICATION TYPE: JOURNAL ARTICLE
ARTICLE TITLE: Measuring patient satisfaction with anesthesia
care: a review of current methodology.
ARTICLE SOURCE: Anesth Analg (United States), Nov 1998, 87(5)
p1089-98
AUTHOR(S): Fung D; Cohen MM
AUTHOR'S ADDRESS: Department of Anesthesia, Sunnybrook Health Science
Centre, Toronto, Ontario, Canada. dfung@efni.com.
INDEXING CHECK TAG(S): Human; Support, Non-U.S. Gov't
PUBLICATION TYPE: JOURNAL ARTICLE; REVIEW (56 references); REVIEW,
TUTORIAL
ARTICLE TITLE: Exposure of postoperative nurses to exhaled
anesthetic gases.
ARTICLE SOURCE: Anesth Analg (United States), Nov 1998, 87(5)
p1083-8
AUTHOR(S): Sessler DI; Badgwell JM
AUTHOR'S ADDRESS: Department of Anesthesia, University of
California-San Francisco, 94143-0648, USA.
sessler@vaxine.ucsf.edu.
PUBLICATION TYPE: JOURNAL ARTICLE
IMPLICATIONS: Some epidemiological evidence suggests that exposure to
waste anesthetic gases may be associated with reproductive toxicity.
Accordingly, the National Institute of Occupational Safety and Health
has established recommended exposure limits for nitrous oxide and
volatile anesthetics. Our data suggest that exposure of healthcare
personnel may exceed recommended levels in poorly ventilated
postanesthesia care units.
ARTICLE TITLE: Use of transesophageal echocardiography probe
imaging to guide internal jugular vein cannulation.
ARTICLE SOURCE: Anesth Analg (United States), Nov 1998, 87(5)
p1032-3
AUTHOR(S): Sha K; Simokawa M; Kawaguchi M; Iwasaka T; Kurehara K;
Kitaguchi K; Furuya H
AUTHOR'S ADDRESS: Department of Anesthesiology, Nara Medical
University, Kashihara, Japan.
PUBLICATION TYPE: JOURNAL ARTICLE
ARTICLE TITLE: Postoperative analgesic effects of three
demand-dose sizes of fentanyl administered by patient-controlled
analgesia.
ARTICLE SOURCE: Anesth Analg (United States), Oct 1998, 87(4)
p890-5
AUTHOR(S): Camu F; Van Aken H; Bovill JG
AUTHOR'S ADDRESS: Department of Anesthesiology, Vrije Universiteit
Brussel, Brussels, Belgium.
PUBLICATION TYPE: CLINICAL TRIAL; JOURNAL ARTICLE; MULTICENTER STUDY;
RANDOMIZED CONTROLLED TRIAL
IMPLICATIONS: The postoperative analgesic efficacy of fentanyl
delivered i.v. by patient-controlled analgesia devices has been
demonstrated for demand doses ranging from 10 to 50 microg, but the
optimal fentanyl dose remains unknown. In this randomized,
double-blind study, we compared three demand dose sizes of fentanyl
(20, 40, and 60 microg) and found that the 40 microg demand dose was
the most appropriate for fentanyl patient-controlled analgesia
management of postoperative pain.
ARTICLE TITLE: Uncompensated blood loss is not tolerated during
acute normovolemic hemodilution in anesthetized pigs.
ARTICLE SOURCE: Anesth Analg (United States), Oct 1998, 87(4)
p786-94
AUTHOR(S): Schou H; Kongstad L; Perez de Sa V; Werner O; Larsson
A
AUTHOR'S ADDRESS: Department of Anesthesia and Intensive Care,
University Hospital, Lund, Sweden.
PUBLICATION TYPE: JOURNAL ARTICLE
MPLICATIONS: Anesthetized pigs with extremely low hemoglobin levels
(one third of normal) showed poor tolerance to blood loss >10
mL/kg. A decreasing arterial blood pressure, a decreasing oxygen
saturation in the venous blood, and an increase in arterial blood
lactate concentration were useful indicators of blood loss.
