MB's Articles of Interest - August 2001

ARTICLE TITLE: Multimodal perioperative management-combining thoracic epidural analgesia, forced mobilization, and oral nutrition-reduces hormonal and metabolic stress and improves convalescence after major urologic surgery
ARTICLE SOURCE: Anesth Analg (United States), Jun 2001, 92(6) p1594-600
AUTHOR(S): Brodner G; Van Aken H; Hertle L; Fobker M; Von Eckardstein A; Goeters C; Buerkle H; Harks A; Kehlet H
AUTHOR'S ADDRESS: Klinik und Poliklinik fur Anasthesiologie und Operative Intensivmedizin, Klinik und Poliklinik fur Urologie, and Institut fur Klinische Chemie und Laboratoriumsmedizin, Westfalische Wilhelms-Universitat Munster, Munster, Germany.
PUBLICATION TYPE: Journal Article
IMPLICATIONS: In patients undergoing radical cystectomy, a multimodal approach combining continuous epidural analgesia, enforced mobilization, and oral nutrition should be used to speed recovery after major urologic surgery.

ARTICLE TITLE: Propacetamol Versus Ketorolac for Treatment of Acute Postoperative Pain After Total Hip or Knee Replacement
ARTICLE SOURCE: Anesth Analg (United States), Jun 2001, 92(6) p1569-75
AUTHOR(S): Zhou TJ; Tang J; White PF
AUTHOR'S ADDRESS: Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center at Dallas, Texas.
PUBLICATION TYPE: Journal Article
IMPLICATIONS: Propacetamol (2 g IV), an acetaminophen prodrug, was similar to ketorolac (15 mg and 30 mg IV) with respect to analgesic properties during a 6-h assessment period. However, the onset of analgesic action of propacetamol seems to be faster than ketorolac (15 mg IV) and its duration of action shorter than ketorolac (30 mg IV).

ARTICLE TITLE: Cardiovascular Responses to Scalp Infiltration with Different Concentrations of Epinephrine With or Without Lidocaine During Craniotomy
ARTICLE SOURCE: Anesth Analg (United States), Jun 2001, 92(6) p1516-9
AUTHOR(S): Murthy HS; Umamaheswara Rao GS
AUTHOR'S ADDRESS: Department of Neuroanaesthesia, National Institute of Mental Health and Neurosciences, Bangalore, India.
PUBLICATION TYPE: Journal Article
IMPLICATIONS: In neurosurgical patients undergoing craniotomy, infiltration of the scalp with a solution containing epinephrine alone causes significant hypertension. The addition of lidocaine attenuates the hypertensive response but entails a biphasic decrease in blood pressure.
MB: When I was a registrar (1961) and was the only anaesthetist in the isolated single neurosurgical theatre. I weaned one neorosurgeon who infiltrated the scalp first off the lignocaine as I was giving a nice abdominal style GA. Then I weaned him off the adrenaline because he was clipping the scalp edges which stopped any bleeding there and his adrenaline had no effect inside the head. He continued to inject saline. When I tried to wean him off that he said, "I have to inject something."
That surgeon eventually died in the scrub bay because the anaesthetist could not intubate him on the floor. As no one else knew exactly what operation was going to be done they woke the patient up.
It was said that another surgeon made a claim on the slot in the operating room schedule created by the death of the surgeon before he was removed from the scrub bay.

ARTICLE TITLE: Issues of concern for the aging anesthesiologist
ARTICLE SOURCE: Anesth Analg (United States), Jun 2001, 92(6) p1487-92
AUTHOR(S): Katz JD
AUTHOR'S ADDRESS: Yale University School of Medicine, New Haven, Connecticut.
PUBLICATION TYPE: Journal Article
MB: They list all the issues but that is it.

ARTICLE TITLE: Intravenous administration of propacetamol reduces morphine consumption after spinal fusion surgery
ARTICLE SOURCE: Anesth Analg (United States), Jun 2001, 92(6) p1473-6
AUTHOR(S): Hernandez-Palazon J; Tortosa JA; Martinez-Lage JF; Perez-Flores D
AUTHOR'S ADDRESS: Departments of Anesthesiology and Neurosurgery, Hospital Universitario 'Virgen de la Arrixaca,' Murcia, Spain.
PUBLICATION TYPE: Journal Article
IMPLICATIONS: We evaluated the utility of propacetamol as an adjunct to the administration of patient-controlled analgesia morphine in the treatment of postoperative pain after spine stabilization surgery. This combination was associated with an appropriate analgesic effect and with a smaller morphine consumption.

ARTICLE TITLE: Aprotinin administration and pulmonary thromboembolism during orthotopic liver transplantation: report of two cases
ARTICLE SOURCE: Anesth Analg (United States), Jun 2001, 92(6) p1418-21
AUTHOR(S): Fitzsimons MG; Peterfreund RA; Raines DE
AUTHOR'S ADDRESS: Department of Anesthesia and Critical Care, Massachusetts General Hospital, Boston, Massachusetts.
PUBLICATION TYPE: Journal Article
MB: I have been pressured to use aprotinin to lower blood replacement. I know of another paper (in press) of 9 cases of intra-cardiac thrombosis as in the above report seems to be with clots attached to heart structures. In that paper most had aprotinin too. We have seen clot in the IVC which could have embolised if they had not been seen. The clots in the above report in one case at least was attached to a heart valve ie it was not an embolus from a peripheral vein,

ARTICLE TITLE: The successful use of hemoglobin-based oxygen carrier as a primary blood substitute during abdominal aneurysm repair with large blood loss
ARTICLE SOURCE: Anesth Analg (United States), Jun 2001, 92(6) p1413-5
AUTHOR(S): Sprung J; Popp H; O'Hara P; Woletz J
AUTHOR'S ADDRESS: Department of Anesthesiology, Mayo Clinic, Rochester, MN.
PUBLICATION TYPE: Journal Article

ARTICLE TITLE: The effects of hydroxyethyl starches of varying molecular weights on platelet function
ARTICLE SOURCE: Anesth Analg (United States), Jun 2001, 92(6) p1402-7
AUTHOR(S): Franz A; Braunlich P; Gamsjager T; Felfernig M; Gustorff B; Kozek-Langenecker SA
AUTHOR'S ADDRESS: Department of Anesthesiology and Intensive Care B, University of Vienna, School of Medicine, Vienna, Austria.
PUBLICATION TYPE: Journal Article
IMPLICATIONS: Comparison of hydroxyethyl starch solutions in healthy adults indicates that increased molecular weight and degree of substitution are associated with inhibition of platelet function by reduction of the availability of platelet surface fibrinogen receptors.

ARTICLE TITLE: Arytenoid dislocation while using a McCoy laryngoscope.
ARTICLE SOURCE: Anesth Analg (United States), May 2001, 92(5) p1347-8
AUTHOR(S): Usui T; Saito S; Goto F
AUTHOR'S ADDRESS: Department of Anesthesia, Asahi Chuoh Hospital, Asahi, Chiba, Japan.
PUBLICATION TYPE: Journal Article
ABSTRACT: Arytenoid dislocation (AD) involves either a complete disruption of the cricoarytenoid joint or a malpositioning of the arytenoid cartilages (AC) with reference to other laryngeal cartilages. In this report, we present a case of AD while using a McCoy laryngoscope. Although McCoy laryngoscope is recognized as a useful option for the cases of difficult endotracheal intubation, we are concerned that AD is likely with this device.

ARTICLE TITLE: Preoxygenation with tidal volume and deep breathing techniques: the impact of duration of breathing and fresh gas flow.
ARTICLE SOURCE: Anesth Analg (United States), May 2001, 92(5) p1337-41
AUTHOR(S): Nimmagadda U; Chiravuri SD; Salem MR; Joseph NJ; Wafai Y; Crystal GJ; El-Orbany MI
AUTHOR'S ADDRESS: Department of Anesthesiology, Illinois Masonic Medical Center, 836 W. Wellington Avenue, Chicago, IL 60657, USA.
PUBLICATION TYPE: Clinical Trial; Journal Article; Randomized Controlled Trial
IMPLICATIONS: Using a circle absorber system, normal breathing of oxygen for 3-5 min achieves optimal oxygenation of the lungs; whereas 4 deep breaths in 30 s does not. However, extending deep breathing to 1.5-2 min and using a high flow of oxygen improves oxygenation of the lungs to the same degree as normal breathing for 3-5 min. This may have important implications for patient safety.
MB: I knew this a priori. I have always done it. No one told me. I did not have to do any studies to find it out.

