ARTICLE TITLE: Efficient management of randomised controlled
trials: nature or nurture.
ARTICLE SOURCE: BMJ (England), Oct 31 1998, 317(7167) p1236-9
AUTHOR(S): Farrell B
AUTHOR'S ADDRESS: Institute of Health Sciences, Oxford OX3 7LF.
Barbara.Farrell@ndm.ox.ac.uk.
PUBLICATION TYPE: JOURNAL ARTICLE; REVIEW (3 references); REVIEW,
TUTORIAL
ARTICLE TITLE: Trials: the next 50 years. Large scale randomised
evidence of moderate benefits [editorial]
ARTICLE SOURCE: BMJ (England), Oct 31 1998, 317(7167) p1170-1
AUTHOR(S): Peto R; Baigent C ]
PUBLICATION TYPE: EDITORIAL
ARTICLE TITLE: Unbiased, relevant, and reliable assessments in
health care: important progress during the past century, but plenty
of scope for doing better [editorial]
ARTICLE SOURCE: BMJ (England), Oct 31 1998, 317(7167) p1167-8
AUTHOR(S): Chalmers I
PUBLICATION TYPE: EDITORIAL
ARTICLE TITLE: Understanding controlled trials: what outcomes
should be measured?
ARTICLE SOURCE: BMJ (England), Oct 17 1998, 317(7165) p1075
AUTHOR(S): Roland M; Torgerson D
AUTHOR'S ADDRESS: National Primary Care Research and Development
Centre, University of Manchester, Manchester M13 6PL.
PUBLICATION TYPE: JOURNAL ARTICLE; REVIEW (10 references); REVIEW,
TUTORIAL
MB There were several other articlaes on trials surrounding these
4.
ARTICLE TITLE: ABC of oxygen: assessing and interpreting arterial
blood gases and acid-base balance.
ARTICLE SOURCE: BMJ (England), Oct 31 1998, 317(7167) p1213-6
AUTHOR(S): Williams AJ
AUTHOR'S ADDRESS: Lane-Fox Respiratory Unit, St. Thomas's Hospital,
London, UK.
Insufficiency [blood] [etiology]
INDEXING CHECK TAG(S): Human
PUBLICATION TYPE: JOURNAL ARTICLE; REVIEW (0 references); REVIEW,
TUTORIAL
ARTICLE TITLE: Being a modern pharmaceutical company: involves
making information available on clinical trial programmes
[editorial]
ARTICLE SOURCE: BMJ (England), Oct 31 1998, 317(7167) p1172
AUTHOR(S): Sykes R
PUBLICATION TYPE: EDITORIAL
ARTICLE TITLE: Ovarian ablation in breast cancer, 1896 to 1998:
milestones along hierarchy of evidence from case report to Cochrane
review.
ARTICLE SOURCE: BMJ (England), Oct 31 1998, 317(7167) p1246-8
AUTHOR(S): Clarke MJ
AUTHOR'S ADDRESS: Clinical Trial Service Unit, Radcliffe Infirmary,
Oxford OX2 6HE. mike.clarke@ctsu.ox.ac.uk.
PUBLICATION TYPE: HISTORICAL ARTICLE; JOURNAL ARTICLE
ARTICLE TITLE: The Wisheart affair: paediatric cardiological
services in Bristol, 1990-5.
ARTICLE SOURCE: BMJ (England), Oct 24 1998, 317(7166) p1144-5
AUTHOR(S): Dunn PM
AUTHOR'S ADDRESS: University of Bristol, Southmead Hospital, Bristol
BS10 5NB.
PUBLICATION TYPE: JOURNAL ARTICLE
ARTICLE TITLE: Regulation of doctors and the Bristol inquiry. Both
need to be credible to both the public and doctors [editorial;
comment]
COMMENTS: Comment on: BMJ 1998 Dec 5; 317(7172):1577-9; Comment on:
BMJ 1998 Dec 5; 317(7172):1579-80; Comment on: BMJ 1998 Dec 5;
317(7172):1581-2
ARTICLE SOURCE: BMJ (England), Dec 5 1998, 317(7172) p1539-40
AUTHOR(S): Smith R
PUBLICATION TYPE: COMMENT; EDITORIAL
ARTICLE TITLE: The Wisheart affair: responses to Dunn [see
comments]
COMMENTS: Comment in: BMJ 1998 Dec 5; 317(7172):1539-40
ARTICLE SOURCE: BMJ (England), Dec 5 1998, 317(7172) p1579-80
AUTHOR(S): Bolsin SN
AUTHOR'S ADDRESS: Department of Perioperative Medicine, PO Box 281,
Geelong, Victoria 3220, Australia.
PUBLICATION TYPE: JOURNAL ARTICLE
ARTICLE TITLE: Bristol doctor refused access to confidential GMC
notes [news]
ARTICLE SOURCE: BMJ (England), Feb 6 1999, 318(7180) p348
AUTHOR(S): Dyer C
PUBLICATION TYPE: NEWS
ARTICLE TITLE: Bristol parents protest over removal of hearts
[news]
ARTICLE SOURCE: BMJ (England), Feb 20 1999, 318(7182) p486
AUTHOR(S): Dobson R
PUBLICATION TYPE: NEWS
ARTICLE TITLE: Bristol again: (very) short service on the Bristol
inquiry [see comments]
COMMENTS: Comment in: BMJ 1998 Dec 5; 317(7172):1539-40
ARTICLE SOURCE: BMJ (England), Dec 5 1998, 317(7172) p1577-9
AUTHOR(S): Barnes N
AUTHOR'S ADDRESS: Addenbrooke's Hospital, Cambridge CB2 2QQ, UK.
PUBLICATION TYPE: JOURNAL ARTICLE
ARTICLE TITLE: Bristol inquiry opens [news]
ARTICLE SOURCE: BMJ (England), Mar 20 1999, 318(7186) p754
AUTHOR(S): Dobson R
PUBLICATION TYPE: NEWS
ARTICLE TITLE: Hyperbaric oxygen therapy.
ARTICLE SOURCE: BMJ (England), Oct 24 1998, 317(7166) p1140-3
AUTHOR(S): Leach RM; Rees PJ; Wilmshurst P
PUBLICATION TYPE: JOURNAL ARTICLE; REVIEW (0 references); REVIEW,
TUTORIAL
ARTICLE TITLE: Magic bullet for obesity.
ARTICLE SOURCE: BMJ (England), Oct 24 1998, 317(7166) p1136-8
AUTHOR(S): Hirsch J
AUTHOR'S ADDRESS: Rockefeller University, New York, NY 10021-6399
USA. Hirsch@raockvax.rockefeller.edu.
PUBLICATION TYPE: JOURNAL ARTICLE; REVIEW (8 references); REVIEW,
TUTORIAL
ARTICLE TITLE: Preventing ischaemic heart disease in one general
practice: from one patient, through clinical audit, needs assessment,
and commissioning into quality improvement [see comments]
COMMENTS: Comment in: BMJ 1998 Oct 24; 317(7166):1093-4
ARTICLE SOURCE: BMJ (England), Oct 24 1998, 317(7166) p1120-3;
discussion 1124
AUTHOR(S): Pringle M
AUTHOR'S ADDRESS: Medical Centre, Collingham, Newark,
Nottinghamshire. mike.pringle@nottingham.ac.uk.
PUBLICATION TYPE: JOURNAL ARTICLE; REVIEW (31 references); REVIEW,
TUTORIAL
ARTICLE TITLE: Assessing heart disease risk in primary care.
Cholesterol lowering should be just one part of a multiple risk
factor intervention [editorial; comment]
COMMENTS: Comment on: BMJ 1998 Oct 24; 317(7166):1120-3; discussion
1124
ARTICLE SOURCE: BMJ (England), Oct 24 1998, 317(7166) p1093-4
AUTHOR(S): Fahey T
PUBLICATION TYPE: COMMENT; EDITORIAL
ARTICLE TITLE: Comparison of potency of inhaled beclomethasone and
budesonide in New Zealand: retrospective study of computerised
general practice records.
ARTICLE SOURCE: BMJ (England), Oct 10 1998, 317(7164) p986-90
AUTHOR(S): Pethica BD; Penrose A; MacKenzie D; Hall J; Beasley R;
Tilyard M
AUTHOR'S ADDRESS: Wellington Asthma Research Group, Wellington School
of Medicine, University of Otago, Wellington, PO Box 7343, Wellington
South, New Zealand. WARG.Sec@wnmeds.ac.nz.
PUBLICATION TYPE: JOURNAL ARTICLE
CONCLUSIONS: In primary care in New Zealand evidence suggests that
budesonide is less potent than beclomethasone. Consideration of
validated, established, and other possible markers of asthma severity
did not support confounding by severity as a reason for the higher
prescribed doses of budesonide. Pending further epidemiological
evaluation, international asthma guidelines may need to be modified
on the equivalence of inhaled corticosteroid doses. Furthermore, the
comparative potency of newly developed inhaled steroids in clinical
trials will need to be confirmed in appropriately designed
epidemiological studies based in general practice.
ARTICLE TITLE: Should inhaled anticholinergics be added to beta2
agonists for treating acute childhood and adolescent asthma? A
systematic review.
ARTICLE SOURCE: BMJ (England), Oct 10 1998, 317(7164) p971-7
AUTHOR(S): Plotnick LH; Ducharme FM
AUTHOR'S ADDRESS: Division of Pediatric Emergency Medicine,
Department of Pediatrics, Montreal Children's Hospital, McGill
University, Montreal, Quebec H3H 1P3, Canada.
PUBLICATION TYPE: JOURNAL ARTICLE; REVIEW (40 references); REVIEW
LITERATURE
.CONCLUSIONS: Adding multiple doses of anticholinergics to beta2
agonists seems safe, improves lung function, and may avoid hospital
admission in 1 of 11 such treated patients. Although multiple doses
should be preferred to single doses of anticholinergics, the
available evidence only supports their use in school aged children
and adolescents with severe asthma exacerbation.
MB. If that is what they concluded after 40 papers one wonders.
ARTICLE TITLE: Repositioning self regulation. The influence of the
GMC may be leaking away [editorial]
ARTICLE SOURCE: BMJ (England), Oct 10 1998, 317(7164) p964
AUTHOR(S): Smith R
PUBLICATION TYPE: EDITORIAL
ARTICLE TITLE: Dying from heart failure: lessons from palliative
care. Many patients would benefit from palliative care at the end of
their lives [editorial]
ARTICLE SOURCE: BMJ (England), Oct 10 1998, 317(7164) p961-2
AUTHOR(S): Gibbs LM; Addington-Hall J; Gibbs JS
PUBLICATION TYPE: EDITORIAL
ARTICLE TITLE: Puzzling out priorities. Why we must acknowledge
that rationing is a political process [editorial]
ARTICLE SOURCE: BMJ (England), Oct 10 1998, 317(7164) p959-60
AUTHOR(S): Klein R
PUBLICATION TYPE: EDITORIAL
ARTICLE TITLE: Certifying fitness for corporal punishment.
ARTICLE SOURCE: BMJ (England), Oct 3 1998, 317(7163) p939-41
AUTHOR(S): Thorns A; Lloyd G; Szmukler G; Welsh J
AUTHOR'S ADDRESS: Trinity Hospice, London, UK.
PUBLICATION TYPE: JOURNAL ARTICLE
ARTICLE TITLE: Bullying in schools: self reported anxiety,
depression, and self esteem in secondary school children.
ARTICLE SOURCE: BMJ (England), Oct 3 1998, 317(7163) p924-5
AUTHOR(S): Salmon G; James A; Smith DM
AUTHOR'S ADDRESS: Highfield Adolescent Unit, Warneford Hospital,
Oxford OX3 7JX.
PUBLICATION TYPE: JOURNAL ARTICLE
ARTICLE TITLE: Is the FDA approving drugs too fast?. Probably
not--but drug recalls have sparked debate [editorial]
ARTICLE SOURCE: BMJ (England), Oct 3 1998, 317(7163) p899
AUTHOR(S): Kleinke JD; Gottlieb S
PUBLICATION TYPE: EDITORIAL
ARTICLE TITLE: Early discharge after surgery for breast cancer.
Might not be applicable to most patients [editorial;
comment]
COMMENTS: Comment on: BMJ 1998 Nov 7; 317(7168):1275-9
ARTICLE SOURCE: BMJ (England), Nov 7 1998, 317(7168) p1264-5
AUTHOR(S): Fallowfield L
PUBLICATION TYPE: COMMENT; EDITORIAL
ARTICLE TITLE: Randomised controlled trial of effects of early
discharge after surgery for breast cancer [see comments]
COMMENTS: Comment in: BMJ 1998 Nov 7; 317(7168):1264-5
ARTICLE SOURCE: BMJ (England), Nov 7 1998, 317(7168) p1275-9
AUTHOR(S): Bundred N; Maguire P; Reynolds J; Grimshaw J; Morris J;
Thomson L; Barr L; Baildam A
AUTHOR'S ADDRESS: Department of Surgery, Christie Hospital NHS Trust,
Manchester M20 4BX. bundredn@fs1.with.man.ac.uk.
PUBLICATION TYPE: CLINICAL TRIAL; JOURNAL ARTICLE; RANDOMIZED
CONTROLLED TRIAL
CONCLUSIONS: Increased rates of physical or psychological illness did
not result from early discharge after surgery for breast cancer. This
policy can be recommended for patients with support at home.
ARTICLE TITLE: Effectiveness of corticosteroid injections versus
physiotherapy for treatment of painful stiff shoulder in primary
care: randomised trial.
ARTICLE SOURCE: BMJ (England), Nov 7 1998, 317(7168) p1292-6
AUTHOR(S): van der Windt DA; Koes BW; Deville W; Boeke AJP; de Jong
BA; Bouter LM
AUTHOR'S ADDRESS: Institute for Research in Extramural Medicine,
Faculty of Medicine, Vrije Universiteit, Van der Boechorststraat 7,
1081 BT Amsterdam, Netherlands.
dawm.van_der_windt.emgo@med.vu.nl.
PUBLICATION TYPE: CLINICAL TRIAL; JOURNAL ARTICLE; RANDOMIZED
CONTROLLED TRIAL
CONCLUSIONS: The beneficial effects of corticosteroid injections
administered by general practitioners for treatment of painful stiff
shoulder are superior to those of physiotherapy. The differences
between the intervention groups were mainly the result of the
comparatively faster relief of symptoms that occurred in patients
treated with injections. Adverse reactions were generally mild but
doctors should be aware of the potential side effects of injections
of triamcinolone, particularly in women.
ARTICLE TITLE: Theories of consent.
ARTICLE SOURCE: BMJ (England), Nov 7 1998, 317(7168) p1313-5
AUTHOR(S): Alderson P; Goodey C
AUTHOR'S ADDRESS: Social Science Research Unit, Institute of
Education, University of London, London WC1H ONS.