ARTICLE TITLE: Gastric fluid volume: is it really a risk factor
for pulmonary aspiration? [editorial; comment]
COMMENTS: Comment on: Anesth Analg 1998 Oct; 87(4):757-60
ARTICLE SOURCE: Anesth Analg (United States), Oct 1998, 87(4)
p754-6
AUTHOR(S): Schreiner MS
PUBLICATION TYPE: COMMENT; EDITORIAL
MEDLINE INDEXING DATE: 199901
ARTICLE TITLE: Should induced hypertension be beneficial after
traumatic brain injury? [editorial]
ARTICLE SOURCE: Anesth Analg (United States), Oct 1998, 87(4)
p751-3
AUTHOR(S): Bedell EA; Prough DS
PUBLICATION TYPE: EDITORIAL
ARTICLE TITLE: Geographic favoritism in liver
transplantation--unfortunate or unfair?
ARTICLE SOURCE: N Engl J Med (United States), Oct 29 1998, 339(18)
p1322-5
AUTHOR(S): Ubel PA; Caplan AL
AUTHOR'S ADDRESS: Philadelphia Veterans Affairs Medical Center, PA,
USA.
PUBLICATION TYPE: JOURNAL ARTICLE
ARTICLE TITLE: Who should determine when health care is medically
necessary?
ARTICLE SOURCE: N Engl J Med (United States), Jan 21 1999, 340(3)
p229-32
AUTHOR(S): Rosenbaum S; Frankford DM; Moore B; Borzi P
AUTHOR'S ADDRESS: George Washington University School of Public
Health and Health Services, Washington, DC 20006, USA.
PUBLICATION TYPE: JOURNAL ARTICLE
ARTICLE TITLE: Prophylactic mastectomy--the price of fear
[editorial; comment]
COMMENTS: Comment on: N Engl J Med 1999 Jan 14; 340(2):77-84
ARTICLE SOURCE: N Engl J Med (United States), Jan 14 1999, 340(2)
p137-8
AUTHOR(S): Eisen A; Weber BL
PUBLICATION TYPE: COMMENT; EDITORIAL
ARTICLE TITLE: The evolving technology of venous access
[editorial; comment]
COMMENTS: Comment on: N Engl J Med 1999 Jan 7; 340(1):1-8
ARTICLE SOURCE: N Engl J Med (United States), Jan 7 1999, 340(1)
p48-50
AUTHOR(S): Wenzel RP; Edmond MB
PUBLICATION TYPE: COMMENT; EDITORIAL
ARTICLE TITLE: A comparison of two antimicrobial-impregnated
central venous catheters. Catheter Study Group [see
comments]
COMMENTS: Comment in: N Engl J Med 1999 Jan 7; 340(1):48-50
ARTICLE SOURCE: N Engl J Med (United States), Jan 7 1999, 340(1)
p1-8
AUTHOR(S): Darouiche RO; Raad II; Heard SO; Thornby JI; Wenker OC;
Gabrielli A; Berg J; Khardori N; Hanna H; Hachem R; Harris RL;
Mayhall G
AUTHOR'S ADDRESS: Department of Medicine, Baylor College of Medicine
and Veterans Affairs Medical Center, Houston, TX 77030, USA.
Darouiche.Rabih.O@Houston.VA.Gov.
PUBLICATION TYPE: CLINICAL TRIAL; JOURNAL ARTICLE; MULTICENTER STUDY;
RANDOMIZED CONTROLLED TRIAL
CONCLUSIONS: The use of central venous catheters impregnated with
minocycline and rifampin is associated with a lower rate of infection
than the use of catheters impregnated with chlorhexidine and silver
sulfadiazine.
ARTICLE TITLE: Self-referral of patients for electron-beam
computed to ography to screen for coronary artery disease
[comment]
COMMENTS: Comment on: N Engl J Med 1998 Dec 31; 339(27):1964-71;
Comment on: N Engl J Med 1998 Dec 31; 339(27):1972-8
ARTICLE SOURCE: N Engl J Med (United States), Dec 31 1998, 339(27)
p2018-20
AUTHOR(S): Taylor AJ; O'Malley PG
AUTHOR'S ADDRESS: Walter Reed Army Institute of Research, Washington,
DC, USA.
PUBLICATION TYPE: COMMENT; JOURNAL ARTICLE
ABSTRACT: As the availability of electron-beam CT increases, it is
appropriate to question the balance among medical science, patient
care, and profits. Broadening patients' sense of empowerment and
promoting their autonomy are worthy goals within medicine.