ARTICLE TITLE: Auditory information processing during adequate propofol anesthesia monitored by electroencephalogram bispectral index.
ARTICLE SOURCE: Anesth Analg (United States), May 2001, 92(5) p1210-4
AUTHOR(S): Kerssens C; Klein J; van der Woerd A; Bonke B
AUTHOR'S ADDRESS: Department of Medical Psychology and Psychotherapy, Netherlands Institute of Health Sciences, Erasmus University Rotterdam, P.O. Box 1738, NL-3000 DR, Rotterdam, the Netherlands. kerssens@mpp.fgg.eur.nl.
PUBLICATION TYPE: Clinical Trial; Journal Article; Randomized Controlled Trial
IMPLICATIONS: This study suggests that stable levels of adequate hypnosis may prevent information processing and memory formation during general anesthesia and supports the feasibility of electroencephalogram bispectral index as a monitor of adequate anesthesia.
MB: We need more than suggestion of possibilities.

ARTICLE TITLE: Rapacuronium: an alternative to succinylcholine for electroconvulsive therapy.
ARTICLE SOURCE: Anesth Analg (United States), May 2001, 92(5) p1171-2
AUTHOR(S): Kadar AG; Kramer BA; Barth MC; White PF
AUTHOR'S ADDRESS: Department of Anesthesiology, Cedars Sinai Medical Center, Los Angeles, California, USA.
PUBLICATION TYPE: Journal Article
MB: Well you need not worry about that stuff any more. It's gone. We never got it. How sad. Sux is still going strong.

ARTICLE TITLE: Do pulmonary artery catheters cause or increase tricuspid or pulmonic valvular regurgitation?
ARTICLE SOURCE: Anesth Analg (United States), May 2001, 92(5) p1117-22
AUTHOR(S): Sherman SV; Wall MH; Kennedy DJ; Brooker RF; Butterworth J
AUTHOR'S ADDRESS: Department of Anesthesiology, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157-109, USA.
PUBLICATION TYPE: Journal Article
IMPLICATIONS: In patients without pulmonic or tricuspid valvular pathology, placement of a pulmonary artery catheter (PAC) worsened tricuspid regurgitation, which is consistently visualized in the right ventricular inflow-outflow view, and often not seen in the midesophageal 4-chamber view. This is consistent with malcoaptation of the anterior and posterior leaflets. PAC-induced pulmonic insufficiency was rarely detected in the midesophageal aortic valve long-axis view. We conclude that a PAC is very unlikely to be the sole cause of severe tricuspid regurgitation or pulmonic insufficiency.
MB: Well that's a relief.

ARTICLE TITLE: A randomized double-blinded multicenter comparison of remifentanil versus fentanyl when combined with isoflurane/propofol for early extubation in coronary artery bypass graft surgery.
COMMENTS: : Anesth Analg. 2001 May; 92(5):1081-3/21222736
ARTICLE SOURCE: Anesth Analg (United States), May 2001, 92(5) p1084-93
AUTHOR(S): Howie MB; Cheng D; Newman MF; Pierce ET; Hogue C; Hillel Z; Bowdle TA; Bukenya D
AUTHOR'S ADDRESS: Department of Anesthesiology, Division of Cardiac Anesthesia, The Ohio State University Medical Center, Doan Hall N408, 410 West 10th Ave., Columbus, OH 43210-1228.
IMPLICATIONS: Both fentanyl and the newer opioid remifentanil, when each is combined with isoflurane and propofol, allowed for fast-track cardiac anesthesia. The remifentanil regimen used in this study resulted in significantly less hemodynamic response to surgical stimulation.

ARTICLE TITLE: The efficacy and resource utilization of remifentanil and fentanyl in fast-track coronary artery bypass graft surgery: a prospective randomized, double-blinded controlled, multi-center trial.
COMMENTS: : Anesth Analg. 2001 May; 92(5):1081-3/21222736
ARTICLE SOURCE: Anesth Analg (United States), May 2001, 92(5) p1094-102
AUTHOR(S): Cheng DC; Newman MF; Duke P; Wong DT; Finegan B; Howie M; Fitch J; Bowdle TA; Hogue C; Hillel Z; Pierce E; Bukenya D
AUTHOR'S ADDRESS: Division of Cardiac Anesthesia & Intensive Care, Toronto General Hospital, University of Toronto, Toronto, Ontario.
PUBLICATION TYPE: Clinical Trial; Journal Article; Multicenter Study; Randomized Controlled Trial
ABSTRACT: We compared (a) the perioperative complications; (b) times to eligibility for, and actual time of the following: extubation, less intense monitoring, intensive care unit (ICU), and hospital discharge; and (c) resource utilization of nursing ratio for patients receiving either a typical fentanyl/isoflurane/propofol regimen or a remifentanil/isoflurane/propofol regimen for fast-track cardiac anesthesia in 304 adults by using a prospective randomized, double-blinded, double-dummy trial. <snip>. We conclude that both anesthesia techniques permit early and similar times until tracheal extubation, less intense monitoring, ICU and hospital discharge, and reduced resource utilization after coronary artery bypass graft surgery.
MB: There was no difference.

ARTICLE TITLE: Fast-tracking after coronary artery bypass graft surgery.
COMMENTS: : Anesth Analg. 2001 May; 92(5):1084-93; : Anesth Analg. 2001 May; 92(5):1094-102
ARTICLE SOURCE: Anesth Analg (United States), May 2001, 92(5) p1081-3
AUTHOR(S): Coriat P; Beaussier M
AUTHOR'S ADDRESS: Department of Anesthesia and Intensive Care, Pitie-Salpetriere University Hospital, 47, Boulevard de l'hopital, 75651 Paris Cedex, France.
PUBLICATION TYPE: Comment; Editorial
MB: Multi-centre blinded study. Remifentanil was no different from fentanyl bolus with no further opioid. They also gave popofol & isoflurane. I suppose they could not restrain/control themselves.

ARTICLE TITLE: Early discharge after coronary artery bypass graft surgery: Are patients really going home earlier
ARTICLE SOURCE: J Thorac Cardiovasc Surg (United States), May 2001, 121(5) p943-50
AUTHOR(S): Lazar HL; Fitzgerald CA; Ahmad T; Bao Y; Colton T; Shapira OM; Shemin RJ
AUTHOR'S ADDRESS: Department of Cardiothoracic Surgery, The Boston Medical Center and the Boston University School of Medicine, Boston, Mass.
PUBLICATION TYPE: Journal Article
CONCLUSIONS: Early extubation and fast track protocols have resulted in earlier discharge from acute care facilities. However, the anticipated earlier return to home has been offset by the increased use of outpatient nursing services, discharges to extended care facilities, and hospital readmissions.
MB: Well there you go.

ARTICLE TITLE: Dog ear: an overview of causes and treatment.
ARTICLE SOURCE: Ann R Coll Surg Engl (England), Mar 2001, 83(2) p136-8
AUTHOR(S): Jaibaji M; Morton JD; Green AR
AUTHOR'S ADDRESS: Department of Burns and Plastic Surgery, Whiston Hospital, Prescot, Merseyside, UK.
PUBLICATION TYPE: Journal Article; Review; Review, Tutorial
ABSTRACT: Dog ear is a term used to describe a characteristic puckering of the skin that can occur after surgical wound closure. Every surgeon practising cutaneous surgery should be conversant with dog ears as they are a common and generally preventable problem. They are significant as they may mar an otherwise excellent aesthetic outcome and may, on occasions, require revisional surgery.
MB: While in Viet Nam our fearless leader, a venerable just retired general surgeon, had an article left by the previous team's young plastics fellow on hare lips. He followed the instructions on the hare lips that he picked up in the local market. The results were utilitarian but not very elegant. They were a bit dog eared----I still have the slides. We had a bored US Army just finished ENT Fellow who came to do a list with us to fix his boredom and to cultivate one of our nurses. Our internist did not like our surgeon so referred the lips to the ENT surgeon. His work was elegant. At lunch after one of the ENT surgeon's sessions our leader remarked that the ENT surgeon was very slow. A minute later I said, "But it looks very nice when he is finished." After another minutes silence our leader said, "I have to do something while I am here." Then we had siesta.