PUBLICATION TYPE: JOURNAL ARTICLE; REVIEW (18 references); REVIEW,
TUTORIAL
ARTICLE TITLE: Height, early energy intake, and cancer. Evidence
mounts for the relation of energy intake to adult malignancies
[editorial; comment]
COMMENTS: Comment on: BMJ 1998 Nov 14; 317(7169):1350-1; Comment on:
BMJ 1998 Nov 14; 317(7169):1351-2
ARTICLE SOURCE: BMJ (England), Nov 14 1998, 317(7169) p1331-2
AUTHOR(S): Albanes D
PUBLICATION TYPE: COMMENT; EDITORIAL
ARTICLE TITLE: Counting the dead in China. Measuring tobacco's
impact in the developing world [editorial; comment]
COMMENTS: Comment on: BMJ 1998 Nov 21; 317(7170):1411-22; Comment on:
BMJ 1998 Nov 21; 317(7170):1423-4
ARTICLE SOURCE: BMJ (England), Nov 21 1998, 317(7170) p1399-400
AUTHOR(S): Lopez AD
PUBLICATION TYPE: COMMENT; EDITORIAL
ARTICLE TITLE: Safer non-cardiac surgery for patients with
coronary artery disease. Medical treatment should be optimised to
improve outcome. [editorial]
ARTICLE SOURCE: BMJ (England), Nov 21 1998, 317(7170) p1400-1
AUTHOR(S): Sonksen J; Gray R; Hickman PH
PUBLICATION TYPE: EDITORIAL
ARTICLE TITLE: The "professional cleansing" of nurses. The
systematic downgrading of nurses damages patient care
[editorial]
ARTICLE SOURCE: BMJ (England), Nov 21 1998, 317(7170) p1403-4
AUTHOR(S): McKenna H
PUBLICATION TYPE: EDITORIAL
MB. They have replaced a lot of trained nurses with untrainned people
in the UK. Now they can't get trainned nurses.
ARTICLE TITLE: Recent advances: control of chronic pain.
ARTICLE SOURCE: BMJ (England), Nov 21 1998, 317(7170) p1438-41
AUTHOR(S): Nurmikko TJ; Nash TP; Wiles JR
AUTHOR'S ADDRESS: Walton Centre for Neurology and Neurosurgery NHS
Trust, Liverpool L9 1AE, UK.
PUBLICATION TYPE: JOURNAL ARTICLE; REVIEW (40 references); REVIEW,
TUTORIAL
ARTICLE TITLE: Carotid endarterectomy for asymptomatic carotid
stenosis. Better data, but the case is still not convincing
[editorial; comment]
COMMENTS: Comment on: BMJ 1998 Nov 28; 317(7171):1477-80
ARTICLE SOURCE: BMJ (England), Nov 28 1998, 317(7171) p1468
AUTHOR(S): Warlow C
PUBLICATION TYPE: COMMENT; EDITORIAL
ARTICLE TITLE: Carotid endarterectomy for asymptomatic carotid
stenosis: a meta-analysis [see comments]
COMMENTS: Comment in: BMJ 1998 Nov 28; 317(7171):1468
ARTICLE SOURCE: BMJ (England), Nov 28 1998, 317(7171) p1477-80
AUTHOR(S): Benavente O; Moher D; Pham B
AUTHOR'S ADDRESS: Department of Medicine, Division of Neurology,
University of Texas Health Science Center, San Antonio, TX
78284-7883, USA. benavente@uthscsa.edu.
PUBLICATION TYPE: JOURNAL ARTICLE; META-ANALYSIS
CONCLUSION: Carotid endarterectomy in patients with asymptomatic
carotid stenosis unequivocally reduces the incidence of ipsilateral
stroke, though the absolute benefit is relatively small. Given the
modest benefit of surgery for unselected patients with asymptomatic
carotid artery stenosis carotid endarterectomy cannot be routinely
recommended for these patients pending reliable identification of
high risk subgroups, and medical management is a sensible alternative
for most patients.
ARTICLE TITLE: The end of the heparin pump? Low molecular weight
heparin has many advantages over unfractionated heparin
[editorial]
ARTICLE SOURCE: BMJ (England), Dec 5 1998, 317(7172) p1540-2
AUTHOR(S): Grubb NR; Bloomfield P; Ludlam CA
PUBLICATION TYPE: EDITORIAL
ARTICLE TITLE: Review of the usefulness of contacting other
experts when conducting a literature search for systematic
reviews.
ARTICLE SOURCE: BMJ (England), Dec 5 1998, 317(7172) p1562-3
AUTHOR(S): McManus RJ; Wilson S; Delaney BC; Fitzmaurice DA; Hyde CJ;
Tobias RS; Jowett S; Hobbs FD
AUTHOR'S ADDRESS: Department of Primary Care and General Practice,
University of Birmingham, Birmingham B15 2TT, UK.
r.j.mcmanus@bham.ac.uk.
PUBLICATION TYPE: JOURNAL ARTICLE; REVIEW (5 references); REVIEW,
TUTORIAL
ARTICLE TITLE: Airline passenger dies after being sedated by
doctor [news]
ARTICLE SOURCE: BMJ (England), Jan 2 1999, 318(7175) p12
AUTHOR(S): Kovac C
PUBLICATION TYPE: NEWS
MB. Manic 33y doctor ? medical returning from a conference. A
(medical) doctor gave IV diazepam.
ARTICLE TITLE: Narrative based medicine: why study narrative?
ARTICLE SOURCE: BMJ (England), Jan 2 1999, 318(7175) p48-50
AUTHOR(S): Greenhalgh T; Hurwitz B
AUTHOR'S ADDRESS: Department of Primary Care and Population Sciences,
Royal Free and University College London Medical School, London N19
5NF. p.greenhalgh@ucl.ac.uk.
PUBLICATION TYPE: JOURNAL ARTICLE; REVIEW (18 references); REVIEW,
TUTORIAL
ARTICLE TITLE: Recent changes: pulmonary medicine.
ARTICLE SOURCE: BMJ (England), Jan 16 1999, 318(7177) p171-6
AUTHOR(S): Roche N
AUTHOR'S ADDRESS: Service de Pneumologie, Hopital Ambroise Pare,
F-92104 Boulogne, France. bnroche@club-internet.fr.
PUBLICATION TYPE: JOURNAL ARTICLE; REVIEW (48 references); REVIEW
LITERATURE
ARTICLE TITLE: What urologists say they do for men with prostate
cancer [editorial]
ARTICLE SOURCE: BMJ (England), Jan 30 1999, 318(7179) p276
AUTHOR(S): Emberton M
PUBLICATION TYPE: EDITORIAL
ARTICLE TITLE: Recent advances: oncology.
ARTICLE SOURCE: BMJ (England), Feb 13 1999, 318(7181) p445-8
AUTHOR(S): Tattersall MH; Thomas H
AUTHOR'S ADDRESS: Department of Cancer Medicine, University of
Sydney, Sydney, NSW 2006, Australia. Mtatt@med.usyd.edu.au.
PUBLICATION TYPE: JOURNAL ARTICLE; REVIEW (33 references); REVIEW,
TUTORIAL
MB Our place.
ARTICLE TITLE: Roles and responsibilities of the problem based
learning tutor in the undergraduate medical curriculum.
ARTICLE SOURCE: BMJ (England), Mar 6 1999, 318(7184) p657-61
AUTHOR(S): Maudsley G
AUTHOR'S ADDRESS: Department of Public Health, University of
Liverpool, Liverpool L69 3GB.
PUBLICATION TYPE: JOURNAL ARTICLE
ARTICLE TITLE: Hand washing [editorial]
ARTICLE SOURCE: BMJ (England), Mar 13 1999, 318(7185) p686
MAJOR SUBJECT HEADING(S): Attitude of Health Personnel; Cross
Infection [prevention & control]; Handwashing
PUBLICATION TYPE: EDITORIAL
ARTICLE TITLE: Peri-operative steroid supplementation.
ARTICLE SOURCE: Anaesthesia (England), Nov 1998, 53(11) p1091-104
AUTHOR(S): Nicholson G; Burrin JM; Hall GM
AUTHOR'S ADDRESS: Department of Anaesthesia, St George's Hospital
Medical School, London, UK.
PUBLICATION TYPE: JOURNAL ARTICLE; REVIEW (125 references); REVIEW,
ACADEMIC
ARTICLE TITLE: The effect of lead time bias on severity of illness
scoring, mortality prediction and standardised mortality ratio in
intensive care--a pilot study.
ARTICLE SOURCE: Anaesthesia (England), Nov 1998, 53(11) p1045-53
AUTHOR(S): Tunnell RD; Millar BW; Smith GB
AUTHOR'S ADDRESS: Department of Intensive Care Medicine, Queen
Alexandra Hospital, Portsmouth, UK.
PUBLICATION TYPE: JOURNAL ARTICLE
ABSTRACT: The effect of lead time bias on severity of illness
scoring, mortality prediction and standardised mortality ratios was
examined in a pilot study of 76 intensive care (ICU) patients using
APACHE II, APACHE III and SAPS II scoring systems. The inclusion of
data collected in the period prior to ICU admission increased
severity of illness scores and estimated risk of hospital mortality
significantly for all three scoring systems (p < 0.01) by up to 14
points and 42.7% (APACHE II), 50 points and 26.3% (APACHE III) and 23
points and 33.4% (SAPS II), respectively. Standardised mortality
ratios fell from 0.99 to 0.79 (APACHE II), 0.96 to 0.84 (APACHE III)
and 0.75 to 0.64 (SAPS II), but these changes failed to reach
statistical significance. Lead time bias had most effect in medical
patients and on emergency admissions, and least effect in patients
admitted from the operating theatre. These trends suggest that
mortality ratios may not necessarily reflect intensive care unit
performance and indicate that a larger study of the effect of lead
time bias, case mix, pre-ICU care or post-ICU management on
standardised mortality ratios is indicated.
ARTICLE TITLE: Can we assess professional behaviour in
anaesthetists? [editorial]
ARTICLE SOURCE: Anaesthesia (England), Nov 1998, 53(11) p1039-40
AUTHOR(S): Myerson KR
PUBLICATION TYPE: EDITORIAL
ARTICLE TITLE: Improving the evidence base for anaesthesia. MASTER
Anaesthesia Trial Study Group.
ARTICLE SOURCE: Anaesth Intensive Care (Australia), Dec 1998, 26(6)
p658-61
AUTHOR(S): Rigg J; Cokis C; Collins K; Glass DD; Jamrozik K; Leslie
K; Myles P; Peyton P; Poustie S; Silbert B
AUTHOR'S ADDRESS: Dept of Public Health, University of Western
Australia.
PUBLICATION TYPE: CONGRESSES; JOURNAL ARTICLE
ABSTRACT: This paper is a brief report of the symposium, "Improving
the Evidence Base for Anaesthesia and Intensive Care", organized by
the MASTER Anaesthesia Trial Study Group at the Annual Scientific
Meeting of the Australian and New Zealand College of Anaesthetists,
Newcastle, N.S.W., on Tuesday, May 5, 1998.
ARTICLE TITLE: Patient-controlled analgesia with oxycodone in the
treatment of postcraniotomy pain.
ARTICLE SOURCE: Acta Anaesthesiol Scand (Denmark), Jan 1999, 43(1)
p42-5
AUTHOR(S): Tanskanen P; Kytta J; Randell T
AUTHOR'S ADDRESS: Department of Anaesthesia, Helsinki University
Central Hospital, Finland.
PUBLICATION TYPE: CLINICAL TRIAL; JOURNAL ARTICLE; RANDOMIZED
CONTROLLED TRIAL
CONCLUSIONS: PCA with oxycodone is a suitable method for pain control
after craniotomy. No progressive hypoventilation, desaturation or
excessive sedation were encountered. Ketoprofen appeared to be more
effective than paracetamol.
MB. I don't think this is a good idea.
ARTICLE TITLE: Craniotomy procedures are associated with less
analgesic requirements than other surgical procedures.
ARTICLE SOURCE: Anesth Analg (United States), Feb 1999, 88(2)
p335-40
AUTHOR(S): Dunbar PJ; Visco E; Lam AM
AUTHOR'S ADDRESS: Department of Anesthesiology, Harborview Medical
Center, University of Washington School of Medicine, Seattle
98104-2499, USA. pjdunbar@u.washington.edu.
PUBLICATION TYPE: JOURNAL ARTICLE
Implications: This study compares the pain report and analgesic use
in patients after intracranial versus extracranial surgery. The
results confirm the commonly held but recently challenged belief that
neurosurgery patients suffer less pain postoperatively than other
patients. In this study, we found that most patients report minimal
pain after intracranial surgery but that a small subset of patients,
many of whom have undergone frontal craniotomies, require aggressive
treatment of postoperative pain
ARTICLE TITLE: Can rocuronium replace succinylcholine in a
rapid-sequence induction of anaesthesia? [editorial;
comment]
COMMENTS: Comment on: Acta Anaesthesiol Scand 1999 Jan; 43(1):4-8
ARTICLE SOURCE: Acta Anaesthesiol Scand (Denmark), Jan 1999, 43(1)
p1-3
AUTHOR(S): Engbaek J; Viby-Mogensen J
PUBLICATION TYPE: COMMENT; EDITORIAL
ARTICLE TITLE: The accuracy and precision of four infrared aural
canal thermometers during cardiac surgery.
ARTICLE SOURCE: Acta Anaesthesiol Scand (Denmark), Nov 1998, 42(10)
p1222-6
AUTHOR(S): Imamura M; Matsukawa T; Ozaki M; Sessler DI; Nishiyama T;
Kumazawa T
AUTHOR'S ADDRESS: Department of Anesthesia, Yamanashi Medical
University, Japan.
PUBLICATION TYPE: JOURNAL ARTICLE
ABSTRACT: BACKGROUND: Four infrared aural canal thermometers are
currently available in Japan: Genius, Thermoscan, Quickthermo, and
Thermopit. We therefore tested the hypothesis that each is
sufficiently accurate and precise for clinical use. METHODS: For the
purpose of this investigation, we considered accuracy to be the mean
difference between the test thermometers and the reference
thermocouple. Precision was considered to be the standard deviation
of the difference between the test and reference values. We evaluated
ten patients undergoing cardiopulmonary bypass with moderate
hypothermia (approximately 30 degrees C). Aural canal temperatures
were measured in random order with each infrared thermometer, and
compared with readings from a thermocouple positioned at the
contralateral tympanic membrane. RESULTS: Compared to the
thermocouple, the Genius and Thermoscan both had regression slopes
> 0.85 and correlation coefficients near 0.87; in contrast, slopes
of the Quickthermo and Thermopit regressions were 0.68 and 0.53,
respectively. The correlation coefficients for each were < 0.65.
The accuracy (offset, or bias) was near 0 degree C with both the
Genius and Thermoscan thermometers. In contrast, it was 1.1 degrees C
with the Quickthermo and a full 2.3 degrees C with the Thermopit. The
precision (standard deviation) of the measurements, however, was
approximately 0.8 degree C in each case. CONCLUSION: We conclude that
none of the tested aural canal infrared thermometers was sufficiently
accurate and precise for perioperative use.
MB. How did our recovery room and some wards get them? We have
Genius.
ARTICLE TITLE: Effect of learning during an anaesthesiological
multicentre trial.