Breast-cancer screening with mammography is an example of a
radiographic test used successfully in a diagnostic program based on
self-referral. But the lessons of such a program, in which the
distinction between the disease and the disease-free state is more
easily recognized than is the case for age-dependent calcific
arterial changes, are not easily extrapolated to screening for
coronary disease. Currently, we are facing the possibility that
market forces may increase interest in electron-beam CT beyond what
is justified by its potential medical benefit. Well-designed clinical
trials are required to define fully the appropriate indications for
and limitations of electron-beam CT. Such trials will eventually
clarify the medical applications of the technique and determine its
suitability as a screening procedure for cardiovascular disease.
Until then, the use of electron-beam CT, like that of all tests in
medicine, should be based on a clearly defined rationale and should
be coupled with a medical evaluation by a physician.
ARTICLE TITLE: Noninvasive detection of atherosclerosis
[editorial; comment]
COMMENTS: Comment on: N Engl J Med 1998 Dec 31; 339(27):1964-71;
Comment on: N Engl J Med 1998 Dec 31; 339(27):1972-8
ARTICLE SOURCE: N Engl J Med (United States), Dec 31 1998, 339(27)
p2014-5
AUTHOR(S): Celermajer DS
MB. Must be our David Celermejer
PUBLICATION TYPE: COMMENT; EDITORIAL
ARTICLE TITLE: Role models--guiding the future of medicine
[editorial; comment]
COMMENTS: Comment on: N Engl J Med 1998 Dec 31; 339(27):1986-93
ARTICLE SOURCE: N Engl J Med (United States), Dec 31 1998, 339(27)
p2015-7
AUTHOR(S): Skeff KM; Mutha S
PUBLICATION TYPE: COMMENT; EDITORIAL
ARTICLE TITLE: Inotropic therapy for heart failure [editorial;
comment]
COMMENTS: Comment on: N Engl J Med 1998 Dec 17; 339(25):1810-6
ARTICLE SOURCE: N Engl J Med (United States), Dec 17 1998, 339(25)
p1848-50
AUTHOR(S): Stevenson LW
PUBLICATION TYPE: COMMENT; EDITORIAL
ARTICLE TITLE: Should intracranial aneurysms be treated before
they rupture? [editorial; comment]
COMMENTS: Comment on: N Engl J Med 1998 Dec 10; 339(24):1725-33
ARTICLE SOURCE: N Engl J Med (United States), Dec 10 1998, 339(24)
p1774-5
AUTHOR(S): Caplan LR
PUBLICATION TYPE: COMMENT; EDITORIAL
ARTICLE TITLE: Unruptured intracranial aneurysms--risk of rupture
and risks of surgical intervention. International Study of Unruptured
Intracranial Aneurysms Investigators [see comments]
COMMENTS: Comment in: N Engl J Med 1998 Dec 10; 339(24):1774-5
ARTICLE SOURCE: N Engl J Med (United States), Dec 10 1998, 339(24)
p1725-33
PUBLICATION TYPE: JOURNAL ARTICLE; MULTICENTER STUDY
ABSTRACT: BACKGROUND: The management of unruptured intracranial
aneurysms requires knowledge of the natural history of these lesions
and the risks of repairing them. CONCLUSIONS: The likelihood of
rupture of unruptured intracranial aneurysms that were less than 10
mm in diameter was exceedingly low among patients in group 1 and was
substantially higher among those in group 2. The risk of morbidity
and mortality related to surgery greatly exceeded the 7.5-year risk
of rupture among patients in group 1 with unruptured intracranial
aneurysms smaller than 10 mm in diameter.
ARTICLE TITLE: Coronary-artery stents--gauging, gorging, and
gouging [editorial; comment]
COMMENTS: Comment on: N Engl J Med 1998 Dec 3; 339(23):1665-71;
Comment on: N Engl J Med 1998 Dec 3; 339(23):1672-8
ARTICLE SOURCE: N Engl J Med (United States), Dec 3 1998, 339(23)
p1702-4
AUTHOR(S): Topol EJ
PUBLICATION TYPE: COMMENT; EDITORIAL
ARTICLE TITLE: Carbon monoxide poisoning.
ARTICLE SOURCE: N Engl J Med (United States), Nov 26 1998, 339(22)
p1603-8
AUTHOR(S): Ernst A; Zibrak JD
AUTHOR'S ADDRESS: Department of Medicine, Beth Israel Deaconess
Medical Center, Boston, MA 02215, USA.