ARTICLE TITLE: Routine fiberoptic endoscopic evaluation of swallowing following prolonged intubation: implications for management.
ARTICLE SOURCE: Arch Surg (United States), Apr 2001, 136(4) p434-7
AUTHOR(S): Ajemian MS; Nirmul GB; Anderson MT; Zirlen DM; Kwasnik EM
AUTHOR'S ADDRESS: Department of Surgery, Waterbury Hospital Health Center, 64 Robbins St, Waterbury, CT 06721, USA. majemian@wtbyhosp.chime.org.
PUBLICATION TYPE: Journal Article
CONCLUSIONS: Fiberoptic endoscopic evaluation of swallowing identified swallowing dysfunction in more than 50% of patients intubated for longer than 48 hours, many of whom are silent aspirators. Dietary recommendations based on Fiberoptic endoscopic evaluation of swallowing (FEES) results prevented clinically significant aspiration.

ARTICLE TITLE: Is unplanned return to the operating room a useful quality indicator in general surgery?
ARTICLE SOURCE: Arch Surg (United States), Apr 2001, 136(4) p405-11
AUTHOR(S): Birkmeyer JD; Hamby LS; Birkmeyer CM; Decker MV; Karon NM; Dow RW
AUTHOR'S ADDRESS: VA Outcomes Group (111B), Department of Veterans Affairs Medical Center, White River Junction, VT 05009, USA. john.d.birkmeyer@dartmouth.edu.
PUBLICATION TYPE: Journal Article
CONCLUSIONS: Unplanned returns to the OR occur across a broad spectrum of general surgical procedures and carry significant implications. Because they most often reflect problems related to the procedure itself, reoperation rates may be useful for monitoring quality across hospitals and for identifying opportunities for quality improvement locally.

ARTICLE TITLE: Mortality associated with congenital heart defects in the United States : trends and racial disparities, 1979-1997
ARTICLE SOURCE: Circulation (United States), May 15 2001, 103(19) p2376-81
AUTHOR(S): Boneva RS; Botto LD; Moore CA; Yang Q; Correa A; Erickson JD
AUTHOR'S ADDRESS: National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Ga.
PUBLICATION TYPE: Journal Article
CONCLUSIONS:Mortality from heart defects is declining in the United States, although it remains a major cause of death in infancy and childhood. Age at death is increasing, suggesting that more affected persons are living to adolescence and adulthood. The racial discrepancies should be investigated to identify opportunities for prevention.

ARTICLE TITLE: Acute effects of continuous positive airway pressure on cardiac sympathetic tone in congestive heart failure
ARTICLE SOURCE: Circulation (United States), May 15 2001, 103(19) p2336-8
AUTHOR(S): Kaye DM; Mansfield D; Aggarwal A; Naughton MT; Esler MD
AUTHOR'S ADDRESS: Departments of Cardiovascular (D.M.K., A.A., M.D.E.) and Respiratory Medicine (D.M., M.T.N.) and Baker Medical Research Institute (D.M.K., A.A., M.D.E.), Melbourne, Australia.
PUBLICATION TYPE: Journal Article
CONCLUSION:The short-term application of continuous positive airway pressure (CPAP) results in an inhibition of cardiac sympathetic nervous activity. Further investigation into the potential value of long-term CPAP in congestive heart failure (CHF) patients is warranted.

ARTICLE TITLE: Defining diastolic heart failure.
ARTICLE SOURCE: Circulation (United States), Apr 10 2001, 103(14) pE82
AUTHOR(S): O'Rourke MF
INDEXING CHECK TAG(S): Human
PUBLICATION TYPE: Letter
MB: Michael O'Rourke almost became an anaesthetist. It appears that the term is a bit vague.

ARTICLE TITLE: Deterioration of left ventricular chamber performance after bed rest : "cardiovascular deconditioning" or hypovolemia?
ARTICLE SOURCE: Circulation (United States), Apr 10 2001, 103(14) p1851-7
AUTHOR(S): Perhonen MA; Zuckerman JH; Levine BD
AUTHOR'S ADDRESS: Institute for Exercise and Environmental Medicine, Presbyterian Hospital and University of Texas Southwestern Medical Center, Dallas, Texas, USA.
PUBLICATION TYPE: Clinical Trial; Journal Article
CONCLUSIONS: Chronic heart to head-down tilt bed rest (HDTBR) leads to ventricular remodeling, which is not seen with equivalent degrees of acute hypovolemia. This remodeling leads to a greater decrease in stroke volume (SV) during orthostatic stress after bed rest than hypovolemia alone, potentially contributing to orthostatic intolerance.

ARTICLE TITLE: Risk factors for fatal myocardial infarction after coronary bypass graft surgery
ARTICLE SOURCE: Eur J Anaesthesiol (England), May 2001, 18(5) p322-9
AUTHOR(S): Ranucci M; Frigiola A; Menicanti L; Cazzaniga A; Soro G; Isgro G
AUTHOR'S ADDRESS: Departments of Cardiovascular Anesthesia and Cardiac Surgery, Cardiovascular Center E. Malan, University of Milan, San Donato Hospital, Milan, Italy.
PUBLICATION TYPE: Journal Article
CONCLUSIONS: In patients undergoing coronary artery bypass surgery, preoperative anticoagulation management with heparin may represent a risk factor for fatal myocardial infarction. Patterns of heparin resistance, whether or not due to heparin pretreatment, seem to be closely related to fatal myocardial infarction.

ARTICLE TITLE: Endovascular treatment of abdominal aortic aneurysms: is there a benefit regarding postoperative outcome?
ARTICLE SOURCE: Eur J Anaesthesiol (England), Apr 2001, 18(4) p245-50
AUTHOR(S): Bertrand M; Godet G; Koskas F; Cluzel P; Fleron MH; Kieffer E; Coriat P
AUTHOR'S ADDRESS: Departments of Anesthesiology and Vascular Surgery, University Paris VI, Pitie-Salpetriere Hospital, Paris, France.
PUBLICATION TYPE: Journal Article
CONCLUSION: The amount of bleeding and the need for blood products were significantly lower in the endovascular treatment group. Despite the absence of significant differences regarding cardiac complications and mortality, there was a lesser incidence of pneumonia, acute respiratory and renal failure. Patients in the endovascular treatment group spent less time in the intensive care unit and in the Hospital.

ARTICLE TITLE: The economics of anaesthesia
ARTICLE SOURCE: Eur J Anaesthesiol (England), Apr 2001, 18(4) p205-7
AUTHOR(S): Elliot RA
AUTHOR'S ADDRESS: Clinical lecturer,School of Pharmacy and Pharmaceutical Sciences,University of Manchester,Oxford Road,Manchester M13 9PL, UK.
PUBLICATION TYPE: Journal Article

ARTICLE TITLE: Postoperative titration of intravenous morphine
ARTICLE SOURCE: Eur J Anaesthesiol (England), Mar 2001, 18(3) p159-65
AUTHOR(S): Aubrun F; Monsel S; Langeron O; Coriat P; Riou B
AUTHOR'S ADDRESS: Department of Anaesthesiology and Critical Care, Centre Hospitalier Universitaire (CHU) Pitie-Salpetriere, Universite Pierre et Marie Curie, Paris, France.
PUBLICATION TYPE: Journal Article
METHODS: Four regimens of morphine titration were studied: every 10 (group 1, n = 400) or 5 min (group 2, n = 400) with a maximum of five intravenous boluses; every 5 min, without any limitation in the number of boluses (groups 3 and 4, n = 400 each); in groups 1, 2, and 3, subcutaneous morphine was administered 4 h after titration. In group 4, administration of subcutaneous morphine was allowed only 2 h after titration.. CONCLUSION: Intravenous morphine titration every 5 min with an unlimited number of boluses and early subcutaneous administration provided the best analgesic regimen.