ARTICLE SOURCE: Acta Anaesthesiol Scand (Denmark), Nov 1998, 42(10)
p1205-8
AUTHOR(S): Honkavaara P; Paloheimo M
AUTHOR'S ADDRESS: Department of Anaesthesia, Helsinki University
Central Hospital, Finland.
PUBLICATION TYPE: CLINICAL TRIAL; JOURNAL ARTICLE; MULTICENTER
STUDY
ABSTRACT: BACKGROUND: After the completion of a multicentre study, it
was disputed whether becoming acquainted with a novel drug would
affect dosing, and how many consecutive patients would be sufficient
for this phenomenon. METHODS: A post hoc analysis of the data on 408
patients from a multicentre study on propofol was performed to reveal
a possible learning effect. For study purposes, the patients were
given consecutive anaesthetic serial numbers per anaesthesiologist.
Patients eligible for the study with serial numbers 3-8 (113) were
included in the initial group, and numbers 12-17 (89) in the end
group. RESULTS: The patients in the end group opened their eyes (4.1
vs. 5.5 min, P < 0.05), gave their date of birth (4.5 vs. 6.3 min,
P < 0.005) and walked sooner (27.1 vs. 49.8 min, P < 0.05) than
the patients in the initial group. They received a higher dose of
propofol at induction (2.37 vs. 2.26 mg kg-1, P < 0.05) and the
last additional dose of propofol earlier (3.3 vs. 2.7 min, P <
0.05). CONCLUSION: This study shows that the learning effect can
influence the results in a multicentre study. Learning contamination
may occur if a novel drug is dosed by clinical judgement, and if the
allocation of patients into groups is markedly uneven during the
different stages of the study.
ARTICLE TITLE: Outcome of femoropopliteal angioplasty.
ARTICLE SOURCE: Ann Surg (United States), Jan 1999, 229(1)
p146-53
AUTHOR(S): Golledge J; Ferguson K; Ellis M; Sabharwal T; Davies AH;
Greenhalgh RM; Powell JT
AUTHOR'S ADDRESS: Department of Vascular Surgery, Imperial College
School of Medicine, Charing Cross Hospital, London, United
Kingdom.
PUBLICATION TYPE: CLINICAL TRIAL; JOURNAL ARTICLE
CONCLUSION: Only half of the patients treated by femoropopliteal
angioplasty had symptomatic improvement at 1 year, raising concern
about the cost-benefit ratio of this procedure. Restoration of
ankle-brachial pressure index (ABPI) to >0.9 predicted a favorable
outcome.
ARTICLE TITLE: An unacceptable concept [editorial;
comment]
COMMENTS: Comment on: Ann Surg 1999 Feb; 229(2):163-71
ARTICLE SOURCE: Ann Surg (United States), Feb 1999, 229(2) p172-3
AUTHOR(S): Trunkey DD
MAJOR SUBJECT HEADING(S): Intensive Care Units [organization
& administration]; Outcome Assessment (Health Care); Surgery
Department, Hospital [organization & administration]
INDEXING CHECK TAG(S): Comparative Study; Human
PUBLICATION TYPE: COMMENT; EDITORIAL
ARTICLE TITLE: Analysis of the effect of conversion from open to
closed surgical intensive care unit [see comments]
COMMENTS: Comment in: Ann Surg 1999 Feb; 229(2):172-3
ARTICLE SOURCE: Ann Surg (United States), Feb 1999, 229(2)
p163-71
AUTHOR(S): Ghorra S; Reinert SE; Cioffi W; Buczko G; Simms HH
AUTHOR'S ADDRESS: Division of Surgical Critical Care, Rhode Island
Hospital, Providence 02903, USA.
PUBLICATION TYPE: JOURNAL ARTICLE
ABSTRACT: OBJECTIVE: To compare the effect on clinical outcome of
changing a surgical intensive care unit from an open to a closed
unit. DESIGN: The study was carried out at a surgical intensive care
unit in a large tertiary care hospital, which was changed on January
1, 1996, from an open unit, where private attending physicians
contributed and controlled the care of their patients, to a closed
unit, where patients' medical care was provided only by the surgical
critical care team (ABS or ABA board-certified intensivists). A
retrospective review was undertaken over 6 consecutive months in each
system, encompassing 274 patients (125 in the open-unit period, 149
in the closed-unit period). Morbidity and mortality were compared
between the two periods, along with length-of-stay (LOS) and number
of consults obtained. A set of independent variables was also
evaluated, including age, gender, APACHE III scores, the presence of
preexisting medical conditions, the use of invasive monitoring
(Swan-Ganz catheters, central and arterial lines), and the use of
antibiotics, low-dose dopamine (LDD) for renal protection,
vasopressors, TPN, and enteral feeding. RESULTS: Mortality (14.4% vs.
6.04%, p = 0.012) and the overall complication rate (55.84% vs.
44.14%, p = 0.002) were higher in the open-unit group versus the
closed-unit group, respectively. The number of consults obtained was
decreased (0.6 vs. 0.4 per patient, p = 0.036), and the rate of
occurrence of renal failure was higher in the open-unit group (12.8%
vs. 2.67%, p = 0.001). The mean age of the patients was similar in
both groups (66.48 years vs. 66.40, p = 0.96). APACHE III scores were
slightly higher in the open-unit group but did not reach statistical
significance (39.02 vs. 36.16, p = 0.222). There were more men in the
first group (63.2% vs. 51.3%). The use of Swan-Ganz catheters or
central and arterial lines were identical, as was the use of
antibiotics, TPN, and enteral feedings. The use of LDD was higher in
the first group, but the LOS was identical. CONCLUSIONS: Conversion
of a tertiary care surgical intensive care unit from an open to
closed environment reduced dopamine usage and overall complication
and mortality rates. These results support the concept that, when
possible, patients in surgical intensive care units should be managed
by board-certified intensivists in a closed environment.
MB. Surprise, surprise!!!
ARTICLE TITLE: Should general surgeons provide critical care?
ARTICLE SOURCE: Arch Surg (United States), Feb 1999, 134(2)
p125-9
AUTHOR(S): Moore FA
AUTHOR'S ADDRESS: Department of Surgery, University of Texas-Houston,
Medical School, Hermann Hospital, 77030, USA.
PUBLICATION TYPE: JOURNAL ARTICLE
ARTICLE TITLE: Reorganizing the delivery of intensive care may
improve patient outcomes [editorial; comment]
COMMENTS: Comment on: JAMA 1999 Apr 14; 281(14):1310-7
ARTICLE SOURCE: JAMA (United States), Apr 14 1999, 281(14)
p1330-1
AUTHOR(S): Randolph AG
PUBLICATION TYPE: COMMENT; EDITORIAL
ARTICLE TITLE: Organizational characteristics of intensive care
units related to outcomes of abdominal aortic surgery [see
comments]
COMMENTS: Comment in: JAMA 1999 Apr 14; 281(14):1330-1
ARTICLE SOURCE: JAMA (United States), Apr 14 1999, 281(14)
p1310-7
AUTHOR(S): Pronovost PJ; Jenckes MW; Dorman T; Garrett E; Breslow MJ;
Rosenfeld BA; Lipsett PA; Bass E
AUTHOR'S ADDRESS: Department of Anesthesiology/Critical Care
Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD
21287-7294, USA. ppronovo@welchlink.welch.jhu.edu.
PUBLICATION TYPE: JOURNAL ARTICLE
ABSTRACT: CONTEXT: Morbidity and mortality rates in intensive care
units (ICUs) vary widely among institutions, but whether ICU
structure and care processes affect these outcomes is unknown.
OBJECTIVE: To determine whether organizational characteristics of
ICUs are related to clinical and economic outcomes for abdominal
aortic surgery patients who typically receive care in an ICU. DESIGN:
Observational study, with patient data collected retrospectively and
ICU data collected prospectively. SETTING: All Maryland hospitals
that performed abdominal aortic surgery from 1994 to 1996. PATIENTS
AND PARTICIPANTS: We analyzed hospital discharge data for patients in
non-federal acute care hospitals in Maryland who had a principal
procedure code for abdominal aortic surgery from January 1994 through
December 1996 (n = 2987). We obtained information about ICU
organizational characteristics by surveying ICU medical directors at
the 46 Maryland hospitals that performed abdominal aortic surgery.
Thirty-nine (85%) of the ICU directors completed this survey. MAIN
OUTCOME MEASURES: In-hospital mortality and hospital and ICU length
of stay. RESULTS: For patients undergoing abdominal aortic surgery,
in-hospital mortality varied among hospitals from 0% to 66%. In
multivariate analysis adjusted for patient demographics, comorbid
disease, severity of illness, hospital and surgeon volume, and
hospital characteristics, not having daily rounds by an ICU physician
was associated with a 3-fold increase in in-hospital mortality (odds
ratio [OR], 3.0; 95% confidence interval [CI],
1.9-4.9). Furthermore, not having daily rounds by an ICU physician
was associated with an increased risk of cardiac arrest (OR, 2.9; 95%
CI, 1.2-7.0), acute renal failure (OR, 2.2; 95% CI, 1.3-3.9),
septicemia (OR, 1.8; 95% CI, 1.2-2.6), platelet transfusion (OR, 6.4;
95% CI, 3.2-12.4), and reintubation (OR, 2.0; 95% CI, 1.0-4.1). Not
having daily rounds by an ICU physician, having an ICU nurse-patient
ratio of less than 1:2, not having monthly review of morbidity and
mortality, and extubating patients in the operating room were
associated with increased resource use. CONCLUSIONS: Organizational
characteristics of ICUs are related to differences among hospitals in
outcomes of abdominal aortic surgery. Clinicians and hospital leaders
should consider the potential impact of ICU organizational
characteristics on outcomes of patients having high-risk
operations.
MB. Maybe the surgeons's abilities are also a factor
I came to the above conclusions in 1972 when we dicided to electively
ventillate all abdominal aneurysms. At first I was worried that they
might kill a few by respirator mishaps. They did not. One surgeon
some years ago persuaded an anaesthetist to extubate at the end of
AAA which was the practice for ALL patients before we had ICU (1972).
He took a few days to go bad but eventually died. We don't have to go
through the same process to produce `evidence'.
Endoluminal is our first choice now. They do not usually go to
ICU.
ARTICLE TITLE: Weekly and seasonal variation in the incidence of
cardiac arrests [see comments]
COMMENTS: Comment in: Am Heart J 1999 Mar; 137(3):384-5
ARTICLE SOURCE: Am Heart J (United States), Mar 1999, 137(3)
p512-5
AUTHOR(S): Peckova M; Fahrenbruch CE; Cobb LA; Hallstrom AP
AUTHOR'S ADDRESS: Department of Biostatistics, University of
Washington, Seattle 98105- 4689, USA.
PUBLICATION TYPE: JOURNAL ARTICLE
CONCLUSIONS: Cardiac arrests do not occur randomly during the week or
year but follow certain periodic patterns. These patterns are
probably associated with patterns of activities.
ARTICLE TITLE: Sotalol: An important new antiarrhythmic.
ARTICLE SOURCE: Am Heart J (United States), Mar 1999, 137(3)
p388-409
AUTHOR(S): Anderson JL; Prystowsky EN
AUTHOR'S ADDRESS: University of Utah and St. Vincent'sHospital,
Northside Cardiology, Salt Lake City, USA.
PUBLICATION TYPE: JOURNAL ARTICLE; REVIEW (81 references); REVIEW,
TUTORIAL
ABSTRACT: On the basis of favorable clinical trials and practice
experience, sotalol has shown a steadily growing impact on the
treatment of arrhythmias during its 5 years of market availability, a
trend that is likely to continue.
ARTICLE TITLE: Cardiopulmonary resuscitation: historical
perspective to recent investigations.
ARTICLE SOURCE: Am Heart J (United States), Jan 1999, 137(1)
p39-48
AUTHOR(S): Thel MC; O'Connor CM
AUTHOR'S ADDRESS: Duke Clinical Research Institute and the Division
of Cardiology, Department of Medicine, Duke University Medical
Center, Durham, NC 27710, USA.
PUBLICATION TYPE: JOURNAL ARTICLE; REVIEW (82 references); REVIEW,
TUTORIAL
ABSTRACT:. Despite 30 years of research, CPR is now performed much as
it was initially. Further research into the mechanisms of cardiac
arrest, development of predictive models, and improved means to
improve cardiac output and survival are needed.
ARTICLE TITLE: SvO2 monitoring during spinal anesthesia and
cesarean section in a parturient with severe cyanotic congenital
heart disease.
ARTICLE SOURCE: Anesthesiology (United States), Apr 1999, 90(4)
p1213-5
AUTHOR(S): Lockhart EM; Penning DH; Olufolabi AJ; Bell EA; Booth JV;
Kern FH
AUTHOR'S ADDRESS: Department of Anesthesiology, Duke University
Medical Center, Durham, North Carolina 27710, USA.
PUBLICATION TYPE: JOURNAL ARTICLE
ARTICLE TITLE: Cardiopulmonary resuscitation: effect of CPAP on
gas exchange during chest compressions.
ARTICLE SOURCE: Anesthesiology (United States), Apr 1999, 90(4)
p1078-83
AUTHOR(S): Hevesi ZG; Thrush DN; Downs JB; Smith RA
AUTHOR'S ADDRESS: Department of Anesthesiology, University of South
Florida College of Medicine, Tampa 33642-4799, USA.
PUBLICATION TYPE: JOURNAL ARTICLE
CONCLUSIONS: Mechanical ventilation may not be necessary during CPR
as long as CPAP is applied. Discontinuation of IPPV will simplify CPR
and may offer physiologic advantage.
ARTICLE TITLE: Nerve injury associated with anesthesia: a closed
claims analysis.
ARTICLE SOURCE: Anesthesiology (United States), Apr 1999, 90(4)
p1062-9
AUTHOR(S): Cheney FW; Domino KB; Caplan RA; Posner KL
AUTHOR'S ADDRESS: Department of Anesthesiology, University of
Washington School of Medicine, Seattle 98195, USA.
fcheney@u.washington.edu.
PUBLICATION TYPE: JOURNAL ARTICLE
ABSTRACT: BACKGROUND: Nerve injury associated with anesthesia is a
significant source of morbidity for patients and liability for
anesthesiologists. To identify recurrent and emerging patterns of
injury we analyzed the current American Society of Anesthesiologists
(ASA) Closed Claims Project Database and performed an in-depth
analysis of claims for nerve injury that were entered into the
database since the authors' initial report of the subject. METHODS:
The ASA Closed Claims Database is a standardized collection of case
summaries derived from the closed claims files of professional
liability insurance companies. Claims for nerve injury that were not
included in the authors' 1990 report were reviewed in-depth. RESULTS:
Six hundred seventy (16% of 4,183) claims were for anesthesia-related
nerve injury. The most frequent sites of injury were the ulnar nerve
(28%), brachial plexus (20%), lumbosacral nerve root (16%), and
spinal cord (13%). Ulnar nerve (85%) injuries were more likely to
have occurred in association with general anesthesia, whereas spinal
cord (58%) and lumbosacral nerve root (92%) injuries were more likely
to occur with regional techniques. Ulnar nerve injury occurred
predominately in men (75%) and was also more apt to have a delayed
onset of symptoms (62%) than other nerve injuries. Spinal cord
injuries were the leading cause of claims for nerve injury that
occurred in the 1990s. CONCLUSION: New strategies for prevention of
nerve damage cannot be recommended at this time because the mechanism
for most injuries, particularly those of the ulnar nerve, is not
apparent.