PUBLICATION TYPE: JOURNAL ARTICLE; REVIEW (66 references); REVIEW,
TUTORIAL
ARTICLE TITLE: A comparison of repeated high doses and repeated
standard doses of epinephrine for cardiac arrest outside the
hospital. European Epinephrine Study Group.
ARTICLE SOURCE: N Engl J Med (United States), Nov 26 1998, 339(22)
p1595-601
AUTHOR(S): Gueugniaud PY; Mols P; Goldstein P; Pham E; Dubien PY;
Deweerdt C; Vergnion M; Petit P; Carli P
AUTHOR'S ADDRESS: Department of Anesthesiology and Emergency Medical
System, Edouard Herriot Hospital, Claude Bernard University, Lyons,
France.
PUBLICATION TYPE: CLINICAL TRIAL; JOURNAL ARTICLE; MULTICENTER STUDY;
RANDOMIZED CONTROLLED TRIAL
ABSTRACT: BACKGROUND: Clinical trials have not shown a benefit of
high doses of epinephrine in the management of cardiac arrest. We
conducted a prospective, multicenter, randomized study comparing
repeated high doses of epinephrine with repeated standard doses in
cases of out-of-hospital cardiac arrest. METHODS: Adult patients who
had cardiac arrest outside the hospital were enrolled if the cardiac
rhythm continued to be ventricular fibrillation despite the
administration of external electrical shocks, or if they had asystole
or pulseless electrical activity at the time epinephrine was
administered. We randomly assigned 3327 patients to receive up to 15
high doses (5 mg each) or standard doses (1 mg each) of epinephrine
according to the current protocol for advanced cardiac life support.
RESULTS: In the high-dose group, 40.4 percent of 1677 patients had a
return of spontaneous circulation, as compared with 36.4 percent of
1650 patients in the standard-dose group (P=0.02); 26.5 percent of
the patients in the high-dose group and 23.6 percent of those in the
standard-dose group survived to be admitted to the hospital (P=0.05);
2.3 percent of the patients in the high-dose group and 2.8 percent in
the standard-dose group survived to be discharged from the hospital
(P=0.34). There was no significant difference in neurologic status
according to treatment among those discharged. High-dose epinephrine
improved the rate of successful resuscitation in patients with
asystole, but not in those with ventricular fibrillation.
CONCLUSIONS: In our study, long-term survival after cardiac arrest
outside the hospital was no better with repeated high doses of
epinephrine than with repeated standard doses.
ARTICLE TITLE: Appropriate use of carotid endarterectomy
[editorial; comment]
COMMENTS: Comment on: N Engl J Med 1998 Nov 12; 339(20):1415-25;
Comment on: N Engl J Med 1998 Nov 12; 339(20):1441-7
ARTICLE SOURCE: N Engl J Med (United States), Nov 12 1998, 339(20)
p1468-71
AUTHOR(S): Chassin MR
CONCLUSIONS: There have been a dramatic fall and rise in the rates of
carotid endarterectomy in both the United States and Canada, which
correlate with the publication of first unfavorable and then
favorable clinical studies. The absence of selective referral of
patients to centers with the lowest mortality rates raises questions
about whether the benefits of carotid endarterectomy in the general
population are similar to those demonstrated in the clinical
trials.
ARTICLE TITLE: Prevention of cardiovascular events and death with
pravastatin in patients with coronary heart disease and a broad range
of initial cholesterol levels. The Long-Term Intervention with
Pravastatin in Ischaemic Disease (LIPID) Study Group.
ARTICLE SOURCE: N Engl J Med (United States), Nov 5 1998, 339(19)
p1349-57
MPUBLICATION TYPE: CLINICAL TRIAL; JOURNAL ARTICLE; MULTICENTER
STUDY; RANDOMIZED CONTROLLED TRIAL
CONCLUSIONS: Pravastatin therapy reduced mortality from coronary
heart disease and overall mortality, as compared with the rates in
the placebo group, as well as the incidence of all prespecified
cardiovascular events in patients with a history of myocardial
infarction or unstable angina who had a broad range of initial
cholesterol levels.
ARTICLE TITLE: Risk factors and clinical impact of central line
infections in the surgical intensive care unit.