ARTICLE TITLE: The future of anaesthesiology
ARTICLE SOURCE: Eur J Anaesthesiol (England), Mar 2001, 18(3) p131-6
AUTHOR(S): Booij LH
AUTHOR'S ADDRESS: Anesthesiologie, Academisch Ziekenhuis Nijmegen; Radboud Centraal, Geert Grooteplein zuid 10; Postbus 9101, 6500 HB Nijmegen; The Netherlands.
PUBLICATION TYPE: Journal Article

ARTICLE TITLE: Small doses of remifentanil or sufentanil for blunting cardiovascular changes induced by tracheal intubation: a double-blind comparison.
ARTICLE SOURCE: Eur J Anaesthesiol (England), Feb 2001, 18(2) p108-12
AUTHOR(S): Casati A; Fanelli G; Albertin A; Deni F; Danelli G; Grifoni F; Torri G
AUTHOR'S ADDRESS: University of Milan, Department of Anaesthesiology, IRCCS H San Raffaele, via Olgettina 60, 20132 Milan, Italy.
CONCLUSIONS: In healthy normotensive patients without cardiovascular disease the use of a relatively small dose of either remifentanil or sufentanil after standard midazolam premedication results in a similar and clinically acceptable effectiveness in blunting the cardiovascular changes induced by tracheal intubation.
MB: They are not the problem. The solution in people with CV disease is adequate stable GA before intubation.

ARTICLE TITLE: Minimal flow sevoflurane and isoflurane anaesthesia and impact on renal function.
ARTICLE SOURCE: Eur J Anaesthesiol (England), Jan 2001, 18(1) p43-50
AUTHOR(S): Goeters C; Reinhardt C; Gronau E; Wusten R; Prien T; Baum J; Vrana S; Van Aken H
AUTHOR'S ADDRESS: Klinik und Poliklinik fur Anasthesiologie und operative Intensivmedizin, Westfalischen Wilhelms-Universitat Munster, Germany.
PUBLICATION TYPE: Clinical Trial; Journal Article; Randomized Controlled Trial
CONCLUSION: Compound A concentrations using 0.5 L min-1 fresh gas flow and a heated absorber were higher than previously published values using an inflow of 1 L min-1. Compound A exposure was similar to other clinical studies which did not show changes in renal and hepatic function.

ARTICLE TITLE: Management of difficult intubation.
ARTICLE SOURCE: Eur J Anaesthesiol (England), Jan 2001, 18(1) p3-12
AUTHOR(S): Janssens M; Hartstein G
AUTHOR'S ADDRESS: Department of Anesthesia and Intensive Care Medicine, Centre Hospitalier Universitaire, B-4000 Liege, Belgium.
PUBLICATION TYPE: Journal Article; Review; Review, Tutorial

ARTICLE TITLE: Ecstasy induced acute myocardial infarction
ARTICLE SOURCE: Heart (England), Jun 2001, 85(6) pE10
AUTHOR(S): Qasim A; Townend J; Davies MK
AUTHOR'S ADDRESS: Department of Cardiology, Queen Elizabeth Hospital, Edgbaston, Birmingham B29 6JD, UK.
PUBLICATION TYPE: Journal Article
ABSTRACT: A 23 year old man presented with a clinical history and ECG compatible with acute myocardial infarction, having taken a single tablet of ecstasy (3,4-methylenedioxymetamphetamine) 18 hours previously. He was treated with aspirin and thrombolytic therapy; however, cardiac catheterisation showed angiographically normal coronary arteries and left ventricular function. Sympathomimetic drugs are freely available and widely abused in Britain, but there is little evidence of the mechanisms or management of cardiac complications. In such cases the use of standard treatment for acute myocardial infarction is recommended with agents such as glyceryl trinitrate and phentolamine to reduce coronary artery spasm. Early coronary angiography may help to determine the relative contribution of spasm, thrombus, and underlying atherosclerotic disease.

ARTICLE TITLE: Poisoning with the recreational drug paramethoxyamphetamine ("death")
ARTICLE SOURCE: Med J Aust (Australia), May 7 2001, 174(9) p453-5
AUTHOR(S): Ling LH; Marchant C; Buckley NA; Prior M; Irvine RJ
AUTHOR'S ADDRESS: Department of Clinical and Experimental Pharmacology, Faculty of Medicine, University of Adelaide, SA.
PUBLICATION TYPE: Journal Article
CONCLUSIONS: At our hospital, PMA poisonings accounted for most of the severe reactions among people who believed they had taken ecstasy. Hypoglycaemia and hyperkalaemia may be specific to PMA poisoning. PMA toxicity should be suspected with severe or atypical reactions to "ecstasy", and confirmed by chromatographic urine drug screens.

ARTICLE TITLE: Outcomes following coronary artery bypass grafting and percutaneous transluminal coronary angioplasty in the stent era: a prospective study of all 9890 consecutive patients operated on in Scotland over a two year period
ARTICLE SOURCE: Heart (England), Jun 2001, 85(6) p662-6
AUTHOR(S): Pell JP; Walsh D; Norrie J; Berg G; Colquhoun AD; Davidson K; Eteiba H; Faichney A; Flapan A; Hogg KJ; Jeffrey RR; Jennings K; McArthur J; Mankad P; Oldroyd K; Pell AC; Starkey IR
AUTHOR'S ADDRESS: Department of Medical Cardiology, University of Glasgow, Glasgow, UK.
PUBLICATION TYPE: Journal Article
CONCLUSIONS: The severity of coronary heart disease was greater than in previously published registry studies and randomised trials. Despite this, overall survival figures were comparable and repeat revascularisation rates lower, particularly following percutaneous transluminal coronary angioplasty (PTCA). Perioperative death and urgent surgery following PTCA were also lower. These favourable outcomes may be attributable, in part, to increased use of bail out and elective stenting.

ARTICLE TITLE: An echocardiographic assessment of cardiac morphology and common ECG findings in teenage professional soccer players: reference ranges for use in screening
ARTICLE SOURCE: Heart (England), Jun 2001, 85(6) p649-54
AUTHOR(S): Somauroo JD; Pyatt JR; Jackson M; Perry RA; Ramsdale DR
AUTHOR'S ADDRESS: The Cardiothoracic Centre, Thomas Drive, Liverpool L14 3PE, UK.
PUBLICATION TYPE: Journal Article
ABSTRACT: OBJECTIVE: To assess physiological cardiac adaptation in adolescent professional soccer players. SUBJECTS CONCLUSIONS: Chamber dimensions, left ventricular wall thickness and mass, and aortic root size were all greater than predicted for controls after matching for age and surface area. Sinus bradycardia and the ECG criteria for left ventricular hypertrophy were common but there was poor correlation with echocardiographic left ventricular hypertrophy. The type of hypertrophy found reflected the combined endurance and strength based training undertaken.

ARTICLE TITLE: Non-cardiac surgery in the heart failure patient
ARTICLE SOURCE: Heart (England), May 2001, 85(5) p505-7
AUTHOR(S): Reginelli JP; Mills RM
AUTHOR'S ADDRESS: Department of Cardiology, The Cleveland Clinic Foundation, Cleveland, Ohio, USA.
PUBLICATION TYPE: Journal Article

ARTICLE TITLE: Three-dimensional computerized tomography angiography-guided surgery of acutely ruptured cerebral aneurysms
ARTICLE SOURCE: J Neurosurg (United States), May 2001, 94(5) p718-27
AUTHOR(S): Matsumoto M; Sato M; Nakano M; Endo Y; Watanabe Y; Sasaki T; Suzuki K; Kodama N
AUTHOR'S ADDRESS: Department of Neurosurgery, Fukushima Medical School, Japan. mat@cc.fmu.ac.jp.
PUBLICATION TYPE: Journal Article
CONCLUSIONS: The authors believe that using three-dimensional computerized tomography (3D-CT) angiography can replace conventional angiography in the diagnosis of ruptured aneurysms and that surgery can be performed in almost all acutely ruptured aneurysms by using only 3D-CT angiography without conventional angiography.

ARTICLE TITLE: Hypophosphatemia and hypomagnesemia induced by cooling in patients with severe head injury
ARTICLE SOURCE: J Neurosurg (United States), May 2001, 94(5) p697-705
AUTHOR(S): Polderman KH; Peerdeman SM; Girbes AR
AUTHOR'S ADDRESS: Surgical Intensive Care Unit, University Hospital Vrije Universiteit, Amsterdam, The Netherlands. k.polderman@tip.nl.
PUBLICATION TYPE: Journal Article
CONCLUSIONS: Induced hypothermia is associated with severe electrolyte depletion, which is at least partly due to increased urinary excretion through hypothermia-induced polyuria. This may be the mechanism through which induced hypothermia can lead to arrhythmias. When using this promising new treatment in patients with severe head injury, stroke, or postanoxic coma following cardiopulmonary resuscitation, prophylactic electrolyte supplementation should be considered and electrolyte levels should be monitored frequently.