ARTICLE TITLE: Awareness during anesthesia: a closed claims
analysis.
ARTICLE SOURCE: Anesthesiology (United States), Apr 1999, 90(4)
p1053-61
AUTHOR(S): Domino KB; Posner KL; Caplan RA; Cheney FW
AUTHOR'S ADDRESS: Department of Anesthesiology, University of
Washington School of Medicine, and the Virginia Mason Medical Center,
Seattle 98195, USA. kdomino@u.washington.edu.
PUBLICATION TYPE: JOURNAL ARTICLE
ABSTRACT: BACKGROUND: Awareness during general anesthesia is a
frightening experience, which may result in serious emotional injury
and post-traumatic stress disorder. We performed an in-depth analysis
of cases from the database of the American Society of
Anesthesiologists Closed Claims Project to explore the contribution
of intraoperative awareness to professional liability in anesthesia.
METHODS: The database of the Closed Claims Project is composed of
closed US malpractice claims that have been collected in a
standardized manner. All claims for intraoperative awareness were
reviewed by the reviewers to identify patterns of causation and
standard of care. Logistic regression analysis was used to identify
independent patient and anesthetic factors associated with claims for
recall during general anesthesia compared to other general anesthesia
malpractice claims. RESULTS: Awareness claims accounted for 79 (1.9%)
of 4,183 claims in the database, including 18 claims for awake
paralysis, i.e., the inadvertent paralysis of an awake patient, and
61 claims for recall during general anesthesia, ie., recall of events
while receiving general anesthesia. The majority of awareness claims
involved women (77%), younger than 60 yr of age (89%), American
Society of Anesthesiologists physical class I-II (68%), who underwent
elective surgery (87%). Most (94%) claims for awake paralysis
represented substandard care involving errors in labeling and
administration, whereas care was substandard in only 43% of the
claims for recall during general anesthesia (P < 0.001). Claims
for recall during general anesthesia were more likely to involve
women (odds ratio [OR] = 3.08, 95% confidence interval
[CI] = 1.58, 6.06) and anesthetic techniques using
intraoperative opioids (OR = 2.12, 95% CI = 1.20, 3.74),
intraoperative muscle relaxants (OR = 2.28, 95% CI = 1.22, 4.25), and
no volatile anesthetic (OR = 3.20, 95% CI = 1.88, 5.46). CONCLUSIONS:
Deficiencies in labeling and vigilance were common causes for awake
paralysis. Claims for recall during general anesthesia were more
likely in women and with nitrous-narcotic-relaxant techniques.
MB. They don't seem to think that there is an inevitable incidence. I
don't either
ARTICLE TITLE: Memory function during anesthesia [editorial;
comment]
COMMENTS: Comment on: Anesthesiology 1999 Mar; 90(3):662-9; Comment
on: Anesthesiology 1999 Mar; 90(3):670-80
ARTICLE SOURCE: Anesthesiology (United States), Mar 1999, 90(3)
p648-50
AUTHOR(S): Veselis RA
PUBLICATION TYPE: COMMENT; EDITORIAL
ARTICLE TITLE: Hemofiltration in parallel to the venovenous bypass
circuit for oliguric hypervolemia during liver transplantation.
ARTICLE SOURCE: Anesthesiology (United States), Mar 1999, 90(3)
p909-11
AUTHOR(S): Tobias MD; Jobes CS; Aukburg SJ
AUTHOR'S ADDRESS: Department of Anesthesia of the University of
Pennsylvania School of Medicine, Philadelphia, USA.
mtobias@mail.med.upenn.edu.
PUBLICATION TYPE: JOURNAL ARTICLE
MB. I could neve follow what this was suppsoed to do.
ARTICLE TITLE: FDA's role in anesthetic drug development.
ARTICLE SOURCE: Anesthesiology (United States), Mar 1999, 90(3)
p882-9
AUTHOR(S): Landow L; Kahn RC; Wright C
AUTHOR'S ADDRESS: Department of Anesthesia, Brigham and Women's
Hospital, Boston, Massachusetts 02215, USA.
landow@zeus.bwh.harvard.edu.
PUBLICATION TYPE: JOURNAL ARTICLE; REVIEW (13 references); REVIEW,
TUTORIAL
ARTICLE TITLE: Postoperative behavioral outcomes in children:
effects of sedative premedication.
ARTICLE SOURCE: Anesthesiology (United States), Mar 1999, 90(3)
p758-65
AUTHOR(S): Kain ZN; Mayes LC; Wang SM; Hofstadter MB
AUTHOR'S ADDRESS: Department of Anesthesiology and Pediatrics,
Children's Clinical Research Center, Yale University School of
Medicine, New Haven, Connecticut 06510, USA.
kain@biomed.med.yale.edu.
PUBLICATION TYPE: CLINICAL TRIAL; JOURNAL ARTICLE; RANDOMIZED
CONTROLLED TRIAL
ABSTRACT: Post hoc analysis demonstrated that during postoperative
days 1-7, a significantly smaller number of children in the midazolam
group manifested negative behavioral changes. At week 2
postoperatively, however, there were no significant differences
between the midazolam and placebo groups. CONCLUSIONS: Children who
are premedicated with midazolam before surgery have fewer negative
behavioral changes during the first postoperative week.
ARTICLE TITLE: Is gaining control of the autonomic nervous system
important to our specialty? [editorial; comment]
COMMENTS: Comment on: Anesthesiology 1999 Mar; 90(3):681-92
ARTICLE SOURCE: Anesthesiology (United States), Mar 1999, 90(3)
p651-3
AUTHOR(S): Ebert TJ
PUBLICATION TYPE: COMMENT; EDITORIAL
ARTICLE TITLE: Application of cell-salvage during cesarean
section.
ARTICLE SOURCE: Anesthesiology (United States), Feb 1999, 90(2)
p619-21
AUTHOR(S): Potter PS; Waters JH; Burger GA; Mraovic B
AUTHOR'S ADDRESS: Department of General Anesthesiology, Cleveland
Clinic Foundation, Ohio 44195, USA.
PUBLICATION TYPE: JOURNAL ARTICLE
MB. I would have thought that blood loss requiring transfusion in
caesarian section should be rare.
ARTICLE TITLE: Intraoperative burns secondary to warmed i.v. bags:
a warning.
ARTICLE SOURCE: Anesthesiology (United States), Feb 1999, 90(2)
p616-8
AUTHOR(S): Rosenfield LK; Pitlyk PJ
AUTHOR'S ADDRESS: Department of Plastic Surgery, Mills-Peninsula
Hospital, Burlingame, California 94010, USA.
PUBLICATION TYPE: JOURNAL ARTICLE
ARTICLE TITLE: Severe intraoperative CO poisoning: should apathy
prevail? [editorial; comment]
COMMENTS: Comment on: Anesthesiology 1999 Feb; 90(2):613-6
ARTICLE SOURCE: Anesthesiology (United States), Feb 1999, 90(2)
p353-4
AUTHOR(S): Woehlck HJ
PUBLICATION TYPE: COMMENT; EDITORIAL
ARTICLE TITLE: Laparoscopic gastrostomy and jejunostomy: safety
and cost with local vs general anesthesia.
ARTICLE SOURCE: Arch Surg (United States), Feb 1999, 134(2)
p151-6
AUTHOR(S): Duh QY; Senokozlieff-Englehart AL; Choe YS; Siperstein AE;
Rowland K; Way LW
AUTHOR'S ADDRESS: Veterans Affairs Medical Center, Department of
Surgery, University of California, San Francisco 94121, USA.
Quan-Yang-Duh@med.va.gov.
PUBLICATION TYPE: CLINICAL TRIAL; JOURNAL ARTICLE; RANDOMIZED
CONTROLLED TRIAL
CONCLUSIONS: Some patients undergoing laparoscopic enteral access may
require deep sedation and a rare patient may require general
anesthesia. Clinical conditions and surgeon preference, therefore,
should determine whether local anesthesia is suitable for
laparoscopic gastrostomies and jejunostomies, and in what setting,
since there is no difference in success rate or complications when
compared with general anesthesia. Potential savings are possible from
the operating room (26% of total cost) or anesthesiologist (12% of
total cost) if these procedures are performed in an endoscopy suite
without monitored anesthesia care.
MB. Why bother?
ARTICLE TITLE: Relationship of systemic inflammatory response
syndrome to organ dysfunction, length of stay, and mortality in
critical surgical illness: effect of intensive care unit
resuscitation.
ARTICLE SOURCE: Arch Surg (United States), Jan 1999, 134(1) p81-7
AUTHOR(S): Talmor M; Hydo L; Barie PS
AUTHOR'S ADDRESS: Department of Surgery, Joan and Sanford I. Weill
Medical College of Cornell University, New York Presbyterian
Hospital-Cornell Medical Center, New York, NY 10021, USA.
PUBLICATION TYPE: JOURNAL ARTICLE
ABSTRACT: BACKGROUND: A systemic proinflammatory response has been
implicated in the pathogenesis of organ dysfunction. The effects of
surgery, surgical stress, anesthesia, and subsequent intensive care
unit (ICU) resuscitation may affect the components of the systemic
inflammatory response syndrome (SIRS) score (temperature, heart rate,
respiratory rate, and white blood cell count). Any SIRS scores
calculated within 24 hours after surgery or at the onset of
nonoperative resuscitation may overestimate the proinflammatory
response itself, making quantitation of SIRS at that time potentially
too sensitive. We hypothesized that SIRS attributable to ICU
resuscitation can be quantitated, and that SIRS after the first day
of therapy in the ICU correlates with several outcomes. METHODS:
Prospective analysis of 2300 surgical ICU admissions during a
49-month period. Acute Physiology and Chronic Health Evaluation III
(APACHE III) scores were recorded after 24 hours. Daily and
cumulative multiple organ dysfunction scores (0-4 points for each of
6 organs, 24 points total) and SIRS scores (1 point for each
parameter, 4 points total) were recorded. Defined end points were
hospital mortality, days in the ICU, and organ dysfunction. RESULTS:
On day 1, 49.4% of patients had SIRS (score > or =2), whereas
34.5% of patients who remained in the ICU had SIRS (score > or =2)
on day 2 (P<.001). The SIRS score decreased by a mean of 0.8
points from day 1 to day 2, regardless of the type of admission. A
SIRS score that decreased on day 2, in comparison with the score on
day 1, resulted in less mortality than a unchanged or higher score on
day 2 (11% vs. 18% vs. 22%, P<.001). Systemic inflammatory
response scores were higher for nonsurvivors than survivors on each
of the first 7 days in the ICU. The day 2 SIRS score correlated well
with the admission APACHE III score (P<.001) and all defined end
points (all P<.001). The day 2 SIRS score also correlated with the
day 2 multiple organ dysfunction score (P<.001). By multiple
logistic regression, APACHE III (P<.001), day 2 SIRS score
(P<.01) (but not day 1 SIRS score, P = .99), and day 2 multiple
organ dysfunction score (P<.001) (but not day 1 multiple organ
dysfunction score, P = .81) predicted mortality. CONCLUSIONS:
Systemic inflammatory response syndrome attributable to surgery or
surgical stress can be quantitated. Twenty-four hours of ICU
resuscitation results in a decline in the SIRS score. The magnitude
of the proinflammatory response on the second ICU day may be a useful
predictor of outcome in critical surgical illness.
MB. Very silly. Why did they bother?
ARTICLE TITLE: Impairment of cardiac performance by laparoscopy in
patients receiving positive end-expiratory pressure.
ARTICLE SOURCE: Arch Surg (United States), Jan 1999, 134(1)
p76-80
AUTHOR(S): Kraut EJ; Anderson JT; Safwat A; Barbosa R; Wolfe BM
AUTHOR'S ADDRESS: Department of Surgery, University of California,
Davis Health System, Sacramento 95817-2214, USA. EKraut1@aol.com.
PUBLICATION TYPE: JOURNAL ARTICLE
CONCLUSIONS: There was a significant reduction in preload and cardiac
output when there was intra-abdominal pressure of 15 mm Hg in the
presence of 10 cm H20 of PEEP. This combination of pressures may pose
a contraindication to laparoscopic surgery.
ARTICLE TITLE: Changes in respiratory mechanics after
tracheostomy.
ARTICLE SOURCE: Arch Surg (United States), Jan 1999, 134(1)
p59-62
AUTHOR(S): Davis K Jr; Campbell RS; Johannigman JA; Valente JF;
Branson RD
AUTHOR'S ADDRESS: Department of Surgery, University of Cincinnati,
Ohio 45267-0558, USA. Kenneth.Davis@UC.edu.
PUBLICATION TYPE: JOURNAL ARTICLE
CONCLUSIONS: We believe that the rigid nature of the tracheostomy
tube represents reduced imposed work of breathing WOB compared with
the longer, thermoliable endotracheal tube. The clinical significance
of this effect is small, although as respiratory rate increases, the
effects are magnified. In patients in whom extubation failed, WOB may
be elevated because of incomplete control of the upper airway. Future
studies should evaluate the cause of increased WOB after
extubation.
ARTICLE TITLE: Lower esophageal sphincter dysfunction often
precludes safe gastric feeding in stroke patients.
ARTICLE SOURCE: Arch Surg (United States), Jan 1999, 134(1) p55-8
AUTHOR(S): Lucas CE; Yu P; Vlahos A; Ledgerwood AM
AUTHOR'S ADDRESS: Department of Surgery, Wayne State University,
Detroit, Mich 48201, USA.
CONCLUSIONS: Vomiting with aspiration due to lower esophageal
sphincter dysfunction is common after acute strokes. Esophageal
manometry serves as a guide to find the optimal feeding route.
ARTICLE TITLE: Effect of intraoperative blood transfusion on
patient outcome in hepatic transplantation.
ARTICLE SOURCE: Arch Surg (United States), Jan 1999, 134(1) p25-9
AUTHOR(S): Cacciarelli TV; Keeffe EB; Moore DH; Burns W; Busque S;
Concepcion W; So SK; Esquivel CO
AUTHOR'S ADDRESS: Department of Surgery, Stanford University Medical
Center, Calif, USA.
PUBLICATION TYPE: JOURNAL ARTICLE
ABSTRACT: OBJECTIVE: To evaluate the effect of intraoperative
transfusion of red blood cells (RBCs) on patient and graft survival.