ARTICLE SOURCE: Arch Surg (United States), Nov 1998, 133(11)
p1241-6
AUTHOR(S): Charalambous C; Swoboda SM; Dick J; Perl T; Lipsett PA
AUTHOR'S ADDRESS: Manchester University School of Medicine,
England.
PUBLICATION TYPE: JOURNAL ARTICLE
ABSTRACT: OBJECTIVE: To determine the risk factors and clinical
impact of central line infections in critically ill surgical
patients. DESIGN: Retrospective study. SETTING: The surgical
intensive care unit of a large tertiary care university hospital.
PATIENTS: A total of 232 consecutive central line catheters sent for
culture from patients in a surgical intensive care unit during 1996
and 1997. Catheters were sent for microbiologic analysis when the
patient was clinically infected and the central line was a possible
source. INTERVENTIONS: None. MAIN OUTCOME MEASURES: Risk factors
associated and clinical impact of a positive catheter culture.
RESULTS: Of 232 consecutive catheters from 93 patients sent for
microbiologic analysis, 114 catheters (49%) had no growth, 40 (17%)
were colonized (<15 colonies), and 78 (34%) were considered
infected (> or =15 colonies). Univariate analysis showed that site
(internal jugular vs subclavian, P<.001), catheter use (monitoring
> dialysis > fluid > nutrition, P=.006), placement in the
operating room vs the intensive care unit (P=.02), and placement of a
new catheter (> guide wire, > new site, P=.003) were all
significant factors. Surprisingly, neither the number of lunmens nor
the duration of the catheter in situ were predictors when a catheter
was suspected and not proved infected compared with a suspected and
proved catheter infection. In the multiple regression model, the
placement of the catheter in the internal jugular position was the
single most important predictor of a catheter infection (P<.001;
odds ratio, 1.83; 95% confidence interval [CI], 1.41-2.37).
The presence or absence of a specific clinical sign of infection was
not predictive of a proved catheter infection. Eighty-six percent of
patients had gram-positive bacteria identified on the culture, while
the remaining patients had gram-negative bacteria or Candida
identified. Of the catheter infections, 68% were monomicrobial,
whereas 32% were polymicrobial. Of the catheters sent for
microbiologic analysis, 209 (90%) had concurrent peripheral blood
cultures for analysis. Nineteen (32%) with no growth from the
catheter, and 14 (23%) of colonized catheters had concurrent
bacteremia; all had another identifiable cause of infection.
Twenty-seven (45%) of infected catheters had a concurrent bacteremia,
and 9 of 27 had a second site positive for the same organism. Death
related to the infection occurred in 15 patients, 2 in the first 72
hours and 13 in the following 14 days. CONCLUSIONS: Central line
infections remain an important cause of morbidity and mortality.
Comprehensive review of hospital practices may show a directed focus
for performance improvement practices. At our institution, internal
jugular catheters have the highest rate of infection. This may
suggest breaks in technique during catheter insertion or during
catheter maintenance and care.
ARTICLE TITLE: Expanding surgical options using minimally invasive
techniques for cardio-aortic and aortic procedures.
ARTICLE SOURCE: Arch Surg (United States), Nov 1998, 133(11)
p1160-5
AUTHOR(S): Svensson LG; Cambria RP
AUTHOR'S ADDRESS: Center for Aortic Surgery, Lahey Hitchcock Clinic,
Burlington, Mass 01805, USA.
PUBLICATION TYPE: JOURNAL ARTICLE; REVIEW (25 references); REVIEW,
TUTORIAL
ABSTRACT: In an effort to minimize the morbidity and mortality of
open cardio-aortic and aortic operations, which are ranked among the
most extensive procedures, surgeons are attempting to use smaller
minimal-access incisions, less-invasive open procedures, or more
distal access sites to place aortic stented grafts by intraluminal
closed methods. We review the latest trends in this rapidly evolving
new field of minimally invasive surgery.
MB. Rater condecending on our bigger expereince than any other
unit.
ARTICLE TITLE: Prospective, randomized trial of Doppler-assisted
subclavian vein catheterization.
ARTICLE SOURCE: Arch Surg (United States), Oct 1998, 133(10)
p1089-93
AUTHOR(S): Bold RJ; Winchester DJ; Madary AR; Gregurich MA; Mansfield
PF
AUTHOR'S ADDRESS: Department of Surgical Oncology, University of
Texas M. D. Anderson Cancer Center, Houston 77030, USA.