ARTICLE TITLE: Cervical spinal motion during intubation: efficacy of stabilization maneuvers in the setting of complete segmental instability.
ARTICLE SOURCE: J Neurosurg (United States), Apr 2001, 94(2 Suppl) p265-70
AUTHOR(S): Lennarson PJ; Smith DW; Sawin PD; Todd MM; Sato Y; Traynelis VC
AUTHOR'S ADDRESS: Department of Anesthesia and Radiology, The University of Iowa Hospitals and Clinics, Iowa City 52242, USA.
PUBLICATION TYPE: Evaluation Studies; Journal Article
CONCLUSIONS: After complete C4-5 destabilization, the effects of attempted stabilization on distraction, angulation, and subluxation were analyzed. Immobilization effectively eliminated distraction, and diminished angulation, but increased subluxation. Traction significantly increased distraction, but decreased angular rotation and effectively eliminated subluxation. Orotracheal intubation without stabilization had intermediate results, causing less distraction than traction, less subluxation than immobilization, but increased angulation compared with either intervention. These results are discussed in terms of both statistical and clinical significance and recommendations are made.

ARTICLE TITLE: Endoscopic surgery with use of a laryngeal mask and a fiberoptic flexible bronchoscope
ARTICLE SOURCE: J Thorac Cardiovasc Surg (United States), Jun 2001, 121(6) p1196-7
AUTHOR(S): Okada S; Ishimori S; Sato M; Sato S; Sugawara H; Tanaba Y
AUTHOR'S ADDRESS: Department of Thoracic Surgery and Medicine, Kamaishi Municipal Hospital, Iwate, Japan.
PUBLICATION TYPE: Journal Article

ARTICLE TITLE: Cerebral injury during cardiopulmonary bypass: Emboli impair memory
ARTICLE SOURCE: J Thorac Cardiovasc Surg (United States), Jun 2001, 121(6) p1150-60
AUTHOR(S): Fearn SJ; Pole R; Wesnes K; Faragher EB; Hooper TL; McCollum CN
AUTHOR'S ADDRESS: Department of Surgery, South Manchester University Hospitals, Manchester, United Kingdom.
PUBLICATION TYPE: Journal Article
CONCLUSIONS: Cognitive deficits were common after cardiopulmonary bypass. Occult cerebrovascular disease was more severe than expected and predisposed to attention difficulties, whereas emboli caused memory deficits. We believe this to be the first report of differing cognitive effects from emboli and hypoperfusion.

ARTICLE TITLE: Coronary artery bypass grafting in non-dialysis-dependent mild-to-moderate renal dysfunction
ARTICLE SOURCE: J Thorac Cardiovasc Surg (United States), Jun 2001, 121(6) p1083-9
AUTHOR(S): Weerasinghe A; Hornick P; Smith P; Taylor K; Ratnatunga C
AUTHOR'S ADDRESS: Department of Cardiothoracic Surgery, Imperial College School of Medicine, University of London, Hammersmith Hospital, London, United Kingdom.
PUBLICATION TYPE: Journal Article
CONCLUSIONS: A mild elevation (130-149 &mgr; mol. L(-1)) in the preoperative serum creatinine level significantly increases the need for mechanical renal support, the duration of special care and total postoperative stay, and the in-hospital mortality. As the preoperative serum creatinine level increases further (>/=150 &mgr; mol. L(-1)), this effect is more pronounced. No significant difference in outcome was observed between the use of cardioplegia or crossclamp fibrillation for myocardial protection.

ARTICLE TITLE: Should screening for lung cancer be revisited?
ARTICLE SOURCE: J Thorac Cardiovasc Surg (United States), Jun 2001, 121(6) p1031-2
AUTHOR(S): Deslauriers J
AUTHOR'S ADDRESS: Centre de Pneumologie de l'Hopital Laval, Sainte-Foy, Quebec, Canada.
PUBLICATION TYPE: Journal Article

ARTICLE TITLE: Computer-enhanced "robotic" cardiac surgery: Experience in 148 patients
ARTICLE SOURCE: J Thorac Cardiovasc Surg (United States), May 2001, 121(5) p842-53
AUTHOR(S): Mohr FW; Falk V; Diegeler A; Walther T; Gummert JF; Bucerius J; Jacobs S; Autschbach R
AUTHOR'S ADDRESS: Department of Cardiac Surgery, Heart Center, University of Leipzig, Leipzig, Germany.
PUBLICATION TYPE: Journal Article
ABSTRACT: OBJECTIVE: A computer-enhanced instrumentation system was used in 148 patients to minimize access in CONCLUSION: In conclusion, computer-enhanced endoscopic cardiac surgery can be performed safely in selected patients. Internal thoracic artery takedown is now routinely performed with good results. Total endoscopic coronary bypass is feasible on the arrested heart but does not offer a major benefit over the minimally invasive direct approach because cardiopulmonary bypass is still required. The early clinical experience with closed-chest beating-heart bypass grafting outlines the limitations of this approach despite some procedural success.

ARTICLE TITLE: Enter the era of facilitated anastomotic devices for coronary bypass surgery
ARTICLE SOURCE: J Thorac Cardiovasc Surg (United States), May 2001, 121(5) p833-4
AUTHOR(S): Shennib H
AUTHOR'S ADDRESS: Department of Cardiothoracic Surgery, McGill University Health Center, Montreal, Quebec, Canada.
PUBLICATION TYPE: Journal Article

ARTICLE TITLE: Alkalosis induced by alpha-stat management: cause of neuronal injury after deep hypothermic perfusion.
ARTICLE SOURCE: J Thorac Cardiovasc Surg (United States), Apr 2001, 121(4) p817-8
AUTHOR(S): Miyamoto TA; Miyamoto KJ
PUBLICATION TYPE: Letter

ARTICLE TITLE: Neuropsychologic impairment after coronary bypass surgery: effect of gaseous microemboli during perfusionist interventions.
ARTICLE SOURCE: J Thorac Cardiovasc Surg (United States), Apr 2001, 121(4) p743-9
AUTHOR(S): Borger MA; Peniston CM; Weisel RD; Vasiliou M; Green RE; Feindel CM
AUTHOR'S ADDRESS: Division of Cardiovascular Surgery, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada.
PUBLICATION TYPE: Clinical Trial; Journal Article
CONCLUSIONS: Introduction of air into the cardiopulmonary bypass circuit by perfusionists, resulting in cerebral microembolization, may contribute to postoperative cognitive impairment.

ARTICLE TITLE: Postoperative atrial fibrillation: an old problem crying for new solutions.
COMMENTS: : J Thorac Cardiovasc Surg. 2001 Apr; 121(4):683-8/21176130
ARTICLE SOURCE: J Thorac Cardiovasc Surg (United States), Apr 2001, 121(4) p638-41
AUTHOR(S): Creswell LL; Damiano RJ
PUBLICATION TYPE: Comment; Editorial; Review; Review, Tutorial

ARTICLE TITLE: Congestive heart failure: treat the disease, not the symptom--return to normalcy.
ARTICLE SOURCE: J Thorac Cardiovasc Surg (United States), Apr 2001, 121(4) p628-37
AUTHOR(S): Buckberg GD
PUBLICATION TYPE: Editorial; Evaluation Studies; Review; Review, Tutorial

ARTICLE TITLE: Pre-registration house officer rotations incorporating general practice: does the order of rotation matter? ARTICLE SOURCE: Med Educ (England), Jun 2001, 35(6) p572-7
AUTHOR(S): Williams C; Cantillon P; Cochrane M
AUTHOR'S ADDRESS: Social Science Research Unit, University of London, London, UK; Department of Postgraduate Medical Education, Guy's, King's and St Thomas' School of Medicine, London, UK.
PUBLICATION TYPE: Journal Article
CONCLUSIONS: This small qualitative evaluation has highlighted a number of advantages and disadvantages specific to each rotation order, and makes some practical recommendations to help alleviate the problems encountered. It is important that future evaluations of similar schemes consider this issue, as there are conflicting reports about the significance of the rotation order.
MB: Presumably all possible orders will have to be experienced by some of the rotating interns