DESIGN: A retrospective study. SETTING: A tertiary care referral
center. PATIENTS: Between January 1, 1992, and December 31, 1994,
medical records from 225 adult patients who underwent primary liver
transplantations were analyzed. RESULTS: Overall patient survival was
90% at 1 year and 86% at 3 years, while graft survival was 89% at 1
year and 85% at 3 years. The following factors were associated with
patient and graft survival: age, sex, medical condition at the time
of transplantation, and intraoperative transfusion of RBCs. When
these factors were subjected to a multivariate analysis, all were
independently associated with survival. Fifty-four recipients (24%)
underwent transplantation without intraoperative transfusion of RBCs,
while 171 recipients (76%) received at least 1 U of RBCs
intraoperatively. Recipients who did not receive transfusion of RBCs
had higher patient and graft survival rates than patients who did
receive RBCs. By multivariate analysis, transplantation without
intraoperative transfusion of RBCs no longer remained statistically
significant, and only sex and the patient's medical condition were
independently associated with patient and graft survival. Patient and
graft survival decreased if 5 or more U were transfused, but
transfusion of 5 or more U was not independently associated with
survival by multivariate analysis. CONCLUSIONS: Increased transfusion
requirement for RBCs was independently associated with patient and
graft survival. While transplantation without transfusion of
intraoperative RBCs was associated with superior patient and graft
survival, these effects were overridden by patient sex and medical
condition at the time of transplantation.
MB. It seems that the transfusion volume was not related to the
survival but I could not be bothered looking up the original. They
must have been desperate for a publication.
ARTICLE TITLE: Indications for positive airway pressure treatment
of adult obstructive sleep apnea patients: a consensus statement.
ARTICLE SOURCE: Chest (United States), Mar 1999, 115(3) p863-6
AUTHOR(S): Loube DI; Gay PC; Strohl KP; Pack AI; White DP; Collop
NA
AUTHOR'S ADDRESS: Walter Reed Army Medical Center, Washington, DC
20307-5001, USA.
PUBLICATION TYPE: JOURNAL ARTICLE
ARTICLE TITLE: Do Australian family physicians screen smokers for
lung cancer?
ARTICLE SOURCE: Chest (United States), Mar 1999, 115(3) p725-8
AUTHOR(S): Sladden MJ; Ward JE
AUTHOR'S ADDRESS: Division of Community and Rural Health, University
of Tasmania, Hobart, Australia. M.Sladden@utas.edu.au.
PUBLICATION TYPE: JOURNAL ARTICLE
CONCLUSIONS: A substantial minority of family physicians recommends
an annual CXR as a screening test despite contradictory evidence from
randomized controlled trials. These significant variations in the
absence of epidemiologic evidence invite further research to develop
effective, efficient, and affordable preventive care in family
practice.
ARTICLE TITLE: Critical care outcomes in the United Kingdom:
sobering wake-up call or stability of the lamppost? [editorial;
comment]
COMMENTS: Comment on: Chest 1999 Mar; 115(3):802-10
ARTICLE SOURCE: Chest (United States), Mar 1999, 115(3) p614-6
AUTHOR(S): Wood KE; Coursin DB; Grounds RM
PUBLICATION TYPE: COMMENT; EDITORIAL
ARTICLE TITLE: Assessing quality of care using in-hospital
mortality: does it yield informed choices? [editorial;
comment]
COMMENTS: Comment on: Chest 1999 Mar; 115(3):793-801
ARTICLE SOURCE: Chest (United States), Mar 1999, 115(3) p613-4
AUTHOR(S): Sivak ED; Rogers MA \
PUBLICATION TYPE: COMMENT; EDITORIAL
ARTICLE TITLE: Conundrums in sleep medicine
[editorial]
ARTICLE SOURCE: Chest (United States), Mar 1999, 115(3) p607-8
AUTHOR(S): Collop NA
PUBLICATION TYPE: EDITORIAL
ARTICLE TITLE: A randomized and controlled trial of the effect of
treatment aimed at maximizing oxygen delivery in patients with severe
sepsis or septic shock.
ARTICLE SOURCE: Chest (United States), Feb 1999, 115(2) p453-61
AUTHOR(S): Alia I; Esteban A; Gordo F; Lorente JA; Diaz C; Rodriguez
JA; Frutos F
AUTHOR'S ADDRESS: Hospital Universitario de Getafe, Madrid,
Spain.
PUBLICATION TYPE: CLINICAL TRIAL; JOURNAL ARTICLE; RANDOMIZED
CONTROLLED TRIAL
CONCLUSION: Treatment aimed at maximizing oxygen delivery in patients
with severe sepsis or septic shock does not reduce mortality or
morbidity.
ARTICLE TITLE: Carbon monoxide poisoning: a disease of a thousand
faces [editorial; comment]
COMMENTS: Comment on: Chest 1999 Feb; 115(2):580-1
ARTICLE SOURCE: Chest (United States), Feb 1999, 115(2) p322-3
AUTHOR(S): Fisher J
PUBLICATION TYPE: COMMENT; EDITORIAL
ARTICLE TITLE: The 1997 Asthma Management Guidelines and
therapeutic issues relating to the treatment of asthma. National
Heart, Lung, and Blood Institute.
ARTICLE SOURCE: Chest (United States), Jan 1999, 115(1) p210-7
AUTHOR(S): Georgitis JW
AUTHOR'S ADDRESS: Department of Pediatrics, Wake Forest University
School of Medicine, Winston-Salem, NC, USA. jgeorgit@wfubmc.edu.
PUBLICATION TYPE: GUIDELINE; JOURNAL ARTICLE; PRACTICE GUIDELINE;
REVIEW (57 references); REVIEW, TUTORIAL
ABSTRACT: In 1997, the National Heart, Lung, and Blood Institute
released the Second Expert Panel Report on the Guidelines for the
Diagnosis and Management of Asthma as a follow-up to the first report
issued in 1991. Implementation of the recommendations from this
report could have a potentially huge impact on care and treatment of
asthma in the United States. Even though the Guidelines are
expansive, there are some areas related to the pharmacologic
component that warrant further discussion and clarification. These
are: (1) safety and efficacy of available asthma medications, (2)
clinical efficacy comparisons of inhaled corticosteroids, (3)
comparative risks among inhaled corticosteroids, and (4) expectations
of different delivery systems used with inhaled corticosteroids.
MB. In Australia & NZ the asthma mortality appears to increase as
the treatment improves. That was the case in 1970 too.
ARTICLE TITLE: The importance of physical fitness in the
performance of adequate cardiopulmonary resuscitation.
ARTICLE SOURCE: Chest (United States), Jan 1999, 115(1) p158-64
AUTHOR(S): Lucia A; de las Heras JF; Perez M; Elvira JC; Carvajal A;
Alvarez AJ; Chicharro JL
AUTHOR'S ADDRESS: Departamento de Ciencias Morfologicas y Fisiologia,
Universidad Europea de Madrid, Spain.
PUBLICATION TYPE: JOURNAL ARTICLE
These results suggest that a certain level of physical fitness may be
beneficial to CPR providers to ensure the adequacy of chest
compressions performed during relatively long periods of cardiac
arrest.
ARTICLE TITLE: Atrial natriuretic peptide attenuates
pacing-induced myocardial ischemia during general anesthesia in
patients with coronary artery disease.
ARTICLE SOURCE: Anesth Analg (United States), Feb 1999, 88(2)
p279-85
AUTHOR(S): Valsson F; Lundin S; Kirno K; Hedner T; Houltz E; Saito Y;
Ricksten SE
AUTHOR'S ADDRESS: Department of Anesthesia and Intensive Care,
Sahlgrenska University Hospital, Goteborg, Sweden.
PUBLICATION TYPE: CLINICAL TRIAL; JOURNAL ARTICLE; RANDOMIZED
CONTROLLED TRIAL
Implications: We evaluated the effects of i.v. atrial natriuretic
peptide (50 ng x kg(-1) x min(-1)) on pacing-induced myocardial
ischemia during general anesthesia in patients with coronary artery
disease. In contrast to placebo, atrial natriuretic peptide
attenuated ST-segment depression and myocardial lactate production
and improved left ventricular function during pacing-induced
ischemia.
ARTICLE TITLE: Elevated plasma atrial natriuretic peptide levels
after occlusion of the thoracic aorta [see comments]
COMMENTS: Comment in: Chest 1999 Jan; 115(1):7-8
ARTICLE SOURCE: Chest (United States), Jan 1999, 115(1) p130-4
AUTHOR(S): Berkenstadt H; Rosenthal T; Peleg E; Segal E; Hackshaw A;
Ben-Ari G; Perel A
AUTHOR'S ADDRESS: Department of Anesthesiology and Intensive Care,
Chaim Sheba Medical Center, Sackler School of Medicine, Tel Aviv
University, Tel Hashomer, Israel. berken@netvision.net.il.
PUBLICATION TYPE: JOURNAL ARTICLE
ABSTRACT: STUDY OBJECTIVE: The influence of occlusion of the thoracic
aorta by an intraluminal balloon on plasma atrial natriuretic peptide
(ANP) levels was evaluated in humans. METHODS: The changes in plasma
ANP and plasma norepinephrine levels, and hemodynamic parameters were
measured in 10 patients under general anesthesia undergoing regional
chemotherapy treatment involving the 15-min inflation and subsequent
deflation of an intraaortic balloon. RESULTS: The hemodynamic changes
observed were similar to those seen during aortic clamping and
declamping in patients undergoing vascular surgery. Plasma ANP levels
(median+/-SD) measured 1 min after inflation (146+/-117 pg/mL) and 1
min after deflation (168+/-189 pg/mL) of the aortic balloon were
significantly higher than baseline values (83+/-55 pg/mL), with a
mean increase, respectively, of 92% and 97% (95% confidence intervals
[CI], 50 to 147% and 53 to 152%). Plasma ANP levels were
still elevated 30 min after deflation (121+/-94 pg/mL), a 56%
increase (95% CI, 21 to 100%), although the hemodynamic parameters
had already returned to their baseline levels. There was no evidence
that the hemodynamic variables were associated with changes in plasma
ANP levels (all p values > 0.30). In addition, there was no
evidence of an association between plasma ANP and plasma
norepinephrine levels at any of the four individual sampling points
(p > 0.17). Thirty minutes after deflation, however,
norepinephrine levels were higher than baseline values. CONCLUSIONS:
The changes in plasma ANP levels after aortic occlusion and
reinstitution of blood flow may be dependent on parameters other than
atrial stretch and pressure.
MB. This subject has always been a mystery to me.
ARTICLE TITLE: Circulating natriuretic peptides: a biologic marker
of tissue injury? [editorial; comment]
COMMENTS: Comment on: Chest 1999 Jan; 115(1):130-4
ARTICLE SOURCE: Chest (United States), Jan 1999, 115(1) p7-8
AUTHOR(S): Rubinstein I; Hong D
PUBLICATION TYPE: COMMENT; EDITORIAL
ARTICLE TITLE: The influence of head and neck position on
oropharyngeal leak pressure and cuff position with the flexible and
the standard laryngeal mask airway.
ARTICLE SOURCE: Anesth Analg (United States), Apr 1999, 88(4)
p913-6
AUTHOR(S): Keller C; Brimacombe J
AUTHOR'S ADDRESS: Department of Anaesthesia and Intensive Care
Medicine, Leopold-Franzens University, Innsbruck, Austria.
PUBLICATION TYPE: CLINICAL TRIAL; JOURNAL ARTICLE; RANDOMIZED
CONTROLLED TRIAL
Implications: There are small changes in oropharyngeal leak pressure
but no changes in cuff position in different head and neck positions
for the flexible and standard laryngeal mask airways. Oropharyngeal
leak pressure may be improved by head and neck flexion and by
avoiding extension.
ARTICLE TITLE: Nerve stimulator and multiple injection technique
for upper and lower limb blockade: failure rate, patient acceptance,
and neurologic complications. Study Group on Regional Anesthesia.
ARTICLE SOURCE: Anesth Analg (United States), Apr 1999, 88(4)
p847-52
AUTHOR(S): Fanelli G; Casati A; Garancini P; Torri G
AUTHOR'S ADDRESS: Department of Anesthesiology, IRCCS H, San
Raffaele, Milan, Italy.
PUBLICATION TYPE: CLINICAL TRIAL; JOURNAL ARTICLE; MULTICENTER
STUDY
ABSTRACT: To evaluate the failure rate, patient acceptance, effective
volumes of local anesthetic solution, and incidence of neurologic
complications after peripheral nerve block performed using the
multiple injection technique with a nerve stimulator, we
prospectively studied 3996 patients undergoing combined
sciatic-femoral nerve block (n = 2175), axillary blocks (n = 1650),
and interscalene blocks (n = 171). The success rate and mean injected
volumes of local anesthetic were: 93% with 22.6 +/- 4.5 mL in the
axillary, 94% with 24.5 +/- 5.4 mL in the interscalene, and 93% with
28.1 +/- 4.4 mL in the sciatic-femoral nerve blocks. Patients
receiving combined sciatic-femoral nerve block showed more discomfort
during block placement and worse acceptance of the anesthetic
procedure than patients receiving brachial plexus anesthesia. During
the first month after surgery, 69 patients (1.7%) developed
neurologic dysfunction on the operated limb. Complete recovery
required 4-12 wk in all patients but one, who required 25 wk. The
only variable showing significant association with the development of
postoperative neurologic dysfunction was the tourniquet inflation
pressure (<400 mm Hg compared with >400 mm Hg, odds ratio 2.9,
95% confidence intervals 1.6-5.4; P < 0.001). We conclude that
using the multiple injections technique with a nerve stimulator
results in a success rate of >90% with a volume of <30 mL of
local anesthetic solution and an incidence of transient neurologic
complication of <2%. Implications: Based on a prospective
evaluation of 3996 consecutive peripheral nerve blocks, the multiple
injection technique with nerve stimulator allows for up to 94%
successful nerve block with <30 mL of local anesthetic solution.
Although the data collection regarding neurologic dysfunction was
limited, the withdrawal and redirection of the stimulating needle was
not associated with an increased incidence of neurologic
complications. Sedation/analgesia should be advocated during block
placement to improve patient acceptance.
MB. Very high incidence of neurological problems.
ARTICLE TITLE: The cost-effectiveness of methohexital versus
propofol for sedation during monitored anesthesia care.
ARTICLE SOURCE: Anesth Analg (United States), Apr 1999, 88(4)
p723-8
AUTHOR(S): Sa Rego MM; Inagaki Y; White PF
AUTHOR'S ADDRESS: Department of Anesthesiology and Pain Management,
University of Texas Southwestern Medical Center at Dallas, USA.
MAJOR SUBJECT HEADING(S): Anesthesia, Local; Anesthetics, Intravenous
[economics]; Methohexital [economics]; Monitoring,
Intraoperative [economics]; Propofol [economics];
Sedatives, Nonbarbiturate [economics]
MINOR SUBJECT HEADING(S): Anesthetics, Intravenous
[administration & dosage]; Heart Rate; Methohexital
[administration & dosage]; Middle Age; Premedication
[economics]; Propofol [administration & dosage];
Respiration; Sedatives, Nonbarbiturate [administration &
dosage]; Time Factors
INDEXING CHECK TAG(S): Comparative Study; Female; Human
PUBLICATION TYPE: CLINICAL TRIAL; JOURNAL ARTICLE; RANDOMIZED
CONTROLLED TRIAL
ABSTRACT: We designed this study to test the hypothesis that
methohexital is a cost-effective alternative to propofol for sedation
during local anesthesia. Sixty consenting women undergoing breast
biopsy procedures under local anesthesia were randomly assigned to
receive an infusion of either propofol (50 microg x kg(-1) x min(-1))
or methohexital (40 microg x kg(-1) x min(-1)). The sedative infusion
rate was titrated to maintain an observer's assessment of
alertness/sedation (OAA/S) score of 3 (with 1 = awake/alert to 5 =
asleep). Fentanyl 25 microg i.v. was administered as a "rescue"
analgesic during the operation. We assessed the level of sedation
(OAA/S score), vital signs, time to achieve an OAA/S score of 3 at
the onset and a score of 1 after discontinuing the infusion,
discharge times, perioperative side effects, and patient
satisfaction. The direct cost of methohexital was lower than that of
propofol, based on the milligram dosage infused during the operation.