PUBLICATION TYPE: CLINICAL TRIAL; JOURNAL ARTICLE; RANDOMIZED
CONTROLLED TRIAL
CONCLUSIONS: Doppler guidance did not increase the success rate or
decrease the complication rate of subclavian vein catheterization
when compared with the standard technique in high-risk patients.
Doppler guidance was not more useful than the standard technique as a
salvage technique following a previous failure of catheterization.
Furthermore, real-time Doppler guidance of subclavian vein
catheterization is a technique that is highly operator dependent.
ARTICLE TITLE: Transfusion timing and postoperative septic
complications after gastric cancer surgery: a retrospective study of
179 consecutive patients.
ARTICLE SOURCE: Arch Surg (United States), Sep 1998, 133(9)
p988-92
AUTHOR(S): Bellantone R; Sitges-Serra A; Bossola M; Doglietto GB;
Malerba M; Franch G; Pacelli F; Crucitti F
AUTHOR'S ADDRESS: Istituto di Clinica Chirurgica, Universita
Cattolica del Sacro Cuore, Roma, Italy.
PUBLICATION TYPE: JOURNAL ARTICLE
ABSTRACT: BACKGROUND: Immunosuppression associated with homologous
blood transfusion was first observed in renal allograft
transplantation.
CONCLUSIONS: Despite transfusion-induced immunomodulation, homologous
blood transfusion should not be considered a risk factor for
postoperative septic morbidity in patients undergoing elective major
abdominal surgery. The timing-response relationship between
transfusions and septic morbidity in multivariate analysis may be the
effect of uncontrolled confounders such as variation of volemia
induced by stress response in patients who were developing or had
just developed infectious complications.
ARTICLE TITLE: Is there a limit to massive blood transfusion after
severe trauma?
ARTICLE SOURCE: Arch Surg (United States), Sep 1998, 133(9)
p947-52
AUTHOR(S): Velmahos GC; Chan L; Chan M; Tatevossian R; Cornwell EE
3rd; Asensio JA; Berne TV; Demetriades D
AUTHOR'S ADDRESS: Department of Surgery, University of Southern
California Medical School and the Los Angeles County + USC Medical
Center, 90033, USA. velmahos@hsc.usc.edu.
PUBLICATION TYPE: JOURNAL ARTICLE
CONCLUSIONS: Although mortality among critically injured patients
requiring operation and massive blood transfusion can be correlated
with independent risk factors, discontinuation of short-term care
cannot be justified based on the need for massive blood transfusion
of up to 68 units.
ARTICLE TITLE: Decision-making in delivery room resuscitation: a
team sport [comment]
COMMENTS: Comment on: Pediatrics 1998 Sep; 102(3 Pt 1):574-82
ARTICLE SOURCE: Pediatrics (United States), Sep 1998, 102(3 Pt 1)
p644-5
AUTHOR(S): Finer NN; Barrington KJ
AUTHOR'S ADDRESS: University of California, San Diego Medical Center,
Department of Pediatrics 92103-8774, USA.
PUBLICATION TYPE: COMMENT; JOURNAL ARTICLE
ARTICLE TITLE: Delivery room resuscitation decisions for extremely
premature infants [see comments]
COMMENTS: Comment in: Pediatrics 1998 Sep; 102(3 Pt 1):644-5
ARTICLE SOURCE: Pediatrics (United States), Sep 1998, 102(3 Pt 1)
p574-82
AUTHOR(S): Doron MW; Veness-Meehan KA; Margolis LH; Holoman EM;
Stiles AD
AUTHOR'S ADDRESS: Department of Pediatrics, University of North
Carolina at Chapel Hill, USA.
PUBLICATION TYPE: JOURNAL ARTICLE
CONCLUSIONS: Physicians resuscitated extremely premature infants at
delivery when they were very uncertain about an infant's prognosis or
when the parents' desires about treatment were unknown. When parents'
preferences were known, parents usually determined the amount of
treatment provided at delivery. Resuscitation at delivery usually
postponed death by only a few days, decreasing prognostic uncertainty
and honoring what physicians perceived were parents' wishes for care,
without substantially contributing to overtreatment.
ARTICLE TITLE: Resuscitation of asphyxiated newborn infants with
room air or oxygen: an international controlled trial: the Resair 2
study.