ARTICLE TITLE: Country report: Australia
ARTICLE SOURCE: Med Educ (England), May 2001, 35(5) p495-504
AUTHOR(S): Prideaux D; Saunders N; Schofield K; Wing L; Gordon J; Hays R; Worley P; Martin A; Paget N
AUTHOR'S ADDRESS: Office of Education, School of Medicine, Flinders University, GPO Box 2100, Adelaide, 5001, South Australia, Australia. David.Prideaux@flinders.edu.au.
PUBLICATION TYPE: Journal Article
ABSTRACT: The last 10 years has been an interesting time for Australian medical education despite reduced funding. WORKFORCE: There are five main workforce trends: a rural/urban maldistribution, a need for more specialists, public hospital staffing difficulties, increasing female practitioners and under-representation of indigenous practitioners. ISSUES FACING THE DEANS: Lack of resources is a problem facing Deans, with pressure for clinical service in teaching hospitals. Entrepreneurial activities have been undertaken including the enrollment of overseas students. Medical schools have also responded to important government initiatives. DEVELOPMENTS IN MEDICAL EDUCATION: Australia's 11 medical schools have undergone significant reform in the last decade. There is a mix of four (graduate), five and six year courses. AUSTRALIA'S NEW MEDICAL SCHOOL: James Cook University opened the first medical school in northern Australia in 2000. The School admits students from rural, northern Australian and indigenous backgrounds. It has a strong regional mission. RURAL AND COMMUNITY-BASED EDUCATION: Government funding to address the maldistribution of the workforce has led to the establishment of rural clubs, Departments of Rural Health and community-based programs. THE FIRST TWO POSTGRADUATE YEARS: There have been recent moves to improve education in the two years following graduation. This includes the initiation of national projects in curriculum and assessment. POSTGRADUATE AND CONTINUING MEDICAL EDUCATION: Postgraduate programs in Australia are being reformed to build on the changes in undergraduate education. CME is also under review. CONCLUSION: Australian medical educators should build on the recent reforms and take on some of the new directions in medical education.
MB: I can't think why.

ARTICLE TITLE: The attitudes of 'tomorrow's doctors' towards mental illness and psychiatry: changes during the final undergraduate year
ARTICLE SOURCE: Med Educ (England), Apr 2001, 35(4) p381-3
AUTHOR(S): Baxter H; Singh SP; Standen P; Duggan C
AUTHOR'S ADDRESS: Nottingham Healthcare NHS Trust, Nottingham, UK; University of Nottingham, Nottingham, UK; University of Leicester, Leicester, UK.
PUBLICATION TYPE: Journal Article
ABSTRACT: AIMS: To compare the efficacy of two teaching styles, didactic teaching and problem based learning, in producing enduring change in final-year medical students' attitudes towards psychiatry and mental illness. METHOD: A 1-year follow-up questionnaire survey of two groups of medical students taught psychiatry in their fourth-year training by two different methods. One-year follow-up scores were compared with pre-attachment and post-attachment scores in the fourth year. RESULTS: 70 (68%) students completed both questionnaires at follow-up. The follow-up scores were significantly lower compared with both the fourth-year pre-attachment and post-attachment scores, suggesting that the positive change in attitudes following psychiatric training in the fourth year significantly decayed during the final year. The two teaching methods did not differ in the magnitude of this reduction. CONCLUSIONS: The positive change that occurs in medical students' attitude towards psychiatry, psychiatrists and mental illness after their fourth-year psychiatric training is transient and decays over the final year.
MB: I am sure that students discerned what answers they were expected to give.

ARTICLE TITLE: Loss of British-trained doctors from the medical workforce in Great Britain
ARTICLE SOURCE: Med Educ (England), Apr 2001, 35(4) p337-44
AUTHOR(S): Goldacre MJ; Lambert TW; Davidson JM
AUTHOR'S ADDRESS: UK Medical Careers Research Group, Unit of Health-Care Epidemiology, University of Oxford, Oxford OX3 7LF, UK.
PUBLICATION TYPE: Journal Article
CONCLUSIONS: Medical workforce planning in Great Britain should assume that 15-20% of home-trained doctors will not be working in the NHS within a few years of graduation. Comparing cohorts at the same career stage showed no evidence of increased loss from the NHS in recent times. Although a higher percentage of women than men were not working in medicine at all, recent trends suggest that this percentage is falling.

ARTICLE TITLE: Guidelines for management of patients with chronic heart failure in Australia
ARTICLE SOURCE: Med J Aust (Australia), May 7 2001, 174(9) p459-66
AUTHOR(S): Krum H
AUTHOR'S ADDRESS: Department of Epidemiology and Preventive Medicine, Monash University, Alfred Hospital, Melbourne, VIC. henry.krum@med.monash.edu.au; Collective Name: National Heart Foundation of Australia and Cardiac Society of Australia & New Zealand Chronic Heart Failure Clinical Practice Guidelines Writing Panel.
PUBLICATION TYPE: Journal Article
ABSTRACT: Chronic heart failure (CHF) affects approximately 1% of people aged 50-59 years, and this high prevalence increases dramatically with age. CHF is a common reason for hospital admission and general practitioner consultation in the elderly. Common causes of CHF are ischaemic heart disease, hypertension and idiopathic dilated cardiomyopathy. Diagnosis of CHF is based on clinical features and objective measurement of ventricular function (eg, echocardiography). Management is directed at prevention, retarding disease progression, relief of symptoms and prolonging survival. Non-pharmacological approaches include exercise, home-based support and risk-factor modification. Angiotensin-converting enzyme (ACE) inhibitors are the cornerstone of pharmacological therapy to prevent disease progression and prolong survival. beta-Blockers prolong survival when added to ACE inhibitors in symptomatic patients. Diuretics provide symptom relief and restoration or maintenance of euvolaemia. Spironolactone, angiotensin II receptor antagonists and digoxin may be useful in some patients. Surgical approaches in highly selected patients may include myocardial revascularisation, insertion of devices and cardiac transplantation.

ARTICLE TITLE: Compliance with clinical guidelines for blood transfusion practice: how can changes be maintained
ARTICLE SOURCE: Med J Aust (Australia), May 7 2001, 174(9) p435
AUTHOR(S): McGrath KM; Hancock L; Foster KM
PUBLICATION TYPE: Editorial

ARTICLE TITLE: Heart failure in older people: the epidemic we had to have
ARTICLE SOURCE: Med J Aust (Australia), May 7 2001, 174(9) p432-3
AUTHOR(S): Horowitz JD; Stewart S
PUBLICATION TYPE: Editorial

ARTICLE TITLE: Part-time specialty training--my experience.
COMMENTS: : Med J Aust. 2001 Apr 16; 174(8):376-7/21243441
ARTICLE SOURCE: Med J Aust (Australia), Apr 16 2001, 174(8) p410-2
AUTHOR(S): Gun MT
AUTHOR'S ADDRESS: Department of Radiology, North Western Adelaide Health Service, The Queen Elizabeth Hospital Campus, Adelaide, SA. olmtosti@chariot.net.au.
PUBLICATION TYPE: Journal Article

ARTICLE TITLE: Physician-assisted suicide in Oregon: why so few occurrences?
ARTICLE SOURCE: Med J Aust (Australia), Apr 2 2001, 174(7) p353-4
AUTHOR(S): Wineberg H
AUTHOR'S ADDRESS: winebergh@hotmail.com.
PUBLICATION TYPE: Journal Article
ABSTRACT: In the first three years that physician-assisted suicide (PAS) has been legal in Oregon, about two persons per month have taken medication to end their life. Most physicians are unwilling to prescribe the lethal medication. Because many terminally ill people are confined to their bed or home, the difficulty of finding a willing physician may have resulted in many abandoning the idea of using PAS. People living a long way from a large urban centre may be severely disadvantaged in their ability to obtain medication to end their lives.
MB: Maybe no body wanted the service.

ARTICLE TITLE: Physician-assisted suicide: experience and controversy
ARTICLE SOURCE: Med J Aust (Australia), Apr 2 2001, 174(7) p325-6
AUTHOR(S): Campbell DA
PUBLICATION TYPE: Editorial

ARTICLE TITLE: Should doctors wear white coats?
ARTICLE SOURCE: Med J Aust (Australia), Apr 2 2001, 174(7) p343-4
AUTHOR(S): Harnett PR
AUTHOR'S ADDRESS: Department of Medical Oncology and Palliative Care, Westmead Hospital, Sydney, NSW. harnettpr@westgate.wh.usyd.edu.au.
PUBLICATION TYPE: Journal Article
ABSTRACT: The wearing of white coats by hospital doctors is becoming a rarity, making it difficult for patients to identify doctors from other hospital staff. I asked patients with cancer whether they thought that doctors, both junior and senior, should wear white coats. Only a minority disapproved.
MB: Not just the patients.