The sedative onset (to achieve an OAA/S score of 3) and the recovery
(to return to an OAA/S score of 1) times, as well as discharge times,
did not differ between the two groups. Patients receiving
methohexital had a significantly lower incidence of pain on initial
injection compared with those receiving propofol (10% vs 23%).
Because the use of methohexital (29.4 +/- 2.7 microg x kg(-1) x
min(-1)) for sedation during breast biopsy procedures has a similar
efficacy and recovery profile to that of propofol (36.8 +/- 15.9
microg x kg(-1) x min(-1)) and is less costly based on the amount
infused, it seems to be a cost-effective alternative to propofol for
sedation during local anesthesia. However, when the cost of the drug
infused and drug wasted was calculated, there was no difference in
the overall drug cost. Implications: When administered to maintain a
stable level of sedation during local anesthesia, methohexital is an
acceptable alternative to propofol. However, the overall drug costs
were similar with the two drugs.
ARTICLE TITLE: The bispectral index: a measure of depth of
sleep?
ARTICLE SOURCE: Anesth Analg (United States), Mar 1999, 88(3)
p659-61
AUTHOR(S): Sleigh JW; Andrzejowski J; Steyn-Ross A; Steyn-Ross M
AUTHOR'S ADDRESS: Intensive Care Unit, Waikato Hospital, Hamilton,
New Zealand. sleighj@hwl.co.nz.
PUBLICATION TYPE: JOURNAL ARTICLE
IMPLICATIONS: Electroencephalographic data were collected from five
subjects during sleep. We found that the Bispectral Index decreased
during increasing depth of sleep in a fashion very similar to the
decrease in Bispectral Index that occurs during general anesthesia.
This study further highlights the electroencephalographic
similarities of states of sleep and general anesthesia.
MB. How long will this thing last?
ARTICLE TITLE: A double-blinded evaluation of propacetamol versus
ketorolac in combination with patient-controlled analgesia morphine:
analgesic efficacy and tolerability after gynecologic surgery.
ARTICLE SOURCE: Anesth Analg (United States), Mar 1999, 88(3)
p611-6
AUTHOR(S): Varrassi G; Marinangeli F; Agro F; Aloe L; De Cillis P; De
Nicola A; Giunta F; Ischia S; Ballabio M; Stefanini S
AUTHOR'S ADDRESS: Department of Anesthesiology and Pain Management,
University of L'Aquila, Italy. giuvarr@tun.it.
PUBLICATION TYPE: CLINICAL TRIAL; JOURNAL ARTICLE; MULTICENTER STUDY;
RANDOMIZED CONTROLLED TRIAL
IMPLICATIONS: Propacetamol and ketorolac, combined with
patient-controlled analgesia morphine, show similar analgesic
efficacy after gynecologic surgery. Morphine consumption and pain
scores were comparable in the two studied groups. Propacetamol is as
effective as ketorolac and has an excellent tolerability after
gynecologic surgery.
MB. After all the hype.
ARTICLE TITLE: The safety and efficacy of intrathecal opioid
analgesia for acute postoperative pain: seven years' experience with
5969 surgical patients at Indiana University Hospital.
ARTICLE SOURCE: Anesth Analg (United States), Mar 1999, 88(3)
p599-604
AUTHOR(S): Gwirtz KH; Young JV; Byers RS; Alley C; Levin K; Walker
SG; Stoelting RK
AUTHOR'S ADDRESS: Department of Anesthesia, Indiana University School
of Medicine, Indianapolis, USA.
PUBLICATION TYPE: JOURNAL ARTICLE
ABSTRACT: To assess the efficacy of the analgesic technique and the
incidence of complications, we prospectively evaluated patients who
received intrathecal opioid analgesia (ITOA) to manage postsurgical
pain. Daily quality assurance data were collected on the first
postoperative day and tabulated for 5969 adult patients who had
received ITOA for major urologic, orthopedic, general/ vascular,
thoracic, and nonobstetrical gynecologic surgery. A scale of 1-10 was
used to quantify each patient's satisfaction with analgesia. The
incidence of side effects, complications, and naloxone usage was also
recorded and tabulated. The mean satisfaction score using a 10-point
numeric rating scale was 8.51, with a score of 1 connoting "complete
dissatisfaction" and 10 connoting "complete satisfaction." Side
effects were minor and easily managed. Pruritus was the most common
(37%). Respiratory depression was the least common (3%), easily
detected by nursing observation, never life-threatening, and always
responsive to treatment with naloxone. There were no deaths, nerve
injuries, central nervous system infections, or naloxone-related
complications. Postdural puncture headaches were rare (0.54%), as was
the need for epidural blood patch (0.37%). IMPLICATIONS: Over a 7-yr
period, intrathecal opioid analgesia was used to control acute
postoperative pain on nearly 6000 patients, resulting in a high
degree of patient satisfaction and a low incidence of side effects
and complications.
MB I don't know what a satisfaction score of 8.5 means but you can
get 90% saying they were satisfied with any method.
ARTICLE TITLE: Arterial oxygenation during one-lung ventilation:
combined versus general anesthesia.
ARTICLE SOURCE: Anesth Analg (United States), Mar 1999, 88(3)
p494-9
AUTHOR(S): Garutti I; Quintana B; Olmedilla L; Cruz A; Barranco M;
Garcia de Lucas E
AUTHOR'S ADDRESS: Service of Anesthesiology and Reanimation, Hospital
General Gregorio Maranon, Madrid, Spain.
PUBLICATION TYPE: CLINICAL TRIAL; JOURNAL ARTICLE; RANDOMIZED
CONTROLLED TRIAL
. IMPLICATIONS: Sixty patients undergoing elective lung surgery
during a prolonged period of intraoperative one-lung ventilation were
studied and randomized to receive general i.v. anesthesia or general
i.v. anesthesia combined with thoracic epidural anesthesia. The
arterial oxygenation in the first group was better than that in the
second group during one-lung ventilation.
MB. When will we stop giving unnecessary regional anaesthesia. I did
about 1966.
ARTICLE TITLE: The effects of in vitro hemodilution with gelatin,
hydroxyethyl starch, and lactated Ringer's solution on markers of
coagulation: an analysis using SONOCLOT.
ARTICLE SOURCE: Anesth Analg (United States), Mar 1999, 88(3)
p483-8
AUTHOR(S): Konrad C; Markl T; Schuepfer G; Gerber H; Tschopp M
AUTHOR'S ADDRESS: Department of Anesthesiology and Intensive Care,
Kantonsspital, Lucerne, Switzerland.
Fieber_Konrad@Compuserve.com.
PUBLICATION TYPE: CLINICAL TRIAL; JOURNAL ARTICLE
ABSTRACT: Blood-saving strategies have recently been established to
avoid allogeneic transfusion during surgery or after trauma. This
includes an expanding use of crystalloids and colloids. These
solutions interfere with coagulation systems, but quantitative
measurements are still lacking. The SONOCLOT (Sienco Company,
Morrison, CO) analysis (SCT), a viscoelastic test, measures clot
formation and includes information on the cellular, as well as the
plasmatic coagulation, system. To quantify hemodilutional effects on
in vitro coagulation, we studied gelatin (G), hydroxyethyl starch 6%
(HES; molecular weight 450,000), and lactated Ringer's solution (RL)
in 33% and 66% dilutions measuring routines laboratory and SCT
variables. Hemodilution with RL tended to increase in vitro
coagulability. Among the tested colloids, G had the least impact on
markers of coagulation. G33% did not differ significantly from the
undiluted control group. HES had the largest impact on markers of
coagulation compared with G and RL. In conclusion, SCT provides a
fast and easy to perform bedside test to quantify in vitro
hemodilution. IMPLICATIONS: The effects of progressive hemodilution
on coagulation are difficult to measure. SONOCLOT analyses provide an
easy to perform test with fast information on cellular and plasmatic
coagulation properties. Among colloids, hydroxyethyl starch has the
largest impact on markers of coagulation compared with gelatin or
lactated Ringer's solution.
MB Yeah. But what does it all mean. I don't think any of the
coagulation machines have been shown to givs any usable answers.
ARTICLE TITLE: The effect of heart rate control on myocardial
ischemia among high-risk patients after vascular surgery [see
comments]
COMMENTS: Comment in: Anesth Analg 1999 Mar; 88(3):475-6
ARTICLE SOURCE: Anesth Analg (United States), Mar 1999, 88(3)
p477-82
AUTHOR(S): Raby KE; Brull SJ; Timimi F; Akhtar S; Rosenbaum S; Naimi
C; Whittemore AD
AUTHOR'S ADDRESS: Department of Medicine, Boston University School of
Medicine, Massachusetts, USA. Khether.Raby@BMC.ORG.
PUBLICATION TYPE: CLINICAL TRIAL; JOURNAL ARTICLE; RANDOMIZED
CONTROLLED TRIAL
IMPLICATIONS: Patients who undergo peripheral vascular surgery often
experience transient cardiac complications and/or permanent heart
damage just after surgery because of inadequate myocardial blood
flow. In this study, we identified patients at high risk of cardiac
complications after vascular surgery and showed that if their heart
rate was carefully controlled for 48 h after surgery, myocardial
ischemia, a common marker of heart injury, was markedly reduced.
MB. Did all who should have have optimal preoperative therapy.
ARTICLE TITLE: Individualizing beta-adrenergic blocker therapy:
patient-specific target-based heart rate control [editorial;
comment]
COMMENTS: Comment on: Anesth Analg 1999 Mar; 88(3):477-82
ARTICLE SOURCE: Anesth Analg (United States), Mar 1999, 88(3)
p475-6
AUTHOR(S): Tuman KJ; McCarthy RJ
PUBLICATION TYPE: COMMENT; EDITORIAL; REVIEW (10 references); REVIEW,
TUTORIAL
MB. May be most of the patients should have been on beta-blockers any
way and continued during perioperative period. Those who did not get
them in the study were often given them.
ARTICLE TITLE: Thromboelastography-guided transfusion algorithm
reduces transfusions in complex cardiac surgery.
ARTICLE SOURCE: Anesth Analg (United States), Feb 1999, 88(2)
p312-9
AUTHOR(S): Shore-Lesserson L; Manspeizer HE; De Perio M; Francis S;
Vela-Cantos F; Ergin MA
AUTHOR'S ADDRESS: Department of Anesthesiology, Mount Sinai Medical
Center, New York, New York 10029, USA.
linda_shore@smtplink.mssm.edu.
PUBLICATION TYPE: CLINICAL TRIAL; JOURNAL ARTICLE; RANDOMIZED
CONTROLLED TRIAL
ABSTRACT: Transfusion therapy after cardiac surgery is empirically
guided, partly due to a lack of specific point-of-care hemostasis
monitors. In a randomized, blinded, prospective trial, we studied
cardiac surgical patients at moderate to high risk of transfusion.
Patients were randomly assigned to either a thromboelastography
(TEG)-guided transfusion algorithm (n = 53) or routine transfusion
therapy (n = 52) for intervention after cardiopulmonary bypass.
Coagulation tests, TEG variables, mediastinal tube drainage, and
transfusions were compared at multiple time points. There were no
demographic or hemostatic test result differences between groups, and
all patients were given prophylactic antifibrinolytic therapy.
Intraoperative transfusion rates did not differ, but there were
significantly fewer postoperative and total transfusions in the TEG
group. The proportion of patients receiving fresh-frozen plasma (FFP)
was 4 of 53 in the TEG group compared with 16 of 52 in the control
group (P < 0.002). Patients receiving platelets were 7 of 53 in
the TEG group compared with 15 of 52 in the control group (P <
0.05). Patients in the TEG group also received less volume of FFP (36
+/- 142 vs 217 +/- 463 mL; P < 0.04). Mediastinal tube drainage
was not statistically different 6, 12, or 24 h postoperatively.
Point-of-care coagulation monitoring using TEG resulted in fewer
transfusions in the postoperative period. We conclude that the
reduction in transfusions may have been due to improved hemostasis in
these patients who had earlier and specific identification of the
hemostasis abnormality and thus received more appropriate
intraoperative transfusion therapy. These data support the use of TEG
in an algorithm to guide transfusion therapy in complex cardiac
surgery. Implications: Transfusion of allogeneic blood products is
common during complex cardiac surgical procedures. In a prospective,
randomized trial, we compared a transfusion algorithm using
point-of-care coagulation testing with routine laboratory testing,
and found the algorithm to be effective in reducing transfusion
requirements.
MB. This does not support the use of TEG but rather the use of any
protocol. It is strange that there was less post-operative blood
transfusion in the control group who received more coagulation
factors.
ARTICLE TITLE: Temperature monitoring and management during
neuraxial anesthesia [editorial; comment]
COMMENTS: Comment on: Anesth Analg 1999 Feb; 88(2):373-7
ARTICLE SOURCE: Anesth Analg (United States), Feb 1999, 88(2)
p243-5
AUTHOR(S): Sessler DI
PUBLICATION TYPE: COMMENT; EDITORIAL
ARTICLE TITLE: A new approach for brachial plexus block under
fluoroscopic guidance.
ARTICLE SOURCE: Anesth Analg (United States), Jan 1999, 88(1)
p91-7
AUTHOR(S): Nishiyama M; Naganuma K; Amaki Y
AUTHOR'S ADDRESS: Department of Anesthesiology, Jikei University
School of Medicine, Tokyo, Japan.
PUBLICATION TYPE: CLINICAL TRIAL; JOURNAL ARTICLE
ABSTRACT: We performed the subclavian perivascular approach to the
brachial plexus using contrast medium to confirm the location of the
tip of the needle and the spread of the injected solution to obtain a
high success rate and to minimize the risk of pneumothorax. Review of
the cases led to the hypothesis that the solution injected inside the
costal attachment of the middle scalene muscle spreads into the
interscalene space. Because of the difference in the placement of the
tip of the needle using our technique and the supraclavicular
approach, including the subclavian perivascular approach, we termed
our technique the supracostal approach. We conducted the present
study to establish the supracostal approach by proving this
hypothesis. A total of 173 blocks in 149 adult patients were studied.