ARTICLE SOURCE: Pediatrics (United States), Jul 1998, 102(1) pe1
AUTHOR(S): Saugstad OD; Rootwelt T; Aalen O
AUTHOR'S ADDRESS: Department of Pediatric Research, National
Hospital, Oslo, Norway.
PUBLICATION TYPE: CLINICAL TRIAL; CONTROLLED CLINICAL TRIAL; JOURNAL
ARTICLE; MULTICENTER STUDY
RESULTS: Forms for 703 enrolled infants from 11 centers were received
by the steering committee. All 94 patients from one of the centers
were excluded because of violation of the inclusion criteria in 86 of
these. Therefore, the final number of infants enrolled in the study
was 609 (from 10 centers), with 288 in the room air group and 321 in
the oxygen group. Median (5 to 95 percentile) gestational ages were
38 (32.0 to 42.0) and 38 (31.1 to 41.5) weeks (NS), and birth weights
were 2600 (1320 to 4078) g and 2560 (1303 to 3900) g (NS) in the room
air and oxygen groups, respectively. There were 46% girls in the room
air and 41% in the oxygen group (NS). Mortality in the first 7 days
of life was 12.2% and 15.0% in the room air and oxygen groups,
respectively; adjusted odds ratio (OR) = 0.82 with 95% confidence
intervals (CI) = 0.50-1.35. Neonatal mortality was 13.9% and 19.0%;
adjusted OR = 0. 72 with 95% CI = 0.45-1.15. Death within 7 days of
life and/or moderate or severe hypoxic-ischemic encephalopathy
(primary outcome measure) was seen in 21.2% in the room air group and
in 23.7% in the oxygen group; OR = 0.94 with 95% CI = 0.63-1.40.
(ABSTRACT TRUNCATED).
MB. I have truncated it more.
ARTICLE TITLE: The collaborative UK ECMO (Extracorporeal Membrane
Oxygenation) trial: follow-up to 1 year of age.
ARTICLE SOURCE: Pediatrics (United States), Apr 1998, 101(4) pE1
PUBLICATION TYPE: CLINICAL TRIAL; JOURNAL ARTICLE; MULTICENTER STUDY;
RANDOMIZED CONTROLLED TRIAL
CONCLUSION: These results are in accord with the earlier preliminary
findings that a policy of ECMO support reduces the risk of death
without a concomitant rise in severe disability. However, 1 in 4
survivors had evidence of impairment with or without disability.
Further follow-up is planned at the age of 4 and 7 years.
ARTICLE TITLE: Circumcision practice patterns in the United
States.
ARTICLE SOURCE: Pediatrics (United States), Jun 1998, 101(6) pE5
AUTHOR(S): Stang HJ; Snellman LW
AUTHOR'S ADDRESS: Department of Pediatrics and Adolescent Medicine,
HealthPartners Medical Group, Minneapolis-St Paul, Minnesota,
USA.
PUBLICATION TYPE: JOURNAL ARTICLE
CONCLUSIONS: A substantial number of PEDs are performing
circumcisions, and they are most likely to use anesthesia (71%),
followed by FPs (56%), then OBs (25%). With recent recognition of the
importance of pain reduction in neonatal procedures and the lack of
substantiated contraindications to newborn anesthetic use, additional
education of current practitioners, residents, and parents is
required to increase the use of anesthesia for circumcision.
ARTICLE TITLE: Pediatric cardiac surgery: the effect of hospital
and surgeon volume on in-hospital mortality.
ARTICLE SOURCE: Pediatrics (United States), Jun 1998, 101(6)
p963-9
AUTHOR(S): Hannan EL; Racz M; Kavey RE; Quaegebeur JM; Williams R
AUTHOR'S ADDRESS: Department of Health Policy, Management, and
Behavior, State University of New York, University at Albany,
USA.
PUBLICATION TYPE: JOURNAL ARTICLE
CONCLUSIONS: Both hospital volume and surgeon volume are
significantly associated with in-hospital mortality, and these
differences persist for both high-complexity and low-complexity
pediatric cardiac procedures.
ARTICLE TITLE: The potential benefits of the pediatric
nonheartbeating organ donor.
ARTICLE SOURCE: Pediatrics (United States), Jun 1998, 101(6)
p1049-52
AUTHOR(S): Koogler T; Costarino AT Jr
AUTHOR'S ADDRESS: Department of Anesthesia and Critical Care
Medicine, Children's Hospital of Philadelphia, Pennsylvania 19104,
USA.