ARTICLE TITLE: White coats and the medical profession
ARTICLE SOURCE: Med J Aust (Australia), Apr 2 2001, 174(7) p324-5
AUTHOR(S): Van Der Weyden MB
PUBLICATION TYPE: Editorial

ARTICLE TITLE: Antibiotics for community-acquired pneumonia: time to return to the straight and narrow?
ARTICLE SOURCE: Med J Aust (Australia), Apr 2 2001, 174(7) p321-2
AUTHOR(S): Andresen DN; Collignon PJ
PUBLICATION TYPE: Editorial

ARTICLE TITLE: Evidence-based medicine: how good is the evidence?
ARTICLE SOURCE: Med J Aust (Australia), Mar 19 2001, 174(6) p293-5
AUTHOR(S): Celermajer DS
AUTHOR'S ADDRESS: Department of Cardiology, Royal Prince Alfred Hospital, University of Sydney, NSW. davidc@card.rpa.cs.new.gov.au.
PUBLICATION TYPE: Journal Article
ABSTRACT: The "evidence" in EBM must be of high quality in order to be useful, but this is not always the case. Even the "gold standard" of evidence-based medicine, the randomised clinical trial, is bedevilled by low inclusion rates and potentially important recruitment biases. "Real world" trials often do not give the same results as these highly artificial controlled clinical studies. Meta-analysis, the next most important level of evidence in EBM, may be unreliable, sometimes giving different results to subsequent large randomised trials. There is a bias in the hypotheses tested in large clinical trials, as the costs involved are usually covered by commercially interested companies. For this reason, trials of non-patentable compounds or therapies of no commercial interest may not be performed. The process of journal review and publication is capricious, slow and may have a selection bias towards positive studies, meaning that communication channels for the "evidence" are often unsatisfactory. For many rarer conditions and situations, there is simply no "high level" evidence, such as in paediatrics and subspecialty surgery.
MB: Brilliant.

ARTICLE TITLE: A randomized comparison of helium-oxygen mixture (heliox) and racemic epinephrine for the treatment of moderate to severe croup
ARTICLE SOURCE: Pediatrics (United States), Jun 2001, 107(6) pE96
AUTHOR(S): Weber JE; Chudnofsky CR; Younger JG; Larkin GL; Boczar M; Wilkerson MD; Zuriekat GY; Nolan B; Eicke DM
AUTHOR'S ADDRESS: Hurley Medical Center, Flint, Michigan.
Conclusion. In patients with moderate to severe croup, the administration of a helium-oxygen mixture (Heliox) resulted in similar improvements in croup scores (CSs) compared with patients given racemic epinephrine (RE).

ARTICLE TITLE: Resuscitation with room air instead of 100% oxygen prevents oxidative stress in moderately asphyxiated term neonates
ARTICLE SOURCE: Pediatrics (United States), Apr 2001, 107(4) p642-7
AUTHOR(S): Vento M; Asensi M; Sastre J; Garcia-Sala F; Pallard FV; Vina J
AUTHOR'S ADDRESS: Servicio de Pediatria, Hospital Virgen del Consuelo, Valencia, Spain.
PUBLICATION TYPE: Journal Article
Conclusions. There are no apparent clinical disadvantages in using room air for ventilation of asphyxiated neonates rather than 100% oxygen. Furthermore, RAR infants recover more quickly as assessed by Apgar scores, time to the first cry, and the sustained pattern of respiration. In addition, neonates resuscitated with 100% oxygen exhibit biochemical findings reflecting prolonged oxidative stress present even after 4 weeks of postnatal life, which do not appear in the RAR group. Thus, the current accepted recommendations for using 100% oxygen in the resuscitation of asphyxiated newborn infants should be further discussed and investigated.

ARTICLE TITLE: Multicenter, randomized, double-blind clinical trial to evaluate the efficacy and safety of a reduced osmolarity oral rehydration salts solution in children with acute watery diarrhea
ARTICLE SOURCE: Pediatrics (United States), Apr 2001, 107(4) p613-8
AUTHOR'S ADDRESS: Collective Name: CHOICE Study Group.
PUBLICATION TYPE: Journal Article
CONCLUSIONS: Treatment with reduced osmolarity oral rehydration salts (ORS) solution was associated with a 33% reduction in the need for unscheduled intravenous therapy and had no apparent effect on stool output and illness duration when compared with treatment with the standard standard World Health Organization (WHO) ORS solution solution. Children with acute diarrhea, therefore, may benefit from a reduced osmolarity ORS solution. The results of trials that examine the efficacy and safety of reduced osmolarity ORS solution in adult patients with cholera have to be taken into consideration before consensus on composition of oral rehydration formulation can be reached.

ARTICLE TITLE: Total intravenous versus inhalational anaesthesia for colonoscopy: a prospective study of clinical recovery and psychomotor function
ARTICLE SOURCE: Anaesth Intensive Care (Australia), Apr 2001, 29(2) p124-36
AUTHOR(S): Theodorou T; Hales P; Gillespie P; Robertson B
AUTHOR'S ADDRESS: Department of Anaesthesia, Westmead Hospital, Sydney, New South Wales.
PUBLICATION TYPE: Journal Article
CONCLUSIONS: It is concluded that a sevoflurane/nitrous oxide anaesthetic has a suitable recovery profile for ambulatory colonoscopy and results in faster recovery of cognitive function compared with a fentanyl, midazolam and propofol combination.

ARTICLE TITLE: Early intravenous anaesthesia
ARTICLE SOURCE: Anaesth Intensive Care (Australia), Feb 2001, 29(1) p3
AUTHOR(S): Ball C; Westhorpe R
AUTHOR'S ADDRESS: Geoffrey Kaye Museum of Anaesthetic History.
PUBLICATION TYPE: Journal Article

ARTICLE TITLE: Editorial I: Conflicts of interest: are they a problem for anaesthesia journals? What should we do about them?
AUTHOR(S): J.Robert Sneyd
ARTICLE SOURCE: Br. J. Anaesth. 2000 85: 811-814.
MB: The BJA seems to think that revealing a conflict absolves the author and the peer review process of responsibility for misleading bias. They state that the reader has to be critical. That is an overwhelming task for the individual reader.

ARTICLE TITLE: Paradoxical changes in bispectral index during nitrous oxide administration
AUTHOR(S): G. D. Puri
AUTHOR'S ADDRESS: Department of Anesthesiology, Postgraduate Institute of Medical Education and Research,Chandigarh, India 160012
ABSTRACT: I report two patients undergoing open heart surgery, with nitrous oxide and isoflurane anaesthesia, for whom bispectral index (BIS) monitoring showed high BIS values with nitrous oxide and isoflurane anaesthesia. The BIS decreasedimmediately after nitrous oxide was stopped and increased again after nitrous oxide was restarted.
ARTICLE SOURCE: Br J Anaesth 2001; 86: 141-2
MB: When are we going to stop blindly believing the claims for this device.