Eighty-four blocks in 74 patients were achieved by using the
supracostal approach with contrast medium. The needle was inserted 1
cm lateral to the palpated subclavian artery and 1-2 cm above to the
clavicle to touch a specific part of the first rib, which we believed
to correspond to the inside of the costal attachment of the middle
scalene muscle. After injecting the anesthetic solution with contrast
medium, radiographs were obtained for each block, while computed
tomographic (CT) studies were performed for five blocks. Five blocks
in five patients were achieved by using the subclavian perivascular
approach with contrast medium and both radiographs and CT studies. In
addition, the anatomical difference between the two approaches was
evaluated in five adult cadavers. Based on these studies, we
determined the proper part of the first rib that corresponded to the
inside of the costal attachment of the middle scalene muscle.
Eighty-four blocks in the remaining 70 patients were performed with
the supracostal approach without contrast medium. Of the 84 blocks
with contrast medium, 80 (95%) produced successful blockade defined
by sensory and motor examination. The radiological studies showed
that, with the supracostal approach, the injected solution, which
spread from the middle scalene muscle into the interscalene space,
did not spread below the first rib. However, with the subclavian
perivascular approach, the solution was confined within the
perineural sheath and spread below the first rib to the axilla. The
anatomical studies could explain this difference, revealing that the
perineural space of the brachial plexus is not identical to the
interscalene space. There was no failure in the 84 blocks performed
with the supracostal approach without contrast medium after we
determined the proper part of the first rib. We conclude that the
supracostal approach to the brachial plexus is reliable, easy to
perform, and associated with a low complication rate. IMPLICATIONS: A
new fluoroscopically guided approach for brachial plexus block has
been established on the basis of anatomical and radiological studies
to be reliable, easy to perform, and associated with a low
complication rate.
ARTICLE TITLE: The "second gas effect" is not a valid concept.
ARTICLE SOURCE: Anesth Analg (United States), Jan 1999, 88(1)
p188-92
AUTHOR(S): Sun X-G; Su F; Shi YQ; Lee C
AUTHOR'S ADDRESS: Department of Anesthesiology, Harbor-University of
California Los Angeles Medical Center, Torrance 90509-2910, USA.
PUBLICATION TYPE: CLINICAL TRIAL; JOURNAL ARTICLE; RANDOMIZED
CONTROLLED TRIAL
ABSTRACT: To determine whether the "second gas effect" is valid, we
determined the pharmacokinetics of 0.2% enflurane with or without 80%
N2) (n = 7 each) under controlled constant volume ventilation in 14
young healthy male patients before their operations. The alveolar
(end-tidal) concentration (FA) and inspired concentration (FI) at the
mouthpiece and the arterial blood concentration of enflurane were
measured, and the ratio of FA to FI was calculated. The FA/FI of
enflurane increased rapidly during the first few minutes of
administration and then increased slowly. No significant difference
was found in the FA/FI between the two groups at any time point (P
> 0.05). The arterial blood concentrations of enflurane increased
progressively and were not significantly different between the two
groups at any time point (P > 0.05). The results indicate that, at
high concentrations, N2O neither facilitated the increase of FA nor
enhanced the uptake of a companion gas. The second gas effect is a
nonexistent phenomenon in clinical practice because the concentrating
effect is very weak and the augmentation effect is nonexistent under
controlled ventilation. IMPLICATIONS: We studied the effects of N2O
on the ratio of alveolar (end-tidal) concentration to inspired
concentration of the second gas (enflurane) and on its blood
concentration in humans. Nitrous oxide did not affect the alveolar or
blood concentration of the second gas under controlled constant
volume ventilation. The "second gas effect" is not a valid
concept.
MB. These people did a similar study on the concentration effect.
They could not detect either using constant volume ventilation. Both
effects occurred using spontaneous breathing and the whole point was
that the volume insired increased because of the absorption of a more
soluble gas (N2O) in exchange for a less soluble one (N2). The
opposite would occur for a less soluble gas eg He.
I don't think that either effect is particularly important as thr
second gas effect is better achieved by over pressure and defusion
hypoxia by post-anaesthetic oxygen.
(All these things are related to volume exchanges when gases of
differing solubility replace each other.)
ARTICLE TITLE: Benefits of lifestyle activity vs structured
exercise [editorial]
ARTICLE SOURCE: JAMA (United States), Jan 27 1999, 281(4) p375-6
AUTHOR(S): Pratt M
PUBLICATION TYPE: EDITORIAL
ARTICLE TITLE: Effects of lifestyle activity vs structured aerobic
exercise in obese women: a randomized trial.
ARTICLE SOURCE: JAMA (United States), Jan 27 1999, 281(4) p335-40
AUTHOR(S): Andersen RE; Wadden TA; Bartlett SJ; Zemel B; Verde TJ;
Franckowiak SC
AUTHOR'S ADDRESS: Division of Geriatric Medicine and Gerontology,
Johns Hopkins University School of Medicine, Baltimore, MD 21224,
USA. andersen@jhmi.edu.
PUBLICATION TYPE: CLINICAL TRIAL; JOURNAL ARTICLE; RANDOMIZED
CONTROLLED TRIAL
CONCLUSIONS: A program of diet plus lifestyle activity may offer
similar health benefits and be a suitable alternative to diet plus
structured aerobic activity for obese women.
ARTICLE TITLE: Efficacy of antiseptic-impregnated central venous
catheters in preventing catheter-related bloodstream infection: a
meta-analysis.
ARTICLE SOURCE: JAMA (United States), Jan 20 1999, 281(3) p261-7
AUTHOR(S): Veenstra DL; Saint S; Saha S; Lumley T; Sullivan SD
AUTHOR'S ADDRESS: Department of Pharmacy, University of Washington,
Seattle, USA. veenstra@u.washington.edu.
PUBLICATION TYPE: JOURNAL ARTICLE; META-ANALYSIS
CONCLUSIONS: Central venous catheters impregnated with a combination
of chlorhexidine and silver sulfadiazine appear to be effective in
reducing the incidence of both catheter colonization and
catheter-related bloodstream infection in patients at high risk for
catheter-related infections.
MB. Not very enthusiastic.
ARTICLE TITLE: From the Centers for Disease Control and
Prevention. Hypothermia-related deaths--Georgia, January
1996-December 1997, and United States, 1979-1995.
ARTICLE SOURCE: JAMA (United States), Jan 13 1999, 281(2) p124-5
PUBLICATION TYPE: JOURNAL ARTICLE .
ARTICLE TITLE: Who is responsible for the common good in a
competitive market? [editorial; comment]
COMMENTS: Comment on: JAMA 1999 Mar 24-31; 281(12):1087-92; Comment
on: JAMA 1999 Mar 24-31; 281(12):1093-8
ARTICLE SOURCE: JAMA (United States), Mar 24-31 1999, 281(12)
p1127-8
AUTHOR(S): Fletcher RH
PUBLICATION TYPE: COMMENT; EDITORIAL
ARTICLE TITLE: The American health care system--Medicare.
ARTICLE SOURCE: N Engl J Med (United States), Jan 28 1999, 340(4)
p327-32
AUTHOR(S): Iglehart JK
PUBLICATION TYPE: JOURNAL ARTICLE
ARTICLE TITLE: Do "America's Best Hospitals" perform better for
acute myocardial infarction? [see comments]
COMMENTS: Comment in: N Engl J Med 1999 Jan 28; 340(4):309-10
ARTICLE SOURCE: N Engl J Med (United States), Jan 28 1999, 340(4)
p286-92
AUTHOR(S): Chen J; Radford MJ; Wang Y; Marciniak TA; Krumholz HM
AUTHOR'S ADDRESS: Department of Medicine, Yale University School of
Medicine, New Haven, CT 06520-8025, USA.
PUBLICATION TYPE: JOURNAL ARTICLE
ABSTRACT: Among patients without contraindications to therapy,
top-ranked hospitals had significantly higher rates of use of aspirin
(96.2 percent, as compared with 88.6 percent for similarly equipped
hospitals and 83.4 percent for non-similarly equipped hospitals;
P<0.01) and beta-blockers (75.0 percent vs. 61.8 percent and 58.7
percent, P<0.01), but lower rates of reperfusion therapy (61.0
percent vs. 70.7 percent and 65.6 percent, P=0.03). The survival
advantage associated with admission to top-ranked hospitals was less
strong after we adjusted for factors including the use of aspirin and
beta-blockers (odds ratio, 0.94; 95 percent confidence interval, 0.82
to 1.08; P=0.38). CONCLUSIONS: Admission to a hospital ranked high on
the list of "America's Best Hospitals" was associated with lower
30-day mortality among elderly patients with acute myocardial
infarction. A substantial portion of the survival advantage may be
associated with these hospitals' higher rates of use of aspirin and
beta-blocker therapy.
ARTICLE TITLE: Understanding the causes of schizophrenia
[editorial; comment]
COMMENTS: Comment on: N Engl J Med 1999 Feb 25; 340(8):603-8
ARTICLE SOURCE: N Engl J Med (United States), Feb 25 1999, 340(8)
p645-7
AUTHOR(S): Andreasen NC
PUBLICATION TYPE: COMMENT; EDITORIAL
ARTICLE TITLE: Transfusion medicine. First of two parts--blood
transfusion.
ARTICLE SOURCE: N Engl J Med (United States), Feb 11 1999, 340(6)
p438-47
AUTHOR(S): Goodnough LT; Brecher ME; Kanter MH; Au Buchon JP
AUTHOR'S ADDRESS: Department of Medicine, Washington University
School of Medicine, St. Louis, MO 63110-1093, USA.
MAJOR SUBJECT HEADING(S): Blood Transfusion
MINOR SUBJECT HEADING(S): Blood Donors [statistics &
numerical data]; Blood Transfusion, Autologous [trends];
Blood Transfusion [adverse effects] [trends]
[utilization]; Disease Transmission, Horizontal; Guidelines;
HIV Infections [transmission]; Hepatitis, Viral, Human
[transmission]; Intensive Care; Lung Diseases
[etiology]; Surgery; Transplantation Immunology; United
States; Utilization Review
PUBLICATION TYPE: JOURNAL ARTICLE; REVIEW (120 references); REVIEW,
TUTORIAL
ARTICLE TITLE: A multicenter, randomized, controlled clinical
trial of transfusion requirements in critical care. Transfusion
Requirements in Critical Care Investigators, Canadian Critical Care
Trials Group [see comments]
COMMENTS: Comment in: N Engl J Med 1999 Feb 11; 340(6):467-8
ARTICLE SOURCE: N Engl J Med (United States), Feb 11 1999, 340(6)
p409-17
AUTHOR(S): Hebert PC; Wells G; Blajchman MA; Marshall J; Martin C;
Pagliarello G; Tweeddale M; Schweitzer I; Yetisir E
AUTHOR'S ADDRESS: Critical Care Program, University of Ottawa, ON,
Canada.
PUBLICATION TYPE: CLINICAL TRIAL; JOURNAL ARTICLE; MULTICENTER STUDY;
RANDOMIZED CONTROLLED TRIAL
ABSTRACT: BACKGROUND: To determine whether a restrictive strategy of
red-cell transfusion and a liberal strategy produced equivalent
results in critically ill patients, we compared the rates of death
from all causes at 30 days and the severity of organ dysfunction.
METHODS: We enrolled 838 critically ill patients with euvolemia after
initial treatment who had hemoglobin concentrations of less than 9.0
g per deciliter within 72 hours after admission to the intensive care
unit and randomly assigned 418 patients to a restrictive strategy of
transfusion, in which red cells were transfused if the hemoglobin
concentration dropped below 7.0 g per deciliter and hemoglobin
concentrations were maintained at 7.0 to 9.0 g per deciliter, and 420
patients to a liberal strategy, in which transfusions were given when
the hemoglobin concentration fell below 10.0 g per deciliter and
hemoglobin concentrations were maintained at 10.0 to 12.0 g per
deciliter. RESULTS: Overall, 30-day mortality was similar in the two
groups (18.7 percent vs. 23.3 percent, P= 0.11). However, the rates
were significantly lower with the restrictive transfusion strategy
among patients who were less acutely ill -- those with an Acute
Physiology and Chronic Health Evaluation II score of < or =20 (8.7
percent in the restrictive-strategy group and 16.1 percent in the
liberal-strategy group; P=0.03) -- and among patients who were less
than 55 years of age (5.7 percent and 13.0 percent, respectively;
P=0.02), but not among patients with clinically significant cardiac
disease (20.5 percent and 22.9 percent, respectively; P=0.69). The
mortality rate during hospitalization was significantly lower in the
restrictive-strategy group (22.3 percent vs. 28.1 percent, P=0.05).
CONCLUSIONS: A restrictive strategy of red-cell transfusion is at
least as effective as and possibly superior to a liberal transfusion
strategy in critically ill patients, with the possible exception of
patients with acute myocardial infarction and unstable angina.
ARTICLE TITLE: Sunscreens: are Australians getting the good
oil?
ARTICLE SOURCE: Aust N Z J Med (Australia), Oct 1998, 28(5)
p639-46
AUTHOR(S): Hayden CG; Roberts MS; Benson HA
AUTHOR'S ADDRESS: School of Pharmacy, University of Queensland,
Brisbane.
PUBLICATION TYPE: JOURNAL ARTICLE; REVIEW (38 references); REVIEW,
TUTORIAL
ARTICLE TITLE: The induction, maintenance, and recovery
characteristics of spinal versus general anesthesia in elderly
patients.
ARTICLE SOURCE: J Clin Anesth (United States), Dec 1998, 10(8)
p623-30
AUTHOR(S): Fredman B; Zohar E; Philipov A; Olsfanger D; Shalev M;
Jedeikin R
AUTHOR'S ADDRESS: Department of Anesthesiology and Intensive Care,
Meir Hospital, Kfar Saba, Israel.
PUBLICATION TYPE: CLINICAL TRIAL; JOURNAL ARTICLE; RANDOMIZED
CONTROLLED TRIAL
CONCLUSION: General anesthesia with propofol and desflurane
facilitates shorter induction and recovery times without adversely
affecting patient comfort. Therefore, this technique may be
preferable to spinal anesthesia for elderly patients undergoing short
transurethral surgical procedures.
MB. Not blinded. If you are going to use spinal for cystoscopies its
best to line them up in advance if you want speed.
ARTICLE TITLE: The force of numbers: why hepatitis C is spreading
among Australian injecting drug users while HIV is not.
ARTICLE SOURCE: Med J Aust (Australia), Mar 1 1999, 170(5) p220-1
AUTHOR(S): Crofts N; Aitken CK; Kaldor JM
AUTHOR'S ADDRESS: Centre for Harm Reduction, Macfarlane Burnet Centre
for Medical Research, Fairfield, VIC. crofts@burnet.edu.au.
PUBLICATION TYPE: JOURNAL ARTICLE
ARTICLE TITLE: Hyperbaric oxygen for carbon monoxide poisoning
[editorial; comment]
COMMENTS: Comment on: Med J Aust 1999 Mar 1; 170(5):203-10
ARTICLE SOURCE: Med J Aust (Australia), Mar 1 1999, 170(5) p197-9
AUTHOR(S): Moon RE; De Long E
PUBLICATION TYPE: COMMENT; EDITORIAL
ARTICLE TITLE: The salt dilemma: some answers, many questions.