PUBLICATION TYPE: JOURNAL ARTICLE
ABSTRACT: OBJECTIVE: To examine the population of the pediatric
intensive care unit in a large children's hospital to determine the
potential importance of pediatric nonheartbeating organ donors
(NHBDs). CONCLUSIONS: The routine use of the NHBD has the potential
to increase organ donation at our institution by 42%. We discuss the
ethical issues relating to NHBDs required to properly include these
patients as potential organ donors.
ARTICLE TITLE: Teaching clinical decision-making to pediatric
residents in an era of managed care.
ARTICLE SOURCE: Pediatrics (United States), Apr 1998, 101(4 Pt 2)
p762-6; discussion 766-7
AUTHOR(S): Chessare JB
AUTHOR'S ADDRESS: Department of Pediatrics, Albany Medical College,
New York, USA.
PUBLICATION TYPE: JOURNAL ARTICLE
ABSTRACT: The growth of managed care has brought a new focus on
physician competency in the appropriate use of resources to help
patients. The community of pediatric educators must improve residency
curricula and teaching methodologies to ensure that graduates of
their programs can effectively and efficiently meet the needs of
children and their families. The educational approach in many
pediatric residency programs is an implicit apprenticeship model,
with which the residents follow the actions of attending physicians
with little attention to scrutiny of the clinical evidence for and
against diagnostic and treatment strategies. Evidence-based medicine
stresses to the trainee the importance of the evaluation of evidence
from clinical research and cautions against the use of intuition,
unsystematic clinical experience, and untested pathophysiologic
reasoning as sufficient for medical decision-making. Managed care
also has helped to create a heightened awareness of the need to
educate residents to incorporate the preferences of patients and
families into diagnostic and treatment decisions. Trainees must know
how to balance their duty to maximize the health of populations at
the lowest resource use with their duty to each individual patient
and family. Changes in the residency curriculum will bring change in
educational settings and the structure of rotations. Potential
barriers to implementation will include the need for faculty
development and financial resources for information technology.
ARTICLE TITLE: Analgesia for neonatal circumcision: a randomized
controlled trial of EMLA cream versus dorsal penile nerve block.
ARTICLE SOURCE: Pediatrics (United States), Apr 1998, 101(4) pE5
AUTHOR(S): Butler-O'Hara M; Le Moine C; Guillet R
AUTHOR'S ADDRESS: Department of Pediatrics, Division of Neonatology,
University of Rochester, Rochester, NY 14642, USA.
INDEXING CHECK TAG(S): Comparative Study; Human; Male; Support,
Non-U.S. Gov't
PUBLICATION TYPE: CLINICAL TRIAL; JOURNAL ARTICLE; RANDOMIZED
CONTROLLED TRIAL
ABSTRACT: OBJECTIVE: To compare the efficacy of the dorsal penile
nerve block (DPNB) with a less invasive form of local anesthesia,
eutectic mixture of local anesthetic (EMLA) cream, for reduction of
pain during neonatal circumcision. CONCLUSIONS: DPNB provides better
pain reduction during neonatal circumcision than EMLA cream. EMLA
cream may provide pain reduction compared with no anesthesia during
neonatal circumcision.
ARTICLE TITLE: Selective head cooling in newborn infants after
perinatal asphyxia: a safety study [see comments]
COMMENTS: Comment in: Pediatrics 1998 Oct; 102(4 Pt 1):972-4
ARTICLE SOURCE: Pediatrics (United States), Oct 1998, 102(4 Pt 1)
p885-92
AUTHOR(S): Gunn AJ; Gluckman PD; Gunn TR
AUTHOR'S ADDRESS: Research Centre for Developmental Medicine and
Biology, Department of Paediatrics, School of Medicine, University of
Auckland, Auckland, New Zealand.
CONCLUSIONS: Mild selective head cooling combined with mild systemic
hypothermia in term newborn infants after perinatal asphyxia is a
safe and convenient method of quickly reducing cerebral temperature
with an increased gradient between the surface of the scalp and core
temperature. The safety of mild hypothermia with selective head
cooling is in contrast with the historical evidence of adverse
effects with greater depths of whole-body hypothermia. This safety
study and the strong experimental evidence for improved cerebral
outcome justify a multicenter trial of selective head cooling for
neonatal encephalopathy in term infants.