ARTICLE TITLE: Editorial I: Peri-operative ß-blockade: a useful treatment that should be greeted with cautious enthusiasm
AUTHOR(S): S. J. Howell, J. W. Sear, and P. Foex
ARTICLE SOURCE: Br. J. Anaesth. 2001 86: 161-164

ARTICLE TITLE: Editorial II: Is peri-operative renal dysfunction of no consequence?
AUTHOR(S): M. L. Cittanova
ARTICLE SOURCE: Br. J. Anaesth. 2001 86: 164-166

ARTICLE TITLE: Editorial III: A breakthrough in the genetic diagnosis of malignant hyperthermia
AUTHOR(S): R. L. Robinson and P. M. Hopkins
ARTICLE SOURCE: ARTICLE SOURCE: Br. J. Anaesth. 2001 86: 166-168

ARTICLE TITLE: Editorial I: Right heart catheterization in intensive care
AUTHOR(S): J.D. Young
ARTICLE SOURCE: Br. J. Anaesth. 2001 86: 327-329

ARTICLE TITLE: Biphasic EEG changes in relation to loss of consciousness during induction with thiopental, propofol, etomidate, midazolam or sevoflurane
AUTHOR(S): K. Kuizenga1, J. M. K. H. Wierda1 and C. J. Kalkman2
AUTHOR'S ADDRESS: 1Department of Anesthesiology, University Hospital of Groningen, PO Box 30.001, 9700 RB Groningen, The Netherlands. 2Department of Anesthesiology, University Medical Centre Utrecht, Heidelberglaan 100, PO Box 85500, 3508 GA Utrecht, The Netherlands
ABSTRACT: The time course of four EEG effect variables, amplitude in the 2-5 Hz and in the 11-15 Hz band, spectral edge frequency 95% (SEF95), and bispectral index (BIS), in response to increasing concentrations of thiopental, propofol, etomidate, midazolam, or sevoflurane during a 10 min induction of anaesthesia was studied in 25 patients to determine the existence of a biphasic effect and to study the relationship of the EEG effect to the moment of loss of consciousness. A biphasic effect, that is, an initial increase of the effect variable followed by a decrease at higher concentrations, during the transition from consciousness to unconsciousness was found in EEG amplitude (both frequency bands) and in SEF95 for all anaesthetics except midazolam. There was a concentration-related decrease in BIS for all anaesthetics. There was no consistent relationship between the time of occurrence of the peak EEG effect, or the value of the EEG variable and the moment of loss of consciousness. With rapidly changing drug concentrations during the induction of anaesthesia, none of these EEG effect variables could be correlated to the moment of loss of consciousness.
ARTICLE SOURCE: Br J Anaesth 2001; 86: 354-60
MB: Good.

ARTICLE TITLE: Analysis of the French health ministry's national register of incidents involving medical devices in anaesthesia and intensive care
AUTHOR(S): L. Beydon, F. Conreux, R. Le Gall, D. Safran, and J. B. Cazalaa
ARTICLE SOURCE: Br. J. Anaesth. 2001 86: 382-387
ABSTRACT: This review was undertaken to discover what assessment instruments have been used as measures of performance during anaesthesia simulation and whether their validity and reliability has been established. The literature describing the assessment of performance during simulated anaesthesia amounted to 13 reports published between 1980 and 2000. Only four of these were designed to investigate the validity or reliability of the assessment systems. We conclude that the efficacy of methodologies for assessment of performance during simulation is largely undetermined. The introduction of simulator-based tests for certification or re-certification of anaesthetists would be premature.
MB: Good

ARTICLE TITLE: Editorial II: Continuous cardiac output by pulse contour analysis?
AUTHOR(S): J.J. van Lieshout and K.H. Wesseling
ARTICLE SOURCE: Br. J. Anaesth. 2001 86: 467-468.

ARTICLE TITLE: Effects of fentanyl, alfentanil, remifentanil and sufentanil on loss of consciousness and bispectral index during propofol induction of anaesthesia
AUTHOR(S): C. Lysakowski, L. Dumont, M. Pellégrini, F. Clergue and E. Tassonyi
AUTHOR'S ADDRESS: Division of Anaesthesiology, Geneva University Hospitals, CH-1211 Geneva 14, Switzerland
ABSTRACT: The relationship between propofol effect-site concentration and BIS was preserved with or without opioids. In the presence of an opioid, LOC occurred at a lower effect-site concentration of propofol and at a higher BIS50 (i.e. the BIS value associated with 50% probability of LOC),compared with placebo. Although clinically the hypnotic effect of propofol is enhanced by analgesic concentrations of mu-agonist opioids, the BIS does not show this increased hypnotic effect.
ARTICLE SOURCE: Br J Anaesth 2001; 86: 523-7
MB: Good!

ARTICLE TITLE: Uptake of isoflurane during prolonged clinical anaesthesia
AUTHOR(S): S. K. Pal*,1, G. G. Lockwood2 and D. C. White3
AUTHOR'S ADDRESS: 1St Andrew's Centre for Plastic Surgery and Burns, Broomfield Hospital, Chelmsford, Essex CM1 7ET, UK. 2Department of Anaesthesia,
Imperial College School of Medicine, London, UK. 3Department of Anaesthesia, Northwick Park Hospital, London, UK*Corresponding author
ABSTRACT: Recent evidence has suggested that the rate of uptake of inhalational anaesthetic is constant during maintenance of anaesthesia, contrary to the predictions of multi-compartment uptake models<snip>. These data do not support the notion that isoflurane uptake is constant during stable maintenance of anaesthesia but is compatible with the conventional multi-compartment model of anaesthetic uptake and distribution.
ARTICLE SOURCE: Br J Anaesth 2001; 86: 645-9

ARTICLE TITLE: Rocuronium: high risk for anaphylaxis?
AUTHOR(S): M. Rose1 and M. Fisher1,2
AUTHOR'S ADDRESS: 1Royal North Shore Hospital of Sydney, St Leonards, NSW, Australia. 2Department of Anaesthesia, University of Sydney, Sydney, Australia*Corresponding author: Intensive Therapy Unit, Royal North Shore Hospital, Pacific Highway, St Leonards, NSW 2065, Australia.
ABSTRACT: The incidence of rocuronium allergy in New South Wales, Australia has risen in parallel with sales, while there has been an associated fall in reactions to other neuromuscular blocking drugs. Data from intradermal testing suggested that rocuronium is intermediate in its propensity to cause allergy in known relaxant reactors compared with low-risk agents (e.g. pancuronium, vecuronium) and higher-risk agents (e.g. alcuronium, succinylcholine).
ARTICLE SOURCE: Br J Anaesth 2001; 86: 678-82

ARTICLE TITLE: Editorial III: Is it safe to artificially ventilate a paralysed patient through the laryngeal mask? The jury is still out
AUTHOR(S): G. Sidaras and J. M. Hunter
ARTICLE SOURCE: Br. J. Anaesth. 2001 86: 749-753.
MB: If you reason the LMA is no different from a face mask for safety. If you use evidence you have to wait till the disasters mount up. As endtracheal intubation is alright I will settle for reason.

ARTICLE TITLE: Editorial: Advances in pain
AUTHOR(S): D.J. Rowbotham
ARTICLE SOURCE: Br. J. Anaesth. 2001 87: 1-2.
MB: The July 2001 BJA is all about pain.

ARTICLE TITLE: Editorial III: BJA Concise - a step too far
AUTHOR(S): Graham Smith
ARTICLE SOURCE: Br. J. Anaesth. 2001 87: 185.
MB: It was a disaster. I am not surprised. They must be defective communicators.

ARTICLE TITLE: A comparison of cardiac output derived from the arterial pressure wave against thermodilution in cardiac surgery patients .
AUTHOR(S): J. R. C. Jansen1, J. J. Schreuder2, J. P. Mulier3, N. T. Smith4, J. J. Settels5 and K. H. Wesseling5
AUTHOR'S ADDRESS: 1Department of Intensive Care, Leiden University Medical Centre, The Netherlands
ABSTRACT: Before calibration, the model cannot replace thermodilution, but after calibration the model method can quantitatively replace further thermodilution estimates.
ARTICLE SOURCE: Br J Anaesth 2001; 87: 212-22

ARTICLE TITLE: Influence of nitrous oxide on induction of anaesthesia with sevoflurane
AUTHOR(S): H. O'Shea, S. Moultrie and G. B. Drummond
AUTHOR'S ADDRESS: Department of Anaesthetics, Critical Care, and Pain Medicine, Royal Infirmary, Edinburgh EH3 9YW, UK
ARTICLE SOURCE: Br J Anaesth 2000; 85: 156P.
ABSTRACT: We studied 64 female patients, randomly allocated to receive inhalation induction of anaesthesia using sevoflurane with or without 50% nitrous oxide in the fresh gas, using a co-axial breathing system (Mapleson D) and a fresh gas flow rate of 3-6 litre min-1. Mean time to induction of anaesthesia (fall of an outstretched arm) was 102 s in both groups, but excitation (limb or head movement) was more frequent in those receiving nitrous oxide (10 patients) than in those receiving oxygen only (five patients) (P<0.05). Oxygenation was similar in both groups. We conclude that nitrous oxide confers no advantage when anaesthesia is induced with sevoflurane in this way.