ARTICLE SOURCE: Med J Aust (Australia), Feb 15 1999, 170(4)
p178-80
AUTHOR(S): Nicholls MG; Richards AM
AUTHOR'S ADDRESS: Department of Medicine, Christchurch Hospital, New
Zealand.
PUBLICATION TYPE: JOURNAL ARTICLE; REVIEW (82 references); REVIEW,
TUTORIAL
ARTICLE TITLE: Ceiling fan injuries: the Townsville
experience.
ARTICLE SOURCE: Med J Aust (Australia), Feb 1 1999, 170(3)
p119-20
AUTHOR(S): Potts JR
AUTHOR'S ADDRESS: Emergency Department, Townsville General Hospital,
QLD. joandchris@bigpond.com.au.
PUBLICATION TYPE: JOURNAL ARTICLE
ABSTRACT: From 1 April 1995 to 31 March 1997, 50 people presented to
Townsville General Hospital with injuries caused by ceiling fans.
Injuries ranged from grazes to compound skull fractures, and seven
patients required admission to hospital for ongoing treatment. Most
of these injuries could have been avoided. Current safety guidelines
for the use of ceiling fans are inadequate.
MB. They were mostly due to stupid behaviour. None were due to the
fan falling down. That is what worries me.
ARTICLE TITLE: Mortality associated with New South Wales methadone
programs in 1994: lives lost and saved [see comments]
COMMENTS: Comment in: Med J Aust 1999 Feb 1; 170(3):100-1
ARTICLE SOURCE: Med J Aust (Australia), Feb 1 1999, 170(3) p104-9
AUTHOR(S): Caplehorn JR; Drummer OH
AUTHOR'S ADDRESS: Department of Public Health and Community Medicine,
University of Sydney, NSW. johnc@dph1.health.usyd.edu.au.
PUBLICATION TYPE: JOURNAL ARTICLE
ABSTRACT: OBJECTIVES: To estimate the effects of methadone programs
in New South Wales on mortality. DESIGN AND CASES: Retrospective,
cross-sectional study of all 1994 New South Wales coronial cases in
which methadone was detected in postmortem specimens taken from the
deceased. Cases were people we identified as patients in NSW
methadone maintenance programs or those whose deaths involved
methadone syrup diverted from maintenance programs. OUTCOME MEASURES:
Relative risks of fatal, accidental drug toxicity in the first two
weeks of treatment and later; the number of lives lost as a result of
maintenance treatment; preadmission risks and the number of lives
saved by maintenance programs, calculated from data from a previous
study. RESULTS: There was very close agreement between this study's
classifications and official pathology reports of accidental drug
toxicity. The relative risk (RR) of fatal accidental drug toxicity
for patients in the first two weeks of methadone maintenance was 6.7
times that of heroin addicts not in treatment (95% CI RR, 3.3-13.9)
and 97.8 times that of patients who had been in maintenance more than
two weeks (95% CI RR, 36.7-260.5). Despite 10 people dying from
iatrogenic methadone toxicity and diverted methadone syrup being
involved in 26 fatalities. In 1994, NSW maintenance programs are
estimated to have saved 68 lives (adjusted 95% CI, 29-128).
CONCLUSIONS: In 1994, untoward events associated with NSW methadone
programs cost 36 lives in NSW. To reduce this mortality, doctors
should carefully assess and closely monitor patients being admitted
to methadone maintenance and limit the use of takeaway doses of
methadone.
ARTICLE TITLE: Accidental drug toxicity associated with methadone
maintenance treatment [editorial; comment]
COMMENTS: Comment on: Med J Aust 1999 Feb 1; 170(3):104-9
ARTICLE SOURCE: Med J Aust (Australia), Feb 1 1999, 170(3) p100-1
AUTHOR(S): Ali RL; Quigley AJ
PUBLICATION TYPE: COMMENT; EDITORIAL
ARTICLE TITLE: Television and music video exposure and risk of
adolescent alcohol use.
ARTICLE SOURCE: Pediatrics (United States), Nov 1998, 102(5) pE54
AUTHOR(S): Robinson TN; Chen HL; Killen JD
AUTHOR'S ADDRESS: Department of Pediatrics, Stanford Center for
Research in Disease Prevention, Stanford University School of
Medicine, Palo Alto, CA 94304, USA.
PUBLICATION TYPE: JOURNAL ARTICLE
ABSTRACT: OBJECTIVE: Alcohol use is frequently portrayed in
television programming and advertising. Exposure to media portrayals
of alcohol use may lead to increased drinking. To address this issue,
we examined prospectively the associations between media exposure and
alcohol use in adolescents. DESIGN: Prospective cohort study.
Setting. Six public high schools in San Jose, California.
Participants. Ninth-grade students (N = 1533; mean age = 14.6 years).
OUTCOME MEASURES: Students reported hours of television, music video,
and videotape viewing; computer and video game use; and lifetime and
past 30 days' alcohol use at baseline and 18 months later.
Associations between baseline media exposure and subsequent alcohol
use were examined with multiple logistic regression. RESULTS: During
the 18-month follow-up, 36.2% of baseline nondrinkers began drinking
and 50.7% of baseline drinkers continued to drink. Onset of drinking
was significantly associated with baseline hours of television
viewing (odds ratio [OR] = 1.09; 95% confidence interval
[95% CI] = 1.01-1.18), music video viewing (OR = 1.31; 95% CI
= 1. 17-1.47), and videotape viewing (OR = 0.89; 95% CI = 0.79-0.99),
controlling for age, sex, ethnicity, and other media use. Computer
and video game use was not significantly associated with the
subsequent onset of drinking. Among baseline drinkers, there were no
significant associations between baseline media use and maintenance
of drinking. CONCLUSIONS: Increased television and music video
viewing are risk factors for the onset of alcohol use in adolescents.
Attempts to prevent adolescent alcohol use should address the adverse
influences of alcohol use in the media.
MB. This is ridiculous. There could be numerous reasons for these
associations which would not indicate cause and effect. Viewing AND
drinking are social activities.
ARTICLE TITLE: Exposure to and compliance with pediatric injury
prevention counseling--United States, 1994.
ARTICLE SOURCE: Pediatrics (United States), Nov 1998, 102(5) pE55
AUTHOR(S): Quinlan KP; Sacks JJ; Kresnow M
AUTHOR'S ADDRESS: Epidemic Intelligence Service, Epidemiology Program
Office. National Center for Injury Prevention and Control, Centers
for Disease Control and Prevention, Atlanta, GA 30341-3714, USA.
PUBLICATION TYPE: JOURNAL ARTICLE
CONCLUSIONS: Injury prevention counseling is associated with reported
preventive safety practices among US children, but a relatively small
proportion of households with young children report receiving such
counseling. Health care providers should increase efforts to provide
injury prevention counseling. counseling, wounds and injuries, child,
accident prevention.
MB. No! They should get it in and from the household. I did---ad
nauseam
ARTICLE TITLE: Three-year multicenter surveillance of pneumococcal
meningitis in children: clinical characteristics, and outcome related
to penicillin susceptibility and dexamethasone use.
ARTICLE SOURCE: Pediatrics (United States), Nov 1998, 102(5)
p1087-97
AUTHOR(S): Arditi M; Mason EO Jr; Bradley JS; Tan TQ; Barson WJ;
Schutze GE; Wald ER; Givner LB; Kim KS; Yogev R; Kaplan SL
AUTHOR'S ADDRESS: Pediatric Infectious Disease, Los Angeles,
California, USA.
PUBLICATION TYPE: JOURNAL ARTICLE; MULTICENTER STUDY
CONCLUSIONS: Children with pneumococcal meningitis caused by
penicillin- or ceftriaxone-nonsusceptible organisms and those
infected by susceptible strains had similar clinical presentation and
outcome. The use of dexamethasone was not associated with a
beneficial effect in this retrospective and nonrandomized study.
(ABSTRACT TRUNCATED).
ARTICLE TITLE: Early sexual initiation: the role of peer
norms.
ARTICLE SOURCE: Pediatrics (United States), Nov 1998, 102(5)
p1185-92
AUTHOR(S): Kinsman SB; Romer D; Furstenberg FF; Schwarz DF
AUTHOR'S ADDRESS: Section of Adolescent Medicine, Division of General
Pediatrics, Children's Hospital of Philadelphia, Philadelphia,
Pennsylvania, USA.
PUBLICATION TYPE: JOURNAL ARTICLE
CONCLUSION: Early sexual intercourse is not an unplanned experience
for many teens. Decisions about initiation are strongly bound to
social context with peers playing an important role in creating a
sense of normative behavior. Specific components of peer norms impact
the process of sexual initiation in both positive and negative ways.
Interventions aimed at delaying the onset of sexual initiation need
to focus on cohort norms as well as on an individual's perceptions
and behaviors.
MB. What did these busy bodies expect.
ARTICLE TITLE: Reducing cesarean birth rates with data-driven
quality improvement activities.
ARTICLE SOURCE: Pediatrics (United States), Jan 1999, 103(1 Suppl E)
p374-83
AUTHOR(S): Main EK
AUTHOR'S ADDRESS: Department of Obstetrics and Gynecology, California
Pacific Medical Center, San Francisco, California 94118, USA.
PUBLICATION TYPE: JOURNAL ARTICLE
ABSTRACT: Reduction of cesarean section rates has been a difficult
process that has not been easily accomplished by the institution of
guidelines. It is more a process of changing physician behavior
rather than of medical education. This article analyzed the role of
intensive feedback of outcomes to bring about such changes. Two large
private obstetric services in San Francisco, CA, were studied.
Intensive outcomes feedback using a computerized information system,
The Perinatal Data Center, regarding cesarean birth rates and a
variety of obstetric outcomes was provided to the medical and nursing
staff at one hospital. The other center served as a control. After
the first observation period, the outcomes system was introduced to
the second hospital. Finally, "open label" feedback,
intradepartmental release of everyone's key statistics with names
attached, was performed. Active management of labor was not practiced
at either hospital. Results. Cesarean birth rates were stable in the
baseline period from 1980 through 1988 at 24% to 25%. Introduction of
the Perinatal Data Center outcomes system was associated with a
reduction to 21% at the first hospital with no change in the control
hospital. Subsequent introduction of the system 3 years later in the
control hospital resulted in a decline from 25% to 20.5%. After
merger of the two obstetric units and the institution of "open label"
feedback, an additional decline to 18.5% was observed. Conclusion.
Physician practice patterns and cesarean birth rates can be altered
with the intensive use of comparative outcome data and strong
physician leadership. Nonblinded, intradepartmental distribution of
outcomes is an even more effective tool.
MB. Doctors want caesarian sections for themselves. The normal
caesarian section rate is zero.
ARTICLE TITLE: Guidelines for the pediatric perioperative
anesthesia environment. American Academy of Pediatrics. Section on
Anesthesiology.
ARTICLE SOURCE: Pediatrics (United States), Feb 1999, 103(2)
p512-5
AUTHOR(S): Hackel A; Badgwell JM; Binding RR; Dahm LS; Dunbar BS;
Fischer CG; Geiduschek JM; Gunter JB; Gutierrez-Mazzora JF; Kain Z;
Liu L; Means L; Myer P; Morray JP; Polaner DM; Striker TW
PUBLICATION TYPE: GUIDELINE; JOURNAL ARTICLE; PRACTICE GUIDELINE
ABSTRACT: The American Academy of Pediatrics proposes the following
guidelines for the pediatric perioperative anesthesia environment.
Essential components are identified that make the perioperative
environment satisfactory for the anesthesia care of infants and
children. Such an environment promotes the safety and wellbeing of
infants and children by reducing the risk for adverse events.
ARTICLE TITLE: Propofol anesthesia for invasive procedures in
ambulatory and hospitalized children: experience in the pediatric
intensive care unit.
ARTICLE SOURCE: Pediatrics (United States), Mar 1999, 103(3) pE30
AUTHOR(S): Hertzog JH; Campbell JK; Dalton HJ; Hauser GJ
AUTHOR'S ADDRESS: Department of Pediatrics, Division of Pediatric
Critical Care and Pulmonary Medicine, Georgetown University Medical
Center, Washington, DC 20007-2197, USA.
PUBLICATION TYPE: JOURNAL ARTICLE
ABSTRACT: OBJECTIVES: To describe our experience with propofol
anesthesia to facilitate invasive procedures for ambulatory and
hospitalized children in the pediatric intensive care unit (PICU)
setting. METHODS: We retrospectively reviewed the hospital records of
115 children who underwent 251 invasive procedures with propofol
anesthesia in our multidisciplinary, university-affiliated PICU
during a 20-month period. All patients underwent a medical evaluation
and were required to fast before anesthesia. Continuous monitoring of
the patient's cardiorespiratory and neurologic status was performed
by a pediatric intensivist, who also administered propofol in
intermittent boluses to obtain the desired level of anesthesia, and
by a PICU nurse, who provided written documentation. Data on patient
demographics, procedures performed, doses of propofol used, the
occurrence of side effects, induction time, recovery time, and length
of stay in the PICU were obtained. RESULTS: Propofol anesthesia was
performed successfully in all children (mean age, 6.4 years; range,
10 days to 20.8 years) who had a variety of underlying medical
conditions, including oncologic, infectious, neurologic, cardiac, and
gastrointestinal disorders. Procedures performed included lumbar
puncture with intrathecal chemotherapy administration, bone marrow
aspiration and biopsy, central venous catheter placement, endoscopy,
and transesophageal echocardiogram. The mean dose of propofol used
for induction of anesthesia was 1.8 mg/kg, and the total mean dose of
propofol used was 8.8 mg/kg. In 13% of cases, midazolam also was
administered but did not affect the doses of propofol used. The mean
anesthesia induction time was 3.9 minutes, and the mean recovery time
from anesthesia was 28.8 minutes for all patients. The mean PICU stay
for ambulatory and ward patients was 140 minutes. Hypotension
occurred in 50% of cases, with a mean decrease in systolic blood
pressure of 25%. The development of hypotension was not associated
with propofol doses, the concomitant use of midazolam, or the
duration of anesthesia, but was associated with older patient age.
Hypotension was transient and not associated with altered perfusion.
Intravenous fluid was administered in 61% of the cases in which
hypotension was present. Respiratory depression requiring transient
bag-valve-mask ventilation occurred in 6% of cases and was not
associated with patient age, propofol doses, concomitant use of
midazolam, or the duration of anesthesia. Transient myoclonus was
observed in 3.6% of cases. Ninety-eight percent of procedures were
completed successfully, and no procedure failures were considered
secondary to the anesthesia. Patients, parents, and health care
providers were satisfied with the results of propofol anesthesia.
CONCLUSIONS: Propofol anesthesia can safely facilitate a variety of
invasive procedures in ambulatory and hospitalized children when
performed in the PICU and is associated with short induction and
recovery times and PICU length of stay. Hypotension, although usually
transient, is common, and respiratory depression necessitating
assisted ventilation may occur. Therefore, appropriate monitoring and
cardiorespiratory support capabilities are essential. Propofol
anesthesia in the PICU setting is a reasonable therapeutic option
available to pediatric intensivists to help facilitate invasive
procedures in ambulatory and hospitalized children.
MB. I hope they are not suggesting that the paediatricians do it.